Theories Relevant to the Nursing Practice

ABRAHAM MASLOW - Maslow’s Hierarchy of Needs

Motivational Theory
The Sullivan Approach to personality – “Good Me” or “Bad Me”

Good Me – personification consists of experiences that are rewarded

Bad Me – personification consists of experiences that are punished
General System Theory – Grand System Theory by Ludwig Von Bertalanffy
- core of general systems theory is the principal of wholeness
Change Theory – Kurt Lewin
“Father of social psychology”
- Unfreezing - determining what needs to be change
- Change – the people involved in communicating are trying to find ways on how to promote change
- Refreezing – it anchors change to the culture

Developmental Theories – systematic ways from babies to adolescence to adult

Sigmund Freud: Psychoanalytic Theory
Moral Development – Psychologist Lawrence Kohlberg
BACHELOR OF SCIENCE IN NURSING
THEORETICAL FOUNDATIONS IN NURSING

COURSE MODULE COURSE UNIT WEEK

3 13 13

THEORIES RELEVANT TO NURSING PRACTICE

✔ Read course and unit objectives

✔ Read study guide prior to class attendance
✔ Read required learning resources; refer to unit
terminologies for jargons
✔ Proactively participate in online discussions
✔ Participate in weekly discussion board (Canvas)
✔ Answer and submit course unit tasks

At the end of the course unit (CM), learners will be able to:
Cognitive:
1. Understand important non-nursing theories relevant to the nursing practice.
2. Explain the different major concepts of the theories relevant to the nursing practice
developed by Maslow, Sullivan, Lewin, Von Bertalanffy, Erikson, Kohlberg and Bandura.
3. Understand the application of non-nursing theories to the nursing practice.
Affective:
1. Show concerns and develop trusting relationship to the patient and family using the different
non-nursing theories.
2. Listen attentively during class discussions.
3. Demonstrate tact and respect when challenging other people’s opinions and ideas.
4. Accept comments and reactions of classmates on one’s opinions openly and graciously.

Psychomotor:
1. Apply safety risk and nursing process during administration of nursing procedures using the
different non-nursing theories.
2. Participate actively during class discussions.
3. Confidently express personal opinion and thoughts in front of the class.

Aliigood Martha R, The Nursing Theorist and their Works,8th edition, Copyright 2014, Mosby

Smith Marlaine C.; Parker Marilyn E.; Nursing Theories and Nursing Practice, 4TH edition. F.A.Davis
Company 2015
Maslow's hierarchy is most often displayed as a pyramid. The lowest levels of the pyramid are made up
of the most basic needs, while the most complex needs are at the top of the pyramid.
Needs at the bottom of the pyramid are basic physical requirements including the need for food, water,
sleep, and warmth. Once these lower-level needs have been met, people can move on to the next level of
needs, which are for safety and security.
As people progress up the pyramid, needs become increasingly psychological and social. Soon, the need
for love (Links to an external site.), friendship, and intimacy becomes important. Further up the
pyramid, the need for personal esteem and feelings of accomplishment take priority.
Like Carl Rogers (Links to an external site.), Maslow emphasized the importance of self-actualization,
which is a process of growing and developing as a person in order to achieve individual potential.

Harry Stack Sullivan

 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.

STAGES OF DEVELOPMENT

 Sullivan explained six developmental stages called "epochs" or heuristic Stages in Development.

  Stages (Epochs) Characteristics

1 Infancy (Birth-18 months) Gratification of needs

2 Childhood (18 mo-6 yrs) Delayed gratification

3 Juvenile era(6-9 yrs) Formation of peer group

4 Preadolescence (9-12 yrs) Developing relationships within same gender

Early Adolescence (12-14

5 yrs) Identity

6 Late Adolescence (14-21 yrs) Forming lasting, intimate relationships

 Sullivan explained about three types of self:

 The ‘good me’ versus the ‘bad me’ based on social appraisal and the anxiety that results from
negative feedback

 The ‘not me’ refers to the unknown,repressed component of the self.

 Sullivan's theory explains about anxiety, self-system and self-esteem:

 Security operations –those measures that the individual employs to reduce anxiety and enhance
security.

 Self-system – all of the security operations an individual uses to defend against anxiety and
ensure self esteem

APPLICATIONS
  Sullivan's interpersonal theory provides the theoretical basis for interpersonal psychotherapy (IPT) for
depression and schizophrenia.

 Interpersonal theory proposes that depression develops most often in the context of adverse events,
particularly interpersonal loss. (Tasman 2008)

 He also wrote on techniques and approaches on psychiatric interview.

The theory of personality developed by Harry Stack Sullivan, which is based on the belief that people’s
interactions with other people, especially significant others, determine their sense of security, sense of self, and
the dynamisms that motivate their behavior. For Sullivan, personality is the product of a long series of stages in
which the individual gradually develops “good feeling” toward others and a sense of a good me toward himself or
herself. The individual also learns how to ward off anxiety and correct distorted perceptions of other people,
learns to verify his or her ideas through consensual validation, and above all seeks to achieve effective
interpersonal relationships on a mature level.

