HEALTH
responses to actual or potential problem.
• Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity.
• Presence or absence of disease
WELNESS
Wellness is considered, “an active process
through which people become aware of, and
make choices toward, a more successful
existence” ---National Wellness Institute
HEALTH & WELLNESS
Health is a state of being, whereas Wellness is
the state of living a healthy lifestyle.
ILLNESS
Illness is a highly personal state in which the
person’s physical, emotional, intellectual,
social, developmental, or spiritual functioning
is thought to be diminished.
• Disease can be described as an alteration in
body functions resulting in a reduction of
capacities or a shortening of the normal life
span.
• Etiology causation of a disease or condition.
• Acute illness is typically characterized by
symptoms of relatively short duration.
• Chronic illness is one that lasts for an
extended period, usually 6 months or longer,
and often for the person’s life
• Illness behavior, a coping mechanism,
involves ways individuals describe, monitor,
and interpret their symptoms, take remedial
actions, and use the health care system.
• Remission, when the symptoms disappear.
• Exacerbation, when the symptoms reappear.
HOW DO WE DEFINE NURSING? :9)
• Is the art of caring sick and well individual. It
refers to the dynamic skills and methods in
assisting sick and well individual in their
recovery and in the promotion and
maintenance of health. It involves the creative
application of knowledge in the service of
people
NURSING (as a science)
• It is the “body of abstract knowledge” arrived
through scientific research and logical analysis
• Is the scientific knowledge and skills in
assisting individual to achieve optimal health. It
is the diagnosis and treatment of human
gained from understanding of the client or
Nursing (as a profession)
• Profession- a calling in which its members
profess to have acquired special knowledge by
training or experience, or both so that they
may guide, advise or save others in that special
field.
FLORENCE NIGHTINGALE 6:9)
• Nursing is the act of utilizing the environment
of the patient to assist him in his recovery.
VIRGINIA HENDERSON
• Nursing is the act of assisting the individual,
sick or well, in the performance of those
activities contributing to health or its recovery
(or to a peaceful death) that he would perform
unaided if he had the necessary strength, will,
or knowledge, and to do this in such a way as to
help him gain independence as rapidly as
possible.
CANADIAN NURSES ASSOCIATION (CNA)
• Nursing is a dynamic, caring, helping
relationship in which the nurse assist the client
to achieve and obtain optimal health. – 1987
THEMES THAT ARE COMMON TO THESE
DEFINITION:
• Nursing is caring
• Nursing is an art
• Nursing is a science
• Nursing is client-centered
• Nursing is holistic
• Nursing is adaptive
• Nursing is concerned with health promotion,
health maintenance, and health restoration
• Nursing is a helping profession
AMERICAN NURSES ASSOCIATION (ANA)
1973-Nursing is direct, goal oriented, and
adaptable to the needs of the individual, the
family, and community during health and
illness.
1980-Nursing is the diagnosis and treatment of
human responses to actual or potential health
problems.
1995-ANA acknowledges FOUR ESSENTIAL
FEATURES OF
CONTEMPORARY NURSING PRACTICE:
• Attention to the full range of human
experiences and responses to health and illness
without restriction to a problem-focused
orientation.
• Integration of objective data with knowledge
• “Nursing encompasses autonomous and
group’s subjective experience.
• Application of scientific knowledge to the
processes of diagnosis and treatment.
• Provision of caring relationship that facilitates
health and healing.
NURSE
• Comes from a Latin word “to nourish” or “to
cherish
• One who cares for the sick, the injured, and
the physically, mentally, and emotionally
disabled
• One who advise and instruct individuals,
families, groups and communities in the
prevention, treatment of illness and diseases
and in the promotion of health.
• An essential member of a health team who
cares for individuals, families and communities
in disease and illness prevention and in the
promotion of health and healthy environment.
• is a person who cares for the sick or infirm;
specifically: a licensed health-care professional
who practice independently or supervised by a
physician, surgeon, or dentist and who is skilled
in promoting and maintaining health (Merriam-
Webster)
• The word "nurse" originally came from the
Latin word "nutrire", meaning to suckle,
referring to a wet-nurse; only in the late 16th
century did it attain its modern meaning of a
person who cares for the infirm.(Wikipedia)
“A dynamic discipline. It is an art and science of
caring for individuals, families, groups and
communities geared toward promotion and
restoration of health, prevention of illness,
alleviation of suffering, and assisting clients to
face death with dignity and peace. It is focused
on assisting the client as he or she responds to
health-illness situations, utilizing the nursing
processes and guided by ethico-legal and moral
principles.” ----Associations of Deans of
Philippine Colleges of Nursing (ADPCN)
American Nursing Association (ANA) –
• “Nursing is the protection promotion, and
optimization of health and abilities, prevention
of illness and injury, alleviation of suffering
through diagnosis and treatment of human
response.
• Nursing is giving direct care and advocacy in
the care off individuals, families, communities,
and populations.”
International Council of Nurses (ICN)
collaborative care of individuals of all ages,
families, groups and communities, sick or well
and in all settings.
• Nursing includes the promotion of health,
prevention of illness, and the care of ill,
disabled and dying people.
• Other key nursing roles include advocacy,
promotion of safe environment, research,
participation in shaping health policies and in
patient and health systems management and
education.”
