FAR EASTERN UNIVERSITY

Institute of Nursing

Manila

MODULE 1
WEEK 1 NURSING IS AN ART-CARING

INTRODUCTION

Caring: a nurturing way of relating to a valued other towards whom one feels a personal sense of commitment and
responsibility. Caring is growth and health-producing (nurturing) occurs in relationships (relating) to the one cared-for (a valued
other); individualized and intimate (personal), with a sense of commitment (passion), accountability and duty (responsibility).

Learning Outcomes:
1.Demonstrate comprehensive understanding caring practice model
2. To understand the theory to serve as anchor in nursing practice
3. To understand aspects of a nurse's skills to increased independence in reliance on abstract ideas and principles and an
increase in critical thinking.

Outline:

I. Caring Practice Models

A. Practice Model: Jean Watson theory of Caring
a. Key Concepts of The Philosophy and Science of Caring
B. Practice Model: Kristen Swanson’s Theory of Caring and Healing
C. Practice Model: Virginia Henderson Basic Nursing Care Model
a. Fourteen Components of Basic Nursing Care
II. 6 C’s of Caring

• The Importance of the 6 C's in the Nursing Profession

 III. Caring for self and others
A. Self-Care Theory
§ Dorothea Orem’s Self-Care Deficit Theory
§ Theory of Nursing System
B. Key Concepts of Three Interlocking
§ Care, Cure, Core Theory of Lydia Hall

C. Theory Of Feminine Morality

Gilligan’s stages of moral development.

CONTENT

I. CARING PRACTICE MODEL

A. JEAN WATSON THEORY OF CARING

Jean Watson’s Philosophy and Science of Caring is concerned on how nurses express care to their patients. Her theory stresses
humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice.

The nursing model states that “nursing is concerned with promoting health, preventing illness, caring for the sick, and restoring
health.” It focuses on health promotion, as well as the treatment of diseases. According to Watson, caring is central to nursing
practice, and promotes health better than a simple medical cure. She believes that a holistic approach to health care is central to the
practice of caring in nursing.

According to her theory, caring can be demonstrated and practiced by nurses. Caring for patients promotes growth; a caring
environment accepts a person as he or she is, and looks to what he or she may become.

Watson also defined three of the four concepts in nursing including person or human being, health, and nursing. She referred human
being as a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a
philosophical view of a person as a fully functional integrated self. Human is viewed as greater than and different from the sum of his
or her parts. Health, meanwhile, is defined as a high level of overall physical, mental, and social functioning; a general adaptive-
maintenance level of daily functioning; and the absence of illness, or the presence of efforts leading to the absence of illness. And
nursing as a science of persons and health-illness experience that are mediated by professional, personal, scientific, and ethical care
interactions.

Key Concepts of The Philosophy and Science of Caring 10 Carative Factors /Caritas Processess

1. forming humanistic-altruistic value systems,

2. instilling faith-hope,
3. cultivating a sensitivity to self and others,
4. developing a helping-trust relationship,
5. promoting an expression of feelings,
6. using problem-solving for decision-making,
7. promoting teaching-learning,
8. promoting a supportive environment,
9. assisting with gratification of human needs, and
10. allowing for existential-phenomenological forces.

B. Practice Model: Kristen Swanson’s Theory of Caring and Healing

This theory states that caring proceeds in a sequence of five categories: knowing, being with, doing for, enabling, and maintaining
belief. When applied to nursing practice, each of these five stages stimulates the caregiver’s attitude and improves the overall patient
well-being. The theory aims at helping nursing personnel to deliver care that promotes dignity, respect, and empowerment. This model
was framed to ensure consistent caring behaviors which would, in turn, improve patient satisfaction.

