Non-Nursing Theories relevant to Nursing
Practice
Maslow, Sullivan, Lewin, Von Bertalanffy,
Erikson, Kohlberg
Support Theory
The intent of this chapter is to introduce you to
several essential theories from the arts,
sciences, and humanities that have had, and still
have, a significant influence on nursing theory,
knowledge, practice and research
Von Bertalanffy’s General and Open Systems
Theories
Two of the most globally influential theories
ever developed are General System Theory
(GST) and Open System Theory (OST)
GST was framed in the 1920’s by Ludwig Von
Bertalanffy, a biologist from Vienna. OST, which
was generated from GST, was framed in the
1930s and presented to the scientific
community
At a meeting at the University of Chicago in
1937
GST was based in the biological sciences and
suggested that there was structure,
organization and interdependent function
among living things based on systems and
subsystems that joined together to form
“wholes”
A. System
B. Subsystem
Ex. Human Body
Wholeness
As GST evolved, Bertalanffy made additional
observation that gave it a new and more global
dimension and ultimately formed a new theory.
This second theory was OST. Whereas GST focus
on the physical aspect of systems, subsystems
and environments, OST focused on their
interaction.
Interaction- Self regulation is composed of
input, output and feedback
Feedback
Example: Dehydration endocrine and renal
system help regulate fluid balance
Environment- Defines as the surroundings or
conditions in which something exists or
operates, it is an essential concepts within OST.
Example: Internal and external environment of
cell, organs and human body
Environments can also be non physical in nature
and include qualitative factors that influence
relationship between systems and subsystems,
such as beliefs, philosophies, behaviors and
attitudes.
Example: Organization can be useful or not
useful
Boundaries- are traditionally defined as lines,
real or imaginary, that separate or enclose.
Boundaries sometimes act as stopping points.
Example; Semi permeable membranes like the
blood brain barriers
Summary of Von Bertalanffy’s Open System
Theory
Phenomenon: Systems, subsystems and
environments interact and influence each other.
Idea: Interactions among systems subsystem
and their environments are self regulating and
goal directed.
Key Concepts/Internal Variables
• System: connected, interdependent,
interacting elements
• Subsystem- a system within a larger
system
 • Environment- internal and external Abraham Maslow’s Theory of Human
surroundings of systems and their Motivation and Hierarchy of Basic Human
subsystems Needs

• Hierarchy-the ordering or ranking of In 1954, Abraham Maslow developed a grand

systems and their subsystems
• Wholeness: systems, subsystems and
environments working as one
theory called Theory of Human Motivation and
Hierarchy of Basic Human Needs that are the
motivation behind people’s behavior.

• Interaction: the exchange of energy,

influence, and matter across a
boundary (in the form of input, output
and feedback)

• Teleology- goal directed interaction

• Entropy- adaptive interaction

• Equifinality- goals accomplished in

different ways

Examples of Propositions:
Summary of Maslow’s Theory of Human
1. Systems, subsystems and their
Motivation and Hierarchy of Basic Human
environments from hierarchical wholes
Needs
that maintain homeostasis and work
toward a common goal Phenomenon: Need motivates behavior
2. Systems, subsytems and their Idea: Needs that motivate behavior are
environments self regulate based on hierarchichal in order
their interactions
Key Concepts/Internal Variables
3. Teleology, entropy and equifinality are
Hierarchy of human needs: those things that
achieved through interactions.
human need to survive and thrive
Examples of Assumptions
• Physiologic: air, food, water
1. Everyone knows what the goal is
• Safety: shelter from harm
2. The hierarchical order is actually
• Love: affection and acceptance
facilitating the achievement of the goal
• Self-esteem: Self- worth, positive self-
3. The system has the resources for
image
entropy and equifinality if needed
• Self-actualization: development of
potential
Maslow’s Hierarchy of Needs
Propositions
• Human Need motivates behavior
• Human needs are ordered according to
a survival hierarchy
the goal is to complete the necessary
developmental tasks before moving to the next
stage, Erickson felt that if tasks of a particular
stage were not accomplished, they would be
revisited by the individual during a later stage.

• The majority of needs in one level must

be met before moving to the next

Assumptions

• Motivation is hierarchal

• Males and females have the same

motivation

• To be well adjusted, physiologic needs

must be met first

Facts/Principles/Laws

Fact: Physiologic needs must be met for survival

Principle: Need are based in a hierarchal

Law: Need motivates Behavior

Eric Erickson Theory of Personality

Development

Eric Erickson, a German-born psychoanalyst,

identified concepts associated with personality
formation that eventually turned into a theory
of personality development. Erickson included
social and cultural experiences as significant to
personality development and emphasized that
there is continual personality development
across the life span

Erickson’s Theory of Personality Development

In his theory, Erickson identified 8

developmental stages that human being move
through. The 8 stages are growth categories of
infant, toddler, preschool, school, adolescent,
young adult, middle adult and older adult. Each
of these categories has a corresponding
developmental stage

