FLORENCE NIGHTINGALE “We are the light in institutional darkness, and in this model, we get

“Environmental Theory” to return to the light of our humanity” (2012)

Born: May 12, 1820  Conceptualized the Human Caring Model
Died: August 13, 1920  “Nursing is concerned with promoting health, preventing
 “Founder of modern Nursing” illness, caring for the sick and restoring health”
  “Lady of the Lamp”  Emphasized that nursing is the application of an art and
 She was influential in developing nursing, education, human Science through transpersonal caring transactions
practice and administration. to help persons achieved mind-body soul harmony, which
 Defined Nursing as generates self-knowledge, self-control, self-care and self-
“The act of utilizing the environment of the patient to assist him in healing. She included health promotion and treatment of
his recovery”  illness in Nursing.
 She was belonging to well educated, affluent, aristocratic  1961- finish nursing in Lewis Gale School of Nursing
Victorian family.  1964- earned Baccalaureate Degree in Nursing 
 She was raised in Derbyshire, England.  1966- finished her Master’s Degree
 Her father tutored here in mathematics, relion and  1973- finished her Doctorate Degree in Educational
philosophy.  Psychology and Counseling
 1837- she wrote her diary “calling”  1980- established the Center for Human Caring 
 1851- she completed her nursing training at Institution of METAPARADIGM OF NURSING
Protestant Deaconesses sin, Kaiser Werth, Germany  PERSON
 1853- she became the superintendent of the Hospital for Human being refers to “a valued person to be cared for, respected,
Invalid Gentlewomen in London. nurtured, understood, and assisted; in general, a philosophical view of
 1859- she wrote “Notes on Nursing” a person as a fully functional integrated self. He, human is viewed as
 1860- Florence set up the Nightingale school of Nursing in greater than and different from, the sum of his or her parts”. 
London ENVIRONMENT
4 major concepts of environmental theory Refers to society. Caring and nursing existed in every society. It
provides the values that determine how one should behave and what
 Physical environment
goals one should strive toward.
 Psychological environment
NURSING 
 Nutritional status
 Consist of knowledge, thought, values, philosophy,
 Nursing care plan and management  commitment an action with some degree of passion
Five essential components of environmental health
 “Human science of people and human health-illness
 Pure air experiences that are mediated/intervened by professional,
 Light  personal, scientific, aesthetic, and ethical human care
 Cleanliness transactions”
 Efficient drainage HEALTH
 Pure water  Refers to unity and harmony within the mind, body and
soul. 
METAPARDIGM OF NURSING  It is also associated with the degree of congruence between
PERSON self as perceived and as experienced. 
 Referred to by Nightingale as “the patient” PATRICIA E. BENNER
 A human being acted upon by a nurse, or affected by the “Benner’s stages of nursing expertise”
environment. 1. Novice- No experience. Performance is limited, inflexible
 Has reparative powers to deal with disease and govern by context-clues rules and regulations rather than
 Recovery is in the patient’s power as long as a safe experience. 
environment exists.  2. Advance Beginner- Demonstrates marginally acceptable
ENVIRONMENT performance. Recognize meaningful aspects of a real
 The foundational component of nightingale’s theory situation. Has experienced enough real situations to make
 The external conditions and forces that affect one’s life and judgment about them. 
development 3. Competent- Demonstrates organizational and planning
 Includes everything from a person’s food to a nurse’s verbal abilities. Differentiates important factors from less important
and nonverbal interactions with the patient. aspects of care. Coordinates multiple complex demand. 
NURSING 4. Proficient- Perceives situation as whole rather than in terms
 Provides fresh air, light, warmth, cleanliness, quiet of parts, as in stage II. Uses maxims as guides for what to
environment and a proper diet. consider in a situation. Has holistic understanding of the
 Facilitates patient’s reparative process by ensuring the best client which improves decision making. Focuses in long term
possible environment goal. 
 Influences the environment to affect the health 5. Expert- Performance is fluid, flexible and highly proficient;
HEALTH no longer requires rules, guidelines or maxims to connect an
 It is “being well and using every power that the person has to understanding of the situation to appropriate action. 
the fullest extent”. MARTHA ROGERS
 Maintained by controlling the environmental factors so as to “SCIENCE OF UNITARY HUMAN BEINGS”
prevent the disease  Born on May 12, 1914 in Dallas, Texas
MARGARET JEAN H. WATSON  Died on March 13, 1994
“Philosophy and Science of Caring / Transpersonal Caring” “Professional practice in nursing seeks to promote symphonic
interaction between man and environment, to strengthen the
 Born on June 10, 1940
coherence and integrity of the human field and to direct and
 Died on October 14, 2018 redirect patterning of the human and environmental field for
 Wife of Douglas Watson realization of maximum health potential.”
 Mather of Jennifer and Julie Watson  1936-Received her Nursing diploma from Knoxville General
Hospital School of Nursing.
  1937-Quickly obtained a B.S from George Peabody College  She believes that these integrated aspects of health are
in Nashville, Tennessee. inseparable. 
 Other Degrees include MA in Public Health (1945), MA in
Public Arts (1952), and ScD (1954).  4 related theories to Self-care deficit
PERSON 1. Theory of self- care
 An open system in continuous process with environment. 2. Theory of dependent care
  Defines unitary human being as an “irreducible, indivisible, 3. Theory of self-care theory
pan dimensional energy field identified by pattern and 4. Theory of nursing system
manifesting characteristics that are specific to the whole. SELF CARE
ENVIRONMENT  Activity that promotes a person’s well-being performed
 “An irreducible, pan dimensional energy field identified by independently by an individual.
pattern and manifesting characteristics different from those  Practice of activities that maturing and mature persons
of the parts. Each environmental field is specific to its given initiate and performed within time frame, on their own
human field. Both changes continuously and creatively.” behalf, and in the interest of maintaining life and healthful
NURSING functioning and continuing personal development and well-
 Learned profession, both a science and an art.  being.
 Purpose of nursing is to promote health and well-being for DEPENDENT CARE
all persons.  Refers to the care that is provided to a person.
 Exist for the care of people and the life process of humans. SELFCARE REQUISITE
HEALTH  “self-care needs”
 Uses the term passive health to symbolize the wellness and  Insights of actions or requirements that a person must be able
the absence of disease and major illness.  to meet and perform in order to achieve well-being. 
ENERGY FIELD  Formalized purposes of self-care.
 Constitutes the fundamental unit of both the living and the Universal Self-Care Requisites  
non-living. 1. Maintenance of a sufficient intake of air.
 Field is a unifying concept and energy signifies the dynamic 2. Maintenance of a sufficient intake of food.
nature of the field.  3. Maintenance of a sufficient intake of water.
UNIVERSE OF OPEN SYSTEM 4. Provision of care associated with elimination.
 Holds the energy fields are infinite, open and integral with 5. Maintenance of balance between activity and rest.
one another. The human and environmental field are in 6. Maintenance of balance between solitude and social
continuous process and are open system. interaction.
PANDIMENSIONALITY 7. Prevention of hazards to human life, human functioning and
 As a non-living domain without spatial or temporal human well-being.
attributes. Best express of a unitary whole. 8. Promotion of human functioning and development.
DOROTHEA OREM Health Deviation Self-care Requisites
“SELF CARE DEFICIT THEORY OF NURSING”  Self-care requisites exist for persons who are ill or injured.
 Born on: July 15, 1914 Health Deviation Self-care Requisites
 Died on: June 22, 2007  Self-care requisites exist for persons who are ill or injured.
“Nursing is practical endeavor, but it is practical endeavor engaged Therapeutic Self-Care Demand
in by persons who have specialized theoretic nursing knowledge  These are the summation of all activities needed to alleviate
with developed capabilities to put this knowledge to work in the existing disease or illness.
concrete situations of nursing practice” Self-care Agency
 early 1930’s- Received diploma of Nursing at Providence  It is the individual’s ability to perform self-care activities
Hospital School of Nursing in Washington, DC. needed for planning a care plan for a client
 1939-Received BSN from the Catholic University of TWO agents:
America (CUA).  1. Self-care Agent
 1940-1949- became the director of both Nursing school and 2. Dependent Care Agent
Department of Nursing at Providence Hospital. Selfcare-deficit
 1946- Finished MS in Nursing Education. dependent-care deficit
 1957- curriculum consultant at the office of education, US Orem’s Nursing Systems
Department of Health, education and welfare  Refers to a series of actions a nurse takes to meet a patient’s
PERSON self-care needs
 An integrated system comprised of physical, psychological,  It is determined by the patient’s self-care needs
interpersonal, and social aspects.   Is composed of THREE systems:
 Human beings different from other living things in terms of o Wholly compensatory
their capacity.  o Partly/partially compensatory
ENVIRONMENT o Supportive-educative compensatory
 External force of influence in the internal interaction of a IMOGENE KING
person’s different aspects. “GOAL ATTAINMENT THEORY AND INTERACTING
NURSING SYSTEM FRAMEWORK”
 Helping clients to establish or identify ways to perform self-  She completed Bachelor of Science in Nursing education in
care activities.  St. Louis University in 1948.
