A.

PHILOSOPHIES

I. FLORENCE NIGHTINGALE

FLORENCE NIGHTINGALE

Ø Was born in Florence Italy

Ø May 12, 1820

Ø was provided with very broad education

Ø fought the bureaucracy for bandages, food, fresh bedding, & cleaning supplies for the
soldiers during the Crimean War

Ø great concern for the well-being of the English soldiers

Ø she provided comfort for the critically ill & dying

Ø after the war, she established schools of nursing

Ø She died on August 13, 1910

Ø MOTHER OF MODERN NURSING ---She used the information gathered through life
experiences in the development of nursing

Ø GERMANY

- was the first site of organized nursing school in1836

- Pastor Theodor Fliedner; opened a hospital in Kaiserswerth Germany

- one patient, one nurse & one cook

- lack of work force led to the development of a school in nursing

- the physician spent time to teach nursing students

Ø GERTRUDE REICHARDT

- 1ST Matron of the Deaconess School of Nursing

- no textbooks available until 1837

- Nightingale visited Kaiserswerth for 14 days

- she entered the nursing program July 6, 1851, the 134th nursing student

- she developed both nursing care & management skills

Approach to Nursing:

Ø Used her knowledge, understanding & prevalence of disease & her observation to
develop an approach to nursing

Ø CONTROL OF ENVIRONMENT---Individuals & family both healthy & ill

1. Ventilation & light

2. Proper disposal of sewage

3. Appropriate nutrition

Ø NOTES ON NURSING:

- thought to women who have personal charge of health of others

- everyday sanitary knowledge

- she wanted women to teach themselves to nurse

- In her writings, she provided much information on the influence of the

environment

Environmental Model

Ø Manipulation of the physical environment as a component of nursing care

Major Areas Of Environment

1. Health Of Houses

- Badly constructed houses do for the healthy what badly constructed hospitals do for
the sick. Once insure that air is stagnant & sickness is certain to follow”

- Cleanliness outside the house affects the inside

2. Ventilation & Warming

- “keep the air he breathes as pure as the external air w/o chilling him”

3. Light

- patient’s need direct sunlight

- sick people rarely lie with their face toward the wall but are much more likely to face
the window

4. Noise
- patient’s should never be waked intentionally or accidentally

- noise affects the healing

5. Variety

- Variety of environment was a critical aspect affecting the patient’s recovery

- effect of the body & the mind

- reading, needlework, writing, cleaning activities to relieve boredom.

6. Bed And Bedding

- Keep bedding clean, neat, & dry & position the patient for maximum comfort

7. Cleanliness Of Rooms And Walls

- “the greater part of nursing consists in preserving cleanliness”

- she urges removal of dust instead of relocating

- a clean room is a healthy room

8. Personal Cleanliness

- Skin is important

- excretion must be washed

- unwashed skin can poison, drying & bathing can provide great relief

- ”it is necessary to keep the pores of the skin free from all obstructing excretions”

- “every nurse ought to wash her hands very frequently during the day

9. Nutrition And Taking Food

10. Chattering Hopes And Pieces Of Advice

11. Observation Of The Sick

12. Social Considerations

Metaparadigm In Nursing

Ø Nursing

- “what nursing has to do...is to put the patient in the best condition for nature to
act upon him”

- signifies the proper use of the major areas in environment

Ø Person

- Not defined by Nightingale specifically, but are defined in relationship to their

environment & the impact on them

Ø Environment

- She focused on ventilation, warmth, noise, light, & cleanliness

- All that surrounds human beings is considered in relation to his state of health

Ø Health

- No definition of health specifically

- pathology teaches the harm disease has done

- “nature alone cures”

- Nursing should provide care to the healthy & ill & discussed health promotion as
an activity in which nurses should engage

II: VIRGINIA HENDERSON

Ø She was the “First Lady of Nursing” and “First Truly International Nurse”.

Ø She began her career in Public health nursing in the Henry Street Settlement and visiting
nurse service in Washington, D.C.

Ø She was First Full-time Instructor in nursing in Virginia when she was at Norfolk
Protestant Hospital.

Ø During her years at Teacher College, Columbia University, she was an outstanding
teacher and student.

Ø She was Selected to the American Nurse Association Hall of Fame and had the sigma
Theta Tau international Library named in her honored.

Ø She introduced Textbook of the Principles and practice.

Ø She also directed twelve-years project entitled Nursing Study Index.

Ø In Nature of Nursing – she expressed her belief about the essence of nursing and
influenced the hearts and mind of those who read it.
Ø In 1921 – Virginia Henderson was an early advocate for introduction of psychiatric
nursing in curriculum and serve on committee to develop such a course at Eastern State
Hospital in Williamsbrug.

Ø Age of 75 – Henderson directed her career to international teaching and speaking.

Ø 1988 – she was honored by the Virginia Nurse association and when the Virginia
Historical Nurse Leadership Award was presented to her.

Ø In 2000 – the Virginia nurse association recognize Henderson as one of fifty-one Pioneer
Nurse in Virginia

"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 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”.

14 Basic Needs

Ø Physiological

1. Breath normally

2. Eat and drink adequately

3. Eliminate body wastes

4. Move and maintain desirable postures

5. Sleep and rest

6. Select suitable clothes - dress and undress

7. Maintain body temperature within normal range by adjusting clothing and modifying
the environment.

8. Keep the body clean and well groomed and protect the integument.

9. Avoid dangers in the environment and avoid injuring others.

10.Communicate with others in expressing emotions, needs, fears, or opinions.

11. Learn, discover, or satisfy the curiosity that leads to normal development and health and
use the available health facilities.

Ø Sociological

12. Work in such a way that there is a sense of accomplishment.

13. Play or participate in various forms of recreation

Ø Spiritual

14.Worship according to one’s faith

Metaparadigm In Nursing

Ø Nursing

- Henderson asserted that nurse function independently from the physician, but they
must promote the treatment plan prescribe by the physician.

- Although part of the health team, the nurse must act independently but in coordination
with with the therapeutic plan developed by the team

Ø Person

- Is an individual who requires assistance to achieve health and independence or in some

case, a peaceful death.

Ø Environment

- Individuals in relation to families

- Supports tasks of private and public agencies

- Society expects nurses to act for individuals who are unable to function independently

- Basic nursing care involves providing conditions under which the patient can perform
the 14 activities unaided

Ø Health

- Definition based on individual’s ability to function independently as outlined in the 14

components.

- Nurses need to stress promotion of health and prevention and cure of disease.

- Good health is a challenge.

- Affected by age, cultural background, physical, and intellectual capacities, and

emotional balance

- Impact on health by working of various social issues.

The Three Level Compromising The Nurse-Patient Relationship:

1. “The nurse as a substitute for the patient”

- In times of illness, when the patient cannot function fully, the nurse serve as then
substitute as to what the patient lack such, as knowledge, will and strength in order to make
him completed, whole independence once again.

2. “The nurse as a helper to the patient”

- In situation where the patient cannot meet his basic needs, the nurse serve as a helper
to accomplish them.

3. “The nurse as a partner with the patient”

- As a partners, the nurse and the patient formulate the plan together. Both as an
advocate and as a resource-person , the nurse can empower the patient to make effective
decisions regarding his care plan.

III. FAYE GLENN ABDELLAH

FAYE GLENN ABDELLAH

Ø Identified 21 nursing problems.

Ø Defined nursing as a service to individuals and families therefore to society.

Ø Conceptualized nursing as an Art and science.

21 Nursing Problems

1. To maintain good hygiene

2. To promote optimal activity; exercise rest and sleep

3. To promote safety

4. To maintain good body mechanics

5. To facilitate the maintenance of a supply of oxygen

6. To facilitate maintenance of nutrition

7. To facilitate maintenance of elimination

8. To facilitate the maintenance of F&E balance

9. To recognize the physiologic responses of the body to disease condition

10. To facilitate the maintenance of regulatory mechanisms and functions

11. To facilitate the maintenance of sensory function

12. To identify and accept the positive and negative expressions, feelings and reactions

13. To identify and accept the interrelatedness of emotions and illness

14. To facilitate the maintenance of effective verbal and non-verbal communication

15. To promote the development of productive interpersonal relationship

16. To facilitate the progress towards achievement of personal spiritual goals

17. To create and maintain a therapeutic environment18. To facilitate awareness of self as an

individual with varying needs

19. To accept the optimum possible goals

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

IV. JEAN WATSON PhD, RN, FAAN, HNC

JEAN WATSON PhD, RN, FAAN, HNC

Ø Theorist was born in West Virginia, US

Ø Educated: BSN, University of Colorado, 1964,

Ø MS, University of Colorado, 1966,

Ø PhD, University of Colorado, 1973

Ø Distinguished Professor of Nursing

Ø Endowed Chair in Caring Science at the University of Colorado Health Sciences Center.

Ø Fellow of the American Academy of Nursing.

Ø Previously, Dean of Nursing at the University Health Sciences Center and President of the
National League for Nursing

Ø Undergraduate and graduate degrees in nursing and psychiatric-mental health nursing

and PhD in educational psychology and counseling. She has six (6) Honorary Doctoral
Degrees.

Ø Her research has been in the area of human caring and loss.
Ø In 1988, her theory was published in “nursing: human science and human care”.

Ø Jean Watson’s Theory of Transpersonal Caring also called Theory of Human

Ø Caring or The Caring Model was developed in 1979.

Theory of Human Caring or The Caring Model

Ø It emphasizes the humanistic aspects of nursing in combination with scientific knowledge

Ø Watson designed this theory to bring meaning and focus to nursing as a distinct health
profession

Ø Watson believes that: “Caring” is an endorsement of professional nurses identity

Ø According to Watson, the nurse’s role is to:

- Establish a caring relationship with patients

- Treat patients as holistic beings (body, mind and spirit)

- Display unconditional acceptance

- Treat patients with a positive regard

- Promote health through knowledge and intervention

- Spend uninterrupted time with patients: “caring moments”

10 CARATIVE FACTORS

1. The formation of a humanistic- altruistic system of values. (concern for the welfare of other,
selflessness)

– Begins developmentally at an early age with values shared with the parents.

– Mediated through one’s own life experiences, the learning one gains and exposure to
the humanities.

– Is perceived as necessary to the nurse’s own maturation which then promotes altruistic
behavior towards others

2. The installation of faith-hope.

– Is essential to both the carative and the curative processes.

– When modern science has nothing further to offer the person, the nurse can continue to
use faith-hope to provide a sense of well-being through beliefs which are meaningful to the
individual.

3. The cultivation of sensitivity to one’s self and to others.

– Explores the need of the nurse to begin to feel an emotion as it presents itself.

– Development of one’s own feeling is needed to interact genuinely and sensitively with
others.