KURT LEWIN (Change Theory)

- considered the father of social psychology, he is known for Group dynamics, action research, T- groups, is often
considered he the father of modern change management theory, developed a change model involving three steps:
unfreezing, changing and refreezing. 
- For Lewin, the process of change entails creating the perception that a change is needed, then moving toward the
new, desired level of behavior and finally, solidifying that the new behavior as the norm.
- Kurt Lewin theorized a three stage model of change that is known unfreezing -change-refreeze model that
requires prior learning to be rejected and replaced. Lewin’s theory states behaviors dynamic balance of forces
working in opposing directions.
- The Kurt Lewin change theory model is based around a 3 step process ( unfreeze-change-freeze)that provides a
high level approach to change. It gives a manager or other change agent a framework to implement a change
effort, which is always very sensitive and must be made as seamless as possible.
- One of the cornerstone models understanding organizational change was developed by Kurt Lewin back in the
1940’s, and still holds true today. His model is known as unfreeze- change- refreeze, which refers to the three
stage process of change that describes.
Six Stages of Change
■Precontemplation
■Contemplation
■Preparation
■Action
■Maintenance
■Termination
 

Theory of Change is a specific type of methodology for planning, participation and evaluation that is used in
companies, philanthropy, not for profit and government sectors to promote social change. Theory of
change defines long term goals and then maps backward to identify necessary precondition.

LUDWIG VON BERTALANFFY – General Systems Theory

-
von Bertalanffy (1968) wrote that a system is a complex of interacting elements and that they are open to, and
interact with their environments. In addition, they can acquire qualitatively new properties through emergence,
thus they are in a continual evolution. When referring to systems, it also generally means that they are self-
regulatin.

General Systems Theory is based on the assumption that there are universal principles of organization, which hold
for all systems, be they physical, chemical, biological, mental or social.
Systems management is the combination of four key elements processes, data, tools, and organization, which are
all needed to manage a system efficiently and effectively.
Characteristics of system theory
Open system: a system keeps evolving and its properties keep emerging through its interaction with environment.
Hollistic view: systems theory focuses on the arrangement of and relations between the parts that connect them
into a whole.

ERIK ERICKSON’S- PSYCHOSOCIAL (DEVELOPMENT THEORY)

- describes the human life cycle as a series of 8 ego development stage from birth to death 
- each stage present a psychosocial crisis, the goal of which is to integrate psychological, maturation and social
demands 
- the result of 1 stage may not be permanent but can be changed by experience later in life.
- occurs a life long series of crises affected by social and cultural,social factors
- each psychosocial crises must be resolved for the child or adult to progress emotionally ,unsuccessful resolution
can leave the person emotionally disabled.
The stages that make up his theory are as follows: 1
Stage 1: Trust vs. Mistrust
Stage 2: Autonomy vs. Shame and Doubt
Stage 3: Initiative vs. Guilt
Stage 4: Industry vs. Inferiority
Stage 5: Identity vs. Confusion
Stage 6: Intimacy vs. Isolation
Stage 7: Generativity vs. Stagnation
Stage 8: Integrity vs. Despair

Stage 1: Trust vs. Mistrust

The first stage of Erikson's theory of psychosocial development occurs between birth and 1 year of age and is the
most fundamental stage in life. Because an infant is utterly dependent, developing trust is based on the
dependability and quality of the child's caregivers.
At this point in development, the child is utterly dependent upon adult caregivers for everything they need to
survive including food, love, warmth, safety, and nurturing. If a caregiver fails to provide adequate care and love,
the child will come to feel that they cannot trust or depend upon the adults in their life.
Outcomes
If a child successfully develops trust, the child will feel safe and secure in the world. 2 Caregivers who are
inconsistent, emotionally unavailable, or rejecting contribute to feelings of mistrust in the children under their
care. Failure to develop trust will result in fear and a belief that the world is inconsistent and unpredictable.
During the first stage of psychosocial development, children develop a sense of trust when caregivers provide
reliability, care, and affection. A lack of this will lead to mistrust.
No child is going to develop a sense of 100% trust or 100% doubt. Erikson believed that successful development
was all about striking a balance between the two opposing sides. When this happens, children acquire hope, which
Erikson described as an openness to experience tempered by some wariness that danger may be present.
Subsequent work by researchers including John Bowlby and Mary Ainsworth demonstrated the importance of
trust in forming healthy attachments during childhood and adulthood.
 
