Misaki S.

Mukaijo

Reviewer in Theoretical Foundations in Nursing

I. Introduction to Nursing
1. Metaparadigm of Nursing
Metaparadigm is a set of theories or ideas that provide structure for how a discipline should function.
a. Human (person)- patient or the receiver of the care.This may also include the family and friends
of the patient
b. Health- environment includes both internal and external factors related to the patient. This may
include the interactions patients have with visitors as well as their surroundings.
c. Environment- the quality and wellness of the patient. It also includes the access the patient has
to health care.
d. Nursing- refers to the nurse and how he or she will apply their knowledge and skills when caring
for patients. It also refers to the attributes of the nurse who is providing the care.
II. Nursing Theorists
1. FLORENCE NIGHTINGALE- ENVIRONMENTAL THEORY (p.50)
a. Major concepts and definition
b. Five essential components of environmental health
1. Pure air- proper ventilation is Nightingale’s greatest concern for the patient’s
environment
2. Pure water- bathing patients on a frequent, or even a daily basis
3. Efficient drainage- appropriate handling and disposal of bodily excretions and sewage to
prevent contamination
4. Cleanliness- dirty environment is a source of infection through the organic matter it
contained
5. Light- direct sunlight as a particular needs of patients; nurse must expose patients to
direct sunlight
c. Major assumptions
1. Nursing- every woman ,at one time in life would be a nurse, being responsible for
someone else’s life.
2. Person- patient; nurses perform tasks to and for the patient environment to enhance
recovery
3. Health- being well and using every power (resources) to the fullest extent in living life
4. Environment- nursing was to assist nature in healing the patient
d. Theoretical assertions
● Disease is a reparative process-- repair or to make amends in the violation of nature
● Nurses must prevent the interruption and help bring back the patient’s optimal conditions
● People desired good health, that they would cooperate with the nurse and nature to to
allow the reparative process, and that they would alter the environment to prevent disease

2. BETTY NEUMAN- SYSTEMS MODEL (p. 231)

a. Major concepts and definition
● Wholistic approach- Neuman’s system model is a dynamic, open, systems approach to
client care originally developed to provide a unifying focus for defining nursing problems
for understanding the client in interaction with the environment
● Open system- there is a continuous flow of input and process, output, and feedback
● Stability- dynamic and desirable state of balance in which energy exchanges can take
place without disruption of the characteristic of the system
 ●Environment- consist of internal and external forces and created environment
surrounding the client
● Client system- consists of five variables in interaction with the environment
● Stressors- tension producing stimuli that have the potential to abrupt the stability
● Prevention as intervention- interventions are purposeful actions to help the client retain,
attain, and maintain system stability
b. Major assumptions
1. Nursing- a unique profession that it is concerned with all of the variables affecting an
individual’s response to stress
2. Human beings- open client system in reciprocal interaction with the environment; may
be an individual, family, group, community or social issue
3. Health- optimal wellness or stability indicates the total system needs are being met
4. Environment- all the internal and external factors that surround and influence the client
system
c. Theoretical assertions
● Nurse is an active participant with the client and as concerned with all the variables
affecting an individual’s response to stressors
● The client is in a reciprocal relationship with the environment by adjusting himself to it
d. Five variables in the client system
1. Physiological variable- body structure and function
2. Psychological variable- mental processes
3. Sociocultural variable- effects and influence of social and cultural conditions
4. Developmental variable- age-related processes and activities
5. Spiritual variable- spiritual beliefs and influences
e. Three levels of nursing intervention
1. Primary prevention- reduce possibility of encounter with stressors; e.g. vaccination
2. Secondary prevention- early case-finding; treatment of symptoms
3. Tertiary prevention- readaptation, reeducation to prevent future occurrences;
maintenance of stability
3. VIRGINIA HENDERSON- THE NEED THEORY (p. 14)
a. Three levels of nurse-patient relationship in which the nurse acts
1. Substitute for the patient
2. Helper to the patient
3. Partner with the patient
b. Henderson’s fourteen (14) needs
● 1-9 physical components
● 10 & 14- psychological component
● 11- spiritual component
● 12-13- sociological component
c. Metaparadigm
1. Person- have basic needs that are component of health and require assistance to achieve
health and independence or a peaceful death
2. Environment- maintaining a supportive environment conducive for health is one of the
elements of her 14 activities for client assistance
3. Health- balance in all realms of human life; equated with the independence or ability to
perform activities without any aid in the 14 components or basic human needs

