Nursing as an Art and Science: Concepts, Roles and Theorists

Southern Luzon State University
College of Allied Medicine
NCM 103 FUNDAMENTALS OF

NURSING
Module 2
Nursing as an Art and Science
Dear students,
This module is dedicated to the students of Southern Luzon
State University at College of Allied Medicine in support to distant
learning during this time of pandemic, we hope that the students who
read this book will prepare you to shape your future in health care.
Southern Luzon State
University Brgy Kulapi,
Lucban Quezon
roracion@slsu.edu.ph
mquintos@slsu.edu.ph
09276449263
09232620275
https://classroom.google
.com/c/MjcxNTI3NDExMj
U5?cjc=wzwg4f5
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NCM 103 PROF MARIA ROWENA S. ORACION / PROF. MELENA V. QUINTOS SY 2020-2021

OVERVIEW
Nursing is a caring profession. As a unique profession, it is practiced with an

earnest concern for the art of care and the science of health. The profession
involves a humanistic blend of scientific knowledge and holistic nursing practice.
Nursing- what it is today is the result of changes in the scientific, technological,

political, social and economic climate. Through the years, the concept of nursing has
been expanded and subsequently, the role of the nurse has become broader to meet
the changing needs of the society. Likewise, career opportunities in nursing gave
greatly expanded.
LEARNING OBJECTIVES
At the end of the subject the student will be able to:
∙ Discuss the Concept of Nursing and Caring and be able to apply to pertinent
scope of practice.
∙ Demonstrate the concept of profession as to its characteristics and attributes.
∙ Enumerate the Roles and functions of a Professional Nurse and be able to
practice in the care of the client.
∙ Identify and explain the type of interventions.
∙ Review of the Nursing Theorist and Conceptual framework / History of Nursing.
University College of
Allied Medicine
DISCUSSION
Concepts of Nursing and Caring

Southern Luzon State
⮚ The four major concepts in nursing theories are the person, environment,
health and nursing.
⮚ The act of utilizing the environment of the patient to assist him in his recovery
(Nightingale).
⮚ The unique function of the nurse is to assist the individuals, sick or well, in the
performance of those activities contributing to the 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 (Henderson).
⮚ A humanistic science dedicated to compassionate concern with maintaining and
promoting health and preventing illness and caring for rehabilitating the sick
and disabled (Rogers).
⮚ A theoretical system of knowledge that prescribes a process of analysis and
action related to the care of the ill person (Roy).
⮚ A helping or assisting service to persons who are wholly or partly dependent
infants, children and adults- when they, their parents and guardians, or other
adults responsible for their care are no longer able to give or supervise their
care (Orem).
⮚ A helping profession that assists individuals and groups in society to attain,
maintain and restore health. If this is not possible, nurse help individuals die
with dignity (King).
⮚ A unique profession in that it is concerned with all of the variables affecting
an individual’s response to stressors, which are intra-, inter-, and extra
personal in nature (Neuman).
⮚ An external regulatory force that acts to preserve the organization and
integration of the client’s behavior at an optimal level under those conditions
in which the behavior constitute a threat to physical or social health or in
which illness is found (Johnson).
⮚ Caring means that persons, events, projects, and things matter to people. It is
a word of being connected. It also reveals what is stressful and the available
options for coping. “Caring creates possibility”. As an inherent feature of
nursing practice, caring enables nurses help clients to recover in the face of
illness, to give meaning to that illness and to maintain or reestablish
connection (Benner).
⮚ Caring is the essence and central unifying, and dominant domain that
distinguishes nursing from the other health disciplines. Care is an essential
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human need, necessary for the health and survival of all individuals. Acts of
caring refer to the direct and indirect nurturant and skillful activities,
processes and decisions that assist people in ways that are emphatic,
compassionate, and supportive; and that are dependent on the needs,
problems and values of the individual being assisted (Leininger).
⮚ Caring- healing is communicated through the consciousness of the nurse to the
individual being cared for. Trans personal caring expand the limits of
openness and allows access to higher human spirit, thus expanding human
consciousness (Watson).
⮚ Caring involves five process: Knowing, being with, doing for, enabling, and
maintaining belief.
■ Knowing is striving to understand an event as it has meaning in the life of
the other.
■ Being with is being emotionally present to the other.
■ Doing for is doing for the other as he or she would do for the self if it
were at all possible.
■ Enabling is facilitating the others passage through life transition (e.g.
birth, death) and unfamiliar event.
■ Maintaining belief is sustaining faith in the others capacity to get
through an event or transition and face a future with meaning (Swanson). ⮚ Caring
in nursing practice involves: providing presence, comforting, listening, and
knowing the client, spiritual caring and family care.
■ Providing presence is when a nurse establishes reassuring presence, eye
contact, body language, voice tone, listening and having a positive and
encouraging attitude, act together to create openness and understanding.
■ Comforting involves the use of touch and the skillful and gentle
performance of nursing care procedures.
■ Listening involves paying attention to an individual’s words and tone of
voice, and entering into his/her frame of reference.
■ Knowing the client is at the core of the process by which nurses make
clinical decisions. To know the client means that the nurse considers the
client as a unique individual.
■ Spiritual caring offers a sense of interconnectedness intra- personally
(with oneself), interpersonally (with others and the environment), and
transpersonally (with the unseen God, or a higher power).
■ Family care involves knowing of the family as thoroughly as one knows the
client. A nurse demonstrate caring by helping family members become
active participants in the client care.
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Concepts of Profession (by Marie Jahoda)
⮚ A profession is an organization of an occupational group based on the

application of special knowledge which establishes its own rules and standards
for the protection of the public and the profession.
⮚ A profession implies that the quality of work done by its members is of greater
importance in its own eyes and the society than the economic rewards they
earn.
⮚ A profession serves all off society and not the specific interest of a group.
⮚ The aims of a profession are altruistic rather than materialistic.
The Characteristics and Attributes of a Professional Person are as follows:
1. Is concerned with quality. He/she possesses competence to practice the

profession in terms of scientific knowledge, technological skills and desirable
attitudes and values.
2. Is self- directed, responsible, and accountable for his/her actions. 3. Is able to
make independent and sound judgement including high moral judgement. 4. Is
dedicated to the improvement of human life.
5. Is committed to the spirit of inquiry. He/she demonstrates zest for continued
studies including research, which will steadily increase and improve knowledge,
skills and attitudes needed by the profession.
Nursing as a Profession
∙ Nursing is a profession. A profession possesses the following primary

characteristics:
1. Education - A profession requires an extended education of its members,
as well as basic liberal foundation.
2. Theory – A profession has a theoretical body of knowledge leading to
defined skills, abilities and norms.
3. Service – A profession provides basic service.
4. Autonomy- Members of a profession have autonomy in decision making and
in practice.
5. Code of Ethics- the profession as a whole has a code of ethics in practice.
A profession has sufficient self-impelling power to retain its members
throughout life. It must not be a mere steppingstone to other occupations.
6. Caring- The most unique characteristic of nursing as a profession is that,
it is a CARING profession

∙ Professional Nursing is an art and a science, dominated by an ideal of service in

which certain principles are applied in the skillful state of the well and the ill,
and through relationship with the client/patient significant others, and other
members of the health team.
∙ A Professional nurse is one who has acquired the art and science of nursing
through her basic education, who interprets her role in nursing in terms of the
social ends for which it exist – the health and welfare of society and who
continuous to add to her knowledge, skills and attitude through continuing
education and scientific inquiry (research) or the use of the results of such
inquiry.
The Qualifications and Abilities of a Professional Nurse are as follows:
1. Has faith in the fundamental values that underlie the democratic way of
life, for example:
∙ Respect for home dignity
∙ Self- sacrifice for the common good.
∙ Strong sense of responsibility for sharing in the solution of the
problems of the society.
2. Has a sense of responsibility for understanding those with whom he/she
works or associates with through the use of the following skills.
∙ Utilizing relevant basic concepts of psychology
∙ Working effectively through therapeutic relationship.
3. Has faith in the reality of spiritual and aesthetic values and awareness of
the value and the pleasure of self-development through the pursuit of
some aesthetic interests.
4. Has the basic knowledge, skills and attitudes necessary to address present
day social problems, realistic, incisive and well organized thoughts through
the use of critical thinking. Critical thinking is securing appraising and
organizing evidence.
5. Has skill in using written and spoken language, both to develop own thoughts
and to communicate them to others.
6. Appreciates and understands the importance of good health.
7. Has emotional balance. Is able to maintain poise and composure in trying
situations.
8. Likes hard work and possesses a capacity for it.
9. Appreciates high standards of workmanship.

