TFN For Finals

Theoretical Foundations in Nursing FINALS
NCM 100 / Lecture / First Semester CDU – CN
Module 1F: History of Nursing
 Nursing was “untaught” and instinctive. It was

Topic Outline performed of compassion for others, out of wish to
help others
1.1 Nursing in History  Primitive men believed that illness was caused by the
1.2 Philippine Nursing History invasion of the victim’s body of evil spirits. They
1.3 Nursing Law believed that the medicine man, Shaman or witch
1.4 History of CDU-CN doctor had the power to heal by using white magic,
hypnosis, charms, dances, incantation, purgatives,
massage, fire, water and herbs as a mean of driving
illness from the victim
1.1 NURSING IN HISTORY  Trephining – drilling a hole in the skull with a rock or
stone without anesthesia was a last resort to drive
 The first known documents that mention nursing as a evil spirits from the body of the afflicted
profession were written approximately 300 AD
o In this period, the Roman Empire endeavored MIDDLE AGES
to build a hospital in each town that was under
its rule, leading to a high requirement for
 The Period of Apprentice Nursing
nurses to provide medical care alongside
o Care was done by crusaders, prisoners,
doctors
The word “nurse” originally came from the Latin word religious orders (women were not the sole
“nutrire”, meaning to suckle, referring to a wet nurse providers of nursing services in this period)
th
o Only in the late 16 century did it attain its o Nursing care was performed without any
modern meaning of a person who cares for the formal education and by people who were
infirm directed by more experienced nurses (on the
 From the earliest time most cultures produced a job training)
stream of nurses dedicated to service on religious
o This kind of nursing was developed by religious
principles
o Both Christendom and the Muslim World orders of the Christian Church. (Religion
generated a stream of dedicated nurses from played a very important role in the Middle
their earliest days Ages)
o In Europe before the foundation of modern  Fabiola (one of the rich matrons in the Roman
nursing, Catholic nuns and the military often Empire)
provided nursing-like services o Used their wealth to provide houses of care
th
 It took until the 19 century for nursing to become a
and healing for the poor, the sick, & the
secular profession
homeless
MEDIEVAL PERIOD  Knight hospitallers
o The caretakers of soldiers were knights who
 The Period of Intuitive Nursing fought during the battles and returned to care
o Nursing was “untaught” and intuitive for the ill and wounded when the fighting
o No caregiving training is evident subsided
o It was based on experience and observation
 Knights of Saint Lazarus
 Nursing was a function that belonged to women
o a natural nurturing job for them o Dedicated themselves to people with leprosy,
o expected to take good care of the children, the syphilis and chronic skin conditions
sick, and the aged in the family o They found they preferred the role of the nurse
o started at home (Nursing has its roots at and nursing became their profession
home)  Nursing went down to the lowest level
 Wet nursing - taking care of babies or children of o Wrath/anger of Protestantism confiscated
their masters. (common in this period)
properties of hospitals and schools connected
 People are superstitious and believe in magic.
Sickness is due to active intervention of: with Roman Catholicism
a. Human - through witchcraft o Nurses fled their lives; soon there was
b. Non-human - through ghosts shortage of people to care for the sick
c. Superhuman beings - caused by deities
History of Nursing | 1
o Hundreds of hospitals closed; there was no NURSING IS AN ART AND A SCIENCE

provision for the sick, no one to care for the
sick  As a professional nurse, you will learn to deliver care
artfully with compassion, caring, and a respect for
o Nursing became the work of the least desirable
each client’s dignity and personhood.
of women - prostitutes, alcoholics, prisoners
 As a science, nursing is based on the body of
 The Deaconess groups which have their origins in the knowledge that is continually changing with new
Roman Empire of the 3rd and 4th Centuries was discoveries and innovations
suppressed during the Middle Ages by the Western  When you integrate the science and art of nursing
Churches. However, these groups of nursing providers into your practice, the quality of care you provide to
resurfaced occasionally throughout the centuries and your clients is at the level of excellence that benefits
clients and their families
most notably 1836
 Pastor Theodore Fliedner and his wife, Frederika, “Nursing is not just an ART, it has a heART. Nursing is
o Established the Kaiserswerth Institute for the not just a SCIENCE, it has a conSCIENCE”
training of Deaconesses (the 1st formal
training school for nurses) in Germany  Degree qualified
o This was where Florence Nightingale receive  Skilled and knowledgeable
SCIENCE
 Professional
her 3-month course of study in nursing
 Capable and Competent
TH TH  Care
NIGHTINGALE ERA 19 - 20 CENTURY
 Compassion
ART  Support
 The Period of Educated Nursing
 Reassurance
 A spiritual calling
 The development of nursing during this period was
strongly influenced by:
o Trends resulting from wars (Crimean, Civil FACTS OF FLORENCE NIGHTINGALE
War). Throughout history, wars have
accentuated the need for nurses  Born on May 12, 1800 in Florence, Italy
o Arousal of social consciousness  Raised in an atmosphere of culture and affluence in
o Increased educational opportunities were England
offered to women  At age 31, she entered the Deaconesses School at
Kaiserswerth in spite of her family’s resistance to her
 Florence Nightingale was asked by Sir Sidney
Herbert of the British War Department to recruit ambitions. She became a nurse over the objections of
female nurses to provide care for the sick and injured society and her family
in the Crimean War  Worked as a superintendent for Gentlewomen
Hospital, a charity hospital for ill governesses
 In 1860, The Nightingale Training School of Nurses
opened at St. Thomas Hospital in London  Mother of Modern Nursing
 Pioneer of Nursing Education
o The school served as a model for other training
schools. Its graduates traveled to other  Lady with the Lamp because of her achievements in
improving the standards for the care of war casualties
countries to manage hospitals and institute
in the Crimean War. She was reported to have made
nurse-training programs
o Nightingale nursing system was more on rounds on her patients at night by the light of a lantern
 Not contented with the social custom imposed upon
developing the profession within hospital.
Nurses should be taught in hospitals her as a Victorian Lady, she developed her self-
appointed goal: To change the profile of Nursing
associated with medical schools and that the
curriculum should include both theory and 1. Compiled notes of her visits to hospitals and her
observations of the sanitary facilities, social
practice
o It was the 1st school of nursing that provided problems of the places she visited
2. Noted the need for preventive medicine and good
both theory-based knowledge and clinical skill
building nursing
3. Advocated for care of those afflicted with
o Formal nursing education and nursing service
diseases caused by lack of hygienic practices
begun in this era
o Nursing evolved as an art and science
4. Disapproved the restrictions on admission of 1.2 PHILIPPINE NURSING HISTORY

patients and considered this unchristian and
incompatible with health care HEALTHCARE DURING THE SPANISH REGIME
5. Upgraded the practice of nursing and made
nursing an honorable profession for women  The context of nursing has manifested through simple
6. Led nurses that took care of the wounded during nutrition, wound care, and taking care of an ill member
the Crimean war of the family
7. Placed down her ideas in 2 published books: Notes  Interventions from babaylan (priest physicians) or
on Nursing: What It Is and What It Is Not and albularyo (herb doctor)
Notes on Hospitals  Early Filipinos subsribed to superstitious belief and
8. Revolutionized the public’s perception of nursing practices in relation to health and sickness
(not the image of a doctor’s handmaiden) and the
 Diseases, their causes and treatment were
method for educating nurses
 Nursing has been identified as an “emerging associated with mysticism and superstitions
profession” for at least 150 years  Cause of disease was caused by another peson (an
 The historical context of nursing’s image is often enemy of witch) or evil spirits
traced back to Florence Nightingale, the “Founder of  Persons suffering from diseases without any
Modern Nursing.” identified cause were believed bewitched by
 International Nurse’s Day is celebrated each year on
“mangkukulam”
her birthday, May 12.
 Difficult childbirth were attributed to “nonos”
 The Nightingale pledge is still recited by new nursing
graduates around the world, often with the  Evil spirits could be driven away by persons with
accompaniment of flickering candles in symbolic lamps powers to expel demons
 Belief in special Gods of of healing: priest-physician,
TH
20 CENTURY word doctors, herbolarios/herb doctors
 The Period of Contemporary Nursing EARLIEST HOSPITALS

o Licensure of nurses started
o Training of nurses in diploma program  Early hospitals during the Spanish Regime
o Development of baccalaureate and advanced o Religious orders exerted efforts to care for the
degree programs (Master’s of arts in nursing) sick by building hospitals in different parts of
o Specialization in hospital and diagnosis (ICU the Philippines:
1. Hospital Real de Manila San Juan de Dios Hospital
nurses, Cardiac nurses, Oncology nursing etc.)
o It was established mainly to care for the
 Scientific and technological development as well as Spanish king’s soldiers, but also admitted
social changes marks this period Spanish civilians; founded by Gov. Francisco
1. Health is perceived as a fundamental human de Sande
right (not just a privilege but a right) 2. San Lazaro Hospital de Aguas Santas (1900)
2. Nursing involvement in community health o Founded by Brother Juan Clemente and was
administered for many years by the
3. Technological advances - disposable supplies
Hospitallers of San Juan de Dios; built
and equipment exclusively for patients with leprosy
4. Expanded roles of nurses was developed 3. Hospital de Indios
(especially in communities)
5. WHO was established by the United Nations NURSING DURING THE PHILIPPINE REVOLUTION
6. Aerospace Nursing was developed
7. Use of atomic energies for medical diagnosis,  In the late 1890’s, the war between the Philippines
treatment and Spain emerges which resulted to significant
amount of casualties
8. Computers were utilized (Data collection,
Many women have assumed the role of nurses in
teaching, diagnosis, inventory, payrolls, order to assist the wounded soldiers
record keeping, and billing) The emergence of Filipina nurses brought about the
9. Use of sophisticated equipment for diagnosis development of the Philippine Red Cross
and therapy
FAMOUS FILIPINA NURSES 3.Philippine General Hospital School of Nursing

