FLORENCE NIGHTINGALE (1820-1910) 4.

RELIGIOUS BELIEFS - Action for the benefit of others is a

Environmental theory
CREDENTIALS AND BACKGROUND OF THE THEORIST:
• Founder of modern Nursing
• Birthdate: May 12, 1820
• Birthplace: Florence, Italy
• Nightingale’s father educated her more broadly than other girls of
the time.
• accdg. to her biographer, Sir Thomas Cook, Nightingale was a
linguist
• Had a vast knowledge of science, mathematics, literature, and the
arts
• She wanted to do more with her life than become an inactive wife of
an aristocrat.
• Florence had a firm faith in God (she was a Unitarian Christian), and
for a time believed she had a religious calling.
• Nightingale wrote about her “calling” in her diary.” God spoke to
me and called me to his service”
• She entered as a 134th nursing student at Fleidner School of Nursing,
Kaiserwerth, Germany, a Protestant religious community with a
hospital
facility
• She was there for approximately 3 months and her teachers declared
her trained as a nurse.
• After her return to England, Nightingale was employed to examine
hospital facilities, reformatories, charitable institutions.
• Only 2 yrs after completing her training (1 853), she became the
superintendent of the Hospital for Invalid Gentlewomen in London.
THE LADY WITH A LAMP (CRIMEAN WAR)
• Sir Sidney Herbert (a family friend and the Secretary of War)
requested Florence with the 34 newly recruited nurses to care for the
wounded soldiers.
• With her lamp, Nightingale traversed the night during the Crimean
War to look and heal for the wounded soldiers.
• She addressed her mission of providing nursing care through the
ENVIRONMENTAL PROBLEM existed
1. lack of sanitation
2. Presence of filth (few chamber pots, contaminated water,
contaminated bed linens, and overflowing cesspools.)
3. Frostbite
4. Louse infestations
5. Wound infections
6. Opportunistic diseases.
NURSE STATISTICIAN
• She was viewed as pioneer in the graphic display of statistics
• Selected a fellow of the Royal Statistical Society in 1858.
• She was an excellent writer.
1. Notes on Matters Affecting the Health
2. Efficiency and Hospital Administration of British Army.
3. Notes on Hospitals
4. Report on Measures Adopted for Sanitary Improvements in
India.
AWARDS and LATER LIFE
1. First woman to be granted the Order of Merit (OM) and the Royal
Red Cross (RRC)
2. Second most famous British person * Her birthday marks the
International Nurses Day celebration each year.
THEORETICAL SOURCES OF NIGHTINGALE’S
THEORY FACTORS INFLUENCING NIGHTINGALE’S
THEORY:
1. Individual/personal 3. Professional Values
2. Societal
SOURCES:
1. EDUCATION
2. LITERATURE- access to persons of power and influence Ex.
Charles Dicken’s novel The Adventures of Martin Chuzzlewit
3. INTELLECTUALS- political leaders, intellectuals, and social
reformers like John Stuart Mill, Benjamin Jowett, Edwin
Chadwick and Harriet Marineu.
primary way of serving God which is a basis for nursing work as
a religious calling. - Her Unitarian faith strongly supports the
education of a person as a means of developing their divine
potential and serving them toward perfection strength throughout
her life.
EMPIRICAL EVIDENCE
• Excellent scientist and researcher
• Generated throughout her lifetime on the different subjects of
healthcare, nursing and social reform. • Efficacy of her hospital
nursing system and organization during the Crimean War
• Her unique written report on the experiences and collected data
• Helped to pioneer the revolutionary notion that social
phenomena could be objectively measure and subjected to
mathematical analysis.
• Research skills includes recording, communicating, ordering,
coding, conceptualizing, inferring, analyzing, and synthesizing.
METAPARADIGM IN NURSING
• NURSING
- Provided essential principles for rendering and implementing an
efficient and effective nursing care. - Instilled an ideal attitude of
thinking and acting like a real nurse.
• PERSON
- Essence of a person as a patient.
- Nurses should perform tasks to and for the patient as well as control
the patient’s environment to facilitate easy recovery.
• HEALTH
- Being well and using every power that the person has to the fullest
extent.
- Prevention of disease through environmental control will greatly
uplift the maintenance of health.
- Illustrated modern public health nursing and concept of health
promotion.
• ENVIRONMENT
- Believed that the sick, poor people would benefit from the
environmental improvements that addressed their physical and mental
aspects.
- Nurses could have a special role in uplifting the social status of the
poor by improving their living situations.
ACCEPTANCE BY THE NURSING COMMUNITY
1. PRACTICE ENVIRONMENTAL ASPECTS OF
NIGHTINGALE’S THEORY:
a. Ventilation c. Quiet e. Diet
b. Warmth d. Cleanliness
2. EDUCATION
- Firmly considered that better practice could result only from better
education.
- Measurement of the art of nursing could not be accomplished through
licensing examinations like testing methods, and case studies
3. RESEARCH.
THEORETICAL ASSERTION
A. DISEASE
- Believed that a disease was a reparative process Reparative process-
nature’s effort to remedy a process of poisoning or decay, or a reaction
against the conditions in which a person was placed. Nursing role was to
prevent an interruption of the reparative process and to provide optimal
conditions for its enhancement.
B. NURSE
- Women were to be specifically trained to provide care for the sick
person.
- nurse should be moral agents.
- Addressed their professional relationship with their patients.
- Instructed the principle of confidentiality.
- Concise and clear decision making regarding the patient.
- Nurses providing preventive healthcare (public health nursing) required
even more training.
- Nurses needed to be excellent at the observation of their patients and the
environment
- Nurses needed to use common sense in their nursing practice, coupled
with their observation, perseverance and ingenuity.
- Persons desired good health and that they would cooperate with the
nurse and nature to allow the reparative process to occur or alter their
environment to prevent disease.
C. INFECTION
- Understood the concept of contagion and contamination through organic
materials from the patient and/ or the environment.
- Nightingale embrace the concept of vaccination against various disease.
- Appropriate manipulations of the environment would prevent disease-
modern sanitation activities.
ANALYSIS
• SIMPLICITY
- believed that the environment was the major component creating
illness in a patient.
3 major relationships of Nightingale theory:
1. Environment to patient
2. Nurse to environment
3. Nurse to patient
- She recognized not only the dangers of the environment, highlighted
the benefit of good environments in preventing illness.
- Her definition for the nurse and patient- relationship suggest cooperation
and collaboration bet. Nurse and patient.
• GENERALITY
- has been used to provide general guidelines for all nurse practitioners
for a number of years.
- The concept of the nurse, patient and environment are still applicable
and relevant in all nursing setting today.
• EMPIRICAL PRECISION
- Are often stated completely and are presented as truths rather than
tentative, testable statements
• DERIVABLE CONSEQUENCES
- Support for a measure of independence and accuracy previously
unknown in nursing may still guide and stimulate nurse today as the
profession.
- Consistently viewed humanity with her theories in nursing
- Nursing as a means of doing the will of God.
• Nursing as a divine calling that has good nurse- patient relationship
towards wellness
• Nightingale’s fundamental principles of environmental
manipulation and psychological care of the patient can be applied
in modern nursing settings.
• Her writings continue to motivate creative thinking nurses and her
works gives food for thought that continues to encourage the
profession
NIGHTINGALE’S ENVIRONMENTAL PRINCIPLES:
The Nursing Process and thoughts:
1. Ventilation and warmth
-Check the patient’s body temperature, room temperature, ventilation and
foul odors.
- Create a plan to keep the room well ventilated and free of odor while
maintaining the patient’s body temperature.
2. LIGHT
- Check room for adequate light. Sunlight is beneficial to the patient.
- Create and implement adequate light in the room without placing the
patient in direct light.
3. CLEANLINESS
- Check room for dust, dampness and dirt.
- Keep room free from dust, dirt and dampness.
4. HEALTH OF HOUSES
-Check surrounding environment for fresh air, pure water, drainage,
cleanliness and light.
-Remove garbage, stagnant water and ensure clean water and fresh air.
5. NOISE
- Check noise level in the room and surroundings.
- Attempt to keep noise level in minimum.
6. BED AND BEDDING
- Check bed and bedding for dampness, wrinkles and soiling.
- Keep the bed dry, wrinkle
- free and lowest height to ensure comfort.
7. PERSONAL CLEANLINESS
-Attempt to keep the patient dry and clean at all times.
-Frequent assessment of the patient’s skin is essential to maintain good
skin integrity.
8. VARIETY
-Attempt to accomplish variety in the room and with the client
-This is done with cards, flowers, pictures and books. Also encourage
friends or relatives to engage in stimulating activities.
9. CHATTERING HOPES AND ADVICES
-Avoid talking without giving advice that is without a fact.
-Respect the patient as a person and avoid personal talk.
10. TAKING FOOD
-Check the diet of the patient. Note the amount of food and fluid
ingested by the patient at every meal.
11. PETTY MANAGEMENT
-This ensures continuity of care
-Document the plan of care and evaluate the outcomes to ensure
continuity
12. OBSERVATION OF THE SICK
-Observe and record anything about the patient
-Continue observation in the patient’s environment and make changes
in the plan of care if needed.
MAJOR CONCEPTS:
-Term SURROUNDING usually referred to as environment.
-Components: ventilation, warmth, light, diet, cleanliness, and noise.