 Human service and based on values.  She earned an MSN in St. Louis University in 1957 and
 Nursing actions are geared toward the independence of the Doctor of Education in 1961 from Teachers College.
client. PERSON 
HEALTH  described person as an existing in an open system as: A
 Supports the WHO’s definition of health as the” states of spiritual being, Rational thinker who makes choices, selects
complete physical, mental, social well-being and not merely alternative courses of actions, has the ability to record history
absence of disease or infirmity.” through their own language and symbols, unique, holistic
and have different needs, wants, and goals.
ENVIRONMENT “ADAPTATION MODEL”
The process of balance involving internal and external interactions  Born on October 14, 1939
inside the social system.  Nurse and educator
NURSING “God is intimately revealed in the diversity of creation and is the
 An act wherein the nurse interacts and communicates with common destiny of creations; persons are human creative abilities
the client. of awareness, enlightenment, and faith; and persons are
HEALTH accountable for the process of deriving, sustaining and
 Viewed health as the ability of a person to adjust to the transforming the universe”
stressors that the internal and external environment exposes  1963- BSN from Mount Saint Marys College in Los
to the client. Angeles.
INTERACTING FRAMEWORK SYSTEM  1966- MA in Pediatric Nursing from University of
 Personal California. 
 Interpersonal  1973- MA in Sociology 
 Social  1977- DD in Sociology
 Action PERSON
 Interaction  Biopsychosocial being in constant interaction with a
 Reaction changing environment.
 Open system  An open, adaptive system who uses coping skills to deal with
BETTY NEUMAN stressors.
“HEALTH CARE SYSTEM MODEL”  Includes people as individuals, or in groups like families,
 She was born on 1924 in a farm near Lowell, Ohio. organizations, communities, nations, and society as a whole.
 She completed her Baccalaureate Degree with Honors in ENVIRONMENT
Nursing in 1957.
 Conditions, circumstances and influences that surround and
PERSON
affect the development and behavior of the person.
 Neuman regarded the concept of a person as an individual, NURSING
family, community or the society.
 Science and practice that expands the adaptive abilities and
ENVIRONMENT
enhances person and environment transformation. Roy’s goal
 Can be internal, external and created force that interacts with of nursing is the promotion of adaptation is each of the four
person’s state of health.  modes thereby contributing to the person’s health, quality of
NURSING life and dying with dignity.
 Neuman believes that nursing requires a holistic approach, HEALTH
an approach that considers all factors affecting a client’s  Process of being and becoming an integrated and whole
health.  person. 
HEALTH ADAPTATION
 Neuman considers health as dynamic in nature and subject to  Defined as the process and outcome whereby thinking and
change. feeling, as individuals and groups, use conscious awareness
STRESSORS and choice to create human and environmental integration.
Forces that produce tensions, alterations or potential problems causing The Roy adaptation Model contains the following key concepts:
instability within the client’s system. These stressors can be:
 The person is adapting in a stable interaction with the
 Intrapersonal environment either internal or external.
 Interpersonal  The environment serves as the source of range of stimuli that
 Extrapersonal will either threaten or promote the person’s unique
NORMAL LINE OF DEFENSE wholeness.
 Represents the stability state for the individual or system.  The person’s major task is to maintain integrity in face of
 To achieve the stability of the system, the Normal line of this environmental stimuli
defense must act in coordination with the normal wellness COPING MECHANISM
state.  Regulator Subsystem
FLEXIBLE LINE OF DEFENSE  Cognator Subsystem. 
 Serves as a boundary for the normal line defense to adjust to Four Adaptive Modes
situations that threatens the imbalance within the client’s 1. Physiologic Modes
stability. 2. Self-Concept
LINE OF RESISTANCE 3. Role function
 It acts to facilitate coping to overcome the stressors that are 4. Interdependence adaptive modes
present within the   individual.  DOROTHY JOHNSON
REACTION “Behavioral System Model”
 Outcomes or produced results of certain stressors and actions Born on August 21, 1919
of the lines of resistance of a client. Died on February 1999
PREVENTION Nurse, instructor, assistant professor in pediatric nursing
 Used to attain balance within the continuum of health. These “All of us, scientist and practicing professionals, must turn our
are actions that generate good results or are aimed towards attention to practice and ask question of that practice. We must be
hindering negative outcomes. inquisitive and inquiring, seeking the fullest and truest possible
3 LEVELS OF PREVENTION understanding of the theoretical and practical problem we
 Primary Prevention  encounter.”
 Secondary Prevention  1938 – Associate degree from Armstrong Junior College,
 Tertiary Prevention  Savannah, Georgia.
RECONSTITUTION  1942 – B.S.N. from Vanderbilt University, Nashville,
 The adjustment state from the degree of reaction. It is state of Tennessee.
going back to the actual state of health.   1948 – M.P.H. from Harvard University, Boston, Mass.
SISTER CALLISTA ROY Massachusetts.
  Assistant professor of pediatrics at Vanderbilt University.
 Assistant professor of pediatrics nursing, an associate
professor of nursing, and a professor of nursing at the
University of California.
 Pediatric nursing advisor for the Christian Medical School of
Nursing in Vellore, South India.
 Chairperson on the California’s Nurses Association that
developed a position statement for specifications for clinical
specialists.   Phases of Nurse Patient Relationship
 Publications include four books, more than 30 articles, and
many other papers, reports, proceedings and monographs.  patient wherein the latter has felt need and expresses the
PERSON
 Having two major systems: the biological system and the
behavioral system.
ENVIRONMENT
 Influence an individual’s behavior
NURSING
 An art and science, which cultivates equilibrium within the
individual.
HEALTH
 Elusive state that is affected by social, biological and
psychological factors.  NURSING ROLE
 Interaction and interdependence of the subsystem of the
behavioral system.   Role of the Resource Person
BEHAVIOR
 The output of the intraorganismic structures and processes as
they are coordinated and articulated by and responsive to
changes in sensory stimulation.
SYSTEM
 Is a whole that functions as a whole by virtue of the
interdependence of its parts.
BEHAVIORAL SUBSYSTEM
 Specialized task or functions to achieve the state of
equilibrium or balance to attain health.
1. The attachment or Affiliative Subsystem
2. The Dependency Subsystem
3.TheIngestiveSubsystem
4. The Eliminative Subsystem
5. The Sexual Subsystem
6. The Aggressive Subsystem
7. The Achievement Subsystem
HILDEGARD PEPLAU
“INTERPERSONAL RELATIONSHIP”
 Born on September 1, 1909 in Reading, Pennsylvania
 Died on March 17, 1999 in her home in Sherman Oaks,
California after a brief illness at the age of 89.  also states that each patient is unique and individual in
 “Mother of Psychiatric Nursing”
 Nurse, psychiatrist, educator, author and theorist
 “Human relationship between an individual who is sick, or
in need of health services, and a nurse specially educated
to recognize and to respond to the need for help.”   Orlando does not define environment. She assumes that a
 Diploma program in Pottstown, Pennsylvania in 1931.
 BA in interpersonal psychology - Bennington College in
1943.
 MA in psychiatric nursing from Colombia University New
York in 1947.
 EdD in curriculum development in 1953.
 Published Interpersonal Relations in Nursing in 1952
 1968: interpersonal techniques-the crux of psychiatric
nursing
PERSON
 Defines person as a man who is organism that lives in an
unstable balance of a given system.
ENVIRONMENT
 Forces outside the organism and in the context of the
socially- approved way of living, from which vital human
social processes are derived such as norms.
NURSING
 Described nursing as a significant, therapeutic interpersonal
process. It functions cooperatively with human processes
that present health as a possible goal for individuals. 
HEALTH
 Considers “health” as a word that symbolizes movement of
the personality and other ongoing human processes that
directs the person towards creative, constructive, productive
and community living. 
1. Orientation - Initial interaction between the nurse and the
desire for professional assistance. The nurse helps the patient
recognize and understand problem and determine his or her
need for help.