Responsibilities of Nurses
✓ Assess patient’s needs and problems
✓ Health maintenance of healthy o individuals
✓ Treatment, safety, and recovery of o acutely
or chronically ill or injured people
✓ Research and non-clinical functions
✓ Teaching and mentoring other nurses
✓ Scope of Work of RNs
✓ Promote health, prevent disease
✓ Advocate and educate patients
✓ Work with physicians
✓ Administer medications
✓ Assist clients in convalescence and
rehabilitation
“Nursing is the art and science of caring”
Nursing as an Art – use of imagination and
creativity in caring
Nursing as a Science – expansion of body
knowledge; health profession that establishes
itself as separate form practice of medicine
PATIENT
• Comes from a Latin word “PATIENS”,means
“to Suffer” or “to Bear”
• An individual who is in the state of physical,
mental, and emotional imbalance
• An individual who seeks for nursing
assistance, medical assistance, or for surgery
due to illness or a disease.
• Is an individual who is waiting or undergoing
medical or surgical care. One who is physically
or mentally disabled.
FIELDS OF NURSING
Nursing in Primary Care Setting
• Primary- initial health care for general
complaints
• Usually the person’s first contact with the
health care delivery system
• Managing current health care needs, and
preventing further problems.
Nursing in Primary Care Setting
1. Public health nursing
2. Occupational nursing
3. Clinic nursing
4. School nursing
5. Private duty nursing
6. Military nursing
7. Ambulatory care nursing
8. Nursing in correctional facilities
Nursing in Secondary Care Setting
• a form of early disease detection, identifies
individuals with high risk factors or preclinical
diseases through screenings and regular care to
prevent the onset of disease.
• Once identified, nurses work with these
patients to reduce and manage controllable
risks, modifying the individuals’ lifestyle choices
and using early detection methods to catch
diseases in their beginning stages when
treatment may be more effective.
• Regular screenings, conducted by a
preventative health care nurse, are the most
common method of secondary prevention and
can dramatically diminish the development of
certain illnesses.
Nursing in Secondary Care Setting
Institutional nursing: Hospital nursing
• Director of nursing
• Clinical coordinator
• Head nurse
• Staff nurse
• OB-Gyne nursing
• Pediatric nursing
• Orthopedic nursing
• OR nursing
• Med-surgical nursing
• Psychiatric nursing
• ER nursing
• Critical care nursing
• Flight nurse
• Infection-surveillance nurse
Nursing in Tertiary Care Setting
• This method involves the treatment of
existing diseases in patients.
• At this point of care, nurses are tasked with
helping individuals execute a care plan and
make any additional behavior modifications
necessary to improve conditions.
• As the primary and secondary methods have
been unsuccessful, this stage encompasses
methods of minimizing negative effects and
preventing future complications.
Nursing in Tertiary Care Setting
1. Skilled care setting
2. Rehabilitation setting
3. Advanced practice nursing (APN)
• Clinical nurse specialist
• Nurse anesthetist
• Nurse educator
• Nurse administrator
• Nurse researcher
ROLES OF A NURSE
Caregiver
• Primary goal
• TYPES OF CARE
1. Full Care -for completely dependent patient
2. Partial Care -for partially dependent patient
3.Supportive-Educative care -to assist clients in
attaining their highest possible level of health
and wellness; for learnings
Communicator
• Integral to all nursing roles
• Nurses communicate with the client, support
persons, other health professionals, and people
in the community
• Nurses identify client problems and then
communicate these verbally or in writing to
other members of the health teams
Teacher
• Nurses help clients learn about their health
and the health care procedure they need to
perform to restore or maintain their health.
• Nurses assesses the client’s learning needs
and readiness to learn, sets specific learning
goals in conjunction with the client, enacts
teaching strategies, and measures learning.
• Nurses also teaches unlicensed assistive
personnel to whom they delegate care, and
they share their expertise with other nurses
and health professionals.
Client Advocate
• Acts to protect the client
• Nurse may represent the client’s needs and
wishes to other health professionals, such as
relaying the client’s wishes for information to
the physician.
• Nurses assist clients in exercising their rights
and help them speak up for themselves
Counselor
• Helping a client recognize and cope with
stressful psychologic or social problems, to
develop improved interpersonal relationships,
and to promote personal growth.
• Involves providing emotional, intellectual and
psychologic support.
• Nurses counsel primarily healthy individuals
with normal adjustment difficulties and focuses
on helping the person develop new attitudes,
feelings, behaviors by encouraging the client to
look at alternative behaviors, recognizing the
choices, and develop sense of control.
Change Agent
• Assisting others to make modifications in
their own behavior.
• Nurses also often act to make changes in a
system if it is not helping client return to health.
Leader
• Influences others to work together to
accomplish a specific goal.
• Can be employed at different levels:
individual client, family, groups of clients,
colleagues, or the community
Case Manager
• Work with the multidisciplinary health care
team to measure the effectiveness of the case
management plan and to monitor outcomes.
• Works with primary or staff nurses to oversee
the care of a specific caseload.
• Primary nurse or provides some level of direct
care to the client and family
• Helps ensure that care is oriented to the
client, while controlling costs.