(Manila, 1907)
1. Josephine Bracken o PGH began in 1901 as a small dispensary for
o Wife of Jose Rizal, installed a field hospital in Civil Officers and Employees in the City of
an estate house in Tejeros Manila and later grew as a Civil Hospital
o She provided nursing care to the wounded o In 1906, Mary Coleman Masters, an educator
night and day advocated for the idea of training Filipino girls
2. Rosa Sevilla de Alvero for the profession of nursing with the approval
o First Filipino to start a school in the country of government officials
o She was instrumental in allowing Filipinas to o Admission was based on an entrance
exercise their right to vote examinations
o Converted their house into quarters for the  Additional Information:
Filipino soldiers during the Philippine-American
War that broke out in 1899 o 1906 - Iloilo Mission Training School of Nursing
st
3. Hilaria de Aguinaldo o 1909 – distinction of graduating the 1 trained
nurses in the Philippines with no standard
o Wife of Emilio Aguinaldo
requirements for admission of applicants except
o Organized the Filipino Red Cross
their “willingness to work”
4. Melchora Aquino (Tandang Sora) o April 1946 – a board exam was held outside of
o Nursed the wounded Filipino soldiers, gave Manila. It was held in the Iloilo Mission Hospital
them shelter and food through the request of Ms. Loreto Tupas, principal
5. Captain Salomen of the school
o A revolutionary leader in Nueva Ecija provided o 1907 - St. Luke’s Hospital School of Nursing opened
nursing care to the wounded when not in after four years as dispensary clinic
combat o 1907 – Mary Johnston Hospital School of Nursing
6. Agueda Kahabagan
o Revolutionary leader in Laguna also provided REVIEW THROUGH THE YEARS
nursing services to her troops
7. Trinidad Tecson (Ina ng Biak na Bato)  The Start of Nursing Practice (1911-1921)
o Stayed in the hospital at Biac na Bato to care o During this period, the Board Examiners for
for the wounded soldiers Nursing was also created. The first nursing
board examination was given in 1920.
HOSPITAL SCHOOL OF NURSING  A Much-Established Professional Organization (1921-
1931)
o The Filipino Nurses Association was
1. Iloilo Mission Hospital
established. (NOW - PNA or the Philippine
o First hospital in the Philippines which trained Nurses Association)
Filipino nurses in 1906 o An act regulating the practice of Nursing
o Established by the Baptist Missionaries Profession in the Philippine Islands, which
o This has been the beginning of development of necessitates all nurses who are practicing the
more nursing schools in the country profession to register yearly
o In this period, the Pensionado Act of 1903 (or o In 1929, the organization also became a
Act 854) was mandated, allowing Filipino member of the International Council of Nurses
nursing students to study in the United States
 Public Health Nursing Development (1931-1941)
2. Saint Paul’s Hospital School of Nursing (Manila,
1907)
 The Degree of Bachelor of Science in Nursing
o was established by the Archbishop of Manila,
(1941-1951)
Jeremiah Harty, under the supervision of the o During this period, College of Nursing was
Sisters of St. Paul de Chartes located in
created
Intramuros
o The First of Colleges of Nursing in the
o it provided general hospital services
Philippines are:
o opened its training school for nurses in 1908,
1. University of Santo Tomas-College of Nursing
with Mother Melanie as superintendent and
(1946)
Miss Chambers as Principal
2. Manila Central University-College of Nursing
(1947)
3. University of the Philippines Manila-College of
Nursing (1948)
 Proliferation of Nurses as a Workforce (1951-1971) o It was ranked 4th out of 151 nursing schools in
o Republic Act 877, known as the “Nursing the country based on a 5-year study by Dept.
Practice Law” was approved of Education, Culture, and Sports (DECS) and
o Limits practice of nursing to those 21 years old Professional Regulation Commission (PRC)
and above  February 8, 2005
 Nursing Profession Development (1971-2000) o In cognizance of the good board performance
o The Professional Regulation Commission was of the different colleges, its contribution to
established society, and the improvement of the different
o Nursing Practice Law was also amended under professions through the different colleges,
Philippine Nursing Act of 1991 Republic Act No. Cebu Doctors’ College was granted by
7164 which expanded nursing practice to other Commission of Higher Education (CHED) the
roles such as management, teaching, decision University status.
making, and leadership  College Deans
o The qualification of nurses or faculty’s in the o Dr. Filomena C. Flores (1975-1985)
academe was also updated to Master’s o Dr. Ofelia F. Sisno (1985-2016)
Degree in Nursing or its equivalent o Dr. Rommel P. Merioles (2016-present)
 Further Changes in Nursing Law (2001 to Present)
o During this period, the Philippine Nursing Act
of 2002 was enacted under the Republic Act
No. 9173 which entails changes on existing ~ END OF MODULE 1F ~
policies under Republic Act No. 7164
o Requirement for faculty and Dean of the Trans by: Jan Kylle Jala BSN 1-I
Colleges of Nursing, as well as the conduct for
Nursing Licensure Exam
1.3 NURSING LAW
 Established as Republic Act 877, known as the

“Nursing Practice Law” in the beginning
 Amended in 1991 through Republic Act No. 7164,
known as the “Philippine Nursing Act of 1991”
Amended in 2002 Republic Act No. 9173, known as
the “Philippine Nursing Act of 2002”
 Amendments in 2020
1.4 HISTORY OF CDU-CN
 Organized in 1971 as Cebu Doctors’ College

o College of Nursing (1973)
o College of Arts & Sciences (1975)
o College of Medicine (1976)
o College of Dentistry (1980)
o College of Optometry (1980)
o College of Allied Medical Sciences (1982)
 October 3, 1984
o School was granted a three-year accredited
status by the Philippine Accrediting
Association of Schools, Colleges, and
Universities (PAASCU)
o CDCN enjoys the distinction of being the first
accredited college of nursing in Cebu City
 1992
o CD-CN was declared an excellent nursing
program in Region VII by DECS Manila
Module 2F: Concept of Nursing
o as we say in CDU-CN “Nursing is where people

Topic Outline are” and that is where the environment takes
place
2.1 Nursing Practice and Education  Health - our goal in nursing
2.2 Understanding the Term o our goal is always to achieve the optimum
2.3 Importance of a Nursing Theory level of health
2.4 Characteristics of a Theory o that is why we look for ways and means to
2.5 Components of a Nursing Theory make sure that we achieve this goal in the
2.6 Nursing Paradigm practice of our profession
2.7 Types of Nursing Theory  Nursing - our means, our way of knowing man, our
2.8 Interdisciplinary Theories way of maintaining an environment which is suitable
2.9 Nursing Theorists and Their Works for our patients in order for us to perform our
2.10 Current Health Care Issues responsibilities relative to the promotion of health and
the prevention of illness
o nursing is also our way towards ensuring that
our clients, ourselves, and the interactive
2.1 NURSING PRACTICE AND EDUCATION
process therein is achieved which is health
CARING CARE
 In CDU-CN, it is an organizational culture that we

have to promote a care that is beyond something.
 We take an extra mile as needed in order to provide
what is something that is worthwhile for the patient
and that is why we describe it as “caring care”
 It is part of our responsibility as a CDU-CN nurse to
promote caring care in all these paradigms whether
towards man, the environment, health, and within the
nursing profession in particular
 The concept of nursing covers both practice and 2.2 UNDERSTANDING THE TERM
education
 Practice - clinical or hospital and community setting  Theory - a system of ideas that is proposed to
where the nursing profession is more seen by people explain a given phenomena; well-articulated idea
who are performing the works of the nurse about something important; describe, predict and
 Education - teachers in the nursing profession have
control phenomena
these concepts or ideas on how to go about the nursing
profession. For example, a student begins their journey  Nursing Theory - a conceptualization of some aspect
as a student nurse in the nursing profession. of nursing communicated for the purpose of describing,
 Our practice and education is guided by concepts, explaining and/or prescribing CARE (Meleis, 1997)
theories, principles, and philosophies which comes  Principle - fundamental truth or proposition that
from the different nursing paradigms serves as the foundation for a system of belief or
behavior or for a chain of reasoning
NURSING PARADIGMS
 Philosophy - belief system and serves as basis for
theoretical formulations
 Man - considered as the recipient of our nursing care
o we should have a deeper and a higher
2.3 IMPORTANCE OF A NURSING THEORY
appreciation of man
o man may be in the form of an individual,
family, or community  Nursing theory - guides knowledge development
 Environment - where the care happens  It directs:
o It could be relative to where the patient is,  Nursing education
where an interaction between the nurse and Used primarily to establish the profession’s
the patient could happen in any setting where place in the university
a nurse performs their duty and responsibility
Concept of Nursing | 1
 Nursing research LEVELS OF ABSTRACTION