Stage 2: Autonomy vs. Shame and Doubt
The second stage of Erikson's theory of psychosocial development takes place during early childhood and is
focused on children developing a greater sense of personal control.
The Role of Independence
At this point in development, children are just starting to gain a little independence. They are starting to perform
basic actions on their own and making simple decisions about what they prefer. By allowing kids to make choices
and gain control, parents and caregivers can help children develop a sense of autonomy. 2
Potty Training
The essential theme of this stage is that children need to develop a sense of personal control over physical skills
and a sense of independence. Potty training plays an important role in helping children develop this sense of
autonomy.
Like Freud, Erikson believed that toilet training was a vital part of this process. However, Erikson's reasoning was
quite different than that of Freud's. Erikson believed that learning to control one's bodily functions leads to a
feeling of control and a sense of independence. Other important events include gaining more control over food
choices, toy preferences, and clothing selection.
Outcomes
Children who struggle and who are shamed for their accidents may be left without a sense of personal control.
Success during this stage of psychosocial development leads to feelings of autonomy; failure results in feelings of
shame and doubt.
Finding Balance
Children who successfully complete this stage feel secure and confident, while those who do not are left with a
sense of inadequacy and self-doubt. Erikson believed that achieving a balance between autonomy and shame and
doubt would lead to will, which is the belief that children can act with intention, within reason and limits.
Stage 3: Initiative vs. Guilt
The third stage of psychosocial development takes place during the preschool years. At this point in psychosocial
development, children begin to assert their power and control over the world through directing play and other
social interactions.
Children who are successful at this stage feel capable and able to lead others. Those who fail to acquire these
skills are left with a sense of guilt, self-doubt, and lack of initiative.
Outcomes
The major theme of the third stage of psychosocial development is that children need to begin asserting control
and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too
much power experience disapproval, resulting in a sense of guilt.
When an ideal balance of individual initiative and a willingness to work with others is achieved, the ego quality
known as purpose emerges.
Stage 4: Industry vs. Inferiority
The fourth psychosocial stage takes place during the early school years from approximately ages 5 to 11. Through
social interactions, children begin to develop a sense of pride in their accomplishments and abilities.
Children need to cope with new social and academic demands. Success leads to a sense of competence, while
failure results in feelings of inferiority.
Outcomes
Children who are encouraged and commended by parents and teachers develop a feeling of competence and belief
in their skills. Those who receive little or no encouragement from parents, teachers, or peers will doubt their
abilities to be successful.
Successfully finding a balance at this stage of psychosocial development leads to the strength known
as competence, in which children develop a belief in their abilities to handle the tasks set before them.
Stage 5: Identity vs. Confusion
The fifth psychosocial stage takes place during the often turbulent teenage years. This stage plays an essential role
in developing a sense of personal identity which will continue to influence behavior and development for the rest
of a person's life. Teens need to develop a sense of self and personal identity. Success leads to an ability to stay
true to yourself, while failure leads to role confusion and a weak sense of self.
During adolescence, children explore their independence and develop a sense of self. 2 Those who receive proper
encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of
self and feelings of independence and control. Those who remain unsure of their beliefs and desires will feel
insecure and confused about themselves and the future.
What Is Identity?
When psychologists talk about identity, they are referring to all of the beliefs, ideals, and values that help shape
and guide a person's behavior. Completing this stage successfully leads to fidelity, which Erikson described as an
ability to live by society's standards and expectations.
While Erikson believed that each stage of psychosocial development was important, he placed a particular
emphasis on the development of ego identity. Ego identity is the conscious sense of self that we develop through
social interaction and becomes a central focus during the identity versus confusion stage of psychosocial
development.
According to Erikson, our ego identity constantly changes due to new experiences and information we acquire in
our daily interactions with others. As we have new experiences, we also take on challenges that can help or hinder
the development of identity.
Why Identity Is Important
Our personal identity gives each of us an integrated and cohesive sense of self that endures through our lives. Our
sense of personal identity is shaped by our experiences and interactions with others, and it is this identity that
helps guide our actions, beliefs, and behaviors as we age.
Stage 6: Intimacy vs. Isolation
Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships,
while failure results in loneliness and isolation. This stage covers the period of early adulthood when people are
exploring personal relationships.2
Erikson believed it was vital that people develop close, committed relationships with other people. Those who are
successful at this step will form relationships that are enduring and secure.
Building On Earlier Stages
Remember that each step builds on skills learned in previous steps. Erikson believed that a strong sense of
personal identity was important for developing intimate relationships. Studies have demonstrated that those with a
poor sense of self tend to have less committed relationships and are more likely to struggler with emotional
isolation, loneliness, and depression.
Successful resolution of this stage results in the virtue known as love. It is marked by the ability to form lasting,
meaningful relationships with other people.
Stage 7: Generativity vs. Stagnation
Adults need to create or nurture things that will outlast them, often by having children or creating a positive
change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure
results in shallow involvement in the world.
During adulthood, we continue to build our lives, focusing on our career and family. Those who are successful
during this phase will feel that they are contributing to the world by being active in their home and community. 2
Those who fail to attain this skill will feel unproductive and uninvolved in the world.
Care is the virtue achieved when this stage is handled successfully. Being proud of your accomplishments,
watching your children grow into adults, and developing a sense of unity with your life partner are important
accomplishments of this stage.
Stage 8: Integrity vs. Despair
The final psychosocial stage occurs during old age and is focused on reflecting back on life. 2 At this point in
development, people look back on the events of their lives and determine if they are happy with the life that they
lived or if they regret the things they did or didn't do.
Erikson's theory differed from many others because it addressed development throughout the entire lifespan,
including old age. Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads
to feelings of wisdom, while failure results in regret, bitterness, and despair.
At this stage, people reflect back on the events of their lives and take stock. Those who look back on a life they
feel was well-lived will feel satisfied and ready to face the end of their lives with a sense of peace. Those who
look back and only feel regret will instead feel fearful that their lives will end without accomplishing the things
they feel they should have.
Outcomes
Those who are unsuccessful during this stage will feel that their life has been wasted and may experience many
regrets. The person will be left with feelings of bitterness and despair.
Those who feel proud of their accomplishments will feel a sense of integrity. Successfully completing this phase
means looking back with few regrets and a general feeling of satisfaction. These individuals will attain wisdom,
even when confronting death.