Research Consumer
• Often use research to improve client care
• Have some awareness of the process and
language of research
• Be sensitive to issues related to protecting the
rights of human subjects
• Participate in the identification of significant
researchable problems
• Be a discriminating consumer of research
findings
Role Model
• Has good physical appearance
• Practices proper hygiene
• Practices healthy lifestyle
Administrator
• Assumes middle management position
• Connects the patient to other services of the
hospital
Expanded Career Roles
• Nurse practitioner, clinical nurse specialist,
nurse midwife, nurse educator, nurse
researcher, and nurse anesthetist
• All of which allow greater independence and
autonomy.
NURSING AS A PROFESSION
CONCEPT OF PROFESSION (Marie Jahoda)
• An organization of an occupational group
based on the application of special knowledge
which establishes its own rules and standards
for the protection of the public and the
professionals.
• A profession implies that the quality of work
done by its members is of greater importance
in its own eyes and the society than the
economic rewards they earn.
• Serves all of society and not the specific
interests of a group
PROFESSIONAL PERSON
• Is concerned with quality.-KSA
• Is self-directed, responsible and accountable
for his actions.
• Is able to make independent and sound
judgment including high moral judgment.
• Is dedicated to the improvement of human
life.
• Is committed to the spirit of inquiry
NURSING AS A PROFESSION Primary
Characteristics:
• Education
• Theory
• Service
• Autonomy
• Code of Ethics
• Caring
Professional Nursing
“performance for a fee , salary, or other reward
or compensation, of professional nursing
services to individuals, families and
communities in various stages of development
toward the promotion of health, prevention of
illness, restoration of health and alleviation of
suffering---the Philippine Nursing Act
Professional Nursing
- art and science, dominated by an ideal of
service in which certain principles are applied in
skillful care of the well and ill, and through
relationship with the client, significant others
and other members of the health team.
• Professional Nurse
- A person who has completed a basic nursing
education program and is licensed in his
country or state to practice professional
nursing.
QUALITIES AND ABILITIES OF A PROFESSIONAL
NURSE
• Has faith in the fundamental values that
underlie the democratic way of life:
• Respect for human dignity
• Self sacrifice for the common good.
• Strong sense of responsibility for sharing in
the solution of the problems of the society.
• Has a sense of responsibility for
understanding those with whom he works or
associates with through the use of skills:
• Has the basic knowledge, skills and attitudes
necessary to address present day social
problems, realistic and well organized thoughts
through the use of critical thinking
• Has skills in using written and spoken
language, both to develop own thoughts and to
communicate them to others.
• Appreciates and understands importance of
good health
• Has emotional balance.
• Accepts and tries to understand people of all
sorts, regardless of race, religion and color.
5 FOLDS NURSING FUNNCTION
1. PROMOTING HEALTH AND WELLNESS
• Wellness – state of well-being. Engaging in
attitudes and behavior that enhance the quality
of life and maximize personal potential
• For both healthy and ill.
• Involve individual and community activities to
enhance healthy lifestyle, such as improving
nutrition and physical fitness, preventing drug
and alcohol misuse, restricting smoking, and
preventing accidents and injury in the home
and workplace.
2. PREVENTING ILLNESS
• The goal is to maintain optimal health by
preventing diseases
• Nursing activities includes immunizations,
prenatal and infant care, and prevention of
sexually transmitted disease.
3. Pain/suffering Alleviation
• The goal is to provide relief from pain to
promote comfortable healing process
4. RESTORING HEALTH
• Focuses on the ill client
• Extends from early detection of disease to
helping the client during the recovery period
NURSING ACTIVITIES:
• Providing direct care to the ill person:
administering medications, baths, and specific
procedures and treatments
• Providing diagnostic and assessment
procedures: measuring BP and examining feces
for occult blood
• Consulting with other health care
professionals about client’s problems
• Teaching clients about recovery activities:
exercise that will accelerate recovery after a
stroke
• Rehabilitating clients to their optimal
functional level following physical or mental
illness, injury, or chemical addiction
5. Creation of a spiritual environment
• Provision of spiritual care
• Involves comforting and caring for people of
all ages who are dying
• Includes helping clients live as comfortable as
possible until death and helping support
persons cope with death.
• Work in homes, hospitals, and extended care
facilities
• Hospices are specifically designed for this
purpose.
HISTORY AND EVOLUTION OF NURSING
INTUITIVE PERIOD/MEDIVAL PERIOD
• Prehistoric to Early Christian Era
•More on “intuition”
•NOMADS – travel from one place to another
• Survival of the fittest
• “Best for the most” – motto
• Sickness is due to “voodoo
• Performed out of feeling of compassion for
others
• Performed out of desire to help
• Performed out of wish to do good
• Nursing is given by the WOMEN
• SHAMAN - uses white magic to counteract the
black magic
• They are the doctors during those time
• TREPHINING - drilling the skull
• Used to treat Psychotic patients.
• Psychotic patients are believed to be
possessed by evil spirits.
• Growth of religion - most important thing that
happened
• Growth of civilization
• Law of preservation – inspire man in search of
knowledge
“Rise in Civilization”
“Rise in Civilization”
• From the mode of Nomadic life → agrarian
society → gradual development of urban
community life
• Existence of means of communication
• Start of scientific knowledge → more complex
life → increase in health problems → demand
for more nurses
• Nursing as a duty of SLAVES and WIVES.