Identifies gaps in the way we approach
specific fields of study GRAND THEORIES
 Clinical practice
The reflection, questioning and thinking about  Broad in scope and complex, require further
what nurses do specification through research before they can be fully
tested
2.4 CHARACTERISTICS OF A THEORY  Provides the structural framework for broad,
abstract ideas about nursing (Fawcett, 1995).
 Clear  Not intended to provide guidance for specific nursing
(consistency, semantic and structural clarity) interventions
 Simple
MIDDLE RANGE THEORIES
(sufficiently comprehensive and at a level of
abstraction provides guidance)
 More limited scope, less abstraction, address
 Empirical precision Based on facts, correct specific phenomena or concept and reflect practice
 Derivable consequences reflect answer, provide answer (administration, clinical or teaching)
2.5 COMPONENTS OF A NURSING THEORY GOALS OF THE THEORY
 Concept - mental formulations of an object or event DESCRIPTIVE THEORIES

that come from individual perceptual experience
 Definition - convey the general meaning of the  The first level of theory development
concepts in manner that fits the theory; measures the  Describe the phenomena, speculate on why the
constructs, relationships or variables within a theory phenomena occur, and describe the consequences of
 Assumptions - statements that describe concepts or the phenomena
connect two concepts that are factual. Determine the  Helps to explain client assessment but does not
nature of the concepts, definitions, purpose, direct specific nursing activities
relationships and structure of the theory
 Phenomenon - aspect of reality that can be PRESCRIPTIVE THEORIES
consciously sensed or experienced
 Predict the consequences of a specific nursing
2.6 NURSING PARADIGM
intervention
 Nursing paradigm - explains the linkages of science,  Action oriented, tests the validity and predictability
philosophy and theory accepted and applied by the of a nursing intervention
discipline  Guides nursing research to develop and test specific
 Person – the recipient of nursing care nursing interventions
 Health – the goal of nursing care
2.8 INTERDISCIPLINARY THEORIES
 Environment - all possible conditions affecting
the client and the setting in which health care  Explain a systematic view of a phenomenon specific
needs occur to the discipline of inquiry
 Nursing - diagnosis and treatment of human  The need for strong scientific knowledge base from
responses to actual or potential health nursing and other disciplines (physical, social and
problems (ANA, 1995) behavioral sciences)
2.7 TYPES OF NURSING THEORY  Systems theory

 Maslow’s hierarchy of needs
 Theories have different purposes and may be  Health-and-wellness models
classified by:  Stress and adaptation
Levels of Abstraction  Growth and developmental theories
Grand theories or middlerange theories  Psychosocial theorieS
Goals of the Theory
Descriptive or prescriptive
2.9 NURSING THEORIES AND THEIR WORKS  Philosopy and Science of Caring
o Caring can be effectively demonstrated and
NURSING PHILOSOPHIES practiced only interpersonally
o Caring consists of carative factors that result
 Environmental Theory by Florence Nightingale in the satisfaction of certain human needs
 Philosophy and Science of Caring by Jean Watson o Effective caring promotes health and
individual or family growth
 Theaory of Bureaucratic by Marilyn Ray
o Caring responses accept person not only as he
 Novice to Expert Theory by Patricia Benner or she is now but as what he or she may
 Proposed Philosophy of Caring by Kari Martinsen become
 Modeling and Role-Modeling Theory of Nursing by o The practice of caring is central to nursing
Helen Lorraine Eriksson, Evelyn Tomlin and Mary Anne
Swain CONCEPTUAL MODELS AND GRAND THEORIES
ENVIRONMENTAL THEORY  Conservation Model by Myra Estrin Levine

Florence Nightingale (1820-1910)  The Science of Unitary Human Beings by Martha
Rogers
 Biography of Florence Nightingale  Self-Care Deficit Theory by Dorothea Orem
 Born in Florence, Italy  Interacting Systems Framework and Theory of Goal
 Founder of Modern Nursing Attainment by Imogene King
 The Lady of the Lamp: made rounds during the  Systems Model by Betty Neuman
night providing emotional comfort to soldiers  Adaptation Model by Sister Callista Roy
during Crimean War  Behavioral System Model by Dorothy Johnson
 Established a teaching institution for nurses at  Nursing as Caring: A Model for Transforming
St. Thomas and King’s College Hospital in Practice by Ann Boykin and Savina Schoenhofer
London, England  Life Perspective Rhythm Model by Joyce Fitzpatrick
 Environmental Theory  Care, Core, Cure Model of Nursing by Lydia Hall
o Contains three major relationships:  Health Promotion Model by Nola Pender
Environment to Patient, Nurse to Environment,  Conceptual Model: The Helping Art of Clinical Nursing
Nurse to Patient by Ernestine Weidenbach
o Theory of the five essential components of
environmental health (pure air, pure water, ADAPTATION MODEL
efficient drainage, cleanliness and light) Sister Callista Roy (1940 – present)
o Theoretical Assertions: Disease was a
reparative process; disease was nature’s  Biography of Sister Callista Roy
 Born in California, USA
effort to remedy a process of poisoning or
 A member of the Sisters of Saint Joseph of
decay, or a reaction against the conditions in Carondelet
which a person was placed.  Sees the individual as a set of interrelated
systems who strives to maintain a balance
PHILOSOPHY AND SCIENCE OF CARING between various stimuli
Jean Watson (1940-present)  Adaptation Model
o Person: Human systems have thinking and
 Biography of Jean Watson feeling capacities rooted in consciousness and
 Born in West Virginia, USA meaning; adjust effectively to changes in the
 “A caring environment is one that offers the environment and in turn affect the
development of potential while allowing the environment
person to choose the best action for himself or o Environment: Conditions, circumstances and
herself at a given point in time” influences surrounding and affecting the
 “Caring is more “healthogenic” than is curing. A development and behavior of persons or
science of caring is complementary to the groups, with consideration of the mutuality of
science of curing” person and health resources
o Health: Health is not freedom from the o The model has three interacting systems:
inevitability of death, disease, unhappiness, personal, interpersonal, and social. Each of
and stress, but the ability to cope with them in these systems has its own set of concepts
a competent way o The concepts for the personal system are
o Nursing: The goal of nursing is the promotion of perception, self, growth and development,
adaptation for individuals and groups in each body image, space, and time
of the four adaptive modes, thus contributing o The concepts for the interpersonal system are
to health, quality of life, and dying with dignity interaction, communication, transaction, role
o Adaptation: The process and outcome and stress
whereby thinking and feeling persons as o The concepts for the social system are
individuals or in groups use conscious organization, authority, power, status, and
awareness and choice to create human and decisionmaking
environmental interaction
SELF-CARE DEFICIT THEORY OF NURSING
SYSTEMS MODEL Dorothea Orem (1914 – 2007)
Betty Neuman (1924 – 2012)
 Biography of Dorothea Orem
 Biography of Betty Neuman  Born in Maryland, USA
 Born in Ohio, USA  Has a strong health promotion and
 A nurse, educator, health counselor, therapist, maintenance focus
author, speaker, and researcher
 Suggested the development of applied nursing
 Designed a nursing conceptual model to expand
students’ understanding of client variables beyond
science and basic, non nursing sciences as part
the medical field of the empirical evidence and knowledge base
 Systems Model to be associated with nursing practice
o The theory is based on the person’s  Self-Care Deficit Theory of Nursing
relationship to stress, the response to it, and o Nursing: “The act of assisting others in
reconstitution factors that are progressive in provision and management of self-care to
nature maintain/improve human functioning at home
o The Neuman Systems Model presents a broad, level of effectiveness.”
holistic and system-based method to nursing o Focuses on activities that adult individuals
that maintains a factor of flexibility perform on their own behalf to maintain life,
o It focuses on the response of the patient health and well-being; identified three related
system to actual or potential environmental concepts: self-care, health, and nursing
stressors and the maintenance of the client system
system’s stability through primary, secondary o Self-care: activities an individual performs
and tertiary nursing prevention intervention to independently throughout life to promote and
reduce stressors maintain personal well-being
o Health: results when individual’s ability is not
INTERACTING SYSTEMS FRAMEWORK AND THEORY OF adequate to meet the known self-care needs
GOAL ATTAINMENT o Nursing system: nursing interventions needed
Imogene King (1923 – 2007) when individual is unable to perform the
necessary self-care activities
 Biography of Imogene King
 Born in Iowa, USA BEHAVIORAL SYSTEM MODEL
Dorothy Johnson (1919 – 1999)
 A pioneer in Nursing Theory Development
 Identified multiple concepts used by nurses to
describe nursing.  Biography of Dorothy Johnson
 Interacting Systems Framework and Theory of Goal  Gergia, USA
Attainment  She held a strong conviction that continuing
o The theory describes a dynamic, interpersonal improvement of care was the ultimate goal of
relationship in which a patient grows and nursing
develops to attain certain life goals. The  Nursing is an external regulatory force which
theory explains that factors which can affect acts to preserve the organization and
the attainment of goals are roles, stress, integration of the patient’s behaviors at an
space and time optimum level under those conditions in which
the behavior constitutes a threat to the o Professional nursing care hastened recovery
physical or social health, or in which illness is and that as less medical care was needed,
found more professional nursing care and teaching
 Behavioral System Model were necessary
o A model of nursing care that advocates the o Nursing functions differ using three (3)
fostering of efficient and effective behavioral interlocking circles to represent aspects of the
functioning in the patient to prevent illness patient: CARE (body), CURE (disease) and
o The patient is identified as a behavioral CORE (person)
system composed of seven behavioral o Nurses function in all three circles but to
subsystems: affiliative, dependency, ingestive, different degrees
eliminative, sexual, aggressive, and
achievement CONSERVATION MODEL
o The three functional requirements for each Myra Estrin Levine (1920 – 1996)
subsystem include protection from noxious
influences, provision for a nurturing  Biography of Myra Estrin Levine
environment, and stimulation for growth  Born in Chicago, USA
o An imbalance in any of the behavioral
subsystems results in disequilibrium. It is  Conservation Model
nursing’s role to assist the client to return to a o The model stresses nursing interactions and
state of equilibrium multiple intervention are intended to promote
adaptation and maintain wholeness
CONCEPTUAL MODEL: THE HELPING ART OF CLINICAL o Nursing care is based on scientific knowledge
NURSING and nursing skills
Ernestine Wiedenbach (1900 – 1998) o Three (3) major concepts: wholeness,
adaptation and conservation
 Biography of Ernestine Wiedenbach o Wholeness - “a sound, organic, progressive
 Born in Hamburg, Germany mutuality between diversified functions and
 Concentrated on the art of nursing and parts within an entirety” (Erikson, 1969)
focused on the needs of the patient o Adaptation - “a process of change whereby
 “People may differ in their concept of nursing, the individual retains his integrity within the
but few would disagree that nursing is realities of his internal and external
nurturing or caring for someone in a motherly environment” (Levine, 1973)
fashion.” o Conservation - “describes the way complex
 Conceptual Model: The Helping Art of Clinical Nursing systems are able to continue to function even
o Clinical Nursing: directed toward meeting the when severely challenged” (Levine, 1990).
patient’s perceived need-for-help (based on (Energy, Structural Integrity, Personal
individual perception) Integrity, Social Integrity)
o The nurse administers the help needed and
validates that the need-for-help was met THE SCIENCE OF UNITARY HUMAN BEINGS
o Four main elements of Clinical Nursing: Martha Rogers (1914 – 1994)
Philosophy, Purpose, Practice and Art
 Biography of Martha Rogers
CARE, CORE, CURE MODEL  Born in Texas, USA
Lydia Hall (1906 – 1969)  “Nursing is a learned profession, both a
Science and an Art.”
 Biography of Lydia Hall  “Nursing exists for the care of people and the
 Born in New York, USA life process of humans.”
 The Science of Unitary Human Beings
 Care, Core, Cure Model o Rested on a set of basic assumptions that
o Defined Nursing as: “Participation in Care, described the life process in human beings
Core and Cure aspects of patient care, where o Human beings are dynamic energy fields
CARE is the sole function of nurses, whereas integral with environmental fields
the CORE and CURE are shared with other o The Life Process is characterized by:
members of the health team.” Wholeness, Openness, Unidirectionality,
Pattern and Organization, Sentience, and  Promoted professional standards of nursing

