SYSTEM, DEVELOPMENTAL, MODELS & THEORIES
THEORETICAL FOUNDATIONS OF NURSING
NCM 100 | FINALS
SYSTEM THEORIES
IMOGENE KING
INTERACTING SYSTEMS FRAMEWORK &
GOAL ATTAINMENT THEORY
● Concepts & Definitions
● Metaparadigms – its definitions
FAYE GLENN ADBELLAH
21 NURSING PROBLEMS
● Metaparadigms – its definitions
● Concepts & Definitions – especially the
21 nursing problems & its categories
DOROTHEA OREM
SELF-CARE DEFICIT NURSING THEORY
(SCDNT)
● Metaparadigms – its definition
● Concepts & Definitions – as outlined
DEVELOPMENTAL THEORIES
SR. CALLISTA ROY
ADAPTATION MODEL
● Metaparadigms – its definitions
● Key Concepts & definitions
● 4 Adaptive Modes
● Nursing Process & its steps
MADELEINE LEININGER
TRANSCULTURAL NURSING THEORY OR
CULTURE CARE OR CULTURE CARE
DIVERSITY & UNIVERSALITY
● Metaparadigms – its definitions
● Difference Diversity & Universality
● Cultural Dimensions
MARGARET JEAN WATSON
THE PHILOSOPHY &
SCIENCE OF NURSING
● Metaparadigms – its definitions
● Major elements – carative factors
(clinical caritas processes),
transpersonal caring relationship, caring
occasion
● 7 Assumptions in the Science of Caring
PATRICIA BENNER
THE NURSING EXPERTISE MODEL / SKILL
ACQUISITION IN NURSING: FROM NOVICE
TO EXPERT
● Metaparadigms – its definitions
● Concepts & Definitions
● Levels of Nursing Practice – novice,
advance beginner, competent, proficient,
expert
● 7 Domains of Nursing Practice
OTHER CONCEPTUAL
MODELS & THEORIES
IDA JEAN ORLANDO
DELIBERATIVE NURSING PROCESS
● Metaparadigms – its definitions
● Main concept & definitions
● Sub-concepts of the Deliberative
Nursing Process
● 5 Stages of the Deliberative Nursing
Process
LYDIA HALL
CORE, CARE, CURE MODEL
● Metaparadigms – its definitions
● Concepts & Definitions – Core, Care, ● Concepts & Definitions
Cure
DR. ROZZANO LOCSIN
NOLA PENDER
TECHNOLOGICAL COMPETENCY AS
HEALTH PROMOTION MODEL (HPM) CARING IN NURSING MODEL

● Metaparadigms – its definitions DR. CARMELITA DIVINAGRACIA

● Main Concept & Definitions
● Health Promotion vs Health Protection COMPOSURE MODEL
● 10 Determinants of Health Promoting
CECILIA LAURENTE
Behavior
THEORY OF NURSING PRACTICE &
MYRA LEVINE
CAREER
CONSERVATION MODEL
● Concepts & Definitions
● Metaparadigms – its definitions
● 4 Principles of Conservation – energy,
structural integrity, personal integrity &
social integrity
● Concepts, sub-concepts & assumptions

LOCAL NURSING THEORIES

SR. LETTY KUAN

RETIREMENT & ROLE DISCONTINUITY

MODEL

● Metaparadigms
● Concepts & Definitions – refer to the
diagram

DR. CARMENCITA ABAQUIN

PREPARE ME: HOLISTIC NURSING

INTERVENTION

● Metaparadigms
● Concepts & Definitions – refer to the
diagram

SR. CAROLINA AGRAVANTE

CASAGRA TRANSFORMATIVE
LEADERSHIP MODEL

● Metaparadigm

SYSTEM THEORIES
IMOGENE KING
(1971, 1981)
“If students can’t do the Fundamentals, how
can they use advanced knowledge?”
“Nursing is an observable behavior found in
the health care system in society that aims
to help individuals maintain their health so
they can function in their roles.”
IMOGENE KING
WHO IS SHE?
● 1945, earned her diploma at St. John’s
Hospital in St. Louis Missouri.
● 1947-1958, she worked as an Instructor
in MedicalSurgical nursing as an
assistant director at St. John’s Hospital
of Nursing.
● 1957, earned her MSN from St. Louis
University and
● 1961, as a Doctor of Education from
Teachers College, Columbia University.
● 1961-1966, she was an Associate
Professor of Nursing at Loyola
University in Chicago where she
developed a Master’s degree program in
Nursing based on a nursing conceptual
framework.
● 1964, her first theory article appeared in
the Nursing Science edited by Dr.
Martha Rogers.
● 1968, published a nursing research
about “A Conceptual Frame of
Reference for Nursing”.
● 1968-1972, she was the director of the
school of Nursing at Ohio State
University in Columbus.
● 1981, her manuscript for her second
book “A Theory for Nursing: Systems,
Concepts, Process” was published.
● Founding member, the King
International Nursing Group (KING).
METAPARADIGM IN NURSING
OF IMOGENE KING
PERSON
● Exists in an open system as a spiritual
being and rational thinker.
● They make choices, select alternative
courses of action.
● Has the ability to record their history
through their own language and
symbols, unique, holistic and have
different needs, wants and goals.
HEALTH
● The ability of a person to adjust to the
stressors that the internal and
external environment exposes to the
client.
● It is the maximal use of the potentials
that a person can perform to achieve
balance in one's health.
ENVIRONMENT
● Personal, interpersonal and social.
● The process of balance involves internal
and external interactions inside the
social system.
● It has a direct exchange of
information between the internal and
external environment.
NURSING
● An act wherein the nurse interacts and
communicates with the client.
● Nurses help clients identify existing
health conditions, exploring and
agreeing on activities to promote health.
● Goal - help clients maintain health
through health promotion &
maintenance, restoration & caring for
the sick & dying.
 ● Palliative care - aims to provide comfort
and acceptance in the situation and not
to cure the patient anymore.
THEORETICAL FRAMEWORK
INTERACTING SYSTEMS FRAMEWORK &
GOAL ATTAINMENT THEORY
PERSONAL
● How the nurse views & integrates self
based from personal goals & beliefs.
● It is composed of body image, growth
& development, perception, self,
space & time.
INTERPERSONAL
● How the nurse interrelates with a
co-worker or patient, particularly in a
nurse-patient relationship.
● It is composed of the concepts of
communication, interaction, role,
stress & transaction.
SOCIAL
● How the nurse interacts with co-workers,
superiors, subordinates & the client
environment in general.
● It is composed of the concepts of
authority, decision-making,
organization, power & status.
3 HEALTH NEEDS OF
HUMAN BEINGS
1. Need for information.
2. Need for care for illness prevention.
3. Need for total care when a person
doesn't have the capacity to help
themselves.
GOAL ATTAINMENT THEORY
MIDDLE-RANGE THEORY
● A Middle-Range Theory that is a
product of developments from the
Interacting Systems Theory.
● Mutual goal-setting between a nurse & a
client is based on:
a. Assessment of a client's
concern, problems &
disturbances in health.
b. Perceptions of interference of
both nurse & client.
c. Sharing of information of both
nurse & client - goals attained.
GOAL ATTAINMENT THEORY
● Nurses interact with family members
when clients cannot verbally participate
in the goal-setting.
● It is focused on the interpersonal
system & interactions that take place
between individuals, most specifically in
the nurse-client relationship.
INTERPERSONAL PROCESS
 5. If transactions are made in nurse-client
interactions, then growth &
development will be enhanced.
6. If role expectations & role
performance as perceived by nurse &
client are congruent, then transaction
will occur.
7. If role conflict is experienced by nurse
& client or both, then stress in
ACTION nurse-client interactions will occur.
8. If nurses with special knowledge & skill
● A means of behavior or activities that communicate appropriate information to
are towards the accomplishment of clients, then mutual goal setting &
certain acts. goal attainment will occur.
● It is both MENTAL & PHYSICAL.

REACTION IMOGENE KING

● Form of reacting or a response to a "A transaction is made when the nurse and
certain stimuli. the patient decide mutually on the goals to
● Feedback. be attained, agree on the means to attain the
goals that represent the plan of care, and
INTERACTION then implement the plan. Evaluation
determines whether or not goals were
● Any situation wherein the nurse relates
attained. If not, ask why not, and the
& deals with a clientele or patient.
process begins again.”
OPEN SYSTEM

● The absence of boundary existence,

wherein exchange of information
transpires without barriers or
hindrances.

PROPOSITIONS OF THE
GOAL ATTAINMENT THEORY

1. If perceptual accuracy is present in

the nurse-client interactions, then
transaction will occur.
2. If nurse & client make transactions,
then goals will be attained.
3. If goals are attained, then
satisfactions will occur.
4. If goals are attained, then effective
nursing care will occur.
 DOROTHEA ELIZABETH OREM
(1970, 1985)
"Individuals, families, groups and
communities need to be taught self-care.”
DOROTHEA ELIZABETH OREM
WHO IS SHE?
● Born in Baltimore, Maryland in 1914.
● One of America's foremost nursing
theorists.
● Her father was a construction worker,
mother was a homemaker and she's the
youngest of two daughters.
● 1930, began her nursing career in
Providence Hospital School of Nursing
in Washington D.C.
● 1939, received her BS in Nursing
Education from the Catholic University
of America (CUA).
● 1946, received her MS in Nursing
Education, same school.
● Early nursing experience includes:
operating room nurse, private duty nurse
(in home and hospital), pediatric and
adult medical-surgical nurse, evening
supervisor in the ER and biological
science technician.
● 1940-1949, held a directorship of both
nursing school and the department of
nursing at Providence Hospital in
Detroit.
● 1949-1957, worked for the Division of
Hospital and Institutional Services of the
Indiana State Board of Health (to
upgrade quality of nursing in general
hospitals), developed her definition of
nursing practice.
● 1958-1960, U.S. Department of Health,
Education and Welfare. Published
"Guidelines for Developing Curricula
for the Education of Practical
Nurses" (1959).
● 1959, subsequently served as acting
dean of the school of Nursing and as an
assistant professor of nursing education
at CUA
● 1984, retired and continued to develop
her theory.
METAPARADIGM IN NURSING
OF DOROTHEA ELIZABETH OREM
PERSON
● An individual with physical and
emotional requirements for development
of self-care and maintenance of their
well-being.
● Human can reflect upon events,
themselves and their environment.
● They can symbolize experiences that
they have been through by using words
and ideas.
● Human functioning is an integrated
system - physical, psychological,
interpersonal and social aspects.
HEALTH
● A state of physical, mental and social
well being and not merely the absence
of disease or infirmity (WHO).
● Structural and functional soundness and
wholeness of the individual.
● It is based on preventive healthcare
which includes:
1. Promotion and maintenance of health.
2. Treatment of disease or injury.
3. Prevention of complications.
ENVIRONMENT
● Client's surroundings which may affect
their ability to perform their self-care
activities.
NURSING
● Helping clients to establish or identify
ways to perform self-care activities.
● Nursing actions are geared towards the
independence of the client.
● It is human service, since its focus is on
persons with inabilities (disabilities) to
maintain continuous provision of
healthcare.
● It is also based on values.
SELF-CARE DEFICIT
NURSING THEORY (SCDNT)
● It addresses client's self-care needs.
● It is a goal-oriented activities that is set
towards generating interest on the part
of the client to maintain life and health
development.
● It aims towards making clients perform
self-care activities in order to live
independently.
THEORETICAL FRAMEWORK
MAJOR CONCEPTS OF
DOROTHEA ELIZABETH OREM
INTERRELATED THEORIES
● The model is a constellation of three
(3) interrelated theories:
1. Theory of Self-Care
2. Theory of Self-Care Deficit
3. Theory of Nursing Systems
3 THEORIES OF
DOROTHEA ELIZABETH OREM
THEORY OF SELF-CARE
● Individuals can take responsibility for
their health and the health of others.
● Individuals have the capacity to care for
themselves or their dependents.
● Based on the philosophy "patients wish
to care for themselves."
SELF-CARE Practice of activities that
individuals initiate and perform
independently on their behalf
in maintaining life, health and
well-being.
SELF-CARE Is a human ability which is the
AGENCY "ability for engaging in
self-care activities"-
conditioned by age,
developmental state, life
experience, sociocultural
orientation, health and
available resources.
THERAPEUTIC "Totality of self-care actions to
SELF-CARE be performed for some
DEMAND duration in order to meet
self-care requisites by using
valid methods and related sets
of operations and actions."
SELF-CARE Actions directed towards
REQUISITES provision of self-care. There
are three (3) categories:
(a) universal
(b) developmental
(c) health deviation.
SELF-CARE REQUISITES
UNIVERSAL Needs all people have
SELF-CARE which are essential to
REQUISITES health and vitality. It
includes: air, water, food,
elimination, activity and
rest, solitude and social
interactions, prevention of
harm and promotion of
normality.
DEVELOPMENTAL needs that relate to the
SELF-CARE development of the
REQUISITES individual. These include
the interventions and
teachings designed to
return a person to or
sustain a level of optimal
health and well-being.
Examples: toilet training a
child or learning healthy
eating.
HEALTH Needs that arise as a
DEVIATION result of a patient's
REQUISITES condition. It encompasses
the variations in self-care
which may occur as a
result of disability, illness
or injury.
3 THEORIES OF
DOROTHEA ELIZABETH OREM
COMPENSATORY
THEORY OF SELF-CARE DEFICIT
DEPENDENT Individuals who takes full
CARE responsibility of taking care of
AGENCY a person who is incapable of
providing care for themselves
or those who are living
dependent on others' aid.
3 THEORIES OF
DOROTHEA ELIZABETH OREM
THEORY OF NURSING SYSTEMS
● The ability of the nurse to aid the person
in meeting current and potential self-care
demands.
● Three (3) support or system
modalities are identified:
WHOLLY Client unable to
do for themselves. Total
SYSTEM nurse care.

