4 1 Hildegard Peplau Combined

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THEORETICAL FOUNDATIONS IN NURSING
HILDEGARD E. PEPLAU
THEORY OF INTERPERSONAL RELATIONS
(Week No. 11)
INTRODUCTION
The need for a partnership between nurse and client is very substantial in nursing
practice. This definitely helps nurses and healthcare providers develop more
therapeutic interventions in the clinical setting. Through these, Hildegard E. Peplau
developed her “Interpersonal Relations Theory” in 1952, mainly influenced by Henry
Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller.
According to Peplau (1952/1988), nursing is therapeutic because it is a healing art,

assisting an individual who is sick or in need of health care. Nursing can be viewed
as an interpersonal process because it involves interaction between two or more
individuals with a common goal. In nursing, this common goal provides the
incentive for the therapeutic process in which the nurse and patient respect each
other as individuals, both of them learning and growing as a result of the interaction.
An individual learns when she or he selects stimuli in the environment and then
reacts to these stimuli.
Hildegard Peplau’s Interpersonal Relations Theory emphasized the nurse-client

relationship as the foundation of nursing practice. It gave emphasis on the give-and-
take of nurse-client relationships that was seen by many as revolutionary. Peplau
went on to form an interpersonal model emphasizing the need for a partnership
between nurse and client as opposed to the client passively receiving treatment and
the nurse passively acting out doctor’s orders.
LEARNING OUTCOME
After finishing this module, the learner will be able to:

1. Identify and define the major concepts in the Interpersonal Theory of Peplau.
2. Discuss or explain the concepts of nurse-patient relationship
3. Appreciate the value of the Interpersonal Theory of Peplau for them to be able to
apply in their related learning experience in the future.
Far Eastern University

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OUTLINE
1. Credentials and Background of the Theorist
2. Assumptions
3. Therapeutic Nurse-Patient Relationship
4. Four Phases of Nurse-Patient Relationship
5. Sub-concepts of Interpersonal Relations Theory
a. Roles of Nurses
b. Four Levels of Anxiety
6. Activity
7. References
CONTENT
A. Credentials and Background
Early Life
Hildegard Peplau was born on September 1, 1909. She was raised in Reading,
Pennsylvania by her parents of German descent, Gustav and Otyllie Peplau. She was the
second daughter, having two sisters and three brothers. Though illiterate, her father was
persevering while her mother was a perfectionist and oppressive. With her young age,
Peplau’s eagerness to grow beyond traditional women’s roles was precise. She considers
nursing was one of few career choices for women during her time. In 1918, she witnessed
the devastating flu epidemic that greatly influenced her understanding of the impact of
illness and death on families.
Education
In 1931, she graduated in Pottstown, Pennsylvania School of Nursing. Peplau earned a
Bachelor’s degree in interpersonal psychology in 1943 at Bennington College in Vermont.
She studied psychological issues together with Erich Fromm, Frieda Fromm-Reichmann,
and Harry Stack Sullivan at Chestnut Lodge, a private psychiatric hospital in Maryland.
Peplau held master’s and doctoral degrees from Teachers College, Columbia University
in 1947.
Notable Achievements
Hildegard Elizabeth Peplau (September 1, 1909 – March 17, 1999) was an American nurse
who is the only one to serve the American Nurses Association (ANA) as Executive Director
and later as President. She became the first published nursing theorist since Florence
Nightingale.

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Peplau was well-known for her Theory of Interpersonal Relations, which helped to
revolutionize the scholarly work of nurses. Her achievements are valued by nurses all over
the world and became known to many as the “Mother of Psychiatric Nursing” and the
“Nurse of the Century.”
Death
On March 17, 1999, Peplau died peacefully in her sleep at home in Sherman Oaks,
California. She is survived by Dr. Leitia Anne Peplau and her husband, Dr. Steven Gordon,
and their son, David Gordon of Sherman Oaks, CA;
B. THEORETICAL ASSERTIONS
Major Concepts of the Interpersonal Relations Theory

The theory explains the purpose of nursing is to help others identify their felt difficulties
and that nurses should apply principles of human relations to the problems that arise at all
levels of experience.
Man
Peplau defines man as an organism that “strives in its own way to reduce tension
generated by needs.” The client is an individual with a felt need. person, which is a
developing organism that tries to reduce anxiety caused by needs.
Health
Health is defined as “a word symbol that implies forward movement of personality and
other ongoing human processes in the direction of creative, constructive, productive,
personal, and community living.”
Society or Environment
The environment which consists of existing forces outside of the person and put in the
context of culture.
Although Peplau does not directly address society/environment, she does encourage the
nurse to consider the patient’s culture and mores when the patient adjusts to hospital
routine.

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Nursing
Hildegard Peplau considers nursing to be a “significant, therapeutic, interpersonal
process.” She defines it as a “human relationship between an individual who is sick, or in
need of health services, and a nurse specially educated to recognize and to respond to the
need for help.”
ASSUMPTIONS
The assumptions of Hildegard Peplau’s Interpersonal Relations Theory are:
(1) Nurse and the patient can interact.
(2) Peplau emphasized that both the patient and nurse mature as the result of the
therapeutic interaction.
(3) Communication and interviewing skills remain fundamental nursing tools.
(4) Peplau believed that nurses must clearly understand themselves to promote
their client’s growth and to avoid limiting the client’s choices to those that nurses
value.
Therapeutic nurse-client relationship

A professional and planned relationship between client and nurse that focuses on the
client’s needs, feelings, problems, and ideas. It involves interaction between two or more
individuals with a common goal. The attainment of this goal, or any goal, is achieved
through a series of steps following a sequential pattern.

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Four Phases of the therapeutic nurse-patient relationship:

The nursing model identifies four sequential phases in the interpersonal relationship:
orientation, identification, exploitation, and resolution.
The orientation phase defines the problem. It starts when the nurse meets the patient, and
the two are strangers. After defining the problem, the orientation phase identifies the type
of service needed by the patient. The patient seeks assistance, tells the nurse what he or
she needs, asks questions, and shares preconceptions and expectations based on past
experiences. Essentially, the orientation phase is the nurse’s assessment of the patient’s
health and situation.
The identification phase includes the selection of the appropriate assistance by a

professional. In this phase, the patient begins to feel as if he or she belongs, and feels
capable of dealing with the problem which decreases the feeling of helplessness and
hopelessness. The identification phase is the development of a nursing care plan based
on the patient’s situation and goals.
The exploitation phase uses professional assistance for problem-solving alternatives. The
advantages of the professional services used are based on the needs and interests of the
patients. In the exploitation phase, the patient feels like an integral part of the helping
environment, and may make minor requests or use attention-getting techniques. When
communicating with the patient, the nurse should use interview techniques to explore,
understand, and adequately deal with the underlying problem. The nurse must also be
aware of the various phases of communication since the patient’s independence is likely
to fluctuate. The nurse should help the patient exploit all avenues of help as progress is
made toward the final phase. This phase is the implementation of the nursing plan, taking
actions toward meeting the goals set in the identification phase.
The final phase is the resolution phase. It is the termination of the professional relationship
since the patient’s needs have been met through the collaboration of patient and nurse.
They must sever their relationship and dissolve any ties between them. This can be difficult
for both if psychological dependence still exists. The patient drifts away from the nurse and
breaks the bond between them. A healthier emotional balance is achieved and both
become mature individuals. This is the evaluation of the nursing process. The nurse and
patient evaluate the situation based on the goals set and whether or not they were met.
The goal of psychodynamic nursing is to help understand one’s own behavior, help others
identify felt difficulties, and apply principles of human relations to the problems that come
up at all experience levels. Peplau explains that nursing is therapeutic because it is a
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healing art, assisting a patient who is sick or in need of health care. It is also an
interpersonal process because of the interaction between two or more individuals who
have a common goal. The nurse and patient work together so both become mature and
knowledgeable in the care process.
Subconcepts of the Interpersonal Relations Theory
Peplau’s model has proved of great use to later nurse theorists and clinicians in developing
more sophisticated and therapeutic nursing interventions.
The following are the roles of the Nurse in the Therapeutic relationship identified by Peplau:
The nurse has a variety of roles in Hildegard Peplau’s nursing theory. The six main roles
are: stranger, teacher, resource person, counselor, surrogate, and leader.
As a stranger, the nurse receives the patient in the same way the patient meets a stranger
in other life situations. The nurse should create an environment that builds trust. As a
teacher, the nurse imparts knowledge in reference to the needs or interests of the patient.
In this way, the nurse is also a resource person, providing specific information needed by
the patient that helps the patient understand a problem or situation. The nurse’s role as a
counselor helps the patient understand and integrate the meaning of current life situations,
as well as provide guidance and encouragement in order to make changes. As a surrogate,
the nurse helps the patient clarify the domains of dependence, interdependence, and
independence, and acts as an advocate for the patient. As a leader, the nurse helps the
patient take on maximum responsibility for meeting his or her treatment goals. Additional
roles of a nurse include technical expert, consultant, tutor, socializing and safety agent,
environment manager, mediator, administrator, record observer, and researcher.
Anxiety was defined as the initial response to a psychic threat. There are four levels of
anxiety described below.
Four Levels of Anxiety
Mild anxiety is a positive state of heightened awareness and sharpened senses, allowing
the person to learn new behaviors and solve problems. The person can take in all available
stimuli (perceptual field).
Moderate anxiety involves a decreased perceptual field (focus on immediate task only);
the person can learn a new behavior or solve problems only with assistance. Another
person can redirect the person to the task.