LAWRENCE KOHBERGY (MORAL DEVELOPMENT)

- involve acceptance of values & rules of society in a way that shapes behavior classified in a series of levels &
behaviors sequential but people do not automatically go from 1 stage or level to the next as they mature.

Kohlberg’s stages of moral development

Kohlberg identified three levels of moral reasoning: pre-conventional, conventional, and post-
conventional. Each level is associated with increasingly complex stages of moral development.

Level 1: Preconventional

Throughout the preconventional level, 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

Stage 1 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?” 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. As a
result, concern for others is not based on loyalty or intrinsic respect, but rather a “you scratch my
back, and I’ll scratch yours” mentality. An example would be when a child is asked by his parents
to do a chore. The child asks “what’s in it for me?” and the parents offer the child an incentive by
giving him an allowance.

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

In stage 3, 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

In stage 4, 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. Most active members of society remain at stage four, where morality is still predominantly
dictated by an outside force.

Level 3: Postconventional

Throughout the postconventional 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.
Post-conventional moralists live by their own ethical principles—principles that typically include
such basic human rights as life, liberty, and justice—and view rules as useful but changeable
mechanisms, rather than absolute dictates that must be obeyed without question. Because post-
conventional individuals elevate their own moral evaluation of a situation over social conventions,
their behavior, especially at stage six, can sometimes be confused with that of those at the pre-
conventional level. Some theorists have speculated that many people may never reach this level of
abstract moral reasoning.

Stage 5: Social-Contract Orientation

In stage 5, 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. This is
achieved through majority decision and inevitable compromise. Democratic government is
theoretically based on stage five reasoning.

Stage 6: Universal-Ethical-Principal Orientation

In stage 6, 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.
Although Kohlberg insisted that stage six exists, he found it difficult to identify individuals who
consistently operated at that level.

 Albert Bandura's 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 approval because it desires approval.

Positive (or negative) reinforcement will have little impact if the reinforcement offered
externally does not match with an individual's needs. Reinforcement can be positive or
negative, but the important factor is that it will usually lead to a change in a person's
behavior.

Third, the child will also take into account of what happens to other people when
deciding whether or not to copy someone’s actions. A person learns by observing the
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, such as parents or older siblings, or could be
fantasy characters or people in the media. The motivation to identify with a particular
model is that they have a quality which the individual would like to possess

Conventional Moral Reasoning - 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.
Equifinality - is the principle that in open systems a given end state can be reached by many potential means.
General Systems Theory - is based on the assumption that there are universal principles of organization, which
hold for all systems, be they physical, chemical, biological, mental or social.

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.
Hollistic-view systems theory - focuses on the arrangement of and relations between the parts that connect them
into a whole.

Instrumental Orientation - expresses the “what’s in it for me?” position, in which right behavior is
defined by whatever the individual believes to be in their best interest.
Law-and-Order Orientation - the child blindly accepts rules and convention because of their
importance in maintaining a functioning society.
Moral Development - involve acceptance of values & rules of society in a way that shapes behavior classified in
a series of levels & behaviors sequential but people do not automatically go from 1 stage or level to the next as
they mature.

Obedience-and-Punishment Orientation- focuses on the child’s desire to obey rules and avoid
being punished.
Postconventional Moral Reasoning - 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.
Preconventional Moral Reasoning - Throughout the preconventional level, a child’s sense of
morality is externally controlled. Children accept and believe the rules of authority figures, such as
parents and teachers.
Psychosocial Development Theory - describes the human life cycle as a series of 8 ego development stage from
birth to death. Each stage present a psychosocial crisis, the goal of which is to integrate psychological, maturation
and social demands.

Social-Contract Orientation - the world is viewed as holding different opinions, rights, and
values..
Systems management - is the combination of four key elements processes, data, tools, and organization,
which are all needed to manage a system efficiently and effectively.