Theory of Personality Development
Propositions
1. Humans develop psychologically by
progressing through specific
developmental stages
2. Developmental stages correspond with
chronological age
3. The goal of each stage is that the
developmental tasks are accomplished
prior to moving to the next stage
Assumptions
1. Developmental stages correlate with
specific chronological ages
2. Accomplishing developmental tasks in
order is necessary for healthy
development
3. If tasks are not accomplished, they will
be revisited at future stages
Facts/Principles/Laws
Fact: Human beings progress through specific
developmental stages
Principles: Progression through developmental
stages is dependent upon accomplishing
developmental tasks
Law: Developmental stage influences the
personality of an individual
Kurt Lewin’s Change Theory
Kurt Lewin a psychologist in the tradition of
Erickson and others, studied the motivation and
intent behind human behavior. However, he
differed from the others in that he not only
offered analysis of the motivation and behavior,
but he also studied how to improve that
behavior, especially with regard to bringing
about change within systems
Change Theory or Force Field Analysis
His work culminated in the development of a
landmark theory of change within the systems.
His work culminated in the development of a
landmark theory of change which is sometimes
referred to as a psychological field theory or the
force field analysis model (FFAM)
FFAM provides structure for identifying and
understanding motivation behind individual’s
responses to change and for improving behavior
during change.
• Driving Force- move behavior toward a
positive state of mind that encourages
change.
• Restraining Force- also known as static
forces, move behavior toward a
negative state of mind that supports
maintaining the status quo, thus
opposing the change
• Driving force may be the result of
external influence on the system or
they may be the result of external
influence on the system.
• According to Lewin, the environment is
also known as fields, this includes not
only the external factors but also the
beliefs, behavior, philosophy and
attitude.
Change Theory
Stages of Change
Unfreezing- The stage of change where the
motivation or need for change becomes
apparent. Driving and restraining forces that
influence change are identified, and activities
are initiated to decrease the restraining forces
and increase the driving force
Moving/Change- The stage where the details of
the change are planned and initiated. This stage
involves people who may not have been
involved in the decision to make the change and
as a result may have to be persuaded as to its
necessity.
Refreezing- The final stage where changes that
have been initiated become integrated,
established and stabilized.
• Phenomenon: People respond to
change differently
• Idea: Motivation influences an
individual’s response to change
• Key Concepts
Change: to make different
Motivating forces: factors that influence
behaviors
Driving forces: Support Change
Restraining forces: resist change
Field: the environment in which driving and
restraining forces are interacting
Change process: the process of making different
Unfreezing: the need for change becomes
apparent
Moving: Change Initiated
Refreezing: change established
• Propositions
1. Change is influenced by driving and
restraining forces
2. Driving and restraining forces interact
within a field
3. Change is dependent upon refreezing,
moving and refreezing behaviors
• Assumptions
1. Change always has oppositions
2. Driving and restraining forces are the
only forces influencing change
3. Moving occurs before refreezing
Harry Sullivan
• Harry Stack Sullivan psychiatry or
Interpersonal Psychoanalysis
• He proposed interpersonal theory of
personality.
• He explained the role of interpersonal
relationships and social experiences in
shaping personality.
• He also explained about the importance
of current life events to
psychopathology.
• The theory further states that the
purpose of all behavior is to get needs
met through interpersonal interactions
and decrease or avoid anxiety
Interpersonal Theory
Key Concepts
• Tensions
• Needs ( Tenderness)
• Anxiety
• Energy Transformation
• Dynamism
• Malevolence
• Intimacy
• Lust
Levels of Cognitions (ways of perceiving,
imagining, and conceiving)
A. Prototaxic (undifferentiated
experiences that are completely
personal)
B. Parataxic (prelogical experiences that
are communicated to others only in a
distorted fashion
C. Syntaxic (consensually validated
experiences that can be accurately
communicated to others)
Lawrence Kohlberg
• Lawrence Kohlberg was an American
psychologist and is very famous for his
work on the Theory on Moral
Development. He was an educator at
the University of Chicago and Harvard
University (Graduate School). Studying
moral development is not popular
during his time, but still he decided to
focus on this subject, he was inspired by
the work of Jean Piaget about children’s
cognitive development
Glass of Water
Level 1: Preconventional
• A child’s sense of morality is
externally controlled. Children
accept and believe the rules of
authority figures, such as parents
and teachers. A child with pre-
conventional morality has not yet
adopted or internalized society’s
conventions regarding what is right
or wrong, but instead focuses
largely on external consequences
that certain actions may bring.
Stage 1: Obedience-and-Punishment
Orientation
Focuses on the child’s desire to obey rules and
avoid being punished. For example, an action is
perceived as morally wrong because the
perpetrator is punished; the worse the
punishment for the act is, the more “bad” the
act is perceived to be.
Stage 2: Instrumental Orientation
Stage 2 expresses the “what’s in it for me?”
(WIFM) position, in which right behavior is
defined by whatever the individual believes to
