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Republic of the Philippines

Mindanao State University

College of Health Sciences
9700, Marawi City, Philippines

Self – learning module

Theoretical Foundation in Nursing
Nsg 101

PROF. JONAID M. SADANG, RN, RM, LPT, MAN

PROF. NAMERA T. DATUMANONG, RN, MAN

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PREFACE

This Self-Learning Module (SLM) in NSG 101 - Theoretical Foundation in Nursing

is designed to help nursing students’ deals with the nursing theories as applied to
nursing practice on the aspect of the metaparadigm (person, health, environment, and
nursing). Likewise, it includes other theories relevant to nursing. It focuses on the
various approaches in helping the learners use these theories as basis and guide in
nursing practice.

Nursing is a professional discipline focused on the study of human health and healing
through caring. Nursing practice is based on the knowledge of nursing, which consists of its
philosophies, theories, concepts, principles, research findings, and practice wisdom. Nursing
theories are patterns that guide the thinking about nursing. All nurses are guided by some
implicit or explicit theory or pattern of thinking as they care for their patients. Too often, this
pattern of thinking is implicit and is colored by the lens of diseases, diagnoses, and
treatments.
This does not reflect practice from the disciplinary perspective of nursing. The major reason
for the development and study of nursing theory is to improve nursing practice and, therefore,
the health and quality of life of those we serve.

This learning package consists of nine (9) modules broken down into 32 lessons. Basic
concepts and principles are presented followed by suggested enrichment activities and
formative assessment. These are designed to provide you with a solid knowledge base and
actualize your learning experiences. They aim to enhance your long-term learning by
allowing you to: (a) pace and monitor your own learning, (b) frame the materials or concepts
in your own terms, (c) come up with your own examples of the concept and their application
to teaching learning process and everyday life, and (c) analyze and appreciate the
contribution of each theories in the field of nursing profession.

You are advised to go through with each topic, do the suggested activities and
participate in the discussion through the learning guides. My role in this course as an
instructional coach of learning is to provide basic information about each topic and to
structure the course so that you will most likely learn from the materials and the tasks. But
the final output will depend on your own efforts. It is quite impossible to cover everything
about the dimension of nursing informatics. Thus, you are advised to supplement this
material with additional readings, exploring the internet reliable websites, personal
experience through actual observation and interview of learners and facilitators of learning or
experts in the field of nursing profession (education, practice, administration, and research).

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As part of your class e-Portfolio, you will be required to create and write a personal learning
journal online, the purpose of which is to stretch your learning from the classroom or
theoretical inputs to the real world so that your learning is actualized and personalized. This
will also help you write out your own philosophy of learning and teaching as future nurses.
GENERAL LEARNING OUTCOMES

At the end of the course, the students are expected to be able to:

• Integrate relevant concepts and metaparadigm of theories on Person,

Health, environment, and Nursing in nursing practice.
• Apply appropriate nursing concepts and actions holistically and
comprehensively.
• Appreciate the value of evidence based nursing practice in the application
of nursing and related models/theories.
• Ensure a working relationship utilizing relevant concepts/theories of
effective communication and interpersonal relationship in nursing practice.
• Discuss relevant concepts of collaboration with interpersonal, cultural, and
related theories.
• Describe specific management and leadership concepts and principles in
selected theories.
• Assume responsibility for lifelong learning, own personal development and
maintenance of competence.
• Exemplify love for country in service of the Filipinos.
• Discuss the systems of informatics related to the application of nursing
theories.
• Demonstrate caring as the core of nursing, Love of God, Love of Country,
and Love of People.
• Manifest professionalism, integrity and excellence.

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CLASS FORMAT REQUIREMENTS

You will be a self-regulated learner in this course. The basic information

about the concepts and theories being discussed will be presented here and our
discussion will be interactive through flexible learning options (e.g. Zoom
software application, Facebook messenger, and Google classroom). Other
queries and comments may be coursed through your respective class professors’
e-mail address, Facebook messenger or mobile contact number.

At the end of every module, you will encounter Enrichment Activities and
Assessment Guide Questions which aimed to synthesize your learning and
check how far you have gone in understanding the material.

Your grade in this class will be determined by your performance and output in
the following requirements:

1. Enrichment Activities and Formative Assessment which may include

Giving Examples, Integrative Essay, and Critical Thinking. Your examples
should be authentic and involves human behavior that you have actually
witnessed or experienced. Integrative Essay and Critical Thinking consist of
questions that require a substantive explanation and you need to pull
together various pieces of information to draw a conclusion.
2. Individual Class e -Portfolio which will serve two very important purposes:
(a) for me to know to what extent you have learned from this course, and (b)
for you to have a permanent record of what you have learned. Your class
portfolio is a repository of documents from the class that consist of:

a. Answers to Enrichment Activities and Formative Assessment

(including responses to my comments, if any).

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b. Personal Learning Journal. This is a personal reflection and monitoring

of your learning which may include questions and insights drawn from
what you have read in the modules and other sources, reactions to
issues raised, notes on miscellaneous readings, anecdotes of actual life
experiences and how they relate to topics discussed and how they
influenced your learning. A suggested format is presented but you are
free to have your own style of writing.

c. Personal Philosophy on Learning and Teaching. From your own

readings, activities, learning journal and actual life experiences, you may
draw your own line of thinking about learning and teaching. Perhaps
unknowingly you have been following this philosophy all along in your
learning and teaching endeavors. This is the opportunity to write it out
and understand how this philosophy is running your life.

3. Summative Assessment – this will be an integration of all learning derived

from this course and its application to actual life situation and the teaching-
learning process.

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LEARNING CONTRACT

I am taking part in this learning contract because the strategies listed

here will facilitate my knowledge and help me perform well in the course,
NSG 101: Theoretical Foundation in Nursing. This contract shall take effect
until end of this 1st Semester of the Academic Year 2020 – 2021. Moreover,
as a student of this course, I am expected to complete the following
actions:

ATTENDANCE
 I will attend at least 80% of class sessions for both synchronous and
asynchronous type of learning in this course.
 I will be on time as scheduled every time we will be having our sessions.

READINGS
 I will complete all the assigned readings in each modules and/or lessons.

GROUP PROJECT
 I will communicate at least weekly with peers in my work group (face-to-face if the
situation permits or virtually/electronically) about our shared course project.

STUDY/ASSIGNMENTS
 I will spend at least 1.5 hours per meeting and 3 hours in a week as prescribed in
this course which includes both lecture sessions and activities in each modules
and/or lessons.
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 I will submit all the output (i.e. enrichment activities, formative and summative
assessments) expected of me at the end of each course modules.

COURSE HELP
 After each class, I will use a copy of class notes supplied by the instructor to fill in
any gaps in my notes.
 I will check in with the instructor during her free period at least once per week and
bring any questions from current work.

I have reviewed and find acceptable the above learning contract.

Signature : _________________________

Full Name : _________________________

Date : _________________________

TABLE OF CONTENTS

PREFACE
GENERAL LEARNING OUTCOMES
CLASS FORMAT REQUIREMENTS
LEARNING CONTRACT
TABLE OF CONTENTS

MODULE ONE: OVERVIEW OF THE THEORY

Learning Objectives
Lesson 1 : Introduction to Nursing Theories
Lesson 2 : Purposes of Nursing Theory
Lesson 3 : Four Ways of Knowing
Lesson 4 : Scope of Theories and Analysis
Lesson 5 : Significance of Theory to Nursing as a Profession
Enrichment Activities
Formative Assessment
References

MODULE TWO: HISTORY OF THE NURSING PROFESSION

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Learning Objectives
Lesson 6 : Evolution of the Nursing Profession
Lesson 7 : Nursing Profession in the Philippines
Lesson 8 : History of the MSU - College of Health Sciences
Lesson 9 : Nightingale’s Environmental Theory
Enrichment Activities
Formative Assessment
References

MODULE THREE: INTERACTIVE THEORIES

Learning Objectives
Lesson 10 : Interpersonal Relations Theory by Hildegard Peplau
Lesson 11 : 14 Basic Human Needs by Virginia Henderson
Lesson 12 : Human to Human Relationship Model by Joyce Travelbee
Enrichment Activities
Formative Assessment
References

MODULE FOUR: SYSTEM THEORY

Learning Objectives
Lesson 13 : System Model in Nursing Practice by Betty Neumann
Lesson 14 : Behavioral System Model by Dorothy Johnson
Lesson 15 : Goal Attainment Theory by Imogene King
Lesson 16 : Self-Deficit Theory of Nursing by Dorothea Orem
Lesson 17 : Twenty-One Nursing Problem by Faye Glenn Abdellah
Enrichment Activities
Formative Assessment
References

MODULE FIVE: DEVELOPMENTAL THEORIES

Learning Objectives
Lesson 18 : Adaptation Model by Sister Callista Roy
Lesson 19 : Transcultural Theory in Nursing by Madeleine Leininger
Lesson 20 : Philosophy and Science of Caring by Margaret Jean Watson
Lesson 21 : From Novice to Expert by Patricia Benner
Enrichment Activities
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Formative Assessment
References

MODULE SIX: OTHER NURSING THEORIES

Learning Objectives
Lesson 22 : Care, Core, and Cure Model by Lydia Hall
Lesson 23 : Conservation Model by Myra Estrin Levine
Lesson 24 : Nursing Process Discipline by Ida Jean Orlando
Lesson 25 : Health Promotion Model of Nursing by Nola Pender
Lesson 26 : Theory of Human Becoming by Rosemarie Rizzo Parse
Lesson 27 : Science of Unitary Human Beings by Martha Rogers
Enrichment Activities
Formative Assessment
References

MODULE SEVEN: LOCAL THEORIES & MODELS OF NURSING

INTERVENTIONS
Learning Objectives
Lesson 28 : Technological Nursing as Caring Model by Rozzano C. Locsin
Lesson 29 : Retirement and Role Discontinuity Model by Sister Letty G. Kuan
Lesson 30 : PREPARE ME Holistic Nursing Interventions by Carmencita M. Abaquin
Lesson 31 : Composure Model by Carmelita C. Divinagracia

Enrichment Activities
Formative Assessment
References

MODULE EIGHT: THEORIES RELEVANT TO NURSING PRACTICE

Learning Objectives
Lesson 32 : Maslow’s Human Needs Theory
Lesson 33 : Erickson’s Psychosocial Development
Lesson 34 : Kohlberg’s Moral Development
Enrichment Activities
Formative Assessment
References

MODULE NINE: CORE COMPETENCIES IN NURSING

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Learning Objectives
Lesson 35 : 2012 National Nursing Core Competency Standards
Enrichment Activities
Formative Assessment
References

Biography of the Contributors

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MODULE ONE

OVERVIEW OF THE THEORY

LEARNING OBJECTIVES:

After going through this module, the students are expected to be able to:

1. Define and discuss the terms in nursing theory using critical thinking skills.
2. Cite and discuss briefly the characteristics of a theory.
3. Develop analytical skills differentiating the types of theory.
4. Explain the relationships of concepts and propositions to theory.
5. Display analytical thinking skills in differentiating the metaparadigms of the
different nursing theories.
6. Explain the four ways of knowing.
7. Develop self-awareness or persona - knowledge (relationship to self,
family, community).
8. Apply appropriate actions in nursing situation through using the four ways
of knowing.
9. Acknowledge the importance of the different ways of knowing.
10. Improve oral proficiency in explaining the concepts.
11. Develop teamwork and unity in identifying the sources of knowledge.
12. Practice the steps of the scientific method in solving problem.
13. Identify and explain the scope of theories.
14. Demonstrate ability in analysis and evaluation of theories.
15. Enumerate the criteria of a profession.
16. Display critical thinking skills in discussing the significance of theories on
research, education, practice, and nursing profession.