Thought regulation through credentials
o Four (4) building blocks of the model: Energy  Introduced the “nurse-patient relationship” and
Field, Universe of Open Systems, Pattern, the concept of advanced nursing practice
Pandimensionality  Theory of Interpersonal Relations
o Used the psychological model to develop the
NURSING AS CARING: A MODEL FOR TRANSFORMING middle-range descriptive theory
PRACTICE o Focuses on the Individual, Nurse, and the
Ann Boykin & Savina Schoenhoffer Interactive Process (NursePatient Relationship
 Client is an individual with a felt need
 The focus of nursing is nurturing persons living caring  Nurse serves as a stranger, resource person,
and growin in caring. As an expression of nursing, teacher, leader, surrogate and counselor
caring is the intentional and authentic presence of the  Nursing is an interpersonal and therapeutic
nurse with another person who is recognized as living process, its goal is to educate the client and
caring and growing in caring family, help the client reach mature
 The most basic premise of the theory is that all personality development
human are caring persons, that to be human is to be
called to live one’s innate caring nature. Developing the THEORIES
full potential of expressing caring is an ideal and for
practical purposes, is a lifelong process  Nursing Process Theory by Ida Jean Orlando
 The major assumptions are:  Cultural Care Diversity and Universality Theory by
 Persons are caring by virtue to their Madeliene Leininger
humanness  Theory of Health as Expanding Consciousness by
 Persons live their caring moment to moment Margaret Newman
 Persons are whole or complete in the moment  Theory of Human Becoming by Rosemarie Rizzo
 Personhood is living grounded in caring Parse
 Personhood is enhanced through participating  Symphonology and Bioethical and Theory by Gladys
in nurturing relationships with caring others Husted
 Nursing is both a discipline and a profession  Fourteen Basic Needs by Virginia Henderson
 Typology of Twenty-one Nursing Problems by Faye
MIDDLE RANGE NURSING THEORIES Glenn Abdellah
 Human-to-Human Relationship Theory by Joyce
 Maternal Role Attainment Theory by Ramona Mercer Travelbee
 Theory of Uncertainty in Illness by Merle Mishel  The Humanistic Nursing Theory by Josephine
 Theory of Self-Transendence by Pamela Reed Paterson and Loretta Zderad
 Theory of Illness Trajectory by Carolyn Wiener and
Marylin Dodd FOURTEEN BASIC HUMAN NEEDS
 Theory of Chronic Sorrow by Georgene Gaskil Eakes, Virginia Henderson
Mary Lermann Burke, and Margaret Hainsworth
 The Tidal Model of Nursing by Phil Barker  Biography of Virginia Henderson
 Theory of Comfort by Katharine Kolcaba  Born in Missouri, USA
 Theory of Postpartum Depression by Cheryl Tatano-  Envisioned the practice of nursing as
Beck independent from practice of physicians
 Theory of Caring Kristen Swanson  Famous for her definition of nursing
 Peaceful End of Life Theory by Cornelia Ruland and  Fourtheen Basic Human Needs
Shirley Moore o Emphasized the art of nursing and identified
 Theory of Interpersonal Relations by Hildegard fourteen (14) basic human needs on which
Peplau nursing care is based
o Nursing: “Assisting the individual, sick or well,
THEORY OF INTERPERSONAL RELATIONS in the performance of those activities that will
Hildegard Peplau contribute to health, recovery, or a peaceful
death and that the individual would perform
 Biography of Hildegard Peplau unaided if he or she had the necessary
 Born in Pennsylvania, USA strength, will or knowledge and to do this in
 Mother of Psychiatric Nursing
such a way to help him gain independence as o Nursing was accomplished through Human-to-
rapidly as possible.” Human relationship that begins with: The
original encounter; emerging identities;
TYPOLOGY OF TWENTY-ONE NURSING PROBLEMS
developing feelings of empathy; sympathy;
Faye Glenn Abdellah
nurse and patient attained rapport
 Biography of Faye Glenn Abdellah o This relationship can be accomplished through
 Born in New York, USA an interaction process
 Typology of Twenty-one Nursing Problems HUMANISTIC NURSING THEORY