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 4. Nursing- the unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery that he would
perform unaided if he had the necessary strength, will or knowledge

4. IMOGENE KING- GOAL ATTAINMENT THEORY (p.213)

a. Major Concepts and Definitions
● Health- dynamic life experiences which implies continuous adjustment to stressors
● Nursing- defined as process of action, reaction, and interaction whereby nurse and client
share information about their perceptions in the nursing situation
● Self- composite of thoughts and feelings which constitute a person’s awareness of his
individual existence
b. Theoretical Assertions
● Focused on the interpersonal system and the interaction , specifically in the nurse-patient
relationship
● Nurse-patient interaction process that lead to goal attainment
c. Major Assumptions
1. Nursing- the goal of nursing is to help individuals maintain their health so they can
function in their roles
2. Person- individuals differ in their needs, wants, and goals
3. Health- dynamic state in the life cycle, whereas illness interferes with that process
4. Environment- an understanding of the ways human beings interact with their
environment to maintain health was essential for nurses

5. FAYE GLENN ABDELLAH- TWENTY-ONE NURSING PROBLEMS (p.15)

a. Categories of Twenty-one nursing problems
1. Basic needs- nos. 1-4; physiological needs and prevention
2. Sustenal care needs- nos. 5-11; maintenance
3. Remedial care needs- nos. 12-18; communication and emotions
4. Restorative care needs- 19-21; goal achievement and problem solving

6. JEAN WATSON- TRANSPERSONAL CARING THEORY (p. 66)

a. Major Concepts & Definitions
● The theory is focused on the centrality of human caring and on the caring-to-caring
transpersonal relationship and its healing potential for both the one who is caring and the
one who is being cared for.
b. Carative Factors and Caritas Processes
● Each carative factor and the clinical caritas processes describe how a patient attains
health or dies peacefully.
c. Major Assumptions
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 the patient as he or she is now, as well as what he or she may
become.
5. A caring environment is one that offers the development of potential while allowing the
patient to choose the best action for him or herself at a given point in time.
6. A science of caring is complementary to the science of curing.

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 7. The practice of caring is central to nursing.
d. Theoretical Assertions
1. Nursing- nurse is both a noun and a verb; consists of knowledge, thought, values,
philosophy, commitment, and action with some degree of passion
2. Person- unity of mind /body/spirit/nature
3. Health- the positive state of physical, mental, and social well-being with the inclusion of
three elements: (1) a high level of overall physical, mental, and social functioning; (2) a
general adaptive-maintenance level of daily-functioning; (3) the absence of illness
(WHO)
- Unity and harmony with the body, mind, and soul
4. Environment- nurse’s role in the environment to attend to supportive, protective and/or
corrective holistic environment

7. HILDEGARD PEPLAU- THEORY OF INTERPERSONAL RELATIONS (p. 12)

a. Four Phases of the therapeutic nurse-patient relationship
1. Orientation- nurse and patient are strangers to each other; defining the problem
2. Identification- selection of professional assistance
3. Exploitation- Use of professional assistance for problem solving alternatives
4. Resolution- termination of professional relationships; evaluation of nursing process
b. Interpersonal Theory and Nursing Process
● Nurse-patient relationship is a significant therapeutic interpersonal process
● Emphasized the nurse-client relationship as the foundation of nursing

8. DOROTHEA OREM- SELF-CARE DEFICIT IN NURSING THEORY (SCDNT) (p. 198)

a. Major Concepts & Definitions
● Self-care- human regulatory function that individuals must, with deliberation, perform
themselves or must have performed for them to maintain, life, health, development, and
well-being
● Dependent-care- care provided to a person who is unable to perform the self care-needed
● Self care deficit expresses the relationship between the action capabilities of individuals
and their demands for care.
b. Major Nursing Assumptions
● Theory of self-care- includes self-care, which is the practice of activities that an
individual initiates and performs on his or her own behalf to maintain life, health, and
well-being
● Theory of nursing systems- describes how the patient’s self-care needs will be met by
the nurse, the patient, or by both.
● Theory of Self-Care Deficit- a client requires nursing due to health-related or health
care-related action limitations
● Theory of Dependent-Care- explains how the self-care system is modified when it is
directed toward a person who is socially dependent and neets assistance in meeting his
self-care requisites

c. What is the condition that indicates that a person needs nursing care?
- The starting point for the development of SCDNT. Orem noted that it was the inability of
persons to maintain their own care or the care of dependents.