NURSING DID NOT CHANGE but there was
progress in the practice of medicine.
• Care of the sick was still closely allied with
superstitions, religion and magic
• Near East – birth place of 3 religious
ideologist:
• Judaism
• Christianity
• Mohammedism or Islam
• Near East culture was adopted by the Greeks
and Romans combined with the wonders of the
Far East by returning crusaders and explorers
improved and was carried to Europe during the
Renaissance Period that resulted to greater
knowledge then to the New World by the Early
settlers.
• New World – a tiny area known as a birth of
monotheism that lies between tigris and
Euprates River
in the Nile River arose the cultures of
babylonia, Egypt and Hebrew.
• MONOTHEISM – believer of one God
“Different Civilization”
• BABYLONIANS
• EGYPTIANS
• HEBREW
• CHINA
• INDIA
• GREECE
• ROMANS
BABYLONIANS
• CODE OF HAMMURABI
• First recording on the medical practice
• Established the medical fees
• Discouraged experimentation
• Specific doctor for each disease
• Right of patient to choose treatment between
the use of charms, medicine, or surgical
procedure
EGYPTIANS
• ART OF EMBALMING
• Mummification
• Removing the internal organ of the dead body
• Instillation of herbs and salt to the dead
• Used to enhance their knowledge of the
human anatomy.
• Since work was done and performed on the
dead, they learned nothing of Philosophy
• “THE 250 DISEASES”
• Documentation about 250 diseases
• and treatments
HEBREW
Teachings of MOSES
• Created Leviticus
• Father of sanitation
• Practice the values of “Hospitality
to strangers” and the “Act of
Charity” – contained in the book
of Genesis
LEVITICUS – 3rd book of the
Old Testament
• Laws controlling the spread of
communicable diseases
• Laws governing cleanliness
• Laws on preparation of food
• Purification of man and his food
• The ritual of CIRCUMCISION
on the 8th day after birth
MOSAIC LAW
• Meant to keep Hebrews pure so
that they may enter the
sanctuary without affronting God
• Meant as a survival for health and
hygienic reason only
CHINA
Use of pharmacologic drugs
• “MATERIA MEDICA”
-Book that indicates the pharmacologic drug
used for treatment
• No knowledge on anatomy
• Use of wax to preserve the body of the dead
• Method of paper making
• FACTOR THAT HAMPERED THE
ADVANCEMENT OF MEDICINE:- Prohibits
dissecting of human body thus thwarting
scientific study
INDIA
SUSHURUTA
• 1st recording on the nursing practice
• Hampered by Taboos due to social structures
and practices of animal worship
• Medicine men built hospitals
• Intuitive form of asepsis
• There was proficient practice of Medicine and
Surgery
• NURSES QUALIFICATIONS: Lay Brothers,
Priest Nurses, combination of Pharmacist,
Masseurs, PT, cooks
• There was also decline in Medical practice
due to fall of Buddhism – state religion of India
GREECE
• AESCULAPIUS- Father of medicine in Greek
mythology, god of healing
• HIPPOCRATES- Father of modern medicine
• 1st to reject the idea that diseases are caused
by evil spirits
• 1st to apply assessment
• Practice medical ethics
• CADUCEUS- Insignia of medicine
• Composed of staff of travellers intertwined
with 2 serpent (the symbol of Aesculapus and
his healing power). At the apex of the staff are
two wings of hermes (Mercury) for speed.
• NURSES → function of untrained slaves
“HIPPOCRATIC OATH AND NIGHTINGALE
PLEDGE”
• Hippocratic oath is an oath historically taken
by the Physicians and other healthcare
professionals swearing to practice medicine
honestly. It is widely believed to have been
written by Hippocrates.
• Nightingale pledge- is a statement that nurses
utter in order to prove their sincerity with their
profession. Nurses undertake promise in front
of the experiences practitioners that they
would abide by the rules and regulations of
nursing care. Also accompanies the Candle
lighting segment ceremony (Capping & Pinning)
ROMANS
• Proper turnover for the sick people
• “if you’re strong, you’re healthy” – motto
• Transition from Pagan to Christianity
• FABIOLA—was converted to Christian and
later she converted her home to a hospital and
used her wealth for the sick. (Roman Matron)-
high rank women
• 1st hospital in the Christian world
APPRENTICE PERIOD/MIDDLE AGES
• 11th century → 1836
• On-the-job training period
-Refers to a beginner (on-the-job training). It
means care performed by people who are
directed by more experienced nurses
• Starts from the founding of Religious Orders
in the 6th century (1836 – when the
deaconesses School of Nursing was established
in Kaiserweith,
• Germany by Pastor THEODORE FLEIDNER)
• There was a struggle for religious, political,
and economic power
• Crusades took place in order to gain religious,
political, and economic power or for adventure
• During the Crusade in this period, it happened
as an attempt to recapture the Holy
• Land from the Turk who obtained and gain
control of the region as a result of power
stuggle. Christians were divided due to several
religious war and Christians were denied visit to
The Holy Sepulcher
•MILITARY RELIGIOUS ORDERS AND THEIR
WORKS
KNIGHTS OF ST. JOHN OF JERUSALEM
(ITALIAN)
• Also called as “Knights of the Hospitalers”
• Established to give care
• Established ambulance service
• Major organizer of the International RedCross
• Military in its character
TEUTONIC KIGHTS (GERMAN)
• Took subsequent wars in the Holy Land
• Cared for the injured and established
hospitals in the military camps
KNIGHTS OF ST. LAZARUS
• Care for those who suffered Leprosy, syphilis,
and chronic skin diseases
(Alexian Brothers School of Nursing)
• ALEXIAN BROTHERS- A monasteric order
founded in 1348. They established the Alexian
Brothers
• School of Nursing, the largest school under
religious auspices exclusively in US and it closed
down in 1969.