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Severe anxiety involves feelings of dread and terror. The person cannot be redirected to
a task; he or she focuses only on scattered details and has physiologic symptoms of
tachycardia, diaphoresis, and chest pain.
Panic anxiety can involve loss of rational thought, delusions, hallucinations, and complete
physical immobility and muteness. The person may bolt and run aimlessly, often exposing
himself or herself to injury.
ACTIVITY
SELF-ASSESSMENT
HILDEGARD PEPLAU INTERPERSONAL RELATIONS THEORY
Multiple Choice: Choose the best answer.
1. It involves a decreased perceptual field and the person can learn a new behavior
or solve problems only with assistance.
a. Mild anxiety
b. Moderate anxiety
c. Severe anxiety
d. Panic anxiety
2. It is a role of the nurse where the nurse imparts knowledge in reference to the
needs or interests of the patient.
a. Stranger
b. Surrogate
c. Teacher
d. Facilitator
3. The nurse helps the patient take on maximum responsibility for meeting his or her
treatment goals.
a. Leader
b. Counselor
c. Surrogate
d. Teacher
4. Helps the patient understand and integrate the meaning of current life situations.
a. Teacher
b. Researcher
c. Surrogate
d. Counselor
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5. The nurse helps the patient clarify the domains of dependence, interdependence,
and independence, and acts as an advocate for the patient.
a. Mediator
b. Consultant
c. Surrogate
d. Tutor
6. The person cannot be redirected to a task; he or she focuses only on scattered

details and has physiologic symptoms of tachycardia, diaphoresis, and chest pain.
a. Mild anxiety
b. Moderate anxiety
c. Severe anxiety
d. Panic anxiety
7. It is the termination of the professional relationship since the patient’s needs have
been met through the collaboration of patient and nurse.
a. Orientation Phase
b. Identification Phase
c. Exploitation Phase
d. Resolution Phase
8. It is the nurse’s assessment of the patient’s health and situation.

d. Resolution Phase
9. It identifies the type of service needed by the patient.

d. Resolution Phase
10. The patient feels like an integral part of the helping environment, and may make
minor requests or use attention-getting techniques.
d. Resolution Phase

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REFERENCES
Alligood, M.R., & Marriner-Tomey,A (2022) Nursing Theorist and their Work
(10th ed.) Maryland Heights, Mo. Mosby/Elsevier
Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW,
N
George B. Julia , Nursing Theories- The base for professional Nursing Practice
, 3rd ed. Norwalk, Appleton & Lange.
Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing

Philadelphia. Lippincott Williams& wilkins.
Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd
ed. Philadelphia, Lippincott.
Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.
Philadelphia, Lippincott.
Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts

Process & Practice 3rd ed. London Mosby Year Book.
Vandemark L.M. Awareness of self & expanding consciousness: using Nursing

theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-
15
Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006
Jul;19(3):225
Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd
edition, Thomson, NY, 2002.
Peplau, H. E. (1952). Interpersonal relations in nursing. In George, J. (Ed.).

Nursing theories: the base for professional nursing practice. Norwalk,
Connecticut: Appleton & Lange.
https://nursing-theory.org/theories-and-models/peplau-theory-of-
interpersonal-relations.php

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IDA JEAN ORLANDO

DELIBERATIVE NURSING PROCESS THEORY
(Week No. 11)
INTRODUCTION
One important thing that nurses do is converse with the patients and
let them know what the plan of care for the day is going to be.
However, regardless of how well thought out a nursing care plan is for
a patient, unexpected problems to the patient’s recovery may arise at
any time. With these, the job of the nurse is to know how to deal with
those problems so the patient can continue to get back and reclaim his
or her well-being. Ida Jean Orlando developed her Deliberative Nursing
Process that allows nurses to formulate an effective nursing care plan
that can also be easily adapted when and if any complexity comes up
with the patient.
Ida Jean Orlando’s nursing theory stresses the reciprocal relationship

between patient and nurse. It emphasizes the critical importance of
the patient’s participation in the nursing process. Orlando also
considered nursing as a distinct profession and separated it from
medicine where nurses as determining nursing action rather than
being prompted by physician’s orders, organizational needs and past
personal experiences. She believed that the physician’s orders are for
patients and not for nurses.
LEARNING OUTCOME
After finishing this module, the learners will be able to;

1. Define the basic concepts of the Theory of Deliberative Nursing Process.
2. Explain the concepts involved in the Theory of Deliberative Nursing
Process.
3. Appreciate the values involved and integrate it to their daily life as well
as in their related learning experience in the future.

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OUTLINE

2. Brief Description of the Deliberative Nursing Process Theory
3. Goal of developing the Deliberative Nursing Process Theory
4. Assumptions of the theory
5. Major concepts of the theory/theoretical assertions
6. Sub-concepts of the theory
7. Activity
8. Assessment
9. References
CONTENT
1. Credentials and Background

Ida Jean Orlando-Pelletier (August 12, 1926 – November 28, 2007) was an
internationally known psychiatric health nurse, theorist and researcher who
developed the “Deliberative Nursing Process Theory.” Her theory allows nurses
to create an effective nursing care plan that can also be easily adapted when
and if any complications arise with the patient.
Early Life
Ida Jean Orlando was a first generation Irish American born on August 12,
1926. She dedicated her life studying nursing and graduated in 1947 and
received a Bachelor of Science degree in public health nursing in 1951.
In 1954, she completed her Master of Arts in Mental Health consultation. While
studying she also worked intermittently and sometimes concurrently as a staff
nurse in OB, MS, ER; as a supervisor in a general hospital, and as an assistant
director and a teacher of several courses. And in 1961, she was married to
Robert Pelletier and lived in the Boston area.
Education
As for being a respectable and credible role-model, Orlando was well educated
with many advanced degrees in nursing.
In 1947, she received a diploma in nursing from the Flower Fifth Avenue
Hospital School of Nursing in New York. In 1951, she received a Bachelor of
Science degree in public health nursing from St. John’s University in Brooklyn,
New York. And in 1954, Orlando received her Master of Arts degree in mental
health consultation from Teachers College, Columbia University.
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Death
Ida Jean Orlando died on November 28, 2007 at the age of 81.
2. Brief Description of the Deliberative Nursing Process Theory

Ida Jean Orlando developed her theory from a study conducted at the Yale
University School of Nursing, integrating mental health concepts into a basic
nursing curriculum. She proposed that “patients have their own meanings and
interpretations of situations and therefore nurses must validate their inferences
and analyses with patients before drawing conclusions.”
The theory was published in The Dynamic Nurse-Patient Relationship: Function,

Process, and Principles (NLN Classics in Nursing Theory) in 1961. Her book
purposed a contribution to concern about the nurse-patient relationship, the
nurse’s professional role and identity, and the knowledge development distinct
to nursing.
3. Goal
Ida Jean Orlando’s goal is to develop a theory of effective nursing practice. The
theory explains that the role of the nurse is to find out and meet the patient’s
immediate needs for help. According to the theory, all patient behavior can be
a cry for help. Through these, the nurse’s job is to find out the nature of the
patient’s distress and provide the help he or she needs.
4. Assumptions
Ida Jean Orlando’s model of nursing makes the following assumptions:
1. When patients are unable to cope with their needs on their own, they
become distressed by feelings of helplessness.
2. In its professional character, nursing adds to the distress of the patient.
3. Patients are unique and individual in how they respond.
4. Nursing offers mothering and nursing analogous to an adult who mothers
and nurtures a child.
5. The practice of nursing deals with people, environment, and health.
6. Patients need help communicating their needs; they are uncomfortable
and ambivalent about their dependency needs.
7. People are able to be secretive or explicit about their needs, perceptions,
thoughts, and feelings.
8. The nurse-patient situation is dynamic; actions and reactions are
influenced by both the nurse and the patient.

