THEORETICAL FOUNDATION OF NURSING

REVIEW MATERIAL
THEORETICAL FOUNDATIONS OF Two types of Nursing Diagnosis
NURSING FINALS o Actual problem – present
o Potential problem – it might happen (future)

Legend: • Planning
Remember Previous Trans o Formulate a plan to solve the problem
Lecturer Book o Prioritize problems/diagnosis
(Exams) Trans Comm
o Formulate goals/desired outcomes
     o Selecting nurse interventions
o Write nursing order
Nursing Proccess o It needs to be SMART
 Specific – behavioral statement
A. Nursing Process
 Measurable – how will you measure
 Attainable – resources
• A systematic, rationale method of planning and providing  Realistic – resources
individualized nursing care.  Time Bound – time frame
• Its purpose is to identify client’s health status, actual or
 You need to have goals & outcomes
potential health care problems or needs, to establish plans to
need those needs and to deliver specific nursing interventions  Goals are broad statements about the effects
to meet those needs. of nursing interventions on the client.
• It has step sand has logical methods  Outcomes are specific, measurable criteria
used to evaluate whether goals have been
• Providing care to actual or potential healthcare problems
met based on specific nursing interventions.
• A set of activities that professional nurses perform to
determine the needs of the patient and make a judgement to • Implementation
provide the care that is needed. o It is the action part
o Determining the nurses need for assistance
Standards of Competent Performance o Implementing the nursing interventions
1. Formulates nursing diagnosis – through observation and
interpretation of information.
• Evaluation
2. Formulates a care plan – in collaboration with the client
3. Perform skills – essential to the nursing actions to be takes o Able to accomplish the plan
4. Delegates tasks – to subordinates o Determining the progress and client’s response
5. Evaluates the effectiveness – of the care plan o MET, PARTIAL MET, UNMET
6. Acts as the client’s advocate
Planning Phase: Interventions
B. Nursing Process • Interventions should always be documented in the medical record
• Interventions should be realistic for client, based on abilities and
resources
• A description of the client’s response to a disease state, • Intervention should be developed which are consistent with the
process, condition or situation. established plan of care
• Diagnosis actual and potential health problems/life process. • Interventions should be implemented in a safe, appropriate
• Describes a response to a disease process, condition or manner based on sound nursing theory and judgement.
situation (Nursing Diagnosis)
• Describes a specific disease process (Medical Diagnosis) Types of Nursing in Interventions
• Oriented to individual changes as client changes (Nursing • Independent
Diagnosis) o Able to implement without a physician’s order
• Oriented to pathology & remains constant (Medical
• Dependent
Diagnosis)
o Must have or obtain physician’s order to implement this
• Complaints medical diagnosis (Nursing Diagnosis) o Well intervention
defined classification system (Medical Diagnosis)
• Collaborative o Combination of dependent/independent nursing
• Re-self-care o Treatments (Medical Diagnosis)
interventions.

Types of Nursing Functions

• Independent - functions that are within scope of nursing practice.
o Assessment – history and physical
o Nursing diagnosis which requires nursing interventions
o Nursing actions
o Referrals to other health members
o Evaluation of patient’s responses
o Dependent – activities performed based on the physician’s order
• Administration of medication
• Carrying our specific treatments
o Interdependent – activities that are carried out in conjunction with
other health team members.
o RN works with a dietician to help a diabetic patient
control blood sugar
o RN works with PT to help improve patient’s ambulation.

Implementation Phase
o Implementation Skills
o Require cognitive skills (problem-solving, creative & critical
thinking skills)
1. Steps of the Nursing Process (ADPIE) o Require interpersonal skills (verbal/non-verbal communication,
teaching, caring etc.)
o Require technical skills (hands-on psychomotor skills, tasks,
• Assessment procedures)
o Gathering data, collecting data, organizing Evaluation Phase
data, Validate data, document data o Determining the client’s progress
o Subjective data – client states o Monitoring the client’s response
o Objective data – nurse gathered, assessment, Evaluation Phase
documentation and vital signs
o Comparing the actual to expected outcomes
• Diagnosis o Determine if the client achieve outcomes. If not, determine why
o Summarizing the data outcomes.
o Analyze data o If you determine the outcomes to be appropriate, assess the
o Identifying health problems, risks and strengths interventions
o Formulate diagnostic statements o If everything looks good, continue with plan of care observing for
improvement.

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Purposes of a Written Care Plan 4. Laurence Kohlberg (Moral Development Theory)
o Provides direction & individualizes client care
o Provides for continuity of care
o Provides direction for follow up & documentation
o Provides assistance in assigning staff
o Provides information for reimbursement

Critical Thinking Process

o Identify the problem
o Identifying the underlying beliefs (patient, personal and other
healthcare providers)
o Find support for the beliefs (accurate, timely, consistent
literature/research)
o Evaluate the situation for possible solutions and weigh the
solutions against the beliefs and values
o Present a course of action.

