CArolina S.

AGRAvante’s CASAGRA Transformative

Leadership Model
- Title derived from her name.
- Focus: Type of leadership in nursing that can challenge the
values of the changing world.
CASAGRA
- Transformative leadership: psycho-spiritual model. (effective
means for faculty to become better teachers and servant
leaders)
- The model is a 3 fold transformation leadership concept rolled
into one.
- Care Complex: Structure in the personality that is significantly
related to leadership behavior.
- Vitality of Care Complex of nursing is related to leadership behavior.

Elements of the model.

1. Servant-Leader Spirituality
2. Self Mastery (vibrant care complex)
3. Special Expertise (lvl in nursing field engaged in)
- Lvl of competence in a particular nursing area.

Servant Leader Formula

- Care complex primer
- Retreat- workshop on servant leadership
- Seminar workshop on transformative teaching for nursing faculty.

Transformative Teaching
- Reflective teaching
- Umbrella term covering ideas; thoughtful instruction, teacher research, teacher narrative,
teacher empowerment.

Nursing Leadership
- Force within the nursing profession that sets vision for practitioners.
- Lays down the roles and functions
- Influences the direction toward which the profession should go.

Care Complex
- NUCLEUS OF CARE EXPERIENCES in the personality of a nurse.
- Combination of maternal care experiences, culture based care practices, indigenous to
race and people and professional training on care acquired in a formal nursing course.

Retreat Workshop
- SPIRITUAL EXERCISE organized in the ambience of prayer where the main theme is
the contemplation of jesus christ as a servant leader.
Minor Information
- Magna cum laude, Board Topnotcher.

Strength
- Can be use in other educational setting not jus ton nursing profession.

Weakness

- CASAGRA limits only Roman catholic and christian nursing educators.

- Did not consider other religions in this study.
-
 Rozzano Locsin TECHNOLOGICAL COMPETENCY AS CARING IN NURSING

Purpose: to provide opportunities for practitioners of nursing to engage in knowing persons as

caring-being technologically competent is the ultimate expression of caring in nursing

Minor Information.
- Native Filipino (Dumaguete City, Philippines.

Technological Competency as Caring in Nursing

- Middle range theory grounded in nursing as caring.
- Coexistence between technology and caring in nursing

Technological competency: harmonious coexistence between technologies and caring in nursing.

Dimensions of Technological Value

1. Technology as completing human beings
- Re-formulate ideal human beings as in replacement parts ( both mechanical/ prosthesis and organic/transplantation of
organs.
2. Technology as machine technologies.
- Computers and gadgets enhancing nursing activities to provide quality patient care.
3. Technologies that mimic human beings and human activities
- Meet the demands of nursing care practices ( cyborgs or nurse robots)

Risk with technology

- Doctor Google: patient diagnosing or misdiagnosing themselves based on information from the internet.
- Confidentiality: widespread availability of private information.
Process of Nursing
- Knowing: knowing person is guided by technological knowing ( persons are appreciated as participants in their care rather
than as objects of care)
- Designing: nurse and patient plan a mutual care process from which the nurse can organize a rewarding nursing practice
that is responsive to the patient’s desire for care.
- Participation in appreciation: simultaneous practices of conjoined activities which are crucial to knowing persons. Process
is an alternating rhythm of implementation and evaluation. Evidence of continuous knowing, implementation and participation
is reflective of the cyclical process of knowing persons.
- Verifying knowledge: continuous circular process demonstrates the ever changing, dynamic nature of knowing in nursing.

Metaparadigm
1. Person
- Recipients of nursing care that have desires, dreams and ambitions are to live life completely as caring persons. Also
want to feel acknowledged as a unique person with hopes and dreams and not as an object.
2. Health
- An experience that is often expressed in terms of wellness and illness and may occur in the presence or absence of
disease.
- Humanity is preserved by technology.
3. Environment
- Surroundings that use technology, such as a critical care unit to understand the persons as a complete moment by
moment.
4. Nursing
- Nurses value technological competency as an expression of caring in nursing.
- Described As a discipline and a specialized practice that uses technologies to individualize care to meet the unique
needs of the person

Call for Nursing

- Nurses rely on the person for calls.
- Knowing the person allows the nurse to use technologies in articulating calls.
- Illustration of the person’s unique hopes, dreams and aspirations.
- Individual expressions such as desire to go home and wishing to die peacefully.
Nursing Response
- Nurses respond to calls from people.
- Respond with authentic intentions to fully know the persons continually in the moment.