10. Accepts and tries to understand people of all sorts, regardless of race,
religion and color.
11. Knows nursing so thoroughly that every client will receive excellent care.
Personal Qualifications of a Nurse
A. Philosophy of Life
∙ It is concerned with those basic truths that contribute to personal

growth in a systematic fashion and with those principles that relate to
the moral values that shape the facets of the character.
∙ Every person must develop a personal philosophy of life and plan for
expanding his personal life.
∙ Theories of nursing can be taught, but not a philosophy of life or a
philosophy of service.
B. Good Personality
∙ Personality consist of the distinctive individual qualities that

differentiates one person from another.
∙ It refers to the impression one makes on others which will include more
than that which meets the eye.
∙ It consists of deeper traits which come from the heart and which
infiltrate the real person if one wishes to exert a magnetic influence
on others.
∙ It is a result of integrating one’s abilities, desires, impulses, habits and
physical character into a harmonious whole.
How to develop one’s personality
1. Warmth of manner, a ready smile, sincere laugh, genuine interest in others.

2. Complete sincerity.
3. Sympathetic grooming: near hair style, appropriate dress, sufficient make-up and
expressive hands; being ever-mindful of the people who see you.
Components of a Good Personality

1. Personal Appearance
Your appearance often reveals more about the real you than any words you may
say. Self-respect is the basis upon which personal appearance is established. It
includes a healthy body motivated by unselfishness and expressing graciousness. The
components of personal appearance are as follows:
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a. Posture
⮚ It refers to the habitual or assumed positions of your body in standing,
sitting or moving about.
⮚ Postures presents some clues to your personality.
⮚As a nurse, you must be responsible for practicing a physical regimen that
helps to develop and maintain good posture and physical fitness.
b. Grooming
⮚ Your hair should truly “crown” the features of your face in an attractive
manner.
⮚ Your hair should be neat, clean and well arranged.
⮚ It also includes personal hygiene and cleanliness.
c. Dress and Uniform

⮚ Just as self-respect is evident in good posture and personal hygiene, so
as it is reflected in the care you exercise with regards to dressing.
Basic Guides for Personal Dress
⮚ Undergarments must be clean and properly fitted for the body support.
⮚ All articles of clothing should be neat, personable and trim, especially
the “give away” articles such as bra straps, the slip and the heels of the
shoes.
⮚ Street attire is expected to be appropriate and to give you a sense of
security in official or social situations.
⮚ Your wardrobe may be limited, but planning it in basic colors and using
contrasting or blending hues can add greatly to its extensiveness. ⮚
Accessories should match the attire and should be suitable to the
occasion and to your personality.
⮚ Current fads and style may have to be disregarded to accommodate
your budget or your body structure.
The Nurse’s Unit

⮚ They come in different colors, but irrespective of color, the nurse’s
distinctive uniform identifies you as a nurse to your patient and his
family as well as to your co-worker.
⮚ You must respect the uniform. It is a part of the nurse’s public image.
⮚ Wear the uniform only during working hours.
⮚ It should not be worn with jewelry, except a school pin or a name plate.
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The Nurse’s Cap
⮚ The style of the cap remains usually the same for a particular school.
⮚ Like the uniform, wear it with respect and dignity.
Points to remember in wearing the nurse’s uniform
⮚ Every item comprising the uniform must be spotlessly clean, well-fitting

and in good repair.
⮚ Shoes and hosiery worn with the uniform should provide for maximum
comfort.
⮚ Uniform designated for use in a given hospital area is worn only in the
line of duty and not to be worn outside the specified department
⮚ Modification of any authorized uniform to suit your individual
preference is not permitted by the dictates of both good taste and
integrity.
2. Character
⮚ Character refers to the moral values and beliefs that are used as guides to
personal behavior and actions.
⮚ It is what a person is inside.
⮚ It the development in proportion to emotional and intellectual growth and
involves the degree to which you understand, direct and channel your feelings. ⮚
The practice of nursing utilize one’s love for fellowman. Charity is the
greatest virtue and serves as the foundation for a sense of values and the
development of human character.
THE NURSE IS BASICALLY A GOOD PERSON

Four Virtues emanating from the practice of charity:
⮚ Justice. The quality of being righteous, correct, fair, and impartial. ⮚

Prudence. Permits us to live with good sense and perspective. Guides one’s
choice of action here and now.
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⮚ Fortitude. Assists in the control of feelings, thoughts and emotions in the

face of difficulty.
⮚ Temperance. Encourages constructive use of the pleasure of the senses.
Attributes of Character
a. Honesty
■ Being truthful, trustworthy and upright in one’s dealing with others as well
as refraining from lying, cheating and stealing.
■ It is demonstrated in terms of:
✔ Trustfulness. The quality of being in arrangement with facts, reality and
experience.
✔ Honor. Making good on commitments.
✔ Integrity. Adhering to one’s set of moral values.
■ Evidences of honesty can be observed in the following:
✔ Care of materials.
✔ Recognition of authority.
✔ Obedience to rules, regulations and authority.
✔ Use of time in terms of punctuality in performing activities.
b.Loyalty
■ The feeling of confidence, trust and affection you have towards your family
and friends and towards those who have helped, guided and stood by you as
you proceeded towards your goals.
■ E.g. speaking well about co-workers and the institution where you work.
c. Tolerance
■ It manifests itself in your recognition of the rights of others. ■ It allows you
to respect and accept others as fellow human beings entitled to enjoy the same
basic rights and privileges that you claims for yourself. It is demonstrated in
the practice of patience,a sense of humor, sympathy, understanding and
unselfishness.
■ E.g. allowing an angry relative to verbalize his/her feelings.
d.Judgement
■ Sometimes referred to as “good sense”, it indicates one’s ability to use one’s
intellectual capacity to form sound opinions. Qualities involved in the use of
judgement are wisdom, discretion and tact.
■ E.g. Questioning an unclear doctor’s orders before acting.
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e.Reliability
■ It is dependability and involves one’s use of sound judgement based upon
careful observation and an understanding of any given situation in which one
is required to act.
■ E.g. performing one’s responsibilities thoroughly even beyond time of duty, as
necessary; reporting on duty even during holidays, floods, typhoon, etc.
f. Motivation
■ Sometimes that moves one to plan and accomplish specific things it is a
positive force that directs one’s personal actions to the fulfillment of
desires or drives that are referred to as basic human needs.
■ E.g. aiming to give the best quality of patient care at all times.
g. Resourcefulness
■ Involves a person’s ability to recognize and deal promptly and effectively with
difficulties or problems that arise. It requires the utilization of information
available about a given situation and using it courageously, sensibly and
constructively in dealing with the situation.
■ E.g. using indigenous materials/articles in the absence of sophisticated ones.
h.Moderation
■ Allows one to maintain harmony and balance among all the elements of one’s
character and in one’s relationship with others by encouraging one to develop
perspective and a sense of objectivity.
■ E.g. indulging in food, material goods, and other factors that provide pleasure
or enjoyment to the senses in controlled manner.
3. Attitude
A manner of acting, thinking, or feeling that is indicated by one’s response

toward another person, situation or experience.
⮚ Personality is shaped by one’s attitudes.