– Striving to become sensitive, makes the nurse more authentic, which encourages self-
growth and self-actualization, in both the nurse and those with whom the nurse interacts.

– The nurses promote health and higher level functioning only when they form person to
person relationship

4. The development of a helping-trust relationship

– Strongest tool is the mode of communication, which establishes rapport and caring.

– Characteristics needed to in the helping-trust relationship are:

– Congruence

– Empathy

– Warmth

– Communication includes verbal, nonverbal and listening in a manner which connotes

empathetic understanding

5. The promotion and acceptance of the expression of positive and negative feelings.

– “Feelings alter thoughts and behavior, and they need to be considered and allowed for
in a caring relationship”.

– Awareness of the feelings helps to understand the behavior it engenders.

6. The systematic use of the scientific problem-solving method for decision making

– The scientific problem- solving method is the only method that allows for control and
prediction, and that permits self-correction.

– The science of caring should not be always neutral and objective

7. The promotion of interpersonal teaching-learning.

– The caring nurse must focus on the learning process as much as the teaching process.

– Understanding the person’s perception of the situation assist the nurse to prepare a
cognitive plan.
8. The provision for a supportive, protective and /or corrective mental, physical, socio-
cultural and spiritual environment.

– Watson divides these into eternal and internal variables, which the nurse manipulates in
order to provide support and protection for the person’s mental and physical well-being.

– The external and internal environments are interdependent.

– Nurse must provide comfort, privacy and safety as a part of this carative factor

9. Assistance with the gratification of human needs.

– It is based on a hierarchy of need similar to that of the Maslow’s.

– Each need is equally important for quality nursing care and the promotion of optimal
health.

– All the needs deserve to be attended to and valued

10. The allowance for existential-phenomenological forces.

– Phenomenology is a way of understanding people from the way things appear to them,
from their frame of reference.

– Existential psychology is the study of human existence using phenomenological analysis.

– This factor helps the nurse to reconcile and mediate the incongruity of viewing the
person holistically while at the same time attending to the hierarchical ordering of needs.

– Thus the nurse assists the person to find the strength or courage to confront life or death.

The Seven Assumption

1. Caring can be effectively demonstrated and practiced only interpersonally.

2. Caring consists of carative factors that result in the satisfaction of certain human needs.

3. Effective caring promotes health and individual or family growth.

4. Caring responses accept person not only as he or she is now but as what he or she may
become.

5. A caring environment is one that offers the development of potential while allowing the
person to choose the best action for himself or herself at a given point in time.

6. Caring is more “ healthogenic” than is curing. A science of caring is complementary to

the science of curing.

7. The practice of caring is central to nursing

Watson’s Ordering of Needs

Lower order needs (biophysical needs)

– The need for food and fluid

– The need for elimination

– The need for ventilation

Lower order needs (psychophysical needs)

– The need for activity-inactivity

– The need for sexuality

Higher order needs (psychosocial needs)

– The need for achievement

– The need for affiliation

– Higher order need (intrapersonal-interpersonal need)

– The need for self-actualization

Metaparadigm In Nursing

Ø Person/Human being

Human being refers to “….. a valued person in and of him or herself to be cared for,
respected, nurtured, understood and assisted; in general a philosophical view of a person as
a fully functional integrated self. He, human is viewed as greater than and different from, the
sum of his or her parts”.

Ø Health

Watson adds the following three elements to WHO definition of health:

– A high level of overall physical, mental and social functioning

– A general adaptive-maintenance level of daily functioning

– The absence of illness (or the presence of efforts that leads its absence)

Ø Environment/society
According to Watson, caring (and nursing) has existed in every society.

A caring attitude is not transmitted from generation to generation.

It is transmitted by the culture of the profession as a unique way of coping with its
environment.

Ø Nursing

“Nursing is concerned with promoting health, preventing illness, caring for the sick and
restoring health”.

It focuses on health promotion and treatment of disease. She believes that holistic health
care is central to the practice of caring in nursing.

She defines nursing as…..

“A human science of persons and human health-illness experiences that are mediated by
professional, personal, scientific, esthetic and ethical human transactions”.

C. MIDDLE RANGE THEORIES

VII. HILDEGARD PEPLAU PhD, RN, FAAN (1909 - 1999)

Ø MOTHER OF PSYCHIATRIC NURSING ( Founder of Modern Psychiatric Nursing)

Ø FAAN - Fellow of the American Academy of Nursing

Ø Made extraordinary and sustained contributions to nursing and health care throughout
their career

Ø Nursing leaders in EDUCATION, MANAGEMENT, PRACTICE and RESEARCH

Ø PhD – Doctor of Philosophy

Ø Born in Reading, Pennsylvania on September 1, 1909

Ø Graduated from the Pottstown, Pennsylvania Hospital

Ø Worked as an Operating room Supervisor at Pottstown Hospital

Ø Received a B.A. in interpersonal Psychology from Bennington College, Vermont, in 1943

Ø M.A. (Psychiatric Nursing) from Teachers College, Columbia, New York, in 1947

Ø Ed. D in curriculum Development from Columbia in 1953

Ø During World Was II, Hildegard Peplau was a member of the Army Nurse Corps and
worked in a neuropsychiatric hospital in London, England

Ø She also did work at Bellevue and Chestnut Lodge Psychiatric Facilities and was in
contact with renowned psychiatrist :

o Freida-Riechman

o Harry Stack Sullivan

Ø Holds numerous awards and position:

- The only nurse to serve the ANA as executive director and later as president

- Served two terms on the Board of the International Council of Nurses (ICN).

- In 1997, she received nursing's highest honor, the Christiane Reimann Prize, at the
ICN Quadrennial Congress.

- In 1996, the American Academy of Nursing honored Peplau as a "Living Legend,"

- In 1998, the ANA inducted her into its Hall of Fame

Ø Retired in 1974

Ø Died peacefully on March 17, 1999 at her home in Sherman Oaks California after a brief of
illness

Psychodynamic Nursing

Ø Understanding of ones own behavior

Ø To apply principles of human relations to the problems that arise at all levels of
experience

Ø Nursing is an interpersonal process because it involves interaction between two or more

individuals with a common goal.

Ø The nurse and patient work together so both become mature and knowledgeable in the
process.

Ø The attainment of goal is achieved through the use of a series of steps following a series
of pattern.
Ø According to Peplau, nursing is therapeutic in that it is a healing art, assisting an
individual who is sick or in need of health care.

Metaparadigm In Nursing

1. Nursing

- A significant therapeutic interpersonal process. It functions cooperatively with other

human process that make health possible for individuals in communities

2. Person

- A developing organism that tries to reduce anxiety caused by needs

3. Environment

- Existing forces outside the organism and in the context of culture

4. Health

- A word symbol that implies forward movement of personality and other ongoing
human processes in the direction of creative, constructive, productive, personal and
community living.

Roles of nurse

Ø Stranger : receives the client in the same way one meets a stranger in other life situations
provides an accepting climate that builds trust.

Ø Teacher : who imparts knowledge in reference to a need or interest

Ø Resource Person : one who provides a specific needed information that aids in the
understanding of a problem or new situation

Ø Counselors : helps to understand and integrate the meaning of current life

circumstances ,provides guidance and encouragement to make changes

Ø Surrogate : helps to clarify domains of dependence interdependence and independence

and acts on clients behalf as an advocate.

Ø Leader : helps client assume maximum responsibility for meeting treatment goals in a
mutually satisfying way

Theory of Interpersonal Relations

Ø Middle range descriptive classification theory

Ø Influenced by Harry Stack Sullivan's theory of inter personal relations (1953)

Ø Also influenced by Percival Symonds , Abraham Maslow's and Neal Elger Miller

Ø Identified four sequential phases in the interpersonal relationship:

1. Orientation

2. Identification

3. Exploitation

4. Resolution

Orientation Phase

Ø During this phase, the individual has a felt need and seeks professional assistance

Ø The nurse helps the individual to recognize and understand his/ her problem and
determine the need for help

Ø Problem defining phase: identifies problem

Ø Starts when client meets nurse as stranger

Ø Defining problem and deciding type of service needed

Ø Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and
expectations of past experiences

Ø Nurse responds, explains roles to client, helps to identify problems and to use available
resources and services

Ø Activities:

• Nurse and patient come together as strangers;

• Meeting initiated by patient who expresses a “felt need”;

• Work together to recognize,

• Clarify and define facts related to need

Identification Phase

Ø The patient identifies with those who can help him/ her.
Ø The nurse permits exploration of feelings to aid the patient in undergoing illness as an
experience that reorients feelings and strengthens positive forces in the personality and
provides needed satisfaction.

Ø Selection of appropriate professional assistance

Ø Patient begins to have a feeling of belonging and a capability of dealing with the problem
which decreases the feeling of helplessness and hopelessness

Ø Activities:

• Patient participates in goal setting;

• has feeling of belonging and selectively responds to those who can meet his or her
needs.

Exploitation Phase

Ø During this phase, the patient attempts to derive full value from what he/ she are offered
through the relationship.

Ø The nurse can project new goals to be achieved through personal effort and power shifts
from the nurse to the patient as the patient delays gratification to achieve the newly formed
goals.

Ø Use of professional assistance for problem solving alternatives

Ø Advantages of services are used is based on the needs and interests of the patients

Ø Individual feels as an integral part of the helping environment

Ø They may make minor requests or attention getting techniques

Ø The principles of interview techniques must be used in order to explore, understand and
adequately deal with the underlying problem

Ø Patient may fluctuates on independence

Ø Nurse must be aware about the various phases of communication

Ø Nurse aids the patient in exploiting all avenues of help and progress is made towards the
final step

Ø Activity: Patient actively seeks and draws knowledge and expertise of those who can help

Resolution Phase

Ø Termination of professional relationship

Ø The patients’ needs have already been met by the collaborative effect of patient and
nurse
Ø Now they need to terminate their therapeutic relationship and dissolve the links between
them.

Ø Sometimes may be difficult for both as psychological dependence persists

Ø Patient drifts away and breaks bond with nurse and healthier emotional balance is
demonstrated and both becomes mature individuals

Ø Activity: Occurs after other phases are completed successfully. This leads to termination
of the relationship

VIII. IDA JEAN ORLANDO

IDA JEAN ORLANDO

Ø Theorist, Ida Jean Orlando was born in 1926.

Ø Ida J. Orlando was one of the first nursing theorists to write about the nursing process.

Ø Nursing diploma - New York Medical College

Ø BS in public health nursing - St. John's University, NY,

Ø MA in mental health nursing - Columbia University, New York.

Ø Associate Professor at Yale School of Nursing and Director of the Graduate Program in
Mental Health Psychiatric Nursing.

Ø Project investigator of a National Institute of Mental Health grant entitled: Integration of

Mental Health Concepts in a Basic Nursing Curriculum.