be in their best interest. Stage two reasoning
shows a limited interest in the needs of others,
only to the point where it might further the
individual’s own interests.
Level 2: Conventional
Throughout the conventional level, a child’s
sense of morality is tied to personal and societal
relationships. Children continue to accept the
rules of authority figures, but this is now due to
their belief that this is necessary to ensure
positive relationships and societal order.
Adherence to rules and conventions is
somewhat rigid during these stages, and a rule’s
appropriateness or fairness is seldom
questioned
Stage 3: Good Boy, Nice Girl Orientation
Children want the approval of others and act in
ways to avoid disapproval. Emphasis is placed
on good behavior and people being “nice” to
others.
Stage 4: Law-and-Order Orientation
The child blindly accepts rules and convention
because of their importance in maintaining a
functioning society. Rules are seen as being the
same for everyone, and obeying rules by doing
what one is “supposed” to do is seen as
valuable and important. Moral reasoning in
stage four is beyond the need for individual
approval exhibited in stage three. If one
person violates a law, perhaps everyone
would—thus there is an obligation and a duty
to uphold laws and rules.
Level 3: Post conventional
Throughout the post conventional level, a
person’s sense of morality is defined in terms of
more abstract principles and values. People
now believe that some laws are unjust and
should be changed or eliminated. This level is
marked by a growing realization that
individuals are separate entities from society
and that individuals may disobey rules
inconsistent with their own principles
Some theorists have speculated that many
people may never reach this level of abstract
moral reasoning.
Stage 5: Social-Contract Orientation
The world is viewed as holding different
opinions, rights, and values. Such perspectives
should be mutually respected as unique to each
person or community. Laws are regarded as
social contracts rather than rigid edicts. Those
that do not promote the general welfare
should be changed when necessary to meet
the greatest good for the greatest number of
people.
Stage 6: Universal-Ethical-Principal Orientation
Moral reasoning is based on abstract reasoning
using universal ethical principles. Generally, the
chosen principles are abstract rather than
concrete and focus on ideas such as equality,
dignity, or respect. Laws are valid only insofar as
they are grounded in justice, and a commitment
to justice carries with it an obligation to disobey
unjust laws.
People choose the ethical principles they want
to follow, and if they violate those principles,
they feel guilty. In this way, the individual acts
because it is morally right to do so (and not
because he or she wants to avoid punishment),
it is in their best interest, it is expected, it is
legal, or it is previously agreed upon.
Albert Bandura- Social Learning Theory
• Albert Bandura is an influential social
cognitive psychologist who is perhaps
best known for his social learning
theory, the concept of self-efficacy, and
his famous Bobo doll experiments. He is
a Professor Emeritus at Stanford
University and is widely regarded as one
of the greatest living psychologists.
Social Learning Theory
• Social learning theory, proposed by
Albert Bandura, emphasizes the
importance of
observing, modelling, and imitating the
behaviors, attitudes, and emotional
reactions of others. Social learning
theory considers how both
environmental and cognitive factors
interact to influence human learning
and behavior.
• In social learning theory, Albert Bandura
(1977) agrees with the behaviorist
learning
theories of classical conditioning and
operant conditioning. However, he adds
two
important ideas:
1. Mediating processes occur between
stimuli & responses.
2. Behavior is learned from the
environment through the process of
observational learning.
 Children observe the people around
them behaving in various ways.
Individuals that are observed are called
models. In society, children are
surrounded by
many influential models, such as
parents within the family, characters on
children’s TV,
friends within their peer group and
teachers at school. These models
provide examples
of behavior to observe and imitate, e.g.,
masculine and feminine, pro and anti-
social,
etc.
 Children pay attention to some of these
people (models) and their behavior. At
a later
time they may imitate (i.e., copy) the
behavior they have observed.
They may do this regardless of whether
the behavior is ‘gender appropriate’ or
not, but
there are a number of processes that
make it more likely that a child will
reproduce the
behavior that its society deems
appropriate for its gender.
• First, the child is more likely to attend
to and imitate those people it perceives
as similar
to itself. Consequently, it is more likely
to imitate behavior modeled by people
of the
same gender.
Second, the people around the child will
respond to the behavior it imitates with
either
reinforcement or punishment. If a child
imitates a model’s behavior and the
consequences are rewarding, the child
is likely to continue performing the
behavior.
• If a parent sees a little girl consoling her
teddy bear and says “what a kind girl
you are,”
this is rewarding for the child and
makes it more likely that she will repeat
the
behavior. Her behavior has been
reinforced (i.e., strengthened).
Reinforcement can be external or
internal and can be positive or negative.
If a child
wants approval from parents or peers,
this approval is an external
reinforcement, but
feeling happy about being approved of
is an internal reinforcement. A child will
behave
 in a way which it believes will earn Local Theories and Models of Nursing
approval because it desires approval. Intervention (Philippine Setting)