Definitions & Concepts:

• Caring: a nurturing way of relating to a valued other towards whom one feels a personal sense of commitment and
responsibility. More specifically, caring is growth and health-producing (nurturing) occurs in relationships (relating) to the one
cared-for (a valued other); individualized and intimate (personal), with a sense of commitment (passion), accountability and
duty (responsibility). Together with this, nurturing is delivered as a set of interrelated processes that evolve from the nurse’s
own convictions, knowledge, and interaction with a patient. The caring process: being with, doing for, enabling, and
maintaining belief, moreover, are grounded in real nursing behaviors.
• Maintaining Belief: an orientation to caring begins with a fundamental belief in persons and their capacity to get through
events and transitions and face their future with meaning. Importantly, this conviction is the base or foundation for the practice
 of nursing care. Besides, whatever health conditions the patient is facing, a nurse believes in her/his the capacity and power to
accept or welcome upcoming days with meaning.
• Knowing: in knowing, one perceives events according to the meaning they have in the life of the other. It involves a thorough
assessment of all the aspects of a patient’s condition and reality, engaging the self or person-hood of the nurse as well as the
patient, in a caring style of approach. The important nursing behaviors for knowing are; a humanistic view of the other,
nurturing, understanding of his/her situation, analysis, and interpretation, compassion, empathy, insight, academic cognition
and imagination, assessment and communication skills, respect for individual differences and recognition of the other as a
significant being. When the process knowing occurs there develops a bond of empathy and understanding between the care
provider and the care recipient.
• Being-with: being with, as well as being emotionally present conveys to patients the message that they and their experiences
are significant to the nurse. Similarly, emotional presence is a technique by which the nurse shares the meanings, feelings and
lived experience of the one-cared for. The nurse assures the patients of her readiness and willingness to be in their reality. it’s a
side-by-side physical presence of clearly conveying one’s availability. Basically, the message is, “you are not alone, what
happens to you matters to us and we are here for you”.
• Doing for: the real meaning of doing for is found in the definition of nursing: The unique function of a nurse is to assist the
individual, sick of well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that
s/he would perform unaided it s/he had the necessary strength, will, or knowledge and to do this in such a way as to help
her/him gain independence as rapidly as possible. In other words, doing for refers to the activities in which a nurse engages
with patients for what they would do for themselves if at all it were possible to them. Doing for as seen in the above definition,
involves on the part of the nurse, measures that are performed on behalf of a patient’s long term welfare. They include
comforting patients, anticipating their needs, performing procedures skillfully, protecting them from harm and ultimately
preserving their human dignity.
• Enabling: facilitating the other’s passage through life transitions and unfamiliar events. As in the case of doing for, enabling
fosters an environment of self-healing. Such an enabling process enhances the patient’s capacity to heal, actualize oneself and
in particular practice self-care. Moreover, self-care animated by intrinsic motivation, self-determination and competence are
the results of empowering that means, a nurse by positively altering one’s self-concept, knowledge, attitude and skill–level
empowers patients in order to facilitate healing. Even more, the external environment such as provisions of safety devices,
removal of physical, social or emotional threats or obstacles also contributes to the healing process. Here, patients are partners,
with knowledge and self-management skills. The cornerstone of enabling is appropriate communication with patients and their
families. This involves regular and frequent contacts with patients, qualified by empathy and sensitivity to family dynamics,
cultural and religious beliefs and previous experience, along with the nature of illness. Communication also embodies
providing information, explanation about the given care, medications, tests, and the overall condition of the patient.
 C. Practice Model: Virginia Henderson Basic Nursing Care Model

The Nursing Need Theory was developed by Virginia Henderson and was derived from her practice and education. Henderson’s goal
was not to develop a theory of nursing, but rather to define the unique focus of nursing practice. The theory emphasizes the
importance of increasing the patient’s independence so that progress after hospitalization would not be delayed. Her emphasis on basic
human needs as the central focus of nursing practice has led to further theory development regarding the needs of the patient and how
nursing can assist in meeting those needs.

Henderson identifies three major assumptions in her model of nursing. The first is that “nurses care for a patient until a patient can
care for him or herself,” though it is not stated explicitly. The second assumption states that nurses are willing to serve and that
“nurses will devote themselves to the patient day and night.” Finally, the third assumption is that nurses should be educated at the
college level in both sciences and arts. The four major concepts addressed in the theory are the individual, the environment, health,
and nursing.

Fourteen Components of Basic Nursing Care:

• Breathe normally. Eat and drink adequately.