2. Identification - The patient identifies with those who can
help him or her (relatedness)
3. Exploitation - The patient derives the full value of
relationship as he moves on from a dependent role to an
independent one.
4. Resolution - The patient earns independence over his care as
he gradually puts aside old goals and formulate new ones. 
 Role of the Stranger
 Teaching Role
 Leadership Role
 Surrogate Role
 Counseling Role
IDA JEAN ORLANDO (PELLETIER)
“NURSING PROCESS THEORY”
 She was born on August 12, 1926. 
 In 1947, she received a diploma in nursing from New York
Medical College. 
 She received a BS Public health Nursing from St. John’s
University in Brooklyn, New York in 1951 and MA in
mental health consultation from Columbia University
Teachers College in 1954.
She has two published books: 
 The Dynamic Nurse-Patient Relationship: Function, Process
and Principles of Professional Nursing Practice
 The Discipline and Teaching of Nursing Process: An
Evaluative Study
PERSON
 Assumes that person behaves verbally and non-verbally. She
his/her response; a professional nurse can recognize that the
same behavior in different patients can signal quite different
needs.
ENVIRONMENT
nursing situation occurs when there is a nurse-patient contact
and that both nurse and patient perceive, think, feel, and act
in the immediate situation.
NURSING
 Orlando major assumptions about nursing is that it should be
a distinct profession that functions autonomously. 
 Orlando states “the function of professional nursing is
conceptualized as finding out and meeting the patient’s
immediate need for help”.
HEALTH
 Orlando does not define health but she assumes that freedom
from mental or physical discomfort and feelings of adequacy
and well-being contribute to health.
NURSES RESPONSIBILITY
 It is the nurse’s responsibility to see that “the patient’s needs
for help are met, either directly by her own activity or
indirectly by calling in the help of others. 
Need
  Requirement of patient which is supplied, relieves or PERSON
diminishes his immediate distressor and improves his  It is the patient who can achieve the maximal potential
immediate sense of adequacy or well-being.  through a learning process; therefore, they need is teaching. 
NURSING PROCESS DISCIPLINE  Patient is composed of three aspects: the body, pathology
 Includes the nurse communicating to the patient his or her and person. 
own immediate reaction, clearly identifying that the item NURSING
expressed belongs to the nurse, and then asking for  It is participation in core, care and cure aspects of patient
validation or correction.  care.
NURSING PROCESS FAYE GLENN ABDELLAH
 Assessment “21 NURSING PROBLEM”
 Nursing Diagnosis  Born on March 13, 1919
 Planning  Died on February 24, 2017
 Intervention  First woman to serve as Deputy surgeon general
 Evaluation  Nurse, researcher, author, educator
JOYCE TRAVELBEE  Defined nursing as:
“HUMAN TO HUMAN RELATIONSHIP MODEL” “a based on an art and science that molds the attitudes, intellectual
 Born on 1926 competencies and technical skills of the individual nurse into the
 Died on 1973 desire and the ability to help people, sick or well, cope with their
 Nurse, educator and writer. help needs, whether they are ill or well.”
“It is believed the spiritual values a person holds will  1942-finished her basic nursing education, magna cum laude
determine, to a great extent, his perception of illness. The from Fitkin Memorial Hospital School of Nursing now Ann
spiritual values of the nurse or her philosophical beliefs about May School of Nursing in Neptune, New Jersey.
illness and suffering will determine the degree to which he or  1947- finished her Master of Arts in Teachers College at
she will be able to help ill persons find meaning or no meaning Columbia University.
in these situations.”   1955- finished her Doctor of Education from the Teachers
She has two published books:  College at Columbia University. 
 ‘Interpersonal Aspects of Nursing” was published in 1966  1960- she was influenced by the desire to promote client
and 1971. comprehensive nursing care centered 
 “Intervention in Psychiatric Nursing Process in the One-to-  2000- inducted as National Woman Hall of fame
One Relationship” was published in 1969. It was edited by  She changed the focus of nursing theory from a disease-
Doona and published in 1979 as “Travelbee’s Intervention in centered to a patient-centered approach and moved nursing
psychiatric Nursing”.  practice beyond the patient to include care of families and
PERSON the elderly. 
 The term person defined as a human being. Both the nurse PERSON
and patient are human beings. A human being is unique,  She classifies as the beneficiary of care as individuals.
irreplaceable individual who is in the continuous process of  People as having physical, emotional and sociological needs
becoming, evolving, and changing. ENVIRONMENT
ENVIRONMENT  The idea of environment is addressed by Abdellah and is
 Environment was not clearly defined in Travelbee’s theory. included in “planning for optimum health on local, state,
She defined human conditions and life experiences national, and international levels”. However, as Abdellah
encountered by all men a sufferings, hope, pain and illness. elaborates her ideas, the apex is nursing service is the
These conditions are associated to the environment.  individual.
NURSING NURSING
 Defines Nursing as an “interpersonal process whereby the  The concept of nursing in this theory is generally grouped
professional nurse practitioner assists an individual, family into twenty-one nursing problem areas for nurses to work out
or community to prevent or cope with the experience of their judgment and appropriate care. 
illness and suffering and if necessary to find meaning in HEALTH
these experiences.”   It is the center and purpose of nursing services. She does not
HEALTH give a definition of health; she speaks to a “total health
 She defines health by the criteria of subjective and objective needs” and a healthy state of mind and body.
health.   Nursing is a helping profession
“The therapeutic use of self is the ability to use one’s personality  Nursing is broadly grouped into the 21 problem areas
consciously and in full awareness in an attempt to establish NURSING PROBLEM
relatedness and to structure nursing intervention.”   Overt
LYDIA E. HALL  Covert
“CORE, CARE & CURE” 21 NURSING PROBLEM
 She was born in New York City on September 21, 1906. 1. To maintain good hygiene and physical comfort
 She earned her BS and MA degrees from Teachers College, 2. To promote optimal activity; exercise, rest and sleep
Columbia University in New York. 3. To promote safety through the prevention of accident injury or
 She promoted involvement of the community in health-care other trauma and through the prevention of the spread of infection
issues. 4. To maintain good body mechanics and prevent and correct
 She derived from her knowledge of psychiatry and nursing deformities
experiences in the Loeb Center the framework she used in 5. To facilitate the maintenance of a supply of oxygen to all body
formulating her theory of nursing. cells.
 The theory contains of three independent and interconnected 6. To facilitate the maintenance of nutrition of all body cells
circles:  7. To facilitate the maintenance of elimination
o The Core  8. To facilitate the maintenance of fluid and electrolyte balance
o The Care   9. To recognize the physiological responses of the body to disease
o The Cure  condition- pathological, physiological and compensatory.
10. To facilitate the maintenance of the regulatory mechanism and
functions.
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feeling
and reactions.
13. To identify and accept the interrelatedness of emotions and
organic illness
14. To facilitate the maintenance of effective verbal and non-verbal
communications
15. To promote the development of productive interpersonal
relationships
16. To facilitate progress toward achievement and personal spiritual
goals.  normal development of health.
17. To create or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying
physical, emotional and developmental needs.
19. To accept the optimum possible goals in the light of limitations,
physical and emotional.  1. Prior related behavior - Refers to the frequency of the same or
20. To use community resources as an aid in resolving problems
arising from illness
21. To understand the role of social problems as influencing factors in
the cause of illness.
VIRGINIA HENDERSON
“14 BASIC HUMAN NEEDS”  3. Personal Biological Factors - Include in personal biological
 Born: November 30, 1897
 Died: March 19, 1996
 “First Lady of Nursing” and the “First Truly International
Nurse”
 Nurse, teacher, author and researcher
 Defined nursing as:  and definition of health.
“The act of assisting the individual, sick or well, in the performance
of those activities contributing to health or its recovery (or to a
peaceful death) that he would perform unaided if he had the
necessary strength, will, or knowledge, and to do this in such a way
as to help him gain independence as rapidly as possible.’’
 1921- received her diploma from the Army School of
Nursing
 1923- Teach Nursing at Norfolk protestant Hospital in
Virginia
 1929- entered to Teachers College, Columbia University
 1932- finished her BS in Teachers College
 1934- finished her MA in Teachers College
 1953- research associate at Yale School of Nursing  implementation of health behavior.
PERSON
 Referred to by Henderson as the patient and an individual
who requires assistance to achieve health and independence
or in some cases, a peaceful death.  care responsibilities. Competing preferences are alternative behaviors
 For the person to function to the utmost, he must be able to
maintain physiological and emotional balance.