Ø Her theory was published in her 1961 book, The Dynamic Nurse-Patient Relationship.

Ø Further development of her theory at McLean Hospital in Belmont, MA as Director of a

Research Project: Two Systems of Nursing in a Psychiatric Hospital. The results were
conceptualized in her 1972 book titled: The Discipline and Teaching of Nursing Processes

Ø A board member of Harvard Community Health Plan, and served as both a national and
international consultant

Ø Theoretical Sources

- Paplau’s focus of interpersonal relationships in nursing

- Paplau acknowledged the influence of Harry Stack Sullivan on the development of her
ideas

- Symbolic interactionism – Chicago school

Ø Use of field methodology

- John Dewey’s theory of inquiry

Ø Major Dimensions
- The role of the nurse is to find out and meet the patient's immediate need for help.

- The patient's presenting behavior may be a plea for help; however, the help needed may
not be what it appears to be.

- Therefore, nurses need good judgment to explore with patients the meaning of their
behavior.

- This process helps nurse find out the nature of the distress and what help the patient need

Nursing Process

Assessment

Ø Systematic and continuous collection, validation and communication of client data as

compared to what is standard/norm

Purpose: to establish a data base

Types Of Assessment:

1. Initial Assessment – assessment performed within a specified time on admission

Ex: -Nursing admission assessment

-Physical assessment on admission

-Physician’s history & physical examination

2. Problem-Focused Assessment – use to determine status of a specific problem identified

in an earlier assessment

Ex: -Fluid intake & urine output (problem on urination-assess) (Diuresis/polyuria, Dysuria,
Anuria, Oliguria)

-Snellens test (Visual Acuity)

3. Emergency Assessment – rapid assessment done during any physiologic/physiologic

crisis of the client to identify life threatening problems.

Ex: Assessment of a client’s airway, breathing status & circulation after a cardiac arrest

4. Time-Lapsed Assessment – reassessment of client’s functional health pattern

– Done several months after initial assessment to compare the clients current status to
baseline data previously obtained.
Types of Data:

1. Subjective Data – Symptom/Covert data

– Information from the client’s point of view or are described by the person experiencing it.

– Information supplied by family members, significant others, other health professionals are
considered subjective data.

Example: -pain, dizziness, ringing of ears/Tinnitus

(-) guarding behavior

(-) facial Grimace

2. Objective Data – Sign/Overt data

– Those that can be detected, observed or measured/tested using accepted standard or

norm.

Example: -pallor, diaphoresis, BP=150/100, yellow discoloration of skin

-Patient has wobbling gait

-Petechiae

Methods of Data Collection:

1. Interview

– A planned, purposeful conversation/communication with the client to get information,

identify problems, evaluate change, to teach, or to provide support or counselling.

2. Observation

– use to gather data by using the 5 senses and instruments

Sources of Data:

1. Primary source – data directly gathered from the client using interview and physical
examination.

2. Secondary source – data gathered from client’s family members, significant others,
client’s medical records/chart, other members of health team, and related care
literature/journals.

Diagnosing

Ø Is the 2nd step of the nursing process

Ø The process of reasoning or the clinical act of identifying problems

Ø Identifies health care needs

Ø Analyze assessment information and derive meaning from this analysis.

Types of Nursing Diagnosis:

1. Actual Nursing Diagnosis – a client problem that is present at the time of the nursing
assessment. It is based on the presence of signs and symptoms.

– Constipation r/t long term use of laxative.

– Ineffective airway clearance r/t to viscous secretions

2. Potential Nursing Diagnosis – evidence about a health problem is incomplete or unclear.

It requires more data to support or reject it; or the causative factors are unknown. Problem is
only considered possible to occur

– Possible nutritional deficit

– Possible low self-esteem r/t loss job

3. Risk Nursing Diagnosis – is a clinical judgment that a problem does not exist, therefore no
S/S are present instead RISK FACTORS are present

*Risk factors indicates that a problem is only is likely to develop unless nurse intervene or
do something about it. No subjective or objective cues are present therefore the factors that
cause the client to be more vulnerable to the problem is the etiology of a risk nursing
diagnosis.

– Risk for Constipation r/t inactivity and insufficient fluid intake

Planning

Ø To identify client goals; to determine priorities of care; to design nursing strategies to

achieve expected outcomes of care; to determine outcome criteria-

Ø SMART –Specific, Measurable, Attainable and Realistically Time-bound.

– Ex: to reduce fever within the baseline data of 37 by giving prn antipyretic medication
and performing tepid sponge bath for 4 hrs
Implementation

Ø To complete nursing actions necessary for accomplishing plan

Ø Reassess client.

Ø Review and modify existing care plan.

Ø Perform nursing actions.

*Nursing actions – directed towards providing for the patient’s immediate need

Evaluation

Ø To determine extent to which expected outcomes have been achieved.

IX. JOYCE TRAVELBEE

JOYCE TRAVELBEE

Ø Born in 1926,

Ø A psychiatric nurse, educator and writer.

Ø In 1956, she completed her Bachelor of Science degree in nursing education at Louisiana
State University and her Master of Science Degree in Nursing from Yale University in 1959.

Ø She started a doctoral program in Florida in 1973.

Ø Unfortunately, she was not able to finish the program because she died later that year.
She passed away at the prime age of 47 after a brief sickness.

Ø In 1952, Travelbee started to be an instructor focusing in Psychiatric Nursing at Depaul

Hospital Affiliate School, New Orleans, while working on her baccalaureate degree. Besides
that, she also taught Psychiatric Nursing at Charity Hospital School of Nursing in Louisiana
State University, New York University and University of Mississippi. In 1970,she was named
Project Director at Hotel Dieu School of Nursing in New Orleans. Travelbee was the director
of Graduate Education at Louisiana State University School of Nursing until her death.
Ø In 1963, Travelbee started to publish various articles in nursing journals. Her first book
entitled: Interpersonal Aspects of Nursing was published in 1966 and 1971.

Ø In 1969, she had her second book published entitled: Intervention in Psychiatric Nursing :
Process in the One-to-One Relationship.

Human to Human Relationship Model

Ø In her human-to-human relationship model, the nurse and the patient undergoes the
following series of interactional phases:

Original Encounter

Ø This is described as the first impression by the nurse of the sick person and vice-versa.
The nurse and patient see each other in stereotyped or traditional roles.

Emerging Identities

Ø This phase is described by the nurse and patient perceiving each other as unique
individuals. At this time, the link of relationship begins to form.

Empathy

Ø Travelbee proposed that two qualities that enhance the empathy process are

Ø Similarities of experience

Ø the desire to understand another person

Ø This phase is described as the ability to share in the person’s experience. The result of
the empathic process is the ability to expect the behavior of the individual with whom he or
she empathized.

Sympathy

Ø Sympathy happens when the

Ø Nurse wants to lessen the cause of the patient’s suffering.

Ø “When one sympathizes, one is involved but not incapacitated by the involvement.” The
nurse should use a disciplined intellectual approach together with therapeutic use of self to
make helpful nursing actions.

Rapport

Ø Rapport is described as nursing interventions that lessens the patient’s suffering.

Ø The nurse and the sick person are relating as human being to human being.

Ø The sick person shows trust and confidence in the nurse. “A nurse is able to establish
rapport because she possesses the necessary knowledge and skills required to assist ill
persons, and because she is able to perceive, respond to, and appreciate the uniqueness of
the ill human being.”
 Note that the above stated interactional phases are in consecutive order and
developmentally achieved by the nurse and the patient as their relationship with one
another goes deeper and more therapeutic

B. GRAND THEORIES

V. MADELEINE LEININGER

MADELEINE LEININGER

Ø Developed the Transcultural Nursing Model.

Ø Advocated that nursing is a humanistic and scientific mode of helping a client through
specific cultural caring process to improve or maintain a health condition.

Ø Leininger is the founder of the transcultural nursing movement in education research and
practice.

Transcultural Nursing

Focus - cultural dynamics that influence the nurse–client relationship.

(area of study and practice focused on comparative cultural care (caring) values, beliefs,
and practices of individuals or groups of similar or different cultures are compared)

Goal – culturally congruent holistic care.

Provide culture-specific and universal nursing care practices to promote well-being or to

help people face unfavorable human conditions in culturally meaningful ways'

VI. NOLA PENDER

NOLA PENDER

The Major Concepts and Definitions of the Health Promotion Model

Ø The health promotion model (HPM) proposed by Nola J Pender (1982; revised, 1996) was
designed to be a “complementary counterpart to models of health protection.”

Ø It defines health as a positive dynamic state not merely the absence of disease. Health
promotion is directed at increasing a client’s level of well being.

Ø The health promotion model describes the multi dimensional nature of persons as they
interact within their environment to pursue health.

A. Individual Characteristics and Experience

Ø Prior related behavior

Ø Frequency of the similar behavior in the past.

Ø Direct and indirect effects on the likelihood of engaging in health promoting behaviors.

Personal Factors

– Personal factors categorized as biological, psychological and socio-cultural. These

factors are predictive of a given behavior and shaped by the nature of the target behavior
being considered.

Personal biological factors

– Include variable such as age gender body mass index pubertal status, aerobic
capacity, strength, agility, or balance.

Personal psychological factors

– Include variables such as self esteem self motivation personal competence perceived
health status and definition of health.

Personal socio-cultural factors

– Include variables such as race ethnicity, acculturation, education and socioeconomic

status.

B. Behavioural Specific Cognition and Affect

Perceived Benefits Of Action

– Anticipated positive outcomes that will occur from health behaviour.

Perceived Barriers To Action

– Anticipated, imagined or real blocks and personal costs of understanding a given

behaviour
Perceived Self Efficacy

– Judgment of personal capability to organize and execute a health-promoting behaviour.

Perceived self efficacy influences perceived barriers to action so higher efficacy result in
lowered perceptions of barriers to the performance of the behavior.

Activity Related Affect

– Subjective positive or negative feeling that occur before, during and following
behavior based on the stimulus properties of the behaviour itself. Activity-related affect
influences perceived self-efficacy, which means the more positive the subjective feeling, the
greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further
positive affect.

Interpersonal Influences

– Cognition concerning behaviours, beliefs, or attitudes of the others. Interpersonal

influences include: norms (expectations of significant others), social support (instrumental
and emotional encouragement) and modelling (vicarious learning through observing others
engaged in a particular behaviour). Primary sources of interpersonal influences are families,
peers, and healthcare providers.

Situational Influences

– Personal perceptions and cognitions of any given situation or context that can facilitate
or impede behaviour. Include perceptions of options available, demand characteristics and
aesthetic features of the environment in which given health promoting is proposed to take
place. Situational influences may have direct or indirect influences on health behaviour.