• Eliminate body wastes.
• Move and maintain desirable postures.
• Sleep and rest.
• Select suitable clothes-dress and undress.
• Maintain body temperature within normal range by adjusting clothing and modifying environment
• Keep the body clean and well groomed and protect the integument
• Avoid dangers in the environment and avoid injuring others.
• Communicate with others in expressing emotions, needs, fears, or opinions.
• Worship according to one’s faith.
• Work in such a way that there is a sense of accomplishment.
• Play or participate in various forms of recreation.
• Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

II Six (6) C’s of Caring

 • Compassion: Is the suffering we experience through another’s suffering and our desire to help. It allows nurses to “treat
people as individuals and not as a disease”. Such a quality cannot be replaced by machines. A genuine and gentle reminder that
we are all human beings. And no matter our differences, we are connected, through care and through empathy. Compassion
lies in the way in which nurses provide care that respects human rights of all background, age and race. Therefore; true
compassion can only exist if a nurse is free of bias and racism and challenges belief upon assumption compassionate care
requires effective communication to gain full understanding of needs and desires of all involved, while competently adhering
to professional boundaries.
• Competence: A competent nurse meets standard that promote quality care based on contemporary, relevant and well founded
knowledge. A competent nurse will then use this evidence based knowledge coupled with interpersonal skills such as
compassion and confidence to work ethically, legally and within their own scope of practice.
• Confidence: Is our trust and understanding of our own competence. Confidence is built through experience, practice and
development of knowledge. To be confident is to form the ability to recognise one’s strengths and limitations. So that they can
practice safely, effectively and collaboratively and with the continual learning and competence. A confident nurse has a strong
belief in self, conscience and in how their work has a positive contribution to the patient and the community.
• Commitment: Commitment is a mindset, both conscious and subconscious. That is the ability to treat every task, every
moment and every interaction with the highest level of care. As a nurse we have moral and ethical commitment to provide
holistic care that is person-centred and aligns with a person’s care and concerns and we have an overall commitment and
responsibility to ensure the delivery of safe and quality care.
• Conscience: Our sense of right or wrong within our scope of practice. Influenced by our ability to see from a patient’s point of
view, and provide a level of care that we would want to receive. It obliges a nurse to do their duty for the sake of the patient.
As the nurse’s primary professional responsibility is to people requiring nursing care. Conscience may mean advocating on
behalf of the person when necessary which requires a level of confidence.
• Comportment: Is our professional presentation. It’s our appearance, attitude and how we behave. Nurses must monitor and
promote personal health through self-care in order to care for others. If we ‘maintain [our] physical and mental health it will
reciprocate into competence for practice.

The Importance of the 6 C's in the Nursing Profession

• This refers to treating patients correctly, in a respectful and non-judgmental manner. Consideration should be paid to their
beliefs and their dignity should be protected at all times. They should be able to trust their nurse to provide a high level of care.
• Nurses often work in very stressful conditions, but in doing so they must remain compassionate. Even if a patient is
particularly difficult, or it's coming to the end of their shift, they should show compassion as it it central to how patients view
their care.
 • Nursing requires constant updating of knowledge and skills in order to keep up to late with the latest practices. Patients have a
wide range of needs and treatments requirements, and they also come from a variety of walks of life. Lots of training and time
spent on personal development ensures that they possess the expertise needed to care for every single patient to a high
standard.
• Excellent communication is vitally important in all areas of the medical professional. Nurses must be good listeners, as this is
the key to good communication. Simple and concise communication with colleagues is all vital as is legible writing of patient
records. What's more, because we live in a multicultural society, it's essential that patients are communicated with in a
language that they understand.
• Nurses must have the courage to do what they think is right and be brave enough to confront fear of difficulties. They often
have to stand by what they believe, even if others do not like it. But, it's important to remember that they are accountable for
their actions as a nurse and that they have a duty of care to their patients.
• Nurses should possess a high level of commitment to their role. Nurses have never been more over-stretched, and with little
financial growth for their exceptional efforts, they still put in the overtime in order to make sure that their patients' needs are
met.