Nursing as Caring
- To direct focus, sustain and maintain the person through calls and responses for nursing.

KNOWING PERSONS
1. Who is person? (person as unique individual)
2. What is person? (empirical facts about the composition of the person as object)

MULTIPLE PATTERNS OF KNOWING NURSING

1. Empirical knowing: factual and aligned with qualitative explanations.
2. Ethical knowing: draws one moral value.
3. Personal knowing- relates to understanding and actualization of a relationship between nurse and patient.
4. Aesthetic knowing: respects the patient and the patient's needs.

ACCEPTANCE BY NURSING COMMUNITY

1. Nursing practice- broad concepts of caring and technologies have been applied to nursing in the critical care setting.
2. Education- technology is used to know the person fully in the moment.
3. Research- technology on competency in nursing fosters the recognition and realization of persons as participants in their
care rather than as objects of care.
 Carmelita Divinagracia ADVANCE NURSE PRACTITIONERS COMPOSURE BEHAVIOR AND
PATIENTS WELLNESS OUTCOME.

Minor Information
- Filipina Nurse, with award “Recipient of Anastasia Giron Tupas Award given by the PNA in 2008.

Objective: determine effects of “composure” behavior of the advanced nurse practitioner on the wellness
outcome of the selected cardiac patients.

Composure Behavior
- Set of behaviors determined by Dr. Divinagracia that would be demonstrated by advanced nurse
practitioners to see how it would affect the recovery of the patients in the coronary care unit of the philippine heart center.

COMPOSURE STANDS FOR

1. COMpetence: nurses should be equipped with knowledge and expertise in consistency in caring for their patients.
2. Presence and Prayer” pertains to the availability of the nurse in time of need not only physically but also holistically.
3. Open-mindedness: Nurses should be receptive to different ideas such as opinions and preferences regarding the patients
medical status. It also conveys the manner of being flexible to accommodate the view of others.
4. Stimulation: act of providing encouragement and appreciation that delivers hope and guidance in the form of positive
encouraging remarks.
5. Understanding: Approach that conveys interest and acceptance to the patient's holistic being.
6. Respect: acknowledging the presence of the patients and showing positive regard.
7. Relaxation: entails a form of exercise that involves alternate tension and relaxation of selected groups of muscles.
8. Empathy: perceives the current positive thoughts and feelings by putting himself/herself in the patients place.
METAPARADIGM
1. Nursing: the quality of nursing care could be improved using an intervention
2. Person: Each individual needs humane, caring, spirituality oriented intervention that can facilitate wellness regardless of
creed, social class, gender, age, and nationality.
CONCLUSION
- Nursing professionals can actively deliver quality care through bio-behaviors caring interventions like the COMPOSURE
behaviors regardless of creed, social class, gender, age, and nationality. Each one needs humane caring spiritually-oriented
interventions.
 Letty G. Kuan “Graceful Aging Theory” : Retirement and Role discontinuity model.

Minor Information
- 2 masters degree (MA in nursing, MA Education)

Physiological Age
- Endurance of cells and tissues to withstand the wear and tear phenomenon of the human
body.

Role
- Set of shared expectations focused upon a particular position. Set or shared expectations
from the retiree’s socialization as well as the adaptation to the expectations socially defined for the
position itself.

Change of Life
- Period between near retirement and post retirement years. In medico-physiologic terms, this equates with the climacteric
period of adjustment to another tempo of life.
Retiree
- Individual who has left the position occupied for the past years of productive life because he/she has reached the prescribed
retirement age of has completed the required years of service.

Role Discontinuity
- Interruption in the line of status enjoyed or performed. The interruption may bring about an accident, emergency, and change
of position or retirement.