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9. People attach meanings to situations and actions that aren’t apparent to
others.
10. Patients enter into nursing care through medicine.
11. The patient is unable to state the nature and meaning of his or her
distress without the help of the nurse, or without him or her first having
established a helpful relationship with the patient.
12. Any observation shared and observed with the patient is
immediately helpful in ascertaining and meeting his or her need, or
finding out that he or she is not in need at that time.
13. Nurses are concerned with the needs the patient is unable to meet
on his or her own.
5. Major Concepts
The nursing metaparadigm consists of four concepts: person, environment,
health, and nursing. Of the four concepts, Ida Jean Orlando only included three
in her theory of Nursing Process Discipline: person, health, and nursing.
a. Human Being
Orlando uses the concept of human as she emphasizes individuality and the
dynamic nature of the nurse-patient relationship. For her, humans in need are
the focus of nursing practice.
b. Health
In Orlando’s theory, health is replaced by a sense of helplessness as the
initiator of a necessity for nursing. She stated that nursing deals with
individuals who are in need of help.
c. Environment
Orlando completely disregarded environment in her theory, only focusing on
the immediate need of the patient, chiefly the relationship and actions between
the nurse and the patient (only an individual in her theory; no families or
groups were mentioned). The effect that the environment could have on the
patient was never mentioned in Orlando’s theory.
d. Nursing
Orlando speaks of nursing as unique and independent in its concerns for an
individual’s need for help in an immediate situation. The efforts to meet the
individual’s need for help are carried out in an interactive situation and in a
disciplined manner that requires proper training.

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6. Subconcepts
Ida Jean Orlando described her model as revolving around the following five
major interrelated concepts: the function of professional nursing, presenting
behavior, immediate reaction, nursing process discipline, and improvement.
a. Function of Professional Nursing

The function of professional nursing is the organizing principle. This means
finding out and meeting the patient’s immediate needs for help. According to
Orlando, nursing is responsive to individuals who suffer, or who anticipate a
sense of helplessness. It is focused on the process of care in an immediate
experience, and is concerned with providing direct assistance to a patient in
whatever setting they are found in for the purpose of avoiding, relieving,
diminishing, or curing the sense of helplessness in the patient. The Nursing
Process Discipline Theory labels the purpose of nursing to supply the help a
patient needs for his or her needs to be met. That is, if the patient has an
immediate need for help, and the nurse discovers and meets that need, the
purpose of nursing has been achieved.
b. Presenting Behavior
Presenting behavior is the patient’s problematic situation. Through the
presenting behavior, the nurse finds the patient’s immediate need for help. To
do this, the nurse must first recognize the situation as problematic. Regardless
of how the presenting behavior appears, it may represent a cry for help from
the patient. The presenting behavior of the patient, which is considered the
stimulus, causes an automatic internal response in the nurse, which in turn
causes a response in the patient. The patient’s behavior reflects distress when
the patient experiences a need that he cannot resolve, a sense of helplessness
occurs.
c. Immediate Reaction
The immediate reaction is the internal response. The patient perceives objects
with his or her five senses. These perceptions stimulate automatic thought, and
each thought stimulates an automatic feeling, causing the patient to act. These
three items are the patient’s immediate response. The immediate response
reflects how the nurse experiences his or her participation in the nurse-patient
relationship.
Nurse Reaction
The patient behavior stimulated a nurse reaction, which marks the beginning
of the nursing process discipline.

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Nurse’s Action
When the nurse acts, an action process transpires. This action process by the
nurse in a nurse-patient contact is called nursing process. The nurse’s action
may be automatic or deliberative.
Automatic Nursing Actions are nursing actions decided upon for

reasons other than the patient’s immediate need.
Deliberative Nursing Actions are actions decided upon after
ascertaining a need and then meeting this need
The following list identifies the criteria for deliberative actions:

Deliberative actions result from the correct identification of patient needs by
validation of the nurse’s reaction to patient behavior. The nurse explores the
meaning of the action with the patient and its relevance to meeting his need.
The nurse validates the action’s effectiveness immediately after completing it.
The nurse is free of stimuli unrelated to the patient’s need when she acts.
d. Nursing Process Discipline

The nursing process discipline is the investigation into the patient’s needs. Any
observation shared and explored with the patient is immediately useful in
ascertaining and meeting his or her need, or finding out he or she has no needs
at that time. The nurse cannot assume that any aspect of his or her reaction
to the patient is correct, helpful, or appropriate until he or she checks the
validity of it by exploring it with the patient. The nurse initiates this exploration
to determine how the patient is affected by what he or she says and does.
Automatic reactions are ineffective because the nurse’s action is determined
for reasons other than the meaning of the patient’s behavior or the patient’s
immediate need for help. When the nurse doesn’t explore the patient’s reaction
with him
or her, it is reasonably certain that effective communication between nurse and
patient stops.
The nurse decides on an appropriate action to resolve the need in cooperation

with the patient. This action is evaluated after it is carried out. If the patient
behavior improves, the action was successful and the process is completed. If
there is no change or the behavior gets worse, the process recycles with new
efforts to clarify the patient’s behavior or the appropriate nursing action.
The action process in a person-to-person contact functioning in secret. The

perceptions, thoughts, and feelings of each individual are not directly available
to the perception of the other individual through the observable action.

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e. Improvement
Improvement is the resolution to the patient’s situation. In the resolution, the
nurse’s actions are not evaluated. Instead, the result of his or her actions are
evaluated to determine whether his or her actions served to help the patient
communicate his or her need for help and how it was met. In each contact,
the nurse repeats a process of learning how he or she can help the patient.
The nurse’s own individuality, as well as that of the patient, requires going
through this each time the nurse is called upon to render service to those
who need him or her.
5 Stages of the Deliberative Nursing Process

The Deliberative Nursing Process has five stages: assessment, diagnosis,
planning, implementation, and evaluation.
Assessment
In the assessment stage, the nurse completes a holistic assessment of the
patient’s needs. This is done without taking the reason for the encounter into
consideration. The nurse uses a nursing framework to collect both subjective
and objective data about the patient.
Diagnosis
The diagnosis stage uses the nurse’s clinical judgment about health problems.
The diagnosis can then be confirmed using links to defining characteristics,
related factors, and risk factors found in the patient’s assessment.
Planning
The planning stage addresses each of the problems identified in the diagnosis.
Each problem is given a specific goal or outcome, and each goal or outcome is
given nursing interventions to help achieve the goal. By the end of this stage,
the nurse will have a nursing care plan.
Implementation
In the implementation stage, the nurse begins using the nursing care plan.
Evaluation
Finally, in the evaluation stage, the nurse looks at the progress of the patient
toward the goals set in the nursing care plan. Changes can be made to the
nursing care plan based on how well (or poorly) the patient is progressing
toward the goals. If any new problems are identified in the evaluation stage,
they can be addressed, and the process starts over again for those specific
problems.

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AXTIVITY
Based from the readings above as well as your understanding of the theory of
Deliberative Nursing Process, provide one strength and one weakness of the
theory. Be able to discuss each in at least 5-10 sentences. Please do not forget
to include your readings and references.

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REFERENCES
Alligood, M. R., & Marriner-Tomey, A. (2022). Nursing theorists and their work (10th
ed.). Maryland Heights, Mo.: Mosby/Elsevier.
George, Julia. (2002). Theories in Nursing: The Base for Professional Nursing
Practice. Pearson Education South Asia Pte Lt.
McEwen and Wills. (2019) Theoretical Basis for Nursing (5 th ed.). Lippincott.Williams
& Wilkins.
Orlando, I. J. (1990). The dynamic nurse-patient relationship: function,

process, and principles (Pub. No. 15-2341). New York: National League for
Nursing. Orlando interview: Nursing process discipline. In Nurse theorists:
Portraits of excellence, Volume (video). Athens, (OH): Fitne.
Kaplan, D., & King, C. (2000). Guide to the Ernestine Wiedenbach papers.
Retrieved from: http://hdl.handle.net/10079/fa/mssa.ms.1647.
May, B. A. (2010). Orlando’s nursing process theory and nursing practice. In

M. R. Alligood (Ed.), Nursing theory: Utilization & application (4th ed., pp. 337–
357). Maryland Heights, (MO): Mosby-Elsevier. 56 UNIT I Evolution of Nursing
Theories
https://nurseslabs.com/ida-jean-orlandos-deliberative-nursing-process-
theory/
https://www.nursing-theory.org/nursing-theorists/Ida-Jean-Orlando.php