ENVIRONMENT
 Important for a healthy individual to control the
environment. But in caring for a sick, it is the responsibility
of the nurse to help the patient manage his surroundings to
protect him from harm or mechanical injury.  exercising regularly, managing stress, gaining adequate rest and
NURSING
 "The unique function of the nurse is to assist the individual,
sick or well, in the performance of those activities
contributing to health or its recovery (or to peaceful death)
that he would perform without help if he had the necessary
strength, will or knowledge".
HEALTH
 Viewed health as a quality of life and is very basic for a
person to function fully
 Gave emphasis in prioritizing health promotion as more
important than care of the sick.
14 BASIC NEEDS
1. Breathing normally
2. Eating and drinking adequately
3. Eliminating Body wastes
4. Moving and maintaining a desirable position/postures
5. Sleeping and resting
6. Selecting suitable clothes
7. Maintaining normal body temperature by adjusting clothing &
modifying the environment 
8. Keeping the body clean and well groomed
9. Avoiding dangers in the environment and avoiding injuring others
10.Communicating with others in expressing emotions, needs, fears,
or opinions
11. Worshipping according to one’s faith
12. Working in such a way that one feels a sense of accomplishment
13. Playing or participating in various forms of recreation
14. Learning, discovering & satisfying the curiosity that leads to
NOLA J. PENDER
“Middle range theories that have been tested in research provide
evidence for evidence-based practice, thus facilitating translation of
research into practice”
similar behavior in the past. This has direct and indirect effects on the
likelihood of engaging in health promotion behavior. 
2. Personal Factors - Are categorized as biological, psychological,
and sociocultural. These factors are predictive of a given behavior and
are shaped by the nature of the target behavior being considered.
factors are variables such as age, gender, body mass index, pubertal
status, menopausal status, aerobic capacity, strength, agility, and
balance.
4. Personal Psychological Factors - Include variables such as self-
esteem, self-motivation, personal competence, perceived health status,
5. Personal Sociocultural - Factors such as race, ethnicity,
acculturation, education, and socioeconomic status are included in
sociocultural factors.
6. Behavioral-Specific Cognitions and Affects - The following are
behavioral-specific cognitions and affects that are considered of major
motivational significance; these variables are modifiable through
nursing action (Pender, 1996).
7. Perceived Benefits of Action - Are anticipated positive outcomes
that will result from health behavior.
8. Perceived Barriers to Action - Are anticipated, imagined, or real
blocks and personal costs of undertaking a given behavior.
9. Commitment to a Plan of Action - Describes the concept of
intention and identification of a planned strategy that leads to
10. Immediate Competing Demands and Preferences - Are
alternative behaviors over which individuals have low control,
because there are environmental contingencies such as work or family
over which individuals exert relatively high control, such as the
choice of ice cream or an apple for a snack.
11. Health-Promoting Behavior - Is an end point or action outcome
that is directed toward attaining positive health outcomes such as
optimal well-being, personal fulfillment, and productive living.
Examples of health-promoting behavior are eating a healthy diet,
spiritual growth, and building positive relationship.
MADELEINE LEININGER
“Transcultural theory in nursing
Culture care: diversity and universality theory”
 She was born in Sutton, Nebraska and began her nursing
career after graduating from a diploma program at St.
Anthony’s School of Nursing in Denver, Colorado in 1948. 
 Founder of transcultural nursing and a leader in transcultural
nursing and human care theory. 
 The first professional nurse with graduate preparation in
nursing to hold a PhD in cultural and social anthropology.
PERSON
 Humans believed to be caring and capable of being
concerned about the desires, welfare, and continued
existence of others. 
  Humans are universally caring beings who survive in a
diversity of cultures through their ability to provide
universality of care in a variety of ways according to
different cultures, needs and settings.  to fit with individual, groups, or institutional cultural values,
ENVIRONMENT
 Leininger speaks about worldview, social structure, and
environmental context.
 Worldwide view
 Cultural and social structure dimension
 Environmental context
NURSING
 Studied scientific and humanistic profession and discipline
that centers on human care activities that assist, support,
facilitate, or enable individuals or group to maintain or
regain their well-being or health in culturally meaningful and
beneficial ways, or to help people face handicaps or deaths.
1. Cultural care preservation/maintenance
2. Cultural care accommodation/negotiation
3. Cultural care repatterning/restructuring
HEALTH
 State of well-being that is culturally defined, valued and
practiced and reflects the ability of individuals or groups to
perform their daily role activities in culturally expressed,
beneficial and patterned lifeways. Health is both universal
and diverse.  NURSING
Cultural Care Diversity
 This refers to the differences or variations that can be found
both between and among different cultures.  recognize their own patterns in interacting with the
Cultural care Universality
 Refers to the commonalities or similarities that exist in
different cultures.
Care
 Related to helping, supporting, or empowering experiences
or behaviors towards others with evident or anticipated needs
to improve a human condition.
Caring
 Refers to behavior directed toward assisting another
individual or group with evident or anticipated needs to
improve the human condition either to recover or face death.
Culture
 Refers to learned, shared, transmitted values, beliefs, norms,
and lifeways of particular group that guides their thinking,
decisions, and actions in patterned ways.
Cultural Care
 The subjectively and objectively obtained values, beliefs,
and outlines of the lifeways that assist, support, facilitate, or
empower another individual or group to maintain well-being,
health, and deal with illness, handicaps or death.
Ethnohistory
 Past facts, events, and experiences of individuals, groups,
and various cultures and institutions that are mainly people
centered (ethnic) and that explains, and interprets human
lifeways within particular cultural trends.
Generic (Folk or Lay) Care System
 Refers to culturally learned and transmitted, indigenous or
traditional, folk knowledge and skills used to provide
assistive, supportive, enabling, or facilitative acts towards or
for another individual or group, or institution with evident or
anticipated needs to ameliorate or improve a human lifeway
or health condition, or to deal with handicaps and death
situations.
Professional Care System
 Refers to formally taught, learned, and transmitted
professional care, health, illness, wellness, and related
knowledge and practice skills that prevail in professional
institution usually with multidisciplinary personnel to serve
consumers.
Cultural Congruent Nursing Care
 Refers to those cognitively based assistive, supportive,
facilitative, or enabling acts or decisions that are tailor made
beliefs and lifeway to provide or support meaningful,
beneficial and satisfying healthcare or well-being services.
MARGARET NEWMAN
“MODEL OF HEALTH”
 She was born on October 10, 1933 in Memphis, Tennessee. 
 She obtained her Bachelor’s degree in Nursing from the
University of Tennessee in Memphis in 1962.
 She received her Master’s degree in Medical-Surgical
Nursing and Teaching from the University of California.
PERSON 
 Defined as consciousness. Person as individuals is identified
by their individual patterns of consciousness. Persons are
further defined as “centers of consciousness within an
overall pattern of expanding consciousness”.
ENVIRONMENT
 She did not explicitly defined environment but it is described
as being the larger whole, which is beyond the consciousness
of the individual. The pattern of consciousness that is the
person interacts within the pattern of consciousness that is
the family and within the pattern of community interactions.
 It is the study of “caring in the human health experience”.
The role of the nurse in this experience is to help clients
environment.
HEALTH
 Health is the pattern of the whole, and wholeness is, one
cannot lose or gain it. 
Consciousness
 Defined as the “informational capacity of the system: the
ability of the system to interact with its environment”.
Consciousness includes not only cognitive and affective
awareness, but also the interconnectedness of the entire
living system which includes physicochemical maintenance
and growth processes as well as the immune system.
Movement
 It is the means whereby one perceives reality and therefore,
is a means of becoming aware of self. 
ROSEMARIE RIZZO PARSE
“HUMAN BECOMING”
 Currently a professor and Chair at the Marcella Niehoff
School of Nursing, Loyola University Chicago. 
 She is the founder and editor of Nursing Science Quarterly 
 Founder of the Institute of Human Becoming
 President of Discovery International Incorporated 
 1977-1982- dean of the Nursing school in Duquesne
University.
 1983-1993- Professor and research Coordinator of the center
for nursing research at hunter College in New York.
 1993-2006- Professor and nieohff Chair at Loyola University
Chicago 
PERSON, ENVIRONMENT, HEALTH
 She views human and universe are inseparable. 
NURSING
“It is the hope of many nurses that nursing as a discipline will enjoy
the recognition of having a unique knowledge base and the profession
will be sufficiently distinct from medicine that people will actually
seek nurses for nursing care, not medical diagnoses.”