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LESSON 1

INTRODUCTION TO NURSING THEORIES

What is a Theory?

- Theory maybe defined as a hypothesis or system of ideas that is proposed to

explain a given phenomenon or idea.
- Theory is a set of statements that tentatively describe, explain, or predict
relationships among concepts that have been systematically selected and
organized as an abstract representation of phenomenon.
- An organized system of accepted knowledge that is composed of concepts,
propositions, definitions and assumptions intended to explain a set of fact,
event or phenomena.
- A comprehensive explanation of a given set of data that has been repeatedly
confirmed by observation and experimentation and has gained general
acceptance within the scientific community but has not been yet decisively
proven.

Characteristics of a Theory

1. It correlates concepts in such a way as to generate a different way of

looking at a certain fact or phenomenon.
2. Logical in nature.
3. Simple but generally broad in nature.
4. Can be a source of hypothesis.
5. Contribute in enriching the body of knowledge.
6. Can be used by practitioner to direct & enhance their practice.
7. Consistent with other validated theories, laws, & principles.

Components of a Theory

1. Concepts
• Ideas and mental images that help to describe phenomena.
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• Defined as an idea formulated by the mind or an experience perceived

and observed such as justice, love, war and disease.
• Building blocks of theories.

• Two types of concept:

 Abstract Concepts
 Indirectly observed or intangible.
 It is independent of time and place.  E.g. Love, care &
freedom.
 Concrete Concepts
 Directly observed or tangible.  E.g. Nurse, mother & pain.
2. Proposition or Assumption
• Explains the relationship of different concepts.
• A statement that specifies the relationship or connection of factual
concepts or phenomena.

3. Definitions
• Composed of various descriptions which convey a general meaning and
reduces the vagueness in understanding a set of concepts.
• Types of definition:
 Conceptual definition
 Meaning of the word is based on how a certain theory or
relevant literature perceives it to be.
 Operational definition
 Meaning of the word is based on the method of how it was
measured or how the person come-up with that perception.

4. Phenomenon
• Refers to an aspect of reality that can be consciously sensed or
experienced.
• A sets of empirical data or experiences that can be physically
observed or tangible such crying or grimacing when in pain.
• In Nursing, Phenomena can be:
 A clinical or environmental setting of nursing,
 Disease-Process,  Client’s Behaviour,
 Interventions, or
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 Practices that are utilized in nursing theories &

metaparadigm.

Why theories are important?

• In science, the purpose of a theory is to guide research, support existing,

knowledge, or generate new knowledge.
• The ultimate goal is to support excellence in practice.
• Framework for thought in which to examine situations.
• Structure for organization, analysis, and decision making.
• A theory helps us to organize our thoughts and ideas.

What are the different types of theories?

1. Descriptive Theories
• Also known as Factor-Isolating Theories and are known to be the primary
level of theory development.
• They identify and describe major concepts of phenomena. However, they
do not explain the relationship of the concepts.
• Its main purpose is to present a phenomenon based on the five senses
together with their corresponding meaning.

2. Explanatory Theories
• Also known as Factor-Relating Theories and are the type of theory that
presents relationship among concepts and propositions.
• These theories aim to provide information on how or why concepts are
related.
• Cause and effect relationship are well explained using explanatory
theories.

3. Predictive Theories
• Otherwise known as Situation-Relating Theories, are achieved when the
relationships of concepts under a certain condition are able to describe
future outcomes consistently.
• This kind of theory is generated and tested using experimental research.

4. Prescriptive Theories
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• Also called as Situation-Producing Theories and deals with nursing

actions, and test the validity and certainty of a specific nursing
intervention
• This kind of theory is commonly used in testing new nursing
interventions.

What is Nursing?

- According to Association of Deans of Philippine Colleges of Nursing

(ADPCN), Nursing is a dynamic discipline. It is an art and a science of caring
for individuals, families, groups and communities geared toward promotion
and restoration of health, prevention of illness, alleviation of suffering and
assisting clients to face death with dignity and peace.
- Nursing was defined by the American Nurses Association (ANA) as the
diagnosis and treatment of human responses to actual or potential health
problems.
- International Council for Nurses (ICN) defined Nursing as an autonomous
and collaborative care of individuals of all ages, families, groups and
communities, sick or well and in all settings.
- International known theorist, Virginia Henderson definition of Nursing is to
assist clients in the performance of activities contributing to health, its
recovery or peaceful death that clients will perform unaided, if they had the
necessary will, strength or knowledge.
- Nursing is focused in supporting communities, families and individuals in
maintaining, restoring or achieving a state of optimum health and functioning.
It is both a science and an art that is concerned with the quality of life as
defined by the clients.

What about Nursing Theories?

- Nursing theories are group of interrelated concepts that are developed from
various studies of disciplines and related experiences.
- Nursing theory provides the theoretical foundation of the profession.
- This aims to view the essence of nursing care.
- Nursing Theory defines what nursing is, what it does, and the goals or
outcomes of nursing care.

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Why Nursing Theories are important?

• It guides nursing practice and generates knowledge.

• It helps to describe or explain nursing.
• Enables nurses to know WHY they are doing WHAT they are doing.
• It strengthened the Nursing Knowledge.
• It assists the nursing discipline in clarifying beliefs, values, and goals.
• Help to define the unique contribution of nursing in the care of clients.
• Standards of clinical practice are developed out of nursing theories.
• It organizes and analyzes patients’ data.
• It helps in understanding connections between pieces of data.
• Maintains professional boundaries in nursing.
• It makes sound clinical judgments based on evidence.
• It makes S.M.A.R.T (specific, measurable, attainable, realistic & time-
bounded) effective plan of care.
• Helps in predicting and evaluating outcomes of interventions or plans of
care.

What is Paradigm and Nursing Paradigms?

- Paradigm is a model that explains the linkages of science, philosophy, and

theory accepted and applied by the discipline.
- Nursing Paradigms are patterns or models used to show a clear
relationship among the existing theoretical works in nursing profession.

What about Metaparadigm of Nursing?

- Metaparadigm came from the word ―meta‖, a Greek word which means
―with‖ and a paradigm which means ―pattern‖.
- It embodies the knowledge base, theory, philosophy, research, practice, and
educational experience and literature identified with the profession.
- Metaparadigm is the most abstract level of knowledge.
- In nursing, this is main concepts that encompass the subject matter and the
scope of the discipline.

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What are the Four Metaparadigms of Nursing?

1. Person o The recipient of nursing care which includes individuals,

families, groups and communities.
2. Health o The degree of wellness or well-being that the patients
experiences.

3. Environment o Environment is the internal and external surroundings that

affect the patient.
o This includes people in the physical environment, such as families,
friends and significant others.
4. Nursing o The interventions of the nurse rendering care in support of or in
cooperation with the client.

What is Philosophy in Nursing?

- Philosophy in nursing is the next knowledge level after metaparadigm.

- It specifies the definition of metaparadigm concepts in each of the conceptual
models of nursing.
- It sets forth the meaning of phenomena through analysis, reasoning, and
logical argument.
- Philosophies have contributed to the knowledge development in nursing by
forming a basis for subsequent developments especially in area of human
science.

What is Science?

- Science came from the latin word ―scientia‖, meaning ―KNOWLEDGE‖.

- It refers to any systematic knowledge or practice in a discipline of study.
- It refers to any system of acquiring knowledge based on scientific method.
- Science is an organized body of knowledge gained through research.

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What are the Steps in Scientific Method?

1. Observation
 Integration of knowledge and/or phenomenon by rational or sentiment
being.

2. Gathering information or data

 Recognition and collecting data for a particular or scientific problem or
inquiry.

3. Formulation of hypothesis
 An attempt to explain or suggest a nature of a phenomenon.

4. Experimental Investigation
 A set of examinations done to solve the particular query raise through the
hypothesis process.

5. Conclusion
 A statement explaining a set of natural phenomena or scientific query
derived from experimental investigation.

What is Knowledge?

- Knowledge can be defined as information, skills and expertise acquired by a

person through various life experiences or through formal/informal learning
such as formal education, self-study or vocational courses.
- Knowledge acquirement involves several cognitive processes (perception,
association, learning, reasoning, and communication).

TYPES OF COGNITIVE PROCESS

PERCEPTION - Achieving understanding of sensory data.

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ASSOCIATION - Combing two or more concepts/ ideas to form a new

concept, or for comparison.
LEARNING - Acquiring experiences, skills, information and
values.
REASONING - Mental processes of seeking conclusions through
reason.
COMMUNICATION - Transferring data from sender to receiver using
different mediums or tools of communication.

What are the sources of knowledge?

1. Traditional knowledge
o This source of knowledge is a nursing practice passed from generation to
generation.

2. Authoritative knowledge
o Authoritative source of knowledge refers to an idea by a person of authority
which is perceived as true because of his or her expertise.

3. Scientific knowledge
o This type of knowledge which came from scientific method through
research.
o These new ideas are tested and measured systematically using objective
criteria.

What about Nursing Knowledge?

- Nursing knowledge is composed of both theoretical and practical

knowledge.
- Theoretical knowledge aims to stimulate thinking and broaden
understanding of the science and practice of the nursing discipline. It

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includes and reflects on the basic values, guiding principles, elements and
phases of conception of nursing.
- Practical knowledge referred to as the art of nursing.

LESSON 2

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PURPOSES OF NURSING THEORY

Purposes of Nursing Theories

a. In Practice
 It assists nurses to describe, explain and predict everyday
experiences.
 Serve to guide assessment, intervention and evaluation of nursing
care.
 Provide a rationale for collecting reliable and valid data about the
health status of clients, which are reliable for effective decision-
making and implementation.
 It establishes criteria to measure the quality of nursing care.
 Helps build common nursing terminology to use in communicating
with other health professionals.
 Enhances autonomy of nursing profession by defining its own
functions.

b. In Education
 Provides general focus for curriculum design.
 Guide curricular decision making.
 It primarily ensure adequate & quality nursing delivery and to clarify
and improve the status of the nursing as a profession.

c. In Research
 Offer framework for generating knowledge and new ideas.
 Assist in discovering knowledge gaps in specific field of study.
 Offer a systematic approach to identify questions for study, select
variables, interpret findings and validate nursing interventions.

What are the current trends influencing Nursing Theories?

 Medical Science.
 Nursing education.
 Professional Nursing Organizations.
 Evolving Research Approaches.
 Global Concerns.
 Consumer Demands.
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 New Technologies.

Interdependence of Theory and Research

- ―Practice without theory, like a map without route, is blind; theory without
practice, like route without map, is empty‖.

- The more research is conducted, the more learning is gained as to what

extent a given theory can be useful in providing knowledge that will enhance
client’s care.

- Research is linked to theory in two – ways by generating and testing.

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. The researcher already has some
predetermined notions as to how phenomenon is and creates a
hypothesis to test the assumptions of the theory.

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LESSON 3

FOUR WAYS OF KNOWING

What are the Four Ways of Knowing?

1. Empirics - the scientific discipline of nursing.

2. Ethics - the moral directions of nursing.
3. Personal - method by which nurses approach their patients.
4. Aesthetic or Esthetic - deals with the emphatic aspect of nursing.

What is Empirical Knowing?

- The first primary model of knowing.

- It refers to any scientific, research-based, theoretical, factual information that
the nurse makes use of.
- The principal form relating factual and descriptive knowing aimed at the
expansion of abstract and theoretical explanations.
- Emphasizes that scientific research is important to nursing knowledge.
- Empirical Knowing focuses on evidence-based research for effective &
accurate nursing practice.
- Examples are knowledge obtained from textbooks, lectures, journals,
literatures, credible online resources, and results of evidence-based
researches.