Coping Approaches
- Refer to the interventions or measures applied to solve a problematic situation or state in order to restore or maintain
equilibrium and normal functioning.
DETERMINANTS OF POSITIVE PERCEPTIONS IN RETIREMENT AND POSITIVE REACTIONS TOWARD ROLE
DISCONTINUITIES.

Health status
- Physiological and mental state of the respondents, classified as either sickly or healthy.

Income
- Economic level and refers to the financial affluence of the respondent which can be classified as poor, moderate or rich.

Work status
- Status of an individual according to her/his work.

Family Constellation
- Type of family composition described either close knit or extended family where three or more generations of family live under
one roof, or distant family whose members live in separate dwelling units or nuclear family where only one husband, wife, and
children live together.

Self Preparation
- Preparing of self to the possible outcomes in life

a. Health status
b. Income
c. Work status
d. Family Constellation

METAPARADIGM
1. Nursing
- Preparing the person to have fulfillment in their retirement years and assisting them in their elderly years in leaving a
legacy.
 2. Person
- Elderly: classification of age 70-80
- Gerone: given to people who are old but gracefully able to function as useful citizens at home and in the community
and an exemplar in fidelity to prayer life.
3. Health
- Defined as aging
- Slow princess of growth towards maturity of mind, body, and spirit. Growing old is reaching a happy plateau.

4. Environment
- Society that supports the aged to feel needed.

ELEMENTS OF LIFE IMPRINTS

- Importance of love
- The hug factor
- Good parental and sibling modelling roles
- The sense of humor and relaxation
- The values of work and prayer life, growing closer to God who loves us tremendously.

APPLICATION
> clinical perspective
- After establishing nurse patient relationship, nurses need to assess the age’s health status, economic level, work status,
family constellation and self-preparation.
 CARMENCITA ABAQUIN: Prepare Me Holistic Interventions

Minor information
- Filipina nurse from UP expert in Oncologic nursing.

PREPARE ME (holistic nursing interventions) or “PREPARE ME INTERVENTIONS AND

QUALITY OF LIFE ADVANCE PROGRESSIVE CANCER PATIENTS.
- Nursing interventions provided to address the multi-dimensional problems of
cancer patients that can be given in any setting where the patients choose to be
confirmed. This program emphasizes a holistic approach to nursing care.

COMPONENTS
1. Presence
- Being with another person during times of need. (includes therapeutic
communication, active listening and touch.

2. Reminiscence therapy
- Treatment that uses all the senses- sight, touch, smell and sound to help individuals with dementia remember events,
people and places from their past.

3. Prayer
- Solemn expression of feelings through deliberate communication directed towards a deity.

4. Relaxation - Breathing
- Technique used to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms
such as pain, muscle tension and anxiety.
5. Meditation
- Way of connecting with a natural state of mind that is spacious and clear.
Values Clarification
- Psychotherapy technique that can often help an individual increase awareness of any values that may have a bearing on
lifestyle decisions and actions.
- Can provide opportunity for a person to reflect on personal moral dilemmas and allow for values to be analyzed and clarified.

METAPARADIGM
Person
- Patients in advanced stages of cancer, holistic beings with physical, psychological, social, religious levels of independence
and environmental aspects.
Environment
- Aspects or dimensions integrated into the cancer patient.
Health
- Cancer; quality of life is defined as a multifaceted construct that encompasses the individual capabilities and abilities to enrich
life when it can no longer be prolonged.
Nursing
- Improvement of quality of life for advanced stage cancer patients despite their current situation.

1. Holistic Nursing Intervention

- Presence, reminiscence therapy, prayer, relaxation activities.breathing, meditation, values clarification.

2. Terminally ill cancer patients

- Physical, social, psychological, religious or spiritual, environment, and level of independence.
3. Quality of life
- Multifaceted construct that encompasses the individuals capacity and abilities with an aim of enriching life when it can
no longer be prolonged.
> To nursing… may be able to provide the care that our clients need in maintaining their quality of life and being instrumental in
birthing them to external life.
 Cecilia Laurente: Nursing practice and Career

Minor Information
- Filipino nursing theories whose work focuses on assisting patients through various support
systems, particularly the family.
- Report out called categorization of nurse actions as seen in medical-surgical ward units in
selected government and commercial hospitals in manila.