FIVE ESSENTIAL COMPONENTS OF ENVIRONMENTAL
HEALTH:
1. Pure air 4. Efficient
2. Light 5. Drainage
3. Cleanliness 6. Pure Water
Jean Watson
The Philosophy and Theory of Transpersonal Caring
The Philosophy and Science of Caring
• defined caring as a nurturing way or responding to a valued client
towards whom the nurse feels a personal sense of commitment and
responsibility. It is only demonstrated interpersonally that results in
the satisfaction of certain human needs. Caring accepts the person as
what he/she may become in a caring environment.
• Watson’s main concepts include the 10 carative factors and
transpersonal healing and transpersonal caring relationship, caring
moment, caring occasion, caring healing modalities, caring
consciousness, caring consciousness energy, and phenomenal file/
unitary consciousness.
• Watson expanded the carative factors to caritas, and offered a
translation of the original carative factors into clinical caritas
processes that suggested open ways they could be considered.
THEORETICAL SOURCES:
• Work has been called a philosophy, blueprint, ethic, paradigm,
worldview, treatise, conceptual model, framework, and theory
(Watson, 1996)
• Acknowledges a phenomenological, existential, and spiritual
orientation from the sciences and humanities as well as philosophical
and intellectual guidance from feminist theory, metaphysics,
phenomenology, quantum physics, wisdom traditions, perennial
philosophy, and Buddhism
Ten Caritas Processes
1. Cultivating the practice of loving- kindness and equanimity toward self
and other as foundational to Caritas Consciousness.
2. Being Authentically Present: Enabling, Sustaining, and Honoring the
Faith, Hope, and Deep Belief System and the Inner- subjective World of
Self/ Other (Watson, 2008)
3. The cultivation of one’s own Spiritual Practices and Transpersonal
Self, Going Beyond Ego- Self.
4. The development and sustaining a Helping-trusting caring relationship.
5. Being Present to, and Supportive of, the expression of Positive and
Negative Feelings.
6. Creative use of self and all Ways of Knowing as Part of the Caring
Process; Engage in the Artistry of Caritas Nursing.
7. Engage in Genuine teaching-learning Experiences that Attends to
Unity of Being and Subjective meaning- Attempting to stay within the
other’s frame of reference.
 -Separates caring from curing.
-Allows the patient to be informed and shifts the responsibility
for wellness and health to the patient (Watson, 2008)
8. Creating a healing environment at all levels. - Nurse must recognize
the influence that internal and external environments have on the health
and illness of individuals.
-Internal (mental, spiritual well- being, and sociocultural
beliefs)
-External (comfort, privacy, safety, and clean, esthetic
surroundings (Watson, 2008)
9. Administering Sacred Nursing Acts of Caring- Healing by trending to
Basic Human Needs.
10. Opening and Attending to Spiritual/ Mysterious and Existential
Unknowns of Life- Death
Phenomenology- describes data of the immediate situation that help
people understand the phenomena in question.
THEORETICAL ASSERTIONS
• NURSING
❑PERSONHOOD (HUMAN BEING)
- person- unity of mind/ body/ spirit/ nature.
• HEALTH
ENVIRONMENT APPLICATION BY THE NURSING
COMMUNITY:
• PRACTICE
- Living on ventilator (Lindahl, 2011)
- Simulating care (Diener & Hobbs,2012).
- Mothers struggling with mental illness (Blegen, Erikson, &
Bondas, 2014)
• ADMINISTRATION AND LEADERSHIP
• EDUCATION
- Focus on educating graduate nursing students and providing
them with ontological, ethical, and epistemological bases for their
practice, along with research directions (Hills & Watson, 2011).
• RESEARCH
- Qualitative, naturalistic, and phenomenological methods have
been identified as particularly relevant to the study of caring and to
development of nursing as a human science (Nelson & Watson,
2011; Watson, 2012)
METAPARADIGM
Person
• A valued being to be cared for, respected, nurtured, understood,
and assisted, a fully functional, integrated self-Environment
• Social environment, caring and the culture of caring affects health
• Physical, mental, and social wellness Nursing.
KATIE ERIKSSON
THEORY OF CARITATIVE CARING
• Theoretical sources
- Eriksson’s leading thoughts have been not only to develop the
substance of caring, but also to develop caring science as an independent
discipline (Eriksson, 1988)
• From the beginning, Eriksson wanted to go back to the Greek
classics by Plato, Socrates, and Aristotle, from whom she found
her inspiration for the development of both the substance and
the discipline of caring science (Eriksson, 1987a)
• From her basic idea of caring science as a humanistic science,
she developed a metatheory that she refers to as “the theory of
science for caring science” (Eriksson, 1988, 2001).
• The basic motive in caring science and caring for Eriksson is
caritas
-which constitutes the leading idea and keeps the various
elements together.
-It gives both the substance and the discipline of caring science
a distinctive character
MAJOR CONCEPTS & DEFINITIONS
Caritas
- Means love and charity.
- In caritas, eros and agapé are united, and caritas is by nature
unconditional love.
- Is the fundamental motive of caring science, also constitutes the motive
for all caring.
- It means that caring is an endeavor to mediate faith, hope, and love
through tending, playing, and learning.
Caring communion
- Constitutes the context of the meaning of caring and is the structure that
determines caring reality.
- It is a form of intimate connection that characterizes caring.
- Caring communion requires meeting in time and space, an absolute,
lasting presence (Eriksson, 1992c)
- Is characterized by intensity and vitality, and by warmth, closeness, rest,
respect, honesty, and tolerance. It cannot be taken for granted but
presupposes a conscious effort to be with the other.
The act of caring
- Contains the caring elements (faith, hope, love, tending, playing, and
learning), involves the categories of infinity and eternity, and invites to
deep communion
- The act of caring is the art of making something very special out of
something less special.
Caritative caring ethics
- comprises the ethics of caring, the core of which is determined by
the caritas motive.
Dignity
- Constitutes one of the basic concepts of caritative caring ethics.
- Human dignity is partly absolute dignity, partly relative dignity.
- Absolute dignity is granted the human being through creation
- Relative dignity is influenced and formed through culture and
external contexts.
- A human being’s absolute dignity involves the right to be confirmed
as a unique human being (Eriksson, 1988, 1995, 1997a).
Invitation
- Refers to the act that occurs when the carer welcomes the patient to the
caring communion.
- The concept of invitation finds room for a place where the human being
is allowed to rest, a place that breathes genuine hospitality, and where the
patient’s appeal for charity meets with a response (Eriksson, 1995;
Eriksson & Lindström, 2000).
Suffering
- Is an ontological concept described as a human being’s struggle between
good and evil in a state of becoming.
- Suffering implies in some sense dying away from something, and
through reconciliation, the wholeness of body, soul, and spirit is
recreated, when the human being’s holiness and dignity appear.
-Three different forms of suffering. (illness, to care, and to life)
Suffering related to illness is experienced in connection
with illness and treatment
• When the patient is exposed to suffering caused by care or absence
of caring, the patient experiences suffering related to care, which
is always a violation of the patient’s dignity. various forms of
suffering related to care:
• Not to be taken seriously, not to be welcome, being blamed, and
being subjected to the exercise of power • In the situation of being
a patient, the entire life of a human being may be experienced as
suffering related to life (Eriksson, 1993, 1994a; Lindholm &
Eriksson, 1993).
- The suffering human being is the concept that Eriksson uses to describe
the patient. The patient refers to the concept of patiens (Latin), which
means “suffering.”
- The patient is a suffering human being, or a human being who suffers
and patiently endures (Eriksson, 1994a; Eriksson & Herberts, 1992).
Reconciliation
- Refers to the drama of suffering.
- A human being who suffers wants to be confirmed in his or her suffering
and be given time and space to suffer and reach reconciliation
Caring culture
- Is the concept that Eriksson (1987a) uses instead of environment.
- It characterizes the total caring reality and is based on cultural elements
such as traditions, rituals, and basic values
 METAPARADIGM
• PERSON
- The conception of the human being.
- Is based on the axiom that the human being is an entity of body, soul,
and spirit (Eriksson, 1987a, 1988).
- The human being is fundamentally holy, and this axiom is related to the
idea of human dignity, which means accepting the human obligation of
serving with love and existing for the sake of others.
• Nursing
- Love and charity, or caritas, as the basic motive of caring has been
found in Eriksson (1987b, 1990, 2001) as a principal idea.
• Environment
- Uses the concept of ethos in accordance with Aristotle’s (1935, 1997)
idea that ethics is derived from ethos.
- The ethos of caring science, as well as that of caring, consists of the idea
of love and charity and respect and honor of the holiness and dignity of
the human being.
• Health
- Considers health in many of her earlier writings in accordance with an
analysis of the concept in which she defines health as soundness,
freshness, and wellbeing. The subjective dimension, or well-being, is
emphasized strongly (Eriksson, 1976).
PATRICIA BENNER
Caring, Clinical Wisdom, Ethics in Nursing Practice
BENNER’S MODEL:
5 Levels of skill acquisition and development:
1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. expert
MAJOR CONCEPTS AND DEFINITIONS 5 LEVELS:
1. NOVICE
- Context- free rules and objective attributes must be given to guide
performance.
- Difficulty discerning bet. Relevant and irrelevant aspects of a situation.
2. ADVANCE BEGINNER
- Develops when the person can demonstrate marginally acceptable
performance, having coped with enough real situations to note, or to have
pointed out by a mentor, the recurring meaningful components of the
situation.