Evidence-Based Practice as part of Empirical knowing

- An accurate & thoughtful decision-making about healthcare delivery for
clients.
- This is based on the result of most relevant & supported evidence derived
from research in response to client’s preferences & expectations.

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- Evidence-based practice (EBP) promotes quality care that has been

demonstrated to be effective. Practice founded on EBP can bridge the gap of
nursing practice and research to provide basis for nurses to transform
research into quality care.
- There are six (6) characteristics of quality healthcare that reinforces aspects
of Evidence-Based Practice (EBP);
 Client-centered,
 Scientifically-based,
 Population-outcome based,
 Develop through quality improvement and benchmarking,

 Individualized to client’s need, and

 Attuned with system policies and resources.

What is Ethical Knowing?

- Involves the judgement of right & wrong in relation to intentions, reasons and
attributes of individuals & situations.
- It requires knowledge of different philosophical views regarding what is good
& right in making moral actions & decisions particularly in the theoretical &
clinical components of nursing.
- The code of morals or code of ethics that leads the conduct of nurses is the
main basis for ethical knowing in the nursing profession.
- It is deeply rooted in the concepts of human dignity, service and respect for
life.

What is Aesthetic or Esthetic Knowing?

- This type of knowing is used in the process of giving appropriate nursing care
through understanding the uniqueness of every patient, thus emphasize the
use of creative & practical styles of care.
- It is related to understanding what is of significance to particular patients
such as feelings, attitudes, and point of view.
- It is also the manifestation of the creative and expressive styles of the nurse.
- Focuses on EMPATHY, the ability for sharing or vividly understanding
another's feeling.

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- It also includes the nurse’s ability in changing ways and manner of rendering
nursing care based on the client’s individual needs and perceptions.

What is Personal Knowing?

- This type of knowing is focused on realizing, meeting, defining the real true
self or in other word ―self-awareness‖.
- It encompasses the knowledge of the self in relation to others and to self.
- It involves the entirety of the nurse - patient relationship.
- It is most difficult to master and to teach.
- It is the key to comprehending health in terms of personal wel-being.

LESSON 4

SCOPE OF THEORIES AND ANALYSIS

What are the concepts to understand?

Theories unique to nursing help the discipline define how it is different from
other disciplines. They are known to have a relative system of ideas that is
intended to explain a give phenomenon or fact.

Nursing Theories reflect particular views of person, health, environment,

nursing and other concepts that contribute to the development of a body of
knowledge specific to nursing concerns.

Scope refers to the qualified level of precision of a certain theory and the
accuracy of its concepts and propositions.

Basically, there are three categories that relate to the scope of a theory: Grand
Theories, Middle – range Theories, and the Micro – range Theories.

What are Grand Theories?

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- These theories are broadest in scope, representing universal and broad

nursing phenomena.
- Grand Theories are simply known to speak about broad range of important
relationship among concepts of a discipline.
- They are made up of concepts representing common and extremely complex
phenomena.
- Basically, its purpose is not expected to provide a perfect guidance for the
formation of specific nursing knowledge but rather provides a general
framework for creating and structuring broad and abstract ideas.
- Commonly known grand theories in the nursing discipline are: Orem’s
Selfcare Theory of Nursing and Neuman Systems Model Theory.

What about Middle – Range Theories?

- These theories are known to have a narrower and detailed focus compared
to grand theories.
- Middle – Range Theories are least abstract level of theoretical knowledge
because they include details specific to nursing practice. Descriptions,
explanations, and predictions are made with the purpose of answering
questions about different nursing phenomena.
- They specify such things as the health condition, the patient population or
age group, the location of practice, and the different interventions of the
nurse.
- Commonly known middle – range theories in the nursing discipline are:
Psychodynamic Nursing by Hildegard Peplau, Human-toHuman Relationship
Model by Joyce Travelbee, Transcultural Theory in Nursing by Madeleine
Leininger, and Model of Health by Margaret Newman.

What about Micro – Range Theories?

- These are known to be the most concrete and narrow in scope.

- Micro – range Theories are situation – specific and limited to particular
populations or fields of practice and also a linking of concrete concepts into a
statement that can be observed in practice and research.

Analysis and Evaluation of Theory

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Things to consider when evaluating a theory:

o The degree of usefulness to guide practice, research, education and

administration.
o Providing a description of a theory through reviewing the entire work
while focusing in its historical aspect. o Critical reflection should be done
by ascertaining how well a theory serves the profession’s progress.

There are different ways in analysis and evaluating of a theory. Chinn and
Kramer (1991) suggested the following criteria in evaluating a theoretical work
which includes:

 Clarity,
 Simplicity,
 Generality,
 Empirical precision, and
 Derivable consequences

What is Clarity?

 In evaluating this, semantics (study of meaning of the language, symbols

and logic) and structure should be considered important.
 It involves identifying the major concepts & sub- concepts used in the
theory.
 Words commonly used with multiple meanings within & across disciplines
should be defined operationally or how it is used in the framework from
which it is derived.
 Diagrams should also be clear and consistent all throughout.
 It should also follow a logical sequence which is understandable.
 Assumptions should be consistent with the defined goals of the theory.
 Questions to be asked:
• Is the theory clearly stated?
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• How clear is the theory?

• Is it easily understood?

What is Simplicity?

 A theory must be adequately comprehensive at a level of abstraction to

offer direction. However, it must have as few concepts as possible having
simple relations to assist clarity.
 The most useful theories are those that offer greatest sense of
understanding.
 Questions to be asked:
• How simple is the theory?

What is Generality?

 It is important to examine the scope of concepts and goals within the

theory for this analysis criterion.
 As a rule of thumb, ―the more limited the concept and goals is, the less
general the theory becomes‖.
 Consequently, the broader the scope of the theory, the greater its
significance.
 Questions to be asked:
• How general is the theory?
• How broad is the scope of the theory?

What is Empirical Precision?

 The degree in which the defined concepts are observable in actual setting.
 Empirical adequacy can be measured by the evidences that support the
theory.
 According to Walker & Avant, a theory must generate a hypothesis and
must add to the body of knowledge.
 Questions to be asked:
• Is theory accessible?
• How accessible is the theory?

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What is Derivable Consequences?

 A nursing theory should lead itself to research testing which would result to
additional knowledge that would guide practice.
 Furthermore, nursing theory should give direction to research and practice,
create new ideas and seek to distinguish the focus of nursing to other
professions.
 Questions to be asked:
• How important is the theory?
• Does the theory have a significant contribution to nursing
knowledge?

LESSON 5

SIGNIFICANCE OF THEORY TO NURSING AS A PROFESSION

What is a Profession?

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- Profession is a calling that requires special knowledge and skilled

preparation.
- It is generally distinguished from other kinds of occupation by:
 Its requirement of prolonged specialized training acquiring a body of
knowledge pertinent to the role to be performed.
 An orientation of the individual toward service, either to community or
organization.

What are the Criteria for a Profession?

1. A profession applies its body of knowledge in practical services that are

vital to human welfare, and especially suited to the tradition of seasoned
practitioners shaping the skills of newcomers to the role.
2. It constantly enlarges the body of knowledge it uses and subsequently
imposes on its members a lifelong obligation to remain current in order to
―DO NO HARM‖.
3. It functions autonomously (with authority) in formulation of professional
policy and in monitoring its practice and practitioners.
4. It utilizes in its practice a well-defines and well - organized body of
knowledge that is intellectual in nature and describes its phenomenon and
practitioners.
5. A profession has a clear standard of educational preparation for entry into
practice.
6. A profession is distinguished by the presence of specific culture, norms
and other values that are common among its members.

What are the Characteristics of a Profession?

 A defined body of knowledge,

 Power & authority over training and education,
 Registration,
 Altruistic service,
 A code of ethics,

 Lengthy socialization, and  Autonomy.

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How Theory is Significant to Nursing Profession?

- Theory is significant mainly because it helps us to settle on what we know

and what we need to know in the future.
- It helps to differentiate what should form the basis of practice by clearly
describing what nursing does and nursing is all about.
- Ideally, nursing theory should provide the principles that support nursing
practice.
- Nursing theory helps the nurse to:
• Organize, examine, and analyze patient’s data,
• Make decisions about effective and efficient nursing interventions,
• Make S.M.A.R.T (Specific, Measurable, Attainable, Realistic, and
Time-bounded) plan of care, and
• Predict and evaluate outcomes of care.

What is a Professional Nurse?

- Professional Nurse is one who has acquired the art and science of nursing
through her basic education, who interprets her role in nursing in terms of the
social ends for which it exists, the health and welfare of society and who
continues to add to her knowledge, skills and attitudes through continuing
education and scientific inquiry or the use of the results of such inquiry.

Characteristics of a Professional Person

 Concerned with quality,

 Self-directed, responsible and accountable his actions,
 Able to make independent and sound judgement including high moral
judgement,
 Dedicated to the improvement of human life, and  Committed to the
spirit of inquiry.

Qualifications and Abilities of a Professional Nurse

 Faith in the fundamental values,

 Sense of responsibility,

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 Faith in the reality of spiritual & aesthetic values and awareness of the
value & the pleasure of self-development through the pursuit of some
aesthetic interest.
 Have the basic knowledge, skills & attitudes necessary to address
present-day social problems.
 Has skill in using written and spoken language.
 Appreciate & understand the importance of good health.
 Has emotional balance.
 Likes hard work & possesses a capacity for it.
 Appreciates high standards of workmanship.
 Accepts & tries to understand people of all sorts, regardless of race,
religion and color.
 Knows nursing so thoroughly that every client will receive excellent care.

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ENRICHMENT ACTIVITIES

A. Let’s create your theory! Instruction:

• Cut at least 10-15 pictures in an old magazine and paste them in a long
bond paper worksheet.
• Then try to arrange them in a manner that will exhibit their relatedness.
Define the meaning of each picture operationally or conceptually then
explain its relationship, and come – up with your own theory about its
relationships.
• Then, present your works in the class by taking a video prerecorded
presentation while explaining your identified or formulated theory.
• Submit your output using the guidelines or means (e.g. e-mail, Facebook
messenger, Google classroom) provided by your respective professors in
this course.

B. Four Ways of Knowing!

Instruction:

• Cut pictures or symbols from old magazines or newspapers depicting the

four ways of knowing and paste them on short bond papers. At least
three (3) pictures each type of knowing.
• Then, present your works in the class by taking a video prerecorded
presentation while explaining the pictures relatedness to the type of
knowing.
• Submit your output using the guidelines or means (e.g. e-mail, Facebook
messenger, Google classroom) provided by your respective professors in
this course.

FORMATIVE ASSESSMENT

A. Let’s test your knowledge and understanding!

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Instruction: Answer the following essay type questions based on your

understanding on the lessons presented from module one. Your answer
must be brief, direct to the point and at least 150-300 words. Submit your
output using the guidelines or means (e.g. e-mail, Facebook messenger,
Google classroom) provided by your respective professors in this course.
PLAGIARISM is a big NO!

1. How has the theory influenced the nursing profession?

2. In what ways has nursing as a professional practice been strengthened
by the theory?
3. What will be the continuing social value of the theory in the
development of nursing profession?

REFERENCES

Alligood, M. R. (2018). Nursing Theorists and Their Work, 9th Edition. Elsevier
(Singapore) Pte. Ltd. Incorporated, 3 Killiney Road, winsland House I,
239519 Singapore.

Berman, A., Snyder, S., Frandsen, G. (2016). Kozier and Erb’s Fundamentals of
Nursing: Concepts, Process and Practice, 10th Edition. Pearson Education
Incorporated, 221 River Street, Hoboken, New Jersey, 07030.