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TRAVELBEE’S HUMAN TO HUMAN

RELATIONSHIP MODEL
(Week No. 12)
INTRODUCTION
Joyce Travelbee believed that everything the nurse (as a human) said or did
with an ill person (as a human) helped to fulfil the purpose of nursing. The
nurse and the patient are human beings, relating to each other. The process is
that of interaction. Nursing is an interpersonal connection, whereby the nurse
facilitates the progress of a patient, a family, or a community in preventing or
coping with an illness or with suffering in ways that could lead to finding
meaning with the experience. The nurse is responsible for educating and
providing strategies to assist the patient in avoiding or alleviating the distress
of unmet needs (Pokorny, 2010; Travelbee, 1971).
The purpose of nursing was to help and support an individual, family, or

community to prevent or cope with the struggles of illness and suffering and,
if necessary, to find significance in these occurrences, with the ultimate goal
being the presence of hope. Nursing was accomplished through human-to-
human relationships. Extended the interpersonal relationship theories of Peplau
and Orlando.
Travelbee believed nursing is accomplished through human-to-human

relationships that begin with the original encounter and then progress through
stages of emerging identities, developing feelings of empathy, and later
feelings of sympathy.
LEARNING OUTCOME
After finishing this module, the student will be able to:
1. Demonstrate comprehensive understanding in Travelbee’s human to

human relationship model
2. Explain the Concept of Travelbee’s human to human relationship model
3. Define the metaparadigm of Travelbee’s human to human relationship
model in relations to nursing practice

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OUTLINE

2. Definition of patient, illness and communication.
3. Interactional Phases of Human-to-Human Relationship Model:
4. Major Assumptions
5. Theoretical Assertions
a. Nursing
b. Health
c. Environment
d. Person
6. Activity
7. References
CONTENT
Credentials and Background of the Theorist
Joyce Travelbee is a psychiatric nurse, educator and writer born in 1926. She
completed her BSN degree at Louisiana State University in 1956. And
continued graduate studies of Master of Science Degree in Nursing at Yale
University in 1959. She is a Psychiatric Nursing Instructor at Depaul Hospital
Affiliate School, New Orleans. Later in Charity Hospital School of Nursing in
Louisiana State University, New York University and University of Mississippi.
She developed the Human-to-Human Relationship Model presented in her
book Interpersonal Aspects of Nursing. She dealt with the interpersonal
aspects of nursing.
Her first publication is entitled Interpersonal Aspects of Nursing and her
second book is Intervention in Psychiatric Nursing: Process in the One-to-One
Relationship in 1969.
The assumptions of the model are based on Soren Kierkegaard’s philosophy
of existentialism and Viktor Frankl’s logo therapy. Existentialism places the
accountability for people’s choices in life on the people who make those
choices. Logo therapy, which was first proposed in Frankl’s Man’s Searching
for meaning (1963), is a form of psychotherapy that makes the assumption
that fulfilment is the best protection against emotional instability.
The concept of patient is a stereotype and category. Travelbee, 1971
impresses upon nurses that "actually there are no patients. There are only
individual human beings in need of care, services and assistance of other
human beings". And since nurses are human beings, Travelbee, 1971 notes:
"All assumptions about being human therefore apply to every human being
categorized as nurse"

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Concepts and definitions
Travelbee expresses the importance for nurses to understand their concept of

what is human, for their relationship with another human being will be
otherwise determined by that concept. The human being is defined by
Travelbee, 1971 as "a unique irreplaceable individual—a one-time being in
this world, like yet unlike any person who ever lived or ever will live.
• Patient is a stereotype and category. Travelbee, 1971 impresses upon

nurses that "actually there are no patients. There are only individual
human beings in need of care, services and assistance of other human
beings"
• Illness is a classification and category. An individual will react to illness
depending on culture, symptom burden, and whether there is a related
significance to those symptoms. Depending on the impairment of
functioning as well as the health-care provider’s responses, a human
connection that fosters understanding of the illness is developed
(Travelbee, 1971). "It is probable that the more an individual cares for,
and about others, the greater the possibilities of suffering". Hope is
future oriented. Without hope, there is no direction for lessening
suffering.
• Communication is a necessity for good nursing and a fundamental
part of this theory. Travelbee (1971) expresses striving to communicate
"to know ill persons, to ascertain and meet nursing needs and to
achieve the purpose of nursing
Interactional Phases of Human-to-Human Relationship Model:
1. Original Encounter
• First impression by the nurse of the sick person and vice-versa.
• Stereotyped or traditional roles
2. Emerging Identities
• the time when relationship begins
• the nurse and patient perceive each other’s uniqueness
3. Empathy
• the ability to share in the person’s experience

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4. Sympathy
• when the nurse wants to lessen the cause of patient’s suffering.
• it goes beyond empathy— “When one sympathizes, one is involved but
not incapacitated by the involvement.” therapeutic use of self
5. Rapport
• Rapport is described as nursing interventions that lessens the patient’s
suffering.
• Relation as human being to human being
• “A nurse is able to establish rapport because she possesses the necessary
knowledge and skills required to assist ill persons and because she is able
to perceive, respond to and appreciate the uniqueness of the ill human
being.”
MAJOR ASSUMPTIONS
Travelbee’s describes assumptions for human to human relationship model
1. The nurse and patient relationship are the objective of nursing

Individuals are social and rational, and are more different than they are alike
(Travelbee, 1966)
2. Human beings endure experiences and will seek meaning in these
experiences. Similarities between individuals are shown through their
experiences
3. Nurses must remember that patients are human beings and to not evoke
stereotypes.
4. Only when the nurse and patient understand each other's uniqueness can a
relationship be established (Meleis, 2007); (Travelbee, 1966)
THEORETICAL ASSERTIONS
• Person
Person is defined as being human. Nurse as well as patient, family, or
community under the umbrella of illness is human. "A person is a
contingent being to whom things happen which are beyond his control.
The person suffers and chooses. Human beings are unique,
irreplaceable, ever evolving, and interacting (Travelbee, 1971, 2013).

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• Health
Health is subjective and objective. Subjective health is an
individually defined state of wellbeing in accord with self-appraisal of
physical-emotional-spiritual status. Objective health is an absence of
discernible disease, disability of defect as measured by physical
examination, laboratory tests and assessment by spiritual director or
psychological counselor. Travelbee (1971) wrote: "A basic assumption
is that illness and suffering are spiritual encounters as well as
emotional-physical experiences"
• Environment
Travelbee relates that the nurse must be observant of the patient in
the place where the patient is present in order to ascertain that the
patient is in need. She speaks of experiences encountered by all
humans: suffering, pain, illness, and hope. Her work with psychiatric
patients and community as well as hospitalized individuals encompass
an awareness of differing environments (Travelbee, 1971, 2013;
Doona, 1979).
• Nursing
"an interpersonal process whereby the professional nurse
practitioner assists an individual, family or community to prevent
or cope with experience or illness and suffering, and if necessary,
to find meaning in these experiences.” The final measure of
nursing competency is always in terms of the extent to which
individuals and families have been assisted with the problems of
illness and suffering.

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ACTIVITY
Instruction: On the space provided below illustrate or explain your

understanding of the difference between EMPATHY and SYMPATHY

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REFERENCES
Alligood, M. R., & Marriner-Tomey, A. (2022). Nursing theorists and their

work (10th ed.). Maryland Heights, Mo.: Mosby/Elsevier.
McEwen and Wills. (2019) Theoretical Basis for Nursing (5th ed.).
Lippincott.Williams & Wilkins.
Sheton, G. (2016). Appraising Travelbee human to human relationship model.

Journal list J. Acty Pract oncol.v.7(6)
Travelbee, J. Interpersonal aspects of nursing. 2nd ed. Philadelphia, PA:
F.A. Davis Company.; 1971.
Travelbee J. Human-to-human relationship model. 2013 Retrieved from
http://currentnursing.com/nursing_theory/Joyce_Travelbee.html.