III.Caring for self and others

A. Self-Care Theory

Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The act of assisting others in the provision and management of
self-care to maintain or improve human functioning at home level of effectiveness.” It focuses on each individual’s ability to perform
self-care, defined as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and
well- being.”

Major Concepts of the Self-Care Deficit Theory

• Nursing: is an art through which the practitioner of nursing gives specialized assistance to persons with disabilities which
makes more than ordinary assistance necessary to meet needs for self-care. The nurse also intelligently participates in the
medical care the individual receives from the physician.
• Humans: are defined as “men, women, and children cared for either singly or as social units,” and are the “material object” of
nurses and others who provide direct care.
• Environment: The environment has physical, chemical and biological features. It includes the family, culture, and
community.
 • Health: is “being structurally and functionally whole or sound.” Also, health is a state that encompasses both the health of
individuals and of groups, and human health is the ability to reflect on one’s self, to symbolize experience, and to
communicate with others.
• Self-care: is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life,
health, and well-being.

Self-Care Agency

Self-care agency is the human’s ability or power to engage in self-care and is affected by basic conditioning factors.

Basic Conditioning Factors

Basic conditioning factors are age, gender, developmental state, health state, socio-cultural orientation, health care system factors,
family system factors, patterns of living, environmental factors, and resource adequacy and availability.

Therapeutic Self-Care Demand

Therapeutic Self-care Demand is the totality of “self-care actions to be performed for some duration in order to meet known self-care
requisites by using valid methods and related sets of actions and operations.”
Self-Care Deficit

Self-care Deficit delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or
guardian) is incapable of or limited in the provision of continuous effective self- care.

Nursing Agency

Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, to know, and to
help others meet their therapeutic self-care demands by exercising or developing their own self-care agency.

Nursing System

Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is
activated when the client’s therapeutic self-care demand exceeds available self-care agency, leading to the need for nursing.

Theories

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated theories: (1) the theory of self-care, (2) the
self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partial
compensatory and supportive-educative.

• Theory of Self-Care

This theory focuses on the performance or practice of activities that individuals initiate and perform on their own behalf to maintain
life, health and well-being.
B. Key Concepts of Three Interlocking Circles (Care, Core and Cure Nursing Theory of Lydia Hall)

Care, Cure, Core Theory

Lydia Hall used her knowledge of psychiatry and nursing experiences in the Loeb Center as a framework for formulating her theory.
Also known as “the Three Cs of Lydia Hall,” it contains three independent but interconnected circles: the core, the care, and the cure.

Description

Lydia Hall’s theory define Nursing as the “participation in care, core and cure aspects of patient care, where CARE is the sole
function of nurses, whereas the CORE and CURE are shared with other members of the health team.” The major purpose of care is to
achieve an interpersonal relationship with the individual that will facilitate the development of the core.
• The core is the patient receiving nursing care. The core has goals set by him or herself rather than by any other person, and
behaves according to his or her feelings and values.
• The cure is the attention given to patients by medical professionals. Hall explains in the model that the cure circle is shared by
the nurse with other health professionals, such as physicians or physical therapists. These are the interventions or actions
geared toward treating the patient for whatever illness or disease he or she is suffering from.
• The care circle addresses the role of nurses, and is focused on performing the task of nurturing patients. This means the
“motherly” care provided by nurses, which may include comfort measures, patient instruction, and helping the patient meet his
or her needs when help is needed.

Sub-concepts

Lydia Hall’s theory has three components which are represented by three independent but interconnected circles. The three
circles are: the core, the care, and the cure. The size of each circle constantly varies and depends on the state of the patient.

The Care Circle

• According to the theory, nurses are focused on performing the noble task of nurturing patients. This circle solely represents the
role of nurses, and is focused on performing the task of nurturing patients. Nurturing involves using the factors that make up
the concept of mothering (care and comfort of the person) and provide for teaching-learning activities.
• The care circle defines the primary role of a professional nurse such as providing bodily care for the patient and helping the
patient complete such basic daily biological functions as eating, bathing, elimination, and dressing. When providing this care,
the nurse’s goal is the comfort of the patient.
• Moreover, the role of the nurse also includes educating patients, and helping a patient meet any needs he or she is unable to
meet alone. This presents the nurse and patient with an opportunity for closeness. As closeness develops, the patient can share
and explore feelings with the nurse.