⮚ It is a part of a pattern of personal behavior.
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⮚ It is based on opinions, viewpoints or feelings.

⮚ It it a result of responses to specific experiences.
⮚ It changes from time to time as additional knowledge is gained and one’s
understanding is broadened.
⮚ A change in attitude results to a change in behavior.
⮚ It develops from awareness of oneself in relation to individuals and
situations.
Eight Be- Attitudes of a Nurse
a. Acceptance
⮚Acceptance of others in indicative of self-maturity.
⮚Facing known and meeting the unknown of life with maximum comfort.
⮚Changing what can be changed within one’s self.
⮚E.g. the nurse accepts the client as an individual and respecting his/her
culture.
b.Helpfulness
⮚ Strong feelings towards helping others;; giving others attention,
reassurance and a protective security in the storms of daily living. ⮚ E.g. the
nurse assist a weak client in feeding and performing hygienic measures.
c. Friendliness
⮚ May be active or passive; warmth of manner; pleasant interaction with
others.
⮚ E.g. the nurse establishes rapport with the client and his/her family.
d.Firmness
⮚ Being alert to the actions of others in a positive, confident way; uses
firm, kind and immediate methods of approach.
⮚ E.g. the nurse implements hospital rules and policies regarding visiting
hours, number of visitors at a time, use of telephone.
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e. Permissiveness
⮚Understanding of motives and the feelings expressed in behavior whether
they are or not capable; loosening or tightening the reign of authority in
the interaction; flexibility in response.
⮚E.g. the nurse allows the adolescent to wear his own clothing a he/she
requests, instead of the hospital gown.
f. Limit Setting
⮚Knowing the value of her influence; offering of praise or blame; limiting
what others may say or do.
⮚E.g. the nurse tells the client who keeps on throwing things that this
behavior is unacceptable.
g.Sincerity
⮚Acting naturally, recognizing one’s anger, fears and other feelings. ⮚E.g.
the nurse tells the client who is crying because she lost her baby, that she
understands how she feels at this time. And the nurse holds the client’s
hand and stays with her.
⮚
h.Competence
⮚Approaching problems intellectually rather than emotionally displaying
knowledge and ability to deal with situations.
⮚E.g. the nurse stays with the client whose wound on the abdomen has
disrupted and reassures the client that help from a physician being sought
for.
4. Charm
⮚ To influence the senses or the mind by some quality or attraction; delight. ⮚

Innate in one who has a depth of feeling and an outgoing manner. ⮚ May be
cultivated by a desire to serve and a deep love for fellow human beings.
To acquire charm, one needs to cultivate the following:
■ Voice: Modulated with clear enunciation.

■ Manner: Courteous, attentive, patient, receptive.
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■ Heart: Attempt never to show indifference or a callused manner. Be

empathetic, understanding and tolerant. Remember to say “Thank you”
as this works miracles in social harmony.
■ Intelligence: Keep an active mind, recognize beauty, accept new ideas
from others, read and exchange opinions with others.
■ Poise: Equanimity, calmness, composure, evennes of temper, self-control.
The requirements for development of poise are as follows:
A. Calmness and Composure

⮚ Face reality
⮚ Avoid emotional flare-ups
B. Control of temper
⮚ Think before acting
⮚ Avoid verbal and physical aggressiveness
The Role and Functions of a Professional Nurse
1. Care Provider. The nurse supports the client by attitudes and actions that show
concern for the client welfare and acceptance of the client as a person. The
nurse is primarily concerned with the client’s need.
2. Communicator/Helper. The nurse communicates with clients, support persons and

colleagues to facilitate all nursing actions.
3. Teacher. The nurse provides health teaching to effect behavior change which
focuses on acquiring new knowledge or technical skills. This role gives emphasis
on health promotion and health maintenance.
4. Counselor. The nurse helps the client to recognize and cope with stressful
psychologic or social problems, to develop improved personal relationships and to
promote personal growth. This role includes providing emotional, intellectual and
psychologic support.
5. Client Advocate. The nurse promotes what is best for the client, ensures that
the client’s needs are met and protects client’s rights.
6. Change Agent. The nurse initiates changes and assists the client make
modifications in the lifestyle to promote health. This role involves, identifying
the
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problem, assessing the client’s motivations and capacities for change,

determining alternatives, exploring the possible outcomes of the alternatives,
assessing resources, determining appropriate helping roles, establishing and
maintaining a helping relationship, recognizing phases of the change process, and
guiding the client through these phase.
7. Leader. The nurse through the process of interpersonal influence helps the client
make decisions in establishing and achieving goals to improve his well-being.
8. Manager. The nurse plans, gives directions, develops staff, monitors operations,
gives rewards fairly, and represents both staff members and administration as
needed. The nurse manages the nursing care of individuals, groups, families and
communities. The nurse manager delegates nursing activities to ancillary workers
and other nurses and supervise and evaluates their performance.
9. Researcher. The nurse participates in scientific investigation and uses research

findings in practice. The nurse develop knowledge about health and the promotion
of health over the full life span; care of persons with health problems and
disabilities; and nursing actions to enhance people’s ability to respond effectively
to actual or potential health problems.
10. Case Manager. The nurse coordinates the activities of other members of the
health care team, such as nutritionist and physical therapist, when managing a
group of client’s care.
11. Collaborator. The nurse works in a combined effort with all those involved in
care delivery, for a mutually acceptable plan to be obtained that will achieve
common goals. The nurse initiates nursing actions within the health team.
Types of Nursing Interventions
1. Independent or nurse initiated interventions. Are autonomous actions based

on scientific rationale that is executed to benefit the client in a predicted way
related to the nursing diagnosis and client-centered goals. These can solve the
client’s problems without consultation or collaboration with physician or other
health care professionals. E.g. The nurse gives health teachings on the ill
effects of cigarette smoking, alcohol abuse and drug abuse.
2. Dependent or physician initiated interventions. Are based on the physician’s
response to a medical diagnosis. The nurse intervenes by carrying out
physician’s
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written orders, but requires nursing judgement or decision making. E.g. The
nurse administers antibiotics to the client with infection.
3. Interdependent or collaborative interventions. Are therapies that require the
knowledge, skill and expertise of multiple health care professionals. E.g. The
nurse assists the client in walking using crutches after conferring with the
physical therapist.
Nursing Theories and Conceptual Framework
Florence Nightingale (mid 1800)
Developed and described the first theory of nursing. Notes on Nursing: What it
is, what it is not. She focused on changing and manipulating the environment in order
to put the patient in the best possible conditions for nature to act.
She believed that in the nurturing environment, the body could repair itself.
Client’s environment is manipulated to include appropriate noise, nutrition, hygiene,
light, comfort, socialization and hope.
Virginia Henderson (1955)
Introduce The Nature of Nursing Model. She identified FOURTEEN BASIC

NEEDS. She postulated that the unique function of the nurse is to assist the client,
sick or well, in the performance of those activities contributing to health or its
recovery, that clients would perform unaided if they had the necessary strength, will
or knowledge. She further believed that nursing involves assisting the client in
gaining independence as rapidly as possible, or assisting him achieved peaceful death
if recovery is no longer possible.
Faye Abdellah (1960)
Introduced Patient- Centered Approaches to Nursing Model. She identified