3. COMPETENT
- Conscious and deliberate planning that determines which aspects of
current and future situations are important and which can be ignored
(Benner, 1984a)
- Most pivotal in clinical learning, because the learner begins to
recognize patterns and determine which elements of the situation warrant
attention and which can be ignored.
4. PROFICIENT
- The performer perceives the situation as a whole (the total picture)
rather than in terms of aspects, and the performance is guided by maxim.
5. EXPERT
- Is achieved when the performer no longer relies on analytical
principle (Rule, guideline, maxim) to connect an understanding of the
situation to an appropriate action (Benner, 1984a)
MAJOR CONCEPTS AND DEFINITIONS ASPECTS OF A
SITUATION
• ASPECT- Are the recurring meaningful situational components
recognized and understood in context bec. The nurse has previous
experience (Benner, 1984a).
• ATTRIBUTES OF A SITUATION- Attributes are measurable
properties of a situation that can be explained without previous
experience in the situation (Benner, 1984a).
• COMPETENCY- Is an interpretively defined area of skilled
performance identified and described by its intent, functions, and
meaning”
• DOMAIN- Is an area of practice having a number of competencies
with similar intents, functions, and meanings (Benner, 1984a).
• EXEMPLAR
• EXPERIENCE- Is not a mere passage of time, but an active process
of refining and changing preconceived theories, notions, and ideas
when confronted with actual situations.
• MAXIM- Is a cryptic description of skilled performance that requires
a certain level of experience to recognize the implications of the
instructions (Benner, 1984a).
• PARADIGM CASE- Is a clinical experience that stands out and alters
the way the nurse will perceive and understand future clinical situations
(Benner, 1984a)
• SALIENCE- Describes a perceptual stance or embodied knowledge
whereby aspects of a situation stand out as more or less important
(Benner, 1984a)
• ETHICAL COMPORTMENT- Is good conduct born out of an
engagement in a particular situation and entails a sense of membership
in the relevant professional group.
• HERMENEUTICS
- Means “interpretive”.
-The term derives from biblical and judicial exegesis. - As used
in research, refers to describing and studying “meaningful human
phenomena in a careful and detailed manner as free as possible from
prior theoretical assumptions, based instead on practical understanding”
(Packer,1985)
• FORMATION- Address the development of sense, esthetics,
perceptual acuities, relational skills, knowledge and dispositions that
take place as student nurses form professional identity.
• SITUATED COACHING- Was identified as the signature pedagogy
in nursing from the educating Nurses study. (Benner et.al, 2010)
METAPARADIGM
• PERSON
- Benner and Wrubel (1989) use Heidegger’s phenomenological
description of person, which they describe as:
- A person is a self-interpreting being, that is, the person does not come
into the world predefined but gets defined in the course of living life.
Four major aspects:
• The role of the situation
• The role of the body
• The role of personal concerns
• The role of temporality
• HEALTH
- What can be assessed, whereas Wellbeing- is the human experience of
health or wholeness.
• NURSING
- Is described as a caring relationship an
“enabling condition of connection and concern”
• ENVIRONMENT
- Used the term SITUATION, because situation conveys a social
environment with social definition and meaningfulness.
- Use the phenomenological terms being situated and situated meaning,
which are defined by the person’s engaged interaction, interpretation, and
understanding of the situation.
THEORETICAL ASSERTIONS
- The skilled practice of nursing exceeds the bounds of formal theory.
- Concrete experience facilitates learning about the exceptions and shades
of meaning in a situation.
- The knowledge embedded in practice can lead to discovering and
interpreting theory, precedes and extends theory, and synthesizes and
adapts theory in caring nursing practice.
ACCEPTANCE BY THE NURSING COMMUNITY
• PRACTICE
- Describes its usefulness for preceptor development, orientation
programs, and career development; Huntsman et al.(1984).
- Detail their implementation of a clinical ladder to recognize and
retain experienced staff nurses; Ullery (1984) presents its usefulness for
conducting annual excellence.
• Balasco and Black (1988) and Silver (1986a, 1986b) used
Benner’s work as a basis for differentiating clinical knowledge
development and career progression in nursing.
• Neverveld (1990) used Benner’s rationale and format in the
development of basic and advanced preceptor workshops.
• Farrell and Bramadat (19900 used Benner’s paradigm case analysis in
a collaborative educational project between a university school of
nursing and a tertiary care teaching hospital to better understand the
development of clinical reasoning skills in actual practice situations.
 Crissman and Jelsma (1990) applied Benner’s findings to develop a
cross-training program to address staffing imbalances.
• EDUCATION
- Benner (1982) critiqued the concept of competency-based testing by
contrasting it.
- Competency- based testing seems limited to the less situational, less
interactional areas of patient care where the behavior can be well defined
and patient and nurse variations do not alter the performance criteria”
• RESEARCH
- Maintains that there is excellence and power in clinical nursing practice
made visible through articulation research.
Articulation research - Dictates data be collected through situation-
based dialogue and observation of actual practice CRITIQUE
• CLARITY
- Novice to Expert model has led to its use among nurses around the
world.
- An identification with the idea of clinical wisdom and varying levels of
clinical expertise development progressed very quickly.
• SIMPLICITY
- Developed interpretive descriptive accounts of clinical nursing practice.
- The model is relatively simple with regard to the five stages of skill
acquisition, and it provides a comparative guide for identifying levels of
nursing practice from individual nurse descriptions validated by
consensus.
• GENERALITY
- Has universal characteristics; that is, it is not restricted by age, illness,
health, or location of nursing practice.
Martha Rogers
Unitary of Human Beings
THEORETICAL ASSERTIONS
• Principles of homeodynamics postulate a way of perceiving unitary
human beings.
• Identified the principles of change as helicy, resonancy, and integrality.
• Helicy principle describes spiral development in continuous,
nonrepeating, and innovative patterning.
• describing the nature of change evolved from probabilistic to
unpredictable, while remaining continuous and innovative.
• According to the principle of resonancy, patterning changes with the
development from lower to higher frequency, that is, with varying
degrees of intensity.
• Resonancy embodies wave frequency and energy field pattern
evolution.
• Integrality, the third principle of homeodynamics “reflects the unity or
wholeness of humans and their environment” (Jarrin,2012).
• The principles of homeodynamics (nature, process, and context of
change) support and exemplify the assertion that “the universe is energy
that is always becoming more diverse through changing, continuous
wave frequencies” (Phillips, 2010) Major Concepts of Rogers model
(four blocks) Energy field
• The energy field is the fundamental unit of both the living and nonliving
• Field- is a unifying concept
• Energy- signifies the dynamic nature of the field.
• Human field- is defined as irreducible, indivisible, pan dimensional
energy field identified by pattern and manifesting characteristics that
are specific to the whole and that cannot be predicted from knowledge
of the parts.
• Environmental field- is defined as an irreducible, pandimensional
energy field identified by pattern and integral with the human filed.
• PANDIMENSIONALITY
- As a nonlinear domain without spatial or temporal attributes, or as
Phillips (2010) notes:” essentially as space less and timeless reality. -
Provides for an infinite domain without limit.
- Best expresses the idea of a unitary whole
• Universe of Open System
- Holds that energy fields are infinite, open, and integral with one
another (Rogers, 1983).
- Human and environmental fields are in continuous process and are
open system.
• Pattern
- Identifies energy fields.
- Distinguishing characteristics of an
energy field and is perceived as a single wave.
METAPARADIGM
Person
- Unitary man, a four-dimensional energy field.
- As open system in continuous process with the open system that is
the environment.
Environment
- As an irreducible pan dimensional energy field identified by pattern and
manifesting characteristics different from those of the parts.
Health
- Not specifically addressed, but emerges out of interaction between
human and environment, moves forward, and maximizes human
potential.
- Uses the term passive health.
- As a value term defined by the culture or the individual.
Nursing
- A learned profession that is both science and art. The professional
practice of nursing is creative and imaginative and exists to serve people.
Dorothea Orem
Self-Care Deficit Theory
• Defined Nursing: “The act of assisting others in the provision and
management of self-care to maintain/ improve human functioning at
home level of effectiveness.”
• Focuses on activities that adult individuals perform on their own behalf
to maintain life, health and wellbeing.
• Has a strong health promotion and maintenance focus.
Four related theories:
1. The Theory of self- care, which describes why and how people care
for themselves.
2. The theory of dependent- care, which explains how family members
and/ or friends provide dependent- care for a person who is socially
dependent.
3. The theory of self- care deficit, which describes and explains why
people can be helped through nursing.
4. The theory of nursing system, which describes and explains
relationships that must be brought about and maintained for nursing to
be produced.
MAJOR CONCEPT
1. SELF-CARE
- practice of activities that maturing and mature persons’ initiate and
perform, within time frames, on their own behalf in the interest of
maintaining life, healthful functioning, continuing personal development,
and well- being by meeting known requisites for functional and
developmental regulations.
2. DEPENDENT CARE
- Refers to the care that is provided to a person who, because of age or
related factors, is unable to perform the self- care needed to maintain life,
healthful functioning, continuing personal development, and well- being
3. SELF- CARE REQUISITES
- Are expressed insights about actions to be performed that are known or
hypothesized to be necessary in the regulation of an aspect of human
functioning and development, continuously or under specified conditions
and circumstances.
Elements:
1. factor to be controlled or managed to keep an aspect of
human functioning and development within the norms
compatible with life, health and personal well-being.