Origin
- She came up with “categorization of observations of nursing activities units of medical surgical
wards in governments that have been chosen and metro’s private hospitals manila.

Anxiety
- Sensation of dread or fear over what might happen.

NURSES CARING BEHAVIORS THAT HAVE BEEN AN IMPACT ON PATIENT ANXIETY.

1. Concern: progress over time based on mutual confidence or trust between the nurse and the patient.
2. Presence: contact between the patient and the nurse on a one on one basis.
3. Stimulation: Nurses stimulate a person’s great sources of energy for healing by using words.

Enhancing Factors and Predisposing Factors

- Enhancing Factors
Ones experience with care, attitudes, and beliefs
Feeling good about work
Learning caring at school
What patients tell about the nurse
Coping mechanism to problems encountered
 Communication

- Predisposing Factors
Age
Sex
Civil status
Educational background
Length of work
Experience

Synchronicity in Human Space Time: A Theory of Nursing Engagement in a Global Community.

- Embracing caring engagement in a neo-modernist perspective asserts that there is interconnectedness between
human thoughts, synchronistic life events and meanings of experiences, critical to living meaningfulness of human
health and well being in a community.
- Advance as foundational to nursing praxis as theoretically based nursing encounter, developing diverse
practiced-based knowledge and methods focused on the life principles of emancipation, equitability, interconnectivity
and human transcendence.
- Study of caring and the perspective of synchronicity and nursing engagements.
- Aims to enlighten nurses in their practice through an innovative demonstration of the nursing care process grounded
on authentic intentions of caring.

4 PRINCIPLES
 1. Interconnectivity
- Principle of human interconnectedness of energy.
- Applying through interpersonal relation, technological knowing, rhythmic connecting, and transformational engaging.

2. Equitability
- Principle of justice and fairness in human caring across healthcare systems.
3. Emancipation
- Principle of liberating the self and others from the limits of human space time realities.
- Internal environmental limitations: physiologic, psychologic, emotional and spiritual.
- External environmental limitations: socio-economic political and organizational dynamics.
4. Human Transcendence
- Personal growth of persons and professional growth among nurses.

APPLICATION
Interpersonal Relating
- Nurturance of a relationship that appreciates the self and others as whole and transcendental beings.
Technological Knowing
- Focus on providing authentic and humane caring guided by technology.
Rhythmical Connecting
- Dancing to the cadence of treatments and nursing activities where each meaningful, caring experience is not merly an
encounter but a fit into a rhythmical pattern through which the interconnectivity of persons within the hst is nurtured.
Transformational Engaging
- Process of intimately concurring with the recognized improvement of the caring moment and human health experiences, a
continuous evaluation and infinite reflection of wholeness by both the nurse and the patient.
Transformational Learning
- Flourished by the engagement of caring attributes, knowledge and skills.
 Abraham Maslow’s Hierarchy of needs theory

- His theory is applied in nursing to guide the prioritization of patient care

needs.
- A psychological based theory

Maslow’s Hierarchy of needs

- Physiologic needs
- Safety needs
- love/belonging needs
- Esteem needs
- Self actualization needs