Theory of Change - s a specific type of methodology for planning, participation and evaluation that is used in
companies, philanthropy, not for profit and government sectors to promote social change. Theory of
change defines long term goals and then maps backward to identify necessary precondition.

Transactional analysis - is a psychoanalytic theory and method of therapy wherein social transactions
are analyzed to determine the ego state of the patient whether parent-like, childlike, or adult-like as a
basis for understanding behavior.
Transactional leader -  someone who values order and structure.
Transactional leadership- depends on self motivated people who work well in a structure, directed
environment. 
Transactional- is something related to a process or other action.

Universal-Ethical-Principal Orientation - moral reasoning is based on abstract reasoning using

universal ethical principles.
8 Stages of Development by Erik Erikson

https://youtu.be/aYCBdZLCDBQ

INTERPERSONAL THEORY - HARRY STACK SULLIVAN

https://youtu.be/-JHkQqYt2eI

Systems Theory of Organizations

https://youtu.be/1L1c-EKOY-w

General systems Theory

https://youtu.be/VSCjWT_nI_Q

1. Case Study:
Mary and Fred have one child and want to adopt a second. Since their first child's infancy had been extremely
difficult on Mary, she was excited at the possibility of adopting an older child, perhaps a well-behaved, toilet-
trained 3 year-old, and skipping the infancy period entirely. Fred, on the other hand, had serious misgivings not
knowing about the quality of care giving and relationships in this child's early life.

In a 3 year-old's case, he felt that inadequate care and improper resolution of what Ericksonian stage could lead to
irreparable damage in later development? Explain.

2. Do you know anyone who demonstrates arrested development (someone who seems immature,
especially in relationships)? Are you able to maintain a friendship with that person, or is the
situation too stressful?
Aliigood Martha R, The Nursing Theorist and their Works,8th edition, Copyright 2014, Mosby

An outline of General Systems Theory. British Journal for the Philosophy of Science

http://en.wikipedia.org/wiki/Ludwig_von_Bertalanffy
BACHELOR OF SCIENCE IN NURSING
THEORETICAL FOUNDATIONS IN NURSING

COURSE MODULE COURSE UNIT WEEK

3 14 14

LOCAL THEORIES: DIVINAGRACIA AND KUAN

✔ Read course and unit objectives

✔ Read study guide prior to class attendance
✔ Read required learning resources; refer to unit
terminologies for jargons
✔ Proactively participate in online discussions
✔ Participate in weekly discussion board (Canvas)
✔ Answer and submit course unit tasks

At the end of the course unit (CM), learners will be able to:
Cognitive:
4. Understand the different local nursing theories developed by Carmelita Divinagracia and
Sister Letty Kuan.
5. Explain the different major concepts of Composure Model and Retirement and Role-
Discontinuity Model.
Affective:
1. Show concerns and develop trusting relationship to the patient and family using the different
nursing theories.
2. Listen attentively during class discussions.
3. Demonstrate tact and respect when challenging other people’s opinions and ideas.
4. Accept comments and reactions of classmates on one’s opinions openly and graciously.

Psychomotor:
1. Apply safety risk and nursing process during administration of nursing procedures using the
different nursing theories.
2. Participate actively during class discussions.
3. Confidently express personal opinion and thoughts in front of the class.

Aliigood Martha R, The Nursing Theorist and their Works,8th edition, Copyright 2014, Mosby

Smith Marlaine C.; Parker Marilyn E.; Nursing Theories and Nursing Practice, 4TH edition. F.A.Davis
Company 2015

Theoretical Foundations of Nursing: The Philippine Perspective” by: Dr. Eufemia Octaviano and Dr.
Carl Balita.
CARMELITA DIVINAGRACIA

The Lived Experiences of Nursing Service Personnel and Nursing Educators on Collaboration

COMPASURE BEHAVIORS

- are sets of behaviors or nursing measures that the nurse demonstrates to selected patients.

COMPOSURE- is acronym hich stands for Competence, Presence,and Prayer, Open-mindedness, Stimulation,

understanding, Respect and Relaxation, Empathy.

Wellness Status- a condition being in a state of well being, a coordinated and integrated living pattern that
involves the dimension of wellness.

SISTER LETTY G. KUAN-RETIREMENT AND ROLE DISCONTINUES

It is primary importance to prepare earlyin life by cultivating other role of options at age 50-60 in order to have a
rewarding retirement period even admidst the presence of role discontinues experienced by this age group.

RETIREMENT- is an inevitable change in one’s life. It is evident in increasing statistics of aging population
accompanied by related disabilities and increased dependence.
-this developmental stage, even 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.
-ROLE DISCONTINUITY-is the interruption in the line of status enjoyed or performed. The interruption may be
brought about by 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.
-Change of life- is the period between near retirement and post-retirement years. In medico-physiological terms,
this equates with the climacteric period of adjustment and re adjustment 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.
CHANGE OF LIFE- is the period between near retirement and post-retirement years. In medico-physiological
terms, this equates with the climacteric period of adjustment and re adjustment to another tempo of life.