D. CONCEPTUAL MODEL/S

X. DOROTHEA OREM

DOROTHEA OREM

Self Care and Self Deficit Theory

Ø Self-care – is the performance or practice of activities that individuals initiate and perform
on their behalf

– The human’s ability or power to engage in self-care

Ø 3 Classifications of Nursing Systems:

 Wholly compensatory – for people who are socially dependent on others for their
existence and well being
 Partly compensatory – both nurse and patient perform care measures
  Supportive – educative – where the nurse is able to perform or can and should learn
to perform required measures of self-care but cannot do so without assistance

XI. MARTHA ROGERS

Ø Conceptualizes the science of unitary human beings.

Ø Nursing as an art and science that is humanistic and humanitarian. It is directed toward
the unitary human and is concerned with the nature and direction of human development.

Ø The goal of every nurse is to participate in the process of change.

XII. IMOGENE KING

I. IMOGENE KING

Ø Postulated the goal attainment model.

Ø Described nursing as a helping profession that assists the individuals and groups in
society to attain, maintain, and restore health.

Ø Nursing is a process of action, reaction and interaction whereby nurse and client share
information about their perception in the nursing situation.

Goal Attainment Theory

Ø Believes that there are 3 interacting systems:

· Individual (Personal System)

· Group (Interpersonal System)

· Society (Social Systems)

Xll: SISTER CALLISTA ROY

Ø Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy.

Ø At age 14 she began working at a large general hospital, first as a pantry girl, then as a
maid, and finally as a nurse's aide.

Ø She entered the Sisters of Saint Joseph of Carondelet.

Ø She earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College, Los
Angeles in 1963.

Ø a master's degree program in pediatric nursing at the University of California ,Los

Angeles in 1966.

Ø She also earned a master’s & PhD in Sociology in 1973 & 1977 ,respectively

Ø Sr. Callista had the significant opportunity of working with Dorothy E. Johnson

Ø Johnson's work with focusing knowledge for the discipline of nursing convinced Sr.
Callista of the importance of describing the nature of nursing as a service to society and
prompted her to begin developing her model with the goal of nursing being to promote
adaptation.

ADAPTATION THEORY

Ø System-a set of parts connected to function as a whole for some purpose.

Ø Stimulus-something that provokes a response, point of interaction for the human system
and the environment

Ø Focal Stimuli-internal or external stimulus immediately affecting the system

Ø Contextual Stimulus-all other stimulus present in the situation.

Ø Residual Stimulus-environmental factor, that effects on the situation that are unclear.

Ø Regulator Subsystem-automatic response to stimulus (neural, chemical, and endocrine)

Ø Cognator Subsystem-responds through four cognitive responds through four cognitive-

emotive channels (perceptual and information processing, learning, judgment, and emotion)

Ø Behavior -internal or external actions and reactions under specific circumstances

Ø Physiologic-Physical Mode

– Behavior pertaining to the physical aspect of the human system

– Physical and chemical processes

– Nurse must be knowledgeable about normal processes

– 5 needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection)

Ø Self Concept-Group Identity Mode

– The composite of beliefs and feelings held about oneself at a given time. Focus on the
psychological and spiritual aspects of the human system.

– Need to know who one is, so that one can exist with a state of unity, meaning, and
purposefulness of 2 modes (physical self, and personal self)

Ø Role function Mode

– Set of expectations about how a person occupying one position behaves toward a
occupying another position. Basic need-social integrity, the need to know who one is in
relation to others

Ø Interdependence Mode

– Behavior pertaining to interdependent relationships of individuals and groups. Focus

on the close relationships of people and their purpose.

– Each relationship exists for some reason. Involves the willingness and ability to give to
others and accept from others.

– Balance results in feelings of being valued and supported by others. Basic need -
feeling of security in relationships

Ø Adaptive Responses-promote the integrity of the human system.

Ø Ineffective Responses-neither promote not contribute to the integrity of the human

system

Ø Coping Process-innate or acquired ways innate or of interacting with the changing of

environment
SEMIFINALS

FILIPINO LOCAL THEORIES

DR. CARMELITA DIVINAGRACIA: Advance Nurse practitioners’ Composure Behavior and

Patient’s Wellness Outcome

DR. CARMELITA DIVINAGRACIA: Advance Nurse practitioners’ Composure Behavior

and Patient’s Wellness Outcome

Biography
Ø Filipino Nurse Theorist
Ø Association of the Deans Philippine Colleges of Nursing (ADPCN) Former President
Ø Dean of University of the East Ramon Magsaysay Memorial Medical Center,
Inc. (UERMMMC) College of Nursing
Ø Member of CHED ‘s Technical committee on Nursing Education. Has been lauded for
developing the art and competency of teaching nursing.
Ø Has been a clinic nurse, staff nurse, head nurse, instructor, assistant dean and dean
Ø Expert in Research and Education
Ø Has lectured and written about her work as a nurse and has use her hands-on experience
to develop better ways to teach nursing.
Ø Her love for nursing and her dedication to carve out learning tools for nursing students
has been a commendable and rare field of discipline.

Education
Ø Bachelor’s degree in Nursing at the University of the East Ramon Magsaysay Memorial
Medical Center in 1962
Ø Master’s degree in Nursing at the University of the Philippines in 1975
Ø Doctorate’s degree in Nursing at the University of the Philippines in 2001

Award
Ø Recipient of the Anastacia Giron Tupas Award given by the Philippine Nursing Association
(PNA) in 2008.

Theory
Objective of the study
Ø Determine the effects of composure behavior of the advance nurse practitioner on the
wellness outcome of the selected cardiac patients

Significance of the Study

Ø Nursing as a healthcare profession would prove its worth of being at par in quality
performance with other healthcare professionals

Study Population
Ø Adult Cardiac Patients admitted and confined at the Philippines Heart center, Coronary
Care Unit.

Definition of Terms

Advance Nurse Practitioners

· BSN graduate
· Licensed and has a clinical experience of at least 2 years in the clinical area
· Has undergone special training in critical area
· Set of behaviors or nursing measures that the nurse demonstrates to selected cardiac
patients

Composure Behaviors
· A condition of being in a state of well-being, a coordinated and integrated living pattern
that involves the dimension of wellness.

Theory COMPOSURE Behaviours

Dr. Carmelita C. Divinagracia conducted a study to determine the effects of COMPOSURE

behaviours of the advanced practitioner on the recovery of selected patients at the
Philippine Heart Center. Behaviours include: competence, presence and prayer, open-
mindedness, stimulation, understanding, respect and relaxation, and empathy.

Composure Behaviours

COMpetence
· An in-depth knowledge and clinical expertise demonstrated in caring for patients.
· This also stands for consistency and congruency of words and deeds of the nurse.
Presence and Prayer
· 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
· 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 to his
current health condition and practices and demonstrate the flexibility of the nurse to
accommodate patient’s views.

Stimulation
· 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 behavioural approach.

Understanding
· According to her, it 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
· Acknowledging the 31 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.

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.

Ø Through the COMPOSURE behaviors of the nurse, holism is guaranteed to the patient.
Ø 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.

Ø This framework represents the orthopedic patients, COMPOSURE behaviors of novice

nurses, and the patient wellness outcome such as physiologic and biobehavioral. The
innermost part of the oval is the orthopedic patients. Being the recipient of care, they are
being influenced by many factors and one of those are the behaviors of nurses in
implementing quality nursing care. As the COMPOSURE behaviors of novice nurses
envelope, the orthopedic patients as shown above, the researcher believe that there will be
an essential improvement in the patient wellness outcome, may it be on physiologic and/or
biobehavioral wellness outcome.

Patient Wellness Outcome

· This refers to the perceived wellness of selected orthopedic patients after receiving
nursing care in terms of physiologic and biobehavioral.

· Many illnesses are curable and may have only a temporary effect on health. Others, such
as diabetes, are not curable but can be managed with proper eating, physical activity, and
sound medical supervision. It should be noted that those possessing manageable conditions
may be more at risk for other health problems, so proper management is essential. For
example, unmanaged diabetes is associated with high risk for heart disease and other
health problems.

Two patient wellness outcomes which have been categorized as:

· Biobehavioral

· Physiologic

These patient wellness outcomes reflect their needs as their illness turn to recovery and
rehabilitation. These needs must be met through high quality nursing care, none other than
through COMPOSURE behaviors. COMPOSURE behaviors have been inspired to the
principle of holistic care wherein a patient wellness outcome can be achieved through
series of quality attributes of nurses, which caters to every aspect of patient wellness, may it
be biobehavioral or physiologic wellness outcome.

Physiologic Wellness Outcome

· This refers to the perceived wellness of selected orthopaedic patients after receiving
nursing care in terms of vital signs, bone pain sensation, and complete blood count.

Biobehavioral Wellness Outcome

· This refers to the perceived wellness of selected orthopaedic patients after receiving
nursing care in terms physical, intellectual, emotional, and spiritual.

Divinagracia (2001) as cited by Leocadio (2009), conceptualized forty statements that

represented the dimensions of wellness which include the physical, emotional, intellectual,
and spiritual domain. Physical domain involves muscle strength, mobility, posture, gait
exercise, and activity tolerance and cardio-respiratory endurance. Emotional domain
includes awareness, orientation, understanding of own and other personal feelings and
ability to control and cope with emotions. Intellectual domain refers knowledge and
perception of a healthy self and ability to recognize the presence of risk factors and
preventive measures and spiritual domain is defined as development of inner self or one’s
soul through a relationship with God and others.

The most basic form of holistic communication is "Active listening". Active listening is a
specific way of hearing what a person says and feels, and reflecting that information back to
the speaker. Its goal is to listen to the whole person and provide her with empathic
understanding. It is the skill of paying gentle, compassionate attention to what has been said
or implied. When you listen in this way to patients, you just try to reflect the other person's
feelings and deeper meanings, which helps them feel heard and understood. You don't
analyze, interpret, judge, or give advice. When patients are listened to in this way, they are
less anxious, complain less about their caregivers, and are more likely to comply with their
treatment plan.

A cardiac patient might be angry and complaining. As the nurse, you may try to avoid his
room, and, when you have to be there, move in and out as quickly as possible. Avoidance is
one solution, but there might be a different approach.

Active listening helps patients clarify and articulate their inner process. For a patient, being
carefully listened to can be a moving and profound experience, one that transforms the
relationship between patient and nurse. Active listening is particularly relevant in a hospital
setting, where patients often report 132 that they feel isolated and invisible. It can make a
difference in rebuilding a patient's sense of self. It can also be rewarding for the nurse.