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9. IDA JEAN ORLANDO- THE NURSING PROCESS (p.22)
a. The Nursing Process (ADPIE)
1. Assessment- the first step and involves critical thinking skills and data collection;
subjective and objective.
- Subjective data involves verbal statements from the patient or caregiver.
- Objective data is measurable, tangible data such as vital signs, intake and
output, and height and weight.
2. Diagnosis- the formulation of a nursing diagnosis by employing clinical judgment assists
in the planning and implementation of patient care
- The North American Nursing Diagnosis Association (NANDA) provides nurses
with an up to date list of nursing diagnoses
3. Planning- where goals and outcomes are formulated that directly impact patient care
based on EDP guidelines. These patient-specific goals and the attainment of such assist in
ensuring a positive outcome
4. Implementation- involves action or doing and the actual carrying out of nursing
interventions outlined in the plan of care
5. Evaluation- final step of the nursing process is vital to a positive patient outcome. they
must reassess or evaluate to ensure the desired outcome has been met. Reassessment may
frequently be needed depending upon overall patient condition. The plan of care may be
adapted based on new assessment data.
b. Major assumptions
1. Nursing theory stresses the reciprocal relationship between patient and nurse.
2. The professional function of nursing as finding out and meeting the patient’s immediate
need for help.

10. MARTHA ROGERS- UNITARY HUMAN BEINGS (p. 180)

a. Major Concepts & Definitions
● Humans are dynamic energy fields that are integral with the environment
● Energy field- constitutes the fundamental unit of both the living and nonliving. Infinite
and pandimensional; two fields-- human field and environment field
● Universe of open systems- holds the energy field which are infinite, open, and integral
with one another
b. Major Assumptions
1. Nursing- science and an art; exists for the care of people and the life process of people
- Science because it is empirical and lies in the phenomenon central to its focus
- Art of nursing the creative use of the science of nursing
2. Person- open system in continuous process with the open system that is the environment
(integrality)
- Unitary human being is an irreducible, indivisible, pandimensional energy field
identified by pattern and manifesting characteristics that are specific to the whole
3. Health- wellness and the absence of illness (passive health)
4. Environment- an irreducible, pandimensional energy field identified by pattern and
manifesting characteristics different from those of the parts
c. Theoretical Assertions
● Focused on unitary human environment
● Principles of change:

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 ○ Helicy- spiral development in continuous, non-repeating, and innovating
patterning
○ Resonancy- continuous change from low to high frequency
○ Integrality- reflects the unity or wholeness of humans and their environment
● Man is unified whole possessing his own integrity and manifesting characteristics more
than and different from the sum of his parts

11. JOYCE TRAVELBEE- HUMAN-TO-HUMAN RELATIONSHIP

a. Goal of Nursing is to assist an individual, family, or community to prevent or cope with
experience, with the ultimate goal being the presence of hope.
b. Human-to-human relationship Theory
● Suffering in an inevitable phenomenon in one’s life
● The nurse-patient relationship is essential to successful patient care, and this
relationship is established by an interaction process.
● Stages nurse-patients go through to achieve nurse-patient relationship
○ Original encounter- first impression by the nurse with the ill person
○ Emerging identities- nurse and patient perceive each other as uniques person
○ Empathy- the ability to share in other’s experience
○ Sympathy- the nurse has the desire to alleviate the cause of the patient’s illness
or suffering
○ Rapport- nursing actions are done to relieve the patient’ distress