TWENTY-ONE NURSING PROBLEMS. She defined nursing as service to individuals
and families; therefore to society. Furthermore, she conceptualized nursing as an art
and a science that molds the attitudes, intellectual competencies and technical skills
of the individual nurse into the desire and ability to help people, sick or well, and
cope with their health needs.
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Dorothy E. Johnson (1960, 1980)
Conceptualized the BEHAVIORAL SYSTEM MODEL. According to Johnson, each

person has a behavioral system and is composed of seven subsystem namely:
1. Ingestive. Taking in nourishment in socially and culturally acceptable

ways.
2. Eliminative. Riddling the body of waste in socially and culturally
acceptable ways.
3. Affiliative. Security seeking behavior.
4. Aggressive. Self-protective behavior
5. Dependence. Nurturance-seeking behavior.
6. Achievement. Master of oneself and one’s environment according to
internalized standards of excellence.
7. Sexual and role identity behavior.
In addition, she viewed that each person strives to achieve balance and stability
both internally and externally and to function effectively by adjusting and adapting
to environmental forces through learned patterns of response.
Furthermore, Johnson believed that the patient strives to become a person

whose behavior is commensurate with social demands; who is able to modify his
behavior in ways that support biologic imperatives; who is able to benefit to the
fullest extent during illness from health care professional’s knowledge and skills;
and whose behavior does not give evidence of unnecessary trauma as a consequence
of illness.
Imogene King (1971, 1981)
Postulated the GOAL ATTAINMENT THEORY. She described nursing as a

helping profession that assists individuals and groups in society to attain, maintain,
and restore health. If this is not possible, nurses help individuals die with dignity.
In addition, King viewed nursing as an interaction process between client and

nurse whereby during perceiving, setting goals, and acting on them, transactions
occur and goals are achieved.
Madeleine Leininger (1978, 1984)
Developed the TRANS CULTURAL NURSING MODEL. She advocate that

nursing is a humanistic and scientific mode of helping a client through specific
cultural caring processes (cultural values, beliefs and practices) to improve or
maintain a health condition.
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Myra Levin (1973)
Describe the FOUR CONSERVATIVE PRINCIPLES. She advocate that nursing

is a human interaction and proposed four conservation principles of nursing which
are concerned with the unity and integrity of the individual. The four conservation
principles are as follows:
1. Conservation of energy. The human body functions by utilizing energy.

The human body needs energy producing input (food, oxygen, fluids) to
allow energy utilization as output.
2. Conservation of Structural Integrity. The human body has physical
boundaries (skin and mucous membrane) that must be maintained to
facilitate health and prevent harmful agents from entering the body.
3. Conservation of Personal Integrity. The nursing interventions are based
on the conservation of the individual’s client’s personality. Every
individual has a sense of identity, self-worth and self-esteem, which
must be preserved and enhanced by nurse.
4. Conservation of Social Integrity. The social integrity of the client
reflects the family and the community in which the client functions.
Health care institutions may separate individuals form their family. It
is important for nurses to consider the individual in the context of the
family.
Betty Neuman (1982, 1989, 1992)
Proposed the HEALTH CARE SYSTEM MODEL. She asserted that nursing is a
unique profession in that it is concerned with all the variables affecting an
individual’s response to stresses, which are intra- (within the individual), inter-
(between one or more other people), and extra personal (outside the individual) in
nature. The concern of nursing is to prevent stress invasion, to protect the client’s
basic structure and to obtain or maintain maximum level of wellness. The nurse helps
the client, through primary, secondary and tertiary prevention modes, to adjust to
environmental stressors and maintain clients stability.
Dorothea Orem (1970, 1985)
Developed the SELF-CARE AND SELF-CARE DEFICIT THEORY. She defined

the self-care as “the practice of activities that individuals initiate and perform on
their own behalf in maintaining life, health and well-being”. She conceptualized three
nursing systems as follows:
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1. Wholly Compensatory: when the nurse is expected to accomplish all the

patient’s therapeutic self-care or to compensate for the patient’s
inability to engage in self-care or when the patients’ needs continuous
guidance in self-care
2. Partially Compensatory: when both the nurse and patient engage in
meeting self-care needs
3. Supportive-Educative: the system that requires assistance in decision
making, behavior control and acquisition of knowledge and skills
Hildegard Peplau (1952)
Introduced the INTERPERSONAL MODEL. She defined nursing as an

interpersonal process of therapeutic interactions between an individual who is sick or
in need of health services and a nurse especially educated to recognize and respond
to the need for help. She identified four phases of the nurse-client relationship;
1. Orientation: the nurse and the client initially do not know each other’s
goals and testing the role each will assume. The client attempts to
identify difficulties and the amount of nursing help that is needed
2. Identification: the client responds to the professionals or the
significant others who can meet the identified needs. Both the client
and the nurse plan together an appropriate program to foster health
3. Exploitation: the client utilizes all available resources to move toward
a goal of maximum health and functionality
4. Resolution: refers to the termination phase of the nurse-client
relationship. It occurs when the client’s needs are met and he/she can
move toward a new goal. Peplau further assumed that nurse-client
relationship fosters growth in both the client and the nurse.
Martha Rogers (1970)
Conceptualized the SCIENCE OF UNITARY HUMAN BEINGS. To Rogers,

unitary man is an energy field in constant interaction with the environment. She
asserted that human beings are more than and different from the sum of their
parts; the distinctive properties of the whole are significantly different from those
of its parts. Furthermore, she believed that human beings is characterized by the
capacity for abstraction and imagery, language and thought, sensation and emotion.
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Sister Callista Roy (1979, 1984)
Presented the ADAPTATION MODEL. She viewed each person as a unified

biopsychosocial system in constant interaction with a changing environment. She
contended that the person as an adaptive system, functions as a whole through
interdependence of its parts. The system consists of input, control processes, output
and feedback. In addition, she advocated that all people have certain needs which
they endeavor to meet in order to maintain integrity. These needs are divided into
four different modes, the physiological, self-concept, role function, and
interdependence. Accordingly, Roy believed that adaptive human behavior is directed
as an attempt to maintain homeostasis or integrity of the individual by conserving
energy and promoting the survival, growth, reproduction and mastery of human
system.
Lydia Hall (1962)
Introduced the model on Nursing: What is it?, focusing on the notion that
centers around three components of CARE, CORE and CURE. Care represents
nurturance and is exclusive to nursing. Core involves the therapeutic use of self and
emphasizes use of reflection. Cure focuses on nursing related to physician’s order.
Core and cure are shared with the other health care providers.
Ida Jean Orlando (1961)
Conceptualized The DYNAMIC NURSE- PATIENT RELATIONSHIP MODEL.

She believed that the nurse helps meet a perceived need that the patients cannot
meet for themselves. Orlando observed that the nurse provides direct assistance to
meet an immediate need for help in order to avoid or to alleviate distress of
helplessness. She emphasized the importance of validating the need and evaluating
care based on observable outcomes. She also indicated that nursing actions can be
automatic (those chosen for reasons other than the immediate need for help) or
deliberative (those resulting form validating the need for help, exploring the meaning
of the need, and validating effectiveness of the actions taken to meet the need).
She also advocated that the three elements composing nursing situation are: client
behavior, nurse reaction and nurse action.
Ernestine Weidenbach (1964)
Developed the CLINICAL NURSING- A HELPING ART MODEL. She advocated

that the nurse’s individual philosophy or central purpose lends credence to nursing
care. She believed that nurses meet the individual’s need for help through the
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identification of the needs, administration of help, and validation that actions were
helpful. Components of clinical practice: Philosophy, purpose, practice and an art.
Jean Watson (1979-1985)
Conceptualized the HUMAN CARING MODEL (NURSING: HUMAN SCIENCE