Filipino Nursing Theorist

Theories Relevant to Nursing Practice
1. Divina Gracia (Composure Model)

1. Ludwig Von Bertlanaffy (General System Theory)

• A state of well being
• Integrated and coordinated patterns of living that involves
• The whole is more than the sum of its part wellness
• The whole is equal to more than the sum of its part, they are • Set of behavior demonstrated by an advanced nurse practitioner
highly organized, and relationship are consistent, and they are affecting the client recovery (cardiac patients in PHC)
defined by boundary o Competence
• A system is a complex of interacting elements and they are  Is an in depth knowing and critical expertise
open to and interact with their environment. demonstrated in caring for patients.
o Presence and prayer
 Being with another person/availability during
the time of need.
 Therapeutic communication, active
listening, touch and praying
o Open-mindedness
 Being receptive to new ideas or to reason
 It conveys a manner of considering patients
preferences and opinion related to his
current health conditions
 Demonstrated by the nurse’s flexibility to
accommodate patient’s view.
o Stimulation
 Demonstrated by providing encouragement
that conveys hope and strength
2. Kurt Lewin (There Stages Model Approaches to Organizational
 Guidance in the form of giving explanation
Changes) and supervision when doing certain
procedures to patient.
• Unfreeze – recognizing the need for change o Understanding
• Changing – attempting to create a new state of affairs  Conveys interest and acceptance not only
for patient’s condition but also his entire
• Refreezing – incorporating the changes, creating and
being.
maintain a new organizational system.
o Respect
• Maintain the change in the organization
 Is acknowledging the patient’s preference
 Preferred nae, cultural background and
3. Erick Erickson (Psychosocial Development) belief.
o Relaxation
• There are eight stages of lifespan showing the development  Entails a form of exercise that involves
• In every stage of development there are negative tasks and alternate tension
positive tasks. o Empathy
• If people successfully deal with the conflict – psychological  Senses accurately other person’s inner
strengths that will serve them well for the rest of their lives. experience
• If they fail to deal effectively – they may not develop the  Perceiving the thoughts and feeling and
essential skills needed for a strong sense of self. communicated by putting himself in the
patient’s place.

Patient Wellness Outcomes

• Refers to the perceived wellness of selected patients after
receiving nursing care in terms of physiologic and biobehavioral.
o Physiologic Wellness outcome
 This refers to the perceived wellness of
selected patients after receiving nursing
care in terms of vital signs, bone pain
sensation, and complete blood count.
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 o Biobehavioral wellness outcome
 Refers to the perceived wellness of selected
orthopedic patients after receiving nursing
care in terms physical, intellectual,
emotional, and spiritual.
2. Divina Gracia (Composure Model)
• Sr. CArolina S. AGRAvante
• Nursing education is faced with a new challenge that is
globalization of nursing services
• Formation of new nursing leaders is urgently needed
Three-fold transformation leadership concept:
o Servant-leader spirituality
o Self-mastery
o Special expertise
Three-fold transformation leadership concept
1. Servant leader spirituality
• A leader, through spiritual exercise, realizes that
his model in caring for individual is Jesus
• Consists of a spiritual exercise, the determination
of the vitality of the care complex in the personality
of an individual and finally a seminar workshop on
transformative teaching.
2. Self-mastery
• Aims to promote self-discovery (knowing strengths
and weakness) controlling internal through
processes.
• Knowing one’s strengths and weak better
individual and professional resulting to an effective
teaching on students and staff.
3. Special expertise
• The level of competence in the particular nursing area.
• Professionals should be aware on what area they are expert at.
• Shown in a creative, caring, critical, contemplative and collegial
teaching of the nurse faculty who is directly involved with the
formation of the nursing.
Servant leader formula is an enrichment intervention which has three
parts that parallel the three concepts of the CASAGRA transformative
leadership model, namely
• The care complex primer
• A retreat workshop on servant leadership
• A seminar workshop on transformative teaching for nursing
faculty.
Main propositions
• Care complex – is a structure in the personality of the caregiver
that is significantly related to the leadership behavior.
• Vitality of care complex – the nursing faculty is directly related
to leadership behavior.
Servant Leadership
• is the perceived behavior of nursing faculty manifested through
the ability to model the servant leadership qualities in order to
bring out the best in students, competence in nursing skills,
commitment to the nursing profession and sense of collegiality
with the school, other health professionals, and local community.
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Transformative teaching aka Reflective teaching
• an umbrella term covering ideas, such as thoughtful instruction,
teacher research, techier narrative and teacher empowerment.
approach of care to advanced cases of cancer patients. Focus is
not on cure but on assisting the patient to explore her humanity
and internal serenity.
• Nurses must be seen not as mere caregivers btu facilitators of
peaceful acceptance of condition.
3. Carmencita M. Abaquin (PREPARE ME: Interventions and
the Quality-of-life advance progressive cancer patients)
Prepare Me
• Provides a framework on non-pharmacologic, non-surgical
approach of care to advanced cases of cancer patients.
• Focus is not on cure but on assisting the patient to explore her
humanity and internal serenity.
• Nurses must be seen not as mere caregivers btu facilitators of
peaceful acceptance of condition.
Person/Patient
• Specific to patients in advanced stages of cancer.
• “Are holistic being with physical, psychological, social, religious,
level of independence and environmental aspects”
• Patients who are terminally ill or those with incurable disease as
with cancer must be approached in multifaceted care to improve
their quality of life.
Environment
• Assume that environment is an aspect or dimension integrated to
the cancer patient.
• Focus on the quality of life.
Health
• Quality of life is defined as a multifaced construct that
encompasses the individuals’ capabilities and abilities of
enriching life when it can no longer be prolonged.
• This included proper care and maintaining integrity of the body,
mind and spirit despite the limitations brought about by the
present condition.
Nursing
• Goal is the improvement of quality of life for advance stage
cancer patients.
o Presence
 Being with another person during the times
of need therapeutic communication, active
listening and touch.
o Reminisce therapy
 Recall of past experiences, feelings and
thoughts to facilitate adaption to present
circumstances.
o Prayer
o Relaxation-breathing
 Techniques to encourage and elicit
relaxation for the purpose of decreasing
undesirable signs and symptoms such as
pain, muscle tension and anxiety.
o Meditation
 A form of relaxation for the purpose of
altering patient’s level of awareness by
focusing on an image of thought to facilitate
inner sight which helps establish connection
and relationship with God.
o Values clarification
 Assisting another individual to clarify his
own values about health and illness in order
to facilitate effective decision-making skills.
 patient develops an open mind that will
facilitate acceptance of disease state or
may help deepen or enhance values.
4. Sister Letty Kuan (Retirement and Role Discontinuities)
• Gracing Gracefully
Basic assumptions and concepts
• Physiological age
o Is the endurance of cells and tissues to withstand the wear-
and-tear.
• Role
o Refers to the set of shared expectations focused upon a
particular position.
• Change of life
 o Period between near retirement and post retirement years. the dynamic through which human persons and intelligent
machine can interface.