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MADELEINE LEININGER’S THEORY OF

TRANSCULTURAL NURSING
(Week No.12)
INTRODUCTION
Transcultural nursing has been integrated into modern nursing education due to the
increased heterogeneity of patient populations. As more people from a variety of cultures and
with a variety of ethnicities now utilize healthcare facilities, nurses need to be aware of their
varying perceptions and levels of tolerance for healthcare. This situation can lead to departures
from the practice norms that would otherwise direct patient care, thus opening up a wide array
of options regarding treatments and follow-ups. Decision-making in patient care involves many
important considerations, including patients' attitudes and how they will react to treatment
advice (Albougami etal. 2016)
Leininger’s Transcultural Theory is for nursing care to have beneficial meaning and health
outcomes for people of different or similar cultural backgrounds. This module focuses on the
discussion of the Transcultural theory of Leininger for the student nurses to be aware to the
cultural needs of clients, relevant to understand the social and cultural reality of the client,
family, and community.
LEARNING OUTCOME
After finishing this module the student will be able to:

1. Know the purpose of the theory
2. Define key terms
3. Explain the Concept of Leininger’s theory of Transcultural Nursing
4. Understand the concept of culture
Far Eastern University 1

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OUTLINE
2. Definition of terms
a. Nursing
b. Health
c. Environment
d. Person
5. Activity
6. Assessment
7. References
CONTENT
Madeleine Leininger was born on July 13, 1925 in Sutton, Nebraska. She lived in a farm with
her four brothers and sisters and graduated from Sutton High School. After graduation from
Sutton High she was in the U.S. Army Nursing Corps while pursuing a basic nursing program.
It was due to her aunt who suffered from congenital heart disease that led her to pursue a
career in nursing.
In 1945, Madeleine Leininger, together with her sister, entered the Cadet Nurse Corps which is a federally-
funded program to increase the numbers of nurses being trained to meet anticipated needs during World
War II.
She earned a nursing diploma from St. Anthony’s Hospital School of Nursing, followed by undergraduate
degrees at Mount St. Scholastica College and Creighton University. Leininger opened a psychiatric nursing
service and educational program at Creighton University in Omaha, Nebraska. She earned the equivalent of

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a BSN through her studies in biological sciences, nursing administration, teaching and curriculum during
1951-1954. She received a Master of Science in Nursing at Catholic University of America in 1954.
In 1965, Leininger embarked upon a doctoral program in Cultural and Social Anthropology at the University
of Washington in Seattle and became the first professional nurse to earn a PhD in anthropology.
Madeleine Leininger was an internationally known educator, author, theorist, administrator, researcher,
consultant, public speaker and the developer of the concept of transcultural nursing that has a great impact
on how to deal with patients of different culture and cultural background.
She is a Certified Transcultural Nurse, a Fellow of the Royal College of Nursing in Australia, and a Fellow of
the American Academy of Nursing. Her theory is now a nursing discipline that is an integral part of how
nurses practice in the healthcare field today.
Purpose of the Transcultural Nursing Theory
• The central purpose of the theory is to discover and explain diverse and universally culturally based
care factors influencing health, well-being, illness, or death of individual or groups.
• This theory could also be used in research studies, in order to provide culturally congruent, safe, and
meaningful care to clients of diverse or similar cultures.
MAJOR CONCEPTS AND DEFINITIONS
Definition
1. Transcultural Nursing a learned subfield or branch of nursing which focuses upon the
comparative study and analysis of cultures with respect to nursing and
health-illness caring practices, beliefs, and values with the goal to
provide meaningful and efficacious nursing care services to people

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according to their cultural values and health-illness context.

Transpersonal caring relationships are a spiritual union. Sitzman (2007)
describe the relationship as a "connection that embraces the spirit or
soul of the other through the process of full, authentic, caring/healing
attention in the moment. Nurses who practice transpersonal caring show
a genuine desire to be present and centered in their interactions with
their patients.
2. Ethnonursing This is the study of nursing care beliefs, values, and practices as
cognitively perceived and known by a designated culture through their
direct experience, beliefs, and value system (Leininger, 1979).
3. Professional Nursing Formal and cognitively learned professional care knowledge and practice
Care skills obtained through educational institutions that are used to provide
assistive, supportive, enabling, or facilitative acts to or for another
individual or group in order to improve a human health condition (or
well-being), disability, lifeway, or to work with dying clients.
4. Cultural and Social This involves dynamic patterns and features of interrelated structural
Structure Dimension and organizational factors of a particular culture (subculture or society)
which includes religious, kinship (social), political (and legal), economic,
educational, technological and cultural values, ethnohistorical factors,
and how these factors may be interrelated and function to influence
human behavior in different environmental contexts.
5. Traditional Concepts of Be aware that health concepts held by many cultural groups may result
Health and Disease in people choosing not to seek Western medical treatment procedures
because they do not view the illness or disease as coming from within
themselves.
In Eastern cultures and other cultures in the developing world, the focus
of control for disease causality often is centered outside the individual,
whereas in Western cultures, the focus of control tends to more internally
oriented.

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Recognize the need to be more flexible in the design programs, policies,

and services to meet the needs and concerns of the culturally diverse
population, groups that are likely to be encountered.
6. Care Refers to assisting, supporting, enabling behaviors that ease or improve
a person’s condition.
Essential for a person’s survival, development, and ability to deal with
life’s events.
7. Cultural Care The values and beliefs that assist, support, or enable another person or
group to maintain well-being, improve personal condition, or face death
or disability.
8. World view Refers to the outlook of a person based on a view of the world or
universe.
9. Folk health or Well being Refers to care or care practices that have special meaning in the culture.
System
10. Traditional Concepts of Be aware that folk illnesses are generally learned syndromes that
Illness Causality individuals from particular cultural groups claim to have and from which
their culture defines etiology, behaviors, diagnostic procedures,
prevention methods, and traditional healing or caring practices.
11. Concept of Culture This is learned by each generation through both formal and informal
life experiences.
12. Cultural Awareness It is an in-depth examination of one’s own background, recognizing
biases and prejudices, and assumptions about other people.

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Major Concepts
Leininger (1991) identified three nursing decision and action models to

achieve cultural congruent care. All the models of professional decisions and
actions are aimed to assist, support, or enable people of particular cultures.
3 Models for Congruent Decisions and Actions
1. Cultural preservation or maintenance. Retain and or preserve

relevant care values so that clients can maintain their well-being, recover
from illness, or face handicaps and/or death.
2. Cultural care accommodation or negotiation. Adapt/negotiate with

others for a beneficial or satisfying health outcome.
3. Cultural care repatterning or restructuring. Change or greatly

modify client’s life ways for a new, different and beneficial health care
pattern.
Concepts..
• Illness and wellness are shaped by a various factors including
perception and coping skills, as well as the social level of the patient.
• Cultural competence is an important component of nursing.
• Culture influences all spheres of human life. It defines health, illness,

and the search for relief from disease or distress.
• Religious and Cultural knowledge is an important ingredient in health

care.
• The health concepts held by many cultural groups may result in people
choosing not to seek modern medical treatment procedures.
• Health care provider need to be flexible in the design of programs,

policies, and services to meet the needs and concerns of the culturally
diverse population, groups that are likely to be encountered.
• Most cases of lay illness have multiple causalities and may require
several different approaches to diagnosis, treatment, and cure including
folk and Western medical interventions..
• The use of traditional or alternate models of health care delivery is

widely varied and may come into conflict with Western models of health
care practice.
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• Culture guides behavior into acceptable ways for the people in a specific
group as such culture originates and develops within the social
structure through interpersonal interactions.
• For a nurse to successfully provide care for a client of a different

cultural or ethnic to background, effective intercultural communication
must take place.
The Sunrise Model of Madeleine Leininger’s Theory
The Sunrise Model enables

nurses to develop critical and
complex thoughts towards
nursing practice. These
thoughts should consider, and
integrate, cultural and social
structure dimensions in each
specific context, besides the
biological and psychological
aspects involved in nursing
care.
In this model, the goal of the

nurse is to render efficient and
effective nursing care.
Leininger’s model of cultural
care can be viewed as the rising
sun. The model reflects
influences of one’s worldview
on cultural and structure
dimensions. The cultural and
social structure dimensions
include technological, religious,
philosophic, kinship, social,
value and lifeway, political,
legal, economic, and
educational factors. Each of
these identified systems affects
health. These cultural and
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social structure dimensions in turn influences environment and language,
wherein emphasis should be placed since this is where the patient/client find
themselves such as home conditions, access to particular types of food and
family access to transport. Environment and language influence the involved
health systems – the folk, professional and nursing systems. The folk health
system includes the traditional beliefs and practices on health care while the
professional health systems are those practices. This knowledge provides
culturally specific meanings and expressions in relation to care and health. The
next focus is on the generic or folk system, professional care systems, and
nursing care. Information about these systems includes the characteristics and
the specific care features of each. The combination of the folk health system
and the professional health system meets the biological, psychosocial, and
cultural health needs of the patient/client. This information allows for the
identification of similarities and differences or cultural care universality and
cultural care diversity. It is followed by nursing care decisions and actions
which involve cultural care preservation or maintenance, cultural care
accommodation or negotiation and cultural care repatterning or restructuring.
It is here that nursing care is delivered.
THEORETICAL ASSERTIONS
NURSING
Learned humanistic and scientific profession and discipline which is
focused on human care phenomena and activities in order to assist,
support, facilitate, or enable individuals or groups to maintain or regain
their well-being (or health) in culturally meaningful and beneficial ways,
or to help people face handicaps or death.
PERSON
1. Referred to as human being
2. Believed to be caring and to be capable of being concerned about the

needs, well-being, and survival of others. Leininger also indicates that
nursing as a caring science should focus beyond traditional nurse-patient
interactions and dyads to include families, groups, communities, total
cultures, and institutions.

