A.

PHILOSOPHIES

I. FLORENCE NIGHTINGALE
 Was born in Florence Italy
 May 12, 1820
 was provided with very broad education
 fought the bureaucracy for bandages, food, fresh bedding, & cleaning
supplies for the soldiers during the Crimean War
 great concern for the well-being of the English soldiers
 she provided comfort for the critically ill & dying
 after the war, she established schools of nursing
 She died on August 13, 1910
 MOTHER OF MODERN NURSING ---She used the information gathered
through life experiences in the development of nursing
 GERMANY
- was the first site of organized nursing school in1836
- Pastor Theodor Fliedner; opened a hospital in Kaiserswerth Germany
- one patient, one nurse & one cook
- lack of work force led to the development of a school in nursing
- the physician spent time to teach nursing students
 GERTRUDE REICHARDT
- 1ST Matron of the Deaconess School of Nursing
- no textbooks available until 1837
- Nightingale visited Kaiserswerth for 14 days
- she entered the nursing program July 6, 1851, the 134 th nursing student
- she developed both nursing care & management skills
Approach to Nursing:
 Used her knowledge, understanding & prevalence of disease & her
observation to develop an approach to nursing
 CONTROL OF ENVIRONMENT---Individuals & family both healthy & ill
1. Ventilation & light
2. Proper disposal of sewage
3. Appropriate nutrition
 NOTES ON NURSING:
- thought to women who have personal charge of health of others
- everyday sanitary knowledge
- she wanted women to teach themselves to nurse
- In her writings, she provided much information on the influence of the
environment
Environmental Model
 Manipulation of the physical environment as a component of nursing care
Major Areas Of Environment
1. Health Of Houses
 - Badly constructed houses do for the healthy what badly constructed
hospitals do for the sick. Once insure that air is stagnant & sickness is
certain to follow”
- Cleanliness outside the house affects the inside
2. Ventilation & Warming
- “keep the air he breathes as pure as the external air w/o chilling him”
3. Light
- patient’s need direct sunlight
- sick people rarely lie with their face toward the wall but are much more
likely to face the window
4. Noise
- patient’s should never be waked intentionally or accidentally
- noise affects the healing
5. Variety
- Variety of environment was a critical aspect affecting the patient’s
recovery
- effect of the body & the mind
- reading, needlework, writing, cleaning activities to relieve boredom.

6. Bed And Bedding

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

7. Cleanliness Of Rooms And Walls

- “the greater part of nursing consists in preserving cleanliness”
- she urges removal of dust instead of relocating
- a clean room is a healthy room

8. Personal Cleanliness
- Skin is important
- excretion must be washed
- unwashed skin can poison, drying & bathing can provide great relief
- ”it is necessary to keep the pores of the skin free from all obstructing
excretions”
- “every nurse ought to wash her hands very frequently during the day
9. Nutrition And Taking Food
10. Chattering Hopes And Pieces Of Advice
11. Observation Of The Sick
12. Social Considerations

Metaparadigm In Nursing
 Nursing
- “what nursing has to do...is to put the patient in the best condition for
nature to act upon him”
- signifies the proper use of the major areas in environment
 Person
- Not defined by Nightingale specifically, but are defined in relationship
to their environment & the impact on them
 Environment
- She focused on ventilation, warmth, noise, light, & cleanliness
- All that surrounds human beings is considered in relation to his state
of health
 Health
- No definition of health specifically
- pathology teaches the harm disease has done
- “nature alone cures”
- Nursing should provide care to the healthy & ill & discussed health
promotion as an activity in which nurses should engage

Teacher’s Insight

The focus of nursing in this model is to alter the patient’s environment in order to
affect change in his or her health. The environmental factors that affect health as
identified in the theory are: fresh air, pure water, sufficient food supplies, efficient
drainage, cleanliness of he patient and environment and light (particulary direct
sunlight). If any of these areas is lacking, the patient may experience diminished
health. A nurse’s role in a patient’s recovery as per Environmental theory is to alter
the environment in order to gradually create the optimal conditions for the patient’s
healing. For instances, minimal noise for clients with seizure or sunlight therapy for
clients with vitamin D deficiency. Other areas also can be manipulated to help
client/patient heal and recover.