• Retiree Levels of Prevention

o An individual who has left the position because he/she has Primary
reached the prescribed retirement age or has completed the • Healthy pt
required years of service. • Promote and maintain wellness
• Role discontinuity Secondary
o Interruption in the line of status enjoyed or role performed. • Population who are at Risk
o Causes: accident, emergency and change of position or • Early detection and screening
retirement. • Antigen Test or PT PCR
• Coping approaches Tertiary
o Refer to the interventions or measures applied to solve a • They have the disease
problematic situation in order to restore or maintain • Treat and prevent complication
equilibrium and normal functioning.

Determinants of (+) perceptions in retirement and (+) reactions

toward role discontinuities:
1. Health Status
• refers to physiological and mental state of the
respondents, classified as either sickly or healthy.
2. Income
• refers to the financial affluence of the respondent
which can be classified as poor, moderate or rich.
3. Work Status
4. Family constellation
• means the type of family composition (close knit or
extended)
5. Self-Preparation
Concepts in this theory:
1. Acquisition
• past experiences, upbringing, and recognition in
childhood is essential to overcome
2. Struggle
• the challenges of daily living in mid-life.
3. Legacy
• Is met if struggles are surpassed and gained and one
will experience a happy and harmonious ageing.
• Those who had unhappy and unfulfilled childhoods
have bitter and difficult ageing.

5. Locsin Rozzano (Technological Competency as caring model)

• Coexistence of technology and caring is best exemplified in

nursing.
• Quality human care, particularly with technologies assuming
indispensable practice process mechanisms is critical.
• He proposed that some technologies are fundamental to the
delivery of quality human health care now, and in the future
(autonomous robots and artificial intelligence)

Assumptions of the theory

1. Persons are caring by virtue of their humanness
• caring is understood as the substantive focus of the
discipline.
2. The ideal of wholeness is a perspective of unity
• The recognition of human beings as complete in their being
without reference to composition of parts.
3. Knowing persons is a multidimensional process
• The nurse and nursed focus on appreciating, celebrating,
supporting, and affirming each other, while allowing for
mutual recognition as dynamic participants in human caring.
4. Technologies of health and nursing are elements for caring
• human persons more fully as active contributors in their care,
rather than simply as passive objects of care.
5. Nursing as a discipline and a professional practice
• nursing is imbued with knowledge derived from rigorous research

• Integration of technological competency in the practice of nursing

through the nurses’ proficient use of advanced technologies.
• Participation in research and development of technologies in
which nursing is increasingly considered vital to human care.
• Engagement in efficient nursing practices involving predictive
interventions in human caring, in which human thinking becomes
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