Sr. Carolina Agravante

• Positive (or negative) reinforcement will She finished her secondary education at St. Paul
have little impact if the reinforcement Univeristy - Manila (formerly St. Paul College -
offered Manila) as class salutatorian.
externally does not match with an
In 1964, she earned her BS Nursing degree in
individual's needs. Reinforcement can
the same school as magna cum laude. In the
be positive or
same year, she passed the nurse licensure
negative, but the important factor is
examinations as the board topnotcher.
that it will usually lead to a change in a
person's From 1967 to 1969, she studied Master’s
behavior. Degree in Nursing Education at Catholic
University of America as a full-fledged scholar.
• Third, the child will also take into
In 2002, she earned her Doctoral Degree in
account of what happens to other
Philosophy at University of the Philippines
people when
Manila - the same year her theory was
deciding whether or not to copy
published. She served as the president of St.
someone’s actions. A person learns by
Paul University - Iloilo, where she taught
observing the
research subjects among senior students.
consequences of another person’s (i.e.,
models) behavior, e.g., a younger sister
observing an older sister being
rewarded for a particular behavior is
more likely to
repeat that behavior herself. This is
known as vicarious reinforcement.

• This relates to an attachment to specific

models that possess qualities seen as
rewarding. Children will have a number
of models with whom they identify.
These may
be people in their immediate world, The CASAGRA Transformative Leadership
such as parents or older siblings, or Model
could be
The CASAGRA Transformative Leadership
fantasy characters or people in the
Model: Servant – Leader Formula & the Nursing
media. The motivation to identify with a
Faculty’s Transformative Leadership Behavior
particular
CArolina S. AGRAvante= CASAGRA
model is that they have a quality which
the individual would like to possess The present day demands in the nursing
profession challenge nursing educators to
revisit their basic responsibility of educating
professional nurses who are responsive to
technological, educational and social changes attended and his involvement in
happening in the Philippines society today. The organizations; and lastly.
reopening of thedoors of foreign market to
3) Special Expertise, which draws emphasis
Filipino nurses, migration made easy, attractive
in the nurse faculty’s involvement in the
salaries and benefits way beyond what hospitals
formation of his students.
can afford to give.