Octaviano, E. F., Balita, C. E. (2020). Theoretical Foundations of Nursing: The

Philippine Perspective: National Nursing Core Competency Standards
Aligned Outcomes-Based Approach, 2020 Edition. Ultimate Learning Series,
2nd Floor Carmen Building, Sampaloc, Metro Manila, Philippines.

Octaviano, E. F., Balita, C. E. (2008). Theoretical Foundations of Nursing: The

Philippine Perspective, 2008 Edition. Ultimate Learning Series, 2nd Floor
Carmen Building, Sampaloc, Metro Manila, Philippines.

Smith, M. C., Parker, M. E. (2015). Nursing Theories and Nursing Practice, 4th
Edition. F.A. Davies Company, 1915 Arch Street Philadelphia, PA 19103

Udan, J. Q. (2011). Theoretical Foundations of Nursing, 1st Edition. Educational

Publishing House, 526-528 United Nations Avenue, Ermita, Manila,
Philippines.

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Udan, J. Q. (2009). Mastering Fundamentals of Nursing Concepts and Clinical

Application, 3rd Edition. Educational Publishing House, 526-528 United
Nations Avenue, Ermita, Manila, Philippines.

MODULE TWO

HISTORY OF THE NURSING PROFESSION

LEARNING OBJECTIVES:

After going through this module, the students are expected to be able to:

1. Trace and summarize the history and evolution of the nursing profession.
2. Develops oral communication skills in stating and describing the different
nursing eras.
3. Explain and summarize the history and prominent pioneering leaders of the
nursing profession in the Philippines.
4. Discuss the contributions of the Nursing Leaders of the 20th Century.
5. Trace and discuss the history of the MSU - College of Health Sciences.
6. Explain and describe the history, principles, and impact of Environmental
Theory by Florence Nightingale to the nursing profession.

LESSON 6

EVOLUTION OF THE NURSING PROFESSION

History and Development of Nursing Profession

A. Period of Intuitive Nursing

- Nursing started in the INTUITIVE PERIOD way of caring for the sick
member of the family.
- Nursing was untaught and instinctive.
- It was performed out of compassion for others, out of the wish to help
others.
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- Nursing was a function that belonged to women, and they are the ones
who stayed at home & took care of the children, the sick and the aged.
- In ancient civilizations, providing care revolves around the use of magical
thinking, superstitious beliefs and religious beliefs.
- During this time, beliefs about the cause of disease were embedded in
superstition and magic and thus treatment often involved magical cures.
- They believed that the medicine man called ―SHAMAN‖ or witch doctor
had the power to heal by using white magic.
- TREPHINING was also being practice as last resort to drive the evil spirits
from the body of the afflicted.
- In Egypt, people worshipped the Goddess Isis & her son, Horus as they
believed to manipulate the dreams of the sick.
- Egyptians introduced the art of embalming, which enhanced their
knowledge of human anatomy.
- Ancient Egyptians developed community planning and strict hygienic rules
to control communicable diseases. The first recorded nurses were seen.
- In the Babylonian civilization, there were references to tasks and practices
traditionally provided by nurses. Nurses are mentioned occasionally in Old
Testament as women who provide care for infant, for the sick and dying
and as midwives who assisted during pregnancy and delivery.
- In ancient ROME, care of the sick and injuries was advanced in
mythology and reality. Although medicine as a
science was developed there was little evidence of
establishing a foundation for nursing.
- The ancient GREEKS, Gods were believed to have special healing power.
In 460 BC, Hippocrates born and credited with being the Father of
medicine. He proved that illness had natural cause and not to be of a
religious or magical cause.
- Hippocrates first proposed such concepts as physical assessment,
medical Ethics, patient – centered care and observation and reporting. He
emphasized the importance of patient care that contributed a lot for the
groundwork of nursing.

B. Middle – Ages or Apprentice Period of Nursing

- This period extends from the founding of religious order nursing orders in
the crusades in 11th century and ended in 1836.
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- Pastor Fliedner and his wife established the Kaiserwert Institute for the
training of Deaconesses (a training school for nurses) in Germany.
- It is the period of ―On the Job Training‖. Nursing care was performed
without any formal education and by people who were directed by more
experience nurses.
- During this time, monasticism and other religious groups offered the only
opportunities for men and women to pursue careers in nursing.
- It was the Christian value of "love your neighbour as the self" that had a
significant impact on the development of western nursing.
- The principle of caring was established with Christ’s parable (short story)
of Good Samaritan providing care for a tired and injured stranger.
- Care was done by crusaders, prisoners and religious nursing orders.
- Men in religious orders were also providing nursing care in the middle
ages (St. Benedictine Nursing Order, Knights of Hospitalers, Teutonic
Knights, and Knights of St. Lazarus).
- Important nursing personages during the Period of Apprentice Nursing:

St. Clare, founder of the second order of St. Assisi; took vows of poverty,
obedience service and chastity, gave nursing care to the sick and the
afflicted.
St. Elizabeth of Hungary, known as the patroness of nurses. She used
her wealth to make the lives of the poor happy and useful. She built
hospitals for the sick and needy.
St. Catherine of Sienna, the first lady with a Lamp. At the age of seven,
she pledged her life to service and was referred as little saint. She was a
hospital nurse, prophetess, researcher and a reformer of society and the
church.

B. Dark Period of Nursing

- Extends from 17th to 19th century.

- In this period Monasteries were closed and the work of women in religious
order was nearly ended.
- Hundreds of hospitals closed and there was no provision for the sick and
no one to care for the sick.

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- The few women who cared for the sick during this time were prisoners or
prostitutes who had little or no training in nursing, and nursing went down
to its lowest level.
- Because of this, nursing was considered as the most minimal of all tasks,
and had little acceptance and prestige.
B. Educated Nursing or Nightingale’s Era

- From 19th – 20th century.

- The development of Nursing during this period was strongly influenced
by:
 Trends resulting from wars (Crimean War & Civil Wars),
 Arousal of social consciousness, and
 Increase educational opportunities offered to women.
- Began from June 15, 1860 when Florence Nightingale School of Nursing
opened at St. Thomas Hospital in London (St. Thomas Hospital School of
Nursing).
- Florence Nightingale, recognized as the ―Mother of theModern Nursing‖
and was known as Lady with a Lamp.
- She advocated for care of those afflicted with diseases caused by lack of
hygienic practices.
- Three images influenced the development of modern nursing:
 Ursuline Sisters of Quebec organized the first training for
nurses.
 Theodore Flender revived the deaconess movement and
opened a School in Kaiserwerth, Germany, which was training
nurses.
 Elizabeth Fry established the institute of Nursing Sisters.
- Latter half of 18th century, Florence Nightingale (Founder of Modern
Nursing) changed the form and direction of nursing and succeeded in
establishing it as a respected profession.
- In spite of opposition from her family and restrictive societal code for
affluent young English woman to be a nurse, Nightingale believed she was
"called‖ by God to help others and to improve the wellbeing of mankind.

B. Period of Contemporary Nursing

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- This covers the period after World War II to the present.

- Scientific, technological developments and social changes mark this
period.
- The role of nurses become defined depending on the different fields of
expertise as time progressed.
- Establishment of World Health Organization by United Nations.
- Licensure of nurses started.
- Specialization of hospital & diagnosis.
- Training of nurses in diploma, baccalaureate and advance degree nursing
programs.
- Nursing involvement in community health is greatly intensified.
- Development of expanded role of nurses (e.g. nurse anesthesist and etc.).
- During the early 20th century, philosophers & scientists argued the use of
EMPIRICISM and RATIONALISM.

- The philosophers point of view is that knowledge should be based on the

understanding of existing theories whereas scientists believe that
knowledge should not only focus on theoretical existence but also on
understanding what there is still to be observed.

 RATIONALISM makes use of reason gained thru expert study, tested

theory and established facts to evidently provide something.
 EMPIRICISM makes use of objective and tangible data or those that
are perceived by senses (smell, sight, taste & feeling) to observed and
collect data.

- The development of knowledge in the 20 th century was mainly affected by

the different nursing leaders and theorist of the early 20th century.

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LESSON 7

NURSING PROFESSION IN THE PHILIPPINES

Early Beliefs and Practices

- Diseases are caused by another person (an enemy or witch) or evil spirits.
- People believed that evil spirits could be driven away by person with powers;
special gods of healing, priest-physician (word doctors) and herbolarios (the
one using leaves or roots to heal).
- Early Filipinos subscribed to superstitious beliefs and practices in relation to
health and practices.
- Herbmen were called ―HERBICHEROS‖, meaning one who practiced
witchcraft.
- Persons suffering from diseases without any identified cause were believed to
be bewitched by the ―MANGKUKULAM‖ or ―MANGAGAWAY‖.
- Difficult childbirth and some diseases (called ―PAMAO‖) were attributed to
―NONOS‖.

Healthcare during the Spanish Regime

Religious orders exerted their efforts to care for the sick by building hospitals
in the different parts of the Philippines.

1. Hospital Real de Manila (1577) – was established mainly to care for the
Spanish King’s soldiers, but also admitted Spanish civilians.
2. San Lazaro Hospital (1578) – built exclusively for patients with leprosy.

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3. Hospital de Indio (1586) – service was in general supported by alms and

contributions from charitable persons.
4. Hospital de Aguas Santas (1590) – near a medicinal spring and was
established in Laguna.
5. San Juan de Dios Hospital (1596) – support was derived from alms and
rents, rendered general health service to the public.

Nursing during the Philippine Revolution

The prominent persons involved in nursing works were:

1. Josephine Bracken – wife of Dr. Jose Rizal and installed a field hospital
in an estate house in Tajeros providing nursing care to the wounded night
and day.
2. Rosa Sevilla de Alvero - converted their house into quarters for the
Filipino soldiers during the Philippine – American war that broke out in
1899.
3. Dona Hilaria de Aguinaldo – wife of Emilio Aguinaldo who organized the
Filipino Red Cross under the inspiration of Apolinario Mabini.
4. Dona Maria Agoncillo de Aguinaldo – second wife of Emilio Aguinaldo
who provided nursing care to Filipino soldiers during the revolution, and
the president of the Filipino Red Cross branch in Batangas.
5. Melchora Aquino (Tandang Sora) – Nursed the wounded Filipino
soldiers and gave them shelter and food.
6. Capitan Salome – a revolutionary leader in Nueva Ecija who provided
nursing care to the wounded when not in combat.
7. Trinidad Tecson – known as Ina ng ―Biak na Bato‖ who stayed in the
hospital at Biac na Bato to care for the wounded soldiers.

Earliest Hospitals and Schools of Nursing

1. Iloilo Mission Hospital School of Nursing in 1906

2. St. Paul’s Hospital School of Nursing in 1907
3. Philippine General Hospital School of Nursing in 1907
4. St. Luke’s Hospital School of Nursing in 1907
5. Mary Johnston Hospital & School of Nursing in 1907
6. Philippine Christian Mission Institute Schools of Nursing
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7. San Juan de Dios Hospital School of Nursing in 1913

8. Emmanuel Hospital School of Nursing in 1913
9. Southern Island Hospital School of Nursing in 1918

First Colleges of Nursing in the Philippines

1. University of Santo Tomas College of Nursing in 1946

2. Manila Central University College of Nursing in 1947
3. University of the Philippines College of Nursing in 1948

Prominent Nursing Leaders in the Philippines

1. Cesaria Tan – first Filipino nurse who had Master’s Degree in Nursing in
United States.
2. Socorro Sirilan – reformed social service for indigenous patients at San
Lazaro Hospital.
3. Magdalena Valenzuela – first Filipino Industrial Nurse.
4. Annie Sand – founded the National League of Philippine Government
Nurses.
5. Cornel Elvegia Mendoza – first female Military Nurse.
6. Loreto Tupaz – known as the Dean of Philippine Nursing Education and
the Florence Nightingale of Iloilo.
7. Socorro Diaz – first editor of ―The Message‖.
8. Conchita Ruiz – first editor of ―The Filipino Nurses‖.
9. Dr. Julieta Sotejo– considered as the ―Florence Nightingale of the
Philippines‖.
• Founder & first Dean of UP-College of Nursing (UPCN).
• Professor Emeritus of UPCN.
• The author of Code of Ethics for Nurses (PRC BON Res #633, 1982).
• Chairman, Committee on Legal Aspect of Nursing (created the first
Philippine Nursing Law or RA No. 877 s. 1953).
10. Anastacia Giron Tupaz - first Filipino Nurse with a title of Nursing
Superintendent Chief Nurse at PGH.
• Founder of Filipino Nurses Association (FNA) now Philippine Nurses
Association (PNA).