● The individual is unable to meet his own PARTIALLY Involves both the
COMPENSATORY nurse and the client
self-care requisites.
SYSTEM sharing in the self-care
● Professional nurse has the duty and requirements.
obligation to recognize and identify such
deficits in order to define a support SUPPORTIVE- Client has primary
modality or intervention. EDUCATIVE responsibility for personal
● Nurses are to rate their patient's SYSTEM health, with nurse
acting as consultant.
dependencies or each of the self-care
deficits on the following scale: NURSE’S ROLES Advocate, redirector,
a. total compensation support person
b. partial compensation and teacher and provide an
c. educative/ supportive environment
● Orem identified five (5) methods of conducive to therapeutic
development.
helping:
1. acting for and doing for others. NURSING A set of established
2. guiding others. AGENCY capabilities
3. supporting another. of a nurse who can
4. providing an environment to legitimately perform
promote the patient's ability. activities
of care for a client. It helps
5. teaching another.
a person achieve their
health care demand.
AGENT The individual who is engaged
in meeting the needs of a NURSING Are professional functions
person. They are like bridges DESIGN that
that facilitates what has been must be performed by the
done and what needs to be nurse in order to meet
done.
 clients need. It serves as a
guideline of needed and
foreseen results.
because I could do all I wanted to in nursing,
DOROTHEA ELIZABETH OREM
“Nursing is a helping profession of assisting
patients overcome or
compensate for their health-associated
limitations and engaging in actions to
regulate their
own functioning and development or that of
their dependents.”
FAYE GLENN ABDELLAH
(1960)
“I never wanted to be a medical doctor
which is a caring profession.”
FAYE GLENN ABDELLAH
WHO IS SHE?
● Born in March 13, 1919 in New York
City.
● 1942, finished her basic nursing
education at
● Fitkin Memorial Hospital School of
Nursing as
● Magna Cum Laude.
● 1945, obtained her Bachelor’s degree.
● 1947, obtained her Master of Arts in
Nursing.
● 1955, her Doctor of Education at the
Teacher’s
● College at Columbia University.
● First woman nurse to serve as Deputy
Surgeon
● General of the US.
● 2000, inducted into the US National
Women’s
● Hall of Fame.
● Fellow, American Academy of Nursing.
● Formulated the “The 21 Nursing
Problem Model”
- described the “areas of nursing”
- distinguished nursing from practice of
medicine
- focus of the theory is patient- centered
- approach and beyond
METAPARADIGM IN NURSING
OF FAYE GLENN ABDELLAH
PERSON
● Defined as beneficiary of care.
 ● Viewed as a holistic being composed of
physical, psychological, sociological and
spiritual concepts.
HEALTH
● Center and purpose of nursing services.
● Is affected by age, culture, intellectual
capacities and emotional balance.
ENVIRONMENT
● Affects / involves in achieving optimal
health levels.
● The home or community from which the
patient comes.
NURSING
● An all inclusive service based on the
disciplines of art and science that serves
individuals to make their function as a
whole of independent.
● Broadly grouped into the 21 problem
areas to guide care and promote use of
nursing judgement.
● A helping profession.
● It is a model describing the “arenas” or
concerns of nursing, rather than a theory
describing relationships among
phenomena.
● In this way, the theory distinguished the
practice of nursing with focus on the 21
nursing problems, from the practice of
medicine, with focus on disease and
cure.
● Three (3) major categories:
a) Physical sociological & emotional
needs of clients
b) Types of interpersonal
relationships between the nurse &
patient
c) Common elements of client care
● Classifications of the 21 Nursing
Problems (Handouts)
TYPOLOGY OF 21 NURSING PROBLEMS
FAYE G. ABDELLA

TWENTY ONE NURSING PROBLEMS

“PATIENT-CENTERED APPROACHES TO
NURSING MODEL”

● Abdellah and colleagues developed a

list of 21 nursing problems.
● It has 3 chief concepts.
● Utilizing these 3 concepts, her theory
proposes that:
● “The utilization of the problem
solving techniques with chief nursing
problems related to the health
requirements of clients.”
 11 NURSING SKILLS

1. Observation of health status.

2. Communication skills.
3. Application of knowledge.
4. Teaching of patients & families.
5. Plan and organizes work.
6. Use of resource materials.
7. Use of personal resources.
8. Problem-solving.
9. Directs work of others.
10. Therapeutic use of self.
11. Nursing procedures.

NURSING PROBLEM

● A condition faced by the patient or

patient’s family that the nurse through
the performance of professional
functions can assist them to meet.
● It could be OVERT or COVERT.
● Identifying and answering overt and
TEN (10) STEPS TO IDENTIFY CLIENT’S covert nursing problems is the core of
PROBLEMS Nursing.

1. Learn to know the patient. OVERT Obvious or can be

2. Sort out relevant and significant data. seen condition.
3. Make generalizations about available
data in relation to similar nursing COVERT Unseen or masked
one.
problems presented by other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and PROBLEM SOLVING PROCESS
make additional generalizations.
6. Validate the patient’s conclusions about 1. Identifying the problem.
his nursing problems. 2. Selecting relevant data.
7. Continue to observe and evaluate the 3. Devising hypothesis.
patient over a period of time to identify 4. Testing hypothesis through assortment
any attitude and clues from affecting his of data.
behavior. 5. Revising hypothesis when necessary.
8. Explore the patient’s and family’s
reaction to the therapeutic plan and
involve them in the plan. FAYE GLENN ABDELLAH
9. Identify how the nurse feels about the
“Nursing is both an art and a science that
patient’s nursing problems.
molds the attitude, intellectual
10. Discuss and develop a comprehensive
competencies and technical skills of the
nursing care plan.
individual nurse into the desire and ability
to help people cope with their health needs,
whether they are ill or well.”
NURSING THEORISTS
& THEIR WORKS
DEVELOPMENTAL THEORIES
● Based their assumptions and
prepositions on the essence of growth
and maturation as a process of
transformation going to a state of a
particular functional competence.
● Appreciate and comprehend Man's
uniqueness for safe and effective
nursing practice.
● Each level of developmental stage must
be met to fulfill the holistic health of the
individual, failure to achieve a positive
resolution or achievement in a particular
phase would result to delay of
succeeding stage and thus alter the
level of wellness of a person.
SR. CALLISTA ROY
WHO IS SHE?
● Born on October 14, 1939 in Los
Angeles, California.
● 1963, earned her BSN degree from
Mount Saint Mary College, LA.
● 1966, Master's Degree in Pediatric
Nursing.
● 1977, Doctorate in Sociology from
University of California. Her postdoctoral
studies in Neuroscience Nursing were at
the University of California at San
Francisco.
● She is a theorist and a professor at the
William F.
● Connell School of Nursing at Boston
College.
● Fellow, American Academy of Nursing
and an active member of nursing
organizations which includes Sigma
Theta Tau and North American Nursing
Diagnosis Association (NANDA).
● 1964, her work Roy Adaptation Model
(RAM) was known.
● She had publications on nursing theory
and other professional topics to include:
(a) Introduction to Nursing: An Adaptation
Model
(b) Essentials of Roy Adaptation Model
(c) Theory of Construction in Nursing: An
Adaptation Model
(d) Roy Adaptation Model: the Definitive
Statement
METAPARADIGM IN NURSING
OF SR. CALLISTA ROY
PERSON
● A biopsychosocial being in constant
interaction with a changing environment.
● An open, adaptive system who uses
coping skills to deal with stressors.
● It includes people as individuals or in
groups (families, organization,
communities, nation and society).
HEALTH
● Is the process of being and becoming an
integrated and whole person.
● ADAPTATION - the process and
outcome whereby thinking and feeling,
as individuals and in groups, use
conscious awareness and choice to
create human and environmental
integration.
ENVIRONMENT
● Conditions, circumstances and
influences that surround and affect the
development and behaviour of a person.
● Describes stressors as "stimuli".
NURSING
 ● Science and practice that expands
adaptive abilities and enhance person
and environment transformation.
● It is about the decrease, enhancement,
modification and alteration of the
stimulus to achieve adaptation.
ENVIRONMENTAL STIMULI
FOCAL those most immediately
confronting the person, it
attracts more attention.
CONTEXTUAL all other stimuli that
strengthens the effect of the
focal stimulus.
RESIDUAL those stimuli that can affect
the focal stimulus but the
effects are unclear.
ROY’S ADAPTATION MODEL
(RAM)
KEY CONCEPTS
KEY CONCEPTS:
1. The person is adapting in a stable
interaction with the environment, either
internal or external.
2. The environment serves as the source
of a range of stimuli that will either
threaten or promote the person's unique
wholeness.
3. The person's major task is to maintain
integrity and face these environmental
stimuli.
INTEGRITY
● degree of wholeness achieved by
adapting to change in needs.
TWO TYPES OF MINDSETS
GROWTH You will always see the
MINDSET positive side of every
negative situation such as
finding opportunity. Altering or
moving the thinking mindset
from negative to positive even
if the situation is negative.
FIXED Stay in one place and always
MINDSET think that that would be the
only one and right strategy.
Even if something happens,
you would not exert effort and
get stuck in the situation
because you believe that you
cannot control it.
ADAPTATION LEVEL
● Ability to respond positively in a
situation.
● It is described as integrated,
compensatory or compromised.
● It is modulated by a person's coping
mechanism and control processes.
CATEGORIES OF COPING MECHANISMS
REGULATOR transpires through neural,
SUBSYSTEM chemical and endocrine
processes. These are
automatic responses to
stimuli. (Increase in vital signs
- sympathetic response to
stress).
COGNATOR occurs through
SUBSYSTEM cognitive-emotive processes
(effects of prolonged
hospitalization to a child).
CATEGORIES OF COPING MECHANISMS
STABILIZER the established structures,
SUBSYSTEM values, & daily activities
whereby participants
accomplish the primary
purpose of the group &
contribute to the common
purpose of society.
INNOVATOR allows the person to change to ● GOAL: Affectional Adequacy
SUBSYSTEM higher levels of potential
through cognitive & emotional
strategies.