• Globalization of nursing services

ROZZANO LOCSIN
• The formation of new nursing leaders is
TECHNOLOGICAL COMPETENCY AS CARING IN
urgently needed; leaders with new
NURSING: A MODEL FOR PRACTICE
vision who will venture new traits and
who have gone through new formation Rozzano Locsin is a Professor of Nursing at
in order to serve the society as Tokushima University (Japan), a Professor
professional nurse. Emeritus of Florida Atlantic University (United
States), and a Visiting Professor at universities
• In Agravante's Theory of Transformative
in Thailand, Uganda, and the Philippines.
Leadership Model, she initially
mentioned the concept of servant-
He has authored a book entitled Technological
leadership spirituality. For nurse
Competency as Caring in Nursing: A Model for
educators, they can apply this concept
Practice, edited and co-authored three more
by being passionate about their craft.
books, including one entitled A Contemporary
They can also show willingness to
Nursing Practice: The (Un)Bearable Weight of
impart their acquired knowledge to
Knowing in Nursing.
their students and colleagues in a
selfless way. These educators, EARLY LIFE
contemplate first by attending a variety
of workshops regarding new trends in ■ Locsin was born in 1954. He is a
nursing, applying evidenced- based registered nurse, a native of Dumaguete
practices through patient simulation, City, Philippines who resides and
and cascading it to the target learning practices his nursing profession at
group. Tokushima University, Tokushima,
Japan as a Professor of Nursing. He is a
• Sister Carolina Agravante’s CASAGRA Professor emeritus of Florida Atlantic
Transformative Leadership University in Boca Raton, Florida, USA.
Theory focuses on the Three-Fold Dr. Rozzano Locsin earned his PhD in
Transformative Leadership Nursing from the University of the
Concept namely: Philippines in 1988, and his MA in
Nursing and Bachelor of Science in
1) Servant-Leader Spirituality, wherein a
Nursing from Silliman University in 1978
leader, through spiritual exercise, realizes
and 1976 respectively in the Philippines
that his model in caring for individual is
Jesus
2) Self-Mastery, which involves individual’s
self-awareness through formal education in
nursing, a continuous education, seminars
ACADEMIC CAREER
■ In 1991, Locsin joined Florida Atlantic
University, Christine E. Lynn College of
Nursing, where he was a tenured
Professor of Nursing, and now a
Professor Emeritus
■ Locsin's middle range nursing theory is
an interesting discussion of the
correlation between hands-on patient
care and the use of technology.
Technology is defined as anything that
makes things efficient – from basic
diagnostic technologies to therapeutic
practices familiar to all nurses.
Specifically, he discusses the
importance of understanding the need
for knowing “high-tech” instruments,
ASSUMPTIONS
e.g. monitors, implants, and devices,
that are a part of patient care, as these
will provide opportunities for the nurse
to know the patient fully as person.
■ Nurses use and encounter technology in
nearly every aspect of their profession.
What does it mean to be technologically
competent? What does it mean to be a
caring nurse? How does technology
support nursing work? How does it
hinder nursing work? How can nurses
care for their patients as technological
advancements are introduced nearly
every day? Technological Competency
as Caring in Nursing: A Model for
Practice provides insight and answers
into how nurses can express their
nursing by being technologically
competent. As such, Locsin sustains the
understanding that being technological
competent is being caring.
■ Locsin's work is obviously guided by the
question asked by thoughtful nurses
everywhere: How can I satisfactorily
reconcile the idea of competent use of
technology with the idea of caring in
nursing? His theory significantly
describes a practical understanding of
the solution enriching the practice value
of all of the general theories of nursing
which are grounded in caring.
Technological competency as caring in
nursing informs nursing as a critical
process of knowing persons’ wholeness.
Locsin's theory book explores, clarifies,
and advances the conception of
technological competency as caring in
nursing. His theory is essential to
modeling a practice of nursing from the
perspective of caring. It is a practical
illumination of excellent nursing in a
technological world.
■ Technological Competency as Caring in
Nursing is a middle range theory
grounded in Nursing as Caring (Boykin
& Schoenhofer), 2001). It is illustrated
in the practice of nursing grounded in
the harmonious coexistence between
technology and caring in nursing. The
assumptions of the theory are:
■ Persons are caring by virtue of their
humanness (Boykin & Schoenhofer,
2001).
■ Persons are whole or complete in the
moment (Boykin & Schoenhofer, 2001).
■ Knowing persons is a process of nursing
that allows for continuous appreciation
of persons moment to moment (Locsin,
2005).
■ Technology is used to know wholeness
of persons moment to moment (Locsin,
2004).
■ Nursing is a discipline and a professional
practice (Boykin & Schoenhofer, 2001).
DIMENSIONS OF TECHNOLOGICAL VALUE IN
THE THEORY
■ Technology as completing human
beings to re-formulate the ideal human
being such as in replacement parts,
both mechanical (prostheses) or organic
(transplantation of organs.)
■ Technology as machine technologies,
e.g. computers and gadgets enhancing
nursing activities to provide quality
patient care such as Penelope or Da
Vinci in the Operating Theatres;
■ Technologies that mimic human beings
and human activities to meet the
demands of nursing care practices, e.g.
cyborgs (cybernetic organisms) or
anthropomorphic machines and robots
such as ‘nursebots’ (Locsin & Barnard,
2007).
TECHNOLOGICAL COMPETENCY AS CARING IN
NURSING
■ Technological competency as caring in
nursing is the harmonious coexistence
between technologies and caring in
nursing.
■ The harmonization of these concepts
places the practice of nursing within the
context of modern healthcare and
acknowledges that these concepts can
co-exist.
■ Technology brings the patient closer to
the nurse. Conversely, technology can
also increase the gap between the
nurse and nursed.
■ When technology is used to know
persons continuously in the moment,
the process of nursing is lived
THE PROCESS OF NURSING
■ A. Knowing: The process of knowing
person is guided by technological
knowing in which persons are
appreciated as participants in their care
rather than as objects of care. The
nurse enters the world of the other. In
this process, technology is used to
magnify the aspect of the person that
requires revealing - a representation of
the real person. The person’s state
change moment to moment - person is
dynamic, living, and can not be
predicted.
■ B. Designing: Both the nurse and the
one nursed (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.
■ C. Participation in appreciation: The
simultaneous practice of conjoined
activities which are crucial to knowing
persons. In this stage of the process is
the alternating rhythm of
implementation and evaluation. The
evidence of continuous knowing,
implementation and participation is
reflective of the cyclical process of
knowing persons.
■ D. Verifying knowledge: The
continuous, circular process
demonstrates the ever-changing,
dynamic nature of knowing in nursing.
Knowledge about the person that is
derived from knowing, designing, and
implementing further informs the nurse
and the one nursed.
Carmelita Divinagracia
 Master in Nursing in 1975
 Doctoral Degree holder in 2001
 Specialty in Cardiology
  Advance Nurse Practitioner Understanding, Respect and Relaxation,
 Dean College of Nursing- University of Empathy
the East Ramon Magsaysay Memorial
Composure Behaviours
Medical Center
COMpetence
The Lived Experiences of Nursing Service
Personnel and Nursing Educators on • An in depth knowledge and clinical
Collaboration expertise demonstrated in caring for
patients.
Three Main Themes and Sub themes were
identified: • This is also stands for consistency and
congruency of words and deeds of the
• Coordination
nurse.
- Intra Organizational Coordination
Presence and Prayer
- Inter Organizational Coordination
• A form of nursing measure which
- Reciprocal Interdependence means being with another person
during times of need.
• Communication
• This includes therapeutic
- Environmental Factors communication, active listening, and
- Personal Factors touch.