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11. Rosario Montemayor Delgado - first President of the Filipino Nurses

Association (FNA).

Nursing Organizations in the Philippines

1. Philippine Nurses Association (PNA) – This is the national organization

of Filipino nurses.
2. National League of Nurses – The association of nurses employed in the
Department of Health (DOH).
3. Catholic Nurses Guild of the Philippines.
4. Association of Deans of Philippine Colleges of Nursing Incorporated
(ADPCN, Inc.).
5. Others: GNAP, ORNAP, MCNAP, IRNOP and etc.

LESSON 8 HISTORY OF MSU – COLLEGE OF HEALTH SCIENCES

Brief History of the College of Health Sciences

The College of Health Sciences was created through BOR Resolution No.
1216 s. 1977. It was approved to offer Diploma in Midwifery and Bachelor of
Science in Nursing as its initial offerings. However, only the Diploma in Midwifery
was immediately offered during that time due to lack of facilities. It was in 1988
when the Bachelor of Science in Nursing (BSN) program was finally offered after
complying with the requirements of the Board of Nursing.

In 1999, the common two-year Associate in Health Science Education

(AHSE) curriculum was implemented offering preparatory subjects, allowing the
students to progress to the study of efficient Health Sciences courses in addition
to Nursing. In 2006, it was deleted and changed to straight Bachelor of Science
in Nursing. Currently, CHS is offering Bachelor of Science in Nursing and Master
of Arts in Nursing - major in Nursing Administration.

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The founding Director of the College was Dr. Agripino Gonzales who was
succeeded by Dr. Cynthia M. Filipinas. When Dr. Filipinas’ term had expired, she
was succeeded by Dr. Nur-Hannipha B. Derico. After two (2) terms, the deanship
was turned over to Dr. Mindamora U. Mutin who was again succeeded by Dr.
Nur-Hannipha B. Derico whose term ended July 1, 2015. Today, the College of
Health Sciences is infused with a new dean in the person of Dr. Naima D. Mala.
Dr. Mala is the first dean alumna of this college and on her 2nd term of deanship.

The College of Health Sciences has always been known for its academic
excellence, dynamism and active community involvement. Gradually, it is
growing in number and improving its standards. The College shall only continue
from henceforth to produce the best nurses, not only in Mindanao but even in the
whole nation.

Philosophy

The CHS in pursuit of its mission believes in: preparing its graduates to become
useful members of the MINSUPALA Region and the country in general.

Vision

The CHS envisions to become a leading college offering health program,

undertaking research and extension services, committed to the health
development of the MINSUPALA Region and the country in general.

Mission

The College of Health Sciences shall be providing continuous opportunities for

quality higher education in the field of health to the young people on MINSUPALA
region particularly the Muslims and other cultural communities for them to be
capable of inculcating values of health and sanitation, prevent illness, and
alleviate suffering of infirmed and handicapped.

Objectives
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The College is dedicated to develop a health worker who:

1. Possesses self-discipline, moral integrity and knowledge of the ethico-legal

aspect of the profession.
2. Develops sensitive awareness of health need and problems in the
communities he/she serves.
3. Possesses caring behavior, nationalistic outlook, critical ability and
competence in the exercise of his/her profession.
4. Utilizes nursing process in assisting individuals, family and community
towards health maintenance, illnesses prevention, health promotion,
restoration and alleviation of sufferings.
5. Possesses knowledge, skills and attitude in research with the end view of
utilizing research findings.
6. Participate in the community development through extension services.
7. Applies management concepts in the work setting as a leader or member
of a team.

Administrative Heads (Academic Year 2020 -2021)

1. Dr. Naima D. Mala, RN, MN, MAN - Dean of the

College
2. Prof. Jonaid M. Sadang, RN, RM, LPT, MAN - College Secretary
3. Dr. Salma M. Basher, RN, LPT, MAN, DScN - Chairman,Graduate Program
4. Dr. Athena – Jalaliyah D. Lawi, RN, MN, MAN - Chairman, Undergraduate Program
5. Dr. Ashley A. Bangcola, RN, MAN - Research
Coordinator

6. Prof. Annie M. Mero, RN, RM, MN - Extension Coordinator

7. Prof. Raquel D. Macarambon, RN, MSN - Clinical Coordinator
8. Prof. Hamdoni K. Pangandaman, RMAN, RN, LPT - Review Coordinator
RN, RM, REB, MAN, MAEd - International Linkage Officer
9. Prof. Moh’d Ryan L. Diamla,
10. Dr. Laarni A. Caorong, RN , MAN - Level I Coordinator
11. Prof. Namera T. Datumanong, RN, MAN - Level II Coordinator
12. Mr. Jamla Tango P. Alawiya, RN, LPT - Level III Coordinator
13. Prof. Romanoff M. Raki-in, RN, MAN - Level IV Coordinator

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Faculty Members with Terminal Degrees in Nursing (PhDs or DScNs)

A. Doctor of Science in Gerontology Nursing

1. Dr. Salma M. Basher, RN, LPT, MAN, DScN

2. Dr. Ashley A. Bangcola, RN, MAN
3. Dr. Laarni A. Caorong, RN , MAN

LESSON 9

NIGHTINGALE’S ENVIRONMENTAL THEORY

Background of the Theorist

- Born on May 12, 1820 in Florence Italy.

- A beautiful Victorian Lady, whose parents were wealthy and well - travelled.
- She took her nursing program from Fleidener School of Nursing in
Kaiserswerth, Germany (July 6, 1851 – October 7, 1851).
- Then went back to England and used knowledge from Kaiserswerth to prove
her cause as a reformer for the well- being of the citizens.
- During Crimean War, battle between English and Turkish, she was
requested by her friend, Sir Sidney Herbert (secretary at Great Britain) to
help for the wounded soldiers.
- With her lamp, she traversed the night to look for the wounded soldiers and
heal them with her consoling hands.
- Called as ―Lady with the Lamp‖ and the Founder and Mother of Modern
Nursing.
- Nightingale was truly a skilled nurse, and was an expert statistician who used
statistics to present her case from hospital reform.
- She was viewed as pioneer in the graphic display of statistics and was
selected a fellow of the royal Statistical Society in 1858, and was bestowed
with honorary membership in the American Statistical Association in 1874.
- She was also an excellent writer, and her famous writing, Notes on Nursing
was frequent cited of all time.
- Her birthday marks the International Nurses Day celebration each year.

Metaparadigm of Nursing

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1. Person
• Viewed the essence of a person as a patient and envisioned as
comprising physical, intellectual, emotional, social & spiritual
components.
• The one who is receiving the care; dynamic & complex being.
2. Health
• According to her, ―Healthy is not only to be well, but to be able to use
well every power we have‖.
• She believed in the prevention and health promotion in addition to
nursing patients from illness to health.
3. Environment
• Anything that can be manipulated to place a patient in the best
possible condition for nature to act.
• Those elements external to and which affect the health of the sick and
healthy person.
4. Nursing
• Considered nursing as very essential for everybody’s well-being.
• She believed nursing to be a spiritual calling and nurses were to assist
nature to repair the patient.

Environmental Model in Nursing

Nightingale viewed the manipulation of the physical environment as a major

component of nursing care. She believed that when one or more aspects of the
environment are out of balance, the client must use increased energy to counter
the environmental stress.
She believed that when one or more aspects of the environment are out
balance, the client must use increased energy to counter the environmental
stress, and these stresses that drains patients’ energy needed for healing She
identified the 13 canons in her theory as major areas of the physical, social, and
psychological environment that the nurse could control:

 Ventilation & warmth

 Light
 Cleanliness
 Health and houses
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 Noise
 Bed and bedding
 Personal cleanliness
 Variety
 Chattering hopes and
advices  Taking food  What
food?
 Petty management
 Observation of the sick

 Ventilation and warmth

- Keeping the air as pure as the external air, without chilling him.
- Believed that ―noxious air‖ or ―effluvia‖ or foul odors affects the client’s
health.
- Emphasized the importance of room temperature (not too warm or too cold).

 Light
- Need for both fresh air and light – sunlight is beneficial to patients.

 Cleanliness
- Check room for dust, dampness and dirt.
- Keep room free from dust, dirt and dampness.

 Health and houses

- Check surrounding environment for fresh air, pure water, drainage,
cleanliness and light.
- Remove garbage, stagnant water, and ensure clean water and fresh air.

 Noise
- Check noise level in the room and surroundings.
- Attempt to keep noise level in minimum.

 Bed and beddings

- Check bed and bedding for dampness, wrinkles and soiling.
- Keep the bed dry, wrinkle-free, and lowest height to ensure comfort.
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 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.

 Variety
- Need for changes in color and form, including bringing the patient brightly
colored flowers and plants.
- Advocated rotating 10-12 paintings and engraving each day, week, or
month to provide variety for the patient.
- Advocated reading, needlework, writing and cleaning as activities to
relieve the sick in boredom.

 Chattering and hopes

- Avoid talking without reason or giving advices that is without fact.
- Continue to talk to the client as a person, and continue to stimulate
patient’s mind.
- Avoid personal talk.
 Taking food
- Continue with the assessment of the diet to include type of food and drink
the client likes or dislikes.
- Attempt to ensure that the client always has some food or drink available
that he or she enjoys.

 What food?
- Addressed the importance of variety in the food served to patients.

 Petty management -
Ensures continuity of care.
- Documents the plan of care and evaluate the outcomes to ensure
continuity.
- House and hospital needed to be well-managed that is organized, clean,
and with appropriate supplies.

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ENRICHMENT ACTIVITIES
A. Let’s Go Back to the Past! Instruction:
• In a short bond paper, identify the nursing leaders of the 20 th century and
describe their respective contributions to the nursing profession.
• Then, choose at least two (2) nursing leaders you’ve inspired with and
present this to the class using a pre-recorded video presentation while
explaining your reasons why. At least 2 – 3 minutes video presentation.
• Submit your outputs using the guidelines or means (e.g. e-mail,
Facebook messenger, Google classroom) provided by your respective
professors in this course.

B. Let’s dig deeper! Instruction:

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• On a short bond paper, enumerate at least three (3) traditional home

practices regarding care of the sick you have observed or experienced
before (you may include pictures if possible) and explain the foundation of
such practices and if could they be used in the nursing too, why or why
not?
• Then, chose one of the three (3) traditional home practices you’ve
identified and present this to the class using a pre-recorded video
presentation. At least 2 - 3 minutes video presentation.
• Submit your output using the guidelines or means (e.g. e-mail, Facebook
messenger, Google classroom) provided by your respective professors in
this course.

FORMATIVE ASSESSMENT
A. Let’s test your knowledge and understanding!
Instruction: Answer the following essay type questions based on your
understanding on the lessons presented from module two. Your answer
must be brief, direct to the point and at least 150-300 words. Submit your
output using the guidelines or means (e.g. e-mail, Facebook messenger,
Google classroom) provided by your respective professors in this course.
PLAGIARISM is a big NO!
1. Nightingale stressed that control of the environment is essential in
maintaining health. With the environment polluted every day, how
would you contribute in protecting the Mother Nature? In your daily
activities, cite examples of your own ways in saving our planet.