2. Nature of the required action
- Formulated and expressed self-care requisites constitute the
formalized purposes of self-care. - Reasons for which self-care
is undertaken; they express the intended or desired result- goal
of self- care (Orem, 2001)
4. UNIVERSAL SELF- CARE REQUISITES
- Are to be met through self-care or dependent care, and they have their
origins in what is known and what is validated, or what is in the process
of being validated, about human structural and functional integrity at
various stages of the life cycle.
5. THERAPEUTIC SELF-CARE DEMAND
- Consists of the summation of care measures necessary at specific times
or over a duration of time to meet all of an individual’s known self-care
requisites, particularized for existent conditions and circumstances by
methods appropriate for the following:
- Controlling or managing factors identified in the requisites, the values
of which are regulatory of human functioning.
- Fulfilling the activity element of the requisites.
 6. HEATH DEVIATION SELF-CARE REQUISITES
- Exist for persons who are ill or injured, who have specific forms of
pathological conditions or disorders, including defects and disabilities,
and who are under medical diagnosis and treatment.
7. SELF-CARE AGENCY
- Is a complex acquired ability of mature and maturing persons to know
and meet their continuing requirements for deliberate, purposive action to
regulate their own human functioning and development.
8. DEPENDENT CARE AGENCY
- Refers to the acquired ability of a person to know and meet the
therapeutic self- care demand of the dependent person and/ or regulate the
development and exercise of the dependents self-care agency.
9. SELF-CARE DEFICIT
- Relation between an individual’s therapeutic selfcare demands and his
or her powers of self-care agency in which the constituent- developed
self-care capabilities within self-care agency are in operable or inadequate
for knowing and meeting some or all components of the existent or
projected therapeutic self-care demand.
NURSING AGENCY
- comprises developed capabilities of persons educated as nurses that
empower them to represent themselves as nurses within the frame of a
legitimate interpersonal relationships to meet their therapeutic self-care
demands and to regulate the development or exercise of their self-care
agency.
• Nursing System
– are series and sequences of deliberate practical actions of nurses
performed at times in coordination with the actions of their patients to
know and meet components of patient’s therapeutic self-care demands
and to protect and regulate the exercise or development of patient’s self-
care agency.
- nursing interventions needed when Individual is unable to perform
the necessary self-care activities:
• Wholly compensatory
- nurse provides entire self-care for the client.
- Accomplishes patient’s therapeutic self-care.
- Compensates for patient’s inability to engage in self-care - Supports
and protects patient Example: care of a new born, care of client
recovering from surgery in a post-anesthesia care unit
• Partial compensatory
- nurse and client perform care; client can perform selected self-care
activities, but also accepts care done by the nurse for needs the client
cannot meet independently.
- Example: Nurse can assist post-operative client to ambulate, Nurse
can bring a meal tray for client who can feed himself
• Supportive-educative
- nurse’s actions are to help the client develop/learn their own self-care
abilities through knowledge, support and encouragement.
- Accomplishes self-care.
- Regulates the exercise and development of self-care agency.
- Example: Nurse guides a mother how to breastfeed her baby,
Counselling a psychiatric client on more adaptive coping strategies.
METAPARADIGM IN NURSING
PERSON - human beings are very much different from other living
things in terms of their capacity. - Believes that individuals have the
potential to be developed and learned.
HEALTH - supports the WHO definition of health as the “state of
physical, mental, and social well-being and not merely the absence of
disease or infirmity.”
ENVIRONMENT
- view of health as a phenomenon affected by inseparable entities
- shows her view of the surrounding environment as an external source of
influence in the internal interaction of a person’s different aspects.
NURSING
- Nursing is helping clients to establish or identify ways to perform self-
care activities.
- According to her, Nursing is a helping or assistive profession to
persons who are wholly or partly dependent or when those who are
supposedly caring for them are no longer able to give care
• Nursing actions are geared towards the independence of a client
• If the client is highly dependent, there is a need for the nurse to assist and
address the needs of the client.
• Nursing as a human service
• Nursing is based on values
ANALYSIS OF THEORY
- Is the process that is carried out to acquire knowledge of the theoretical
work.
- First step in applying nursing theoretical works to education, research,
administration or practice.
1. CLARITY
- A word should be defined carefully and specifically to the framework
- Diagrams and examples facilitate clarity and consistency.
- Concepts and relationships between concepts must be clearly identified
and valid.
2. SIMPLICITY
- Sufficiently comprehensive, presented at a level of abstraction to
provide guidance, and have as few concepts as possible with simplistic
relations to aid clarity
3. GENERALITY
- Scope of concepts and purpose within theory
4. EMPIRICAL PRECISION
- How accessible is this theory?
- Is linked to the testability and ultimate use of a theory, and it refers
to the “extent that the defined concepts are grounded in observable
reality”
5. DERIVABLE CONSEQUENCES
- How important is this theory?
* Critical reflection of each theoretical works
PURPOSES OF NURSING THEORY
-Nursing Theory are developed to improve the quality of care rendered
by nurses to their clients.
-Theory development is inherent in the different nursing fields:
education, research and clinical practice,
EDUCATION
• Nursing theories were primarily used to develop and guide nursing
education in universities and instructors.
• They were once known to be more strongly established in the fields
of academics rather than clinical practice
• In the 1970’s and 1980’s, a number of nursing programs recognized
the major concepts of some nursing models, structured these
concepts into a conceptual framework, and build the complete
curriculum around that framework.
• With these models, they were able to come up with unique terms
such as: programs objectives, course objectives, course description
and clinical performance criteria.
• These new terms assist and direct the entire education system to
create a more comprehensive curriculum.
• Theoretical concepts primarily prepare students for practice as
members of the professional community
• The general purpose of theory development primarily is to ensure
adequate and quality nursing delivery and to clarify and improve the
status of Nursing as a profession.
CLINICAL PRACTICE
• Theories thoroughly guide critical thinking and decision- making in
clinical nursing practice
• Nurses will have a better understanding on the basis and nature of
their work and be able to express it clearly in collaboration with other
professionals.
• Nursing theories strengthen professional independence by guiding
the deepest and most important part of their practice
• Nursing Theories are always critical in assisting nurses to facilitate
questions, reflections and critical thinking in every aspect of care.
RESEARCH
• The more research is conducted; the more learning is gained as what
extent a given theory can be useful in providing knowledge that will
enhance client’s care.
2 ways of research linked to theory:
a. Theory- generating research
- Is designed to discover and describe
relationships and phenomena without imposing
predetermined notions on the nature of the phenomena.
- In conducting this type of research, the investigators make
observations with an open mind in order to view a phenomenon
in a new way.
b. Theory- testing research
- Is utilized to determine how accurate a theory describes a
phenomenon.

IMOGENE KING
Conceptual System and Middle- Range Goal Attainment Theory
MAJOR CONCEPTS & DEFINITIONS
HEALTH - Is defined as dynamic life experiences of a human being,
which implies continuous adjustment to stressors in the internal and
external environment through optimum use of one’s resources to achieve
maximum potential for daily living.
NURSING - Is defined as a process of action, reaction, and interaction
whereby nurse and client share information about theory perceptions in
the nursing situation.
SELF - Is composite of thoughts and feelings which constitute a
person’s awareness of his/ her individual existence, his conception of who
and what he / she is.
Nursing process - is defined as dynamic interpersonal process
between nurse, client and health care system.
Postulated the Goal Attainment Theory
>She described nursing as a helping profession that assists individuals
and groups in society to attain, maintain, and restore health.
>If is this not possible, nurses help individuals die with dignity.
> In addition, King viewed nursing as an interaction process between
client and nurse whereby during perceiving, setting goals, and acting on
them transactions occurred and goals are achieved.
GOAL ATTAINMENT THEORY
ACTION- means of behavior or activities that are towards the
accomplishment of certain act.
REACTION- form of reacting or a response to certain stimuli.
INTERACTION- any situation wherein the nurse relates and deals
with a clientele or patient.
OPEN SYSTEM- absence of boundary existence, where a dynamic
interaction between the internal and external environment can exchange
information without barriers or hindrances.
>The nurse would assess or observe the client’s present condition,
including the physical signs, symptoms and feelings about self and
people.
>Plan a care, illness prevention in the future and nursing care.
>Careful evaluation of personality and behavior especially on self-
expression and socialization behaviors.
METAPARADIGM
• Person - Biopsychosocial being; rational and sentient.
• Person has ability to:
– perceive
– think
– feel
– choose
– set goals
– select means to achieve goals and
– to make decision
Human being has three fundamental needs:
>The need for the health information that is unable at the time when it
is needed and can be used,
>The need for care that seek to prevent illness, and
>The need for care when human beings are unable to help themselves.
Environment
• Internal and external environment continually interacts to assist in
adjustments to change.
• Internal environment: transforms energy to enable person to adjust
to continuous external environmental changes.
• External environment: involves formal and informal organizations.
Nurse is a part of the patient’s environment.
Health
• A dynamic life experience with continued goal attainment and
adjustment to stressors.
• Nursing
• Perceiving, thinking, relating, judging, and acting with an individual
who comes to a nursing situation.
BETTY NEUMAN
SYSTEM MODEL IN NURSING PRACTICE
The Neuman System Model or Health Care System Model
• Stress reduction is a goal of system model of nursing practice.