PRINCIPLES
1. Structuring meaning multidimensionally is cocreating reality
through the languaging of valuing and imaging.
2. Cocreating rhythmical patterns of relating is living the paradoxical
unity of revealing-concealing and enabling limiting while connecting-
separating.
3. Nontranscendent with the possible is powering unique ways of
originating in the process of transforming.
 Imaging
 Valuing. 
 Languaging
 Revealing
 Enabling-Limiting
 Connecting-separating.
 Contranscending
 Powering
 Originating
 Transforming
MASLOW’S HUMAN NEED THEORY
 Maslow’s theory of human needs was used to label and
articulate their personal observations that “all people want to
be the best that they can possibly be; unmet basic needs
interfere with holistic growth whereas satisfied needs
promote growth” (Erickson, Tomlin, & Swain, 2002, p. 56;
Erickson, M., 1996a, 1996b, 2006; Jensen, 1995).   It offers a theory for child development by explaining how
 Maslow provides a set of objectives “basic human needs”
that reflect a different discipline, theoretical orientation, and
worldview. For example, Maslow’s (1954) seminal work on
motivation and personality provided the contextual
underpinnings from which his hierarchical model of human
needs evolved. Educated as a psychologist, Maslow
depicted the basic human needs as those necessary for
survival or those needs that would produce frustration or
psychopathology if not met.
 Consistent with his interest in psychopathology, and as many
other clinical psychologists have done, Maslow (1954) put
aside the less understood cognitive and aesthetic needs,
designating them as “prerequisites for the basic need
satisfactions”.
 Therefore, the cognitive desires to know and to understand
and the overlapping aesthetic needs become part of the
“gestalt” in Maslow’s holistic dynamic view of personality.
 Maslow’s scientific philosophy or worldview emanates from
organismic theory. His conception of man is of a “whole,
functioning, adjusting individual” who can best be
understood from a holistic-analytic style. One essential
characteristic of this form of analysis is its dependence on
understanding the whole. However, to understand the
dynamic whole, one must understand the role any given part
plays within the gestalt of the whole. That is, the whole and
its parts are mutually related; the whole is necessary to an
understanding of the part and, in turn, the parts to an
understanding of the whole.  Freedom from historical maladaptation embedded in the childhood
 Based on organismic theory, Maslow proposed five basic
human needs: physiological needs, safety needs,
belongingness and love needs, esteem needs, and needs
for self-actualization. According to Maslow, these needs
constitute an inexact hierarchy beginning with the
physiological needs and culminating in a drive for self-
actualization.
SULLIVANS TRANSACTIONAL ANALYSIS
 Transactional analysis integrates the theories of psychology
and psychotherapy because it has elements of
psychoanalytic, humanist and cognitive ideas. According to
the International Transactional Analysis Association, TA "is
a theory of personality and a systematic psychotherapy
for personal growth and personal change."
 As a theory of personality, TA describes how people are
structured psychologically. It uses what is perhaps its best-
known model, the ego-state (Parent-Adult-Child) model,
to do this. The same model helps explain how people
function and express their personality in their behavior.
 As Berne set up his psychology, there are four life positions
that a person can hold, and holding a particular psychological
position has profound implications for how an individual
operationalizes his or her life. The positions are stated as:
 I'm OK and you are OK. This is the healthiest position
about life and it means that I feel good about myself and
that I feel good about others and their competence.
 I'm OK and you are not OK. In this position I feel good
about myself but I see others as damaged or less than
and it is usually not healthy.
 I'm not OK and you are OK. In this position the person
sees him/herself as the weak partner in relationships as
the others in life are definitely better than the self. The
person who holds this position will unconsciously accept
abuse as OK.
 I'm not OK and you are not OK. This is the worst
position to be in as it means that I believe that I am in a
terrible state and the rest of the world is as bad.
Consequently, there is no hope for any ultimate
supports.
 It is a theory of communication that can be extended to
the analysis of systems and organizations.
our adult patterns of life originated in childhood. This
explanation is based on the idea of a "Life (or Childhood)
Script": the assumption that we continue to re-play childhood
strategies, even when this results in pain or defeat. Thus, it
claims to offer a theory of psychopathology.
 In practical application, it can be used in the diagnosis and
treatment of many types of psychological disorders and
provides a method of therapy for individuals, couples,
families and groups.
 Outside the therapeutic field, it has been used in education to
help teachers remain in clear communication at an
appropriate level, in counselling and consultancy, in
management and communications training and by other
bodies.
Philosophy
 People are OK; thus, each person has validity,
importance, equality of respect.
 Positive reinforcement increases feelings of being OK.
 All people have a basic lovable core and a desire for
positive growth.
 Everyone (with only few exceptions, such as the severely
brain-damaged) has the capacity to think.
 All of the many facets of an individual have a positive
value for them in some way.
 People decide their story and destiny; therefore, these
decisions can be changed.
 All emotional difficulties are curable.
script is required in order to become free of inappropriate, inauthentic
and displaced emotions which are not a fair and honest reflection of
here-and-now life (such as echoes of childhood suffering, pity-me and
other mind games, compulsive behavior and repetitive dysfunctional
life patterns). The aim of change under TA is to move toward
autonomy (freedom from childhood script), spontaneity, intimacy,
problem solving as opposed to avoidance or passivity, cure as an ideal
rather than merely making progress and learning new choices.
VON BERTALANFFY’S GENERAL SYSTEM THEORY
 The major tenets of General System Theory (GST) as a
general science of wholeness include the concept of system
as organized wholes, the elements of which are
interdependent and in mutual interaction; and the principles
of emergence, entropy and negentropy, equifinality, and so
forth, applicable to systems regardless of the nature of parts
and their relationships among the parts (Bertalanffy, 1969).
 Added to these notions of GST is Koestler’s (1967) concept
of open hierarchical systems for which he states that what we
find are intermediary structures on a series of levels in an
 ascending order of complexity: sub-wholes which display,
according to the way you look at them, some of the
characteristics commonly attributed to wholes and some of
the characteristics commonly attributed to parts.”
 Inherent in this conceptualization of hierarchy is the idea that
no entity is fundamentally a part or a whole except when the
entities are considered in relation to one another. Entities
therefore are subordinated as parts to the higher centers in
the hierarchy, but at the same time function as quasi-
autonomous wholes. They are Janus faced. The face turned
upward, toward the higher levels, is that of a dependent part;
the face turned downward, towards its own constituents, is
that of a whole of remarkable self-sufficiency (Koestler,
1978, p. 27)
 These systems-based ideas for holism thus do not require
holists to use organismic metaphors in addressing wholes as
units of analysis.
LEWIN’S CHANGE THEORY
 Lewin’s theory posits the idea of a force field involving
protagonists of and antagonists to change. For change to
occur there must be an upset in the equilibrium between
these two forces.  
 He identified three basic steps for introducing planned
change. These are unfreezing, moving and refreezing.
 Unfreezing involves a destabilizing of the forces that are
preserving the status quo. The organization is ready for
unfreezing if expectations have not been met, if there is guilt
or anxiety owing to some action or lack of action and if
previous obstacles to change have disappeared. Lewin
believes that unfreezing can be accomplished by provisional
involvement, direct confrontation, acceptance of
ambivalence and by the creation of a vacuum. These
strategies will instill in participants the need for change and
the motivation to change.
 In the second step, moving, the change is implemented and
‘cognitive redefinition’ takes place among those involved in
the change process. Cognitive redefinition involves viewing
the situation from a different perspective. This can occur
through ‘identification’ or ‘scanning’. In identification, the
participants are influenced towards change by someone who
has power or their respect. In scanning, the participants
review the possibilities and select the best approach by
mutual decision. The status quo is then left behind and the
organization moves to a new level of functioning.   Virtue: Purpose, Maldevelopment:
 Refreezing, the last step in Lewin’s theory, involves the
introduction of stability and equilibrium at the new level.
The new method of work or behavior is then internalized
into the culture of the organization and into the actions of
participants.
ERICKSON PSYCHOSOCIAL DEVELOPMENT
 Erikson’s Stages of Psychosocial Development is a theory
that was introduced in the 1950s by the psychologist and
psychoanalyst Erik Erikson. It built upon Freud’s theory of
psychosexual development by drawing parallels in childhood
stages while expanding it to include the influence of social
dynamics as well as the extension of psychosocial
development into adulthood.
 It posits eight sequential stages of individual human
development that are influenced by biological,
psychological, and social factors throughout the lifespan.