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HEALTH
1. It is a state of well-being that is culturally defined, valued, and practiced,

and which reflects the ability of individuals (or groups) to perform their
daily role activities in culturally expressed, beneficial, and patterned
lifeways.
ENVIRONMENT
1. This is not specifically defined by Leininger.
2. The concepts of worldview, social structure, and environmental context

are discussed.
3. It is closely related to the concept of culture.
Refer to the links below on Leininger’s interview on the importance of

transcultural nursing:
https://www.youtube.com/watch?v=a4GTo_uthZQ
https://www.youtube.com/watch?v=6xchWCgeMM4

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REFERENCES
Alligood, M. R., & Marriner-Tomey, A. (2022). Nursing theorists and their

work (10th ed.). Maryland Heights, Mo.: Mosby/Elsevier.
Quimbao-Udan, J. (2020). Theoretical Foundation in Nursing 2nd Ed. APD

Publishing House

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NOLA PENDER’S HEALTH PROMOTION MODEL

OF NURSING
(Week No. 13)
INTRODUCTION
The concept of health promotion is necessary in disease prevention and in nursing

practice. Health care providers share a common goal of improving the health and well-
being of the clients. Pender’s Health Promotion Model serves as a guide for nurses to
plan for behavior modification interventions for the improvement of the client’s health
condition.
The purpose of this model is to assist the nurse in understanding the determinant of
health behavior based as basis for behavioral counseling to promote health lifestyles
(Pender, 2011).
LEARNING OUTCOME

1. Discuss the concept of Nola Pender on Health Promotional Model of Nursing.
2. Understand the significance of the Health Promotional Model of Nola Pender.
3. Discuss the function of the Health Promotion Model (HPM) in Nursing
OUTLINE

2. Features of HPM of Nursing
a. Nursing
b. Health
c. Environment
d. Person
5. Activity
6. References
CONTENT
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Nola Pender attended Michigan State University to earn her Bachelor

and Master’s degrees in 1964 and 1965, respectively. Sher earned her
PhD. from Northwestern University in 1969.
She received a Lifetime Achievement Award from the Midwest Nursing

Research Society in 2005. She was awarded an honorary Doctorate of
Science degree in 1992 from Widener University. She was given a Distinguished
Alumni Award from the Michigan State University School of Nursing in 1972. She has
many publications in a variety of texts and journals, including six editions of Health
Promotion in Nursing Practice (6th edition).
Nola Pender has served as a member of organizations. She is also a co-founder of the
Midwest Nursing Research Society, and currently serves as a trustee. She is currently
a Professor Emerita in the Division of Health Promotion and Risk Reduction at the
University of Michigan School of Nursing, and serves as a Distinguished Professor at
Loyola University Chicago’s School of Nursing. Currently, she is already retired and
spends her time consulting on health promotion research nationally and
internationally.
Purpose of Health Promotion Model of Nursing (HPM)
• The purpose of this model is not merely to cure a disease but to promote
healthy lifestyle and choices that affect the health of individuals.
• This model would convey the self-determining quality of an individual. Health
is a dynamic process, whereas, the individual is posited in this model as
“being” healthy, “living” it, rather than health as a static state.
• Offer framework on promoting health to rationalize research studies.
Definition of Health Promotion Model of Nursing (HPM)
The Health Promotion Model defines health as positive dynamic state rather than
simply the absence of disease. Health promotion is directed at increasing a client’s
level of well-being. The HPM describes the multidimensional nature of persons as they
interact with their environment to pursue health.
The Health Promotion Model
Nola Pender has developed a rational-choice model of healthcare. This is not really a
nursing theory per se, but a psychological look at how human beings perceive
themselves, their health, and their ability to change their lifestyles to promote health.
Thus, Pender’s model is normally called the “ Health Promotion Model” of nursing.

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THEORETICAL FOUNDATIONS IN NURSING The

Major Concepts and Definitions Health Promotion Model
• Individual characteristics and experiences includes personal factors such

as a)prior related behavior, b) personal factors ie. biologic, psychological, and
socio-cultural factors.
• Behavior-specific cognitions and affect include perceived barriers to
action, perceived self-efficacy, activity related affect, interpersonal influences,
and situational influences.
• Behavioral outcome are commitment to action plan, and immediate
competing deman and preferences.
Definition
1. Personal Factors Personal factors are categorized as biological,
psychological, and socio-cultural. These factors are
predictive of a given behavior and shaped by the
nature of the target behavior.
2. Personal Include variables such as age, gender, body mass
biological factors index, pubertal status, aerobic capacity, strength,
agility, or balance.
3. Personal Include variables such as self-esteem, self-
psychological motivation, personal competence, perceived health
factors status, and definition of health.
4. Personal socio- Include variables such as race, ethnicity, socio-
cultural factors culturation, education, and socio-economic status.
Behavior specific cognition and affect.
5. Perceived Anticipated, positive outcomes that will occur from
Benefits of Action health behavior.
6. Perceived Barriers Anticipated, imagined or real blocks and personal
to Action costs of understanding a given behavior.
7. Perceived Self Judgment of personal capacity to organize and
Efficacy execute a health-promoting behavior. Perceived self
efficacy influences perceived barriers to action so
higher efficacy result in lowered perception of barriers
to the performance of the behavior.
8. Activity Related Subjective positive or negative feeling that occurs
Affect before, during, and following behavior based on the
stimulus properties of the behavior itself. Activity
related affect influences perceived self efficacy,
which, means the more positive the subjective feeling
the greater the feeling of efficacy. In turn, increased
feelings of efficacy can generate further positive
effect.
9. Interpersonal Cognition concerning behaviors, beliefs, or attitudes
Influences of the others. Interpersonal influences include norms
(expectations of significant other), social support
(instrumental and emotional encouragement), and
modeling (various learning through observing others
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engaged in a particular behavior). Primary sources of
interpersonal influence are families, peers, and
healthcare providers.
10. Situational Personal perceptions and cognition of any given
Influences situation or context that can facilitate or impede
behavior. Include perception of options available,
demand characteristics and aesthetic features of the
environment in which given health promoting is
proposed to take place. Situational influences may
have direct or indirect influences on health behavior.
11. Behavioral The concept of intention and identification of a
Outcomes planned strategy leads to implementation of health
Commitment to behavior.
Plan of Action
12. Immediate Competing demands are those alternative behaviors
Competing over which individuals have low control because there
Demand and are environmental contingencies such as work or
Preferences family care responsibilities. Competing preferences
are alternative behavior over which individuals exert
relatively high control over things.
Assumptions of the Health Promotion Model
1. Individual seek to actively regulate their own behavior.
2. Individuals in all their biopsychosocial complexity interact with the environment,

progressively transforming the environment and being transformed over time.
3. Health professionals constitute a part of the interpersonal environment, which

exerts influence on persons throughout their lifespan.
4. Self-initiated reconfiguration of person-environment interactive patterns is

essential to behavior change.

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Revised HPM (From Pender, NJ (2002). Health Promotion in Nursing Practice, 4 th Ed.
Murdaugh, C.L. & Pasons, MA.
Pender’s model focuses on three areas: individual characteristics and

experiences, behavior-specific cognitions and affect, and behavioral outcomes.
The theory notes that each person has unique personal characteristics and
experiences that affect subsequent actions. The set of variables for behavior
specific knowledge and affect have important motivational significance. The
variables can be modified through nursing actions. Health promoting behavior
is the desired behavioral outcome, which makes it the end point in the Health
Promotion Model. These behaviors should result in improved health, enhanced
functional ability and better quality of life at all stages of development. The final
behavioral demand is also influenced by the immediate competing demand and
preferences, which can derail intended actions for promoting health.