Nursing actions are in primary, secondary or tertiary level of prevention
-The nurse helps the client, through primary, secondary, and tertiary
prevention modes, to adjust to environmental stressors and maintain
client stability
•The concern of nursing is to prevent stress invasion, to protect the
client’s basic structure and to obtain or maintain a maximum level of
wellness.
SYSTEM MODEL
•CLIENT VARIABLES
-physiological, psychological sociocultural, developmental and
spiritual functions to achieve stability.
•LINES OF RESISTANCE
-A series of broken rings surrounding the basic core structure
-acts when the Normal Line of Defense is invaded by too much
stressors, producing alterations in the client’s health.
-Acts to facilitate coping to overcome the stressors that are present
within the individual.
•NORMAL LINE OF DEFENSE
- act in coordination with normal wellness state to achieve the stability
of the system.
-Is the model’s outer solid circle. It represents the adaptational level of
health developed over the course of time and serves as the standard by
which to measure wellness deviation determination”.
•FLEXIBLE LINE OF DEFENSE
-serves as boundary for the Normal Line of defense to adjust to
situations that threaten the imbalance within client’s stability.
-model’s outer broken ring, it is perceived as serving as a protective
buffer for preventing stressors from breaking through the usual
wellness state as represented by the normal line of defense.
•STRESSORS
-forces that produce tensions, alterations, or potential problems
causing instability within the client’s system.
-the importance of identifying the stressors helps nurses to
appropriately use actions to address and help solve the produce
problem.
•Intrapersonal
- occurs within self and comprises of man as a psycho spiritual being.
- type of forces occurring within the individual, such as conditioned
responses.
•Interpersonal
- occurs between one or more individual and consist of man as a social
being.
-Type of forces occurring between one or more individuals, such as
role expectations.
•Extrapersonal forces
- occurring outside the individual, such as financial circumstances.
•REACTION
- outcomes or produced results of certain stressors and actions of the
lines resistance of a client either negative or positive.
• Negentropy
- set towards stability or wellness
• Egentropy
- set towards disorganization of the system producing illness.
PREVENTION
•PRIMARY
- foreseeing the result of an act preventing its effects
-Is used when stressor is suspected or identified.
Purpose: to reduce the possibility of encounter with the stressor or to
decrease the possibility of a reaction.
Ex. health promotion and disease prevention.
•SECONDARY
- helps alleviate the actual existing effects of an action that altered that
balance of health of a person.
-Involves interventions or treatment initiated after symptoms from
stress have occurred.
-The clients internal and external resources are used to strengthen
internal lines of resistance, reduce the reaction, and increase resistance
factors
Ex. Early detection of disease and prompt treatment.
•TERTIARY
-focuses on actual treatments or adjustments to facilitate the
strengthening of person after being exposed to a certain disease or
prevention.
-Occurs after the active treatment or secondary prevention stage.
-Goal is to maintain optimal wellness by preventing recurrence of
reaction or regression.
Ex. Physical therapy
•RECONSTITUTION
-Occurs after treatment for stressor reactions.
-It represents return of the system to stability” which may be at a higher
or lower level of wellness than before stressor invasion.
 METAPARADIGM - Focuses on the ability of Individuals, families, groups, communities,
Person or societies to adapt to change.
• Concept of a person as an individual, family, community, or the - The degree of internal or external environmental change and the
society. person’s ability to cope with that change is likely to determine the
• A client system that is composed of physiologic, psychological, person’s health status.
sociocultural, and environmental variables. - Nursing interventions are aimed at promoting physiologic,
Environment
psychologic, and social functioning or adaptation.
• Internal and external forces surrounding humans at any time.
Health
• Health or wellness exists if all parts and subparts are in harmony with Coping Processes
the whole person. Are innate or acquired ways of interacting with the changing
Nursing - is a unique profession in that it is concerned with all the environment (Roy & Andrews, 1999)
variables affecting an individual’s response to stressors. A. INNATE COPING MECHANISM
Are genetically determined or common to the species and are generally
DOROTHY E. JOHNSON viewed as automatic processes; humans do not have to think about them.
BEHAVIORAL SYSTEM MODEL B. ACQUIRED COPING MECHANISM
• Focuses on how the client adapts to illness; the goal of nursing is to • Are developed through strategies such as learning.
reduce stress so that the client can move more easily through recovery. • The experiences encountered throughout life contribute to customary
• Viewed the patient’s behavior as a system, which is a whole with responses to particular stimuli.
interacting parts.
• Successful use of Johnson’s behavioral system theory in clinical 2 categories of coping mechanism
practice requires the incorporation of the nursing process (assessment, • Regulator subsystem
disorders, treatment and evaluation). - transpires through neural, chemical and endocrine processes
• According to Johnson, each person as a behavioral system is - like the increase in vital signs-sympathetic response to stress.
composed of seven subsystems namely: • Cognator subsystem on the other hand, occurs through cognitive-
• Ingestive. Taking in nourishment in socially and culturally emotive processes (perceptual and information processing, learning,
acceptable ways. judgment, and emotion)”
• Eliminative. Riddling the body of waste in socially and culturally
acceptable ways. Adaptive responses
• Attachment- Affiliative. Security and survival seeking behavior. • Those that promote integrity in terms of the goals of human systems.
• Aggressive- protective. Protection and reservation A. INEFFECTIVE RESPONSES
• Dependency. Nurturance – seeking behavior. - Those that do not contribute to the integrity in terms of the goals of
• Achievement. Mastery of an aspect of self or environment to some the human system.
standards of excellence. B. INTEGRATED LIFE REPONSES
• Sexual. dual functions of protection and gratification. - Refers to the adaptation level at which the structures and functions of
a life process are working as a whole to meet human needs
THEORETICAL ASSERTIONS
• FOUR STRUCTURAL ELEMENTS: 4 adaptive modes:
1. Drive or goal- ultimate consequence of behaviors in it. 1. Physiological
2. Set- a tendency or predisposition to act in a certain way: - the way a person responds as a physical being to stimuli from
a. preparatory- what a person usually attends to. the environment.
b. Perseverative- the habits one maintains in a - Physiological needs (oxygenation, nutrition, elimination,
situation. activity and rest, and protection)
3. Choice- which represents the behavior a patient sees himself or - Complex needs (senses, fluid, electrolytes, neurological and
herself as being able to use in any given situation. endocrine function).
4. Action or the behavior of an individual. Goal: physiological integrity
2. Self- concept-group identity
Three functional requirements each of subsystem: - Psychological and spiritual characteristics of the person consist
1. Protection 2. Nurturance 3. Stimulation of all beliefs and feelings that one has formed about oneself.
Goal: psychological integrity
• Responses by the subsystem are developed through: 3. Role function
a. Motivation b. Experience c. Learning - primary, secondary, or tertiary roles that a person performs in the
Factors that influenced: biological, psychological, and social factors. society.
3a. Primary
Metaparadigm - Determined by age, sex and developmental stage.
• Person - Determines the majority of behavior engaged in by the person
- Is behavioral system with seven interrelated subsystem. during a particular period of life.
- Each subsystem is formed from a set of behavioral responses, or 3b. Secondary
responsive tendencies, or action systems that share a common drive or - Are those that a person assumes to complete the task associated
goal. with a developmental stage.
• Environment 3c. Tertiary
- All forces that affect the person and that influence the behavioral - Are related primarily to secondary roles and represent ways in
system which individuals meet their roles associated obligations.
• Health - Normally temporary in nature, freely chosen by the individual
- Focus on person, not illness. Health is a dynamic state influenced by (Clubs, hubbies)
biologic, psychological, and social factors Goal: social integrity
• Nursing 4. Interdependence
- Promotion of behavioral system, balance and stability. An art and a - Coping mechanism from close relationship which results to giving
science providing external assistance before and during balance and receiving of love, respect, knowledge, skills, time, and value.
disturbances. 2 relationship: significant others, or most important and support
Sister Callista Roy system
Adaptation Model Goal: affectional adequacy
- She viewed each person as a unified biopsychosocial system in
constant interaction with a changing environment. Metaparadigm
- She contented that the person as an adaptive system, functions as a Person
whole through interdependence of its part. • Biopsychological being and the recipient of nursing care.
- The system consists of input, control processes, output feedback. Environment
 • All conditions, circumstances, and influences surrounding and
affecting the development of an organism or groups of organisms.
Stimuli (stressors)
a. Focal - those most immediately confronting the person, it attracts
the most attention.
b. Contextual - all other stimuli that strengthens the effect of the focal
stimulus.
c. Residual - those stimuli that can affect the focal stimulus but the
effects are unclear.
Health
• The person encounters adaptation problems in changing the
environment.
Nursing
• A theoretical system of knowledge that prescribes a process of
analysis and action related to the care of the ill or potentially ill persons.
HILDEGARD PEPLAU
THEORY OF INTERPERSONAL RELATIONS
• Defined Nursing: “An interpersonal process of therapeutic
interactions between an Individual who is sick or in need of health
services and a nurse especially educated to recognize, respond to the need
for help.
• Nursing is a “maturing force and an educative instrument”
INTERPERSONAL RELATIONS THEORY:
4 PHASES OF NURSE- PATIENT RELATIONSHIP
1. ORIENTATION
- The nurse and the client initially do not know each other’s
goal’s and testing the role each will assume.
- The initial interaction between the nurse and the patient
wherein latter has felt need and expresses the desire for professional
assistance.