• ST. VINCENT DE PAUL- SISTERS OF CHARITY
• LOUISE de GRAS-patron saint of sick people,
widows and orphans in 1960s
Prior to Florence Nightingale Is the Dark Age
for Nursing because…
• Nursing is considered as
• A very low job in terms of social hierarchy.
• A job for the uneducated and poor.
• A desperate occupation.
Who are the nurses?
• Women of lowest social standing
• Wayward women of low status, instead of
going to prison, they were asked to served as
nurses.
• monastic women or untrained helpers of low
repute.
• Poor unmarried woman with no family or no
chance of getting married.
The Dark Period of Nursing
• From 17th century – 19th century
• Also called the Period of Reformation
• until the American Civil War
• Hospitals were closed
• Nursing were the works of the least desirable
people (criminals, prostitutes, drunkards,
slaves, and opportunists)
• Nurses were uneducated, filthy, harsh, ill-fed,
overworked
• Mass exodus for nurses
(Martin Luther)
The American civil war was led by Martin
Luther, the war was a religious upheaval that
resulted to the destruction in the unity of
Christians.
The conflict swept everything connected to
Roman Catholicism in schools, orphanages, and
hospitals
THEODORE FLIEDNER
• (a pastor) reconstituted the deaconesses and
later be established the School of Nursing at
Kaiserswerth, Germany-where Florence
Nightingale had her first formal training for 3
months as nurse
Florence Nightingale
• An English lady from a wealthy family during
the Victorian era
• During the Crimean War known to be the
“Lady with the Lamp”
• A nursing theorist, writer and statistician.
• Changed the image of nursing
• Dubbed as the “Lady with the Lamp”
NOTES on NURSING (1859)
“What it is and What it is not”
EDUCATIVE PERIOD/NIGHTANGLE ERA
(Florence Nightingale School of
Nursing )
• Began in June 15, 1860 when Florence
Nightingale School of Nursing opened at St.
Thomas Hospital in London England, where 1st
program for formal education of Nurses began
and contributed growth of Nursing in the US
School of Nursing
• In 1860, Nightingale laid the foundation of
professional nursing when the first school of
nursing was established.
• Nightingale Training School at St. Thomas’
Hospital
FACTORS THAT INFLUENCED DEVELOPMENT
OF NURSING EDUCATION:
• Social forces
• Trends resulting from war
• Emancipation of women
• Increased educational opportunities
Florence Nightingale
• Mother of modern Nursing
• Born on May 12, 1820 in Florence, Italy
• Her SELF-APPOINTED GOAL – to change the
profile of Nursing
• She complied notes of her visit to hospitals,
her observations of sanitation practices and
entered Deaconessess School of Nursing at
Kaiserswerth Germany for 3 months.
• Became the Superintendent of the
Establishment for Gentle Women during the
illness (refers to the ill governess or instructors
of Nursing)
• She disapproved restriction on admission of
patient and considered this unchristian and
contrary to health care.
• Upgraded the practice of Nursing and made
Nursing a honorable profession
• Led other nurses in taking care of the
wounded and sick soldiers during the Crimean
War
• She was designated as Superintendent of the
Female Establishment of English General
Hospital in Turkey during the Crimean War
• She reduced the casualties of war by 42% - 2%
thru her effort by improving the practice of
sanitation techniques and procedure in the
military barracks
THE CONCEPT OF FLORENCE NIGHTINGALE ON
NURSING SCHOOL:
• School of Nursing should be self – supporting
not subject to the whimps of the Hospital.
• Have decent living quarters for students and
pay Nurse instructors
• Correlate theories to practice
• Support Nursing research and promote
continuing education for nurses
• Introduce teaching knowledge that disease
could be eliminated by cleanliness and
sanitation and Florence Nightingale likewise did
not believe in the Germ Theory of Bacteriology
OTHER SCHOOLS OF NURSING
• LINDA RICHARDS – the first graduate nurse in
United States Graduated in September 1, 1873
- the first American trained Nurse (1870)
became a great nursing pioneer in USA and
Japan.
• 2 NUSING ASSOCIATION / ORGANIZATION
THAT UPGRADED NURSING PRACTICE IN US:
-American Nurses Association
-National League for Nursing Education
CONTEMPORARY PERIOD
• World War II – present
• his refers to the period after World
• War I and the changes and development in
the trends and practice of Nursing occurring
since 1945 after World War II.
• Includes scientific and technological
development, social changes occurring after
the war.