o Views nursing as both an art and a science Josephine Paterson & Loretta Zderad
that molds the attitude, intellectual
competencies and technical skills of the  “Nursing is an experience lived between human
individual nurse to help people (well or ill) beings”
cope with their health needs  The theory revolves around everyone being their own
o Based on the problem-solving method (vehicle unique person and how the nurse should understand
for delineating nursing problems as the patient that. No person or experience is the same
moves toward a healthy outcome)  The conceptual framework of the theory is
o Progressed to a second-generation
existentialism, and it presents a phenomenological
development of patient problems and patient
outcomes method of inquiry that can be used by nurses to
examine and understand their everyday practice
NURSING PROCESS THEORY  Developed five (5) phases related to the concepts:
Ida Jean Orlando-Pelletier preparation of the nurse knower for coming to know;
nurse knowing of the other intuitively; nurse knowing
 Biography of Jean Orlando-Pelletier the other scientifically; nurse complementarily
 Born in New Jersey, USA
synthesizing known others; succession within the nurse
 The first nurse to develop a theory from actual
nurse-patient situations from the many to the paradoxical one
 Nursing Process Theory
o One of the first nursing leaders to identify and CULTURE CARE THEORY OF DIVERSITY AND
emphasize the elements of the nursing process UNIVERSALITY
and the critical importance of the patient’s Madeliene Lenninger
participation in the nursing process
o Nursing Process – the action process by the  Biography of Madeliene Lenninger
nurse in a nursepatient contact  Born in Nebraska, USA
 Observation of the other’s behavior  Culturally based care (caring) is essential for
 Perception: The resulting thought about this well-being, health, growth and survival and to
observation face handicaps or death
 Feeling originating from the person’s  Culture Care Theory of Diversity and Universality
perception or thought o Goal of the Theory: To improve and to provide
 An Action chosen by each individual in culturally congruent care to people that is
response to the reaction beneficial, will fit with, and will be useful to the
client, family or culture group healthy lifeways
HUMAN-TO-HUMAN RELATIONSHIP THEORY o Involves knowing and understanding different
Joyce Travelbee cultures with respect to nursing and health-
illness caring practices, beliefs and values with
 Biography of Joyce Travelbee the goal to provide meaningful and efficacious
 Born in Louisiana, USA nursing care services to people according to
their cultural values and health-illness context
 Psychiatric Nurse and Educator
 Human-to-Human Relationship Theory
o Synthesized unique ideas on the therapeutic
human relationship between NURSE and
PATIENT
THEORY OF HUMAN BECOMING o Nursing activity focuses on enhancing the

Rosemarie Rizzo Parse developmental process toward health
o A central concern of nursing science and the
 Biography of Rosemarie Rizzo Parse nursing profession is the meaning attributed to
 Born in Texas, USA life as the basic understanding of human
 Created the theory on human becoming to existence
guide nurses to focus on quality of life from o The identification and labeling of concepts
each person’s own perspective as the goal of allows for recognition and communication with
nursing others, and the rules for combining those
 Theory of Human Becoming concepts permits thoughts to be shared
o It presents an alternative to most of the other through language
theories of nursing, which take a bio-medical
or bio-psychosocial-spiritual approach 2.10 CURRENT HEALTH CARE ISSUES
o The three major assumptions about human
becoming are:  Cultural beliefs and practices
 Meaning: Human Becoming is freely choosing  Global Health Pandemic
 The Expanding Role of Health Care Professionals
personal meaning in situations in the
 Health, Wellness, and Safety in the Workplace
intersubjective process of living value  Moral, Ethical, and Legal Considerations in Health
priorities. Man’s reality is given meaning Care Practice
through lived experiences. Man and
environment co-create
 Rhythmicity: Human Becoming is co-creating ~ END OF MODULE 2F ~
rhythmical patterns of relating in mutual
Trans by: Jan Kylle Jala BSN 1-I
process with the universe. Man and
environment co-create (imaging, valuing,
languaging) in rhythmical patterns
 Transcendence: Human Becoming is co-
transcending multidimensionally with emerging
possible. Refers to reaching out and beyond
the limits that a person sets. One constantly
transforms
LIFE PERSPECTIVE RHYTHM MODEL

Joyce Fitzpatrick
 Biography of Joyce Fitzpatrick

 Born in Texas, USA
 Life Perspective Rhythm Model
o Life Perspective Rhythm Model is a complex
nursing model which contribute to nursing
knowledge by providing taxonomy for
identifying and labeling nursing concepts to
allow for their universal recognition and
communication with others
o The major assumptions are:
o The process of human development is
characterized by rhythms that occur within
the context of continuous person-environment
interaction.”
Module 3F: Concept of Health
 Positive Health Behavior - activities related to

Topic Outline maintaining, attaining, or regaining good health and
preventing illness
3.1 Concept of Health  Examples of Positive Health Behavior:
3.2 Stages of Illness
 Sleeping early for 8-10 hrs
3.3 Impact of Illness
3.4 Six Links in the Chain of Infection  Immunization to protect the body from
3.5 Levels of Preventive Care diseases
3.6 Types of Immunity  Eating fruits and vegetables
3.7 Models of Health and Wellness  Negative Health Behavior – are practices actually or
3.8 Variables Influencing Health Status, Beliefs, and potentially harmful to health
Practices
 Examples of Negative Health Behavior:
 Smoking and drinking alcohol
 Taking harmful and prohibited drug
3.1 CONCEPT OF HEALTH
 Consuming unhealthy foods
 As future professional nurses, you need to learn the
ILLNESS
concept of health because you are in a unique position
to assisst clients in achieving and maintaining optimal
levels of health  Illness - inability of an individual’s adaptive
 As nurses, you also embrace the opportunity to use responses to maintain physical and emotional balance
activities to promote health and wellness and prevent that subsequently results in an impairment of
illness functional abilities
 Nurses who understand how clients react to illness
can minimize the effects of illness and assist clients ILLNESS BEHAVIOR
and their families in maintaining or returning to the
highest level of functioning  Illness Behavior - involves ways an individual
describes, monitors, and interprets the symptoms,
TERMS take remedial actions, and use health care systems
o In other words, it is how people react, manage
HEALTH and perceives to be ill
 Health - is a global term because it refers to every WELLNESS

aspect of a person’s life including physical status,
emotional wellbeing, social relationships, intellectual  Wellness – the quality or state of being in good
functioning, spiritual condition health especially as an actively sought goal
 State of complete physical, mental, and social well-
being, not merely the absence of disease or infirmity IMMUNITY
(WHO,1948)
 The ability to maintain normal roles (Talcott Parsons,  Immunity – the ability to resist a particular infection
1951)
or toxin by the action of specific antibodies or
 Dynamic state of being in which the developmental
and behavioral potential of an individual is realized to sensitized white blood cells
the fullest extent possible (ANA)
3.2 STAGES OF ILLNESS
 For many people, conditions of life rather than
pathological states are what define health (Pender et
al., 2006) ACUTE AND CHRONIC ILLNESS
HEALTH BEHAVIOR  Acute Illness

o characterized by severe symptoms of
 Health Behavior - is An action a person takes to relatively short period of time, usually
reversible
understand his or her health state, maintain an
o appear abruptly and subside quickly
optimal state of health, prevent illness or injury and o ex. fever, cough, colds, diarrhea
reach their maximum physical and mental potentials
Concept of Health | 1
 Chronic Illness  When the symptoms of illness persist or increase