A positive total outlook on life is essential to wellness and each of the wellness
dimensions. A “well” person is satisfied in his/her work, is spiritually fulfilled, enjoys
leisure time, is physically fit, is socially involved, and has a positive emotional-mental
outlook. This person is happy and fulfilled. Many experts believe that a positive total
outlook is a key to wellness
The way one perceives each of the dimensions of wellness affects total outlook. Researchers
use the term self-perceptions to describe these feelings. Many researchers believe that self-
perceptions about wellness are more important than actual ability. For example, a person
who has an important job may find less meaning and job satisfaction than another person
with a much less important job. Apparently, one of the important factors for a person who
has achieved high level wellness and a positive life’s outlook is the ability to reward
himself/herself. Some people, however, seem unable to give themselves credit for their
life’s experiences. The development of a system that allows a person to positively perceive
the self is important. Of course, the adoption of positive perceive lifestyles that encourage
improved self-perception is also important.

· Emotional wellness is a person’s ability to cope with daily circumstances and to deal with
personal feelings in a positive, optimistic, and constructive manner. A person with
emotional wellness is generally characterized as happy, as opposed to depressed.

Ø A person with intellectual health is free from illnesses that invade the brain and other
systems that allow learning. A person with intellectual health also possesses intellectual
wellness.

· Intellectual wellness is a person’s ability to learn and to use information to enhance the
quality of daily living and optimal functioning. A person with intellectual wellness is
generally characterized as informed, as opposed to ignorant.

Ø A person with intellectual health is free from illnesses that invade the brain and other
systems that allow learning. A person with intellectual health also possesses intellectual
wellness.

· Physical wellness is a person’s ability to function effectively in meeting the demands of the
day’s work and to use free time effectively. Physical wellness includes good physical fitness
and the possession of useful motor skills. A person with physical wellness is generally
characterized as fit versus unfit.

Ø A person with physical health is free from illnesses that affect the physiological systems of
the body such as the heart, the nervous system, and the like. A person with physical health
possesses an adequate level of physical fitness and physical wellness

· Spiritual wellness is a person’s ability to establish a values system and act on the system of
beliefs, as well as to establish and carry out meaningful and constructive lifetime goals. It is
often based on a belief in a force greater than the individual that helps one contribute to an
improved quality of life for all people. A 138 person with spiritual wellness is generally
characterized as fulfilled as opposed to unfulfilled

Ø Spiritual health is the one component of health that is totally comprised of the wellness
dimension; for this reason, spiritual health is considered to be synonymous with spiritual
wellness.
Optimal health includes many areas, thus the term holistic (total) is appropriate. In fact, the
word health originates from a root word meaning “wholeness”

The holistic nurse is an embodiment of the care she renders. The nurse creates the calm
environment in any setting that facilitates treatment, healing and recovery from any pain or
discomfort.

In terms of the COMPOSURE behaviors of advanced beginner nurses.

a. Competence • They always manifest good interpersonal and communication skills in

dealing with patients and able to extract significant information to aid in planning and
delivery of effective nursing care. However, they rarely develop health education plan
based on the assessed and anticipated needs of the patients.

b. Prayer • The advanced beginner nurses always allows some moment of silence. But they
rarely pray with the patients.

c. Presence • Indeed, the advanced beginner nurses often establish the purpose of the
interaction and often display interest to the 279 patients. Moreover, they sometimes spend
time with patient even in silence

d. Open-mindedness • The advanced beginner nurses often create an environment of trust

and rapport. On the other hand, they sometimes listen attentively to patient.

e. Stimulation • Likewise, the advanced beginner nurses always tell patient what he can do,
what he is supposed to do, and how to do it. More so, they often encourage patient to
evaluate his action.

f. Understanding • The advanced beginner nurses to often encourage the patient to feel
comfortable in the nurse-patient relationship. More so, they often clarify the message
through the use of question and feedback.

g. Respect • The advanced beginner nurses always call the patient by his/her preferred
name and utilize “po” and “opo” when being asked and they also provide options before
making decisions.

h. Relaxation • They always evaluate and document the patient’s response to the
intervention, observe his/her breathing, and ask if he/she is feeling relaxed yet they
sometimes take note of facial expression and unnecessary body movements.

i. Empathy • Shows that they always encourage expression of feelings; focus on verbal and
nonverbal behavior and they often provide continuous feedback

DR. CARMELITA DIVINAGRACIA: Advance Nurse practitioners’ Composure Behavior and

Patient’s Wellness Outcome
SR. CAROL AGRAVANTE: CARAGSA Transformative Leadership Model

SR. CAROL AGRAVANTE: CARAGSA Transformative Leadership Model

Biography:

Ø She is famous for being the first Filipina theorist for writing the CASAGRA Transformative
Leadership Model. The title of the theory was derived from her
name, CArolina S. AGRAvante.

Ø She finished her secondary education at St. Paul University - Manila (formerly St. Paul
College Manila) as class salutatorian.

Ø In 1964, she earned her BS Nursing degree in the same school as magna cum laude. In the
same year, she passed the nurse licensure examinations as the board topnotcher.

Ø From 1967 to 1969, she studied Master’s Degree in Nursing Education at Catholic
University of America as a full-pledged scholar.

Ø In 2002, she earned her Doctoral Degree in Philosophy at University of the Philippines
Manila and in

Ø the same year her theory was published.

Ø She served as the president of St. Paul University - Iloilo, where she taught research
subjects among senior students.

Ø She was a former president of the Association of Deans of the Philippines Colleges of
Nursing (ADPCN) as she became the representative in the International Nursing Congress
that was held in Brunei in 1996. A year after, she was a part of a delegation that participated
in the International Council of Nursing in Vancouver, Canada.

Ø Received a Service Award from the Philippine Accreditation Association of Schools,

Colleges and Universities (PAASCU) for being one of the accreditors.

Ø One of the founding members of the Integrated Registered Nurses of the Philippines
(IRNP).

Ø Currently, she is the President of St. Paul College - Ilocos Sur while performing the duties
of the Vice-President for Academics. Moreover, she also functions as the program chair of
the school's Department of Nursing
Theory: The CASAGRA Transformative Leadership Model

The complete title of the model is:

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. Generalizibility /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; and

f. Source of Development – Derived from practice or deduced from middle range theory or
grand theory.

Purpose
Ø The present day demands in the nursing profession challenge nursing educators to revisit
their basic responsibility of educating professional nurses who are responsive
to technological, educational and social changes happening in the Philippines society
today. The reopening of the doors of foreign market to Filipino nurses, migration made easy,
attractive salaries and benefits way beyond what hospitals can afford to give.

Ø Nursing education is faced with a new concern that is globalization of nursing services for
the international market. Therefore, a need to develop globalization of care with focus on
developing caring nurses.

Ø The formation of new nursing leaders is urgently needed; leaders with new vision who
will venture new traits and who have gone through new formation in order to serve
the society as professional nurse.

Ø Nurses need competent leaders with a dream of what nursing can be, whose basic stand is
caring and service who are competent in nursing, assertive of their own rights with the help
profession.

Main Propositions

Ø CASAGRA Transformative Leadership is a psycho-spiritual model, was an effective means

for faculty to become better teachers and servant-leaders.

Ø Care complex is a structure in the personality of the caregiver that is significantly related
to the leadership behavior.

Ø The CASAGRA servant-leadership formula is an effective modality in enhancing the

nursing faculty’s servant-leadership behavior.

Ø Vitality of Care Complex of the nursing faculty is directly related to leadership behavior.

CONCEPTS

1. Key Concepts

Ø 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.

Ø 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.
Ø 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.

Ø 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.

Ø 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.

Ø Transformative teaching may also be termed Reflective teaching, an umbrella term

covering ideas, such as thoughtful instruction, teacher research, teacher narrative, and
teacher empowerment.

Ø 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.

Three-Fold Transformative Leader Concept

I. The Servant-Leadership Spirituality here is prescribed to run parallel to the generic

elements of the transformative leadership model.

This formula 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.

The servant-leader formula prescription includes a spiritual retreat that goes through the
process of awareness, contemplation, storytelling, reflection, and finally commitment to
become servant-leaders in the footsteps of Jesus.

II. The Self-Mastery consists of a vibrant care complex possessed to a certain degree by all
who have been through formal studies in a care giving profession such as nursing.
III. The Special-Expertise level is shown in a creative, caring, critical, contemplative and
collegial teaching of the nurse faculty who is directly involved with the formation of the
nursing.

MEANING AND PARADIGM

Meaning of the Theory

Based on the study, the effect of the CASAGRA Leadership model using the servant leader
model on the leadership behavior of the nursing faculty, the care complex in the personality
of the nursing faculty is highly correlated to their leadership behavior. The care complex is
necessary given as a stimulant in the performance of the leadership activities. The
leadership behavior of the faculty after going to the servant leadership formula was
significantly higher in the two-posttest periods than during the pre-test. It improved the
leadership behavior of the nursing faculty in both groups.

The Paradigm of the Theory

Ø The conceptual framework is logical because the variables are very well explained on
how transformative-leadership model be applicable through care complex, transformative
teaching servant-leader spirituality, and servant-leader behavior.

Ø A person with dynamic care complex is the cornerstone of nursing leadership. According
to care complex of Agravante, caring personality rests on the possession of a care complex
with in a person as an energy source of caring.

Ø The framework explains and predicts the continuous formation of nursing leadership
behavior in nursing faculty that will eventually affect their teaching function.

Ø Servant-leadership formula runs parallel to the generic elements of the transformative-

leadership model.

Ø Transformative teaching is the guide that desired for the modern educative process
designed to form the millennium professional nurse.
Ø Expertise is the practice of caring and proactive in face of challenges for the profession
go hand-in-hand. Education and practice bring this about.

LETTY KUAN: Retirement and Role Discontinuities

LETTY KUAN: Retirement and Role Discontinuities

RETIREMENT AND ROLE DISCONTINUITIES CONCEPTUAL MODEL (as studied and

researched by the author) Determinants of Fruitful Aging

• Prepared retirement
• Health Status
• Income
• Family Constellation
• Self- Preparation Retirement Role Discontinuities (Aging Process)

BACKGROUND

· 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 through 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 of options at age
50-60 in order to have a rewarding retirement period even amidst the presence of role
discontinuities experienced by this age group.

BASIC ASSUMPTIONS AND CONCEPTS

· Physiological Age- is the endurance of cells and tissues to withstand the wear-and-tear
phenomenon of the human body. -some individuals are gifted with the strong genetic
affinity to stay young for a long time period.

Role – Refers to the set of shared expectations focused upon a particular position. These may
include beliefs about what goals or values the position incumbent is to pursue and the norms
that will govern his behavior.

ROLE

It is also the set shared expectations from the retirees socialization experiences and the
values internalized while preparing for the position as well as the adaptations to the
expectations socially defined for the position itself. For every social role there is
complementary set of roles in the social structure among which interaction constantly occurs.