COMPASURE BEHAVIORS - are sets of behaviors or nursing measures that the nurse demonstrates to selected
patients.

COMPOSURE- is acronym hich stands for Competence, Presence,and Prayer, Open-mindedness, Stimulation,

understanding, Respect and Relaxation, Empathy.
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.
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.
RETIREMENT- is an inevitable change in one’s life. It is evident in increasing statistics of aging population
accompanied by related disabilities and increased dependence.
ROLE DISCONTINUITY-is the interruption in the line of status enjoyed or performed. The interruption may be
brought about by an accident, emergency, and change of position or retirement.

WELLNESS STATUS- a condition being in a state of well being, a coordinated and integrated living pattern that
involves the dimension of wellness.

Sister Letty Kuan's Graceful Aging Theory Part 1

https://youtu.be/WW06RyRBssA

Sister Letty Kuan's Graceful Aging Theory Part 2

https://youtu.be/uIrKSXB1_tI

Nursing Theory Of Carmelita C Divinagracia http://urluss.com/13nnml

Theoretical Foundations of Nursing: The Philippine Perspective” by: Dr. Eufemia Octaviano and Dr.
Carl Balita.
Case Scenario:

Aging is pretty much feared by most people. It is something that is not well received and may in fact
pose negative health outcomes to patients. As a nurse working in a geriatric unit how could you apply
the theory of Letty Kuan? Focuses on the key elements needed to prevent negative adaptation to
retiring and aging using both philosophical and practical determinants.

Aliigood Martha R, The Nursing Theorist and their Works,8th edition, Copyright 2014, Mosby

Smith Marlaine C.; Parker Marilyn E.; Nursing Theories and Nursing Practice, 4TH edition. F.A.Davis
Company 2015
THE TRANSFORMATIVE LEADERSHIP THEORY

She is famous for being the first Filipina theorist for writing the CASAGRA Transformative
Leadership Model. The title of the theory was derived from her name, CArolina S. AGRAvante.

- She finished her secondary education at St. Paul Univeristy - Manila (formerly St. Paul College
- Manila) as class salutatorian.

- In 1964, she earned her BS Nursing degree in the same school as magna cum laude. In the
same year, she passed the nurse licensure examinations as the board topnotcher.

- From 1967 to 1969, she studied Master’s Degree in Nursing Education at Catholic University
of America as a full-fledged scholar.

- In 2002, she earned her Doctoral Degree in Philosophy at University of the Philippines Manila -
the same year her theory was published.

- She served as the president of St. Paul University - Iloilo, where she taught research subjects
among senior students.

- She was a former president of the Association of Deans of the Philippines Colleges of Nursing
(ADPCN) as she became the representative in the International Nursing Congress that was held
in Brunei in 1996. A year after, she was a part of a delegation that participated in the
International Council of Nursing in Vancouver, Canada.

- Received a Service Award from the Philippine Accreditation Association of Schools, Colleges
and Universities (PAASCU) for being one of the accreditors.

- One of the founding members of the Integrated Registered Nurses of the Philippines (IRNP).

- Currently, she is the President of St. Paul College - Ilocos Sur while performing the duties of
the Vice-President for Academics. Moreover, she also functions as the program chair of the
school's Department of Nursing.
The CASAGRA Transformative Leadership Model: Servant – Leader Formula & the Nursing
Faculty’s Transformative Leadership Behavior.

The theory “CASAGRA Transformative Leadership” is a psycho spiritual model. It is coined after the
name of the investigator: Sr. CArolina S. AGRAvante

The model is a Three-Fold Transformation Leadership Concept rolled into one, comprising of the
following elements:

1. Servant-Leader Spirituality;
2. Self-Mastery expressed in a vibrant care complex;
3. Special Expertise level in the nursing field one is engaged in.

These elements rolled into one make-up the personality of the modern professional nurse who
will challenge the demands of these crucial times in society today.

The CASAGRA Transformative Leadership Theory is classified as a Practice Theory basing on the
characteristics of a Practice Theory stated by McEwen (2007), which are the following:
a. Complexity / Abstractness, Scope - Focuses on a narrow view of reality, simple and straightforward;
b. Generalizibility /Specificity - Linked to a special populations or an identified field of practice;
c. Characteristic of Scope – Single, concrete concept that is operationalized;
d. Characteristic of Proposition – Propositions defined;
e. Testability – Goals or outcomes defined and testable;
f. Source of Development – Derived from practice or deduced from middle range theory or grand theory.