• Nursing is offered in College and Universities
FACTORS AFFECTING NURSING TODAY:
• Economics
• Consumer’s Demand
• Family Structure
• Information and Telecommunications
• Legislation
HISTORY OF NURSING (PHILIPPINE SETTING)
EARLY BELIEFS AND PRACTICES
• Beliefs about Causation of diseases:
-Caused or inflicted by other person (enemy or
witch)
-Evil spirits
-Beliefs that evil spirits could be driven off by
person with powers to expel bad spirits:
-Believed in Gods of Healing
• Word doctors – priest physicians
• HERBULARIOS – herb doctors
EARLY CARE FOR THE SICK
-HERBICHEROS – herb men who practice
Witchcraft
-MANGKUKULAM / MANGANGAWAY – a
suffering from disease without any identified
cause and were believed bewitched by such
-Difficult child birth and some diseases
attributed to (NONO) midwives
-Difficult child birth, witches were supposed to
be the cause, gunpowder exploded froma
bamboo pole close to the head of the mother
to drive evil spirits
EARLY HOSPITALS
Hospital Real de Manila – 1577
-First hospital established by Gov. Francisco de
Sande
-To give service to the king’s Spaniard soldiers
• San Lazaro Hospital – 1578
• Fray Juan Clemente
• Named after the Knights of St. Lazarus
• Hospital for the lepers
• Hospital de Indios – 1586
• Franciscan Orders
• Hospital for the poor Filipino people
• Hospital de Aguas Santas - 1590
• Fray Juan Bautista
• Named after its location (near spring) because
people believed that spring has a healing
power.
• San Juan de Dios Hospital – 1596
• For poor people
• Located at Roxas Boulevard
PERDONAGES
Dona Hilaria de Aguinaldo
• first wife of Emilio Aguinaldo
• Established Philippine Red Cross – February,
17 1899
Dona Maria Agoncillo de Aguinaldo
• second wife of Emilio Aguinaldo
• 1st president of Philippine Red Cross
(Batangas Chapter)
Josephine Bracken
Helped Rizal in treating sick people
Melchora Aquino “Tandang Sora”
Took care of the wounded Katipuneros
Anastacia Giron Tupas
• Founder of Filipino Nurses Association
– established on October 15, 1922
• 1st Filipino chief nurse of PGH
• 1st Filipino Superintendent of Nurses in the
Philippines
CesariaTan
• 1st Filipino to receive Masteral Degree in
Nursing abroad
Socorro Sirilan
• Pioneer in social service at San Lazaro
Hospital
• Also the Chief Nurse Francisco Delgado
• 1st president of Filipino Nurses Association
Socorro Diaz
• 1st editor of PNA magaziine called, “The
Message”
Conchita Ruiz
• Full time editor of the PNA newly named
magazine, “The Filipino Nurse”
Sor Ricarda Mendoza
• Pinoneer in Nursing Education
Loreto Tupaz
• “Dean of the Philippine Nursing”
• Florence of Iloilo
EARLY NURSING SCHOOLS
• Iloilo Mission Hospital School of Nursing (Ilo
ilo City, 1906)
• Ran by the baptist foreign mission society of
America.
• Miss Rose Nicolet, graduate of New EnglanD
Hospital for women and children.
• In Boston, Masachusetts was the first
superintendent for nurses.
• It moved to its present location in Jaro road,
Iloilo
city 1929.
• Miss Flora Ernst, an American nurse, took
charge of the school in 1942
Hospital and School of Nursing
Iloilo Mission Hospital School of Nursing
• Established in 1906 under the supervision of
Rose Nicolet (American)
• Nursing course – 3 years
• Produced 1st batch of nursing graduates in
1909 – 22 nurses
• 1st TRAINED NURSES
- Nicasia Cada
- Felipa dela Pena
- Dorotea Caldito
• April 1946 – 1st nursing board exam at Iloilo
Mission Hospital
• Mary Johnson School of Nursing
• PGH School of Nursing – 1907
Mary Johnson School of Nursing
• Organized in 1907 by Dr. Rebecca Parish, Rosa
Dudley and Gertrude Dreisback, the first
Superintendent of the School
St. Paul’s Hospital School of Nursing (Manila,
1907)
• The hospital was established by the
Archbishop of Manila, the most Reverend,
Jeremiah harty under the supervision of the
sisters of St. Paul the charters.
• Located in the Intramuros, and it
provided general hospital services.
• 1908 – operated its training school for nurses
with Rev. Mother Melanie as superintendent
and Miss E Chambers as principal.
Philippine General Hospital School of Nursing
(1907)
• Anastacia Giron Tupas – first Filipino nurse to
occupy the position of chief nurse and
superintendent. St. Luke’s Hospital School of
Nursing
• (Quezon city, 1907)
• 1907 – the school opened with
• three Filipino girls admitted.
• These girls had their first year in combined
classes with the PGH
• Hospital School of Nursing and St. Paul’s
Hospital School of Nursing.
• Vitaliana Beltran was the firstFilipino
superintendent of nurse.
First Colleges of Nursing in the Philippines
University of Santo Tomas College of Nursing
• February 11, 1941 – the college began as the
UST school of nursing education
• Dr. Jesus Bacala- was appointed the First
Dean of College
• Sor Taciana Trinanes was its first Directress.