· Change of Life - is the period between near retirement and post-retirement years. In
medico-physiological terms, this equates with the climacteric period of adjustment and
readjustment to another tempo of life.

· Retiree – is an individual who has left the position occupied for the past years of productive
life because he/she has reached the prescribed retirement age or has completed the
required years of service.

· Role Discontinuity - is the interruption in the line of status enjoyed or performed. The
interruption may be brought about by an accident, emergency, and change of position or
retirement.

· Coping Approaches- Refer to the interventions or measures applied to solve a problematic

situation or state in order to restore or maintain equilibrium and normal functioning.

DETERMINANTS OF POSITIVE PERCEPTIONS IN RETIREMENT AND POSITIVE

REACTIONS TOWARD ROLE DISCONTINUITIES:

1. Health Status - refer to physiological and mental state of the respondents, classified as
either sickly or healthy.

2. Income – (economic level) refers to the financial affluence of the respondent which can be
classified as poor, moderate, or rich.

3. Work Status (according to Webster’s dictionary) status of an individual according to

his/her work.

4. 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.

5. Self-Preparation (according to Webster’s dictionary) - it is preparing of self to the

possible outcomes in life.

FINDINGS AND RECOMMENDATIONS

1. Health status dictates the capacities and the type of role one takes both for the present
and for the future. - It fits for the everyone to maintain and promote health at all ages
because only proper care of the mind and body is needed to maintain health in old age.

2. Family constellation is a positive index regarding retirement positively and also in

reacting to role discontinuities. In the Philippines, the family undoubtedly stands as the
security or trusting bank where all members, young and old can always run and get
help. When one retires, the shock of the role discontinuities is softened because the family
not only cushions the impact, but also offers gainful substitutes, as in providing monetary
support, absorbing emotional strains that often times with discontinuities and other forms of
surrogating.

3. Income has a high correlation with both the perception of retirement and reactions
towards role discontinuities. Since income is one of the factors that secure the outlook of
individual, efforts must be exerted to save and spend money wisely while still actively
earning in order to have some reserved when one grows old. It also implies that retirement
pensions should be adjusted to meet the demands of the elderly. This should be done in
order to have a more relevant and realistic pension and benefits adjustment.

4. Work status goes hand and hand with economic security that generates decent
compensation. For the retired, it implies that retirement should not be conceptualized as a
period of no work because capabilities to function get sharpened and refined as they
practice it on a regular basis. Work enhances the aspects of self-esteem and contributes to
the feeling of wellness even and old age.

5. Self-preparation which are said to be both therapeutic and recreational in essence pays
its worth in old age. This does not only account professionalism or expertise but also
benevolent work as in charitable actions with the colleagues. Self-preparation is investing
not in monetary benefits but in something that gives them and dignity; enhance their
feelings of self-worth and happiness.

6. To cope with the changes brought by retirement, one must cultivate interest in
recreational activities to channel feelings of depression or isolation and facing realities
through confrontation with some issues.

7. To perceive retirement positively, it requires early socialization of the various roles we

take in life. The best place to start is at home extending to schools, neighbourhoods, The
community and society in general. In retirement, their fellow retirees are their own best
advocates. To facilitate this, barriers to full participation in the areas where important
decisions are rich should be eliminated in order to give recognition and appreciation of the
knowledge, wisdom, experience and values which are the social assets that make the
retired age and the custodians’ folk wisdom.

8. Government agency to construct holistic preretirement preparation program which will

take care of the retiree’s finances, psychological, emotional, and social needs.

9. Retirement should be recognized as the fulfillment of every individual’ s birthright and

must be lived meaningfully.

“I have grown and sown and now I can reap the reward and blessing of a life lived in joy
and love, for I too have made others grow. ” Prof. Letty Gurdiel Kuan, RN, RGC, EdD

LETTY KUAN: Retirement and Role Discontinuities

CARMENCITA ABAQUIN: “Prepare Me” Theory

Biography

· Carmencita M. Abaquin is a nurse with Master’s Degree in Nursing obtained from the
University of the Philippines College of Nursing.

· An expert in Medical Surgical Nursing with subspecialty in Oncologic Nursing, which made
her known both here and abroad.

· She had served the University of the Philippines College of Nursing, as faculty and held the
position as Secretary of the College of Nursing.

· Her latest appointment as Chairman of the Board of Nursing speaks of her competence and
integrity in the field she has chosen.

About her Theory:

“PREPARE ME” Interventions and the Quality of Life Advance Progressive Cancer
Patients.

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:

· Presence – being with another person during the times of need. This includes therapeutic
communication, active listening, and touch.

· Reminisce Therapy – recall of past experiences, feelings and thoughts to facilitate

adaptation to present circumstances.

· Prayer

· Relaxation-Breathing – techniques to encourage and elicit relaxation for the purpose of

decreasing undesirable signs and symptoms such as pain, muscle tension, and anxiety.

· 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.

· 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.

“To Nursing… may be able to provide the care that our clients need in maintaining their
quality of life and being instrumental in “Birthing” them to External life”

Identify Origins of the theory (what prompted)

the incidence of cancer has significantly increased not only in the Philippines but also
worldwide

Examine the meaning of theory

1. Terminally-ill patients especially cancer patients require holistic approach of nursing in
different aspects of man namely the emotional, psychological, social and spiritual. In this
premise, patients with incurable disease require multidimensional nursing care to improve
quality of life.

2. PREPARE ME nursing interventions are effective in improving quality of life in terminally-

ill patients.

3. Utilization of intervention as a basic part of care given to cancer patients, likewise,

incorporation in the basic nursing curriculum in the care of these patients. PREPARE ME
must be introduced and focus during training of nurse both in academe and practice.

4. Development of training programs for care provider as well as health care profession
where intervention is a part of treatment modalities.

5. The nurse must be honest about the feedback on his/her condition. Nurses must do this so
that they would know what the expectations of the patient and the family so that they may
render a holistic caring style for the patient together with his family in his dying days. This
would help the patient and family address the needs of the patient in any manner
possible. (physical, emotional and spiritual)

6. The nurse must help make a supportive environment for the patient and his family in his
dying days. An environment like this would promote dignity in his days left thus helping the
patient accept his fate and help him/her be ready for the afterlife. The family is also guided
in this rough time addressing their grieving process by instilling in them that death is part of
life.

CARMENCITA ABAQUIN: “Prepare Me” Theory

CECILIA LAURENTE: Theory of Nursing Practice and Career

Biography

Ø Cecilia Laurente is a Filipino nursing theorist, who focused her works primarily on helping
a patient through support systems, specifically the family.

Ø She published a paper entitled, “Categorization of Nursing Activities as Observed in

Medical-Surgical Ward Units in selected Government and Private Hospitals in Metro
Manila.”

Ø Cecilia Laurente is known for her work in the field of nursing. In her theory of nursing
practice, she emphasized effective communication and championed using the family as an
entry point to help a patient.

Cecilia Laurente’s Career

· Graduated BSN at University of the Philippines in 1967 and

· a Master of Nursing in 1973.

· She worked as a Staff Nurse in 1968-1969

· She became a Head Nurse in 1970-1972

· And as a Nursing Supervisor IN 1973-1976 at Philippine General Hospital

· She also worked at Metropolitan Hospital in Michigan US in 1977-1979

· She came and become an Instructor at University of the Philippines College of Nursing in
1979

· And later on, she became a Dean of College of Nursing in UP Manila from 1966 - 2002

NURSING THEORY: Theory of Nursing Practice and Career

"Categorization of Nursing Activities as Observed in Medical-Surgical Ward Units in

Selected Government and Private Hospitals in Metro Manila"

Theory of Nursing Practice and Career

Ø The theory was from her study, the Categorization of Nursing Activities as Observed in
Medical-Surgical Ward Units in selected Government and Private Hospitals in Metro Manila,
which was conducted from January to June year 1987
Ø In the recent study of Laurente she states that the other entry point of helping the patient is
through the family, when nurses can be of great assistance to prevent at the very beginning
serious complications. The nurse can help strengthen the family’s term of knowledge, skills,
and attitude through effective communication, employed informative, psychotherapeutic,
modeling, behavioral, cognitive-behavioral, and/or hypnotic techniques are summarized
and evaluated

Concepts of the Theory

Ø What is “Anxiety”?

- A mental state of fear or nervousness about what might happen

Nursing Caring Behavior that affect patient’s Anxiety:

Ø Presence

- Person to person contact between the client and the nurses.

Ø Concern

- Development in the time though mutual trust between the nurse and the patient

Ø Stimulation

- Nurse stimulation through words tops the powerful resources of energy of person for
healing

Enhancing and Predisposing Factor

Ø What is a predisposing Factor?

- Predisposing factors are defined in these models as factors that exert their effects prior to a
behavior occurring, by increasing or decreasing a person or population’s motivation to
undertake that particular behavior.

Ø Predisposing Factors

- Age
- Sex

- Civil Status

- Educational Status

- Length of Work

- Experience

Ø Enhancing Factors

- One’s caring experience, beliefs and attitude

- Feeling good about

- Learning at school

- What patients tell about the nurse coping mechanism to problems encountered

- Communication

BACKGROUND

Ø Communication is key when getting nurses to engage patients and families in their care.

Ø Research to develop the guide found that communication gaps between patients and
caregivers can occur when hospitals do not address the issues that patients' thoughts are
most important. Another factor is the available tools are to give health providers insights
into patients' needs and concerns. As a result, efforts by patients, families and health
providers to communicate more effectively with each other can fall short of their goal.

Ø Each strategy includes educational tools and resources for patients and families, training
materials for healthcare professionals and real-world examples that show how strategies are
being implemented in hospital settings. The strategies describe how patients and families,
working with hospital staff, can: be advisors; promote better communication at the bedside
to improve quality; participate in bedside shift reports; and prepare to leave the hospital.
FINALS COVERAGE

NURSING CORE VALUES

1. Love of God

2. Caring

Ø We are caring people. Despite our frustration, we keep getting up and caring for people
every day. Even though documentation, regulation, financial constraints, and a dozen other
challenges impede our abilities to provide our patients with the kind of care that we wish to
provide, we keep giving our best. We may not always feel like it, but we are optimists. We
have to be in order to continue on in our mission of improving health and wellness for all
people.

· Compassion
Ø Compassion in nursing takes a nurse from competent care that includes the required skills
and knowledge to treat their patients to outwardly caring through actions and deeds that
involve the emotional aspects of the relationship. A nurse’s compassionate care can affect a
patient’s outcome “The nurse's compassion is an invaluable aspect of care,” states Koplowitz,
“because it provides patients with emotional support, which can lessen depression and
strengthen the patient's will to survive.”