12. DOROTHY JOHNSON- BEHAVIORAL SYSTEM (p. 273)

a. Major Concept & Definition
● Behavioral system- ecompasses the patterned, repetitive, and purposeful ways of
behaving. A person as a behavioral system tries to achieve stability and balance by
adjustments and adaptations to some degree of functioning.
● Subsystems of the behavioral system:
1. Attachment-affiliative subsystem- most critical, basis for social organization
2. Dependency subsystem- behavior that calls for nurturing response
3. Ingestive subsystem- what we eat; appetitive function
4. Eliminative subsystem- what we eliminate
5. Sexual subsystem- dual functions of procreation and gratification
6. Achievement subsystem- manipulation of environment to achieve a standard of
excellence
7. Aggressive-protective subsystem- protection and preservation
● Equilibrium- stabilized but more or less transitory, resting state in which the individual
is in harmony with himself and his environment
● Regulation- implies that deviations will be detected and corrected
● Tension- state of being stretched or strained and can be viewed as an end-product of a
disturbance in equilibrium
● Stressor- internal or external stimuli that produce tension and result in a degree of
instability
b. Metaparadigm in Nursing
1. Nursing- the goal is to maintain and restore the person’s behavioral system balance and
stability or to help a person achieve a more optimum level of balance and functioning

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 2. Person- a behavioral system with patterned, repetitive, and purposeful ways of behaving
that link the person with environment
3. Health- dynamic state influenced by biological, psychological, and social factors. It is
reflected by the organization, interaction, interdependence, and integration of the
subsystems of the behavioral system
4. Environment- consists of all the factors that are not part of the individual’s behavioral
system, but that influence them
c. Biological (Medicine’s Focus) versus Behavioral System (Nursing Focus)
● Human beings have to major systems: the biological and behavioral systems. The role of
medicine is to focus on the biological system, while nurse’s focus is on the behavioral
system
13. MADELEINE LENINGER- TRANSCULTURAL THEORY (p. 339)
a. Major Concepts & Definitions
● Care- expressions of assistive, supportive, enabling, and facilitating ways toward or
about self or others.
○ Generic care- culturally- learned, home-based care
○ Professional care- formally taught, learned, and transmitted professional care,
health, illness, wellness, and related knowledge and practice skills
○ Culture care- care from certain culture
● Culture- learned, shared, and transmitted values, beliefs, norms, and lifeways of a
particular culture that guide thinking, decisions, and actions in patterned ways
● Culturally congruent care- culturally-based care knowledge, acts, and decisions used in
sensitive, creative, and meaningful ways to appropriately fit the client’s health and
well-being, prevent illness, disability, and death
● Culture care diversity- variabilities or differences in culture care beliefs
● Culture care universality- commonly shared or similar culture care phenomena of
human beings
b. Major Assumptions
● Care is the essence and central dominant, distinct, and unifying focus of nursing.
● Culturally congruent and therapeutic care occurs when culture care values, beliefs,
expressions, and patterns are explicitly known and used appropriately.
● Transcultural nursing is a discipline with a body of knowledge and practices to attain
and maintain the goal of culturally congruent care for health and well-being.
● Health- giving culturally aligned health care
● Environment- cultural conflicts/differences
c. Theoretical Assertions or Tenets
1. Care diversities and universalities existed among and between cultures in the world.
2. Worldview, social structure factors such as religion, economics, education, etc would
greatly influence culture care meanings, expressions, and patterns in different cultures.
3. Both generic and professional care needs to be taught, researched, and brought together
into care practices for satisfying care for clients which leads to their health and
well-being
4. Conceptualization of three major care modes of decisions and actions to arrive at
culturally congruent care for the general health of clients.
d. Culturally Congruent Care for Health, Well-Being or Dying
● Sunrise model depicts humans are inseparable from their cultural backgrounds
● Three culture care modes of nursing decisions and actions:

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 ○ Culture care preservation/maintenance- retain and/or preserve relevant care
values
○ Culture care accommodation/negotiation- to adapt to or negotiate with others
for a beneficial or satisfying health outcome
○ Culture care repatterning/restructuring- help clients reorder, change, or
greatly modify their lifeways for new, different, and beneficial health care pattern
while respecting the clients’ cultural values and beliefs