The Core Circle

• The core, according to Hall’s theory, is the patient receiving nursing care. The core has goals set by him or herself rather than
by any other person and behaves according to his or her feelings and values. This involves the therapeutic use of self and is
shared with other members of the health team.
• This area emphasizes the social, emotional, spiritual, and intellectual needs of the patient in relation to family, institution,
community and the world. This is able to help the patient verbally express feelings regarding the disease process and its effects
 by the use of the reflective technique. Through such expression, the patient is able to gain self-identity and further develop
maturity.
• Reflective technique is used by the professional nurse in a way the he or she acts as a mirror to the patient to help the latter
explore his or her own feelings regarding his or her current health status and related potential changes in lifestyle.
• Motivations are discovered through the process of bringing into awareness the feelings being experienced. With this
awareness, the patient is now able to make conscious decisions based on understood and accepted feelings and motivation.
• The Cure Circle
• The cure as explained in this theory is the aspect of nursing which involves the administration of medications and
treatments. Hall explains in the model that the cure circle is shared by the nurse with other health professionals, such as
physicians or physical therapists.
• In short, these are the interventions or actions geared toward treating the patient for whatever illness or disease he or
she is suffering from. During this aspect of nursing care, the nurse is an active advocate of the patient.

I. Gilligan’s Theory Of Feminine Morality

Gilligan challenged Kohlberg’s claim that all moral reasoning is “justice reasoning.” She argued that Kohlberg’s stage theory makes
assumptions for example, that the moral ideal is attained through an abstract, impersonal, individualistic “prior-to-society” perspective
that do not respect the experiences of women, who prioritize interpersonal relationships. Kohlberg’s theory thus estranges women
from the process of moral development.

Gilligan argued that women’s moral judgments necessarily include feelings of compassion and empathy for others, as well as concern
for commitments that arise out of relationships. Women engage in “care reasoning,” not “justice reasoning,” and thus consider their
own and other’s responsibilities to be grounded in social context and interpersonal commitments.

Gilligan identified several stages of moral development.

Level 1: Self-Oriented (caring for oneself)

Focus is on the needs of oneself. Here, the survival of oneself is of sole concern. The transition to level 2 begins with the recognition
of the conflict between one’s own needs and the needs of others (i.e., what one owes to oneself vs. what one owes to others).

Level 2: Other Oriented (caring for others)

Focus is on the needs of others. Here, the self-adopts the traditional conception of feminine goodness, the maternal morality of self-
sacrifice, whereby the good is equated with caring for others. Consequently, one’s own needs become devalued. The transition to level
3 begins with the recognition that the self cannot be left out, but must also be an object of one’s caring.

Level 3: Universal Oriented (caring for self and others)

Focus is on the universal obligation of caring. Here, care is a self-chosen principle that condemns exploitation, violence, and neglect
and demands active response to suffering. Caring for oneself and others is seen as intertwined because the self and others are
recognized as interdependent. Thus, all acts of caring are seen as beneficial to both self and others.

ACTIVITY This activity is group discussion The student given task to read and recall the nursing theories pertains to caring practice
model and share it with in the class during discussion. The student will listen and write important main key points during lecture.

Instruction
 After recalling the theory. The student must have listen attentively and write important key points of class discussion in
preparation for their written quiz next week.

Assessment:

a. Interactive discussion with in the class

b. Written quiz 15 items to be taken on the week 2

*References:

Alligood, M. R., & Marriner-Tomey, A. (2022). Nursing theorists and their work (10th ed.). Maryland Heights, Mo.: Mosby/Elsevier.
Kozier, B. (2018). Fundamentals of Nursing: Concepts, Principles, and Practice. 10th Edition. By Pearson Education Asia ltd.
P. Stockert & P. Hall (2019). Fundamentals of Nursing (E-book). 9th Edition. by Evolve Study Resources
Kozier, B. Fundamentals of Nursing: Concepts, Principles, and Practice. 7th Edition; 419- 467