This bio-psychosocial approach has influenced several fields
of study, including gerontology, personality development,
identity formation, life cycle development, and more.
 Stages arise as individuals grow and face new decisions and
turning points during childhood, adolescence, and adulthood.
Each stage is defined by two opposing psychological
tendencies – one positive/syntonic, and the other being
negative/dystonic. From this develops an ego virtue/strength
or maldevelopment, respectively. If the virtue is adopted, it
can help to resolve the current decision or conflict. It will
also be helpful in subsequent stages of development and in
contributing to a stable foundation for core belief systems in
relating to the self and the outer world. The opposite is true
with the adoption of the maldeveloped quality.
 As an example, the ego identity crystallizes in stage 5, during
adolescence. The two opposing qualities are ego identity and
confusion/diffusion. Those who develop ego identity yield
the virtue of fidelity, while the inability to do so – ego
confusion – creates a quality of repudiation. With a stronger
sense of ego identity, the interaction with the outer and inner
world is of rejecting incongruent evaluations of self and a
decreased level of anxiety, respectively.
 While adopting the syntonic attribute is clearly beneficial in
this example, doing so should be done within reason.
Extreme ego identity can become fanaticism, which can
create unhealthy interactions with the self and others. One
must navigate the two opposing values in each stage to find a
balance, instead of only striving for the positive quality.
Straying too far towards the positive tendency can be
maladaptive while leaning too far toward the negative can be
malignant.
Components - Some scholars have attempted to confine
stages to specific ages, but Erikson did not initially define
this. Instead, there are periods within childhood,
adolescence, and adulthood. Each stage provides an example
in which the positive attribute may be furthered.
 Stages of childhood
o Stage 1 – Infancy period: Trust vs. Mistrust
 Virtue: Hope, Maldevelopment:
Withdrawal
 Concomitant Freudian stage: oral stage
 Example: Secure environment provided by
the caregiver, with regular access to
affection and food
 Stage 2 – Early Childhood period: Autonomy vs.
Shame, doubt
 Virtue: Will, Maldevelopment:
Compulsion
 Concomitant Freudian stage: anal stage
 Example: Caregiver promotes self-
sufficiency while maintaining a secure
environment
 Stage 3 – Play Age period: Initiative vs. Guilt
Inhibition
 Concomitant Freudian stage: genital stage
 Example: Caregiver encourages, supports,
and guides the child’s own initiatives and
interests
 Stage 4 – School Age period: Industry vs.
Inferiority
 Virtue: Competence, Maldevelopment:
Inertia (passivity)
 Concomitant Freudian stage: latency stage
 Example: Reasonable expectations set in
school and at home, with praise for their
accomplishments
 Stage of adolescence
 Stage 5 – Adolescence period: Identity vs. Identity
confusion
 Virtue: Fidelity, Maldevelopment:
Repudiation
 Example: Individual weighs out their
previous experiences, societal
expectations, and their aspirations in
establishing values and ‘finding
themselves.’
 Stages of adulthood 
 Stage 6 – Young Adulthood period: Intimacy vs.
Isolation
  Virtue: Love, Maldevelopment:
Distantiation
 Example: Individual forms close
friendships or long-term partnership
 Stage 7 – Adulthood period: Generativity vs
Stagnation/Self-absorption
 Virtue: Care, Maldevelopment: Rejectivity
 Example: Engagement with the next
generation through parenting, coaching, or
teaching
 Stage 8 – Old Age period: Integrity vs. Despair
 Virtue: Wisdom, Maldevelopment:
Disdain   with justice and that it continued throughout the individual's
 Example: Contemplation and
acknowledgment of personal life
accomplishments
 A ninth stage was added by Erik Erikson’s
wife, Joan Erikson. It considers new
challenges experienced with continued
aging and incorporates aspects from all
previous eight stages of psychosocial
development.
 The sequential layout of Erikson’s Stages of Psychosocial
Development might initially suggest that stage outcomes
become fixed once the next stage is engaged. While there is a
fixed sequence, resolution can be a life-long process, re-
activated at various times depending on life events that affect
the ego strength or maldeveloped belief pattern. Resolution
is not required to move on to the next stage. Additionally,
with advancement to a new stage, preceding stages are
questioned and must be reintegrated. This is why his theory
is sometimes referred to as an ‘epigenetic principle.’
Additional research suggests that the latter four stages are, to
an extent, a repetition of previous stages. As an example, the
stage of intimacy can be considered a combination of
autonomy and trust. Thus, the developmental stages and
formation of identity is an ever-evolving process, as opposed
to a rigid concrete system.
 Clinical Significance - Several clinical tools and further
research have emanated from and have undergone significant
influence by Erikson’s Stages of Development:
 Studying Erikson’s stages serve as a basis of
treatment for different recovery stages of mental
illness. As an example, the initial stage of trust vs.
mistrust parallels the mental illness recovery stage
concerning the acceptance of the mental illness and
trusting the idea of recovery.
 The Erikson Psychosocial Stage Inventory (EPSI)
was based on Erikson’s stages, and the modified
version following it (MEPSI) is a reliable tool used
to assess psychosocial development.  assumptions of the theory are:
 A model of psychodynamic psychotherapy is based
on the concept and staging of Erikson’s theory.
 Nursing, Allied Health, and Interprofessional Team
Interventions - Erikson's Stages of Psychosocial
Development can be utilized by mental health providers
when treating patients who are facing periods of adjustment
or turning points in life. When taken in the appropriate
context to social and cultural factors, it can be a means for
the patient to augment awareness and understanding of
themselves. While many stages focus on periods early in life,
it can serve as a conceptual and possibly actionable guide for
those later in life as well. This area continues to be an active
focus of research, as Erickson's developmental maturity in
mid-life is studied alongside global cognitive and executive
function, as well as emotional health.
KOHLBERG’S MORAL DEVELOPMENT
 Lawrence Kohlberg's stages of moral development constitute
an adaptation of a psychological theory originally conceived
by the Swiss psychologist Jean Piaget. Kohlberg began work
on this topic while being a psychology graduate student at
the University of Chicago in 1958 and expanded upon the
theory throughout his life.
 The theory holds that moral reasoning, a necessary (but not
sufficient) condition for ethical behavior, has six
developmental stages, each more adequate at responding to
moral dilemmas than its predecessor. Kohlberg followed the
development of moral judgment far beyond the ages studied
earlier by Piaget, who also claimed that logic and morality
develop through constructive stages.
 Expanding on Piaget's work, Kohlberg determined that the
process of moral development was principally concerned
life, a notion that led to dialogue on the philosophical
implications of such research.
 The six stages of moral development occur in phases of pre-
conventional, conventional and post-conventional morality.
For his studies, Kohlberg relied on stories such as the Heinz
dilemma and was interested in how individuals would justify
their actions if placed in similar moral dilemmas. He
analyzed the form of moral reasoning displayed, rather than
its conclusion and classified it into one of six stages.
 There have been critiques of the theory from several
perspectives. Arguments include that it emphasizes justice to
the exclusion of other moral values, such as caring; that there
is such an overlap between stages that they should more
properly be regarded as domains or that evaluations of the
reasons for moral choices are mostly post hoc
rationalizations (by both decision makers and psychologists)
of intuitive decisions.
 A new field within psychology was created by Kohlberg's
theory, and according to Haggbloom et al.'s study of the
most eminent psychologists of the 20th century, Kohlberg
was the 16th most frequently cited in introductory
psychology textbooks throughout the century, as well as the
30th most eminent. Kohlberg’s scale is about how people
justify behaviors and his stages are not a method of ranking
how moral someone's behavior is; there should be a
correlation between how someone scores on the scale and
how they behave. The general hypothesis is that moral
behavior is more responsible, consistent and predictable
from people at higher levels.
LOCSINS’S TECHNOLOGICAL NURSING AS CARING
MODEL
ASSUMPTIONS:
Technological Competency as Caring in Nursing is a middle range
theory grounded in Nursing as Caring (Boykin &Schoenhofer), 2001).
It is illustrated in the practice of nursing grounded in the harmonious
coexistence between technology and caring in nursing. The
 Persons are caring by virtue of their humanness
(Boykin &Schoenhofer, 2001).
 Persons are whole or complete in the moment
(Boykin &Schoenhofer, 2001).
 Knowing persons is a process of nursing that allows
for continuous appreciation of persons moment to
moment (Locsin, 2005).
 Technology is used to know wholeness of persons
moment to moment (Locsin, 2004).
 Nursing is a discipline and a professional practice
(Boykin &Schoenhofer, 2001).