Manila Central University College of Nursing
• June1947, offered the BSN course
• Miss Consuelo Gimeno was its first principal
• The idea of opening the college began in
conference between Miss Julita Soteja
and the UP President Gonzales
• In 1948, the university council approved the
curriculum, and the board of regents
recognized the profession as having equal
standing as medicine, law, engineering, etc.
• Miss Julita Sotejo was its first dean.
Far Eastern University Institute of Nursing
• Established in June 1955
• 3-year diploma program and post basic
Advanced Professional Program
• The school has graduated a total of 440
students, 144 of whom graduated as Graduates
in Nursing
• June 1963, the Institue started its 5-year basic
program leading to the degree of Bachelor of
Science in Nursing
University of the East College of
Nursing
• Established in October 1958
• 5-year collegiate program leading to the
degree of Bachelor of Science in Nursing
The First Nurse Board Examination
• The first Nurse Law (Act No. 2808)-provided
for the holding of the examinations for the
practice of nursing on the second Monday of
June and December of each year.
• Section 13 of Act No. 2808- nurses need to
secure certificates of registration as nurse from
the Board upon payment of the prescribed fee
of ten pesos.
• The first examination was held in Manila on
June 14, 21, 22 and 25, 1920
• Theoretical Examination was held in
Ampitheater of the College of Medicine and
Surgery of the UP
• Practical Examination was given in the Library
of the PGH
• 68 out 99 examinees passed
• Anna Dahlgen-93.5%
• Virginia Pamintuan-93.4%
• Melecio Zabalo-84.6%
Theories
A set of statements that tentatively describe,
explain, or predict relations among concepts
that have been systematically selected and
organize as an abstract representation of some
phenomenon (McEwen &Wills 2019.
Nursing Theories
• Nursing theories are organized bodies of
knowledge to define what nursing is, what
nurses do, and why do they do it.
• Nursing theories provide a way to define
nursing as a unique discipline that is separate
from other disciplines (e.g. medicine)
• It is a framework of concepts and purposes
intended to guide the practice of nursing at a
more concrete and specific level.
History of Nursing Theories
• In 1860, Florence Nightingale defined
nursing in her “Environmental Theory”
• In 1952, Hildegard Peplau introduced her
Theory of Interpersonal Relations
• In 1955, Virginia Henderson
conceptualized the nurse’s role in assisting
sick or healthy individuals
• In 1960, Faye Abdellah published her
work “Typology of 21 Nursing Problems”
• In 1962, Ida Jean Orlando viewed the
professional function of nursing as finding
out and meeting the patient’s immediate
need for help
• In 1968, Dorothy Johnson pioneered the
Behavioral System Model
• In 1970, Martha Rogers viewed nursing as
both science and an art
• In 1971, Dorothea Orem-nursing care is
required if the client is unable to fulfill needs
• In 1971, Imogene King’s Theory of Goal
attainment- nurse patient relationship in
meeting goals.
• In 1972, Betty Neumann- Stress Reduction is
the goal
• In 1979, Sr. Callista Roy –Maintain the balance
between various stimuli for adaptation
• In 1979, Jean Watson developed the
philosophy of caring highlighted humanistic
aspects of nursing
Stages in the Development of Nursing Theory
Components of a Theory
o Concepts
o Definition
o Assumptions
o Phenomenon
Concepts
• Building blocks of theories
• Serves as primary vehicle
• Concepts may be abstract or concrete.
• Examples: Noise, cleanliness, ventilation,
bed and beddings, warmth in
Nightingale’s Environmental theory
Definitions
• It conveys the general meaning of the
concepts in a manner that fits the theory.
• An example in Newman’s theory she
defined stressor as any stimuli that can
produced tension and cause instability
within the system
Two Types of Definition
1.Theoretical definition concepts that are
defined in the dictionary or based on the
theorist’s perspective
Ex: Temperature is the hemo thermic range of
a person’s internal environment maintained
by the thermoregulatory system of the body
2. Operational definition concepts based on
how these concepts are used or will be used
within the context of the phenomenon being
observed or experienced
Ex: Temperature is the degree of temperature
measured by the oral thermometer taken for
one minute under the tongue
Assumptions
• These are statement of the describe
concepts or connect two concepts that
are flactual.
• These are the ‘’taken for granted
statements that determine the nature of
the concepts, definition, purpose,
relationship and structure of the theory
Example of Assumptions
• For example, Neuman’s systems model
the assumptions include the following:
describe concepts or connect two
concepts
Phenomenon
• A phenomenon is the term, description, or
label given to describe an idea or responses
about an event , a situation, a process, a group
of events, or a group of situations.
• Examples of phenomenon of nursing include
caring, self-care, and patient responses to
stress.
Conceptual Framework
• A set of interrelated concepts that
symbolically represents and conveys a mental
image of a phenomenon.
• Conceptual models of nursing identify
concepts and describe their concepts and
describe their relationships to the phenomena
of
central concern to the discipline:
person, environment, health and
nursing
Hypothesis
•It is an educated guess based upon
observation
• Can be supported or proven false by
experimentation or continued observation
Model
• Representations of the interaction among
and between the concepts showing patterns
• Models are typically accompanied by a
pictorial representation of the
variables and their interrelationships
Theoretical Model
Philosophy
• Beliefs & values that define a way of thinking
& are generally known & understood by a group
(discipline)
Paradigm
• Refers to a pattern of shared understanding
and assumptions about reality and the world
Metaparadigm
• Specifies the main concepts that
encompass the subject matter and the
scope of discipline.