II. VIRGINIA HENDERSON

 She was the “First Lady of Nursing” and “First Truly International Nurse”.
 She began her career in Public health nursing in the Henry Street Settlement
and visiting nurse service in Washington, D.C.
 She was First Full-time Instructor in nursing in Virginia when she was at Norfolk
Protestant Hospital.
 During her years at Teacher College, Columbia University, she was an
outstanding teacher and student.
 She was Selected to the American Nurse Association Hall of Fame and had the
sigma Theta Tau international Library named in her honored.
 She introduced Textbook of the Principles and practice.
 She also directed twelve-years project entitled Nursing Study Index.
 In Nature of Nursing – she expressed her belief about the essence of nursing
and influenced the hearts and mind of those who read it.
 In 1921 – Virginia Henderson was an early advocate for introduction of
psychiatric nursing in curriculum and serve on committee to develop such a
course at Eastern State Hospital in Williamsbrug.
 Age of 75 – Henderson directed her career to international teaching and
speaking.
 1988 – she was honored by the Virginia Nurse association and when the Virginia
Historical Nurse Leadership Award was presented to her.
 In 2000 – the Virginia nurse association recognize Henderson as one of fifty-one
Pioneer Nurse in Virginia
 "The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful
death) that he would perform unaided if he had the necessary strength, will or
knowledge. And to do this in such a way as to help him gain independence as
rapidly as possible”.
14 Basic Needs
 Physiological
1. Breath normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes - dress and undress
7. Maintain body temperature within normal range by adjusting clothing
and modifying the environment.
8. Keep the body clean and well groomed and protect the integument.
9. Avoid dangers in the environment and avoid injuring others.
10.Communicate with others in expressing emotions, needs, fears, or
opinions.
11. Learn, discover, or satisfy the curiosity that leads to normal
developmentand health and use the available health facilities.
 Sociological
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation
 Spiritual
14.Worship according to one’s faith

Metaparadigm In Nursing
 Nursing
- Henderson asserted that nurse function independently from the
physician, but they must promote the treatment plan prescribe by the
physician.
- Although part of the health team, the nurse must act independently
but in coordination with with the therapeutic plan developed by the
team
 Person
- Is an individual who requires assistance to achieve health and
independence or in some case, a peaceful death.
 Environment
- Individuals in relation to families
- Supports tasks of private and public agencies
- Society expects nurses to act for individuals who are unable to function
independently
- Basic nursing care involves providing conditions under which the
patient can perform the 14 activities unaided
 Health
- Definition based on individual’s ability to function independently as
outlined in the 14 components.
- Nurses need to stress promotion of health and prevention and cure of
disease.
- Good health is a challenge.
 - Affected by age, cultural background, physical, and intellectual
capacities, and emotional balance
- Impact on health by working of various social issues.

The Three Level Compromising The Nurse-Patient Relationship:

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

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

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

- In situation where the patient cannot meet his basic needs, the nurse
serve as a helper to accomplish them.
3. “The nurse as a partner with the patient”
- As a partners, the nurse and the patient formulate the plan together.
Both as an advocate and as a resource-person , the nurse can
empower the patient to make effective decisions regarding his care
plan.

III. FAYE GLENN ABDELLAH

 Identified 21 nursing problems.
 Defined nursing as a service to individuals and families therefore to society.
 Conceptualized nursing as an Art and science.

21 Nursing Problems
1. To maintain good hygiene
2. To promote optimal activity; exercise rest and sleep
3. To promote safety
4. To maintain good body mechanics
5. To facilitate the maintenance of a supply of oxygen
6. To facilitate maintenance of nutrition
7. To facilitate maintenance of elimination
8. To facilitate the maintenance of F&E balance
9. To recognize the physiologic responses of the body to disease condition
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
12. To identify and accept the positive and negative expressions, feelings and
reactions
13. To identify and accept the interrelatedness of emotions and illness
14. To facilitate the maintenance of effective verbal and non-verbal
communication
15. To promote the development of productive interpersonal relationship
16. To facilitate the progress towards achievement of personal spiritual goals
17. To create and maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying needs
19. To accept the optimum possible goals
20. To use community resources as an aid in resolving problems arising from
illness
 21. To understand the role of social problems as influencing factors

IV. JEAN WATSON PhD, RN, FAAN, HNC

 Theorist was born in West Virginia, US
 Educated: BSN, University of Colorado, 1964,
 MS, University of Colorado, 1966,
 PhD, University of Colorado, 1973
 Distinguished Professor of Nursing
 Endowed Chair in Caring Science at the University of Colorado Health Sciences
Center.
 Fellow of the American Academy of Nursing.
 Previously, Dean of Nursing at the University Health Sciences Center and
President of the National League for Nursing
 Undergraduate and graduate degrees in nursing and psychiatric-mental health
nursing and PhD in educational psychology and counseling. She has six (6)
Honorary Doctoral Degrees.
 Her research has been in the area of human caring and loss.
 In 1988, her theory was published in “nursing: human science and human care”.
 Jean Watson’s Theory of Transpersonal Caring also called Theory of Human
 Caring or The Caring Model was developed in 1979.