AND HUMAN CARE). she emphasized that nursing is the application of the art and
human science through transpersonal caring transactions to help persons achieve
mind-body-soul harmony, which generates self-healing. She included health promotion
and treatment of illness in nursing. She believed that a person is a valued being to be
cared for, respected, nurtured, understood and assisted; a fully functional
integrated self.
Rosemarie Rizzo Parse (1981, 1987, 1992)
Introduced the THEORY OF HUMAN BECOMING. She emphasized free choice

of personal meaning in relating value priorities, co-creating of rhythmical patterns, in
exchange with the environment, and con transcending in many dimensions as
possibilities unfold. She also believed that each choice opens certain opportunities
while closing others. Thus, she referred to revealing-concealing, enabling-limiting,
and connecting-separating. Since each individual makes hos or her own personal
choices, the role of the nurse is that of guide, not decision maker.
Joyce Travelbee (1966, 1971)
She postulated the INTERPERSONAL ASPECTS OF NURSING MODEL. She

advocated that the goal of nursing is to assist individual or family in preventing or
coping with illness, regaining health finding meaning in illness, or maintaining maximal
degree of health. She further viewed that interpersonal process is a
human-to-human relationship formed during illness and experience of suffering.”
She believed that a person is a unique, irreplaceable individual who is in a continuous
process of becoming, evolving and changing.
Josephine Pekerson and Loretta Zderad (1976)
Provided the HUMANISTIC NURSING PRACTICE THEORY. This is based on

their belief that nursing is an existential experience. Nursing is viewed as a lived
dialogue that involves the coming together of the nurse and the person to be nursed.
The essential characteristic of nursing is nurturance. Humanistic care cannot take
place without the authentic commitment of the nurse to being with and the doing of
the client. Humanistic nursing also presupposes responsible choices.
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Helen Erickson, Evelyn Tomlin, and Mary Ann Swain (1983)
Developed MODELLING AND ROLE MODELLING THEORY. The focus of

this theory is on the person. The nurse models (assesses). Role model (plans), and
intervenes in this interpersonal and interactive theory. They asserted that each
individual is unique, has some self- care knowledge, needs simultaneously to be
attached to and separate from others, and has adaptive potential. Nurses in this
theory, facilitate, nurture and accept the person unconditionally.
Margaret Newman
Focused on HEALTH AS AN EXPANDING CONSCIOUSNESS. She believed

that humans are unitary beings in whom disease is a manifestation of the pattern of
health. She defined consciousness as the information capability of the system which
is influenced by time, space and movement and is ever- expanding. Change occurs
through transformation. Nursing is involved with human beings who have reached
points and found that their old ways are no longer effective. Caring is a moral
imperative for nursing. The nurse is partner with the client rather than the general
setter and outcome predictor.
Patricia Benner
Proposed the PRIMARY OF CARING MODEL. They believed that caring is

central to the essence of nursing. Caring created the possibilities for coping and
creates possibilities for connecting with and concern for others.
Anne Boykin and Savina Schoenhofer
Presented the GRAND THEORY OF NURSING IS CARING. They believed

that all persons are caring, and nursing is a response to a unique social call. The focus
of nursing is on nurturing persons living and growing in caring in a manner that is
specific to each nurse-nursed relationship or nursing situation. Each nursing situation
is original. They support that caring is a moral imperative. Nursing is Caring is not a
based or deficit but is egalitarian model of helping.
MORAL THEORIES
Freud (1961)
Believed that the mechanism for right and wrong within the individual is the
superego or conscience. He hypothesized that a child internalized and adopts the
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moral standards and character or character traits of the model parent through the
process of identification. The strength of the superego depends on the intensity of
the child’s feelings of aggression or attachment toward the model parent rather
than on the actual standards of the parent.
Erickson (1964)
Erickson’s theory on the development of virtues or unifying strengths of the

“good man” suggest that the moral development continues throughout life. He
believed that if the conflicts of each psychosocial development stages are favorably
resolved an “ego-strength” or virtue emerges.
Kohlberg
Suggested of normal development. He focused on the reasons for the making

of a decision, not on the morality of the decision itself. At first level called
premoral or the preconventional level, children are responsive to cultural to
cultural rules and labels of good and bad, right and wrong. However, children
interpret these terms of the physical consequences of their actions, i.e. punishment
or reward. At the second level, the conventional level, the individual is concerned
about maintaining the expectations of the family, groups or nation and sees this as
right. At the third level called the postconventional, autonomous, or principled
level. At this level, people make an effort to define valid values and principles
without regard to outside authority or the expectations of others. These involve
respect for other humans and bebelief that relationships are based on mutual
trust.
Peters (1961)
Proposed a concept of rational morality on principles. Moral development is

usually considered to involve three separate components: moral emotion (what one
feels), moral judgement (how one reasons), and moral behavior (how one acts). In
addition, Peters believed that the development of character traits or virtues is an
essential aspects of moral development. And that virtues or character traits can
be learned from others and encourages by the example of others. Also, Peters
believed that some virtues can be described as habits because they are in some
sense autonomic and therefore are performed habitually, such as a politeness,
chastity, tidiness, thrift and honesty.
Schulman and Mekler (1985)
Believed that morality is a measure of how people treat fellow human and
that a moral child is one who strives to be kind and just. They believe that
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morality has two components, namely: 1. The intention of the person acting must be
good in the sense that the goal of the act is the well-being of one or more people; 2.
The person acting must be fair or just in the sense that the person considers the
rights of others without prejudice or favoritism. Furthermore, the aforementioned
authors asserted that the theory of moral development is based on three
foundations, which they believed can be taught as follows:
a. Internalizing parenteral standards of right and wrong
b. Developing emphatic reactions.
c. Acquiring personal standards.
Gilligan (1982)
Included the concepts of caring and responsibility. She described three

stages in the process of developing an “Ethic of Care” which are as follows:
a. Caring for oneself.
b. Caring for others.
c. Caring for self and others.
She believed that women see morality in the integrity of relationship and caring.
For women, what is right is taking responsibility for others as a chosen decision. On
the other hand, men consider what is right be what is just.
Spiritual Theories
Fowler (1979)
Describe the development of faith. He believed that faith, or the spiritual

dimension is a force that gives meaning to a person’s life. He used the term “faith” as
a form of knowing, a way of being in relation “to an ultimate environment.” To Fowler,
faith is a relational phenomenon: it is “and active made-of-being-in-relation to
another or others in which we invest commitment belief, love, risk and hope.”
Westerhoff
Proposed that faith is a way of behaving. He developed a four stage theory of

faith development based largely on his life experiences and the interpretation fo
those experiences. These stages are as follows:
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a. Experienced faith (infancy to early adolescence): experiences faith
through interaction with others who are living a particular faith. b. Affiliative faith
(late adolescence): actively participates in activities that Characterize a particular
faith tradition.
c. Searching faith (Young adulthood): through a process of questioning and
doubting own faith, acquires a cognitive as well as affective faith.
d. Owned faith (middle adulthood): Puts faith, into personal and social action
and is willing to stand up for what he/she believes even against the nurturing
community.
History of Nursing in the Philippines

Early Beliefs and Practices
Diseases and their causes and treatment were shrouded with mysticism and
superstitions.
1. Beliefs about causation of disease:
a. Another person (an enemy or a witch)

b. Evil spirits
2. People believed that evil spirits could be driven away by persons with
powers to expel demons.
3. People believed in special gods of healing, with the priest physician (called
“word doctors) as intermediary. If they used leaves or roots they were called
herb doctors (“herbolarios”)
Early Care of the Sick
The early Filipinos subscribed to superstitious beliefs and practices in relation

to health and sickness. Herbmen were called “Herbicheros”. Meaning one who
practiced witchcraft. Persons suffering from diseases without any identified cause
were believed to be bewitched by the “mangkukulam” or “mangagaway”. Difficult
childbirth and some diseases (called “pamao”) were attributed to “nonos”. Midwife
assited in childbirth. During labor, the “mabuting hilot” (good midwife”) was called in.
If the birth became difficult, witches were supposed to be the cause. To dispense
25

their influence, gunpowder was exploded from a bamboo cane close to the head of
the sufferer.
Health Care during the Spanish Regime:
The religious orders exerted their efforts to care for the sick by building
hospitals in the different parts of the Philippines.
The earliest Hospitals established were the following:
1. Hospital Real de Manila (1577) – It was established mainly to care of the