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THEORETICAL PROPOSITION OF THE HEALTH PROMOTION MODEL
Theoretical statements derived from the model provide a basis for investigative
work on health behaviors. The HPM is based on the following theoretical
proposition:
1. Prior behavior and inherited and acquired characteristics influence beliefs,

effect, and enactment of health-promoting behavior.
2. Persons commit to engaging in behaviors from which they anticipate deriving
personally valued benefits.
3. Perceived barriers can constrain commitment to action, a mediator of behavior
as well as actual behavior.
4. Perceived competence of self efficacy to execute a given behavior increases the
likelihood of commitment to action and actual performance of the behavior.
5. Greater perceived self-efficacy results in fewer perceived barriers to specific
health behavior.
6. Positive affect toward a behavior results in greater perceived self-efficacy, which
can in turn, result in increased positive effect.
7. When positive emotions are associated with a behavior, the probability of
commitment and action is increased.
8. Persons are more likely to commit to and engage in health-promoting behaviors
when significant others model the behavior, expect the behavior to occur, and
provide assistance and support to enable behavior.
9. Families, peers, and health care providers are important sources of
interpersonal influence that can increase/decrease commitment to and
engagement in health promoting behavior.
10.Situational influences in the external environment can increase/decrease
commitment/participation in health promoting behavior.
11.The greater the commitments to a specific plan of action, the more likely health
promoting behaviors are maintained over time.
12.Commitment to a plan of action is less likely to result in the desired behavior
when competing demands over which persons have little control require
immediate attention.
13.Commitment to a plan pf action is less like to result in the desired behavior
when competing behavior/actions are more attractive and thus preferred over
the target behavior.
14.Persons can modify cognitions, affect, and the interpersonal and physical
environment to create incentives for health actions.

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ACTIVITY
Instruction: Answer the question as directed and write your answer on the space
provided below.
Question/Direction: Ask your mother/father/guardian to identify two health

concerns that they would like to improve/resolve. Recommend two health
promoting activities for each health concern. Indicate your Reference(s) on
the said activities
Source of Information: Mommy/Daddy/Guardian - ____________________
Health Concerns Health Promoting Activities

1. 1
2. 1
REFERENCES for Health Promoting Activities

___________________________________________________________________
_______________________________________________________
___________________________________________________________________
_______________________________________________________

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REFERENCES
Alligood, M. R., & Marriner-Tomey, A. (2022). Nursing theorists and their work (10th
ed.). Maryland Heights, Mo.: Mosby/Elsevier.
McEwen and Wills. (2019) Theoretical Basis for Nursing (5 th ed.). Lippincott.Williams
& Wilkins.
Sitzman and Eichelberger. (2017). Understanding the Work of Nurse Theorists: A

Creative Beginning (3rd ed.). Jones & Bartlett Learning, LLC, an Ascend Learning
Company.

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LOCAL NURSING THEORIES

(Week No. 14)
INTRODUCTION
In general, nursing theory describes and explains the phenomena of interest to nursing in a systematic way
in order to provide understanding for use in nursing practice and research. However, in the Philippines
theories are less abstract than conceptual models or systems, although they vary in scope and levels of
abstraction. Nursing practice theory has the most limited scope and level of abstraction and is developed
for use within a specific range of nursing situations. Theories developed at this level have a more direct
impact on nursing practice than do theories that are more abstract.
Nursing practice theories provide frameworks for nursing interventions, and predict outcomes and the
impact of nursing practice. At the same time, nursing questions, actions, and procedures may be described
or developed as nursing practice theories. Ideally, nursing practice theories are interrelated with concepts
from middle-range theories, or may be deduced from theories at the middle range.
LEARNING OUTCOME

1. Determine different Local Nursing Theories with their Conceptual Model
2. Define the metaparadigm of each identified local nursing theorist
3. Inculcate their works as an essential part of nursing practice.

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OUTLINE
2. Conceptual Model
3. Metaparadigm
5. Activity
6. References
CONTENT
A. Carmencita Abaquin
PREPARE ME” Interventions & the Quality of Life of Advance Progressive Cancer Patients
• Obtained her Master’s Degree in Nursing from the University of the Philippines College of Nursing.
• An expert in Medical Surgical Nursing with subspecialty in Oncologic Nursing, which made her known
both here and abroad
• She had served the University of the Philippines College of Nursing, as faculty and held the position
as Secretary of the College of Nursing.
o Being appointed as Chairman of the Board of Nursing speaks of her

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CONCEPTTUAL MODEL
Nursing Interventions
“Prepare Me”
Presence
Reminisce Therapy
Prayer
Relaxation-Breathing SYMPTOMS
Meditation
RELIEF QUALITY
:
Terminally ill Patients (Cancer) OF LIFE
Physical
Psychological
Social
Religious
Level of Independence

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4
Meaning of theory
1. Terminally-ill patients especially cancer patients require holistic approach of nursing in different aspects
of man namely the emotional, psychological, social and spiritual. In this premise, patients with incurable
disease require multidimensional nursing care to improve quality of life.
2. PREPARE ME nursing interventions are effective in improving quality of life in terminally-ill patients.
3. Utilization of intervention as a basic part of care given to cancer patients, likewise, incorporation in the
basic nursing curriculum in the care of these patients. PREPARE ME must be introduced and focus during
training of nurse both in academe and practice.
4. Development of training programs for care provider as well as health care profession where intervention
is a part of treatment modalities.
5. The nurse must be honest about the feedback on his/her condition. Nurses must do this so that they
would know what the expectations of the patient and the family so that they may render a holistic caring
style for the patient together with his family in his dying days. This would help the patient and family address
the needs of the patient in any manner possible. (physical, emotional and spiritual)
6. The nurse must help make a supportive environment for the patient and his family in his dying days. An
environment like this would promote dignity in his days left thus helping the patient accept his fate and help
him/her be ready for the afterlife. The family is also guided in this rough time addressing their grieving
process by instilling in them that death is part of life.
B. DR. ARACELI O. BALABAGNO (FEU)

"Functional Health Performances Outcomes of Compliance to Home Instruction Program
after Infarction."
• The home instruction program and scheduled home visits were prescribed to address the client's
needs. The intervention was based on the concepts of interaction, goal setting and information support.
"A Nursing Model of Adult Day Care for Filipino Older Persons"
• By increasing the quality of interaction between the client, the nurse and significant others, successful
adjustment and recovery will be attained and functional health performance will improve.

Manila, Philippines
5
C. DR. CARMELITA C. DIVINAGRACIA (UERM)

"Advanced Nurse Practitioners' 'COMPOSURE Behavior and Patient's Wellness Outcome"
Contributes to the well-being of the patients
• A personal commitment
• Strong administrative support
• Balancing science and humanistic aspects of nursing
Competence - the professional has reached the highest level of competence in his chosen practice.
Presence and Prayers
Presence - Attending to individual's requests, a physical and emotional presence that says to the
patient that you are there all day for them.
Prayer - Spiritual and religious beliefs are essential components of one's life especially in time of
sickness and impending death.
• Open - Mindedness - Having no prejudgment or biases of opinions
• Stimulation
Encouragement
Guidance
Appropriate Smiling
Complimentary words
• Respect and Relaxation - Treating the person as a means but also as an end
• Understanding - put into consideration all aspects of the patient.
• Empathy

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6
D. SR. CAROLINA S. AGRAVANTE, S.P.C, PhD (ST.PAUL)

"The CASAGRA Transformative Leadership Model: Servant - Leader Formula & the Nursing
Faculty's Transformative Leadership Behavior."
• Is a psycho spiritual model.
• It is a Three-Fold Transformation Leadership Concept rolled into one, comprising of the following
elements:
1. Servant-Leader Spirituality - spiritual retreat
2. Self-Mastery expressed in a vibrant care complex.
3. Special Expertise level in the nursing field one is engaged in.
• 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.
E. Sister Letty Kuan

‘RETIREMENT AND ROLE DISCONTINUITIES”
• Born on November 19, 1936 in Katipunan-Dipolog, Zamboanga del Norte, she was nurse with two
(2) Master’s Degrees, MA in Nursing and MS in Education major in Guidance Counselling. Holds a
Doctoral Degree in Education major in Guidance Counselling. All these postgraduate studies were
obtained from the University of the Philippines - Diliman, Quezon City
• For her vast contributions to the University of the Philippines - College of Nursing faculty and
academic achievements, she was awarded the distinctive post of Professor Emeritus, a title
awarded only to a few who met the strict criteria set by the University of the Philippines in
September 2004.

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CONCEPTUAL MODEL
Strengths
The theory can be applied not only for the population undergoing retirement process, but also for the
population that is undergoing life transitions.
The theory is easy to understand, wherein most people can relate to the effects of role change.
Weakness/ Limitations
The theory focuses too much on the positive determinants. Retirement adjustment is clearly a
multidimensional process but the theory only used a single indicator which is the positive determinants to
retirement.