Theory of Human Caring or The Caring Model

 It emphasizes the humanistic aspects of nursing in combination with scientific

knowledge
 Watson designed this theory to bring meaning and focus to nursing as a distinct
health profession
 Watson believes that: “Caring” is an endorsement of professional nurses identity
 According to Watson, the nurse’s role is to:
- Establish a caring relationship with patients
- Treat patients as holistic beings (body, mind and spirit)
- Display unconditional acceptance
- Treat patients with a positive regard
- Promote health through knowledge and intervention
- Spend uninterrupted time with patients: “caring moments”

1. The formation of a humanistic- altruistic system of values.

2. The installation of faith-hope.
3. The cultivation of sensitivity to one’s self and to others.
4. The development of a helping-trust relationship
 5. The promotion and acceptance of the expression of positive and negative
feelings.
6. The systematic use of the scientific problem-solving method for decision
making
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and /or corrective mental, physical,
socio-cultural and spiritual environment.
9. Assistance with the gratification of human needs.
10. The allowance for existential-phenomenological forces

The Seven Assumption

1. Caring can be effectively demonstrated and practiced only interpersonally.
2. Caring consists of carative factors that result in the satisfaction of certain human
needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept person not only as he or she is now but as what he or
she may become.
5. A caring environment is one that offers the development of potential while
allowing the person to choose the best action for himself or herself at a given
point in time.
6. Caring is more “ healthogenic” than is curing. A science of caring is
complementary to the science of curing.
7. The practice of caring is central to nursing

Ten Primary Carative Factors

1. The formation of a humanistic- altruistic system of values. (concern for the
welfare of other, selflessness)
– Begins developmentally at an early age with values shared with the
parents.
– Mediated through one’s own life experiences, the learning one gains and
exposure to the humanities.
– Is perceived as necessary to the nurse’s own maturation which then
promotes altruistic behavior towards others
2. The installation of faith-hope.
– Is essential to both the carative and the curative processes.
– When modern science has nothing further to offer the person, the nurse
can continue to use faith-hope to provide a sense of well-being through
beliefs which are meaningful to the individual.
3. The cultivation of sensitivity to one’s self and to others.
– Explores the need of the nurse to begin to feel an emotion as it presents
itself.
– Development of one’s own feeling is needed to interact genuinely and
sensitively with others.
 – Striving to become sensitive, makes the nurse more authentic, which
encourages self-growth and self-actualization, in both the nurse and those
with whom the nurse interacts.
– The nurses promote health and higher level functioning only when they
form person to person relationship
4. The development of a helping-trust relationship
– Strongest tool is the mode of communication, which establishes rapport
and caring.
– Characteristics needed to in the helping-trust relationship are:
– Congruence
– Empathy
– Warmth
– Communication includes verbal, nonverbal and listening in a manner
which connotes empathetic understanding
5. The promotion and acceptance of the expression of positive and negative
feelings.
– “Feelings alter thoughts and behavior, and they need to be considered
and allowed for in a caring relationship”.
– Awareness of the feelings helps to understand the behavior it engenders.
6. The systematic use of the scientific problem-solving method for decision making
– The scientific problem- solving method is the only method that allows for
control and prediction, and that permits self-correction.
– The science of caring should not be always neutral and objective
7. The promotion of interpersonal teaching-learning.
– The caring nurse must focus on the learning process as much as the
teaching process.
– Understanding the person’s perception of the situation assist the nurse to
prepare a cognitive plan.
8. The provision for a supportive, protective and /or corrective mental, physical,
socio-cultural and spiritual environment.
– Watson divides these into eternal and internal variables, which the nurse
manipulates in order to provide support and protection for the person’s
mental and physical well-being.
– The external and internal environments are interdependent.
– Nurse must provide comfort, privacy and safety as a part of this carative
factor
9. Assistance with the gratification of human needs.
– It is based on a hierarchy of need similar to that of the Maslow’s.
– Each need is equally important for quality nursing care and the promotion
of optimal health.
– All the needs deserve to be attended to and valued
10. The allowance for existential-phenomenological forces.
– Phenomenology is a way of understanding people from the way things
appear to them, from their frame of reference.
 – Existential psychology is the study of human existence using
phenomenological analysis.
– This factor helps the nurse to reconcile and mediate the incongruity of
viewing the person holistically while at the same time attending to the
hierarchical ordering of needs.
– Thus the nurse assists the person to find the strength or courage to
confront life or death.

Teacher’s Insight

In Caring Science, we as nurses need as much knowledge in caring as we do

in curing. When we put caring into science, we provide the best care for our patients.

Watson believes it is essential that we “Pause to Care!” Before any patient

interaction, center yourself on the compassion you need to provide not only to your
patients, but to yourself as well. In the busy day and age we live in, this is so very
important! Remember that every human being needs to be heard, seen, know that
they matter, and needs to have touch. Look at your patients beyond their physical
disease process and truly apply the principle of caring for that patient. Being present
with your patients is important too.