2. With the current pandemic crisis, COVID-19 happening these days,

how would you explain and apply the importance of Environmental
Theory by Florence Nightingale in preventing and controlling the
spread of the said illness or virus in the community?

REFERENCES

Alligood, M. R. (2018). Nursing Theorists and Their Work, 9th Edition. Elsevier
(Singapore) Pte. Ltd. Incorporated, 3 Killiney Road, winsland House I,
239519 Singapore.

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Berman, A., Snyder, S., Frandsen, G. (2016). Kozier and Erb’s Fundamentals of
Nursing: Concepts, Process and Practice, 10th Edition. Pearson Education
Incorporated, 221 River Street, Hoboken, New Jersey, 07030.

Mindanao State University (2020). Special Order No. 410 on the Designation of
Faculty Members to Administrative Position/s at the College of Health
Sciences. 2nd Street, MSU – Campus, Marawi City, Philippines.

Octaviano, E. F., Balita, C. E. (2020). Theoretical Foundations of Nursing: The

Philippine Perspective: National Nursing Core Competency Standards
Aligned Outcomes-Based Approach, 2020 Edition. Ultimate Learning Series,
2nd Floor Carmen Building, Sampaloc, Metro Manila, Philippines.

Octaviano, E. F., Balita, C. E. (2008). Theoretical Foundations of Nursing: The

Philippine Perspective, 2008 Edition. Ultimate Learning Series, 2nd Floor
Carmen Building, Sampaloc, Metro Manila, Philippines.

Smith, M. C., Parker, M. E. (2015). Nursing Theories and Nursing Practice, 4th
Edition. F.A. Davies Company, 1915 Arch Street Philadelphia, PA 19103

Student Handbook (2018). MSU – College of Health Sciences Student

Handbook, 2018 Edition. Barangay Biaba Damag, MSU – Campus, Marawi
City,
Philippines.

Udan, J. Q. (2011). Theoretical Foundations of Nursing, 1st Edition. Educational

Publishing House, 526-528 United Nations Avenue, Ermita, Manila,
Philippines.

Udan, J. Q. (2009). Mastering Fundamentals of Nursing Concepts and Clinical

Application, 3rd Edition. Educational Publishing House, 526-528 United
Nations Avenue, Ermita, Manila, Philippines.

MODULE THREE

INTERACTIVE THEORIES

LEARNING OBJECTIVES:

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After going through this module, the students are expected to be able to:

1. Explain and describe the history and roots of the Interactive Theories in
Nursing by Hildegard Peplau, Virginia Henderson, and Joyce Travelbee.
2. Explain, describe, and apply the principles and concepts of the Interactive
Theories by Hildegard Peplau, Virginia Henderson, and Joyce Travelbee.
3. Describe the respective views of the interactive theorists in the four
metaparadigms of nursing, and empower the students in reciting their own
values and beliefs in relation to the patient, environment, health and
nursing.
4. Describe the impact of the Interactive Theories by Hildegard Peplau,
Virginia Henderson, and Joyce Travelbee to the nursing profession.
5. Empower the students to call on their classmates to recite own values and
beliefs in relation to the patient, environment, health and nursing.
6. Recall the definitions of nursing used by the different theorists.

Lesson 10

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INTRPERSONAL RELATIONS THEORY BY HILDEGARD PEPLAU

Background of the Theorist

• Born on September 1, 1909 at Reading, Pennsylvania.

• Often regarded as the Psychiatric Nurse of the Century.
• She graduated from Pottstown, Penssylvania Hospital School of Nursing in
1931 and later worked as an operating room supervisor at Pottstown
Hospital.
• In 1943, she received a Bachelor of Arts in Interpersonal Psychology from
Bennington College, Vermont, a Master of Arts in Psychiatric Nursing from
Teacher’s College, Columbia, New York in 1947, and a Doctor of
Education in Curriculum Development from Columbia in 1953.
• She became a member of the Army Nurse Corps and worked in a
neuropsychiatric hospital in London, United Kingdom during World War II.
• She also worked at Bellevue and Chesnut Lodge Psychiatric Facilities and
was able to work with renowned psychiatrists, Freida Fromm-Riechman
and Harry Stack Sullivan.
• Introduced ―Interpersonal Relations in Nursing Model or Psychodynamic
Nursing Model‖.
• Provide the clear design for the practice of Psychiatric Nursing.  Identified
the Four Phases of the Nurse-Client Relationship.
• Called as ―Psychiatric Nurse of the Century‖.
• Her first book, Interpersonal Relations in Nursing was published in 1952
and was one of the first books that stated the need to emphasize
importance of the nurse-patient relationship in providing health care.
• Hildegard Peplau had been considered as one of the renowned nursing
leaders of her time that her writings and research are repeatedly featured
at the American Journal of Nursing from 1951 to 1960.
• She defined nursing as an interpersonal process of therapeutic interaction
between an individual who is sick or in need of health services and a nurse
especially educated to recognized and respond to the need for help.

Metaparadigm of Nursing

1. Person

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• She defines person as a man who is an organism that lives in an

unstable balance of a given system.
2. Health
• Health according to her is a word that symbolizes movement of the
personality and other on-going human processes that directs the
person towards creative, constructive, productive and community
living.
• She also gave importance on the belief that for one’s health to be
achieved and maintained, his needs must be met and these needs are
physiological demands and interpersonal conditions.
3. Environment
• Environment for her are 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.
However, these given conditions that lead to health always include the
interpersonal process.
4. Nursing
• She described nursing as a significant, therapeutic interpersonal process.
• It functions cooperatively with human processes that make health
possible as a possible goal for individuals in communities.
• Nursing for her is therapeutic because it is a healing art, assisting an
individual who is sick or in need of health care.

Interpersonal Relations Theory

Peplau described the nurse-patient relationship as a four-phase phenomenon.

One can view them as separate entities, but they could overlap with each other
over the course of the nurse-patient interaction. Each phase is unique and has
distinguished contributions on the outcome of the nurse-patient relationship.

FOUR PHASES OF NURSE – PATIENT RELATIONSHIP

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- The initial interaction between the nurse and the

patient wherein the clients attempts to identify
1. ORIENTATION difficulties and expresses the desire for professional
help.
- The nurse assists the patient in recognizing and
understanding his experience as a patient.

-
The patient and the nurse explore the experience
2. IDENTIFICATION and the needs of the patient and plan together an
appropriate program to foster health.
- It is very important in the relationship that the nurse
assist the patient in t reorienting his feelings and
sustaining a constant positive environment.

-
The patient derives the full value of the relationship
- as he moves from dependent to independent one.
3. EXPLOITATION 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.

-
The patient earns independence over his care as he
gradually put aside old goals and formulates new
- ones.
4. RESOLUTION Even though the relationship ends, it is very
apparent that the experience leaves a lasting
impression on the patient since illness and
assuming a dependent role is a unique human
experience.

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The interpersonal therapeutic process was based on the theory proposed by

Peplau and particularly useful in helping a psychiatric patient become receptive
for therapy, and is often referred as Psychological Mothering which includes the
following steps:

• The patient is accepted unconditionally as a participant in a relationship

that satisfies his needs.
• There is recognition of and response to the patient’s readiness for growth,
as his initiative; and
• Power in the relationships shifts to the patient, as the patient is able to
delay gratification and to invest in goal achievement.

She also advocates the roles of the nurse in the nurse-patient

interpersonal relationship which he or she needs to assume for him/her to be
empowered and equipped in meeting the patient needs are as follows:

1. Role of the stranger – in their initial contact, the nurse and patient are
strangers to one another, and as the nurse attempts to know the patient
better, she must treat him with outmost courtesy, which includes
acceptable of the patient as a person and due respect over his
individuality. This phase coincides with the Identification Phase.
2. Role of the resource person – the nurse provides specific answers to his
queries which include health information, advices and simple explanation
of the healthcare team’s course of care. it is the responsibility of the nurse
to appropriately change her responses to the patient’s level of
understanding.
3. Teaching role – the nurse must determine how the patient understands
the subject at hand. She must develop her discussion around the interest
of the patient and his ability of using the information provided.
4. Leadership role – the nurse as a leader must act in behalf of the patient’s
best interest and at the same time enable him to make decision over his
own care, and this is achieved through cooperation and active
participation.

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5. Surrogate role – the patient’s dependency for his care gives the nurse a
surrogate (temporary caregiver) role. However, the nurses must assist the
patient to make sure that her surrogate role is different and only
temporary.
6. Counseling role – the nurse helps the patient to understand and integrate
the meaning of current life circumstances, provides guidance and
encouragement to make changes.

Other additional roles which the nurse may assume includes: technical expert,
consultant, health teacher, tutor, socializing agent, manager of environment,
mediator, administrator, recorder observer, and researcher.

Lesson 11

14 BASIC HUMAN NEEDS

BY VIRGINIA HENDERSON

Background of the Theorist

• Henderson is popularly known and tagged as The Nightingale of Modern

Nursing, Modern – Day Mother of Nursing, First Truly International Nurse,
and The 20th century Florence Nightingale.
• She began her career in public health nursing in Washington, D.C and was
the first full-time instructor in nursing when she was at Norfolk Protestant
Hospital.
• She was an early advocate for the introduction of psychiatric nursing in the
curriculum and served as committee to develop such a course at Eastern
State Hospital in Williamsburg, Virginia in 1929.

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• At the age of 75, she directed her career to international teaching and
speaking, and this enabled another generation to harvest the benefits of
contact with this outstanding nurse of the 20th century.
• In her book, Nature of Nursing, she postulated that the unique function of
the nurse is to assists the clients, sick or well, in the performance of those
activities contributing to health or its recovery, that clients would perform
unaided if they had necessary strength, will or knowledge.

Metaparadigm of Nursing

1. Person
• Referred to a person as a patient.
• According to her, a person is an individual who requires assistance to
achieve health and independence or in some cases peaceful death.
• She introduced the concept of the mind and body of a person as
inseparable. Meaning, for a person to function to the utmost, he must
be able to maintain physiological and emotional balance.
2. Health
• She viewed health as a quality of life and is very basic for a person to
function fully.
• As a vital need, health requires independence and interdependence.
• Since health is a multifactor phenomenon, it is influence by both
internal and external factors which play independent and
interdependent roles in achieving health. Henderson also give
emphasis in prioritizing health promotion as more important than care
of the sick, prevention is better than cure.
3. Environment
• It is important for a healthy individual to control the environment, but
as illness occurs, this ability is diminished or affected.
• In caring for the sick it is the responsibility of the nurse to help the
patient manage his surroundings to protect him from harm or any
mechanical injury.
4. Nursing
• Henderson asserted that nurses function independently from physician
but they must promote the treatment plan prescribed by the physician.
• Another special role of the nurse is to help both the sick and well
individual.

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• The care given by the nurse must empower the patient to gain
independence as rapidly as possible.
• In the role of the nurse as a healthcare provider, the nurse must be
knowledgeable in both biological and social sciences and must have the
ability to assess basic human needs.

The Nature of Nursing Model

Henderson theory encompasses a definition of nursing, a description of the

function of a nurse, and the enumeration of the 14 components that make up
basic nursing care or basic human needs.