2. IDENTIFICATION
- The client responds to the professionals or the significant
others who can meet the identified needs.
- Both the client and the nurse plan together an appropriate
program to foster health.
- The client and the nurse explore the experience and the needs
of the patient which leads to a feeling of relatedness
3. EXPLOITATION
- The client utilizes all available resources to move toward a
goal of maximum health or functionality.
- The client derives the full value of the relationship as he
moves on from a dependent role to an independent one.
- New goals are projected by the nurse, but the power is shifted
to the patient as these goals would be achieved through personal or self-
effort.
4. RESOLUTION
- Refers to the termination phase of the nurse-client
relationship.
- Occurs when the client’s needs are met and he/she can move
toward a new goal.
- Assumed that the nurse- client relationship fosters growth in
both the client and the nurse.
- Even though the client and the nurse end the relationship, it is
very apparent that the experience leaves a lasting impression on the
client since illness and assuming a dependent role is a unique
experience
INTERPERSONAL THERAPEUTIC PROCESS
• Is based on the theory proposed by Peplau and particularly
useful in helping psychiatric patients become receptive for therapy.
Steps:
1. The patient is accepted unconditionally as a participant in a
relationship that satisfies his needs
2. There is recognition of and response to the patient’s readiness
for growth, as his initiative
3. Power in the relationships shifts to the patient, as the patient
is able to delay gratification and to invest in goal achievement.
NURSING ROLES
1. ROLE OF THE STRANGER
- Nurse attempts to know the patient better
- the nurse must treat him with outmost courtesy, which
includes acceptance of the patient as a person and due respect over his
individuality
2. ROLE OF THE RESOURCE PERSON
- Nurse provides specific answers to his queries which include health
information, advices, and a simple explanation of the healthcare team’s
course of care-patient assumes a dependent role.
3. TEACHING ROLE
- Nurse assumes a teaching role as she gives much importance
for self- care and in helping him understand the therapeutic plan.
- Nurse must determine how the patient understands the subject
at hand
4. LEADERSHIP ROLE
- The nurse must act in behalf of the patient’s best interest and
that the same time enable him to make decisions over his own care.
5. SURROGATE ROLE (temporary care giver)
- The nurse must assist the patient to make sure that her
surrogate role is different and only temporary.
- creates an atmosphere wherein feelings previously felt, such
as feelings towards her mother, relationships are reactivated and nurtured.
6. COUNSELLING ROLE
- Greatest importance and emphasis in nursing
- Strengthens the nurse patient relationship as the nurse
becomes a listening friend, an understanding family member and
someone who gives sound and emphatic advices.
METAPARADIGM
• PERSON
- Man who is an organism that lives in an unstable balance of a given
system.
• HEALTH
- A word that symbolizes movement of the personality and
other ongoing human processes that directs the person towards creative,
constructive, productive and community living.
- Also gave importance on the belief that for one’s health to be
achieved and maintained, his needs must be met. These needs are
psychological demands and interpersonal conditions.
• ENVIRONMENT
- forces outside the organism and in the context of the socially-
approved way of living, from which vital human social processes are
derived such as norms, customs, and beliefs- always include the
interpersonal process.
• NURSING
- significant, therapeutic interpersonal process
- functions cooperatively with human processes that present
health as a possible goal for individuals.
IDA JEAN (ORLANDO) PELLETIER
Nursing Process Theory and The Dynamic Nurse-Patient
Relationship
• The Dynamic Nurse-Patient Relationship
• She believed that the nurse helps patients meet a perceived need that
the patient cannot meet for themselves.
• Orlando observed that the nurse provides direct assistance to meet an
immediate need for help in order to avoid or to alleviate distress or
helplessness.
• She emphasized the importance of validating the need and evaluating
care based on observable outcomes.
3 elements:
• client behaviors, nurse’s reactions, and nursing actions to take
METAPARADIGM
• Person
-Unique individual behaving verbally nonverbally. Assumption
is that individuals are at times able to meet their own needs and at other
times unable to do so
• Environment
- Not defined
• Health
- Not defined. Assumption is that being without emotional or
physical discomfort and having a sense of well-being contribute to a
healthy state.
• Nursing
- Professional nursing is conceptualized as finding out and
meeting the client’s immediate need for help.
JOYCE TRAVELBEE
HUMAN-TO HUMAN RELATIONSHIP
• She postulated the Interpersonal Aspects of Nursing Model. She
advocated that the goal of nursing individual or family in preventing or
coping with illness, regaining health finding meaning in illness, or
maintaining maximal degree of health.
• She further viewed that interpersonal process is a human-to-human
relationship formed during illness and “experience of suffering”
• She believed that a person is a unique, irreplaceable individual who
is in a continuous process of becoming, evolving and changing.
HUMAN- TO- HUMAN RELATIONSHIP
 • Her theory was greatly influenced by her experiences in nursing
education and practice in Catholic charity institutions.
• She concluded that the nursing care rendered to patients in these
institutions lacked compassion.
• She thought that nursing care needed a “humanistic revolution”- a
return to focus on the caring function towards the ill person.
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
- Ability to share in the person’s experience. The result of the
emphatic process is the ability to expect the behavior of the individual
with whom he or she emphasized.
• SYMPATHY
- Happens when the nurse wants to lessen the cause of the
patient’s suffering.
- It goes beyond empathy. “When one sympathizes one is
involved but not in capacitated by the involvement.”
- The nurse should use a disciplined intellectual approach
together with therapeutic use of self to make helpful nursing actions.
• RAPPORT
- Described as nursing interventions that lessens the patient’s
suffering.
- The nurse and the sick person are relating as human being to
human being.
- 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.
METAPARADIGM
• Person
- A unique, irreplaceable individual who is in a continuous
process of becoming, evolving, and changing.
• Environment
- Not defined
• Health
- Heath includes the individual’s perceptions of health and the
absence of disease.
• Nursing
- An interpersonal process whereby the professional nurse
practitioner assists an individual, family, or community to prevent or cope
with the experience of illness and suffering, and if necessary, to find
meaning in these experiences.
LYDIA HALL
Core, Care and Cure Model
• The client is composed of the ff. overlapping parts: person (core),
pathologic state and treatment (cure) and body (care).
• Care represents nurturance and is exclusive to nursing. Core
involves the therapeutic use of self and emphasizes the use of reflection.
Cure focuses on nursing related to the physician’s orders. Core and cure
are shared with the other health care providers.
• The major purpose of care is to achieve an interpersonal
relationship with the individual that will facilitate the development of the
core.
METAPARADIGM
• Person
- Client is composed of body, pathology, and person. People set
their own goals and are capable of learning and growing.
• Environment
- Should facilitate achievement of the client’s personal goals.
• Health
- Development of a mature self-identity that assists in the
conscious selection of actions that facilitate growth.
• Nursing
- Caring is the nurse’s primary function. Professional nursing is
most important during the recuperative period.
MADELEINE M. LEININGER
Theory of Culture Care Diversity and Universality
• Transcultural Care Theory and Ethnonursing
• Developed the Transcultural Nursing Model. She advocated that
nursing is a humanistic and scientific mode of helping a client through
specific cultural caring processes (cultural values, beliefs and practices)
to improve or maintain a health condition.
• Nursing is a learned humanistic and scientific profession and
discipline which is focused on human care phenomena and activities in
order 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.
• Transcultural nursing as a learned subfield or branch of nursing
which focuses upon the comparative study and analysis of cultures with
respect to nursing and health-illness caring practices, beliefs and values
with the goal to provide meaningful and efficacious nursing care services
to people according to their cultural values and health illness context.
• Focuses on the fact that different cultures have different caring
behaviors and different health and illness values, beliefs, and patterns of
behaviors.
• Awareness of the differences allows the nurse to design culture-
specific nursing interventions.
MAJOR CONCEPTS AND DEFINITIONS
• CARE AND CARING
- Refers to the abstract and manifest phenomena with expressions of
assistive, supportive, enabling, and facilitating ways to help self or others
with evident or anticipated needs to improve health, a human condition,
or lifeways or to face disabilities or dying.
• GENERIC CARE
- Refers to the learned and transmitted lay, indigenous, traditional or
local folk knowledge and practices to provide assistance, supportive,
enabling, and facilitative acts for or toward others with evident or
anticipated health needs in order to improve wellbeing or help with dying
or other human conditions.
• PROFESSIONAL CARE
- Professional nursing care refers to formal and explicit cognitively
learned professional care knowledge and practices obtained generally
through educational institutions.
• CULTURE
- Refers to patterned lifeways, values, beliefs, norms, symbols and
practices of individuals, groups, or institutions that are learned shared and
usually transmitted from one generation to another.
• CULTURE CARE
- Refers to the synthesized and culturally constituted assistive,
supportive, enabling or facilitative caring acts toward self or others
focused on evident or anticipated needs for the client’s health or well-
being or to face disabilities, death or other human conditions.
• CULTURALLY CONGRUENT CARE
- Is culturally based care knowledge, acts and decisions used in
sensitive, creative, and meaningful ways to appropriately fit cultural
values, beliefs, and lifeways of clients for their health and wellbeing or to
prevent or face illness, disabilities or death.
• CULTURE CARE DIVERSITY
- Refers to cultural variability or differences in care beliefs, meaning,
patterns, values, symbols and lifeways within and between cultures and
human beings.
• WORLDVIEW
- Refers to the way an individual or a group looks out on and
understand the world about them as a value, stance, picture or perspective
about life and world.