Watson’s Ordering of Needs

Lower order needs (biophysical needs)
– The need for food and fluid
– The need for elimination
– The need for ventilation
Lower order needs (psychophysical needs)
– The need for activity-inactivity
– The need for sexuality
Higher order needs (psychosocial needs)
– The need for achievement
– The need for affiliation
– Higher order need (intrapersonal-interpersonal need)
– The need for self-actualization

Metaparadigm In Nursing
 Person/Human being
Human being refers to “….. a valued person in and of him or herself to be cared
for, respected, nurtured, understood and assisted; in general a philosophical
view of a person as a fully functional integrated self. He, human is viewed as
greater than and different from, the sum of his or her parts”.
 Health
 Watson adds the following three elements to WHO definition of health:
– A high level of overall physical, mental and social functioning
– A general adaptive-maintenance level of daily functioning
– The absence of illness (or the presence of efforts that leads its absence)
 Environment/society
According to Watson, caring (and nursing) has existed in every society.
A caring attitude is not transmitted from generation to generation.
It is transmitted by the culture of the profession as a unique way of coping with
its environment.
 Nursing
“Nursing is concerned with promoting health, preventing illness, caring for the
sick and restoring health”.
It focuses on health promotion and treatment of disease. She believes that
holistic health care is central to the practice of caring in nursing.
She defines nursing as…..
“A human science of persons and human health-illness experiences that are
mediated by professional, personal, scientific, esthetic and ethical human
transactions”.

B. GRAND THEORIES

V. MADELEINE LEININGER
 Developed the Transcultural Nursing Model.
 Advocated that nursing is a humanistic and scientific mode of helping a client
through specific cultural caring process to improve or maintain a health
condition.
 Leininger is the founder of the transcultural nursing movement in education
research and practice.

Transcultural Nursing

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

(area of study and practice focused on comparative cultural care (caring)
values, beliefs, and practices of individuals or groups of similar or different
cultures are compared)
Goal – culturally congruent holistic care.
Provide culture-specific and universal nursing care practices to promote
well-being or to help people face unfavorable human conditions in
culturally meaningful ways'
VI. NOLA PENDER

The Major Concepts and Definitions of the Health Promotion Model

 The health promotion model (HPM) proposed by Nola J Pender (1982; revised,
1996) was designed to be a “complementary counterpart to models of health
protection.”
 It defines health as a positive dynamic state not merely the absence of disease.
Health promotion is directed at increasing a client’s level of well being.
 The health promotion model describes the multi dimensional nature of persons
as they interact within their environment to pursue health.

A. Individual Characteristics and Experience

 Prior related behaviour
 Frequency of the similar behaviour in the past.
 Direct and indirect effects on the likelihood of engaging in health promoting
behaviors.
Personal Factors
– Personal factors categorized as biological, psychological and socio-cultural. These
factors are predictive of a given behavior and shaped by the nature of the target
behaviour being considered.
Personal biological factors
– Include variable such as age gender body mass index pubertal status, aerobic
capacity, strength, agility, or balance.
Personal psychological factors
– Include variables such as self esteem self motivation personal competence
perceived health status and definition of health.
Personal socio-cultural factors
– Include variables such as race ethnicity, acculturation, education and
socioeconomic status.

A. Behavioural Specific Cognition and Affect

Perceived Benefits Of Action
– Anticipated positive outcomes that will occur from health behaviour.
Perceived Barriers To Action
– Anticipated, imagined or real blocks and personal costs of understanding a given
behaviour
Perceived Self Efficacy
– Judgment of personal capability to organise and execute a health-promoting
behaviour. Perceived self efficacy influences perceived barriers to action so
higher efficacy result in lowered perceptions of barriers to the performance of
the behavior.
Activity Related Affect
– Subjective positive or negative feeling that occur before, during and following
behavior based on the stimulus properties of the behaviour itself. Activity-related
affect influences perceived self-efficacy, which means the more positive the
subjective feeling, the greater the feeling of efficacy. In turn, increased feelings
of efficacy can generate further positive affect.
Interpersonal Influences
– Cognition concerning behaviours, beliefs, or attitudes of the others. Interpersonal
influences include: norms (expectations of significant others), social support
(instrumental and emotional encouragement) and modelling (vicarious learning
through observing others engaged in a particular behaviour). Primary sources of
interpersonal influences are families, peers, and healthcare providers.
Situational Influences
– Personal perceptions and cognitions of any given situation or context that can
facilitate or impede behaviour. Include perceptions of options available, demand
characteristics and aesthetic features of the environment in which given health
promoting is proposed to take place. Situational influences may have direct or
indirect influences on health behaviour.