Her definition of nursing was ―doing things for patients that they would do for
themselves if they could, that is if they were physically able or had the required
knowledge. Nursing helps the patient become healthy or die peacefully, and also
helps people work toward independence, so that they can begin to perform the
relevant activities for themselves as quickly as possible‖. Henderson 14 basic
human needs or components as enumerated in her theory which according to her
serves as basis for nursing care are as follows:

1. Breathing normally,
2. Eating and drinking adequately,
3. Eliminating body wastes,
4. Moving and maintaining a desirable position,
5. Sleeping and resting,
6. Selecting suitable clothes,
7. Maintaining a normal body temperature by adjusting clothing & modifying
the environment,
8. Keeping the body clean & well groomed to promote integument (skin),

9. Avoiding dangers in the environment & avoiding injuries to others,

10. Communicating with others in expressing emotions, needs, fears or
opinions,
11. Worshiping according to one’s faith,
12. Working in such a way that one feels a sense of accomplishment,
13. Playing or participating in various forms of recreation, and

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14. Learning, discovering of satisfying the curiosity that leads to normal

development and health & using available health facilities.

Moreover, Henderson also postulated that the nurse functions in relation with
the patient, physician and other members of the health team and each type of
relationship gives nurses specific responsibilities and roles, as follows:

A. The Nurse - Patient Relationship

- Henderson stated that there are three levels compromising the
nursepatient relationship:

• The nurse as substitute to the patient – in times of illness 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.

• The nurse as 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.

• The nurse as partner with the patient - as partners, the nurse and the
patient formulate the care plan together. Both as an advocate and a
resource – person, the nurse can empower the patient to make effective
decisions regarding his care plans and as the relationship goes on, they
both see each other as partners whose interest are the same having the
patient achieve health and independence.

B. The Nurse – Physician Relationship

- Henderson asserted that nurses function independently from physicians.
- Though the nurse and 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.

- She also insisted that nurses do not follow doctor’s order; rather they
follow in a philosophy which allows physicians to give orders to patients

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or other healthcare team members, nurses’ function in the nurse–

physician relationship.
- Henderson also indicated that many nursing roles and responsibilities
overlap with that those of physician’s.

C. The Nurse as a Member of the Healthcare Team

- The nurse works and contributes in carrying out the total program of
care. However, working independently, as Henderson indicated, does
not include taking other member’s roles and responsibilities.

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LESSON 12

HUMAN TO HUMAN RELATIONSHIP MODEL BY JOYCE

TRAVELBEE

Background of the Theorist

• Travelbee was born in 1926.

• She was a psychiatric nurse, educator and writer.
• She completed her Bachelor of Science in Nursing (BSN) degree at
Louisiana State University and her Master of Science Degree in Nursing
from Yale University in 1959.
• In 1952, Travelbee started as an instructor focusing in Psychiatric Nursing
at Depaul Hospital Affiliate School, New Orleans while working on her
baccalaureate degree.
• She also taught Psychiatric Nursing at Charity Hospital School of Nursing
in Louisiana State University, New York University and University of
Mississippi.
• She holds the position of Project Director in 1970 at Hotel Dieu School of
Nursing, New Orleans and the director of Graduate Education at Louisiana
State University School of Nursing until her death.
• Her first book and second entitled Interpersonal Aspects of Nursing was
published in 1966 and 1971. While, her second book entitled Intervention
in Psychiatric Nursing: Process in the One-to-One Relationship was
published in 1969.

Metaparadigm of Nursing

1. Person
• Person is defined as human being. Both the nurse and patient are
human beings.
• A human being is a unique, irreplaceable individual who is in the
continuous process of becoming, evolving, and changing.

2. Health
• Health for Travelbee is measured by subjective and objective health.

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• A person subjective health status is an individually defined state of

well-being in accord with self-appraisal of physical, emotional, and
spiritual status.
• On the other hand, objective health is an absence of discernible
disease, disability, or defect as measured by physical examination,
laboratory tests, assessment by a spiritual director or psychological
counselor.

3. Environment
• She defined human conditions and life experiences encountered by all
men as sufferings, hope, pain, and illness. These conditions are
associated to the environment.

4. Nursing
• Nursing for Travelbee is 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.
• Nursing is interpersonal because it is an experience that occurs between
the nurse and an individual or group of individuals.

Human-to-Human Relationship Model

Travelbees’ formulation of her theory was 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 nursing care need a humanistic revolution, a return to focus on the
caring function towards the ill person.

In human-to-human relationship model, the nurse and the patient undergoes the
following series of interactional phases, as follows:

1. Original Encounter
• The first impression by the nurse of the sick persona and vice-versa.
• The nurse and patient see each other in stereotyped or traditional
roles.

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2. Emerging Identities
• The nurse and patient in this phase perceive each other as unique
individuals.
• At this time, the link of relationship begins to form.

3. Empathy • This phase is described s the ability to share in the person’s

experience.
• The result of empathic process is the ability to expect the behavior of
the individual with whom he or she empathized.
• Travelbee proposed that two qualities of that enhance the empathy
process are similarities of experience and the desire to understand
another person.

4. Sympathy
• Happens when the nurse wants to lessen the cause of one is involved
but not incapacitated by the environment.
• The nurse should use a disciplined intellectual approach together with
therapeutic use of self to make helpful nursing actions.

5. 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.

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ENRICHMENT ACTIVITIES

A. Let’s explore its application! Instruction:

• Browse your internet and search at least two (2) published research
papers where any of the interactive theories was used or applied as basis
of their theoretical framework or objectives then read and understand its
content from introduction to conclusion.
• Choose one of the two articles and present this in the class using a pre-
recorded video presentation while explaining how did the researcher/s
use and was guided by the interactive in conceptualizing such study. At
least 2 – 3 minutes video presentation.
• Submit your output using the guidelines or means (e.g. e-mail, Facebook
messenger, Google classroom) provided by your respective professors in
this course.

FORMATIVE ASSESSMENT

A. Let’s test your knowledge and understanding!

Instruction: Answer the following essay type questions based on your
understanding on the lessons presented from module three. Your answer
must be brief, direct to the point and at least 150-300 words. Submit your
outputs using the guidelines or means (e.g. e-mail, Facebook messenger,
Google classroom) provided by your respective professors in this course.
PLAGIARISM is a big NO!
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1. Think of your closest friend and identify the qualities he or she has that
make your friendship strong then ask yourself if you also have those
qualities as well. How could you use and apply the Interpersonal
Theory by Hildegard Peplau in further deepening your friendship with
others?
2. The conceptualization of the Human-to-Human Relationship Model by
Joyce Travelbee has guided the nurse – patient interaction. Cite at
least two (2) examples and explain why and how it was applicable.

REFERENCES

Alligood, M. R. (2018). Nursing Theorists and Their Work, 9th Edition. Elsevier
(Singapore) Pte. Ltd. Incorporated, 3 Killiney Road, winsland House I,
239519 Singapore.

Berman, A., Snyder, S., Frandsen, G. (2016). Kozier and Erb’s Fundamentals of
Nursing: Concepts, Process and Practice, 10th Edition. Pearson Education
Incorporated, 221 River Street, Hoboken, New Jersey, 07030.

Octaviano, E. F., Balita, C. E. (2020). Theoretical Foundations of Nursing: The

Philippine Perspective: National Nursing Core Competency Standards
Aligned Outcomes-Based Approach, 2020 Edition. Ultimate Learning Series,
2nd Floor Carmen Building, Sampaloc, Metro Manila, Philippines.

Octaviano, E. F., Balita, C. E. (2008). Theoretical Foundations of Nursing: The

Philippine Perspective, 2008 Edition. Ultimate Learning Series, 2nd Floor
Carmen Building, Sampaloc, Metro Manila, Philippines.

Smith, M. C., Parker, M. E. (2015). Nursing Theories and Nursing Practice, 4th
Edition. F.A. Davies Company, 1915 Arch Street Philadelphia, PA 19103

Udan, J. Q. (2011). Theoretical Foundations of Nursing, 1st Edition. Educational

Publishing House, 526-528 United Nations Avenue, Ermita, Manila,
Philippines.

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Udan, J. Q. (2009). Mastering Fundamentals of Nursing Concepts and Clinical

Application, 3rd Edition. Educational Publishing House, 526-528 United
Nations Avenue, Ermita, Manila, Philippines.

MODULE FOUR

SYSTEM THEORY

LEARNING OBJECTIVES:

After going through this module, the students are expected to be able to:

1. Explain and describe the history and roots of the System Theories in
Nursing by Betty Neumann, Dorothy Johnson, Imogene King, Dorothea
Orem, and Faye Glenn Abdellah.
2. Explain, describe, and apply the principles and concepts of the System
Theories in Nursing by Betty Neumann, Dorothy Johnson, Imogene King,
Dorothea Orem, and Faye Glenn Abdellah.
3. Describe the respective views of the interactive theorists in the four
metaparadigms of nursing, and empower the students in reciting their own
values and beliefs in relation to the patient, environment, health and
nursing.
4. Describe the impact of the System Theories in Nursing by Betty Neumann,
Dorothy Johnson, Imogene King, Dorothea Orem, and Faye Glenn

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Abdellah to the nursing profession.

5. Empower the students to call on their classmates to recite own values and
beliefs in relation to the patient, environment, health and nursing.
6. Recall the definitions of nursing used by the different theorists.

Lesson 13

SYSTEM MODEL IN NURSING

BY BETTY NEUMAN

Background of the Theorist

• Born in 1924 on a farm in rural Ohio - this background helped her develop
compassion for those in need.
• Education, 1947- RN from diploma program in OH , 1957-BSN, UCLA
mental health & public health, 1966-MSN, UCLA, and 1967-1973, UCLA
faculty.
• Developed first community mental health program for graduate students at
UCLA.
• 1985 - PhD Western Pacific University-clinical psychology.
• Developed in 1970 as a teaching tool to integrate four variables of man.

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• 1974 - published and classified as a systems model called "The Betty

Neuman Health-Care Systems Model: A Total Approach to Patient
Problems"
• Published first book detailing NSM in 1982. Notable change: "patient" now
referred to as "client"
• The Neuman Systems Model, 2nd ed.,1989. Spiritual variable added to
diagram as fifth variable.
• 3rd, 4th & 5th editions of The Neuman Systems Model published in 1995,
2002 & 2010

Metaparadigm of Nursing

1. Person
• The person is a layered multidimensional being. Each layer consists of five
person variables or subsystems: Physical/Physiological Psychological
Socio-cultural Developmental Spiritual.
• Neuman sees a person as an open system that works together with other
parts of its body as it interacts with the environment
• An open system that interacts with both internal and external
environmental forces and stressors. Open system is characterized by the
presence of an exchange of information and reaction with other factors
surrounding a person.
• The human being is in constant change, moving toward a dynamic state of
system stability or toward illness or varying degrees.

2. Health

• “Health is a condition in which all parts and subparts (variables) are in

harmony with the whole of the client.”
• considers health as dynamic in nature in which the person’s health is at
the level of health continuum—wellness or illness.
• equated with wellness
• Wellness exists when all the part or system of person works harmoniously.
• the condition or degree of system stability and is viewed as a continuum
from wellness to illness

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• Neuman proposes a wellness-illness continuum, with the person's position

on that continuum being influenced by their interaction with the variables
and the stressors they encounter. The client system moves toward illness
and death when more energy is needed than is available. The client
system moves toward wellness when more energyis available than is
needed.

3. Environment

• The totality of the internal and external forces which surround a person and
with which they interact at any given time. These forces include the
intrapersonal, interpersonal and extra personal stressors which can affect
the person's normal line of defense and so can affect the stability of the
system.
• INTERNAL ENVIRONMENT – exists within the system; all forces and
interactive influences that are solely within the boundaries of the client
system
• EXTERNAL ENVIRONMENT – exists outside the client system.
• CREATED ENVIRONMENT – developed unconsciously by the client and is
symbolic of system wholeness; it represents the open system exchange of
energy with both the internal and external environments.