• “There is a general agreement that
nursing’s metaparadigm consists of the
central concepts of person, environment,
health and nursing.” (Powers and Knapp)
Nursing Metaparadigm
Metaparadigm
Person
-also referred to as Client or Human Beings
-it is the recipient of nursing care and may
include individuals, patients, groups, families,
and communities
Environment
-is defined as the internal and external
surrounds that affect the client.
-it includes all positive or negative conditions
that affect the patient, the physical
environment such as families, friends and
significant others, and the setting for where
they go for their healthcare
Health
-defined as the degree of wellness or wellbeing
that the client experiences.
-it may have different meanings for each
patient, the clinical setting and the healthcare
provider
Nursing
-the attributes, characteristics, and actions of
the nurse providing care on behalf or in
conjuction with, the client.
Classification of Nursing Theories
•Based on scope (complexity
and degree of abstraction)
•Based on types of Purpose
•According to Meleis
Types of Theory Based on
Scope
Theory:
• Metatheory
• Grand theories
• Middle range theories
• Practice theories
Level of Abstraction:
• Most abstract
• Least abstract
Levels of Nursing Theory
a. Metatheory
• These are theories whose subject matters are
some other theories (theories about theories)
• It describes the philosophical basis of the
discipline (aka Nursing Philosophies)
• The highest level of theory in terms of
abstraction thus very difficult to for practical
application
Example of Metatheory
• Ray and Turkel, Theory of Relational Caring
Complexity, regarded “the caring relationship
as the complexity in nursing science” with
multidisciplinary focus and “spiritual-ethical
caring at the center of complex relational caring
practice of nursing in healthcare organizations”
b. Grand theory
• It describes the comprehensive conceptual
frameworks (aka Nursing Conceptual Models)
• Are broad in scope and complex and
therefore requires further specification
through research before they can be tested
• Focus on broad, nonspecific, and general
areas and concepts
• They lack operational definitions
Example of Grand theories
• An example of a grand nursing theory is Ida
Jean Orlando Pelletier’s Deliberative Nursing
Process Theory.
C. Middle- Range theories
• They have more limited scope, less
abstraction, address specific phenomena or
concepts and reflect practice (e.g. pain, stress
adaptation)
• They more precise and highly specific in
nursing
• They exhibit “best of both world”- i.e. easy
applicability in practice and abstract enough to
be scientifically interesting
• They are easier to apply as frameworks for
research studies
Examples of Middle- Range theories
• An example of a middle range nursing theory
is Imogene King’s Theory of Goal Attainment.
D. Practice Theory
• They are also called situation-specific
theories, prescriptive theories and are the least
complex and “action-oriented”
• They are more specific than middle range
theories and produce specific directions for
practice
• They are usually limited to specific
populations or fields of practice
Examples of Practice Theories
• Examples of practice theories developed and
used by nurses are theories of postpartum
depression, infant bonding and oncology pain
management.
By Goal Orientation
Theories can also be classified based on their
goals.
• descriptive
• prescriptive
Types of Descriptive Theories
1. Factor-isolating theories (descriptive
theories)
• These describe, observe, and name concepts,
properties and dimensions but does not explain
how or why the concepts are related.
• It is generated and tested by descriptive
research techniques (case studies, literature
review, phenomenology, ethnography)
Example of Descriptive Theory
• Theoretical model describing the experience
of caring for a dying spouse
Types of Descriptive Theories
2. Factor-relating theories (explanatory
theories)
• They relate concepts to one another, describe
the interrelationships among concepts or
propositions
• They attempt to tell how or why the concepts
are related and may deal with cause and effect
and correlations or rules that regulate
interactions.
• They are developed by correlational research
• Example: Theory of spirituality-based nursing
practice by Nardi & Rooda
Types of Purpose Theories
3. Situation-relating theories (predictive
theories or promoting or inhabiting theories)
• This predicts occurrence of a phenomenon
when the cause is present
• Experimental research is used to generate
and test them in most cases
• Example: The relationship between
spirituality and health status among adults
living with HIV by Cobb
Types of Purpose Theories
4. Situation- producing theories (prescriptive
theories)
• Prescriptive theories address nursing
therapeutics and consequences of
interventions.
• “Prevents” occurrence of the phenomenon by
controlling or eliminating possible causes
• Example: A prescriptive theory explaining
medical acupuncture to reduce stress and
enhance well being
Nursing Theories Classification
According Meleis (2011)
• “Needs theories.
• “Interaction theories”
• “Outcome theories”
 Nursing Theories Classification
According Meleis (2011)
1. “Needs” theories
 Are based around helping individuals to fulfill
their physical and mental needs.
2.“Interaction” theories
 As described by Peplau (1988), these theories
revolve around the relationships nurses form
with patients.
3. “Outcome” theories"
 Outcome theories portray the nurse as the
changing force, who enables individuals to
adapt to or cope with ill health