o gradual that lasts a long time, is irreversible then the person is motivated now to move on from
o usually 6 months or longer stage 2 to stage 3
o ex. cancer, diabetes, mellitus, hypertension,
arthritis STAGE 3 – MEDICAL CARE CONTACT
STAGES OF ILLNESS BY SUCHMAN (1979)  The sick person seeks health care provider for
diagnosis and treatment
 Remember that not all client progress through each o either they on their own would go to the
stage professional health provider or they were
o There are clients who only experience the first forced by their significant others to go because
two stages and then they recover so they they are very sick already
don’t proceed into stage 3 anymore o when people seek for medical advice they are
o There are also cases wherein a client skips asking for three types of information:
stages 1 and 2 and goes directly to stage 3 for validation of the real illness from the
medical care contact (ex. heart attack, professional healthcare provider, they want to
stroke, motor vehicular accidents) be explained of the symptoms and these are in
understandable terms, and they want to be
STAGE 1 - SYMPTOM EXPERIENCE reassured that they will be alright or what the
outcome would be in the future
 The person is aware that something is wrong. Either  May give up independence
he recognizes one or more symptoms like fever, o the healthcare professional will determine if
rashes, pain, etc. or somebody mentions that he does the client is sick or not and the client may
not look well accept or deny the diagnosis of the healthcare
 The unwell person usually consults others and provider
validates these symptoms o If the diagnosis is accepted, then the client
 It is also the time wherein they do home remedies
usually follows the prescribed treatment plan
(ex. drinking over the counter medications, tepid
sponge bath) and so they move on to the next stage.
Otherwise, if the client would want to seek
 Three aspects in stage 1 advice of another healthcare professional then
o Physical – experience of the symptom/s that is always the client’s right
o Cognitive – how the person interprets the o So in this stage, if they accept the medical
symptoms in terms that have meaning to that
care and diagnosis, the client may give up
person
independence
o Emotional response – wherein you have fear
and anxiety within you
STAGE 4 – DEPENDENT CLIENT ROLE
 If self-management is ineffective, the individual
enters stage 2  The client depends on the health care professionals
for the relief of symptoms
STAGE 2 – ASSUMPTION OF THE SICK ROLE  Requires assistance in carrying out the activities of
daily living; needs emotional support
o people vary greatly in the degree of ease in
 If symptoms persist and become severe, the person
which they can actually give up their
assume the sick role
independence
o other people continue with self-treatment and
o if clients have a role in society, (ex. parents
they delay the contact with healthcare
who are earning for their family, student who
professionals as long as possible
is on their studies, or active members in
 Sick people seek validation from family and social
sports) it would be very difficult for them and
group
could complicate the decision to give up
 During this stage, people may be excused already
independence
from their normal duties and role expectations
o most people accept their dependence on the
 Emotional feelings that come within this stage aside
primary care provider although they have
from anxiety and fear, there is depression and
varying degrees of control over their own lives
withdrawal depending on the severity of the illness
(ex. others delay their treatment while others o body image is the subjective concept of
proceeds with the treatment) physical appearance. Some illnesses result in
o for some clients, illness may meet dependence changes in physical appearance
needs that have never been met and thus o So when a change in body image (ex. result
provide satisfaction from a leg amputation) the patient generally
o other people have minimal dependence needs adjust in the following phases: shock,
and do everything possible to return to withdrawal, then the patient acknowledges,
independent functioning accepts, and then there is rehabilitation
3. Lifestyle changes
STAGE 5 – RECOVERY OR REHABILITATION o In addition to participating in treatments and
taking medications, the ill person may need to
 The client may return to health at a higher level of change his diet, activity, exercise, and his rest
functioning and sleep patterns
 Resumes normal activities and responsibilities
 During this stage, the client is expected to give up IMPACT OF ILLNESS ON THE FAMILY
the dependent role and resume to the former roles and
responsibilities he has  A person’s illness affects not only the person who is ill
o for people with acute illness, recovery is but also the family
usually fast but for those with long term illness  The kind of effect and extent depends chiefly on three
and must adjust to their lifestyles, they could factors: the member of the family who is ill, the
find recovery more difficult seriousness and length of the illness, and the cultural
o for people with permanent disability, recovery and social customs the family follows
may require some therapy to learn how to
make major adjustments in functioning 1. Role changes
o for example, the head of the family gets sick
3.3 IMPACT OF ILLNESS and the illness is life threatening, there will be
role changes in the family
IMPACT OF ILLNESS ON THE CLIENT o it may be that an adult child becomes a parent
because the head of the family cannot do the
1. Behavioral and emotional changes responsibilities and functions anymore
o people react differently to illness or the threat 2. Task reassignments and extra demands on time
of illness o there will be task reassignments and extra
o an individual behavioral and emotional demands on time because they need to take
reaction depends on the nature of the illness care of the ill
o if the illness is short term and non life 3. Increased stress and conflict
threatening, it could evoke few behavioral
o it is expected in the family especially if the
changes in the functioning of the client (ex. if
the client has colds and fever, he becomes client has a change of self concept and feels
irritable, lacks energy, and does not interact that he is weak. So the expectations change
that much) that results to increased stress and conflict
o if the illness is severe and life threatening, it 4. Financial Problems
could evoke more major behavioral changes o there will be financial problems especially if
(ex. if a client is diagnosed with cancer, of there is a need to pay more for the treatment
course the client will feel anxiety, shock,
5. Loneliness
denial, anger, and withrawal)
2. Changes in self-concept and body image o loneliness comes in when its life threatening
o self-concept is a mental self image of your and its terminally ill that could lead to death
strengths and weaknesses in all aspects of 4. Change on social customs
personality. It is very important in o social customs is a commonly accepted
relationships with other family members manner of behaving or doing something
(ex. a client whose self concept changes
particularly in the family as a whole
because of illness may no longer meet family
expectations leading to conflict. As a result, o there are changes on social customs in the
family members change their interactions with family when there is a major illness in the
the patient) family
3.4 SIX LINKS IN THE CHAIN OF INFECTION o Salmonella which is transmitted by poultry,
cattle, sheep and pigs
 Environmental Reservoirs
o The environment contains a large number of
reservoirs of infection, including:
o soil which carries a causative agent of tetanus
o water and food
PORTAL OF EXIT
 Portal of exit - is any route which enables a pathogen

to leave the reservoir or host. In humans the key
portals of exit are:
o Alimentary via vomiting, diarrhoea or biting
o Genitourinary via sexual transmission
o Respiratory through coughing, sneezing and
PATHOGEN talking
o Skin via skin lesions
 Pathogen – infectious agent o Trans-placental where transmission is from
 A pathogen can take the form of: mother to fetus
o Bacteria
o Virus MODE OF TRANSMISSION
o Fungi
o Parasite  Mode of Transmission can be in the form of:
 How well any pathogen is able to thrive depends on o Direct contact tends to be instantaneous and
three factors: occurs when there is direct contact with the
o Pathogenicity or the ability to produce the infectious agent. Examples include tetanus,
disease glandular fever, respiratory diseases and
o Degree of Virulence or the severity or sexually transmitted diseases
o Indirect contact they can be taken from food,
harmfulness
water, biological products or surgical
o Invasiveness is its tendency to spread instruments
o Vectors are brought about by flees, ticks, flies,
RESERVOIR or mosquitos or via innanmate mechanisms
 Reservoir – is the principle habitat in which a PORTAL OF ENTRY

pathogen lives, flourishes and able to multiply
 Reservoir can come in the form of:  Portal of Entry can be in the form of:
o People o Mouth
o Animals o Nose
o Soil o Eyes
o Food o Cuts in skin
o Water  Portals of entry into the human body include:
 Two forms of Reservoir in People: o Inhalation via the respiratory tract
o Acute clinical cases in which someone is o Absorption via mucous membranes such as
infected and you can see the signs and the eyes
symptoms of the disease o Ingestion via the gastrointestinal tract
o Carriers in which the person may look well o Inoculation as the result of an inoculation
without signs and symptoms but the person injury (vacination or needle prick)
actually is infected o Introduction via the insertion of medical
 Animal and Insects Reservoir devices
o Lyme disease which is transmitted via ticks
o Rabies which is transmitted by dogs, cats,
foxes and bats
SUSCEPTIBLE HOST PRIMARY PREVENTION
 Susceptible Host includes:  Seeks to prevent a disease or condition

o Elderly Applied to clients considered physically and
o Infants emotionally healthy
o Immunocompromised There is no condition or disease yet in primary
o ANYONE! prevention
 How susceptible any host will be, depends on a
variety of factors: HEALTH PROMOTION
o Their age and in particular if they are very
young or very old 1. Health education programs
o Whether there is any presence of malnutrition o ex. education on the bad effects of smoking
or dehydration 2. Immunizations
o Whether there is any underlying chronic o done especiallyfor infants so they will not
disease contract diseases when they grow up
o If the host suffers from immobility 3. Nutritional programs
o If they are taking any medication which could o ex. the right food to eat
disrupt or suppress their immune response 4. Physical fitness activities
o General resistance factors (such as mucous o the good effects of exercising and sleeping
membranes, skin, cough reflex etc) that can enough hours
help defend against infection
SPECIFIC PROTECTION
BREAKING THE CHAIN OF INFECTION
1. Immunization for influenza
 Opportunities to break or disrupt the chain at any o this is protection against the flu virus
link in a healthcare setting: 2. Hearing protection in occupational settings
1. Rapid and accurate diagnosis of an infectious o ex. if people work in factories that have loud
disease noise that could potentially damage the
2. Prompt treatment of infected clients eardrums, then hearing protection is a
3. Safe disposal of waste primary prevention
4. Sterilization and disinfection of medical 3. Use of seatbelts and bike helmets
equipment 4. Control on the use of hazardous products
5. Implementation of an environmental o ex. the use of asbestos and all other products
decontamination strategy that could be harmful to one’s health
 In order to disrupt the chain of any link is not solely in
the hospital setting but in any setting for that matter SECONDARY PREVENTION
and you just have to reduce the risk with common
sense (ex. we should have the common sense to follow  Focuses on individuals experiencing health problems
covid-19 protocols) or illnesses and are risk for developing complications
 Prevention is always the case and you will reduce the or worsening conditions
risk with common sense  An individual already have problems and we are
 You also have to form positive habits and take doing some prevention in order for this not to develop
responsible actions always into complications
 Follow expert advice from the professional
healthcare workers EARLY DIAGNOSIS AND PROMT TREATMENT
3.5 LEVELS OF PREVENTIVE CARE 1. Screening activities