C. MIDDLE RANGE THEORIES

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

 MOTHER OF PSYCHIATRIC NURSING ( Founder of Mordern Psychiatric Nursing)

 FAAN - Fellow of the American Academy of Nursing
 Made extraordinary and sustained contributions to nursing and health care
throughout their career
 Nursing leaders in EDUCATION, MANAGEMENT, PRACTICE and RESEARCH
 PhD – Doctor of Philosophy
 Born in Reading, Pennsylvania on September 1, 1909
 Graduated from the Pottstown, Pennsylvania Hospital
 Worked as an Operating room Supervisor at Pottstown Hospital
 Received a B.A. in interpersonal Psychology from Bennington College, Vermont,
in 1943
 M.A. (Psychiatric Nursing) from Teachers College, Columbia, New York, in 1947
 Ed. D in curriculum Development from Columbia in 1953
 During World Was II, Hildegard Peplau was a member of the Army Nurse Corps
and worked in a neuropsychiatric hospital in london, England
 She also did work at Bellevue and Chestnut Lodge Psychiatric Facilities and was
in contact with renowned psychiatrist :
o Freida-Riechman
o Harry Stack Sullivan
 Holds numerous awards and position:
- The only nurse to serve the ANA as executive director and later as president
- Served two terms on the Board of the International Council of Nurses (ICN).
- In 1997, she received nursing's highest honor, the Christiane Reimann Prize,
at the ICN Quadrennial Congress.
- In 1996, the American Academy of Nursing honored Peplau as a "Living
Legend,"
- In 1998, the ANA inducted her into its Hall of Fame
 Retired in 1974
 Died peacefully on March 17, 1999 at her home in Sherman Oaks Californina
after a brief of illness

Psychodynamic nursing

 Understanding of ones own behavior

 To apply principles of human relations to the problems that arise at all levels of
experience
 Nursing is an interpersonal process because it involves interaction between
two or more individuals with a common goal.
 The nurse and patient work together so both become mature and knowledgeable
in the process.
 The attainment of goal is achieved through the use of a series of steps following
a series of pattern.
 According to Peplau, nursing is therapeutic in that it is a healing art, assisting an
individual who is sick or in need of health care.

Metaparadigm In Nursing
4. Nursing
- A significant therapeutic interpersonal process. It functions
cooperatively with other human process that make health possible for
individuals in communities
5. Person
a. A developing organism that tries to reduce anxiety caused by needs

Environment
- Existing forces outside the organism and in the context of culture
6. Health
- A word symbol that implies forward movement of personality and
other ongoing human processes in the direction of creative,
constructive, productive, personal and community living.
Roles of nurse
 Stranger : receives the client in the same way one meets a stranger in other life
situations provides an accepting climate that builds trust.
 Teacher : who imparts knowledge in reference to a need or interest
  Resource Person : one who provides a specific needed information that aids in
the understanding of a problem or new situation
 Counselors : helps to understand and integrate the meaning of current life
circumstances ,provides guidance and encouragement to make changes
 Surrogate : helps to clarify domains of dependence interdependence and
independence and acts on clients behalf as an advocate.
 Leader : helps client assume maximum responsibility for meeting treatment goals
in a mutually satisfying way

Theory of Interpersonal Relations

 Middle range descriptive classification theory

 Influenced by Harry Stack Sullivan's theory of inter personal relations (1953)
 Also influenced by Percival Symonds , Abraham Maslow's and Neal Elger Miller
 Identified four sequential phases in the interpersonal relationship:
1. Orientation
2. Identification
3. Exploitation
4. Resolution

Orientation Phase
 During this phase, the individual has a felt need and seeks professional
assistance
 The nurse helps the individual to recognize and understand his/ her problem and
determine the need for help
 Problem defining phase: identifies problem
 Starts when client meets nurse as stranger
 Defining problem and deciding type of service needed
 Client seeks assistance ,conveys needs ,asks questions, shares preconceptions
and expectations of past experiences
 Nurse responds, explains roles to client, helps to identify problems and to use
available resources and services
 Activities:
• Nurse and patient come together as strangers;
• Meeting initiated by patient who expresses a “felt need”;
• Work together to recognize,
• Clarify and define facts related to need
Identification Phase
 The patient identifies with those who can help him/ her.
 The nurse permits exploration of feelings to aid the patient in undergoing illness
as an experience that reorients feelings and strengthens positive forces in the
personality and provides needed satisfaction.
 Selection of appropriate professional assistance
  Patient begins to have a feeling of belonging and a capability of dealing with the
problem which decreases the feeling of helplessness and hopelessness
 Activities:
• Patient participates in goal setting;
• has feeling of belonging and selectively responds to those who can meet
his or her needs.
Exploitation Phase
 During this phase, the patient attempts to derive full value from what he/ she
are offered through the relationship.
 The nurse can project new goals to be achieved through personal effort and
power shifts from the nurse to the patient as the patient delays gratification to
achieve the newly formed goals.
 Use of professional assistance for problem solving alternatives
 Advantages of services are used is based on the needs and interests of the
patients
 Individual feels as an integral part of the helping environment
 They may make minor requests or attention getting techniques
 The principles of interview techniques must be used in order to explore,
understand and adequately deal with the underlying problem
 Patient may fluctuates on independence
 Nurse must be aware about the various phases of communication
 Nurse aids the patient in exploiting all avenues of help and progress is made
towards the final step
 Activity:
• Patient actively seeks and draws knowledge and expertise of those who
can help
Resolution Phase
 Termination of professional relationship
 The patients’ needs have already been met by the collaborative effect of patient
and nurse
 Now they need to terminate their therapeutic relationship and dissolve the links
between them.
 Sometimes may be difficult for both as psychological dependence persists
 Patient drifts away and breaks bond with nurse and healthier emotional balance
is demonstrated and both becomes mature individuals
 Activity:
• Occurs after other phases are completed successfully. This leads to
termination of the relationship.
VIII. IDA JEAN ORLANDO