Spanish King’s soldiers, but admitted Spanish civilians founded by Gov.
Francisco de Sande.
2. San Lazaro Hospital (1578) – Founded by Brother Juan Clemente and
administered for many years by the Hospitalliers of San Juan de Dios built
exclusively for patients with leprosy.
3. Hosptal de Indio (1586) - Established by the Franciscan orders; service was
in general supported by alms and contributions from charitable persons. 4.
Hospital de Aguas Santas (1590)- established in Laguna near medicinal spring.
Founded by Brother J. Bautista of the Franciscan Orders. 5. San Juan de Dios
Hospital (1596) – founded by the Brotherhood of Misericordia and
administered by the Hospitalliers of San Juan de Dios: supporters was derived
from alms and rents; rendered general health service to the public.
Nursing During the Philippine Revolution
The prominent persons involved in nursing works were:
1. Josephine Bracken, wife of Jose Rizal Installed a field hospital in an estate in

Tejeros; provided nursing care to the wounded night and day.
2. Rosa Sevilla de Alvero – Converted their house into quarters for the Filipino
Soldiers, during the Philippine-American War that broke out in 1899. 3. Doña
Hilaria de Aguinaldo- Wife of Emilio Aguinaldo; organized the Filipino Red Cross
Under the inspiration of Apolinario Mabini
4. Doña Maria Agoncillo de Aguinaldo – Second-wife of Emilio Aguinaldo
provided nursing care to Filipino Soldiers during the revolution. President of
the Filipino Red Cross branch in Batangas.
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5. Melcora Aquino (Tandang Dora) – Nursed the wounded Filipino soldiers and
gave them shelter and food
6. Captain Salome - A revolutionary leader in Nueva Ecija, provided nursing care
to the wounded when not in combat.
7. Agueda Kahabagan – Revolutionary leader in Laguna, also provided nursing
services to her troops.
8. Trinidad Tecson – “Ina ng Biac na Bato”, stayed in the Hospitals at Biac na
Bato to care for the wounded soldiers.
Filipino Red Cross
∙ Malolos, Bulacan was the location of the National Headquarters. ∙

Established branches in the provinces.
Functions of Filipino Red Cross:
1. Collection of war funds and materials through concerts, charity, bazaars and
voluntary contributions
2. Provisions of nursing care to wounded Filipino soldiers.
Requirements for Membership
1. At least 14 years old, age requirements for officer was 25 years

old. 2. Of Sound reputation
Hospitals and Schools of Nursing
1. Iloilo Mission Hospital School of Nursing (Iloilo City, 1906) It was ran by
the Baptist Foreign Mission Society of America. Miss Rose Nicolet, a graduate
of New England Hospital for women and Children in Boston, Massachusetts, was
the first superintendent for nurses. It moved to its present location in Jaro
Road Iloilo City in 1929. Miss Flora Ernst, an American nurse, took charge of the
school in 1942. In March, 1944, 22 nurses graduated; in April 1944 graduate
nurses took the First Nurses Board Examination at the Iloilo Mission Hospital.
2. St. Paul’s Hospital School of Nursing (Manila, 1907)

The hospital was established by the Archbishop of manila, the Most
Reverend Jeremiah Harty under the supervision of the Sisters of St. Paul de
Charters. It was located in Intramuros and it provided general hospital services.
It had a free dispensary and dental clinic. It opened its training school for nurses
27

in 1908, Rev. Mother Melanie as superintendent and Miss E. Chambers as

Principal.
3. Philippine General Hospital School of Nursing (1907)

The PGH began in 1901 as a small dispensary mainly for “Civil Officers and
Employees” in the City of Manila. It later grew into Civil Hospital.
In 1906, Mrs. Coleman Masters, an educator advocated for idea of

training Filipino girls for the Profession of nursing. With the approval of
government Officials, she first opened a dormitory for girls enrolled at the
Philippine Normal Hall and the University of the Philippines.
In 1907, with the support of Governor General Forbes and the

Director of Health among others, she opened classes in nursing under the
auspices of the Bureau of Education. Admission into the school was based on an
entrance examination. The applicant must have completed elementary education
to the seventh grade. Julia Nichols and Charlotte Clayton taught the students
nursing subjects. American physicians also served as lecturers.
In 1910, Act No. 1976 modified the organization of the s=school placing
it under the supervisions of the Director of Health, The Civil Hospital was
abolished; the PGH was established. The school became known as the Philippine
General Hospital School of Nursing.
When she became chief nurse, Elsie McCloskey-Gaches introduced

several improvements in the school. The course was made attractive and more
practical. Anastacia Giron Tupas, The first Filipino nurse to occupy the position
of chief Nurse and superintendents in the Philippines succeeded her.
4. St. Luke’s Hospital School of Nursing (Quezon City, 1977) The Hospital is
an Episcopalian Institution, It began as a small dispensary in 1903. In 1907, the
school opened with three Filipino girls admitted. These girls had their first year
in combined classes with the Philippine General Hospital School of Nursing and St.
Paul Hospital School of Nursing. Ms. Helen Hicks was the first principal. Miss
Vitaliana Beltran was the first Filipino superintendent of nurses. Dr. Jose
Flores was the first Filipino medical Director of the Hospital.
Note: in the period of organization between 1907 and 1910, the first year
nursing students of the Philippine general Hospital. St. Lukes Hospital and St.
Paul’s Hospital has a common first year course. This was known as the Central
28

School Idea in nursing education. The schools selected their own students
based on the following requirements:
1. Educational preparation, at least completion of seventh
grade 2. Sound physical and mental health
3. Good moral character
4. Good family and social standing
5. Recommendations from three different persons well known in the

community.
The three groups of students from these schools were later fused in one
class, lived in the dormitory, and received the same instruction in anatomy and
physiology, message practical nurturing, materia medica, bacteriology and English.
5. Mary Johnson Hospital and School of Nursing (Manila, 1907)
It started as a small dispensary on Calle Cervantes (now Avenida Rizal ). It was

called the Bethany Dispensary and funded by the Methodist Mission for the
relief of suffering among women and children. In 1907, Sister Rebecca Parrish
together with registered nurses Rose Dudley and Gertude Dreisbach, organized
the Mary Johnston School of Nursing. The nurses’ training course began with
three Filipino young girls fresh from elementary as their first students.
In 1908, Mr. D.S.B. Johnston of Minnesota donated as a Memorial to

his wife $12,500.00 for hospital Building, in 1911, the Philippine Assembly
appropriated a monthly sum of $500.00 for the hospital, in appreciation for its
services during the cholera epidemics in the previous years. Later P11, 000.00 was
provided by the assembly for the construction of a maternity station and
dispensary. At the outbreak of the World War II, It became an emergency
hospital where the wounded were treated. It was allowed to operate as a hospital
even during the Japanese Occupation. It was burned down in 1945, it was
reconstructed through the contributions of Methodist Church in America. It
reopened in 1947 at the Harris Memorial. Miss Libranda Javalera was the first
Filipino director of the school.
6. Philippine Christian Mission Institute School of Nursing
29

The United Christian Missionary Society of Indianapolis, Indiana- a Protestant

organization of the Disciples of Christ operated three schools of nursing.
∙ Sallie Long Memorial Hospital School of Nursing (Laoag, Ilocos Norte

1903)
∙ Mary Chiles Hospital School of Nursing (Manila 1911). The hospital was
established by Dr. W.N. Lemon in small house on Azcarraga, Sampaloc,
Manila. In 1913, Miss Mary Chiles of Independence, Montana, donated a
large sum of money with which the present building at Gastambide was
brought. The Tuazon Annex donated by Miss Esperanza Tuazon, a Filipino
Philantropist.
∙ Frank Dunn Memorial Hospital (Vigan, Ilocos Sur, 1912
7. San Juan De Dios Hospital School of Nursing (manila, 1973) In 1913,

through the initiative of Dr. Benito Valdez, the board of inspectors and the
executive board of the hospital passed a resolution to open school of nursing.
The school has been run by the Daughters of Charity since then. Sister
Taciana Tinanes was the first Directress of the School
8. Emmanuel Hospital School of Nursing (Capiz, 1913)

In 1913, the American Baptist Foreign Mission Society sent Dr.
P.H.J.Lerrigo to Capiz for the purpose of opening a hospital. Miss Rose
Nicolet assisted him. The school offered a 3-year training course for an
annual fee of Php 100.00. Miss Clara Pedroso was the first principal
9. Southern Islands Hospital School of nursing (Cebu, 1918) The hospital was
established in 1911 under the Bureau of Health. The school opened in 1918
with Anastacia Giron-Tupas as the organizer. Miss Visitacion Perez was the
first principal
10. Other Schools of Nursing established were as follows: 1.