> how does it pertain to nursing

- Prioritization
- Clinical judgement
NURSING POINTS
a. Physiological needs
b. safety
c. love/belonging
d. Self esteem.
1. Physiological needs
- Highest priority level, take priority over other needs.
- Eg: shelter, elimination, nutrition, fluids, oxygen.
2. Safety
- Second level prioritization
- Physical safety: patients wants to feel physically safe.
- Psychological safety: people will attempt to seek safety before meeting any other needs.
- Eg: law and order, shelter, employment, health.
3. Love/Belonging
- Third level need
- Satisfies acceptance of others
- Eg: relationship with family, friends, social relationships, intimate rs.
4. Self esteem needs
- Fourth level need
- Become more important once other needs level are met.
- Focus on outer acceptance first, then on esteem.
- Need to feel useful, feelings of accomplishment, self confident
- Eg: recognition,status,respect.
5. Self Actualization
- Must meet all other needs levels before fulfilling this level.
- Need to actualize my full potential.
- Focuses on coping
- encourage s problem solving capabilities
- Being your best self.
- Eg: pursuing a talent, personal growth, creativity.
Summary:
Maslow’s Hierarchy of Need Theory focuses on the positive aspects of human nature. Many psychologists focused on aspects of
human nature that were considered abnormal, Abraham Maslow shifted focus to look at the positive sides of mental health. His work
helps nurses to view mental health in a different aspects. His work influenced how we see mental health. His interest in human
potential, peak experiences, the improvement of mental health, and personal growth had a lasting influence on psychology. His work
continues to exert an influence today. While Maslow’s work fell out of favor with many academic psychologists and some suggest his
hierarchy might be due for an update, his theories are enjoying a resurgence due to the rising interest in positive psychology.

Interpersonal Theory Work of Harry Sullivan

- American psychiatrist
- His research was the basis of psychology known as PSYCHOANALYSIS.

- Theory suggest that the way people interact with others could provide valuable clues to their
mental health

- Coined the term “self esteem” to describe components of a person much like Sigmund
Freud's conscious, subconscious and unconscious.

- He developed the concept of developmental epochs to explain the development of personality

across the lifespan.

1. Active self: the waking conscious self.

2. Eccentric self: source of a person’s identity and personality
3. State of sleep: dormant self
 Ludwig Von Bertalanffy’s General system theory
- Father of system theory
- Wrote general system theory.

SYSTEM THEORY
- A system is a “whole” composed of elements that interact with one another.
- OPEN SYSTEMS: interact with the larger environment via inputs and outputs.
- Simple: a theory that sees an organization as a set of interrelated and interdependent
parts.
- Promotes holistic view of reality.
- Systems theory like organization are like living organisms, are made up of numerous
component subsystems that must work together in harmony for the larger system to succeed.

IMPORTANT VIEWPOINTS ON ORGANIZATION

1. Open systems
2. Closed system
3. Subsystem
4. Synergy
5. Entropy

CHARACTERISTICS/FEATURES OF THE SYSTEMS THEORY

1. Communication: must be put in place for organizational systems to exchange relevant information with it’s environment.
2. Systems, subsystems, and supersystem:
- System: a set interrelated part that turns inputs to outputs through processing.
- Subsystem: step that does the processing of the objectives within an organization.
- Supersystem: survival of the focal system is dependent.
3. Boundaries: part of a system that separates it from its environment.
- 4 types: physical linguistically, systematic and psychological boundaries.
4. Goal-directedness
- Systems are goal oriented and engage in feedback in order to meet the goals of the organization.
 Kurt Lewin’s change Theory
- Known for experiential learning, field theory, and group dynamics.

Change theory
- Most influential theory of kurt lewin.
- He defined behavior in this model as “a dynamic balance of forces working in opposing
directions”

3 MAJOR CONCEPTS
1. Driving Forces
- Pushes in a direction where change will happen; initiating change and keep it
going.
- Where nurses motivate their patients in changing something and pointing
towards the direction of the transition.

2. Restraining Forces
- Forces that restrain/ counter the driving forces
- It hinders the change that is about to happen as they push in the opposing direction

3. Equilibrium
- State in which no change occurs- where:
Driving forces = Restraining Forces.
- Increases/ decreases between the driving forces and restraining forces can affect the equilibrium

Unfreezing
- Necessary to overcome the strains of individual resistance and group conformity.
- Methods:
A. increase the driving force (to lead patient out of the existing situation)
B. Decrease the restraining forces (negatively affect the movement of the existing equilibrium)
C. Find a Combination (of the first two methods.)
Change
- Moving to a new level; the stage of transition.
- Involves the process of change in thoughts, feelings, behavior or all three that is in some way more liberating or productive.

Refreezing
- Standard operating procedure
- Critical because it is easy for the patient to go back to their old habit without firm ground in their new re-established ways.