Dimensions of Technological Value in the Theory:
 Technology as completing human beings to re-formulate the
ideal human being such as in replacement parts, both
mechanical(prostheses) or organic (transplantation of
organs.)
 Technology as machine technologies, e.g., computers and
gadgets enhancing nursing activities to provide quality
patient care such as Penelope or Da Vinci in the Operating
Theatres;
  Technologies that mimic human beings and human activities
to meet the demands of nursing care practices, e.g., cyborgs
(cybernetic organisms) or anthropomorphic machines and
robots such as ‘nursebots’ (Locsin & Barnard, 2007).
Technological Competency as Caring in Nursing
 Technological competency as caring in nursing is the
harmonious coexistence between technologies and caring in
nursing.
 The harmonization of these concepts places the practice of
nursing within the context of modern healthcare and
acknowledges that these concepts can co-exist.
 Technology brings the patient closer to the nurse.
Conversely, technology can also increase the gap between
the nurse and nursed.
 When technology is used to know persons continuously in
the moment, the process of nursing is lived.
The Process of Nursing
 Knowing: The process of knowing person is guided by
technological knowing in which persons are appreciated as
participants in their care rather than as objects of care. The
nurse enters the world of the other. In this process,
technology is used to magnify the aspect of the person that
requires revealing – are presentation of the real person. The
person’s state change moment to moment - person is
dynamic, living, and cannot be predicted.
 Designing: Both the nurse and the one nursed(patient) plan a
mutual care process from which the nurse can organize a
rewarding nursing practice that is responsive to the patient’s
desire for care.
 Participation in appreciation: The simultaneous practice of
conjoined activities which are crucial to knowing persons. In
this stage of the process is the alternating rhythm of
implementation and evaluation. The evidence of continuous
knowing, implementation and participation is reflective of
the cyclical process of knowing persons.
 Verifying knowledge: The continuous, circular process
demonstrates the ever-changing, dynamic nature of knowing
in nursing. Knowledge about the person that is derived from
knowing, designing, and implementing further informs the
nurse and the one nursed.
THE CASAGRA TRANSFORMATIVE LEADERSHIP
MODEL: SERVANT – LEADER FORMULA & THE NURSING
FACULTY’S TRANSFORMATIVE LEADERSHIP
BEHAVIOR.
 The theory “CASAGRA Transformative Leadership” is a
psycho spiritual model. It is coined after the name of the
investigator: Sr. CArolina S. AGRAvante
 The model is a Three-Fold Transformation Leadership
Concept rolled into one, comprising of the following
elements:
1. Servant-Leader Spirituality;
2. Self-Mastery expressed in a vibrant care
complex;
3. Special Expertise level in the nursing field one is
engaged in.
 These elements rolled into one make-up the personality of
the modern professional nurse who will challenge the
demands of these crucial times in society today.
 The CASAGRA Transformative Leadership Theory is
classified as a Practice Theory basing on the characteristics
of a Practice Theory stated by McEwen (2007), which are
the following:
a. Complexity / Abstractness, Scope - Focuses on a
narrow view of reality, simple and straightforward;
b. Generalizability /Specificity - Linked to a special
population or an identified field of practice;
c. Characteristic of Scope – Single, concrete concept
that is operationalized;
d. Characteristic of Proposition – Propositions defined;
e. Testability – Goals or outcomes defined and testable;
f. Source of Development – Derived from practice or
deduced from middle range theory or grand theory.
 Main Propositions:
o CASAGRA Transformative Leadership is a psycho-
spiritual model, was an effective means for faculty to
become better teachers and servant-leaders.
o Care complex is a structure in the personality of the
caregiver that is significantly related to the leadership
behavior.
o The CASAGRA servant-leadership formula is an
effective modality in enhancing the nursing faculty’s
servant-leadership behavior.
o Vitality of Care Complex of the nursing faculty is
directly related to leadership behavior. 
 Key Concepts:
o The CASAGRA Transformative Leadership Model have
concepts of leadership from a psycho-spiritual point of
view, designed to lead to radical change from apathy or
indifference to a spiritual person.
o Servant-leader formula is the enrichment package
prepared as intervention for the study which has three
parts that parallel the three concepts of
the CASAGRA transformative leadership model,
namely: the care complex primer, a retreat-workshop on
Servant-leadership, and a seminar-workshop on
Transformative Teaching for nursing faculty. 
o Special expertise is the level of competence in the
particular nursing area that the professional nurse is
engaged in workshop is the spiritual exercise organized
in an ambience of prayer where the main theme is the
contemplation of Jesus Christ as a Servant-leader.
o Servant-leadership behavior refers to the perceived
behavior of nursing faculty manifested through the
ability to model the servant leadership qualities
to students, ability to bring out the best in students,
competence in nursing skills, commitment to the nursing
profession, and sense of collegiality with the school,
other health professionals, and local community.
o Nursing leadership is the force within the nursing
profession that sets the vision for its practitioners, lays
down the roles and functions, and influences the
direction toward which the profession should go. 
o Transformative teaching may also be termed Reflective
teaching, an umbrella term covering ideas, such as
thoughtful instruction, teacher research, teacher
narrative, and teacher empowerment.
o Care complex is the nucleus of care experiences in the
personality of a nurse formed by a combination of
maternal care experiences, culture based-care practices
indigenous to a race and people, and the professional
training on care acquired in a formal course of nursing. 
DIVINAGRACIA’S COMPOSURE MODEL
 Divinagracia (2001) conducted a study to determine the
effects composure behaviors of the advanced practitioner on
the recovery of selected patients at the Philippine Heart
Center. 
 Behaviors include competence, presence and prayer, open-
mindedness, understanding, respect, and empathy.
 Competence is an in-depth knowledge and clinical expertise
demonstrated in caring for patients. Presence and prayer are
a form of nursing measure which means being with another
person during times of need. This includes therapeutic
communication, active listening, and touch. It is also a form
of nursing measure which is demonstrated through reciting a
prayer with the patient and concretized through the nurse’s
personal relationship and faith in God. Open-mindedness is a
form of nursing measure which means being receptive to
new ideas or to reason. It conveys a manner of considering
 patient’s preferences and opinions related tohis current
health condition and practices and demonstrate the flexibility
of the nurse to accommodate patient’s views. Moreover,
stimulation is a form of nursing measure demonstrated by
means of providing encouragement that conveys hope and
strength, guidance in the form of giving explanation and
supervision when doing certain procedures to patient, use of
complimentary words or praise and smile whenever
appropriate. Appreciation of what patient can do is
reinforced through positive encouraging remarks and this is
done with kind and approving behavioral approach.
Understanding, according to her conveys interest and
acceptance not only of patient’s condition but also his entire
being. This is manifested through concerned and affable
facial approach; this is a way of making the patient feel
important and unique. Respect is acknowledging the
patient’s presence. Use of preferred naming in addressing the
patient, po and opo is a sign of positive regard. It is also
shown through respectful nods and recognition of the patient
as someone important. Relaxation entails a form of exercise
that involves alternate tension and relaxation of selected
group of muscles. And lastly, empathy senses accurately
other person’s inner experience. The empathic nurse
perceives the current positive thought and feelings and
communicates by putting himself in the patient’s place.
Through the composure behaviors of the nurse, holism is
guaranteed to the patient.
 Furthermore, Divinagracia (2001) stated that nursing is a
profession that surpasses time and aspects of the individual
as one of its clients. From the time the nurse admits a patient
to the time of his discharge, the nurse’s presence becomes a
meaningful occasion for the two parties to develop mutual
trust, acceptance, and eventually satisfying relationships.
KUAN’S RETIREMENT AND ROLE DISCONTINUITY
MODEL
 Dr. Letty G. Kuan, RN, RGC, EdD entitled "Retirement and
Role Discontinuities", she found out that retirement is an
inevitable change in one's life. It is evident in the increasing
statistics of aging population accompanied by related
disabilities and increased dependence. 
 This developmental stage, even at the later part of life, must
be considered desirable and satisfying though the
determination of factors that will help the person enjoy his
remaining years of life. It is of primary importance to
prepare early in life by cultivating other role options at age
50 to 60 in order to have a rewarding retirement period even
amidst the presence of role discontinuities experienced by
this age group.