 Theorist, Ida Jean Orlando was born in 1926.

 Ida J. Orlando was one of the first nursing theorists to write about the nursing
process.
 Nursing diploma - New York Medical College
 BS in public health nursing - St. John's University, NY,
 MA in mental health nursing - Columbia University, New York.
 Associate Professor at Yale School of Nursing and Director of the Graduate
Program in Mental Health Psychiatric Nursing.
 Project investigator of a National Institute of Mental Health grant entitled:
Integration of Mental Health Concepts in a Basic Nursing Curriculum.
 Her theory was published in her 1961 book, The Dynamic Nurse-Patient
Relationship.
 Further development of her theory at McLean Hospital in Belmont, MA as
Director of a Research Project: Two Systems of Nursing in a Psychiatric Hospital.
The results were conceptualized in her 1972 book titled: The Discipline and
Teaching of Nursing Processes
 A board member of Harvard Community Health Plan, and served as both a
national and international consultant
 Theorethical Sources
- Paplau’s focus of interpersonal relationships in nursing
- Paplau acknowledged the influence of Harry Stack Sullivan on the
development of her ideas
- Symbolic interactionism – Chicago school
 Use of field methodology
- John Dewey’s theory of inquiry
 Major Dimensions
- The role of the nurse is to find out and meet the patient's immediate
need for help.
- The patient's presenting behavior may be a plea for help; however, the
help needed may not be what it appears to be.
- Therefore, nurses need good judgment to explore with patients the
meaning of their behavior.
- This process helps nurse find out the nature of the distress and what
help the patient need

Nursing Process

Assessment
 Systematic and continuous collection, validation and communication of client
data as compared to what is standard/norm
Purpose: to establish a data base
Types Of Assessment:
1. Initial Assessment – assessment performed within a specified time on admission
Ex: Nursing admission assessment
 Physical assessment on admission
Physician’s history & physical examination
2. Problem-Focused Assessment – use to determine status of a specific problem
identified in an earlier assessment
Ex: Fluid intake & urine output (problem on urination-assess)
(Diuresis/polyuria, Dysuria, Anuria, Oliguria)
Snellens test (Visual Acuity)
3. Emergency Assessment – rapid assessment done during any
physiologic/physiologic crisis of the client to identify life threatening problems.
Ex: Assessment of a client’s airway, breathing status & circulation after a
cardiac arrest
4. Time-Lapsed Assessment – reassessment of client’s functional health pattern
– Done several months after initial assessment to compare the clients current
status to baseline data previously obtained.
Types of Data:
1. Subjective Data – Symptom/Covert data
– Information from the client’s point of view or are described by the person
experiencing it.
– Information supplied by family members, significant others, other health
professionals are considered subjective data.
Example: pain, dizziness, ringing of ears/Tinnitus
(-) guarding behavior
(-) facial Grimace