• CULTURE CARE UNIVERSALITY
- Refers to commonalities or similar culturally based care meanings
(“truths“), pattern, values, symbols, and lifeways reflecting care as a
universal humanity.
• CULTURAL AND SOCIAL STRUCTURE DIMENSIONS
- Refers to the dynamic, holistic, and interrelated patterns of structured
features of a culture (or subculture), including religion (or spirituality ),
kinship ( social ), political characteristics ( legal ), economics, education,
technology, cultural values, philosophy, history and language.
• ETHNOHISTORY
- Refers to the sequence of facts, events, or developments overtime as
known, witnessed, or documented about a designated people of a culture.
• EMIC
- Refers to local indigenous or the insiders view and values about
phenomenon.
• ETIC
- Refers to the outsiders or more universal views and values about a
phenomenon.
• TRANSCULTURAL NURSING
- Refers to a formal area of humanistic and scientific knowledge and
practices focused on holistic culture care (caring) phenomena and
competencies to assist individuals or groups to maintain or regain their
health (or well-being) and deal with disabilities, dying or other human
conditions in culturally congruent and beneficial ways.
• CARE PRESERVATION OR MAINTENANCE
- Refers to assistive, supportive, facilitative or enabling professional
actions and decisions that help people of a particular culture to retain,
preserve, or maintain meaningful care beliefs and values for their well-
being, to recover from illness or to deal with handicaps or dying.
• CULTURE CARE ACCOMMODATION OR NEGOTIATION
- Refers to those assistive, accommodating, facilitative, or enabling
creative professional care actions and decisions that help people of a
designated culture to adapt to or negotiate with others for culturally
congruent, safe effective care for meaningful and beneficial health
outcomes.
• CULTURE CARE REPATERNING OR RESTRUCTURING
-refers to the assistive, supportive facilitative or enabling professional
actions and decisions that help client reorder, change or modify their
lifeways to beneficial health care patterns practices, or outcomes.
METAPARADIGM
• PERSON
- human beings are best explained in her assumptions. - humans are
thus believed to be caring and capable of being concerned about the
desires, welfare, and continued existence of others.
• ENVIRONMENT
- speaks about world worldview, social structure, and environmental
context.
ENVIRONMENT FRAMEWORK
• is defined as being the totality of an event, situation, or
experience.
• her description of culture centers on a particular group (society)
• And the patterning of actions, thoughts, and decisions that occurs
as the result of “learned, shared, and transmitted values, beliefs, norms,
and lifeways.”
• HEALTH
- discussed about components of health, specifically: health systems,
health care practices, changing health patterns, health promotions, health
maintenance.
• NURSING
- showed her concern to nurses who do not have sufficient preparation
for a transcultural perspective.
3 types of nursing actions that are culturally- based:
a. Cultural care preservation/ maintenance
b. Cultural care accommodation/ negotiation
c. Cultural care repatterning/ restructuring
NORA J. PENDER
Health Promotion Model
• a “complementary counterpart to models of health protection.”
• It defines health as a positive dynamic state rather than simply the
absence of disease. Health promotion is directed at increasing a patient’s
level of well-being.
• The health promotion model describes the multidimensional nature
of persons as they interact within their environment to pursue health.
• Pender’s model focuses on three areas: individual characteristics and
experiences, behavior-specific cognitions and affect, and behavioral
outcomes.
• The theory notes that each person has unique personal characteristics
and experiences that affect subsequent actions.
• The set of variables for behavior specific knowledge and affect have
important motivational significance.
• The variables can be modified through nursing actions.
• Health promoting behavior is the desired behavioral outcome, which
makes it the end point in the Health Promotion Model.
• These behaviors should result in improved health, enhanced
functional ability and better quality of life at all stages of development.
• The final behavioral demand is also influenced by the immediate
competing demand and preferences, which can derail intended actions for
promoting health.
MAJOR CONCEPTS AND DEFINTIONS:
• PRIOR RELATED BEHAVIOR
- Refers to the frequency of the same or similar behavior in the past.
• PERSONAL FACTORS
- Are categorized as biological, psychological and sociocultural.
• PERSONAL BIOLOGICAL FACTORS
- Are variables such as age, gender, body mass index, pubertal status,
menopausal status, aerobic capacity, strength, agility, and balance.
• PERSONAL PSYCHOLOGICAL FACTORS
- Includes such as self-esteem, self- motivation, personal competence,
perceived health status and definition of health
• PERSONAL SOCIOCULTURAL FACTORS
- Such as race, ethnicity, acculturation, education, and socioeconomic
status are included in sociocultural factors.
• BEHAVIORAL- SPECIFIC COGNITIONS AND AFFECTS
- Are considered of major motivational significance; these variables
are modifiable through nursing actions (Pender, 1996).
• PERCIEVED BENEFITS OF ACTION
- Are anticipated positive outcomes that will result from health
behavior.
• PERCEIVED BARRIERS TO ACTION
- Are anticipated, imagined, or real blocks and personal costs of
undertaking a given behavior.
• PERCIEVED SELF-EFFICACY
- Is judgment of personal capability to organize and execute a health
promoting behavior.
• ACTIVITY –RELATED AFFECT
- Describes subjective positive or negative feelings that occur before,
during, and after behavior based on the stimulus properties of the
behavior itself.
• INTERPERSONAL INFLUENCES
- Are cognitions concerning behaviors, beliefs, or attitudes of others.
- Primary sources: families, peers, and health care providers.
• SITUATIONAL INFLUENCES
- Are personal perceptions and cognitions of any given situation or
context that can facilitate or impede behavior.
• IMMEDIATE ANTECEDENTS OF BEHAVIOR AND
BEHAVIOR OUTCOMES
Behavioral event- is initiated by a commitment to action unless there
is a competing demand that cannot be avoided.
• COMMITMENT TO A PLAN OF ACTION
- Commitment describes the concept of intention and identification of
a planned strategy that leads to implementation of health behavior.
• IMMEDIATE COMPETING DEMANDS AND
PREFERENCES
- Are alternative behaviors over which individuals have low control,
because there are environmental contingencies such as work or family
care responsibilities.
• HEALTH – PROMOTING BEHAVIOR
- Is an end point or action outcomes that is directed toward attaining
positive health outcomes such as optimal well- being, personal
fulfillment, and productive living.
VIRGINIA HENDERSON
The Nature of Nursing
- “First Lady of Nursing” and the “First Truly International Nurse”
- Her writing, presentations, research, and contacts with nurses have
profoundly affected nursing and gave an impression on the recipients of
care by nurses throughout the world.
- In Henderson’s book, “NATURE OF NURSING”, she expressed her
belief about the essence of nursing and influenced the hearts and minds
of those who read it.
14 BASIC NEEDS
1. B - Breathing normally
2. E/ D - Eating and drinking adequately
3. E - Eliminating body waste
4. M - Moving and Maintaining a desirable position
5. S/R - Sleeping and resting
6. S - Selecting suitable clothes
7. M - Maintaining normal body temperature by adjusting clothing and
modifying the environment
8. K - Keeping the body clean and well-groomed to promote
integument
9. A - Avoiding dangers in the environment and avoiding injuring
others
10. C - Communicating with others in expressing emotions, needs,
fears, or opinions
11. W - Worshipping according to one’s faith
12. W - Working in such a way that one feels a sense of
accomplishment
 13. P - Playing or participating in various forms of recreation
14. L - Learning, discovering or satisfying the curiosity that leads to
normal development and health, and using available health facilities.
- She emphasized also the need to view the patient and his family as a
single unit.
- For the patient to achieve health, he must be able to meet his need for
support system (emotional needs) which in many cases provided by the
family.
NURSE FUNCTIONS IN RELATION TO:
A. THE NURSE- PATIENT RELATIONSHIP
3 LEVELS:
1. The nurse as a substitute for the patient
- When the patient cannot function fully, the nurse serves as the
substitute as to what the patient lacks such as knowledge, will and
strength in order to make him complete, whole and independent once
again.
2. The nurse as a helper to the patient
- In situations where the patient cannot meet his basic needs, the nurse serves
as a helper to accomplish them.
- The nurse focuses her attention in assisting the patient meet these needs so as
to regain independence as quickly as possible.
3. The nurse as a partner with the patient.
- The nurse and the patient formulate the care plan together.
- Both as an advocate and as a resource- person
B. THE NURSE- PHYSICIAN RELATIONSHIP
• Nurses function independently from physicians
• Though the nurse and the patient, as partners, formulate the plan of care, it must
be implemented in such a way that will promote the physician’s
prescribed therapeutic plan.
• Henderson indicated that many nursing roles and responsibilities overlap with
that those of the physician’s
C. THE NURSE AS A MEMBER OF THE HEALTHCARE TEAM • For a
team to work together in harmony, every member must work
independently.
• The nurse, as a member of the healthcare team, works and contributes in
carrying out the total program of care.
• However, working interdependently, as Henderson indicated, does not include
taking other member’s roles and responsibilities.
METAPARADIGM
• Person
- Individual requiring assistance to achieve health and independence or a
peaceful death. Mind and body are inseparable.
• Environment
- All external conditions and influences that affect life and development
• Health
- Equated with independence, viewed in terms of the client’s ability to perform
14 components of nursing care unaided: breathing, eating, drinking,
maintaining comfort, sleeping, resting clothing, maintaining body
temperature, ensuring safety, communicating, worshiping, working,
recreation, and continuing development.