Ø Compassionate nursing is broadly associated with caring actions. Examples of

compassion in nursing include:

o Being empathetic to better understand what your patients are going through

o Getting to know your patients to better understand their needs

o Giving patients someone to talk to, which is especially important for patients who don’t
have family or friends to lean on

o Being an active listener when patients discuss their health issues or complaints, which also
helps you pick up on unspoken concerns

o Solidifying your bond with patients by following up with their health concerns or
complaints

o Providing emotional support during critical times of your patient’s treatment and recovery

o Using a positive voice and body language to imbue confidence in your patients about their
eventual recovery

o Knocking on the door before entering to show patients respect, dignity and a modicum of
privacy where privacy is often limited

o Taking time to explain tests and procedures and answering your patients’ questions, so
they feel important

o Helping relieve your patients’ concerns, so they can concentrate on getting well

Benefits of compassionate nursing

o Being a compassionate nurse not only benefits the patient, it also benefits the
nurse. Nurses more concerned about their patients’ well-being and the pain and fear they
feel typically enjoy their jobs more and feel more connected to their careers.

o Providing emotional support to your patients can also offer tremendous self-gratification,
but take care to not fall victim to compassion fatigue. When caring for your patients
becomes too much of an emotional drain, you could experience a mix of emotional, physical
and behavioral symptoms; mental and physical exhaustion; and emotional withdrawal.

· Conscience

Ø The influence of conscience on nurses in terms of guilt has frequently been described. It
primarily affects the ethical values of a nurse. For example, nurses are consistently
encountering ethical issues related but not limited to: restrictions in providing quality
patient care, or in providing care they do not perceive to be beneficial or ethical to carry out
for their patients, and/or encountering care practices they are ethically at odds with, which
creates ethical dilemmas and can result in issues of conscience for nurses. At times, nurses
may encounter an issue in practice that so strongly conflicts with their personal, ethical
beliefs that they may declare a conscientious objection to refrain from participating in or
carrying out an aspect of clinical practice. Living through an experience of making a
conscientious objection, as a nurse, sheds light on how to weave through the contentious
fabric of what it means to be an ethical nurse in today's world.

· Competence

Ø As professional nurses, we are competent to practice nursing by virtue of our education

and licensure as registered nurses. The concept of competence is regarded as a basic
aspect in practice, particularly when assessing the ability of a nurse to offer nursing care. It
is an essential professional issue in nursing practice as far as professional standards, the
quality of care and patient safety is concerned. Reorganization within the healthcare
delivery systems has pressurized the nursing profession to guarantee the continued
competence of its nurses. It is also important because it affects many other realms of nursing
profession like education and management. It is also an issue of concern for regulators,
hospitals, the public and insurance companies.

· Confidence

Ø Confidence is one of those words that we understand at face value, but have a hard time
quantifying. It is a factor of mental well-being that is determined by your level of
achievement, sense of belonging, and your self-esteem. It has a lot to do with how you see
yourself, but even more to do with how you perceive others to see you. Some of the common
attributes of a nurse with confidence include:

· Optimism

· Independence

· Assertiveness

· Trust
· Enthusiasm

· Emotional Maturity

Ø Humans look to people who possess confidence and admire their calm and cool
demeanors in the eye of the storm. You can build your own confidence and become a more
effective nurse by:

· Counting Your Achievements – Make your own log of your most recent achievements,
and refer to it whenever you feel self-doubt. This list can include exam scores from nursing
school, recommendations from your professors, or something you did to help someone else.

· Adding to Your List – Catch yourself doing something right and add it to your own nursing
achievement list. This will be even more impactful when it is something that you previously
felt unsure of, such as starting an IV or taking a patient history. This forces your mind to
focus on the positive contributions you are making in nursing and encourages you to strive
for even more.

· Reaching Out to a Mentor – This may sound backward, but the truth is, confident people
are those who are not afraid to ask for help when they need it. Ask your nurse mentor to
watch over your shoulder as you perform a procedure for the first time or for advice on how
to talk to a patient’s family members.

· Setting Realistic Goals for Yourself – Give yourself some time to acclimate in your new
role as a practicing nurse by setting goals for what you need to accomplish. Your confidence
will build every time you are able to cross another one off of the list.

· Rewarding Your Accomplishments – Self-praise helps to restore your confidence by

acknowledging that you have reached an important milestone. Treat yourself to a special
lunch, buy a new lab coat, or go for a massage when you feel good about the work you have
accomplished as a nurse.

· Sharing Your Glories – Pick a friend or family as your confidence building buddy, and
share your accomplishments with them. Preferably this will be someone who will be
overjoyed at your successes and gush over every little thing – like your mom. Confident
nurses don’t need to point out every achievement to their co-workers and peers, but when
you are working on building yours, it helps to have someone in your corner.

· Allowing Room for Mistakes – To err is human, and as a new nurse, you might do this a
lot. But rather than beat yourself up over every little one, make a commitment to learn from
them. Once you have mastered the art of bouncing back over accepting defeat, you will
have reached a new level of self-confidence.

· Confidence is a learned trait, and a lack of it is not a permanent condition. Once you have
regained yours in nursing, you will begin to develop faith in the future of your career and
see all obstacles as surmountable challenges.

· Commitment
Ø When you look up the definition of commitment, you’ll see it concerns a pledge or a
promise, an obligation to something. The definition that describes commitment is dedication.

Ø Healthcare, whatever area you are in, is not a career upon which you can or should
embark unless you are dedicated to it. There is an everyday challenge of providing a
service where your actions directly affect a person’s life. Commitment is:

o Awareness of the challenges ahead and working to overcome these for the sake of your
patient and your team

o Accepting that your social life may, at times, be secondary to the needs of your patients

o Maintaining your own health to be the very best role model

o Exhibiting a willingness to learn from your co-workers

o Always striving to provide the best possible guidance and care for your patients

Ø Nursing requires you to always put the patient first. This can mean working late when
someone is sick, putting a uniform on and working nights when your friends are dressed up
and out partying, opening your Christmas presents a day late, and being shouted at by
people who are upset, scared or in pain.

Ø It also means realizing that you are an ambassador for health and, in that sense, you are
never off duty.

3. Love of People

Respect for the dignity of each person regardless of race, creed, color and gender

4. Love of Country

a. Patriotism (Civic duty, social responsibility and good governance)

b. Preservation and enrichment of the environment and culture heritage

CORE COMPETENCIES UNDER THE 11 KEY AREAS OF RESPONSIBILITIES

LEGAL BASES

Article 3 Sec.9 I of R.A. 9173/ “Philippine Nursing Act 2002”

Board shall monitor & enforce quality standards of nursing practice necessary to ensure the
maintenance of efficient, ethical and technical, moral and professional standards in the
practice of nursing taking into account the health needs of the nation.
PATIENT CARE COMPETENCIES

SAFETY AND QUALITY

o The first key area of nursing responsibility focuses on providing nursing care that is safe
and of high quality. Under this key area, core competencies include demonstrating
knowledge about the health status and illness of a patient; making appropriate decisions
when caring for patients and their families; and ensuring patient safety, privacy and
comfort. Competencies also include setting appropriate priorities in patient care, working
with the medical team to ensure stability of care, effectively administering medications and
other treatment modalities and performing assessments and nursing services against a
background of established nursing guidelines. The nurse also works with the medical team
and patient’s family to develop a plan of care. Identifying the goals of care and evaluating
progress toward those goals are also core competencies within this key area.

CORE COMPETENCY 1:
Demonstrate knowledge based on health/illness status of individual/ groups

Indicators :
○ Identifies health needs of patients/groups
○ Explains patient/group status

You must have an in- depth knowledge regarding the diseases; their pathology; onset,
manifestation and management. So that you can identify manifesting signs and symptoms of
your patient. In this competency, you must be equipped with the fundamentals of nursing for it
serves as foundation for you to distinguish whether what you see from your clients is normal or
considered deficiency. That includes your knowledge as regards anatomy and physiology.

CORE COMPETENCY 2:
Provides sound decision making in care of individual/groups considering their beliefs,
values

Indicators :
○ Problem identification
○ Data gathering related to problem
○ Data analysis
○ Selection appropriate action
○ Monitor progress of action taken

in this area, your understanding and skill in utilizing the nursing process is appreciated, from a
thorough assessment, objective and problem- focused diagnosis, SMART planning,
implementation of appropriate intervention down to significant evaluation.

CORE COMPETENCY 3:
Promotes patient safety and comfort
Indicators :
○ Performs age-specific safety measures and comfort measure in all aspects of patient care

CORE COMPETENCY 4:
Priority setting in nursing care based on patients’ needs

Indicators :
○ Identifies priority needs of patients
○ Analysis of patients’ needs
○ Determine appropriate nursing care to be provided

CORE COMPETENCY 5:
Ensures continuity of care

Indicators :
○ Refers identified problems to appropriate individuals/ agencies
○ Establish means of providing continuous patient care

CORE COMPETENCY 6:
Administers medications and other health therapeutics

Indicators :
○ Conforms to the 10 golden rules in medication administration and health therapeutics

CORE COMPETENCY 7:
Utilizes nursing process as framework for nursing. Performs comprehensive, systematic
nursing assessment

Indicators :
○ Obtains consent
○ Complete appropriate assessment forms
○ Performs effective assessment techniques
○ Obtains comprehensive client information
○ Maintains privacy and confidentiality
○ Identifies health needs

CORE COMPETENCY 8:
Formulates care plan in collaboration with patients, other health team members
Indicators :
○ Includes patients, family in care planning
○ States expected outcomes in nursing interventions
○ Develops comprehensive patient care plan
○ Accomplishes patient centered discharge plan

CORE COMPETENCY 9:
Implements NCP to achieve identified outcomes

Indicators :
○ Explain interventions to patient, family before carrying them out
○ Implement safe, comfortable nursing interventions
○ Acts according to client’s health conditions, needs
○ Performs nursing interventions effectively and in timely manner

CORE COMPETENCY 10:

Implements NCP progress toward expected outcomes

Indicators :
○ Monitors effectiveness of nursing interventions
○ Revises care plan PRN

CORE COMPETENCY 11:

Responds to urgency of patient’s condition

Indicators :
○ Identifies sudden changes in patient’s health conditions
○ Implements immediate, appropriate interventions

COMMUNICATION

o In this key area, core competencies include establishing communication with the patient
and treatment team, learning to read verbal and nonverbal cues, using visual aids and other
resources when necessary, responding to patient and group needs and effectively using
technology to facilitate communication.