• Interpersonal Relationship • It is also a form of nursing measure

which is demonstrated through reciting
- Engagement a prayer with the patient and
- Esprit (Morale) concretized through the nurse’s
personal relationship and faith in God.
- Concern
Open-mindedness
- Support
• A form of nursing measure which
means being receptive to new ideas or
to reason.
COMPOSURE Behaviors
• It conveys a manner of considering
• Are sets of behaviors or nursing
patient’s preferences and opinions
measures that the nurse demonstrates
related to his current health condition
to selected patients
and practices and demonstrate the
• A condition of being in a state of well- flexibility of the nurse to accommodate
being, a coordinated and integrated patient’s views.
living pattern that involves the
Stimulation
dimension of wellness.
• a form of nursing measure
• COMPOSURE is a acronym which stands
demonstrated by means of providing
for COMpetence, Presence and Prayer,
Open-mindedness, Stimulation, encouragement that conveys hope and
strength, guidance in the form of giving
 explanation and supervision when
doing certain procedures to patient, use
of complimentary words or praise and
smile whenever appropriate.
• Appreciation of what patient can do is
reinforced through positive encouraging
remarks and this is done with kind and
approving behavioural approach.
Understanding
• According to her, it conveys interest
and acceptance not only of patient’s
condition but also his entire being.
• This is manifested through concerned
and affable facial approach; this is a
way of making the patient feel
important and unique.
Respect
• Acknowledging the 31 patient’s
presence.
• Use of preferred naming in addressing
the patient, po and opo, is a sign of
positive regard.
• It is also shown through respectful nods
and recognition of the patient as
someone important.
Relaxation
• Entails a form of exercise that involves
alternate tension and relaxation of
selected group of muscles.
Empathy
• Senses accurately other person’s inner
experience.
• The empathic nurse perceives the
current positive thought and feelings
and communicates by putting himself in
the patient’s place.
• Through the COMPOSURE behaviours of
the nurse, holism is guaranteed to the
patient.
 Divinagracia (2001) stated that nursing is a
profession that surpasses time and aspects
of the individual as one of its clients. From
the time the nurse admits a patient to the
time of his discharge, the nurse’s presence
becomes a meaningful occasion for the two
parties to develop mutual trust, acceptance,
and eventually satisfying relationships.
 This framework represents the orthopaedic
patients, COMPOSURE behaviours of novice
nurses, and the patient wellness outcome
such as physiologic and biobehavioral. The
innermost part of the oval is the
orthopaedic patients. Being the recipient of
care, they are being influenced by many
factors and one of those are the behaviours
of nurses in implementing quality nursing
care. As the COMPOSURE behaviours of
novice nurses envelopes the orthopaedic
patients as shown above, the researcher
believe that there will be an essential
improvement in the patient wellness
outcome, may it be on physiologic and/or
biobehavioral wellness outcome.
 Patient Wellness Outcome
 This refers to the perceived wellness of
selected orthopaedic patients after
receiving nursing care in terms of
physiologic and biobehavioral.
 Many illnesses are curable and may
have only a temporary effect on health.
Others, such as diabetes, are not
curable but can be managed with
proper eating, physical activity, and
sound medical supervision. It should be
 noted that those possessing
manageable conditions may be more at
risk for other health problems, so
proper management is essential. For
example, unmanaged diabetes is
associated with high risk for heart
disease and other health problems.
 Two patient wellness outcomes which
have been categorized as:
 Biobehavioral
 Physiologic
 These patient wellness outcomes reflect
their needs as their illness turn to
recovery and rehabilitation. These
needs must be met through high quality
nursing care, none other than through
COMPOSURE behaviors. COMPOSURE
behaviours have been inspired to the
principle of holistic care wherein a
patient wellness outcome can be
achieved through series of quality
attributes of nurses, which caters to
every aspect of patient wellness, may it
be biobehavioral or physiologic wellness
outcome.
 Physiologic Wellness Outcome
 This refers to the perceived wellness of
selected orthopaedic patients after
receiving nursing care in terms of vital
signs, bone pain sensation, and
complete blood count.
 Biobehavioral Wellness Outcome
 This refers to the perceived wellness of
selected orthopaedic patients after
receiving nursing care in terms physical,
intellectual, emotional, and spiritual.
 Divinagracia (2001) as cited by Leocadio
(2009), conceptualized forty statements
that represented the dimensions of
wellness which include the physical,
emotional, intellectual, and spiritual
domain. Physical domain involves
muscle strength, mobility, posture, gait
exercise, and activity tolerance and
cardio-respiratory endurance.
Emotional domain includes awareness,
orientation, understanding of own and
other personal feelings and ability to
control and cope with emotions.
Intellectual domain refers knowledge
and perception of a healthy self and
ability to recognize the presence of risk
factors and preventive measures and
spiritual domain is defined as
development of inner self or one’s soul
through a relationship with God and
others.
 The most basic form of holistic
communication is "Active listening".
Active listening is a specific way of
hearing what a person says and feels,
and reflecting that information back to
the speaker. Its goal is to listen to the
whole person and provide her with
empathic understanding. It is the skill of
paying gentle, compassionate attention
to what has been said or implied. When
you listen in this way to patients, you
just try to reflect the other person's
feelings and deeper meanings, which
helps them feel heard and understood.
You don't analyze, interpret, judge, or
give advice. When patients are listened
to in this way, they are less anxious,
complain less about their caregivers,
and are more likely to comply with their
treatment plan.
 A cardiac patient might be angry and
complaining. As the nurse, you may try
to avoid his room, and, when you have
to be there, move in and out as quickly
as possible. Avoidance is one solution,
but there might be a different
approach.
 Active listening helps patients clarify
and articulate their inner process. For a
patient, being carefully listened to can
be a moving and profound experience,
one that transforms the relationship
between patient and nurse. Active
listening is particularly relevant in a
hospital setting, where patients often
report 132 that they feel isolated and
invisible. It can make a difference in
rebuilding a patient's sense of self. It
can also be rewarding for the nurse.
 A positive total outlook on life is
essential to wellness and each of the
wellness dimensions. A “well” person is
satisfied in his/her work, is spiritually
fulfilled, enjoys leisure time, is
physically fit, is socially involved, and
has a positive emotional-mental
outlook. This person is happy and
fulfilled. Many experts believe that a
positive total outlook is a key to
wellness
 The way one perceives each of the
dimensions of wellness affects total
outlook. Researchers use the term self-
perceptions to describe these feelings.
Many researchers believe that self-
perceptions about wellness are more
important than actual ability. For
example, a person who has an
important job may find les meaning and
job satisfaction than another person
with a much less important job.
Apparently, one of the important
factors for a person who has achieved
high level wellness and a positive life’s
outlook is the ability to reward
himself/herself. Some people, however,
seem unable to give themselves credit
for their life’s experiences. The
development of a system that allows a
person to positively perceive the self is
important. Of course, the adoption of
positive perceive lifestyles that
encourage improved self-perception is
also important.
 Emotional wellness is a person’s ability
to cope with daily circumstances and to
deal with personal feelings in a positive,
optimistic, and constructive manner. A
person with emotional wellness is
generally characterized as happy, as
opposed to depressed.
 A person with intellectual health is free
from illnesses that invade the brain and
other systems that allow learning. A
person with intellectual health also
possesses intellectual wellness.
 Intellectual wellness is a person’s ability
to learn and to use information to
enhance the quality of daily living and
optimal functioning. A person with
intellectual wellness is generally
characterized as informed, as opposed
to ignorant.
 A person with intellectual health is free
from illnesses that invade the brain and
other systems that allow learning. A
person with intellectual health also
possesses intellectual wellness.
 Physical wellness is a person’s ability to
function effectively in meeting the
demands of the day’s work and to use
free time effectively. Physical wellness
includes good physical fitness and the
possession of useful motor skills. A
person with physical wellness is
 generally characterized as fit versus collaboration based in the lived
unfit. experiences of the respondents