FOUR ADAPTIVE MODES

1. Physiological Adaptive Modes

2. Self Concept/ Group Identity Adaptive
Modes
3. Role Function Adaptive Modes
4. Interdependence Adaptive Modes
NURSING PROCESS

● A problem solving approach for

FOUR ADAPTIVE MODES
OF SR. CALLISTA ROY
PHYSIOLOGICAL
● The way a person respond as a physical
being to stimuli from the environment.
● GOAL: Physiological Integrity
gathering data, identifying the capacities
& needs of the human adaptive system,
selecting & implementing approaches
for nursing care & evaluation the
outcome of care provided.
● It is goal-oriented.

SELF CONCEPT/ GROUP IDENTITY NURSING PROCESS

● Psychological & spiritual characteristics 1. Assessment of Behavior

of the person consist of all beliefs & 2. Assessment of Stimuli
feelings that one has formed about 3. Nursing Diagnosis
one-self. 4. Goal Setting
● Components includes: physical (body 5. Intervention
sensation & image) and personal self 6. Evaluation
(ideals, morals & spiritual self)
● GOAL: Psychological Integrity A.D.P.I.E.

ROLE FUNCTION ● Assessment

● Diagnosis
● A set of expectations about how a ● Planning
person occupying one's position ● Intervention
behaves towards a person occupying ● Evaluation
another position.
● GOAL: Social Integrity

INTERDEPENDENCE

● Occurs between the person & the most

significant others or between the person
and support system which result in
giving and receiving of love, respect &
value.
 ASSESSMENT

SUBJECTIVE Statement of the patient. It is

ASSESSMENT based on personal opinions
without any verifiable facts.

OBJECTIVE Assessment of the nurse. It

ASSESSMENT means making an unbiased,
balanced observation based
on facts which can be verified.
 MADELEINE LEININGER TRANSCULTURAL
(1925 - 2012) NURSING THEORY

"Care is the heart of nursing: Care is power; OR KNOWN AS

Care is essential healing; Care is curing; CULTURE CARE THEORY
and Care is the central and dominant focus
of nursing & transcultural nursing decisions ● Involves knowing and understanding
& actions." different cultures concerning nursing
and health-illness caring practices,
beliefs, and values to provide
MADELEINE LEININGER meaningful and efficacious nursing care
services to people’s cultural values and
WHO IS SHE? health-illness context.
● It focuses on the fact that different
● Born on (July 13, 1925 – August 10,
cultures have different caring behaviors
2012) was an internationally known
and different health and illness values,
educator, author, theorist, administrator,
beliefs, and patterns of behaviors.
researcher, consultant, public speaker,
● The cultural care worldview flows into
and the developer of the concept of
knowledge about individuals, families,
transcultural nursing that has a great
groups, communities, and institutions in
impact on how to deal with patients of
diverse health care systems.
different cultures and cultural
● This knowledge provides culturally
backgrounds.
specific meanings and expressions
● Her aunt, who had congenital heart
about care and health.
disease, led her to pursue a career in
● The next focus is on the generic or folk
nursing.
system, professional care system(s),
● She earned a nursing diploma from St.
and nursing care.
Anthony’s Hospital School of Nursing,
● Information about these systems
followed by undergraduate degrees at
includes the characteristics and the
Mount St. Scholastica College and
specific care features of each.
Creighton University.
● This information allows for the
● Leininger opened a psychiatric nursing
identification of similarities and
service and educational program at
differences or cultural care universality
Creighton University in Omaha,
and cultural care diversity.
Nebraska.
● Next are nursing care decisions and
● She earned the equivalent of a BSN
actions which involve cultural care
through her studies in biological
preservation/maintenance, cultural care
sciences, nursing administration,
accommodation/negotiation, and cultural
teaching, and curriculum during
care repatterning or restructuring. It is
1951-1954.
here that nursing care is delivered.
● She is a Certified Transcultural Nurse, a
Fellow of the Royal College of Nursing
in Australia, and a Fellow of the TRANSCULTURAL
American Academy of Nursing. NURSING THEORY
● Her theory is now a nursing discipline
that is an integral part of how nurses DESCRIPTION
practice in the healthcare field today.
● In 1995, Madeleine Leininger defined
transcultural nursing as “a substantive
area of study and practiced focused
on comparative cultural care (caring)
values, beliefs, and practices of
individuals or groups of similar or
different cultures to provide
culture-specific and universal
nursing care practices in promoting
health or well-being or to help people
to face unfavorable human
conditions, illness, or death in
culturally meaningful ways.”
MAJOR CONCEPTS OF
THE TRANSCULTURAL
NURSING THEORY
TRANSCULTURAL NURSING
● Defined as a learned subfield or branch
of nursing that focuses upon the
comparative study and analysis of
cultures concerning nursing and
health-illness caring practices, beliefs,
and values to provide meaningful and
efficacious nursing care services to their
cultural values and health-illness
context.
ETHNONURSING
● This is the study of nursing care beliefs,
values, and practices as cognitively
perceived and known by a designated
culture through their direct experience,
beliefs, and value system.
NURSING
● Defined as a learned humanistic and
scientific profession and discipline which
is focused on human care phenomena
and activities to assist, support,
facilitate, or enable individuals or groups
to maintain or regain their well-being (or
health) in culturally meaningful and
beneficial ways, or to help people face
handicaps or death.
PROFESSIONAL NURSING CARE (CARING)
● Defined as formal and cognitively
learned professional care knowledge
and practice skills obtained through
educational institutions that are used to
provide assistive, supportive, enabling,
or facilitative acts to or for another
individual or group to improve a human
health condition (or well-being),
disability, lifeway, or to work with dying
clients.
CULTURAL CONGRUENT
(NURSING) CARE
● Defined as those cognitively based
assistive, supportive, facilitative, or
enabling acts or decisions that are
tailor-made to fit with the individual,
group, or institutional, cultural values,
beliefs, and lifeways to provide or
support meaningful, beneficial, and
satisfying health care, or well-being
services.
HEALTH
● It is a state of well-being that is culturally
defined, valued, and practiced.
● It reflects individuals’ (or groups) ‘ ability
to perform their daily role activities in
culturally expressed, beneficial, and
patterned lifeways.
HUMAN BEINGS
● Such are believed to be caring and
capable of being concerned about
others’ needs, well-being, and survival.
● Leininger also indicates that nursing as
a caring science should focus beyond
traditional nurse-patient interactions and
dyads to include families, groups,
 communities, total cultures, and
institutions.
SOCIETY AND ENVIRONMENT
● Leininger did not define these terms;
she speaks instead of worldview, social
structure, and environmental context.
WORLDVIEW
● Is how people look at the world, or the
universe, and form a “picture or value
stance” about the world and their lives.
CULTURAL AND SOCIAL STRUCTURE
DIMENSIONS
● Defined as involving the dynamic
patterns and features of interrelated
structural and organizational factors of a
particular culture (subculture or
society) which includes religious,
kinship (social), political (and legal),
economic, educational,
technological, and cultural values,
ethnohistorical factors, and how these
factors may be interrelated and function
to influence human behavior in different
environmental contexts.
ENVIRONMENTAL CONTEXT
● Is the totality of an event, situation, or
particular experience that gives meaning
to human expressions, interpretations,
and social interactions in particular
physical, ecological, sociopolitical,
and/or cultural settings.
CULTURE
● Is learned, shared, and transmitted
values, beliefs, norms, and lifeways of a
particular group that guides their
thinking, decisions, and actions in
patterned ways.
CULTURE CARE
● Defined as the subjectively and
objectively learned and transmitted
values, beliefs, and patterned lifeways
that assist, support, facilitate, or enable
another individual or group to maintain
their well-being, health, improve their
human condition lifeway, or deal with
illness, handicaps or death.
CULTURE CARE DIVERSITY
● Indicates the variabilities and/or
differences in meanings, patterns,
values, lifeways, or symbols of care
within or between collectives related to
assistive, supportive, or enabling human
care expressions.
CULTURE CARE UNIVERSALITY
● Indicates the common, similar, or
dominant uniform care meanings,
patterns, values, lifeways, or symbols
manifest among many cultures and
reflect assistive, supportive, facilitative,
or enabling ways to help people.
SUBCONCEPTS OF TRANSCULTURAL
NURSING THEORY
GENERIC (FOLK OR LAY)
CARE SYSTEMS
● Are culturally learned and transmitted,
indigenous (or traditional), folk
(home-based) knowledge and skills
used to provide assistive, supportive,
enabling, or facilitative acts toward or for
another individual, group, or institution
with evident or anticipated needs to
ameliorate or improve a human life way,
health condition (or well-being), or to
deal with handicaps and death
situations.
EMIC
● Knowledge gained from direct
experience or directly from those who
have experienced it.
● It is generic or folk knowledge.
PROFESSIONAL CARE SYSTEMS
● Defined as formally taught, learned, and
transmitted professional care, health,
illness, wellness, and related knowledge
and practice skills that prevail in
professional institutions, usually with
multidisciplinary personnel to serve
consumers.
ETIC
● The knowledge that describes the
professional perspective.
● It is professional care knowledge.
ETHNOHISTORY
● Includes those past facts, events,
instances, experiences of individuals,
groups, cultures, and instructions that
are primarily people-centered (ethno)
and describe, explain, and interpret
human lifeways within particular cultural
contexts over short or long periods of
time.
CARE (NOUN)
● Defined as those abstract and concrete
phenomena related to assisting,
supporting, or enabling experiences or
behaviors toward or for others with
evident or anticipated needs to
ameliorate or improve a human
condition or lifeway.
CARE (VERB)
● Defined as actions and activities
directed toward assisting, supporting, or
enabling another individual or group with
evident or anticipated needs to
ameliorate or improve a human
condition or lifeway or face death.
CULTURE SHOCK
● May result when an outsider attempts to
comprehend or adapt effectively to a
different cultural group.
● The outsider is likely to experience
feelings of discomfort and helplessness
and some degree of disorientation
because of the differences in cultural
values, beliefs, and practices.
● Culture shock may lead to anger and
can be reduced by seeking knowledge
of the culture before encountering that
culture.
CULTURAL IMPOSITION
● Refers to the outsider’s efforts, both
subtle and not so subtle, to impose their
own cultural values, beliefs, behaviors
upon an individual, family, or group from
another culture.
SUNRISE MODEL OF MADELEINE
LEININGERS’S THEORY
● The Sunrise Model is relevant because
it enables nurses to develop critical and
complex thoughts about nursing
practice.
● These thoughts should consider and
integrate cultural and social structure
dimensions in each specific context,
besides nursing care’s biological and
psychological aspects.