Zamboanga General Hospital School of Nursing (1921)
2. Chinese General Hospital School of Nursing (1921)
3. Baguio General Hospital School of Nursing (1923)
4. Manila Sanitarium Hospital and School of Nursing (1930)
5. St. Paul School of Nursing in Iloilo City (1946)
6. North General Hospital and School of Nursing (1946)
7. Siliman University School of Nursing (1947)
30

The First Colleges of Nursing in the Philippines

1. University of Santo Tomas-College of Nursing (1946)
In its first year of existence, its enrollees were consisted of students from
different school of nursing whose studied were interrupted by the war. In 1947, the
Bureau of Private Schools permitted UST to grant the title Graduate Nurse to the
21 students who were of advanced standing from 1948 up to the present. The
college has offered excellent education leading to a baccalaureate degree (BSN) .
Sor Taciana Trinanes was its first directress. Presently, Associate Professor
Glenda A. Vargas, RN, MAN serves as its Dean.
2. Manila Central University-College of Nursing (1947)
The MCU Hospital first offered BSN and Doctor of Medicine degrees in 1947 and
served as the clinical field for practice. Miss Consuelo Gimeno was its first
principal. Presently, Professor Lina A. Salarda, RN, MAN, EdD serves as its
Dean.
3. University of the Philippines Manila-College of Nursing (1948)
The idea of opening the college began in a conference between Miss Julita Sotejo
and UP President Gonzales. Nurses who attended biennial convention in May, 1946
endorsed the idea. In April 1948, the University Council approved the curriculum,
and the Board of Regents recognized the profession as having an equal standing as
Medicine, Engineering etc. Miss Julita Sotejo was its first dean.
Nursing Leaders in the Philippines
1. Anastacia Giron Tupas- First Filipino nurse to hold the position of Chief
Nurse Superintendent; founder of the Philippine Nurses Association
2. Cesaria Tan – First Filipino to receive a Master’s Degree in Nursing abroad.
3. Socorro Sirilan- Pioneered in Hospital Social Service in San Lazaro Hospital
where she was the Chief Nurse.
4. Rosa Militar- A pioneer in school health education.
5. Sir Ricarda Mendoza – A pioneer in nursing education.
6. Socorro Diaz – First editor of the PNA magazine called “The Message” 7.
Conchita Ruiz- First full-time editor of the newly named PNA magazine “The
Filipino Nurse”
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8. Loreto Tupaz – “Dean of the Philippine Nursing”; Florence Nightingale of Iloilo.
Health and Nursing Organization
Nursing Organizations:
1. Philippine Nurses Association. This is the National organization of Filipino

nurses.
2. National League of Nurses. The association of nurses employed in Department
of Health.
3. Catholic Nurses Guild of the Philippines
4. Others: ORNAP, MCNAP, IRNOP etc.
History of Nursing
∙ PERIOD OF INTUITIVE NURSING

Intuitive nursing was practiced since prehistoric times among primitive tribes and
lasted through the early Christian era. Nursing was untaught and instinctive. It was
performed out of compassion for others, out of the wish to help others.
Beliefs and Practices of Prehistoric Man
1. He was nomad. His philosophy of life was “the best for the most” and he was
ruled by the law of self-preservation.
2. Nursing was a function that belonged to women. They took good care of the
children, the sick and the aged.
3. He believed that illness was caused by the invasion of the victim’s body by evil
spirit through the use of black medicine or voodoo.
4. He believed that the medicine man called “shaman” or witch doctor had the
power to heal by using white magic. Among others, the shaman used hypnosis,
charms, dances, incantations, purgatives massage, fire water and herbs as a
means of driving illness from the victim. He also practiced “trephining”
(drilling a hole in the skull with a rock or stone without the benefit of
anesthesia as a last resort to drive evil spirits from the body of the
afflicted).
∙ Period of Apprentice Nursing

This period from the founding of religious nursing orders in the Crusaders,
which began in the 11th century and ended in 1836, when Pastor Fliedner and
32

his wife established the Kaiserwerth Institute for the training of

Deaconesses (a training school for nurses) in Germany.
It is called the Period of “on the Job” training, Nursing

care was performed without any formal education and by people who were
directed by more experienced nurses. Religious orders of the Christian
Church were responsible for the development of this kind of nursing.
Important Nursing Personages during the Period of Apprentice Nursing

1. St. Clare. Founder of the second order of St. Francis of Assisi; took vows of
poverty, obedience service and chastity; nursing to the sick and the afflicted. 2.
St. Elizabeth of Hungary. Known as the “Patroness of Nurses,” as she was the
daughter of the Hungarian King. She lived her life frugally despite her wealth.
She used all her wealth. To make the lives of the poor happy and useful. She
built hospitals for the sick and the needy. She fed the sick with her own hands
and made their beds. She provided for orphans and fed 300-900 persons daily at
her gate. To avoid idleness, she employed those who were able to work
continually in her hospital and in the homes of the poor and to go fishing in
streams to help provide for the many sufferers.
3. St. Catherine of Siena. The first Lady with a Lamp. She was 25th child of a
humble Italian parents. She pledged her life to service at the age of seven and
was referred to as little saint. She was a hospital nurse, prophetess,
researcher and a reformer society and the church.
The world of nursing, despite wars and plagues made considerable progress
under the influence of Christianity. It may be said that nursing owes its
foundation to the work of benevolent men and women, the crusades and the
guilds. But this progress in nursing was brought to a halt by industrial and
political revolution and the Reformation in the in the 16th century. This left the
world in the following situations:
1. The masses of people huddled in slums as a result of famine, wars and

the introduction of machinery (industrial revolution)
2. Living in blighted slum areas, the people sank into brutal and immoral
way of life.
3. Ambition for power and the antagonism resulting from the attempts to
achieve this power replaced human empathy.
4. Class lines could be bypassed in some parts of the world, and people
struggled against one another for power, wealth and leisure.
33

5. Skepticism was the result of political, intellectual and ideological

revolutions; everything in life had to be based upon scientific fact.
Nothing else was true
In the 16th century hospitals were established for the care of the sick. The
hospitals were gloomy, cheerless and airless. They were unsanitary. People entered
hospitals only under compulsion or as last resort. There was little employment and
education was only for rich and the titled. St. Vincent de Paul seeing the pervading
poverty and the generally poor health conditions organized the group called “Le
Charite” and the community of the Sisters of Charity. The later was composed of
women who lived uncloistered and were dedicated to doing God’s work through caring
for the sick, the poor, the orphaned, and the widowed. Louise de Gras (nee Marillac)
was the first and co-founder of this order.
The Dark Period of Nursing
This extends from the 17th to the century from the period reformation until
the U.S. Civil War. The religious upheaval led by Martin Luther destroyed the unity
of the Christian faith. The wrath of Protestantism swept everything connected with
Roma Catholicism in school, orphanages and hospitals. Properties of hospitals and
schools were confiscated. Nurses fled for their lives. In England, hundreds of
hospitals were closed. There were no provisions for the sick, no one to care for
the sick. Nursing became the work of the least desirable women—women who
took bribe from patients, who stole the patient’s food and who used alcohol as
tranquilizer. They worked seven days a week, slept in cubbyhole near the
hospital ward or patient and ate scraps of food when they could find them.
These women were personified in a Charles Dickens novel as Sairey Camp and
Betsy Preg.
Several leaders sought to bring about reforms, Among them were:
1. John Howard. A prison reformer, helped improved the living conditions in