2. Selective examinations
o these involve examinations that could further
diagnose the condition
o ex. the person has a lump in their breast then
the doctor may request for a mamogram (a
procedure to detect breast cancer)
o ex. should their be signs and symptoms of
prostate cancer then the person could be
screened for the presence of prostate cancer ACTIVE ARTIFICIAL IMMUNITY

cells through screening and selective
examinations  Antigen are administered to stimulate antibody
production (vaccines/toxoids)
DISABILITY LIMITATIONS o these are in the form anttenuated vaccines
wherein the virus is weakened and they are
1. Adequate treatment to arrest disease process injected into your body in order that when you
o ex. if the person has already undergone actually get the disease, you will not have it in
stroke, and so he was given a daily low dose a severe form
of aspirin by the doctor in order to arrest the o so when you are given the vaccine of the
disease process or there should minimal weakened virus, you don’t get sick you just
exercise to be done for the stroke not to occur have some minor symptoms in order for you
for the second or third time to not get the disease (ex. covid-19 vaccines)
2. Provision of facilities to limit disability and death
PASSIVE IMMUNITY
TERTIARY PREVENTION
 Antibodies are produced by another source
 Occurs when a defect or disability is permanent or (animal/human ) and they are brought into the body of
irreversible the person
 Involves minimizing the effects of long-term disease
or disability by interventions directed at preventing PASSIVE NATURAL IMMUNITY
complications and deterioration
 Antibodies (Ig A) are transferred naturally from an
RESTORATION AND REHABILITATION immune mother to her baby through the placenta or in
the colostrum (milk)
1. Provision of hospital and community facilities for
retraining and education to maximize use of remaining PASSIVE ARTIFICIAL IMMUNITY
capacities
o ex. use of wheelchair and perform ADLs  Immune serum antibody from an animal or another
independently for a stroke victim human is injected in order to help with the disease
2. The goal of returning the individual to OLOF process
(optimum level of functioning)  Examples are rabies and snake venom
3.6 TYPES OF IMMUNITY 3.7 MODELS OF HEALTH AND WELLNESS
 Antigens cause the disease while antibodies fight DUNN’S HIGH-LEVEL WELLNESS GRID
them
 Antigens and antibodies work together in your  Wellness is an integrated method of functioning
immune system which is oriented towards maximizing the potential of
which the individual is capable
ACTIVE IMMUNITY
 In this model, Dunn distinguished between good
 Antibodies are produced by the body in response to health that is not being ill, and what he termed high
an antigen level wellness
ACTIVE NATURAL IMMUNITY  Dunn defined high level wellness is a condition of

change in which the individual moves forward climbing
 Antibodies are formed in the presence of active toward a higher potential of functioning. So its not just
infection in the body having a good health but according to Dunn, there is a
o for example, when you have chicken pox, then model wherein you aim for high level wellness
the antigen that are brought by the disease
goes into your body and so your body
produces antibodies, and that would protect
you already for a lifetime of not acquiring the
chiceknpox anymore
POOR HEALTH
 Poor health in an unfavorable environment geared

towards death
o e.g., a young child who is starving in a drought
ridden country
TRAVIS’ ILLNESS-WELLNESS CONTINUUM
 A graphical illustration of well-being concept first

proposed by Travis. It proposes the well-being includes
mental and emotional health, as well as the presence
or absence of illness
 composed of two axis's
o a health axis which ranges from peak wellness  Travis believed it is possible to be physically ill and
to death at the same time you will be oriented toward wellness
o a environmental axis which ranges from very or to be physically healthy and at the same time
favorable to very unfavorable function from an illness mentality
 the two axis's form four quadrants
o high-level wellness, emergent high-level
wellness, protected poor health, and poor
health
HIGH LEVEL WELLNESS
 High Level Wellness in a favorable environment

(most favorable) geared towards peak wellness
o e.g., a person who implements healthy life-
style behaviors and has the
biopsychosocialspiritual resources to support
this life-style  composed of two arrows pointing in opposite
directions and joined at a neutral point
EMERGENT HIGH LEVEL WELLNESS
TOWARDS HIGH LEVEL WELLNESS
 Emergent High Level Wellness in an unfavorable
environment but geared towards peak wellness  Movement to the right on the arrows indicates an
o e.g., a woman who has the knowledge to increasing levels of health and well-being for an
implement healthy life-style practices but individual
does not implement adequate self-care  Achieved in three steps:
practices because of family responsibilities,  Awareness
job demands, or other factors  Education
 Growth
PROTECTED POOR HEALTH
TOWARDS PRE-MATURE DEATH
 Protected poor health in a favorable environment but
geared towards death  Movement to the left on the arrows indicates
o e.g., an ill person whose needs are met by the progressively decreasing levels of health
health care system and who has access to  Achieved in three steps:
appropriate medications, diet, and health care Signs
instruction Symptoms
Disability
 Compares a treatment model with wellness model o Examples of perception and likelihood of
action is about people who will not change
TREATMENT PARADIUM their health behaviors unless they believe that
they are at risk
 If a treatment model is used, an individual can move o eg. an individual who do not think they will get
right only to the neutral point the flu are less likely to get a yearly flu shot
o e.g., a hypertensive client who only takes his o eg. people who think they are unlikely to get
medications without making any other life- skin cancer when they expose themselves
style changes under the heat of the sun are less likely to
wear sunscreen or limit their sun exposure
WELLNESS PARADIUM
MASLOW’S HIERARCHY OF NEEDS
 If a wellness model is used, an individual can move
right past the neutral point  Human needs ranked on an ascending scale
o e.g., a hypertensive client who not only takes according to how essential the needs are:
his medications, but stops smoking, looses Psychological Needs, Safety and Security, Love and
weight, starts an exercise program, etc. Belongingness, Self Esteem, and Self-Actualization
 The wellness paradium can be initiated at any point
on the continuum. In fact, the wellness paradium and
treatment paradium can work together
HEALTH BELIEF MODEL
 A psychological model that attempts to explain and

predict health behaviors
 The health belief model asserts that when a person
believes he/she is susceptible to a health problem with
severe consequences on the seriousness of the disease,
the person will more likely conclude that the benefits
outweigh the barriers associated with changing one’s
behavior to prevent the problem
 It is a model that nurses use to understand the
interrelationships of basic human needs
 There are certain human needs that are more basic
than others; that is, some needs must be met before
other needs (eg. fulfilling physiological needs before the
needs of love and belonging)
 According to Maslow, self actualization is the
highest expression of one’s individual potential and
allows for continual self discovery
 Maslow’s model takes into account individual
experiences which are always unique to your clients
when working as professional nurses
 It is composed of three components  When applying the model, the focus of care is on
the patients’ needs rather than on strict adherance to
o Once a person perceives susceptibility of the hierarchy has presented
 It is unrealistic to always expect a client’s basic
seriousness of the disease, and the perception
is there on the threat of disease to one’s life, needs to occur in the fixed hierarchical order
 Maslow’s hierarchy of needs can be very useful
then there is the likelihood of behavioral
when applied to each client individually
change
o Remember that there are modifying factors on  In all cases, an emergent physiological need takes
the perception on the threat of disease to one’s precedence with your higher level need. However, in
health that affects your perception on the other situations, a safety need takes priority (eg. when
health (may influence you to change your there is fire, you need to keep yourself safe because of
fear of injury and death). In this way, we don’t use it
behavior)
strictly into their hierarchy
 It is important not to assume the patient’s needs just ENVIRONMENT

because other patients react in a certain way.
Therefore, it is important to treat each patient  External factors that make illness more or less likely
uniquely and individually o Physical environment - climate, living
 To provide the most effective care as nurses, it is conditions, sound (noise) levels, and economic
important to understand the relationships of the level
different needs and the factors that determine the o Social Environment – interaction with others
priorities for each of the patients and life events, such as death of spouse,
stress, or conflicts
SITUATIONS
CLINICAL MODEL
1. A client who has just had surgery
o Physiological need, Safety and Security  People are viewed as physiological systems with
2. A client who had a mastectomy (removal of related functions
breast)  Health is identified by the absence of signs and
o Self-esteem symptoms of disease or injury
3. A homeless child roaming around the street  The focus is on the relief of signs and symptoms of
o Safety and Security disease and the elimination of malfunction and pain,
and so when these signs and symptoms are no longer
AGENT-HOST-ENVIRONMENT MODEL present, the nurse or the medical practitioner
considers the individual’s health has restored
 Each factor constantly interacts with the others  This is the narrowest interpretation of health that
 When in balance, health is maintaned occurs in nursing
 When not in balance, disease occurs
 Used primarily in predicting illness rather than ADAPTIVE MODEL
promoting wellness
 Model is composed of three dynamic,  Health is a creative process; disease is a failure in
interactive elements adaptation
 Aim of treatment is to restore ability of a person to
adapt and cope
 Extreme good health is flexible adaptation to the
environment and interaction with the environment to
maximum advantage
 Focus is stability along with growth and change
ROLE PERFORMANCE MODEL
 Health is the ability to do societal roles (eg. mother

role, daughter role, friend role)
 People are considered healthy if they can fulfill their
roles even if they have clinical illness (eg. a man who
AGENT works all day at his job, as expected is healthy
eventhough he is partially deaf)
 Any internal or external factor or stressor  Sickness in this model is the inability to perform one’s
(biological, chemical, mechanical, physical, or work role
psychological) that by its presence or absence makes
the person sick (eg. lack of essential nutrients could HOLISTIC HEALTH MODEL
lead to illness or disease)
 Considers emotional, spiritual and other dimensions
HOST to be important aspects of physical wellness
 This model attempts to create conditions that
 Person who may be at risk of acquiring a disease promote a patient’s optimal level of health. This is
 This model pertains to human beings, and so when we through the use of natural healing abilities of the body
take care of our clients, these are our clients in the and incorporate complimentary and alternative
hospital
interventions (meditation, music, therapy, reminisce,  Age