3 MODES OF NURSING CARE DECISIONS
● The cultural care worldview flows into
knowledge about individuals, families,
groups, communities, and institutions in
diverse health care systems.
● This knowledge provides culturally
specific meanings and expressions
concerning care and health.
● The next focus is on the generic or folk
system, professional care systems, and
nursing care.
● Information about these systems
includes the characteristics and the
specific care features of each.
● This information allows for the
identification of similarities and
differences or cultural care universality
and cultural care diversity.
● Next are nursing care decisions and
actions which involve cultural care
preservation or maintenance, cultural
care accommodation or negotiation, and
cultural care repatterning or
restructuring.
● It is here that nursing care is delivered.
AND ACTIONS
CULTURAL CARE PRESERVATION
(MAINTENANCE)
● Includes those assistive, supporting,
facilitative, or enabling professional
actions and decisions that help people
of a particular culture to retain and/or
preserve relevant care values so that
they can maintain their well-being,
recover from illness, or face handicaps
and/or death.
CULTURE CARE ACCOMMODATION
(NEGOTIATION)
● Includes those assistive, supportive,
facilitative, or enabling creative
professional actions and decisions that
help people of a designated culture to
adapt to or negotiate with others for a
beneficial or satisfying health outcome
with professional care providers.
CULTURE CARE REPATTERNING
(RESTRUCTURING)
● Includes those assistive, supporting,
facilitative, or enabling professional
actions and decisions that 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 and
still providing a beneficial or healthier
lifeway than before the changes were
established with the clients.
 MARGARET JEAN WATSON
(1940 - present)
“Caring in nursing conveys physical acts,
but embraces the mind-body-spirit as it
reclaims the
embodied spirit as its focus of attention.”
MARGARET JEAN WATSON
WHO IS SHE?
● Born on (June 10, 1940 – present) is an
American nurse theorist and nursing
professor known for her “Philosophy
and Theory of Transpersonal Caring.”
● She has also written numerous texts,
including Nursing: The Philosophy
and Science of Caring.
● Watson’s study on caring has been
integrated into education and patient
care to various nursing schools and
healthcare facilities worldwide.
● Is a nurse theorist who developed
“Philosophy and Theory of
Transpersonal Caring” or “Caring
Science” and founder of Watson Caring
Science Institute.
● Through her nursing education, earning
her bachelor’s degree in nursing in
1964, a master of science in psychiatric
and mental health nursing in 1966, and
a Ph.D. in educational psychology and
counseling in 1973, all from the
University of Colorado at Boulder.
METAPARADIGM IN NURSING
OF MARGARET JEAN WATSON
PERSON
● Human being is a valued person – cared
for, respected, nurtured, understood &
assisted.
● A fully functional integrated self
(philosophical view).
● A being-in –the-world who holds 3
spheres – mind, body and spirit – that
are influenced by the concept of self &
who is unique & free to make choices.
HEALTH
● Unity & harmony within the mind, body &
soul.
● Also associated with the degree of
congruence between self as perceived &
as experienced.
● Aside from WHO’s definition, she
includes 3 elements:
1. A high level of overall physical,
mental & social functioning.
2. A general adaptive-maintenance level
of daily functioning.
3. The absence of illness (or the
presence of efforts that lead to its
absence.
ENVIRONMENT
● Provides the values that determine how
one should behave and what goals one
should strive toward.
● Thus, “Caring (and nursing) has
existed in every society. Every
society has some people who have
cared for others. A caring attitude is
not transmitted from generation by
genes. It is transmitted by the culture
of the profession as a unique way of
coping with its environment.”
NURSING
● A human science of people and human
health-illness experiences that are
mediated by professional, personal,
scientific, aesthetic, and ethical human
care transactions.
THE PHILOSOPHY &
SCIENCE OF CARING
 MAJOR ELEMENTS OF
WATSON’S THEORY:

● The Carative Factors

● The Transpersonal caring relationship
● The caring occasion / caring moment

MAJOR ELEMENTS OF
WATSON’S THEORY:

THE CARATIVE FACTORS

● Guides for the core of nursing.

● Derived from a humanistic perspective
combined with a scientific knowledge
base.
● It honors the human dimensions of
nursing’s work & the inner life world &
subjective experiences of the people we
serve.
● Comprised of 10 elements (Carative
Factors)
10 CARATIVE FACTORS
CONCEPT OF CLINICAL
CARITAS PROCESSES
● This was introduced replacing the
carative factors.
● “Caritas” – Greek vocabulary meaning
to cherish and to give special loving
attention.
● Translation of the carative factors into
clinical caritas processes.

1. Humanistic-altruistic system of value

2. Faith-hope CARATIVE FACTORS AND
3. Sensitivity of self and others CARITAS PROCESSES
4. Helping-trusting, human care
relationship
5. Expressing positive & negative feelings
6. Creative problem-solving caring process
7. Transpersonal teaching-learning
8. Supportive, protective, and/or corrective
mental, physical, societal and spiritual
environment
9. Human needs assistance
10. Existential-phenomenological-spiritual
forces
 ● In assisting with the gratification of
human needs, Watson’s hierarchy of
needs begins with lower-order
biophysical needs or survival needs,
including the need for food and fluid,
elimination, and ventilation.
● Next are the lower-order
psychophysical needs or functional
needs, including the need for activity,
inactivity, and sexuality. The
higher-order psychosocial needs or
integrative needs include the need for
achievement and affiliation.
● And finally, the higher-order
intrapersonal-interpersonal need or
growth-seeking need, which is
self-actualization.
MAJOR ELEMENTS OF
WATSON’S THEORY:
TRANSPERSONAL CARING RELATIONSHIP
● Characterizes a special kind of human
care relationship which depends on the
Nurse’s:
1. Moral commitment in protecting &
enhancing human dignity as well as the
deeper/higher self.
2. Caring consciousness communicated to
preserve & honor the embodied spirit,
TF not reducing the person to the moral
status of an object.
3. Caring consciousness & connection
having the potential to heal since
experience, perception & intentional
connection are taking place.
● Transpersonal – to go beyond one’s
own ego and the here and now, as it
WATSON’S PHILOSOPHY AND SCIENCE OF
allows one to reach deeper spiritual
connections in promoting the patient’s
comfort & healing.
● Goal is to protect, enhance & preserve
the person’s dignity, humanity,
wholeness & inner harmony.
MAJOR ELEMENTS OF
WATSON’S THEORY:
CARING OCCASION
● The moment when the nurse and
another person come together in such a
way that an occasion for human caring
is created.
7 ASSUMPTIONS IN THE
SCIENCE OF CARING
1. Caring can be effectively demonstrated
& practiced only interpersonally.
2. Effective caring promotes health &
individual or family growth.
3. Caring responses accept a person not
only as he or she is now but as what he
or she may become.
4. 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.
5. Caring is more “healthogenic” than is
curing. The practice of caring integrates
biophysical knowledge with knowledge
of human behavior to generate or
promote health and to provide care to
those who are ill. A science of caring is
therefore complementary to the science
of curing.
6. The practice of caring is central to
nursing.
7. Focus of nursing is on the carative
factors.
MAJOR CONCEPTS OF
CARING THEORY:
HUMAN BEING
● A valued person to be cared for,
respected, nurtured, understood, and
assisted; in general, a philosophical
 view of a person as a fully functional WATSON’S PHILOSOPHY AND
integrated self. SCIENCE OF CARING THEORY:
● A human is viewed as greater than and
different from the sum of his or her PHENOMENAL FIELD
parts.
● The totality of human experience of
HEALTH one’s in the world.
● This refers to the individual’s frame of
● Unity and harmony within the mind, reference that can only be known to that
body, and soul; health is associated with person.
the degree of congruence between the
self and the self as experienced. SELF
● It is defined as a high level of overall
● The organized conceptual gestalt is
physical, mental, and social functioning;
composed of perceptions of the
a general adaptive-maintenance level of
characteristics of the “I” or “ME” and
daily functioning; and the absence of
the perceptions of the relationship of the
illness, or the presence of efforts leading
“I” and “ME” to others and various
to the absence of illness.
aspects of life.
NURSING
TIME
● A human science of persons and human
● The present is more subjectively real,
health-illness experiences mediated by
and the past is more objectively real.
professional, personal, scientific,
● The past is before or in a different mode
esthetic, and ethical human care
of being than the present, but it is not
transactions.
clearly distinguishable.
ACTUAL CARING OCCASION ● Past, present, and future incidents
merge and fuse.
● Involves actions and choices by the
nurse and the individual.
● The moment of coming together on a
caring occasion presents the two
persons with the opportunity to decide
how to be in the relationship – what to
do with the moment.

TRANSPERSONAL

● Is an intersubjective human-to-human
relationship in which the nurse affects
and is affected by the other person.
● Both are fully present in the moment and
feel a union with the other; they share a
phenomenal field that becomes part of
both's life stories.

SUBCONCEPTS OF
 PATRICIA BENNER
(1942 - present)
“Nursing is concerned with the social
sentient body that dwells in finite human
world; that gets sick and recovers; that is
altered during illness, pain and suffering;
and that engages with the world differently
upon recovery.”
METAPARADIGM IN NURSING
OF PATRICIA BENNER
PERSON
● A self-interpreting being, that is the
person does not come into the world
predefined but gets defined in the
course of living a life.
● It has an effortless and non-reflective
understanding of the self in the world. It
is viewed as a participant in common
meanings.
● Made up of significant aspects: Role of
the - situation, body, personal
concerns & temporality.
HEALTH
● A person may have a disease & not
experience illness because illness is
the human experience of loss or
dysfunction, while disease is what can
be assessed at the physical level.
● It focuses on the “lived experience of
being healthy & ill.
● Health – is what can be assessed;
● Well-being – is the human experience
of health or wholeness.
ENVIRONMENT
● The term “situation” is used which
suggests a social environment with
social definition & meaning.
● Used the phenomenological terms of
“being situated” and “situated
meaning” – defined by the person’s
engaged interaction, interpretation &
understanding of the situation.
NURSING
● The care & study of the lived experience
of health, illness & disease & the
relationships among these three
elements.
● An enabling condition of connection &
concern, which shows a high level of
emotional involvement in the
nurse-client relationship.
THEORY AND MODEL OF
PATRICIA BENNER
THE NURSING EXPERTISE MODEL/ SKILL
ACQUISITION IN NURSING: FROM NOVICE
TO EXPERT
● Benner applied the Dreyfus model of
skill acquisition in nursing. Her area of
concern was not how to do nursing but
rather “how do nurses learn nursing?”
● Dreyfus model is situation & describes
the five levels of skill acquisition &
development. It proposes that, as a
person improves in skill level, there is a
corresponding change in the
performance of a given skill.
THE NURSING EXPERTISE MODEL/ SKILL
ACQUISITION IN NURSING: FROM NOVICE
TO EXPERT
EXPERIENCE – based skill
acquisition is safer and
quicker when it is
founded on a sound
educational
base.
SKILL – refers to nursing
interventions & clinical
judgement skills in
actual situations.
 EXPERTISE – is developed when
the clinician tests and
modifies
principle-based
expectations in the
actual setting.
LEVELS OF NURSING EXPERIENCE
NOVICE – is a beginner with no
experience. They are taught
general rules to help perform
tasks, and their rule-governed
behavior is limited and
inflexible. In other words, they
are told what to do and simply
follow instructions.
EXPERT – nurses no longer rely on
principles, rules, or guidelines
to connect situations and
determine actions. They have a
deeper background of
experience and an intuitive
grasp of clinical situations.
Their performances are fluid,
flexible, and highly-proficient.
Benner’s writings explain that
nursing skills through
experience are a prerequisite
for becoming an expert nurse.

ADVANCED – shows acceptable

BEGINNER performance, and has gained
prior experience in actual
nursing situations. This helps
the nurse recognize recurring
meaningful components so that
principles, based on those
experiences, begin to formulate
in order to guide actions.