prisons and gave prisoners renewed hope.
2. Mother Mary Aikenhand. Established the Irish Sisters of Charity to bring
back into nursing the dedication of the early Christian era.
3. Pastor Theodor Fliedner and Frederika Munster Fliedner. Established the
Institute for the training of Deaconesses at Kaiserwerth, Germany (1836),
the first organized training school for nurses. Requirements for entering the
school were.
a. Character reference from clergyman.
b. A certificate of health from a physician.
34

c. Permission from their nearest relative.
Nursing in America
People began to settle in the North American continent, to seek for

adventure, new quests and new trade routes.
Mdme. Jeanne Mance was the first laywoman who worked as a nurse in North
America. She founded the Hotel Dieu of Montreal, a log cabin hospital.
1. Pre-Civil War Nursing
In the USA and Canada, religious nursing orders, both Catholic and
protestant carried out nursing. Augistinian nuns, Ursuline sisters, Deaconesses of
Kaiserwerth, protestant sisters of Charity and many others helped found and staff
hospitals.
Mrs. Elizabeth Seton, An American, founded the sisters of Charity

of Emmitsberg, Maryland in 1809.
2. American Reforms in Nursing
a. The Nurse’s Society of Philadelphia organized a school of nursing

under the direction of Dr. Joseph Warrington in 1839. Nurses were trained on the
job and attended some preparatory courses.
b. Women’s Hospital in Philadelphia established a six-month course in

nursing to increase the nurse’s knowledge while they worked.
They were taught a minimum amount of medical and surgical nursing,

materia medica and diatetics.
3. Nursing During the Civil War
The American Medical Association during the Civil War created the
committee on Training of nurses. It was designated to study and make
recommendations with regards to the training of nurses. Doctors realized the need
for qualified nurses.
Some of the Important Personages at this time were:
A. Dorothea Lynde Dix. She established the Nurse Corps of the

United Stated Army. She directed the nursing of the injured.
35

b. Clara Borton Founded the American Red Cross.
Period of Educated Nursing

The period began in June 15, 1860 when Florence Nightingale School
of Nursing opened at St. Thomas Hospital in London (St. Thomas Hospital
School of Nursing). The development of nursing during this period was strongly
influenced by trends resulting from wars, from an arousal of social consciousness
from the emancipation of women and from the increased educational opportunities
offered to women.
Fact about Florence Nightingale:
∙ Recognized as the “Mother of Modern Nursing”; she was also known as the
“Lady with a Lamp”
∙ Born on May 12, 1820 in Florence Italy.
∙ Raised England in an atmosphere of culture and affluence learned languages,
mathematics and social graces.
∙ Her education was rounded by a continental tour.
∙ Not contented with the social custom imposed upon her as a Victorian Lady, she
developed her self – appointed goal “To change the profile of nursing”. ∙
Compiled notes of her visits to hospitals, her observation of the sanitary
facilities, and social problems of the places she visited.
∙ Noted the need for preventive medicine and good nursing.
∙ Advocated for care of those afflicted with disease caused by lack of hygienic
practices.
∙ At the age of 31, she overcame her family’s resistance to her ambition. She
entered the Deaconess School at Kaiserworth.
∙ Worked as a superintendent for Gentle women during Illness. ∙ Disapproved of
the restrictions on admission of patients and considered this unchristian and
incompatible with health care.
∙ Upgraded the practice of nursing and made nursing an honorable profession foe
gentle women.
∙ Led the nurses that took care of the wounded during the Crimean War. ∙ Put
down her ideas in two published books: Notes on Nursing and Notes on Hospitals.
36

Other Important Person/Groups/Events During the period of Educated Nursing.
1. Linda Richards. First graduate nurse in the US; graduated September 1,

1872 from the new England Hospital for Women in Boston
2. Dr. Willian Halstead. Designed the first rubber gloves.
3. Caroline Hampton Robb. The first nurse to wear rubber gloves while
working as an operating room nurse.
4. Establishment of nursing organizations; the American Nurse Association
and the National League for Nursing Education; contributed to the uplift
of the nursing profession.
5. Isabel Hampton Robb, The first principal of John Hopkins Hospital
School of nursing; the most influential in directing the development of
nursing during this period.
6. Clara Louise Maas. Engaged in medical research on yellow fever during
the Spanish-American War. She died of yellow fever.
7. Development of private duty nursing, settlement house nursing (forerunner
of PHN); school nursing government service of nursing, and prenatal and
maternal health nursing (1900-1912)
8. Age of Specialization began in the first decade of the 20th Century. 9.
Preparation of Standard Curriculum based on educational objectives for
schools of nursing (1913-1937)
10. Edith Cavell. Known as “Mata Hari”, served the wounded soldier during
the World War I (both English and Russian soldiers). This was why she
was suspected as a spy (“Mata Hari”). She was and English nurse, she has
a monument in Russia as a recognition to her services.
Period of Contemporary Nursing
This covers the period after World War II to the present. Scientific
and technological developments as well as social changes marked this period.
Events and Trends
1. Establishment of the World Health Organizations by the United

Nations to assist in fighting disease by providing health information
and improving nutrition, living standards and environmental conditions
of all people.
2. Use of atomic/nuclear energy for medical diagnosis and treatment.
37

3. Utilization of computers for collecting data, teaching, establishing

diagnosis, maintaining inventory, making payrolls, record keeping, and
billing.
4. Use of sophisticated equipment for diagnosis and therapy. 5. The
advent of space medicine also brought about the development of
aerospace nursing. Colonel Pearl Tucker developed a comprehensive
one-year course to prepare nurses for aerospace nursing at Cape
Kennedy.
6. Health perceived as a fundamental human right. Laws were legislated
to provide such right.
7. Nursing involvement in community health is greatly intensified.
8. Technological advances, such as the development of disposable
supplies and equipment have relieved the nurse from numerous
tedious tasks.
9. Development of the expanded role of the nurse. The nurse is constantly
assuming responsibilities in patient care which were formerly the sole
prerogative of the physician, Nursing became a dynamic profession
because of the scope of nursing practice to expanding in the light of
the modern developments in the constantly changing world.
EVALUATION
CRITICAL THINKING EXERCISES NO. 2
Nursing as an Art and Science
Announcements on quiz will be posted to
our google classroom (class stream)
38

Activity 1
COLLEGE OF ALLIED MEDICINE
Lucban, Quezon
A.Y. 2019-2020, 2nd Semester
FUNDAMENTALS OF NURSING
Name: Date: Year/Section:
1. Define the following:
a. Profession
b. Vocation
c. Nursing
d.
2. Is nursing a profession or a vocation? Why? Explain
Activity 2
Activity 2
Independent Dependent Interdependent
Identify the following nursing interventions

a. Administering medication
b. Health education
c. Urinary catheterization
d. Insertion of intravenous fluid
e. Provide therapeutic environment
f. Reduce noise
g. Manage environmental temperature
h. Feeding thru nasogastric tube
i. Oxygen administration
j. Giving physical therapy exercises
k. Giving special dietary instruction
l. Giving insulin injection
m. Documenting
n. Reporting or referral
o. Changing of linen
p. Taking vital signs
39

q. Apply antifungal cream

r. Turning side to side
s. Monitor intake and output
t. Monitor temperature
Activity 3
Name: Date: Year/Section:
HISTORY OF NURSING
Enumerate, draw and describe the 4 PERIODS OF NURSING

DRAW DESCRIBE
II
III
IV
40

4
1
REFERENCES
Kozier & Erb’s, (2017). Fundamentals of Nursing Concepts, Process and Practice,
Berman, Synder et. al,
Venson L. M. et al., (2010). Professional Nursing in the Philippines 11th Edition, C and E
Publishing, Inc
Martha RaileAligood, Ann MarrinerTomey, Nursing Theory 9th Ed. Reprinted Edition
2010
42

Nursing as an Art and Science: Concepts, Roles and Theorists

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NCM 103 FUNDAMENTALS OF