PURPOSE
The present day demands in the nursing profession challenge nursing educators to revisit
their basic responsibility of educating professional nurses who are responsive to technological,
educational and social changes happening in the Philippines society today. The reopening of
the doors of foreign market to Filipino nurses, migration made easy, attractive salaries and
benefits way beyond what hospitals can afford to give.
Nursing education is faced with a new concern that is globalization of nursing services for the
international market. Therefore a need to develop globalization of care with focus on developing
caring nurses.

The formation of new nursing leaders is urgently needed; leaders with new vision who will
venture new traits and who have gone through new formation in order to serve the society as
professional nurse.

Nurses need competent leaders with a dream of what nursing can be, whose basic stand is
caring and service who are competent in nursing, assertive of their own rights with the help
profession.

MAIN PROPOSITIONS

- CASAGRA Transformative Leadership is a psycho-spiritual model, was an effective means for

faculty to become better teachers and servant-leaders.
- Care complex is a structure in the personality of the caregiver that is significantly related to the
leadership behavior.
- The CASAGRA servant-leadership formula is an effective modality in enhancing the nursing
faculty’s servant-leadership behavior.
- Vitality of Care Complex of the nursing faculty is directly related to leadership behavior. 

CONCEPTS

Key Concepts

- The CASAGRA Transformative Leadership Model have concepts of leadership from a psycho-

spiritual point of view, designed to lead to radical change from apathy or indifference to a
spiritual person. 
- Servant-leader formula is the enrichment package prepared as intervention for the study which
has three parts that parallel the three concepts of the CASAGRA transformative leadership
model, namely: the care complex primer, a retreat-workshop on Servant-leadership, and a
seminar-workshop on Transformative Teaching for nursing faculty. 

- Special expertise is the level of competence in the particular nursing area that the professional
nurse is engaged in workshop is the spiritual exercise organized in an ambience of prayer
where the main theme is the contemplation of Jesus Christ as a Servant-leader. 

- Servant-leadership behavior refers to the perceived behavior of nursing faculty manifested

through the ability to model the servant leadership qualitiesto students, ability to bring out the
best in students, competence in nursing skills, commitment to the nursing profession, and sense
of collegiality with the school, other health professionals, and local community.

- Nursing leadership is the force within the nursing profession that sets the vision for its
practitioners, lays down the roles and functions, and influences the direction toward which the
profession should go. 

- Transformative teaching may also be termed Reflective teaching, an umbrella term covering
ideas, such as thoughtful instruction, teacher research, teacher narrative, and teacher
empowerment. 

- Care complex is the nucleus of care experiences in the personality of a nurse formed by a
combination of maternal care experiences, culture based-care practices indigenous to a race
and people, and the professional training on care acquired in a formal course of nursing. 
Three-Fold Transformative Leader Concept

I. The Servant-Leadership Spirituality here is prescribed to run parallel to the generic

elements of the transformative leadership model.

      

This formula consists of a spiritual exercise, the determination of the vitality of the care
complex in the personality of an individual and finally a seminar workshop on transformative
teaching.

The servant-leader formula prescription includes a spiritual retreat that goes through the

process of awareness, contemplation, story telling, reflection, and finally commitment to become
servant-leaders in the footsteps of Jesus.

II. The Self-Mastery consists of a vibrant care complex possessed to a certain degree by all

who have been through formal studies in a care giving profession such as nursing.

III. The Special-Expertise level is shown in a creative, caring, critical, contemplative and

collegial teaching of the nurse faculty who is directly involved with the formation of the nursing.

PARADIGM
The conceptual framework is logical because the variables are very well explained on how
transformative-leadership model be applicable through care complex, transformative teaching
servant-leader spirituality, and servant-leader behavior.

A person with dynamic care complex is the cornerstone of nursing leadership. According to care
complex of Agravante, caring personality rests on the possession of a care complex with in a
person as an energy source of caring.

The framework explains and predicts the continuous formation of nursing leadership behavior in
nursing faculty that will eventually affect their teaching function.

Servant-leadership formula runs parallel to the generic elements of the transformative-

leadership model.

Transformative teaching is the guide that desired for the modern educative process designed to
form the millennium professional nurse.

Expertise is the practice of caring and proactive in face of challenges for the profession go
hand-in-hand. Education and practice bring this about.
SUMMARY

Indeed, Sr. Carolina’s CASAGRA Transformative Leadership Theory is timely in this ever fast-
paced world. Nursing as a profession is inevitably changing and the demand to be at par with
technology made it more competitive. Nursing students need nursing teachers to look up to.
Embodied with these three concepts, it is timely to put this theory into practice.
TECHNOLOGICAL COMPETENCY AS CARING IN NURSING: A MODEL
FOR PRACTICE

Rozzano Locsin is a Professor of Nursing at Tokushima University (Japan), a

Professor Emeritus of Florida Atlantic University (United States), and a Visiting
Professor at universities in Thailand, Uganda, and the Philippines.

He has authored a book entitled Technological Competency as Caring in Nursing:

A Model for Practice, edited and co-authored three more books, including one
entitled A Contemporary Nursing Practice: The (Un)Bearable Weight of Knowing
in Nursing.