COMPETENT – nurse generally has two or

three years’ experience on the
job in the same field. For
example, two or three years in
intensive care. The experience
may also be similar day-to-day
situations. These nurses are
more aware of long-term goals,
and they gain perspective from
planning their own actions,
which helps them achieve
greater efficiency and
organization.
PROFICIENT – nurses perceive and
understand situations as whole
parts. He or she has a more
holistic understanding of
nursing, which improves
decision-making. These nurses
learn from experiences what to
expect in certain situations, as
well as how to modify plans as
needed.
SEVEN DOMAINS OF
NURSING PRACTICE
1. Helping role.
2. Teaching & coaching function.
3. Diagnostic client-monitoring function.
4. Effective management of rapidly
changing situations.
5. Administering & monitoring therapeutic
interventions & regimens.
6. Monitoring & ensuring quality of health
care practices.
7. Organizational & work-role
competencies.
HELPING ROLE
● This includes competencies related to
establishing a healing relationship,
providing comfort measures, and inviting
 active patient participation and control in ● This includes competencies in priority
care. setting, team building, coordinating and
providing for continuity.
TEACHING & COACHING FUNCTION

● This includes timing, readying patients

for learning, motivating, change,
assisting with lifestyle alterations, and
negotiating agreement on goals.

DIAGNOSTIC
CLIENT-MONITORING FUNCTION

● This refers to competencies in ongoing

assessment and anticipation of
outcomes.

EFFECTIVE MANAGEMENT OF RAPIDLY

CHANGING SITUATIONS

● This includes the ability to contingently

match demands with resources and to
assess and manage care during crisis
situations.

ADMINISTERING & MONITORING

THERAPEUTIC INTERVENTIONS &
REGIMENS

● This includes competencies related to

preventing complications during drug
therapy, wound management, and
hospitalization.

MONITORING & ENSURING QUALITY OF

HEALTH
CARE PRACTICES

● This includes competencies with regard

to maintenance of safety, continuous
quality improvement, collaboration and
consultation with physicians,
self-evaluation and management of
technology.

ORGANIZATIONAL &
WORK-ROLE COMPETENCIES
 OTHER CONCEPTUAL MODELS &
THEORIES
LYDIA ELOISE HALL
(1906 - 1969)
Nursing as the “participation in care, core
and cure aspects of patient care, where
CARE is the sole function of nurses,
whereas the CORE and CURE are shared
with other members of the health team.”
LYDIA ELOISE HALL
WHO IS SHE?
● Born on (September 21, 1906 –
February 27, 1969) was a nursing
theorist who developed the Care, Cure,
Core model of nursing. Her theory
defined Nursing as “a participation in
care, core and cure aspects of patient
care, where CARE is the sole function of
nurses, whereas the CORE and CURE
are shared with other members of the
health team.”
● In 1927, she earned her nursing diploma
and went on to complete a Bachelor of
Science in Public Health Nursing in
1937.
● She earned a Master's degree to teach
natural sciences in 1942.
● Hall worked as the first director of the
Loeb Center for Nursing.
● Her nursing experience was in clinical
nursing, nursing education, research,
and in a supervisory role.
● She was an innovator, motivator, mentor
to nurses in all phases of their careers,
and an advocate for chronically ill
patients. She worked to involve the
community in public health issues.
METAPARADIGM IN NURSING
OF LYDIA ELOISE HALL
PERSON
● Hall emphasizes the importance of the
individual as unique, capable of growth
and learning, & requiring a total person
approach.
● The source of energy & motivation for
healing is the individual care recipient
NOT the health care provider.
HEALTH
● Health can be inferred to be a state of
self-awareness with a conscious
selection of behaviors that are optimal
for that individual.
● Hall stresses the need to help the
person explore the meaning of his or her
behavior to identify and overcome
problems through developing
self-identity & maturity.
ENVIRONMENT
● The concept of environment is dealt with
in relation to the individual.
● The hospital environment during
treatment of acute illness creates a
difficult psychological experience for the
ill individual.
● In such a setting, the focus of the action
of the nurses is the individual, so that
any actions taken in relation to society
or environment are for the purpose of
assisting the individual in attaining a
personal goal.
NURSING
● Nursing is identified as consisting of
participation in the care, core, and cure
aspects of patient care.
THEORY AND MODEL OF
LYDIA ELOISE HALL
CARE, CORE, CURE THEORY
● Hall postulated that individuals could be CURE
conceptualized in three separate
domains: CARE (hands on bodily ● The cure is the attention given to
care), CORE (using the self in patients by medical professionals.
relationship to the patient), and CURE ● Hall explains in the model that the nurse
(applying medical knowledge) shares the cure circle with other health
● Hall believed that patients should professionals.
receive care only from professional ● These are the interventions or actions
nurses. geared toward treating the patient for
● Nursing involves interacting with a whatever illness or disease they are
patient in a complex process of teaching suffering from.
& learning.
● Hall believed that professional nursing
hastened the recovery of patients and
that more professional nursing care &
health teaching was needed in the light
of decreasing medical care rendered to
the patient.
● Hall emphasized the autonomy inherent
in professional nursing.
● Her model encompasses adult patients
who have passed the acute stage of
disease and who are now in the
rehabilitation phase of healthcare.
● The goal is to make sure that the
patient achieves success in
self-actualization and self-love after
the disease.

CARE
● The care circle addresses the role of
nurses and is focused on performing the
task of nurturing patients.
● This means the “motherly” care provided
by nurses, which may include comfort
measures, patient instruction, and
helping the patient meet his or her
needs when help is needed.
CORE
● The core is the patient receiving nursing
care.
● The core has goals set by him or herself
rather than by any other person and
behaves according to their feelings and
values.
MAJOR CONCEPTS OF
HALL’S CARE, CORE, CURE THEORY:
INDIVIDUAL
● The individual human who is 16 years of
age or older and past the acute stage of
long-term illness focuses on nursing
care in Hall’s work.
● The source of energy and motivation for
healing is the individual care recipient,
not the health care provider.
● Hall emphasizes the individual’s
importance as unique, capable of growth
and learning, and requiring a total
person approach.
HEALTH
● Health can be inferred as a state of
self-awareness with a conscious
selection of optimal behaviors for that
individual.
● Hall stresses the need to help the
person explore the meaning of his or her
behavior to identify and overcome
problems through developing
self-identity and maturity.
SOCIETY AND ENVIRONMENT
● The concept of society or environment is
dealt with concerning the individual.
● Hall is credited with developing Loeb
Center’s concept because she assumed
that the hospital environment during
treatment of acute illness creates a
difficult psychological experience for the
ill individual.
● Loeb Center focuses on providing an
environment that is conducive to
self-development.
● In such a setting, the focus of the
nurses’ action is the individual.
● Any actions taken concerning society or
the environment are to assist the
individual in attaining a personal goal.
SUBCONCEPTS OF
HALL’S CARE, CORE, CURE THEORY:
THE CARE CIRCLE
● According to the theory, nurses are
focused on performing the noble task of
nurturing patients.
● This circle solely represents the role of
nurses and is focused on performing the
task of nurturing patients.
● Nurturing involves using the factors that
make up the concept of mothering (care
and comfort of the person) and provide
for teaching-learning activities.
● The care circle defines a professional
nurse’s primary role, such as providing
bodily care for the patient and helping
the patient complete such basic daily
biological functions as eating, bathing,
elimination, and dressing.
● When providing this care, the nurse’s
goal is the comfort of the patient.
● Moreover, the nurse’s role also includes
educating patients and helping a patient
meet any needs he or she is unable to
meet alone.
● This presents the nurse and patient with
an opportunity for closeness.
● As closeness develops, the patient can
share and explore feelings with the
nurse.
THE CORE CIRCLE
● The core, according to Hall’s theory, is
the patient receiving nursing care.
● The core has goals set by him or herself
rather than by any other person and
behaves according to their feelings and
values.
● This involves the therapeutic use of self
and is shared with other members of the
health team.
● This area emphasizes the patient’s
social, emotional, spiritual, and
intellectual needs concerning family,
institution, community, and the world.
● This can help the patient verbally
express feelings regarding the disease
process and its effects by using the
reflective technique.
● Through such expression, the patient
can gain self-identity and further develop
maturity.
● The professional nurse uses the
reflective technique to act as a mirror to
the patient to help the latter explore his
or her own feelings regarding his or her
current health status and related
potential changes in lifestyle.
● Motivations are discovered through the
process of bringing into awareness the
feelings being experienced. With this
awareness, the patient can now make
 conscious decisions based on highest level of care possible from
understood and accepted feelings and all concerned health professions.
motivation.
CURE – It refers to the independent roles
and functions of the nurse in so far
THE CURE CIRCLE
as his or her knowledge and skills
about the patient's condition will
● As explained in this theory, the cure is
allow her to carry on with her
nursing, which involves the nursing responsibilities.
administration of medications and
treatments.
● Hall explains in the model that the nurse
shares the cure circle with other health
professionals, such as physicians or
physical therapists.
● In short, these are the interventions or
actions geared toward treating the
patient for whatever illness or disease
he or she is suffering from.
● During this aspect of nursing care, the
nurse is an active advocate of the
patient.

CONCEPTS AND DEFINITIONS

CARE – the exclusive domain of nursing.

CORE – refers to the person or the

recipient of care and includes the
use of therapeutic self to relate
with the patient.

CURE – refers to medical interventions

that are performed on the patient. It
includes nursing activities that are
dependent upon the orders of the
physician.

APPLICATIONS

CARE – It delineates nursing functions

that are dependent on the
members of the medical profession.
Examples like medication
administration, the performance of
diagnostic procedures, etc.