• Nursing
- Assists and supports the individual in life activities and the attainment of
independence.
MARGARET NEWMAN
Health as Expanding Consciousness
• Newman’s theory of Health as Expanding Consciousness is not
limited by person or setting. It is generalized to anybody, anywhere.
• Her presentation of nursing within this theory is limited to those
situations in which caring occurs.
• She states that without caring nursing is not present.
Major concepts and definitions:
• HEALTH
- Pattern of the whole of a person and includes disease as manifestation
of the pattern of the whole, based on the premise that life is an ongoing
process of expanding consciousness.
• PATTERN
- Is information that depicts the whole and understanding of the
meaning of all of the relationships at once.
• CONSCIOUSNESS
- Is both the informational capacity of the system and the ability of the
system to interact with its environment.
• MOVEMENT-SPACE-TIME
- Emphasizes the importance of examining movement space time
together as dimensions of emerging patterns of consciousness rather than
as separate concepts of the theory.
METAPARADIGM
• PERSON
- Terms client, patient, person, individual, and human being are used
interchangeably.
- Clients are viewed as participants in the transformative process.
- Persons as individuals are identified by their individual patterns of
consciousness and defined as centers of consciousness within an overall
pattern of expanding consciousness.
• ENVIRONMENT
- Is not explicitly defined, it is described as being the larger whole,
which contains the consciousness of the individual.
- Client and environment are viewed as a unitary evolving pattern.
• HEALTH
- a fusion of disease and non-disease creates a synthesis regarded as
health
• NURSING
- Emphasizes the primacy of relationships as a focus of nursing. Both
nurse- client relationships and relationships within client’s lives
ROSEMARIE RIZZO PARSE
THEORY OF HUMAN BECOMING
• Nursing is a scientific discipline, the practice of which is a
performing art
• Three assumption about Human Becoming
– Human becoming is freely choosing personal meaning in situation
in the inter subjective process of relating value priorities
– Human becoming is co-creating rhythmic patterns or relating in
mutual process in the universe
– Human becoming is co-transcending multidimensionality with
emerging possibilities.
3 THEMES:
1. MEANING
- Is borne in the messages that persons give and take with others in
speaking, moving, silence and stillness.
- Nurses cannot know what will mean for a family to hear news of
an unexpected illness or change in health until they learn the meaning
it holds from the family’s perspective.
2. RHYTMICITY
- Is about patterns and possibility.
- Patterns of relating incarnate their priorities, and these patterns are
changing constantly as they integrate new experiences and ideas with
what is becoming visible- invisible in the emerging now.
- People change their patterns when they integrate new priorities,
ideas, and dreams, and show consistent patterns that continue like
threads of familiarity and sameness throughout life.
3. TRANSCENDENCE
- Is about change and possibility, the infinite possibility that is
human becoming.
- to believe one thing or another, to go in one direction or another,
to be persistent or let go, to struggle or acquiesce.
METAPARADIGM
• PERSON, ENVIRONMENT, HEALTH
- Viewed as human universe, human becoming, and Health.
- speaks of health as a personal commitment.
• NURSING
- Is a science, and the performing art of nursing is practiced in
relationships with persons (individuals, groups, and communities) in their
process of becoming.
SET OF FUNDAMENTALS FOR PRACTICING THE ART OF
NURSING:
• Know and use nursing frameworks and theories.
• Be available to others.
• Value the other as a human presence.
• Respect differences in view
• Own what you believe and be accountable for your actions.
• Move on to the new and untested.
 • Connect with others.
• Take pride in self.
• Like what you do.
• Recognize the moments of joy in the struggles of living.
• Appreciate mystery and be open to new discoveries.
• Be competent in your chosen area.
• Rest and begin anew.
FAYE ABDELLAH
TWENTY-ONE NURSING PROBLEMS
● Nursing is broadly grouped into 21 problem areas to guide care
and promote the use of nursing judgement.
Introduced Patient – Centered Approaches to Nursing Model.
● She defined nursing as service to individual and families;
therefore, the society. Furthermore, she conceptualized nursing as
an art and a science that molds the attitudes, intellectual
competencies and technical skills of the individual nurse into the
desire and ability to help people, sick or well, and cope with their
health needs.
● Her theory changed the focus of nursing from disease-centered to
patient-centered, and began to include the care of families and the
elderly in nursing care.
● Abdellah’s work is a set of problems formulated in terms of
nursing- centered services, which are used to determine the
patient’s needs.
● A theoretical statement from Abdellah’s works can be created by
utilizing her three chief concepts of health, nursing problems, and
problem solving.
● Abdellah’s theory proposes that nursing is the utilization of the
problem-solving techniques with chief nursing problems related to
the health requirements of clients.
Typology of twenty- one nursing problems:
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, sleep.
3. To promote safety through prevention of accident, injury, or other
trauma and through the prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct
deformity.
5. To facilitate the maintenance of a supply of a oxygen to all body
cells.
6. To facilitate the maintenance of elimination.
7. To facilitate the maintenance of nutrition of all body to disease
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiological responses of the body to disease
conditions- pathological, physiological and compensatory.
10. To facilitate the maintenance of the regulatory mechanism and
functions.
11. To facilitate the maintenance of sensory function.
12. To identify and accept positive and negative expressions, feelings
and reactions.
13. To identify and accept positive and negative expressions, feelings,
and reactions.
14. To facilitate the maintenance of effective verbal and non verbal
communications.
15. To promote the development of productive interpersonal
relationships.
16. To facilitate progress toward achievement and personal spiritual
goals.
17. To create or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying
physical, emotional and developmental needs.
19. To accept the optimum possible goals in the light of limitations,
physical and emotional
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
in the cause of illness. Major Concepts • She describe the recipients
of nursing
Major Concepts
● She describe the recipients of nursing as individuals (and families),
although she does not delinate her beliefs or assumptions about the
nature of human beings.
● Health, or the achieving of it, is the purpose of nursing services.
Although Abdellah does not give a definition of health, she speaks
to “total health needs” and “a healthy state of mind and body.”
(Abdellah et al., 1960)
● Health may be defined as the dynamic pattern of functioning
whereby there is a continued interaction with internal and external
forces that results in the optimal use of necessary resources to
minimize vulnerabilities. (Abdellah & Levine, 1986; Torres &
Samton, 1982).
● Society is included in “planning for optimum health on local, state,
and international levels.” However, as Abdellah further delineates
her ideas, the focus of nursing service is clearly the individual.
Nursing Problems
● The client’s health needs can be viewed as problems, which may
be overt as an apparent condition, or covert as a hidden or
concealed one.
o Because covert problems can be emotional, sociological,
and interpersonal in nature, they are often missed or
perceived incorrectly. Yet, in many instances, solving
the covert problems may solve the overt problems as
well. (Abdellah, et al., 1960)
Problem Solving
● Quality professional nursing care requires that nurses be able to
identify and solve overt and covert nursing problems. These
requirements can be met by the problem-solving process involves
identifying the problem, selecting pertinent data, formulating
hypotheses, testing hypotheses through the collection of data, and
revising hypotheses when necessary on the basis of conclusions
obtained from the data. (Abdellah & Levine, 1986)
● The needs of patients are divided into four categories:
o basic to all patients
o sustenal care needs
o remedial care needs
o restorative care needs.
● Needs that are basic to all patients are - to maintain good
hygiene and physical comfort; promote optimal activity, including
exercise, rest and sleep; promote safety through the prevention of
accidents, injury or other trauma and through the prevention of the
spread of infection; and maintain good body mechanics and
prevent or correct deformity.
● Sustenal care needs
o facilitate the maintenance of a supply of oxygen to all
body cells;
o facilitate the maintenance of nutrition of all body cells;
o facilitate the maintenance of elimination;
o facilitate the maintenance of fluid and electrolyte
balance; -
o recognize the physiological responses of the body to
disease conditions; - facilitate the maintenance of
regulatory mechanisms and functions; - facilitate the
maintenance of sensory function.
● Remedial care needs
o identify and accept positive and negative expressions,
feelings, and reactions.
o identify and accept the interrelatedness of emotions and
organic illness;
o facilitate the maintenance of effective verbal and non-
verbal communication; promote the development of
productive interpersonal relationships;
● Restorative care needs
o include the acceptance of the optimum possible goals in
light of limitations, both physical and emotional.
o the use of community resources as an aid to resolve
problems that arise from illness.
o the understanding of the role of social problems as
influential factors in the case of illness.
Nursing skills in the theory are:
● observation of health status
● skills of communication
● application of knowledge
● teaching of patients and families
● planning and organization of work
● use of resource materials
● use of personnel materials
● problem-solving
● direction of work of others
● therapeutic use of the self
● nursing procedure
METAPARADIGM
 PERSON
● The recipients of nursing care having physical, emotional, and
sociologic needs that may be overt or covert.
ENVIRONMENT
● Not clearly defined. Some discussion indicates that clients interact
with their environment, of which nurse is a part.
● “planning for optimum health on local, state, national, and
international levels.
● The apex (core) in nursing service is the individual
HEALTH
● A state when the individual has no unmet needs and no anticipated
or actual impairment.
● Total health needs and a healthy state of mind and body.
NURSING
● As an art and a science that mold the attitude, intellectual
competencies, and technical skills of the individual nurse into the
desire and ability to help individuals cope with their health needs,
whether they are ill or well.