 A person with physical health is free • Quality patient care and training of
from illnesses that affect the students can be at best only if nursing
physiological systems of the body such service and education can truly
as the heart, the nervous system, and operationalize the meaning of
the like. A person with physical health collaboration and put into real action
possesses an adequate level of physical
• The connectedness of nursing service
fitness and physical wellness
and education calls for a new wave of
 Spiritual wellness is a person’s ability to visionary leadership, empowerment
establish a values system and act on the and an environment or cf trust and
system of beliefs, as well as to establish openness
and carry out meaningful and
• Nursing as a profession can really draw
constructive lifetime goals. It is often
a power base if only a unification model
based on a belief in a force greater than
can be crafted which is culture based,
the individual that helps one contribute
practical, relevant and acceptable to the
to an improved quality of life for all
concerned nursing professionals
people. A 138 person with spiritual
wellness is generally characterized as • Recommend “Unification model for
fulfilled as opposed to unfulfilled collaboration”
 Spiritual health is the one component of
health that is totally comprised of the
wellness dimension; for this reason,
spiritual health is considered to be
synonymous with spiritual wellness.

 Optimal health includes many areas,

thus the term holistic (total) is
appropriate. In fact, the word health
originates from a root word meaning
“wholeness”

 The holistic nurse is an embodiment of Local Theories and Models of Nursing

the care she renders. The nurse creates
the calm environment in any setting
that facilitates treatment, healing and
recovery from any pain or discomfort.
Conclusion
• Coordination, communication and
interpersonal relationships have been
identified as major components of
Intervention (Philippine Setting)
Letty G. Kuan
“I have grown and sown and now I can reap the
reward and blessing of a life lived in joy and
love, for I too have made others grow”
Dr. Kuan is a nurse. She had 2 Masters Degrees,
MA in Nursing and MA education, (Guidance
and Counseling). For her vast contributions to
the University of the Philippines College of
Nursing faculty and academic achievements,
she is now a professor emeritus, a title awarded
only to a few who met the strict criteria
She had clinical fellowship and specialization in
neuropsychology in University of Paris, France.
Neurogerentology in Watertown, New York. She
also had bioethics formal training at institute of
religion, Ethics and Law at Baylor College of
Medicine in Houston Texas. She is a recipient of
the Metrobank Foundation Outstanding
TeachersnAWard in 1995.
Retirement and Role Discontinuities
Retirement is an inevitable change in one’s life.
It is evident in the increasing statistics of aging
increasing statistics of aging population
accompanied by related disabilities and
increased dependence. This developmental
stage, even at the later part of life must be
considered desirable and satisfying through
The determination of factors that will help the
person enjoy his remaining years of life. It is of
primary importance to prepare early in life by
cultivating other role options at age 50 to 60 in
order to have a rewarding retirement period
even amidst the presence of role discontinuities
experienced by this age group.
Basic Assumptions and Concepts
Physiological Age- is the endurance of cells and
tissues to withstand the wear and tear
phenomenon of the human body
Role- refers to the set of shared expectations
focused upon a particular position. These may
include beliefs about what goals or values the
position incumbent is to pursue and the norms
that will govern his behavior.
Change of life- is the period between near
retirement and post retirement years. In the
medico-physiologic terms, this equates with the
climacteric period of adjustment and
readjustment to another tempo of life.
Retiree- is an individual who has left the
position occupied for the past years of
productive life because he/she has reached the
prescribed retirement age or has completed the
required years of service.
Role Discontinuity- is the interruption in the
line of status enjoyed or role performed. The
interruption in the line of status enjoyed or role
performed.
Coping Approaches- refer to the interventions
or measure 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:
1. Health Status- refer to physiological and
mental state of the respondents, classified as
either sickly or healthy.
2. Income- refers to the financial affluence of
the respondent which can be classified as poor,
moderate or rich.
3. Work Status
4. Family Constellation- means the type of
family composition described either close knit
or extended family where three or more
generations of family members live under one
roof; or distanced family. Whose member live in
separate dwelling units; or nuclear type of
family where only husband, wife and children
live together
5. Self Preparation
Findings and Recommendations
1. Health status dictates the capacities
and the type of role one takes both for
the present and for the future.
2. Family constellation is a positive index
regarding retirement positively and also
in reacting to role discontinuities.
3. Income has a high correlation with both
the perception of retirement and
reactions toward discontinuities.
4. Work status goes hand in hand with
economic security that generates
descent compensation.
5. Self Preparation which are said to be
both therapeutic and recreational in
essence pays its worth in old age. This
does not only account professionalism
or expertise but also benevolent work
as in charitable actions with the
colleagues.
6. To cope with the changes brought by
retirement, one must cultivate interest
in recreational activities to channel
feelings of depression or isolation and
facing realities through confrontation
with some issues
7. To perceive retirement positively, it
requires early socialization of the
various roles we take in life. The best
place to start is at home extending to
schools, neighborhood, the community
and society in general.
8. Government agency to construct
holistic pre retirement preparation
program which will take care of the
retiree’s finances, psychological.
Emotional and social needs.
9. Retirement should be recognized as the
fulfillment of every individual’s
birthright and must lived meaningfully.
Application to Nursing
O The theory of Sister Letty G. Kuan
stated that without positive acquisitions
during childhood, the person (patient)
will be “in a pathological state” to
delinquency. Now, this is the challenge
that nurses will face. The role of the
nurse is to put back what they have
missed during childhood and to fill this
gap. Nurses need to let them acquire
good things through setting an example
and to make them feel loved and
important. The role of the nurse is to
become a therapeutic self and spiritual
self by showing empathy and
compassion.
O She quoted this:
O “The Longer you stay in life, the more
you have acquired, the better you
should be, the Legacy is given.”
Carmencita M. Abaquin
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”
Abaquin is a nurse with Master’s and Doctoral
Degree in Nursing obtained from the University
of the Philippines College of Nursing. She is an
expert of Medical Surgical Nursing with
subspecialty in Oncolologic Nursing, which
made her known both here and abroad. She
had served the University of the Philippines
College of Nursing her alma matter
As faculty and held the position as secretary of
the college of nursing. Her latest appointment
as chairman of the board of nursing speaks her
competence and integrity in the field she has
chosen.
Prepare Me
“Prepare Me” Interventions and the Quality of
life of Advance Progressive Cancer Patients”
During the past decade, the incidence of cancer
has significantly increased not only in the
Philippines but also worldwide. Cancer has been
associated with multifaceted issues and
concerns regardless of stages of development.
For patients with advance progressive cancer,