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8
Usefulness
The theory is useful in geriatric nursing where nurses can derive a plan of care to help the patient to have
ease of movement through a transitional process
If individuals have a better understanding of the retirement process and their new role, they will prepare
and adjust better. (Kelly & Swisher, 1998)
Major Assumptions
Physiological Age
• Is the endurance of cells and tissues to withstand the wear-and-tear phenomenon of the human body.
Some individuals are gifted with strong genetic affinity to stay young for a long time.
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. It is also the set of shared expectations from the retiree’s socialization experiences and the
values internalized while preparing for the position as well as the adaptations to the expectations
socially defined for the position itself. For every social role, there is complementary set of roles in the
social structure among which interaction constantly occurs.
Change of Life
• Is the period between near retirement and post retirement years. In 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 of has completed the required years of service.

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9
Role Discontinuity
• Is the interruption in the line of status enjoyed or role 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.
F. DR. CECILIA LAURENTE (UP-M)

“Categorization of Nursing Activities as Observed in Medical-Surgical Ward Units in Selected
Government and Private Hospitals in Metro Manila"
• Another entry point of helping the patient is through the family.
• Nurses can be a great assistant in preventing a serious complication from the beginning.
• Nurses can help strengthen the family's term of knowledge, skills, and attitude through effective
communication
• Communication gaps between patients and caregivers can occur when hospitals do not address the
issues that patients think are most important.
• Availability of educational tools is important

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10
Locale Nursing Theories and their Conceptual Model
MAJOR CONCEPTS AND DEFINITIONS
THEORIST CONCEPT METAPARADIGM

1. DR. CARMENCITA "PREPARE ME" Interventions Person/Patient - patients in advanced stages of
M. ABAQUIN and the Quality of Life cancer. They are holistic being with physical,
(U.P) Advance Progressive Cancer psychological, social, religious, level of
Patients. independence, and environmental aspects
.
Environment - an aspect or dimension integrated to
the cancer patient. Quality of life can also be
assessed in this aspect.
Health - illness, particularly cancer and the provision

of holistic care to improve quality of life despite their
terminal cases.
Nursing - goal of nursing care is the improvement

of quality of life for advance stage cancer patients
despite their current situation.
2. DR. ARACELI O. "Functional Health • The home instruction program and scheduled
BALABAGNO Performances Outcomes of home visits were prescribed to address the client's
(FEU) Compliance to Home needs. The intervention was based on the concepts
Instruction Program After of interaction, goal setting and information support.
Infarction."
"A Nursing Model of Adult • By increasing the quality of interaction between

Day Care for Filipino Older the client, the nurse and significant others,
Persons"

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11
successful adjustment and recovery will be attained

and functional health performance will improve.
3. DR. CARMELITA "Advanced Nurse • Contributes to the well-being of the patients

C. DIVINAGRACIA Practitioners' 'COMPOSURE • A personal commitment
(UERM) Behavior and Patient's • Strong administrative support
Wellness Outcome" • Balancing science and humanistic aspects of
nursing
• Competence - the professional has reached the
highest level of competence in his chosen practice.
• Presence and Prayers
Presence - Attending to individual's requests, a
physical and emotional presence that says to the
patient that you are there all day for them.
Prayer - Spiritual and religious beliefs are essential
components of one's life especially in time of
sickness and impending death.
• Open - Mindedness - Having no prejudgment or
biases of opinions
• Stimulation
Encouragement
Guidance
Appropriate Smiling
Complimentary words
• Respect and Relaxation - Treating the person as a
means but also as an end
• Understanding - put into consideration all aspects
of the patient.
• Empathy

Manila, Philippines
12
4. SR. CAROLINA S. "The CASAGRA • is a psycho spiritual model.

AGRAVANTE, Transformative Leadership • It is a Three-Fold Transformation Leadership
S.P.C, PhD Model: Servant - Leader Concept rolled into one, comprising of the following
(ST.PAUL) Formula & the Nursing elements
Faculty's Transformative 1. Servant-Leader Spirituality - spiritual retreat
Leadership Behavior." 2. Self-Mastery expressed in a vibrant care
complex;
3. Special Expertise level in the nursing field one is
engaged in
• 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.
5. SR. LETTY G. "Retirement and Role Retirement - inevitable change in one's life.
KUAN, RN, RGC Discontinuities" • This developmental stage, even at later part of
EdD (UP) life, must be considered desirable and satisfying
through the determination of factors that will help
the person enjoy his remaining years of life.
METAPARADIGMS:
NURSING: preparing and assisting the person to
have fulfillment in their retirement years
PERSON: Elderly (70's up to 80's)
HEALTH: slow process of growth towards maturity
of mind, body and spirit (Aging)
BASIC ASSUMPTIONS
• Physiological Age - endurance of cells and tissues
to withstand the wear-and-tear phenomenon of the
human body.

Manila, Philippines
13
• Role - set of shared expectations focused upon a

particular position.
• Change of Life - period between near retirement
and post retirement years
• Retiree - individual who has left the position
occupied for the past years of productive life
• Role Discontinuity - interruption in the line of
status enjoyed or role performed.
• Coping Approaches - interventions or measures
applied to solve a problematic situation or state
6. DR. CECILIA " Categorization of Nursing • Another entry point of helping the patient is
LAURENTE (UP- Activities as Observed in through the family.
M) Medical-Surgical Ward Units • Nurses can be a great assistant in preventing a
in Selected Government and serious complication from the beginning.
Private Hospitals in Metro • Nurses can help strengthen the family's term of
Manila" knowledge, skills, and attitude through effective
communication
• Communication gaps between patients and
caregivers can occur when hospitals do not address
the issues that patients think are most important.
• Availability of educational tools is important

Manila, Philippines
14
ACTIVITY
Instruction: On the space provided below choose 1 Local Nursing Theory with
their work and identify an area of nursing practice for comfort research, and
explain why it is needed.

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15
REFERENCES
Udan, Josie. (2020) Theoretical Foundation in Nursing (2nd ed.). Educational

Publishing House, Jade Bookstore.

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1

THEORETICAL FOUNDATIONS IN NURSING

According to Peplau (1952/1988), nursing is therapeutic because it is a healing art,

Hildegard Peplau’s Interpersonal Relations Theory emphasized the nurse-client

After finishing this module, the learner will be able to:

Far Eastern University

THEORETICAL FOUNDATIONS IN NURSING

A. Credentials and Background

Far Eastern University

THEORETICAL FOUNDATIONS IN NURSING

Major Concepts of the Interpersonal Relations Theory

Far Eastern University

THEORETICAL FOUNDATIONS IN NURSING

Therapeutic nurse-client relationship

Far Eastern University

THEORETICAL FOUNDATIONS IN NURSING

Four Phases of the therapeutic nurse-patient relationship:

The identification phase includes the selection of the appropriate assistance by a

THEORETICAL FOUNDATIONS IN NURSING

Subconcepts of the Interpersonal Relations Theory

Four Levels of Anxiety

Far Eastern University

THEORETICAL FOUNDATIONS IN NURSING

Multiple Choice: Choose the best answer.

THEORETICAL FOUNDATIONS IN NURSING

6. The person cannot be redirected to a task; he or she focuses only on scattered

8. It is the nurse’s assessment of the patient’s health and situation.

9. It identifies the type of service needed by the patient.

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THEORETICAL FOUNDATIONS IN NURSING

Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing

Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts

Vandemark L.M. Awareness of self & expanding consciousness: using Nursing

Peplau, H. E. (1952). Interpersonal relations in nursing. In George, J. (Ed.).

Far Eastern University

THEORETICAL FOUNDATIONS IN NURSING

IDA JEAN ORLANDO

Ida Jean Orlando’s nursing theory stresses the reciprocal relationship

After finishing this module, the learners will be able to;

Far Eastern University

THEORETICAL FOUNDATIONS IN NURSING

1. Credentials and Background of the Theorist

1. Credentials and Background

THEORETICAL FOUNDATIONS IN NURSING

2. Brief Description of the Deliberative Nursing Process Theory

The theory was published in The Dynamic Nurse-Patient Relationship: Function,

Far Eastern University

THEORETICAL FOUNDATIONS IN NURSING

Far Eastern University

THEORETICAL FOUNDATIONS IN NURSING

a. Function of Professional Nursing

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THEORETICAL FOUNDATIONS IN NURSING

Automatic Nursing Actions are nursing actions decided upon for

The following list identifies the criteria for deliberative actions:

d. Nursing Process Discipline

The nurse decides on an appropriate action to resolve the need in cooperation

The action process in a person-to-person contact functioning in secret. The

Far Eastern University

THEORETICAL FOUNDATIONS IN NURSING

5 Stages of the Deliberative Nursing Process

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THEORETICAL FOUNDATIONS IN NURSING