2. Objective Data – Sign/Overt data

– Those that can be detected, observed or measured/tested using accepted
standard or norm.
Example: pallor, diaphoresis, BP=150/100, yellow discoloration of
skin
Pain scale – 0/10
“Hindi na masakit ang tiyan ko” as verbalized by the patient
Patient reports of dizziness
Patient has wobbling gait
“Masakit ang tiyan ko” as verbalized by the patient
Petechiae
Methods of Data Collection:
1. Interview
– A planned, purposeful conversation/communication with the client to get
information, identify problems, evaluate change, to teach, or to provide support
or counselling.
2. Observation
– use to gather data by using the 5 senses and instruments
Sources Of Data:
1. Primary source – data directly gathered from the client using interview and
physical examination.
2. Secondary source – data gathered from client’s family members, significant
others, client’s medical records/chart, other members of health team, and related
care literature/journals.
Diagnosing
 Is the 2nd step of the nursing process
 The process of reasoning or the clinical act of identifying problems
 Identifies health care needs
 Analyze assessment information and derive meaning from this analysis.
Types of Nursing Diagnosis:
1. Actual Nursing Diagnosis – a client problem that is present at the time of the
nursing assessment. It is based on the presence of signs and symptoms.
– Constipation r/t long term use of laxative.
– Ineffective airway clearance r/t to viscous secretions
2. Potential Nursing Diagnosis – evidence about a health problem is incomplete or
unclear. It requires more data to support or reject it; or the causative factors are
unknown. Problem is only considered possible to occur
– Possible nutritional deficit
– Possible low self-esteem r/t loss job
3. Risk Nursing Diagnosis – is a clinical judgment that a problem does not exist,
therefore no S/S are present instead RISK FACTORS are present
*Risk factors indicates that a problem is only is likely to develop unless nurse
intervene or do something about it. No subjective or objective cues are present
therefore the factors that cause the client to be more vulnerable to the problem is
the etiology of a risk nursing diagnosis.
– Risk for Constipation r/t inactivity and insufficient fluid intake
Planning
 To identify client goals; to determine priorities of care; to design nursing
strategies to achieve expected outcomes of care; to determine outcome criteria-
 SMART –Specific, Measurable, Attainable and Realistically Time-bound.
– Ex: to reduce fever within the baseline data of 37 by giving prn antipyretic
medication and performing tepid sponge bath for 4 hrs
Implementation
 To complete nursing actions necessary for accomplishing plan
 Reassess client.
 Review and modify existing care plan.
 Perform nursing actions.
*Nursing actions – directed towards providing for the patient’s immediate
need
Evaluation
  To determine extent to which expected outcomes have been achieved.

One of the fundamental principles for developing critical thinking is the

nursing process,” Vest says. “It needs to be a lived experience in the learning
environment.”

Nursing students often find that there are multiple correct solutions to a problem.
The key to nursing is to select the “the most correct” solution—one that will be the
most efficient and best fit for that particular situation. You will often find yourself in
situations where there are few “correct” forms of care, but one that is most
appropriate. Using the nursing process, students can narrow down their options
to select the best one.

IX. JOYCE TRAVELBEE

 Born in 1926,
 A psychiatric nurse, educator and writer.
 In 1956, she completed her Bachelor of Science degree in nursing education at
Louisiana State University and her Master of Science Degree in Nursing from Yale
University in 1959.
 She started a doctoral program in Florida in 1973.
 Unfortunately, she was not able to finish the program because she died later that
year. She passed away at the prime age of 47 after a brief sickness.
 In 1952, Travelbee started to be an instructor focusing in Psychiatric Nursing at
Depaul Hospital Affiliate School, New Orleans, while working on her
baccalaureate degree. Besides that, she also taught Psychiatric Nursing at
Charity Hospital School of Nursing in Louisiana State University, New York
University and University of Mississippi. In 1970,she was named Project Director
at Hotel Dieu School of Nursing in New Orleans. Travelbee was the director of
Graduate Education at Louisiana State University School of Nursing until her
death.
 In 1963, Travelbee started to publish various articles in nursing journals. Her first
book entitled: Interpersonal Aspects of Nursing was published in 1966 and 1971.
 In 1969, she had her second book published entitled: Intervention in Psychiatric
Nursing : Process in the One-to-One Relationship.

Human to Human Relationship Model

 In her human-to-human relationship model, the nurse and the patient

undergoes the following series of interactional phases:

Original Encounter
  This is described as the first impression by the nurse of the sick person and vice-
versa. The nurse and patient see each other in stereotyped or traditional roles.
Emerging Identities
 This phase is described by the nurse and patient perceiving each other as unique
individuals. At this time, the link of relationship begins to form.
Empathy
 Travelbee proposed that two qualities that enhance the empathy process are
 Similarities of experience
 the desire to understand another person
 This phase is described as the ability to share in the person’s experience. The
result of the empathic process is the ability to expect the behavior of the
individual with whom he or she empathized.
Sympathy
 Sympathy happens when the
 Nurse wants to lessen the cause of the patient’s suffering.
 “When one sympathizes, one is involved but not incapacitated by the
involvement.” The nurse should use a disciplined intellectual approach together
with therapeutic use of self to make helpful nursing actions.
.

Teacher’s Insight
The terms empathy and sympathy are often confused. Although both of the words
deal with the relationship a person has to the feelings and experiences of another
person One is considered to be of more therapeutic than the other.