METAPARADIGMS
Person
- Affect in a way that explains the striving forces of the person to maintain status quo and the will to push for the change.
Environment
- Motivates healthcare clients to reflect on the routine. Not something that can positively or negatively affect their well-being
nurses are bound to maintain stability to any patient's health therefore equilibrium as a major concept of the theory affects
community health care.
Health
- Critical aspects of each and everyone and we should take care of it.
Nursing
- Helps motivate the patient to change in a way that prioritizes the patient’s overall well being.
.
 Erikson’s Stages of Psycho-Development.
- Coined the phrase “identity crisis”

8 STAGES OF PSYCHO-DEVELOPMENT
STAGE 1: Infancy
- Trust and mistrust
- 0- 18months
- Hope is developed in this stage (most important virtue in life)

STAGE 2: Early Childhood

- Autonomy and Doubt
- 2-3 yrs old
- Will is developed and learns to say no/ Self control (potty training)

STAGE 3: PRE-SCHOOL
- Initiative and Guilt
- 3 - 5 yrs old
- Learn to ask “why?” and exploration and purpose.

STAGE 4: School Age

- Industry and inferiority
- 6-11 yrs old
- Evaluation, sense of pride/achievements, self esteem/confidence.

STAGE 5: Adolescence
- Identity and Identity Confusion
- 12-18 yrs old
 - “Who am i?” (trying to find direction in life). Social relationships and fidelity.

STAGE 6: Young Adulthood

- Intimacy and Isolation
- 19-40 yrs old
- Relationships and Love.
- married/children, experienced failures= less committed relationships, isolation, loneliness and depression.

STAGE 7: Middle Adulthood

- Generativity and Stagnation
- 40-65 yrs old
- Parenthood and Care
- Failure= midlife crisis, boredom, restlessness, depression.

STAGE 8: Maturity
- Integrity and Despair
- 65 yrs- death
- Contentment, reflecting on life's accomplishment, developed moral values and gained wisdom in experience.

The stages of psychosocial development were postulated and highlighted by Erik Erikson (1902-1994), a well-known phycologist and
psychoanalyst. His theory maintained that the psychology of a person is determined by his/her ability to succeed or fail in the major challenges
of the eight stages of life. Poor development in even one of these psychological stages can mean that the individual would struggle with a
personality disorder, e.g. lack of confidence, all their life.
 Theory of Lawrence Kohlberg “Moral Development”

Minor information
- He committed suicide because of parasitic infection that caused him to be
depressed.
- Known for moral development theory

MORAL DEVELOPMENT THEORY

- Influenced by swiss psychologist jean piaget’s stage based theory of development.
- Claimed “the most important aspect in moral thinking was proper moral reasoning
that corrects moral reasoning and would lead to ethical behavior.

- Study how children acquire morality and moral reasoning. According to his theory,
moral development develops in 3 levels with 6 stages.

MORAL DEVELOPMENT
- Process by which children develop proper attitudes and behaviors toward other people in society, as determined by social and cultural
norms, rules and laws.

3 levels of moral development

LEVEL 1: Pre-conventional
- Stage 1: obedience and punishment
● People at this stage see rules as fixed and absolute therefore obeying is important to avoid punishment.
- Stage 2: Individualism and exchange
 ● In this stage individuals recognize that there is not just one right view handed down by authorities but different individuals have different
viewpoints.

LEVEL 2: Conventional
- Stage 3: good interpersonal relationships
● “Good boy/girl” orientation, focused on living up to social expectations and roles.
- Stage 4: Maintaining Social Order
● Individuals become aware of the wider rules of society, so judgements concern obeying the rules in order to uphold the law and avoid
guilt.

LEVEL 3: Post-Conventional
- Stage 5: Social Contract and Individual Rights
● Individuals become aware that while rules/laws might exist for the good of the greatest number, there are times when they will work
against the interest of particular individuals.
- Stage 6: Universal Principles.
● People in this stage developed their own set of moral guidelines which may or may not fit the law.
METAPARADIGM
PERSON
- Individuals progress through stages of moral development just as they progress through stages of cognitive development.

HEALTH: Not stated

ENVIRONMENT: Not stated

NURSING:
- Nurses must develop a strong system of morals in order to uphold the strict ethics required of them.