CORE – It is our responsibility to make

sure that the patient receives the
 NOLA J. PENDER
(1941 - present)
"Nursing is a helping profession that
empowers patients towards self-attribution,
self-evaluation, and self-efficacy”
NOLA J. PENDER
WHO IS SHE?
● Born in (1941– present) in Lansing,
Michigan and is a nursing theorist who
developed the Health Promotion Model
in 1982.
● Pender entered the School of Nursing at
West Suburban Hospital in Oak Park,
Illinois, and received her nursing
diploma in 1962.
● In 1965, she received her master’s
degree in human growth and
development from the same university.
● Years later, she finished masters-level
work in community health nursing at
Rush University.
● In 1962, She began working on a
medical- surgical unit and subsequently
in a pediatric unit in a Michigan hospital.
● For 40 years at Michigan State
University, she trained students at
undergraduate and graduate levels and
mentored many postdoctoral
candidates.
● She moved to Northwestern University
in Evanston, Illinois to obtain a Ph.D. in
psychology & education in 1969.
● She is also an author and a professor
emeritus of nursing at the University of
Michigan.
● She started studying health-promoting
behavior in the mid-1970s and first
published the Health Promotion Model in
1982.
● She was president of the Midwest
Nursing Research Society from 1985 to
1987.
● President of the American Academy of
Nursing from 1991 to 1993.
● Member of Research America’s Board
of Directors from 1991 to 1993.
● Member of the US Preventative
Services Task Force from 1998 to 2002.
● Associate Dean for Research at the
University of Michigan School of Nursing
from 1990 to 2001.
● Co-founder of the Midwest Nursing
Research Society, she served as a
trustee of its foundation since 2009
● She is presently a Professor Emeritus at
Michigan State University.
● She also serves as Distinguished
Professor of Nursing at Loyola
University School of Nursing in Chicago,
Illinois.
● Her Health Promotion Model indicates
preventative health measures and
describes nurses’ critical function in
helping patients prevent illness by
self-care and bold alternatives.
● Pender has been named a Living
Legend of the American Academy of
Nursing.
METAPARADIGM IN NURSING
OF NOLA PENDER
PERSON
● Man seeks to create conditions of living
through which they can express their
unique human health potential.
● Man also has the capacity for reflective
self- awareness, including the
assessment of his own competencies.
● Man values growth in positive directions
and attempts to achieve a personally
acceptable balance between change &
stability.
● Man also seek to actively regulate their
own behavior.
HEALTH
● 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.
● It describes the multi-dimensional nature
of persons as they interact within the
environment to pursue health.
ENVIRONMENT
● Persons always interact with the
environment, transform the environment
progressively, and become transformed
themselves over time.
NURSING
● Nursing is a helping profession that
empowers patients towards
self-attribution, self-evaluation, and
self-efficacy.
THEORY AND MODEL OF
NOLA PENDER
HEALTH PROMOTION MODEL
● It encourages scholars to look
integratively at variables that have been
shown to impact health behavior.
● It synthesizes research findings from
nursing, psychology and public health
into an explanatory model of health
behavior that still must undergo further
testing.
● It focuses on ten categories of
determinants of health-promoting
behaviors.
● It views a person's health-promoting
behavior in the light of his individual
characteristics and experiences.
● The person’s level of cognitive abilities
and affect also play a major role in the
development of these health-promoting
behaviors.
CONCEPTS AND DEFINITIONS
HEALTH – defined as behavior
PROMOTION motivated by the desire to
increase well-being and
actualize human
health potential. It is an
approach to wellness.
HEALTH – or illness prevention is
PROTECTION described as
behavior motivated
desire to actively avoid
illness, detect it early,
or maintain functioning
within the constraints of
illness.
TEN DETERMINANTS OF
HEALTH-PROMOTING BEHAVIORS
1. Prior related Behavior
2. Perceived benefits of action
(health-promoting behaviors)
3. Perceived barriers to action
(health-promoting behaviors)
4. Perceived self-efficacy
5. Activity-related affect
6. Interpersonal influences (family, friends,
providers, norms, support, and models)
7. Situational influences (options, demand
characteristics, aesthetics)
8. Immediate competing demands (low
control) and preferences (high control)
9. Commitment to a plan of action
10. Personal factors (biological,
psychological, sociocultural)
CONCEPTS AND DEFINITIONS
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.
 BIOLOGICAL – Age, gender, BMI, (vicarious learning through observing
pubertal status, aerobic others engaged in a particular behavior.
capacity, strength, agility, ● Primary sources of interpersonal
etc. influences are families, peers and
healthcare providers.
PSYCHOLOGICAL – Self-esteem, self-
motivation, personal SITUATIONAL INFLUENCES
competence, perceived
health status, & definition ● Personal perceptions and cognitions of
of health. any given situation or context that can
facilitate or impede behavior.
SOCIO-CULTURAL – Race, ethnicity, ● Include perceptions of options available,
acculturation, education demand characteristics and aesthetic
and socioeconomic features of the environment in which
status. given health promoting is proposed to
take place
PERCEIVED BENEFITS OF ACTION ● It may have direct or indirect influences
on health behavior.
● Anticipated positive outcomes that will
occur from health behavior. IMMEDIATE COMPETING
DEMANDS & PREFERENCES
PERCEIVED BARRIERS TO ACTION
COMPETING – are those alternative
● Anticipated, imagined or real blocks and DEMANDS behaviors over which
personal costs of understanding a given individuals have low
behavior. control because there
are environmental
PERCEIVED SELF-EFFICACY contingencies such as
work or family care
● Judgment of personal capability to
responsibilities.
organize and execute a health-promoting
behavior. COMPETING – are alternative
● It influences perceived barriers to action PREFERENCES behaviors over which
so higher efficacy results in lowered individuals exert
perceptions of barriers to the relatively high control,
performance of the behavior. such as choice of ice
cream or apple for a
ACTIVITY-RELATED AFFECT
snack.
● Subjective positive or negative feeling
COMMITMENT TO PLAN OF ACTION
that occurs before, during and following
behavior based on the stimulus ● The concept of intention and
properties of the behavior itself. identification of a planned strategy leads
● Influences perceived self-efficacy, which to the implementation of health behavior.
means the more positive the subjective
feeling, the greater the feeling of efficacy. HEALTH – PROMOTING BEHAVIOR
INTERPERSONAL INFLUENCES ● An endpoint or action outcome that is
directed toward attaining positive health
● Cognition concerning behaviors, beliefs, outcomes such as optimal wellbeing,
or attitudes of others. personal fulfillment, and productive
● Interpersonal influences include norms living.
(expectations of significant others),
social support (instrumental and
emotional encouragement) and modeling
 IDA JEAN ORLANDO
(1926 - 2007)
“Patients have their own meanings and
interpretations of situations and therefore
nurses must validate their inferences and
analyses with patients before concluding.”
IDA JEAN ORLANDO
WHO IS SHE?
● Born in (August 12, 1926 – November
28, 2007) was an internationally known
psychiatric health nurse, theorist, and
researcher who developed the
“Deliberative Nursing Process
Theory.”
● Ida Jean Orlando was a first-generation
Irish American born on August 12, 1926.
● She dedicated her life to studying
nursing and graduated in 1947 and
received a Bachelor of Science degree
in public health nursing in 1951.
● In 1954, she completed her Master of
Arts in Mental Health consultation.
● While studying, she also worked
intermittently and sometimes
concurrently as a staff nurse in OB, MS,
ER, as a general hospital supervisor,
and as an assistant director and a
teacher of several courses.
● In 1947, she received a nursing diploma
from the Flower Fifth Avenue Hospital
School of Nursing in New York.
● In 1951, she received a Bachelor of
Science degree in public health nursing
from St. John’s University in Brooklyn,
New York.
● And in 1954, Orlando received her
Master of Arts degree in mental health
consultation from Teachers College,
Columbia University.
● Her theory allows nurses to create an
effective nursing care plan that can also
be easily adapted when and if any
complications arise with the patient.
METAPARADIGM IN NURSING
OF IDA JEAN ORLANDO
PERSON
● Orlando uses the concept of human as
she emphasizes individuality and the
dynamic nature of the nurse-patient
relationship.
● For her, humans in need are the focus of
nursing practice.
HEALTH
● In Orlando’s theory, health is replaced
by a sense of helplessness as the
initiator of a necessity for nursing.
● She stated that nursing deals with
individuals who require help.
ENVIRONMENT
● Orlando completely disregarded the
environment in her theory, only focusing
on the patient’s immediate need, chiefly
the relationship and actions between the
nurse and the patient (only an individual
in her theory; no families or groups were
mentioned).
● The effect that the environment could
have on the patient was never
mentioned in Orlando’s theory.
NURSING
● Orlando speaks of nursing as unique
and independent in its concerns for an
individual’s need for help in an
immediate situation.
● The efforts to meet the individual’s need
for help are carried out in an interactive
situation and in a disciplined manner
that requires proper training.
THEORY AND MODEL OF
IDA JEAN ORLANDO
 DELIBERATIVE NURSING
PROCESS THEORY
● One important thing that nurses do is
converse with the patients and let them
know what the plan of care will be.
● However, regardless of how well thought
out a nursing care plan is for a patient,
unexpected problems to the patient’s
recovery may arise at any time.
● With these, the nurse’s job is to know
how to deal with those problems so the
patient can continue to get back and
reclaim his or her well-being.
● Ida Jean Orlando developed her
Deliberative Nursing Process that
allows nurses to formulate an
effective nursing care plan that can
also be easily adapted when and if
any complexity comes up with the
patient.
● Orlando’s nursing theory stresses the
reciprocal relationship between patient
and nurse.
● It emphasizes the critical importance of
the patient’s participation in the nursing
process.
● Orlando also considered nursing as a
distinct profession.
● Separated it from medicine, where
nurses determine nursing action rather
than being prompted by physician’s
orders, organizational needs, and past
personal experiences.
● She believed that the physician’s orders
are for patients and not for nurses.
● Orlando’s goal is to develop a theory of
effective nursing practice.
● The theory explains that the nurse’s role
is to find out and meet the patient’s
immediate needs for help.
● According to the theory, all patient
behavior can be a cry for help. Through
these, the nurse’s job is to determine the
nature of the patient’s distress and
provide the help he or she needs.
ASSUMPTIONS OF
IDA JEAN ORLANDO
1. When patients cannot cope with their
needs on their own, they become
distressed by feelings of helplessness.
2. In its professional character, nursing
adds to the distress of the patient.
3. Patients are unique and individual in
how they respond.
4. Nursing offers mothering and nursing
analogous to an adult who mothers and
nurtures a child.
5. The practice of nursing deals with
people, the environment, and health.
6. Patients need help communicating their
needs; they are uncomfortable and
ambivalent about their dependency
needs.
7. People can be secretive or explicit about
their needs, perceptions, thoughts, and
feelings.
8. The nurse-patient situation is dynamic;
actions and reactions are influenced by
both the nurse and the patient.
9. People attach meanings to situations
and actions that aren’t apparent to
others.
10. Patients enter into nursing care through
medicine.
11. The patient cannot state the nature and
meaning of his or her distress without
the nurse’s help or him or her first
having established a helpful relationship
with the patient.
12. Any observation shared and observed
with the patient is immediately helpful in
ascertaining and meeting his or her
need or finding out that he or she is not
in need at that time.
13. Nurses are concerned with the needs
the patient is unable to meet on his or
her own.
SUBCONCEPTS OF
ORLANDO’S DELIBERATIVE NURSING DISTRESS – The patient’s behavior
PROCESS THEORY: reflects distress when the
patient experiences a
FUNCTION OF need that he cannot
PROFESSIONAL NURSING resolve, a sense of
helplessness occurs.
● The function of professional nursing is
the organizing principle. IMMEDIATE REACTION
● This means finding out and meeting
the patient’s immediate needs for ● The immediate reaction is the internal
help. response.
● According to Orlando, nursing is ● The patient perceives objects with his or
responsive to individuals who suffer or her five senses.
who anticipate a sense of helplessness. ● These perceptions stimulate automatic
● It is focused on the process of care in an thought, and each thought stimulates an
immediate experience. automatic feeling, causing the patient to
● It is concerned with providing direct act.
assistance to a patient in whatever ● These three items are the patient’s
setting they are found to avoid, relieve, immediate response.
diminishing, or curing the patient’s ● The immediate response reflects how
sense of helplessness. the nurse experiences his or her
● The Nursing Process Discipline participation in the nurse-patient
Theory labels the purpose of nursing to relationship.
supply the help a patient needs for their
needs to be met. NURSE REACTION
● If the patient has an immediate need for
● The patient’s behavior stimulated a
help, and the nurse discovers and meets
nurse’s reaction, which marks the
that need, the purpose of nursing has
nursing process discipline’s beginning.
been achieved.
NURSE’S ACTION
PRESENTING BEHAVIOR
● When the nurse acts, an action process
● Presenting behavior is the patient’s
transpires.
problematic situation.
● This action process by the nurse in a
● Through the presenting behavior, the
nurse-patient contact is called the
nurse finds the patient’s immediate need
nursing process.
for help.
● The nurse’s action may be automatic or
● To do this, the nurse must first recognize
deliberative.
the situation as problematic.
● Regardless of how the presenting AUTOMATIC – are nursing actions
behavior appears, it may represent a cry NURSING decided upon for reasons
for help from the patient. ACTIONS other than the patient’s
● The patient’s presenting behavior, which immediate need.
is considered the stimulus, causes an
automatic internal response in the DELIBERATIVE – are actions decided
nurse, which in turn causes a response NURSING upon after ascertaining a
in the patient. ACTIONS
 need and then meeting communication between nurse and
this need. patient stops.
● The nurse decides on appropriate action
The following list identifies the criteria for to resolve the need in cooperation with
deliberative actions: the patient. This action is evaluated after
it is carried out.
a) Deliberative actions result from the
● If the patient’s behavior improves, the
correct identification of patient needs by
action is successful, and the process is
validating the nurse’s reaction to patient
completed.
behavior.
● If there is no change or the behavior
b) The nurse explores the meaning of the
gets worse, the process recycles with
action with the patient and its relevance
new efforts to clarify the patient’s
to meeting his needs.
behavior or the appropriate nursing
c) The nurse validates the action’s
action.
effectiveness immediately after
completing it.
d) The nurse is free of stimuli unrelated to
the patient’s need when she acts.