relaxation and others) o The distribution of disease varies with age
 Using the nursing process, nurses consider patients o There are diseases very common to the middle
to be the ultimate experts concerning their own health aged males (eg. atherosclerosis heart
and respect patients’ subjective experience disease) compared to the younger people
 Nurses actually use holistic therapies either alone or o There are communicable diseases common
conjunction with conventional medicines: among children only that adults cannot have
 Nurses may use reminisce in the geriatric  Developmental Level
population to help relieve anxiety for a patient o It has a high major impact on health status
dealing with memory loss or for a cancer o eg. adolescents who strive to conform to peers
patient dealing with the difficult side effects of are more prone to risk taking behavior
chemotherapy compared to adults so they are more prone to
 Nurses may use music therapy in the injuries
operating room which creates a soothing o eg. toddlers are learning how to walk so they
environment are more prone to falls and injury compared to
 Relaxation therapies are frequently useful to older children
distract a patient during a painful procedure o eg. infants lack the psychological and
such as dressing change physiological maturity for defenses while the
 Breathing exercises are commonly taught to very old have declining physical and sensory
help patients deal with the pain associated perceptual abilities that can protect them
with labor and delivery
 These holistic strategies can be used in all stages of PSYCHOLOGICAL DIMENSION
health and illness in our integral in the expanding role
of nursing  Mind-Body Interaction
o It can affect health status positively or
3.8 VARIABLES INFLUENCING HEALTH STATUS, negatively and the emotional responses to
BELIEFS AND PRACTICES stress affects the body function
o eg. a student who is extremely anxious before
INTERNAL VARIABLES a test may experience some urinary frequency
and diarrhea
BIOLOGIC DIMENSION o eg. when a person is worried or stressed about
something, the reaction there might be that
 Genetic Make-up the person does something that is unhealthy to
o refers to how a person is predisposed to the the body (smoking, stress eating)
illness o In the long run, this can affect a person’s
o it has been related to the susceptability to immune system and prolonged distress may
specific diseases increase susceptability to organic disease or
o eg. some people in a certain country have precipitate the formation of these diseases
higher incidence to get sick from a certain  Self-Concept
condition compared to another o This is how a person feels about self, looking
o Genetic predisposition is an increased into the self esteem and perceives the physical
likelihood of developing a particular disease self or the body image
based on a person's genetic makeup. A genetic o Such attitudes can affect health practices and
predisposition results from specific genetic responses to stress and illness
variations that are often inherited from a o eg. a woman with anorexia who deprives
parent herself of needed nutrients because she
 Sex believes she is too fat eventhough she is well
o There are certain types of sex who are more below in an acceptable weight level
commonly into that disease compared to the o Along with this is self perception which is also
other associated with person’s definition of health
o eg. females are more common to have o eg. an elderly man who feels he should be able
osteoporosis and autoimmune diseases while to move large objects just as he did when he
males are common to have stomach ulcers, was younger, he needs to examine and
abdominal hernias, and respiratory diseases redefine his concept on health envy of his age
and ability
COGNITIVE DIMENSION people. In excessive levels, they are harmful to

health
 Lifestyle Choice
o Lifestyle refers to a person’s general way of STANDARDS OF LIVING
living including the living conditions and
individual patterns of behavior that are  An individual standard of living which reflects the
influenced by factors like sociocultural and occupation, income, and education is related to health
personal characteristics morbidity and mortality
o In lifestyle choices, you have control over it  This includes hygiene, food habits, and the ability to
but it could still pose as a positive and seek healthcare
negative influence on you o usually the low income families prioritize their
o If there is a negative effect on the person, in finances than on healthcare
healthcare we usually refer this as risk factors o the environmental conditions, for example in
o eg. overeating, getting insufficient exercise, slum neighborhoods are overcrowded and
and not getting enough sleep, which leads to sanitation services tend to be inadequate
overweight is a cause for diabetes millietus or (piles of garbage and pests are common)
hypertension  Occupation roles also predispose people to certain
o eg. if you smoke, then that could lead to illnesses
cancer of the lungs and other respiratory and o industrial workers are exposed to carcinogenic
cardiovascular diseases agents and there are high pressure social or
 Spiritual and Religious Beliefs occupational roles that predispose some to
o These significantly affect health behavior stress related diseases
o eg. there are religions that oppose blood
transfusions. So when the person needs blood FAMILY AND CULTURAL BELIEFS
transfusion in the hospital, then they are not
able to get it because they don’t believe in it  The family passes on patterns of daily living and
and they oppose it lifestyle to offspring
o eg. people in some religions believe that o eg. a man who was abused as a child may
serious illness is a punishment from God and physically abuse his own children and long
they just let it be and don’t want to be cured term abuse may tend to give health problems
because they accept it as their punishment in the long run
o eg. some religiuos groups are also strict o eg. a family of open communication sharing
vegetarians and cannot get all nutrients and love fosters the fulfillment of optimum
needed in the body health potential
 Culture and social interactions also influence how a
EXTERNAL VARIABLES person perceives experiences and copes with health
and illness, and each culture has their own
ENVIRONMENT o eg. a person of asian origin may prefer to use
herbal remedies and acupuncture to treat pain
 Geographic location determines climate and climate rather than taking analgesics and other
affects health medications
 Malaria related conditions which is mosquito
born occur more frequently in tropical rather SOCIAL SUPPORT NETWORKS
than temporate climates
 Pollution of the water, air, and soil affects the  Support networks include family, friends, co-
health of the cells workers, neighbors, partner, community member that
 Harmful effects of radiation from the sun’s helps people avoid illness
ultraviolet rays (light skinned people are more  Remember that support persons also helps the
susceptible to the harmful effects of the sun individual confirm the illness that exist within the
than the dark skinned people) person
 Pestisides and chemicals used to control  People with inadequate support network sometimes
weeds and plant diseases are other sources of allow themselves to become increasingly ill before
environmental contamination. These confirming the illness and seeking therapy
contaminants can be found in some animals  Social support network provide the motivation for an
and plants, and are subsequently ingested by ill person to become well again
~ END OF MODULE 3F ~
Trans by: Jan Kylle Jala BSN 1-I

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Theoretical Foundations in Nursing FINALS

NCM 100 / Lecture / First Semester CDU – CN

Module 1F: History of Nursing

 Nursing was “untaught” and instinctive. It was

Module 1F: History of Nursing

o Hundreds of hospitals closed; there was no NURSING IS AN ART AND A SCIENCE

Module 1F: History of Nursing

4. Disapproved the restrictions on admission of 1.2 PHILIPPINE NURSING HISTORY

 The Period of Contemporary Nursing EARLIEST HOSPITALS

Module 1F: History of Nursing

FAMOUS FILIPINA NURSES 3.Philippine General Hospital School of Nursing

Module 1F: History of Nursing

1.3 NURSING LAW

 Established as Republic Act 877, known as the

1.4 HISTORY OF CDU-CN

 Organized in 1971 as Cebu Doctors’ College

Module 2F: Concept of Nursing

o as we say in CDU-CN “Nursing is where people

 In CDU-CN, it is an organizational culture that we

Module 2F: Concept of Nursing

 Nursing research LEVELS OF ABSTRACTION

 Concept - mental formulations of an object or event DESCRIPTIVE THEORIES

2.7 TYPES OF NURSING THEORY  Systems theory

Module 2F: Concept of Nursing

ENVIRONMENTAL THEORY  Conservation Model by Myra Estrin Levine

Module 2F: Concept of Nursing

Module 2F: Concept of Nursing

Module 2F: Concept of Nursing

Pattern and Organization, Sentience, and  Promoted professional standards of nursing

Module 2F: Concept of Nursing

 Typology of Twenty-one Nursing Problems HUMANISTIC NURSING THEORY

Module 2F: Concept of Nursing

THEORY OF HUMAN BECOMING o Nursing activity focuses on enhancing the

LIFE PERSPECTIVE RHYTHM MODEL

 Biography of Joyce Fitzpatrick

Module 3F: Concept of Health

 Positive Health Behavior - activities related to

 Health - is a global term because it refers to every WELLNESS

HEALTH BEHAVIOR  Acute Illness

Module 3F: Concept of Health

 Chronic Illness  When the symptoms of illness persist or increase

Module 3F: Concept of Health

Module 3F: Concept of Health

 Portal of exit - is any route which enables a pathogen

 Reservoir – is the principle habitat in which a PORTAL OF ENTRY

Module 3F: Concept of Health

SUSCEPTIBLE HOST PRIMARY PREVENTION

 Susceptible Host includes:  Seeks to prevent a disease or condition

3.5 LEVELS OF PREVENTIVE CARE 1. Screening activities

Module 3F: Concept of Health

screened for the presence of prostate cancer ACTIVE ARTIFICIAL IMMUNITY

3.6 TYPES OF IMMUNITY 3.7 MODELS OF HEALTH AND WELLNESS

ACTIVE NATURAL IMMUNITY  Dunn defined high level wellness is a condition of

Module 3F: Concept of Health

 Poor health in an unfavorable environment geared

TRAVIS’ ILLNESS-WELLNESS CONTINUUM

 A graphical illustration of well-being concept first

HIGH LEVEL WELLNESS

 High Level Wellness in a favorable environment

Module 3F: Concept of Health

HEALTH BELIEF MODEL

 A psychological model that attempts to explain and

Module 3F: Concept of Health