CORE COMPETENCY 1:
Establishes rapport with patients, significant others and members of the health team.
Indicators:
○ Creates trust and confidence
○ Listens attentively to client’s queries and requests
○ Spends time with the client to facilitate conversation that allows client to express concern

CORE COMPETENCY 2:
Identifies verbal and non-verbal cues

Indicator:
○ Interprets and validates client’s body language and facial expression

CORE COMPETENCY 3:
Utilizes formal and informal channels

Indicator:
○ Makes use of available visual aids

CORE COMPETENCY 4:
Responds to needs of individuals, family, group and community

Indicator:
○ Provides re- assurance through therapeutic, touch, warmth and comforting words of
encouragement
○ Readily smiles

CORE COMPETENCY 5:
Uses appropriate information technology to facilitate communication

Indicator:
○ Utilizes telephone, mobile phone, email and internet, and informatics
○ Identifies a significant other so that follow up care can be obtained
○ Provides “holding” or emergency numbers of services

HEALTH EDUCATION
o Educational core competencies include assessing the educational needs of the patient and
family, developing and implementing health education plans and learning materials and
evaluating the outcome of education administered.

CORE COMPETENCY 1:
Assesses the learning needs of the patient and the family

Indicators:
○ Obtains learning information through interview, observation and validation
○ Defines relevant information
○ Completes assessment records appropriately
○ Identify priority needs

CORE COMPETENCY 2:
Develops Health Education plan based on assessed and anticipated needs.

Indicators:
○ Considers nature of the learner in relation to social, cultural, political, economic,
educational, and religious factor

CORE COMPETENCY 3:
Develops learning material for health education

Indicators:
○ Involves the patient, family and significant others and other resources
○ Formulates a comprehensive health educational plan with the following components ,
objectives, content and time allotment
○ Teaching-learning resources and evaluation parameters
○ Provides for feedback to finalize plan

CORE COMPETENCY 4:
Implements the health Education Plan

Indicators:
○ Provides for conducive learning situation in terms of timer and place
○ Considers client and family preparedness○ Utilize appropriate strategies
○ Provides reassuring presence through active listening, touch and facial expression and
gestures
○ Monitors client and family’s responses to health education
CORE COMPETENCY 5:
Evaluates the outcome of health Education

Indicators:
○ Utilizes evaluation parameters
○ Documents outcome of care
○ Revises health education plan when necessary

TEAMWORK

o The teamwork and collaboration key area includes core competencies of establishing
beneficial working relationships with peers and colleagues and communicating care plans
with health team members.

CORE COMPETENCY 1:
Establishes collaborative relationship with colleagues and other members of the health team

Indicators:
○ Contributes to decision making regarding patients” needs and concerns
○ Participates actively in patients care management including audit
○ Recommends appropriate intervention to improve patient care
○ Respects the role of the other members of the health team
○ Maintains good interpersonal relationships with patients, colleagues and other members
of the health team

CORE COMPETENCY 2:
Collaborates plan of care with other members of the health team

Indicator:
○ Refers patients to allied health team partners
○ Acts liaison / advocate of the patients
○ Prepares accurate documentation of efficient communication of services

ENHANCING COMPETENCIES

RESEARCH
o Core competencies in the research key area include gathering and analyzing research
data, sharing results and applying findings to work functions.

CORE COMPETENCY 1:
Gathers data using different methodologies

Indicators:

 Identifies researchable problems regarding patient care and community health

 Identifies appropriate methods of research for a particular patient/community
problem
 Combines quantitative and qualitative nursing design thru simple explanation on the
phenomena observed
 Analyzes data gathered

CORE COMPETENCY 2:
Recommends actions for implementation

Indicator:

 Based on the analysis of data gathered, recommends practical solutions appropriate

for the problem

CORE COMPETENCY 3:
Disseminates results of research findings

Indicators:

 Communicates results of findings to colleagues/patients/family and to others

 Endeavors to publish research
 Submits research findings to own agencies and others as appropriate

CORE COMPETENCY 4:
Applies research findings in nursing practice

Indicators:

 Utilizes and findings in research in the provision of nursing care to

individuals/groups/communities
 Makes use of evidence-based nursing to ameliorate nursing practice
 QUALITY IMPROVEMENT

o In the quality improvement key area, core competencies include identifying areas for
improvement, participating in nursing rounds and audits, staying aware of variances in
treatment and recommending solutions to improve quality.

CORE COMPETENCY 1:
Gathers data for quality improvement

Indicators:

 Demonstrates knowledge of method appropriate for the clinical problems identified

 Detects variation in the vital signs of the patient from day to day
 Reports necessary elements at the bedside to improve patient stay at hospital
 Solicits feedback from patient and significant others regarding care rendered

CORE COMPETENCY 2:
Participates in nursing audits and rounds

Indicators:

 Contributes relevant information about patient condition as well as unit condition and
patient current reactions
 Shares with the team current information regarding particular patients condition
 Encourages the patient to speak about what is relevant to his condition
 Documents and records all nursing care and actions
 Performs daily check of patient records/condition
 Completes patients records
 Actively contributes relevant information of patients during rounds thru readings and
sharing with others

CORE COMPETENCY 3:
Identifies and reports variances

Indicators:

 Documents observed variance regarding patient care and submits to appropriate

group within 24 hours
 Identifies actual and potential variance to patient care
 Reports actual and potential variance to patient care
 Submits report to appropriate groups within 24 hours
CORE COMPETENCY 4:
Recommends solutions to identified problems

Indicators:

 Gives appropriate suggestions on corrective and preventive measures

 Communicates and discusses with appropriate groups
 Gives and objective and accurate report on what was observed rather than an
interpretation of the event.

EMPOWERING
COMPETENCIES

LEGAL RESPONSIBILITIES

o Core competencies in the legal key area include following legally mandated state and
federal processes and procedures, such as obtaining informed consent from patients and
adequately documenting all procedures performed for patients.

CORE COMPETENCY 1:
Adheres to practices in accordance with the nursing law and other relevant legislation
including contract and informed consent.

Indicators:
○ Fulfill legal requirements in Nursing Practice
○ Holds current professional license
○ Acts in accordance with the terms of contract of employment and other rules and
regulation
○ Complies with the required CPE
○ Confirms information given by the doctor for informed consent
○ Secures waiver of responsibility for refusal to undergo treatment or procedures
○ Check the completeness of informed consent and other legal forms

CORE COMPETENCY 2:
Adheres to organizational policies and procedures, local and national

Indicators:
○ Articulates the vision and mission of the institution where one belongs
○ Acts in accordance with the established norms and conduct of the institution/ organization
CORE COMPETENCY 3:
Document care rendered to patients.

Indicators:
○ Utilizes appropriate patient care records and reports
○ Accomplish accurate documentation in all matters concerning patient care in accordance
with the standard of nursing practice.

ETHICAL RESPONSIBILITIES

o In this key area that concerns morals and ethics, core competencies include respecting the
rights of all individuals and groups, accepting responsibility for individual decisions and
adhering to the nurses’ national and international code of ethics.

CORE COMPETENCY 1:
Respects the rights of individual/ groups

Indicator:
○ Renders nursing care consistent with the patient’s bill of rights (ie. Confidentiality of
information, privacy, etc.)

CORE COMPETENCY 2
Accepts responsibility & accountability for own decisions and actions

Indicators:
○ Meets nursing accountability requirements as embodied in the job description
○ Justifies basis for nursing actions and judgment
○ Protects a positive image of the profession

CORE COMPETENCY 3
Adheres to the national and international code of ethics for nurses

Indicators:
○ Adheres to the Code of Ethics for Nurses and abides by its provisions
○ Reports unethical and immoral incidents to proper authorities

PROFESSIONAL DEVELOPMENT
o The professional development key area includes core competencies of identifying
personal needs for education and pursuing those goals, participating in professional
organizations and community activities, presenting a professional image and positive
attitude as well as performing work duties in a professional manner.

CORE COMPETENCY 1
Identifies own learning needs

Indicators:
○ Verbalizes strengths, weaknesses, limitations.
○ Determines personal and professional goals and aspirations.

CORE COMPETENCY 2
Pursues continuing education

Indicators:
○ Participates in formal and non-formal education.
○ Applies learned information for the improvement of care.

CORE COMPETENCY 3
Gets involved in professional organizations and civic activities

Indicators:
○ Participates actively in professional, social, civic and religious activities
○ Maintain membership to professional organizations
○ Support activities related to nursing and health issues

CORE COMPETENCY 4
Projects a professional image of nurse

Indicators:
○ Demonstrate good manners and right conduct at all times.
○ Dresses appropriately.
○ Demonstrates congruence of words and actions.
○ Behaves appropriately at all times.
CORE COMPETENCY 5
Possesses positive attitude towards change and criticism
Indicators:
○ Listens to suggestions and recommendations.
○ Tries new strategies or approaches.
○ Adapts to changes willingly.

CORE COMPETENCY 6
Performs function according to professional standards

Indicators:
○ Assesses own performance against standards of practice.
○ Sets attainable objectives to enhance nursing knowledge and skills.
○ Explains current nursing practices, when situations call for it.

ENABLING COMPETENCIES

RESOURCES AND ENVIRONMENT

o The next key area is the management of resources and environment. Core competencies
in this area include identifying tasks that need to be completed, developing financially
effective programs, ensuring that equipment performs adequately and maintaining safety in
the environment.

CORE COMPETENCY 1:
Organizes workload to facilitate patient care

Indicators:
○ Identifies task or activities that need to be accomplished
○ Plans the performance of task or activities based on priority
○ Finishes work assignment on time

CORE COMPETENCY 2:
Utilizes resources to support patient care

Indicators:
○ Determines the resources needed to deliver patient care
○ Control the use of equipment

CORE COMPETENCY 3:
Ensures the functioning of resources

Indicators:
○ Check proper functioning of the equipment
○ Refers Malfunctioning equipment to appropriate unit

CORE COMPETENCY 4:
Check the Proper functioning of the Equipment

Indicators:
○ Determines the task and procedures that can be safely assigned to the other members of
the team
○ Verifies the competence of the staff prior to delegating tasks

CORE COMPETENCY 5:
Maintains safe Environment

Indicators:
○ Observe proper disposal of waste
○ Adheres to policies, procedures and protocols on prevention and control of infection
○ Defines steps to follow in case of fire , earthquake and other emergency situation

RECORDS MANAGEMENT

o The records management key area includes core competencies of maintaining

appropriate documentation using the appropriate system and staying within legal
boundaries in the area of patient privacy.

CORE COMPETENCY 1:
Maintains accurate and updated documentation of patient care

Indicator:

 Completes updated documentation of patient care

CORE COMPETENCY 2:
Records outcome of patient care

Indicator:

 Utilizes a record system

CORE COMPETENCY 3:
Observes legal imperatives in recording keeping

Indicators:

 Observes confidentially and privacy of patient’s records

 Maintains an organized system of filing and keeping patient’s records in a
designated area
 Refrains from releasing records and other information without proper authority