THEORY AND MODEL OF

IDA JEAN ORLANDO

NURSING PROCESS DISCIPLINE

● The nursing process discipline is the

investigation into the patient’s needs.
● Any observation shared and explored
with the patient is immediately useful in
ascertaining and meeting his or her
need or finding out they have no needs
at that time.
● The nurse cannot assume that any
aspect of his or her reaction to the
patient is correct, helpful, or appropriate
until he or she checks its validity by
exploring it with the patient.
● The nurse initiates this exploration to
determine how the patient is affected by
what they say and do.
● Automatic reactions are ineffective
because the nurse’s action is
determined for reasons other than the
meaning of the patient’s behavior or the
patient’s immediate need for help.
● When the nurse doesn’t explore the
patient’s reaction with him or her, it is
reasonably certain that effective
 MYRA LEVINE
(1926 - 2007)
“The conservation principles do not, of
course, operate singly and in isolation from
each other. They are joined within the
individual as a cascade of life events,
churning and changing as the
environmental challenge is confronted and
resolved in each individual’s unique way.
The nurse as a caregiver becomes part of
that environment, bringing to every nursing
opportunity his or her own cascading
repertoire of skill, knowledge, and
compassion. It is a shared enterprise, and
each participant is rewarded.” (Levine, 1989)
MYRA ESTRIN LEVINE
WHO IS SHE?
● Born in (1921–1996) is a nursing
theorist known for her esoteric nursing
model—the Conservation Model.
● In this model, nursing aims to promote
adaptation and maintain wholeness
using the four principles of conservation.
● Myra Estrin Levine had experienced
several careers. She was a private duty
nurse in 1944, a civilian nurse in the
U.S. Army in 1945, a preclinical
instructor in the physical sciences at
Cook County from 1947 to 1950,
director of nursing at Drexel Home in
Chicago from 1950 to 1951, and surgical
supervisor at both the University of
Chicago Clinics from 1951 to 1952, and
the Henry Ford Hospital in Detroit from
1956 to 1962.
● In 1951, Levine also became a clinical
instructor at Bryan Memorial Hospital in
Lincoln, Nebraska, and administrative
supervisor at the University of Chicago.
● Levine also worked as a chairperson of
clinical nursing at her alma mater, the
Cook County School of Nursing, from
1963 to 1967.
● She managed to work her way up the
academic ranks at Loyola University
from 1967 to 1977 and the University of
Illinois from 1962 to 1963 and from 1977
to 1987.
● She coordinated the graduate nursing
program in oncology at Rush University
from 1974 to 1977.
● Aside from being a major influence in
the nursing profession, Levine was also
a family woman, friend, educator,
administrator, student of humanities,
scholar, enabler, and confidante.
● She was creative and knowledgeable,
opinionated, and global in her concept
of nursing.
METAPARADIGM IN NURSING
OF MYRA LEVINE
PERSON
● The person is a unique individual in
unity, integrity, feeling, belief, thinking,
and whole.
HEALTH
● Health is the pattern of adaptive change
of the whole being.
ENVIRONMENT
● The environment includes both the
internal and external environment.
Three Aspects of Environment Drawn
upon Bates’ (1967) Classification:
● The operational environment consists of
the undetected natural forces that
impinge on the individual.
● The perceptual environment consists of
information that is recorded by the
sensory organs.
● The conceptual environment is
influenced by language, culture, ideas,
and cognition.
 NURSING
● Nursing is the human interaction relying
on communication, rooted in the
individual human being’s organic
dependency in his relationships with
other human beings.
THEORY AND MODEL OF
MYRA LEVINE
THE CONSERVATION MODEL
● Levine’s conservation model believes
nursing intervention is a conservation
activity, with energy conservation as a
fundamental concern, four conservation
principles of nursing.
● It guides nurses to concentrate on the
importance and responses at the level of
the person.
● Nurses fulfill the theory’s purpose by
conserving energy, structure, and
personal and social integrity.
● Every patient has a different array of
adaptive responses, which vary based
on personal factors, including age,
gender, and illness.
● The fundamental concept of Myra
Estrin Levine’s theory is
conservation.
● When an individual is in a phase of
conservation, it means that the person
can adapt to the health challenges with
the slightest amount of effort.
● The core of Levine’s Conservation
Model is to improve a person’s physical
and emotional well-being by considering
the four domains of conservation she set
out.
● By proposing to address the
conservation of energy, structure, and
personal and social integrity, this nursing
theory helps guide nurses in providing
care that will help maintain and promote
the health of the patient.
WHAT IS THE
CONSERVATION MODEL?
● The core of the conservation model is to
improve a person’s physical and
emotional well-being by considering the
four domains of conservation she set
out.
● Nursing’s role in conservation is to help
the person with the process of “keeping
together” the total person through the
least amount of effort.
● Levine (1989) proposed the following
four principles of conservation:
a) The conservation of energy of the
individual.
b) The conservation of the structural
integrity of the individual.
c) The conservation of the personal
integrity of the individual.
d) The conservation of the social
integrity of the individual.
CONSERVATION OF ENERGY
● Conservation of energy refers to
balancing energy input and output to
avoid excessive fatigue. It includes
adequate rest, nutrition, and exercise.
● Examples: Availability of adequate
rest; Sustenance of adequate
nutrition.
CONSERVATION OF
STRUCTURAL INTEGRITY
● Conservation of structural integrity refers
to maintaining or restoring the body’s
structure, preventing physical
breakdown, and promoting healing.
● Examples: Assist patient in ROM
exercise; Preservation of patient’s
personal hygiene.
CONSERVATION OF
PERSONAL INTEGRITY
● Conservation of personal integrity
recognizes the individual as one who
strives for recognition, respect,
self-awareness, selfhood, and
self-determination.
● Example: Acknowledge and preserve
patient’s space needs.
CONSERVATION OF
SOCIAL INTEGRITY
● Conservation of social integrity exists
when a patient is recognized as
someone who resides within a family, a
community, a religious group, an ethnic
group, a political system, and a nation.
● Example: Help the individual to
preserve his or her place in a family,
community, and society.
MAJOR CONCEPTS
OF LEVINE’S THE
CONSERVATION MODEL:
CONSERVATION
● Conservation includes joining together
and is the product of adaptation,
including nursing intervention and
patient participation to maintain a safe
balance.
PERSONAL INTEGRITY
● Personal integrity is a person’s sense of
identity and self-definition.
● Nursing intervention is based on the
conservation of the individual’s personal
integrity.
SOCIAL INTEGRITY
● Social integrity is life’s meaning gained
through interactions with others.
● Nurses intervene to maintain
relationships.
STRUCTURAL INTEGRITY
● Structural integrity: Healing is the
process of restoring structural integrity
through nursing interventions that
promote healing and maintain structural
integrity.
3 CONCEPTS OF ADAPTATION
HISTORICITY
● Adaptation is a historical process.
● Responses are based on past
experiences, both personal and genetic.
SPECIFICITY
● Adaptation is also specific.
● Each system has particular responses.
● The physiologic responses that “defend
oxygen supply to the brain are distinct
from those that maintain the appropriate
blood glucose levels.” (Levine, 1989)
REDUNDANCY
● Although the changes that occur are
sequential, they should not be viewed as
linear.
● Rather, Levine describes them as
occurring in “cascades” in which there is
an interacting and evolving effect in
which one sequence is not yet
completed when the next begins.
SUBCONCEPTS
OF LEVINE’S THE
CONSERVATION MODEL:
ENERGY CONSERVATION
● Nursing interventions are based on the
conservation of the patient’s energy.
HOLISM
● The singular yet integrated response of
the individual to forces in the
environment.
HOMEOSTASIS
● Stable state normal alterations in
physiologic parameters respond to
environmental changes; an energy
sparing state, a state of conservation.
MODES OF COMMUNICATION
● The many ways information, needs, and
feelings are transmitted among the
patient, family, nurses, and other health
care workers.
THERAPEUTIC INTERVENTIONS
● Interventions that influence adaptation
favorably, enhancing the adaptive
responses available to the person.
LOCAL NURSING THEORIES
SR. LETTY KUAN
WHO IS SHE?
● Sister Letty G. Kuan is a nurse with a
Master's Degree in Nursing and
Guidance Counseling.
● She also holds a Doctoral Degree in
Education.
● For her vast contributions to the
University of the Philippines College of
Nursing faculty and academic
achievements, she is now Professor
Emeritus, a title awarded only to a few
who met the strict criteria.
● She had two Master’s Degrees, MA in
Nursing and MS Education, Major in
Guidance Counseling, culminating in
Doctor of Education (Guidance and
Counseling).
● She has clinical fellowship and
specialization in Neuropsychology at the
University of Paris, France (Salpetriere
Hospital).
● Neuro Gerontology in Waterson, New
York (Good Samaritan Hospital) and
Syracuse University, New York.
● She also had Bioethics formal training at
Institute of Religion, Ethics and Law at
Baylor College of Medicine in Houston,
Texas.
● She authored several books giving her
insight in the areas of Gerontology, Care
of Older Persons and Bioethics.
● She authored several books giving her
insight in the areas of Gerontology, Care
of Older Persons and Bioethics.
● She is a recipient of the Metrobank
Foundation Outstanding Teachers
Award in 1995 and an Award for
Continuing Integrity and Excellence in
Service (ACIES) in 2004. Her religious
community is the Notre Dame de Vie
founded in France in 1932.
● As a former member of the Board of
Nursing, her legacy to the Nursing
Community is without a doubt,
indisputable.
● About her Theory: “Retirement and
Role Discontinuities”.
BASIC ASSUMPTIONS
AND CONCEPTS
PHYSIOLOGICAL AGE
● 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 strong
genetic affinity to stay young for a long
time.
ROLE
● 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.
● It is also the set of shared expectations
from the retiree’s 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 a
complementary set of roles in the social
structure among which interaction
constantly occurs.
CHANGE OF LIFE
● Change of Life is the period between
near retirement and post retirement
years.
● In medico-physiologic terms, this
equates with the climacteric period of
adjustment and readjustment to another
tempo of life.
RETIREE
● 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
● Role Discontinuity is the interruption in
the line of status enjoyed or role
performed.
● The interruption may be brought about
by an accident, emergency, and change
of position or retirement.
COPING APPROACHES
● 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
HEALTH STATUS
● refer to the physiological and mental
state of the respondents, classified as
either sickly or healthy.
INCOME
● (economic level) refers to the financial
affluence of the respondent which can
be classified as poor, moderate or rich.
WORK STATUS
FAMILY CONSTELLATION
● means the type of family composition
described as either close knit or
extended family where three 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.
SELF-PREPARATION
CARMENCITA ABAQUIN
WHO IS SHE?
● Carmencita M. Abaquin is a nurse with a
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.
“PREPARE ME”
Interventions and the Quality-of-Life
Advance Progressive Cancer Patients.
THEORY OF CARMENCITA ABAQUIN
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.
FOCUS OF THE THEORY
● The focus is not on cure but on assisting
the patient to explore her humanity and
internal serenity as one is faced with the
challenge of life and death.
● This program emphasizes a holistic
approach to nursing care.
● PREPARE ME has the following
components:
PRESENCE
● Being with another person during 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 a 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.
COMMON INQUIRY IN THE THEORY
Nurses, in the Prepare me theory, should be
seen as what?
● Nurses must be seen not as mere
caregivers but facilitators of peaceful
acceptance of condition.
Though specific to patients in advanced
stages of cancer, how did
Abaquin describes the person in her theory?
Nursing that can Challenge the Values of the
● They are holistic beings with physical,
psychological, social, religious, level of
independence, and environmental
aspects.
What approach must be applied and used
with Patients who are
terminally-ill or those with incurable
diseases as with cancer? Why?
● Patients who are terminally-ill or those
with incurable diseases must be
approached in multifaceted care to
improve their quality of life.
What is developed in the patient when
patient clarifies her/his
values?
● Open mind that will facilitate acceptance
of the disease state or may help deepen
or enhance values.
Why is values clarification important and
helpful to the patient?
● The process of values clarification helps
one become internally consistent by
achieving closer between what we do
and what we feel.
SR. CAROLINA AGRAVANTE
(CASAGRA MODEL)
WHO IS SHE?
● Highschool Salutatorian - St. Paul
University.
● Magna Cum Laude - BS Nursing (1964)
St. Paul University
● Board Topnotcher (1964)
● Scholar - Masters in Nursing (1969)
Catholic University of America
● Ph.D. in Nursing (2002) - University of
the Philippines Manila
● Theory published in 2002
“Focus on the Type of Leadership in
Changing World”
THREE-FOLD TRANSFORMATION
LEADERSHIP CONCEPT
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.
SERVANT-LEADERSHIP SPIRITUALITY
● 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, story telling,
reflection, and finally commitment to
become servant-leaders in the footsteps
of Jesus.
SELF-MASTERY
● The Self-Mastery consists of a vibrant
care complex possessed to a certain
degree by all who have been through
formal studies in a caregiving profession
such as nursing.
SPECIAL-EXPERTISE
● 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.
KEY CONCEPTS
CASAGRA TRANSFORMATIVE
LEADERSHIP MODEL
● Has concepts of leadership from a
psycho-spiritual point of view, designed
to lead to radical change from apathy or
indifference to a spiritual person.
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.
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.
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.
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.
TRANSFORMATIVE TEACHING
● may also be termed Reflective
teaching, an umbrella term covering
ideas, such as thoughtful instruction,
teacher research, teacher narrative, and
teacher empowerment.
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.
CONCLUSION
SERVANT-LEADER SPIRITUALITY
● wherein a leader, through spiritual
exercise, realizes that his model in
caring for individual is Jesus;
SELF-MASTERY
● which involves individual's
self-awareness through formal
education in nursing, a continuous
education, seminars attended and his
involvement in organizations; and lastly,
SPECIAL EXPERTISE
● which draws emphasis in the nurse
faculty's involvement in the formation of
his students.
SR. CAROLINA AGRAVANTE
Sr. Carolina's CASAGRA Transformative
Leadership Theory is timely in this ever
fast-paced world. Nursing as a profession is
inevitably changing and the demand to be at
par with technology made it more
competitive. Nursing students need nursing
teachers to look up to. Embodied with these
three concepts, it is timely to put this theory
into practice.
DR. ROZZANO LOCSIN
WHO IS HE?
● Ph.D. in Nursing – University of the
Philippines (1988)
● MA in Nursing – Silliman University
(1978)
● BS in Nursing - Silliman University
(1976)
● Professor - Florida Atlantic University,
Christine E. Lynn
● College of Nursing (1991)
● Published/Edited Books:
(a) Advancing Technology, Caring, and
Nursing (2001)
(b) Technological Competency as Caring in
Nursing (Middle Range Theory, 2005)
(c) Technology and Nursing: Practice,
Concepts, and Issues (2007)
(d) A Contemporary Nursing Process: The
(Un)Bearable Weight of Knowing in
Nursing (2009
Dr. Locsin’s research and scholarly works
concerning technology and caring in
nursing converge on the theme “life
transitions in human health”
LOCSIN’S THEORY
TECHNOLOGICAL COMPETENCE AS
CARING IN NURSING
● Technological competency in nursing
fosters the recognition and realization of
persons as participants in their care
rather than as objects of care.
● The idea of "participation in their
care" stems from active engagement;
the nurse enters the world of the one
nursed, through available appropriate
technologies, attempting to know the
nurse more fully in the moment.
● In this practice, the assumption is
understood that the one nursed allows
the nurse to enter his or her world so
that together, they may mutually
support, affirm and celebrate each
other's being.
● In this relationship of the "knower"
and the "known", technology
provides the efficiency and the value
that marks their mutual and
momentary reality.
 ASSUMPTIONS