EARLY LIFE
Locsin was born in 1954. He is a registered nurse, a native of Dumaguete City,
Philippines who resides and practices his nursing profession at Tokushima
University, Tokushima, Japan as a Professor of Nursing. He is a Professor emeritus
of Florida Atlantic University in Boca Raton, Florida, USA. Dr. Rozzano Locsin
earned his PhD in Nursing from the University of the Philippines in 1988, and his
MA in Nursing and Bachelor of Science in Nursing from Silliman University in
1978 and 1976 respectively in the Philippines

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 [2] 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, 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.
ASSUMPTIONS
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.
Wk 15
Local Theories and Models of Nursing Intervention

SISTER LETTY G. KUAN – THEORY ABOUT GRACEFUL AGING

Retirement and Role Discontinuities

 While we age, we gain our purpose in life like happy retirement

 Determinants of fruitful aging – we have to be prepared during our retirement in terms of financial,
we have financial ability
 Family constellation – method of family therapy – we know the role of our family
 Self-preparation
BACKGROUND

 Retirement -
o is an inevitable change in one’s life. It is evident in the increasing statistics of aging
population accompanied by related disabilities and increased dependence
o This developmental stage even at 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.
o Withdrawal of one’s position from active working life
o Retirement age in PH is 65
o It is primary importance to prepare early in life by cultivating other role of options at age 50-
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 –
o is the endurance of cells and tissues to withstand the wear-and-tear phenomenon of the
human body.
o Some individuals are genetic affinity to say young for a long time period.
 Role –
o 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
o Is the period between near retirement and post-retirement years. In medico-physiological
terms, this equates with the climacteric period of adjustment and ret-adjustment to another
tempo of life.
 Retiree
o 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
o Is the interruption in the line status enjoyed or performed. The interruption may be brought
about by an accident, emergency, and change of position or retirement.
 Coping Approaches
o Refer to the interventions or measures applied to solve a problematic situation or state in
order to restore or maintain equilibrium and normal functioning.
DTEREMINANTS 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 – (economic level) refers to the financial affluence of the respondent which can be
classified as poor, moderate, or rich.
3. WORK STATUS (according to Webster’s dictionary) – status of an individual according to his/her
work.
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 members live in separate dwelling units; or nuclear type of family where
only husband, wife and children live together.
5. SELF-PREPARATION – it is preparing of self to the possible outcomes in life.
6. GOVERNMENT AGENCY – to construct holistic pre-retirement preparation program which will take
care of the retiree’s finances, psychological, emotional and social needs.
7. RETIREMENT – should be recognized as the fulfillment of every individual’s birth right and must be
lived meaningfully.
APPLICATION TO NURSING

 “The longer you stay in life, the more you have e=acquired, the better you should be, the Legacy is
given,”

CARMELITA DIVINA GRACIA – THEORY OF COMPOSURE BEHAVIORS

Theory of Composure Behaviors

 A condition of being in a state of well-being. a coordinated and integrated living pattern that
involves the dimension of wellness.
 Dr. Carmelita C. Divina gracia conducted a study to determine the effects of COMPOSURE
behaviours of the advanced practitioner on the recovery of selected patients at the PhilippinE Heart
Center. Behaviours include: competence. presence and prayer, open-mindedness, stimulation.
understanding. respect and relaxation, and empathy.
 

COMPOSURE BEHAVIOURS
COMpetence

 An in-depth knowledge and clinical expertise demonstrated in caring for patients.

 This is also stands for consistency and congruency of words and deeds of the nurse.
Presence and Prayer

 A form of nursing measure which means being with another person during times of need.
 This includes therapeutic communication. active listening, and touch.
 It is also a form of nursing measure which is demonstrated through reciting a prayer with the
patient and concretized through the nurse-s personal relationship and faith in God.
Open-mindedness

 A form of nursing measure which means being receptive to new ideas or to reason.
 It conveys a manner of considering patient's preferences and opinions related to his current
health condition and practices and demonstrate the flexibility of the nurse to accommodate
patients’ views.
Stimulation
  a form of nursing measure demonstrated by means of providing 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

 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.
Patient Wellness Outcome

 This refers to the perceived wellness of selected orthopedic patients after receiving nursing care in
terms of physiologic and biobehavioral.
Two patient wellness outcomes which have been categorized as:
1. Biobehavioral
2. Physiologic

o 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.
 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.
 A positive total outlook on life is essential to wellness and each of the wellness dimensions.
 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 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
 SPIRITUAL WELLNESS is a person is ability to establish a values system and act on the system of
beliefs. as well as to establish and carry out meaningful and constructive lifetime goals.
o SPIRITUAL HEALTH is the one component of health that is totally comprised of the wellness
dimension: for this reason. spiritual health is 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 the care she renders. The nurse creates the calm
environment in any setting that facilitates treatment. healing and recovery from any pain or
discomfort