 She also identified determinants of positive perceptions in
retirement and positive reactions toward role discontinuities:
o Health Status – refers to physiological and mental
state of the respondents, classified as either sickly
or healthy
o Income – (economic level) refers to the financial
affluence of the respondent which can be classified
as poor, moderate or rich.
o Work Status
o Family Constellation – means the type of family
composition described either close knit or extended
family where three or more generations of family
members live under one roof; or distanced family,
whose members live in separate dwelling units; or
nuclear type of family where only husband, wife
and children live together.
o Self-Preparation
CARMENCITA ABAQUIN “PREPARE ME” HOLISTIC
NURSING INTERVENTION
 Basic Assumptions and Concepts: PREPARE ME (Holistic
Nursing Interventions) are the nursing interventions provided
to address the multi-dimensional problems of cancer patients
that can be given in any setting where patients choose to be
confined. This program emphasizes a holistic approach to
nursing care. PREPARE ME has the following components:
o Presence – being with another person during the
times of need. This includes therapeutic
communication, active listening, and touch.
o Reminisce Therapy – recall of past experiences,
feelings and thoughts to facilitate adaptation 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 – encourages an elicit form of relaxation
for the purpose of altering patient’s level of
awareness by focusing on an image or thought to
facilitate inner sight which helps establish
connection and relationship with God. It may be
done through the use of music and other relaxation
techniques.
o Values Clarification – assisting another individual
to clarify his own values about health and illness in
order to facilitate effective decision-making skills.
Through this, the patient develops an open mind
that will facilitate acceptance of disease state or
may help deepen or enhance values. The process of
values clarification helps one become internally
consistent by achieving closer between what we do
and what we feel.
LAURENTE’S THEORY OF NURSING PRACTICE AND
CAREER.
 Cecilia Laurente is a local nursing theorist in the Philippines,
who focused her works on helping a patient through support
systems specifically the family. 
 Overview
o The theory was from her study, the Categorization
of Nursing Activities as Observed in Bedical-
Surgical Ward Units in Selected Government and
Private Hospitals in Metro Manila, which was
conducted from January to June year 1987.
 Anxiety - A mental state of fear or nervousness about what
might happen 
 Nurses Caring Behavior that affect the patient anxiety: 
o PRESENCE- person to person contact between the
client and the nurses
o CONCERN - development in the time through
mutual trust nurse and the patient.
o STIMULATION- nurse stimulation through words
tops the powerful resources of energy of person for
healing.
 Enhancing Factors
o One's caring experience, beliefs and attitude.
o Feeling good about 
o Learning at school 
o What patients tell about the nurse coping
mechanism to problems encountered.
o Communication
 Predisposing Factors 
o Age 
o Sex 
o Civil Status 
o Educational Background 
o Length of work 
o Experience
SYNCHRONICITY IN HUMAN SPACE TIME; A THEORY OF
NURSING ENGAGEMENT IN A GLOBAL COMMUNITY
Description of the Synchronicity in HST Theory of Nursing
Engagement
The HST theory is a study of caring, HST, and the perspective of
synchronicity and nursing engagement. This theory aims to enlighten
nurses in their practice through an innovative demonstration of
nursing care processes grounded on authentic intentions of caring
transcending extant reductionistic approaches. Furthermore,
SynHSTTNE is a useful theoretical base for future research that aims
to describe the meaningful connectedness in human experiences of
transcendence, interconnectivity, emancipation, and equitability with
humanistic approaches in the discipline of nursing.
Assumptions of the Theory
Synchronicity in the HST consciousness, interconnectivity of persons,
and nonlinearity of human caring experiences in nursing are all
integrated into an equity-oriented healthcare system. Within this
framework, nursing praxis has transcended the traditional medical-
oriented view. Furthermore, human being sare viewed as integral to
space–time and their experiences. Nursing theory, research, and
practice have been advancing together with the progress demanded
from within the HST, in which nursing praxis unfolds in a unitarily
developing pattern. The irreducibly evolving lived experiences and
energy fields foster human transcendence between the nurse and the
nursed. Moreover, meaningful connectedness within the HST
consciousness of radiating energy fields and the development of
nursing praxis are pan dimensionally transforming in an open and
nonlinear pattern. Under the lens of unitary-transformative paradigm
in nursing, the SynHSTTNE asserts the following assumptions:
 HST is a metaphysical sphere of caring experiences among
persons with patterns of occurrence viewed as meaningful
for both the nurse and the nursed. The HST consciousness of
caring experiences is similar to Watson’s caring moment that
transcends space and time (Watson, 2007) as well as Parse’
Shuman universe viewpoint that is indivisible, unpredictable,
and everchanging in cocreating reality of becoming (Parse,
2013). The theory claims that synchronicity and nursing
engagement occurs through the appreciation of the
integrality of human—environment and the time being. This
is illustrated, for example, as synchronistic nursing
engagement in various settings (e.g., emergency department,
community setting, hospital ward) perceiving the patient not
as a disease or a product of some stereotypical clients, rather
as individuals whose internal and external wholeness are
connected.
 Nursing unfolds in a unitarily pattern of wholeness
integrated within the HST processes. Humans are
assimilating their lives with technology, instigating the
nursing profession toward transformations. The
conceptualization of caring, nursing, and technology by
Locsin (2015) elucidates the nursing profession as
continually evolving here, now, and beyond. Therefore, in
enhancing caring praxis through SynHSTTNE, the
humanistic caring patterns are beyond bedside procedures
and routines or technological expertise. According to Reed
(1997), nursing is developing, fostering, healing, helping,
nourishing, progressing, and sustaining the well-being of
humans, and to Smith (2015), “nursing is the voice that
represents the wholeness of the person; no other discipline
does this”.
 The nurse–nursed HST consciousness is irreducibly evolving
thus co-creating human transcendence. The individual
experiences and perspectives of the nurse and the one being
nursed are not deductively viewed apart from the whole
nurse–nursed relationship. This is summarily illustrated, for
instance, in the practice of nursing in disaster occasions.
Nurses in their practice share the struggle with the people
with resilient attitude. In this situation, both the nurse and the
people’s experience influence the hoped-for understanding
of the nursing engagement. The theoretical assertion is that
human transcendence mediates the relationship between
resilience and well-being and that the HST consciousness of
persons is the driving force that pervades the sense of faith,
hope, and love in all processes of nursing engagements. In
nursing engagement, the lived experience of self and other is
honored, human dignity is sustained, humanity is preserved,
and wholeness of persons is held within human caring
transcending the limits of space, time, illness, diagnosis
(Watson, 2007), sociopolitical conditions, and technological
advancements.
 SynHSTTNE is a pan dimensionally transforming process of
interconnectedness among humanity and beyond infinity.
Based on the tenets of the Rogerian Science of Unitary
Human Beings, pan dimensionality is viewed as “a nonlinear
domain without spatial or temporal attributes” (Watson&
Smith, 2002), and transformation is the outcome of the ever-
evolving human transcendence. Synchronicity in the HST
exists within the dynamic transcendence of human beings,
space, time, and the emerging variables around the universe.
Within this theory, nurses appreciate the progressions in the
healthcare system, including the individual’s participation in
human caring within technological advancements (i.e.,
nursing informatics, telehealth, big data analytics, robotics)
thereby espousing that caring praxis in the SynHSTTNE
takes full advantage of resources, optimizing the potentials
of humanistic nursing care regardless of future social and
environmental demands. Under any circumstances, such as
nursing shortage, ethical dilemmas, administrative, and
political biases, expression of nursing actions and intentions
of caring are inseparable, optimizing human health and well-
being.
Principles of the Theory
SynHSTTNE is structured around four life principles, namely,
interconnectivity, the connectedness of beings and systems;
equitability, the system of fairness and justice within and across
healthcare systems; emancipation, the liberation from oppressive
situations or human health conditions; and human transcendence, the
ability to go beyond the limits of HST boundaries or the
transformation of persons beyond their biologic nature, social norms,
and universal perspectives. These principles guide nurses in living
caring within the HST, in health and well-being of their patients.
Synchronicity as “meaningful connectedness” strengthens a more
human-to-human interaction co-creating patterns, new interpretations
or meanings, new understanding, and realities. By ensuring equity,
patients receive human care regardless of their background,
affiliations, and conditions and without the influence of administrative
prejudices. The stereotype perspectives among nurses and persons
nursed metamorphose from being passive players to active leaders in
their healthcare situations. Nursing practice and equity-oriented
healthcare systems also explore human transcendence within the
metaphysical and spiritual realms where nursing engagements are
understood as integral to the wholeness of human beings. Nurses are
liberated from the task-oriented nursing practice as interconnectivity
of persons within the HST bridges the individualism in the system,
the structure, and the processes of healthcare delivery system.