Both sympathy and empathy have roots in the Greek term páthos meaning
“suffering, feeling.”Sympathy is largely used to convey commiseration, pity, or
feelings of sorrow for someone else who is experiencing misfortune. You feel bad for
them … but you don’t know what it is like to be in their shoes. Empathy on the other
hand is now most often used to refer to the capacity or ability to imagine oneself in
the situation of another, experiencing the emotions, ideas, or opinions of that person.

For the two, empathy is more of therapeutic use than sympathy. Meaning for nurses,
we should be aware that we must understand our patient’s feelings by trying to put
our self in their situation to better understand their needs but not to be sympathetic
to their situation in anyway.

Rapport
 Rapport is described as nursing interventions that lessens the patient’s suffering.
 The nurse and the sick person are relating as human being to human being.
  The sick person shows trust and confidence in the nurse. “A nurse is able to
establish rapport because she possesses the necessary knowledge and skills
required to assist ill persons, and because she is able to perceive, respond to,
and appreciate the uniqueness of the ill human being.”

Note that the above stated interactional phases are in consecutive order and
developmentally achieved by the nurse and the patient as their relationship with one
another goes deeper and more therapeutic
D. CONCEPTUAL MODEL/S

X. DOROTHEA OREM
Self Care and Self Deficit Theory
 Self-care – is the performance or practice of activities that individuals initiate
and perform on their behalf
– The human’s ability or power to engage in self-care
 3 Classifications of Nursing Systems:
- Wholly compensatory – for people who are socially dependent on
others for their existence and well being
- Partly compensatory – both nurse and patient perform care measures
- Supportive – educative – where the nurse is able to perform or can
and should learn to perform required measures of self-care but cannot
do so without assistance

XI. MARTHA ROGERS

 Conceptualizes the science of unitary human beings.
 Nursing as an art and science that is humanistic and humanitarian. It is directed
toward the unitary human and is concerned with the nature and direction of
human development.
 The goal of every nurse is to participate in the process of change.

XII. IMOGENE KING

 Postulated the goal attainment model.
 Described nursing as a helping profession that assists the individuals and groups
in society to attain, maintain, and restore health.
 Nursing is a process of action, reaction and interaction whereby nurse and client
share information about their perception in the nursing situation.

Goal Attainment Theory

 Believes that there are 3 interacting systems:

 Individual (Personal System)

 Group (Interpersonal System)
 Society (Social Systems)
XIII. SISTER CALLISTA ROY

 Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs.
Fabien Roy.
 At age 14 she began working at a large general hospital, first as a pantry girl,
then as a maid, and finally as a nurse's aid.
 She entered the Sisters of Saint Joseph of Carondelet.
 she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's
College, Los Angeles in 1963.
 a master's degree program in pediatric nursing at the University of California ,Los
Angeles in 1966.
 She also earned a master’s & PhD in Sociology in 1973 & 1977 ,respectively
 Sr. Callista had the significant opportunity of working with Dorothy E. Johnson
 Johnson's work with focusing knowledge for the discipline of nursing convinced
Sr. Callista of the importance of describing the nature of nursing as a service to
society and prompted her to begin developing her model with the goal of nursing
being to promote adaptation.
ADAPTATION THEORY

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

 Stimulus-something that provokes a response, point of interaction for the
human system and the environment
 Focal Stimuli-internal or external stimulus immediately affecting the system
 Contextual Stimulus-all other stimulus present in the situation.
 Residual Stimulus-environmental factor, that effects on the situation that are
unclear.

 Regulator Subsystem-automatic response to stimulus (neural, chemical, and

endocrine)
 Cognator Subsystem-responds through four cognitive responds through four
cognitive-emotive channels (perceptual and information processing, learning,
judgment, and emotion)
 Behavior -internal or external actions and reactions under specific
circumstances

 Physiologic-Physical Mode
– Behavior pertaining to the physical aspect of the human system
– Physical and chemical processes
– Nurse must be knowledgeable about normal processes
– 5 needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection)
 Self Concept-Group Identity Mode
– The composite of beliefs and feelings held about oneself at a given time.
Focus on the psychological and spiritual aspects of the human system.
– Need to know who one is, so that one can exist with a state of unity,
meaning, and purposefulness of 2 modes (physical self, and personal self)
 Role function Mode
– Set of expectations about how a person occupying one position behaves
toward a occupying another position. Basic need-social integrity, the need to
know who one is in relation to others
 Interdependence Mode
– Behavior pertaining to interdependent relationships of individuals and groups.
Focus on the close relationships of people and their purpose.
– Each relationship exists for some reason. Involves the willingness and ability
to give to others and accept from others.
– Balance results in feelings of being valued and supported by others. Basic
need - feeling of security in relationships

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

 Ineffective Responses-neither promote not contribute to the integrity of the
human system
 Coping Process-innate or acquired ways innate or of interacting with the
changing of environment