14. CALLISTA ROY- ADAPTATION MODEL (p. 249)

a. Major Concept & Definitions
● Coping processes- innate or acquired ways of interacting with the changing environment
○ Innate coping mechanisms- genetically determined or common to the species;
automatic processes
○ Acquired coping mechanisms- developed through strategies such as learning
b. Major Assumptions
1. Nursing- health care profession that focuses on human life processes and patterns and
emphasizes health promotion of health
2. Person- an adaptive system, a whole with parts that function for some purpose
3. Health- state and a process of being and becoming integrated and whole person;
reflection of adaptation
4. Environment- all the conditions, circumstances, and influences surrounding and
affecting the person
c. Theoretical Assertions
● A person continually experiences stimuli, adaptation occurs when a response is made
which may either be adaptive or an ineffective response
○ Adaptive response- promotes integrity and help the person to achieve the goals
○ Ineffective response- fails to achieve or threaten the goals of adaptation
d. Roy’s category of coping processes:
● Physiological-physical mode- basic needs: oxygenation, nutrition, elimination, activity
and rest protection
● Self-concept-group identity mode- the need to know who one is and how to act in
society
● Role-function mode- role of a person in the society
● Interdependence mode- interactions of people in the society
e. Cognator and regulator subsystems
● Cognator subsystem-person’s physiological coping mechanism involving the neural =,
chemical, and endocrine systems
● Regulator subsystem- mental coping mechanism; perceptual and information
processing, learning, judgment, and emotion

15. NOLA PENDER- HEALTH PROMOTION MODEL (p. 323)

a. Health Promotion Model
● Health promotion is defined as behavior motivated by the desire to increase well-being
and actualize human health potential. It is an approach to wellness.
● Health protection or illness prevention is described as behavior motivated desire to
actively avoid illness, detect it early, or maintain functioning within the constraints of
illness.

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 ● Complementary counterpart to models of health protection
● Conducted because of the smokers and alcoholics
b. Major Concepts & Definitions
● Prior related behavior- frequency of the same behavior in the past
● Personal factors- predictive of a given behavior and are shaped by the nature of the
target behavior being considered
○ Personal biological factors- age, gender, BMI, pubertal status, etc
○ Personal psychological factors- self-esteem, self-motivation, personal
competence, perceived health status, and definition of health
○ Personal socio-cultural factors- race, ethnicity, acculturation, education, and
socioeconomic status
● Behavioral-specific cognitions and affects
○ Perceived benefits of action- anticipation of positive outcome
○ Perceived barriers to action- blocks and personal costs of a given behavior
○ Perceived self-efficacy-judgment of personal capability to organize and execute
a health-promoting behavior
○ Activity-Related Affect- subjective positive or negative feeling that occurs
before, during and following behavior based on the stimulus properties of the
behavior itself.
○ Interpersonal Influences- cognition concerning behaviors, beliefs, or attitudes
of others.
○ Situational Influences- Personal perceptions and cognitions of any given
situation or context that can facilitate or impede behavior.
c. Major Assumptions
● Individuals seek to actively regulate their own behavior.
● Individuals in all their biopsychosocial complexity interact with the environment,
progressively transforming the environment and being transformed over time.
● Health professionals constitute a part of the interpersonal environment, which exerts
influence on persons throughout their life span.
● Self-initiated reconfiguration of person-environment interactive patterns is essential to
behavior change.
d. Fourteen Theoretical Assertions
1. Prior behavior and inherited and acquired characteristics influence beliefs, affect, and
enactment of health-promoting behavior.
2. Persons commit to engaging in behaviors from which they anticipate deriving personally
valued benefits.
3. Perceived barriers can constrain commitment to action, a mediator of behavior as well as
actual behavior.
4. Perceived competence or self-efficacy to execute a given behavior increases the
likelihood of commitment to action and actual performance of the behavior.
5. Greater perceived self-efficacy results in fewer perceived barriers to a specific health
behavior.
6. Positive affect toward a behavior results in greater perceived self-efficacy, which can, in
turn, result in increased positive affect.
7. When positive emotions or affect are associated with a behavior, the probability of
commitment and action is increased.
8. Persons are more likely to commit to and engage in health-promoting behaviors when
significant others model the behavior, expect the behavior to occur, and provide
assistance and support to enable the behavior.

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9. Families, peers, and health care providers are important sources of interpersonal influence
that can increase or decrease commitment to and engagement in health-promoting
behavior.
10. Situational influences in the external environment can increase or decrease commitment
to or participation in health-promoting behavior.
11. The greater the commitments to a specific plan of action, the more likely
health-promoting behaviors are to be maintained over time.
12. Commitment to a plan of action is less likely to result in the desired behavior when
competing demands over which persons have little control require immediate attention.
13. Commitment to a plan of action is less likely to result in the desired behavior when other
actions are more attractive and thus preferred over the target behavior.
14. Persons can modify cognitions, affect, and the interpersonal and physical environment to
create incentives for health actions.