these problems are compounded,
Thus the need to develop interventions that can
address the needs especially those concerning
the ability to be in control and maintaining their
dignity.
Basic Assumptions and Concepts
Prepare Me (Holistic Nursing Interventions) are
the nursing interventions provided to address
the multi-dimensional problems choose to be
confined. This program emphasizes a holistic
approach to nursing care.
Quality of Life- is a multifaceted construct that
encompasses the individual’s capacities and
abilities with an aim of enriching life when it
cannot longer be prolonged. This includes
proper care of the body, mind, and spirit to
maintain integrity of the whole person despite
limitations brought by the present situation.
This can be seen with the following dimensions
of man-physical, psychological, social, religious,
level of independence, environment and
spiritual.
Finding and Recommendations
1. Terminally-ill patients require holistic
approach of nursing that encompasses
the different aspects of man namely
physical, psychological, social, religious,
level of independence, environment
and spiritual.
2. Prepare me intervention as a basic part
of care given to cancer patients is
recommended, as well as the
incorporation of the intervention in the
basic nursing curriculum in the care of
these patients
3. The utilization of the intervention as a
basic part of care given to cancer
patients is recommended. As well as the
incorporation of the intervention in the
basic nursing curriculum in the care of
these patients.
4. Development of training programs for
care providers, as well as health care
professionals where intervention is a
part of treatment modalities, is also
recommended
5. For patients, an honest view and
feedback regarding their illness and
management and obtaining their
perceptions can lead to improvement of
services and communication between
patients with advanced progressive
cancer, their families and health team.
6. Supportive environment where
patients with advanced progressive
cancer and the terminally ill patients
can attain dignity of dying with peace
while their families are given the
necessary support they need to cope up
with. Thus, healthcare professionals and
family members have to provide this
kind of venue whether in the home of
hospital setting. This will maintain a
holistic support for this special type of
clients.
Cecilia Laurente
Local nursing theorist in the Philippines, who
focused her works on helping a patient through
support systems specifically the family. She has
a publication entitled "Categorization of Nursing
activities as Observed in Medical Surgical Ward
Units in Selected Government and Private
Hospitals in Metro Manila.
BSN Graduate from the University of the
Philippines (1967)
Dean College of Nursing 1996-2002 UP-Manila
Theory of Nursing Practice and Career
A unique trademark of a genuine nurse who
demonstrates excellence in nursing practice is
caring behavior. This is said to be a
subconscious effort to be sensitive and respond
to human needs and the human person. The
study was undertaken to determine the effects
of nurses caring behaviors on the clients
Specifically, the following questions were asked:
1) what are the perceptions of the clients of
what a caring nurse is to them, and; 2) what
are the perceptions of the clients of the effects
on them of the nurses caring behavior
The first 5 caring behaviors cited by patients
are:
a) Respectful
b) Patience
c) Various helping acts
d) Gentleness
e) Guidance
f) The rest of the findings are:
g) Competence
h) therapeutic touch
i) verbal communication
j) close proximity/is accessible
k) active listening
l) smiling/cheerful/with humor
It is a fact that these caring behaviors require
extra time and energy on the part of nurses, but
these behaviors would pave the way to infuse
quality of life on the clients. They feel that they
are persons with dignity and it is at this time
when they are ill that they need caring the most
The clients perception of the effects of nurses
caring behaviors was varied.
Some of them feel happy/satisfied (99.53
percent), secured/relaxed (7.42 percent), with
increased fighting spirit (92.58 percent), with
increased hope for early recovery (86.77
percent), trustful of the nurse (55.16 percent):
Any combination of these is characteristic of
well-being. They feel that although they are ill,
there is someone, the nurse, whom they can
entrust their whole being
Based on the results of the study, it can be
concluded that nurses caring behaviors have
impact on the well-being of the clients that go
beyond physiologic responses. They feel that
they are cared for by nurses, not merely to
improve their nutritional status or maintain
fluid and electrolyte balance but to boost their
personhood and dignity.
Synchronicity on Human Space-Time: A Theory
of Nursing Engagement in a Global Community
Freslyn Lim-Saco, RN, MN
Silliman University College of Nursing,
Dumaguete City, Philippines Cliford
Masayon Kilat, RN, MA
St. Paul University Dumaguete, Dumaguete City,
Philippines
Rozzano Locsin, RN, PhD, FAAN
Florida Atlantic University, Boca Raton, Florida
Tokushima University, Tokushima, Japan
The purposes of this theoretical article are to
describe SynHSTTNE, emphasizing the process
of nursing in guiding disciplinary nursing praxis
and to rationalize theory-based nursing as
essential to the appreciation of nursing as a
discipline of knowledge and a practice
profession.
By exemplifying nursing as integral to human
health and well-being in a global community, an
equity oriented healthcare system is
underscored as the nurse and the person being
nursed participate in a synchronistic healthcare
practice in which SynHSTTNE delineates a
practice process of engagement affirming and
celebrating human beings as persons
Assumptions
• HST is a metaphysical sphere of caring
experiences among persons with
patterns of occurrence viewed as
meaningful for both the nurse and the
nursed
• Nursing unfolds in a unitarily pattern of
wholeness integrated within the HST
processes. Humans are assimilating
their lives with technology, instigating
the nursing profession toward
transformations.
• The nurse–nursed HST consciousness is
irreducibly evolving thus co-creating
human transcendence. The individual
experiences and perspectives of the
nurse and the one being nursed are not
deductively viewed apart from the
whole nurse–nursed relationship.
• SynHSTTNE is a pandimensionally
transforming process of
interconnectedness among humanity
and beyond infinity
Terminologies
Emancipation is a principle of liberating the self
and others from the limits of human-space-time
realities.
Application
• Interpersonal Relating. IR is the
nurturance of a relationship that
appreciates the self and others as whole
and transcendental beings, connecting
to the nursed illuminated in the dance
of caring persons in which synchronicity
is founded
• Technological Knowing. Adapted from
Locsin (2015) Theory of Technological
Competency as Caring in Nursing, TK is
focused on providing authentic and
humane caring. Guided by technology,
TK is the process that leads the nurse in
sensing relevant data and pattern
information about the nursed in
interaction as persons and not as
objects of care
• Rhythmical Connecting. RC means
dancing to the cadence of treatments
and nursing activities where each
meaningful, caring experience is not
merely an encounter, but a fit into a
rhythmical pattern through which the
interconnectivity of persons within the
HST is nurtured. In this process, open
communication enables the nurse, and
the nursed to interconnect.
• Transformational Engaging. TE refers to
the 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 nursed.
Energy is continuously moving from “subatomic
particles to the biosphere, including the planet
Earth, all forming a whole”

Equitability is a principle of justice and fairness

in human caring across healthcare systems.

Human transcendence indicates personal

growth of persons and professional growth
among nurses.

Interconnectivity is a principle of human

interconnectedness of energy.

Space factors could mean internal and external

environmental limitations.