1. Persons are whole or complete at the

moment.
2. Knowing persons is a practice process
of nursing that allows for continuous
appreciation of a person moment to
moment.
3. Nursing is a discipline and a
professional practice.
4. Technology is used to know persons
fully in the moment.

LOCSIN: KNOWING THE OTHER PERSON

KEY POINTS FROM
TECHNOLOGICAL COMPETENCE: LOCSIN’S THEORY

● Assists the nurse in acknowledging the
person as a focus of nursing; using
technology competently to compliment
or assist the nurse in knowing the
patient in the moment.
CARING IN NURSING:
● Authentically knowing the person in the
moment, to the extent to which they
wish to be known.
CARING IN NURSING:
1. "The nurse can know the person fully
only in the moment".
2. "It is not entirely possible for the nurse
to fully know another human being,
except in the moment and only if the
person allows the nurse to know him/her
by entering into the other's world".
3. "The expectation is that the nurse is to
use multiple ways of knowing
competently in using technologies in
order to know the other fully as a
person".

● Knowing the patient in the moment as

RISKS WITH TECHNOLOGY
whole and complete persons, despite
IN NURSING
their condition.
- Ex. Amputees, hysterectomy, etc. these DOCTOR GOOGLE
people are still whole or complete as
human beings, even if using technology ● Patients diagnosing or misdiagnosing
to live themselves based on information from
- Ex. pacemaker, dialysis machine, the Internet.
prosthetic limbs.
CONFIDENTIALITY

● The widespread availability of private

information.
● Staff/patients posting on social media,
systems hacking, laptops stolen.
 EMR
● Permanent, nationally accessible health
record.
● Does a physiotherapist need to know
about the STI you had in 2009 etc.
COMPOSURE BEHAVIOR AND PATIENT’S
TECHNOLOGICAL COMPETENCE KEY
POINTS
1. Technological competency is seeing
people as participants in their care.
2. The Idea of participation in their care
stems from an active engagement; the
nurse enters the patient's world through
technology in an attempt to know the
patient fully in the moment.
3. Assumption: The patient consents to
the nurse entering his world so that
together, they may mutually support,
affirm and celebrate each other's being.
4. Technology provides efficiency and
value that marks mutual and momentary
reality between the knower and the
known.
CARMELITA DIVINAGRACIA
WHO IS SHE?
● Filipino Nurse Theorist
● Master in Nursing in 1975
● Doctoral Degree Holder in 2001
● Cardiologist Nurse
● Advanced Nurse Practitioner
● Dean of University of the East Ramon
Magsaysay Memorial
● Medical Center (UERMMMC) College of
Nursing
● Former President of The Association of
the Philippine Colleges of Nursing
(ADPCN)
● She has been a clinic staff and head
nurse, instructor, assistant dean and
dean.
● She lectured and wrote about her work
as a nurse and she used her hands-on
experiences to develop better ways to
teach nursing.
“ADVANCE NURSE PRACTITIONERS’
WELLNESS OUTCOME”
OBJECTIVE
1. Determine the effects of the
“COMPOSURE” behavior of the
advance nurse practitioner on the
wellness outcome of the selected
cardiac patients.
2. Significance of the Study - Nursing as
a healthcare profession would prove its
worth of being at PAR in quality
performances with other healthcare
professionals.
3. Study Population - Adult Cardiac
Patients---- admitted and confined at the
Philippine Heart Center, Coronary Care
Unit.
COMPOSURE MODEL
GOAL / PURPOSE OF THE THEORY
● To deliver quality care through
bio-behavioral caring interventions.
ADVANCE NURSE PRACTITIONER
● BSN graduate
● Licensed and has a clinical experience
of at least 2 years in the clinical area.
● Has undergone special training in critical
areas.
COMPOSURE MODEL
COMPOSURE BEHAVIORS
● Set of behaviors or nursing measures
that the nurse demonstrates to selected
cardiac patients; COMPOSURE is an
acronym which stands for:
● COM – petence
● P – resence & Prayer
● O – penmindedness
● S – timulation
● U – nderstanding
● R – espect and Relaxation
● E – mpathy
COMPETENCE
● In-depth knowledge and clinical
expertise demonstrated in caring for
patients.
PRESENCE AND PRAYER
● Being with another person during times
of need and reciting prayers that are
made through the nurse's personal
relationship and faith in God.
● Therapeutic communication, active
listening, and touch.
OPEN-MINDEDNESS
● Being receptive/open to new ideas or
reasons.
● Considering the patient's preferences
and opinions related to his or her current
health condition.
● Flexibility of the nurse to accommodate
the patient's views.
STIMULATION
● Providing encouragement that conveys
hope and strength.
● Giving explanation and supervision
when doing certain procedures to
patients.
● Use of complimentary words or praise
and smile whenever appropriate.
UNDERSTANDING
● Conveys interest and acceptance of a
patient's condition and his or her entire
being.
RESPECT AND RELAXATION
● Acknowledging the patient's presence.
● Use of preferred naming in addressing
the patient ("po" and "opo" are signs of
positive regard).
● Involves alternate tension and relaxation
of selected groups of muscles.
EMPATHY
● Senses accurately another person's
inner experience.
● Perceives the current positive thought or
feeling and communicates by putting
themselves in the patient's place.
CECILIA M. LAURENTE
WHO IS SHE?
● Filipino Nurse Theorist
● In 1967, she finished her nursing degree
at the University of the Philippines.
● From 1968 - 1969, she was a staff
nurse.
● From 1970 - 1972, she served as a
head nurse of the hospital.
● In 1973, she finished her masters
degree in nursing.
● From 1973 - 1976, she became the
nursing supervisor at the Philippine
General Hospital.
● From 1977 - 1979, she worked at a
Metropolitan Hospital in Michigan, USA.
● In 1979, same year, she became an
instructor at the University of
Philippines, College of Nursing.
● In 1987, she published a paper “the
Categorization of nursing activities as
observed in medical surgical wards or
units in selected government and private
hospitals in Metro, Manila.
 ● From 1966 - 2002, she served as the ● Sex / gender
Dean of College of Nursing in UP, ● Civil status
Manila. ● Age
● Length of work
● Experience
DEFINITIONS BY LAURENTE

ANXIETY

● A mental state of fear or nervousness

about what might happen.

NURSING CARE BEHAVIORS THAT AFFECT

THE PATIENT'S ANXIETY

PRESENCE

● Person to person contact between the

client and the nurse.

CONCERN

● Development in the time through mutual

trust of the nurse and the patient.

STIMULATION

● Nurse stimulation through words tops

the powerful resources of energy of a
person for healing.

ENHANCING AND
PREDISPOSING FACTORS

ENHANCING FACTORS

● One’s caring attitude, beliefs and

attitude.
● Feeling good about it.
● Learning at school.
● What patients tell about the nurse’s
coping mechanism to problems
encountered.
● Communication skills and style.

PREDISPOSING FACTORS

● Educational background