4. Nursing

• A unique profession that is concerned with all of the variables which

influence the response a person might have to a stressor
• Neuman believes that nursing requires a holistic approach that considers
all factors affecting a client's health—physical, physiological,
psychological, mental, social, cultural, developmental and spiritual well-
being.
• Actions which assist individuals, families and groups to maintain a
maximum level of wellness, and the primary aim is stability of the
patient/client system, through nursing interventions to reduce stressors
• The primary concern of NURSING is to define the appropriate action in
situations that are stress related or in relation to possible reactions of the
client or client systems to stressors.

The Neuman Systems Model

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The goal of the model was to provide a wholistic overview of the

physiological, psychological, sociocultural, and developmental aspects of human
beings.

Neuman Systems Model’s two major components are stress and the reaction
to stress. The client in Neuman Systems Model is viewed as an open system in
which repeated cycles of input, process, output and feedback constitute a
dynamic organizational pattern. Using the systems perspective, the client may be
an individual, a group, a family, a community, or any aggregate. As they become
more complex, the internal conditions of regulation become more complex.
Exchanges with the environment are reciprocal; both the client and the
environment may be affected either positively or negatively by the other. The
system may adjust to the environment or adjust the environment to itself.

MAJOR CONCEPTS

I. PERSON VARIABLES

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Each layer, or concentric circle, of the Neuman model is made up of the five
person variables. Ideally, each of the person variables should be considered
simultaneously and comprehensively.

a. Physiological - refers of the physicochemical structure and function of

the body.
b. Psychological - refers to mental processes and emotions.
c. Sociocultural - refers to relationships; and social/cultural expectations
and activities.
d. Spiritual - refers to the influence of spiritual beliefs.
e. Developmental - refers to those processes related to development
over the lifespan.

II. CENTRAL CORE

The basic structure, or central core, is made up of the basic survival factors
that are common to the species (Neuman, 1995, in George, 1996). These factors
include: system variables, genetic features, and the strengths and weaknesses of
the system parts. Examples of these may include: hair color, body temperature
regulation ability, functioning of body systems homeostatically, cognitive ability,
physical strength, and value systems. The person's system is an open system
and therefore is dynamic and constantly changing and evolving. Stability, or
homeostasis, occurs when the amount of energy that is available exceeds that
being used by the system. A homeostatic body system is constantly in a dynamic
process of input, output, feedback, and compensation, which leads to a state of
balance.

III. FLEXIBLE LINES OF DEFENSE

The flexible line of defense is the outer barrier or cushion to the normal line of
defense, the line of resistance, and the core structure. If the flexible line of
defense fails to provide adequate protection to the normal line of defense, the
lines of resistance become activated. The flexible line of defense acts as a
cushion and is described as accordion-like as it expands away from or contracts
closer to the normal line of defense. The flexible line of defense is dynamic and
can be changed/ altered in a relatively short period of time.
IV. NORMAL LINE OF DEFENSE

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The normal line of defense represents system stability over time. It is

considered to be the usual level of stability in the system. The normal line of
defense can change over time in response to coping or responding to the
environment. An example is skin, which is stable and fairly constant, but can
thicken into a callus over time.

V. LINES OF RESISTANCE

The lines of resistance protect the basic structure and become activated
when environmental stressors invade the normal line of defense. Example:
activation of the immune response after invasion of microorganisms. If the lines
of resistance are effective, the system can reconstitute and if the lines of
resistance are not effective, the resulting energy loss can result in death.

VI. RECONSTITUTION

Reconstitution is the increase in energy that occurs in relation to the degree

of reaction to the stressor. Reconstitution begins at any point following initiation
of treatment for invasion of stressors. Reconstitution may expand the normal line
of defense beyond its previous level, stabilize the system at a lower level, or
return it to the level that existed before the illness.

VII. STRESSORS

The Neuman Systems Model looks at the impact of stressors on health and
addresses stress and the reduction of stress (in the form of stressors). Stressors
are capable of having either a positive or negative effect on the client system. A
stressor is any environmental force which can potentially affect the stability of the
system: they may be:

• Intrapersonal - occur within person, e.g. emotions and feelings

• Interpersonal - occur between individuals, e.g. role expectations
• Extra personal - occur outside the individual, e.g. job or finance pressures

The person has a certain degree of reaction to any given stressor at any
given time. The nature of the reaction depends in part on the strength of the lines
of resistance and defense. By means of primary, secondary and tertiary

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interventions, the person (or the nurse) attempts to restore or maintain the
stability of the system.
VII. PREVENTION

As defined by Neuman's model, prevention is the primary nursing

intervention. Prevention focuses on keeping stressors and the stress response
from having a detrimental effect on the body.

Primary -Primary prevention occurs before the system reacts to a stressor.

On the one hand, it strengthens the person (primarily the flexible line of defense)
to enable him to better deal with stressors, and on the other hand manipulates
the environment to reduce or weaken stressors. Primary prevention includes
health promotion and maintenance of wellness.

Secondary-Secondary prevention occurs after the system reacts to a

stressor and is provided in terms of existing systems. Secondary prevention
focuses on preventing damage to the central core by strengthening the internal
lines of resistance and/or removing the stressor.

Tertiary -Tertiary prevention occurs after the system has been treated
through secondary prevention strategies. Tertiary prevention offers support to the
client and attempts to add energy to the system or reduce energy needed in
order to facilitate reconstitution.

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LESSON 14

BEHAVIORAL SYSTEM MODEL

BY DOROTHY JOHNSON

Background of the Theorist:

• Born August 21st 1919 in Savannah, Georgia.

• 1942 – B.S.N. from Vanderbilt University, Nashville, Tennessee.
• 1948 – M.P.H. from Harvard University, Boston, Mass. Massachusetts.
• Death in February 1999 at the age of 80.
• Assistant professor of pediatrics at Vanderbilt University.
• Assistant professor of pediatrics nursing, an associate professor of
nursing, and a professor of nursing at the University of California.
• Pediatric nursing advisor for the Christian Medical School of Nursing in
Vellore, South India.
• Chairperson on the California’s Nurses Association that developed a
position statement for specifications for clinical specialists.
• Publications include four books, more than 30 articles, and many other
papers, reports, proceedings and monographs.  The BSM of Nsg was
first propose in 1968.
• Influenced heavily by Florence Nightingale’s book, Notes on Nursing.
• Used the work of behavioral scientist, psychology, sociology, and
ethnology to form her seven subsystems.
• The nurses’ role is to help the patient maintain his/her equilibrium.

Metaparadigm of Nursing

1. PERSON

• Johnson views human beings as having two major systems: the biological
system and the behavioral system.

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• It is the role of medicine to focus on the biological system, whereas

nursing’s focus is the behavioral system.

2. HEALTH

• It is an elusive state that is determined by psychological, social, biological,

and physiological factors.
• Johnson’s behavioral model supports the idea that the individual is
attempting to maintain some balance or equilibrium.
• The individual’s goal is to maintain the entire behavioral system efficiently
and effectively but with enough flexibility to return to an acceptable
balance if a malfunction disrupts the original balance.

3. ENVIRONMENT

• Refers to the environment in which an individual exists.

• According to Johnson, an individual’s behavior is influenced by all the
events in the environment.
• Cultural influences on the individual’s behavior are viewed as profound;
however, it is felt that there are many paths, varying from culture to
culture, that influence specific behaviors in a group of people, although the
outcome for all the groups or individuals is the same.

4. NURSING

• Nursing is ―an external regulatory force which acts to preserve under the
organization and integration of the patient’s behavior at an optimal level
under those conditions in which the behavior constitutes a threat to
physical or social health or in which illness is found‖.
• Nursing is viewed as part of the external environment that can assist the
client to return to a state of equilibrium or balance.
• Nursing is concerned with the organized and integrated whole, but that the
major focus is on obtaining a balance in the behavioral system when
illness occurs in the individual.
• Johnson believes that nurses need to be well grounded in the physical and
social sciences; particular emphasis should be placed on knowledge from
both the physical and social sciences that is found to influence behavior.

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• Nursing’s primary goal is to foster equilibrium within the individual, which

allows for the practice of nursing with individuals at any point in the health-
illness continuum.

JOHNSON’S BEHAVIORAL SYSTEM MODEL

• Johnson believes each individual has patterned, purposeful, repetitive

ways of acting that comprise a behavioral system specific to that
individual.  These actions or behaviors form an ―organized and
integrated functional unit that determines and limits the interaction
between the person and his environment and establishes the relationship
of the person to the objects, events, and situations in his environment.
• Johnson identifies seven subsystems within the Behavioral System
Model, an identification that is at variance with others who have published
interpretations of Johnson’s model (see figure 1).

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Figure 1: Johnson’s Model

SEVEN BEHAVIORAL SUBSYSTEMS 1.

ATTACHMENT OR AFFILIATIVE

• Identified as the first response system to develop in the individual.  The

optimal functioning of the affiliative subsystem allows ―social inclusion,
intimacy, and the formation and maintenance of a strong social bond‖.
• Attachment to a significant caregiver has been found to be critical for the
survival of an infant.
• As the individual matures, the attachment to the caretaker continues and
there are additional attachments to other significant individuals as they
enter both the child’s and the adult’s network.

2. DEPENDENCY

• Dependency behaviors are ―succoring‖ behaviors that precipitate

nurturing behaviors from other individuals in the environment.
• The result of dependency behavior is ―approval, attention or
recognition, and physical assistance‖.
• It is difficult to separate the dependency subsystem from the affiliative
or attachment subsystem because without someone invested in or
attached to the individual to respond to that individual’s dependency
behaviors, the dependency subsystem has no intimate environment in
which to function.

3. INGESTIVE

• Relates to the behaviors surrounding the intake of food.

• It is related to the biological system, however, the emphasis for nursing,
from Johnson’s perspective, is the meanings and structures of the
social events surrounding the occasions when food is eaten.
• Behaviors related to the ingestion of food may relate more to what is
socially acceptable in a given culture than to the biological needs of the
individual.

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4. ELIMINATIVE

• Relates to behaviors surrounding the excretion of waste products from

the body.
• Johnson admits this may be difficult to separate from a biological
system perspective; however, as with behaviors surrounding the
ingestion of food, there are socially acceptable behaviors for the time
and place for humans to excrete waste.
• Example: Biological cues are often ignored if the social situation
dictates that it is objectionable to eliminate at a given time.

5. SEXUAL

• Reflects behavior related to procreation.

• Both biological and social factors affect behaviors in the sexual
subsystem.
• The key is that the goal in all societies has the same outcome –
behaviors acceptable to society at large.

6. AGGRESSIVE

• Relates to behaviors concerned with protection and self-preservation.

• Johnson views the aggressive subsystem as on that generates
defensive responses from the individual when life or territory is
threatened.
• The aggressive subsystem does not include those behaviors with a
primary purpose of injuring other individuals, but rather those whose
purpose is to protect and preserve self and society.

7. ACHIEVEMENT

• Provokes behaviors that attempt to control the environment.

• Intellectual, physical, creative, mechanical, and social skills are some of
the areas that Johnson recognizes.

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LESSON 15

GOAL ATTAINTMENT THEORY BY IMOGENE KING

Background of the theorist:

• January 30, 1923 – December 24, 2007

• Nursing Diploma, St. Johns Hospital School of Nursing, St. Louis, Missouri
1945
• Bachelor of Science in Nursing Education, St. Louis, Missouri 1948
• Master of Science in Nursing, St. Louis University, 1957
• Doctorate of Education, Teachers College, Columbia University, NY 1961
• Work based in education, administration, and research
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- St. Johns hospital school of nursing

- Ohio State University
- Loyola University
- University of South Florida

Metaparadigm of Nursing

1. PERSON

 A spiritual being and rational thinker. King believes that individuals have the
ability to think, choose, feel, set goals, perceive, make decisions and
achieve goals.

2. HEALTH

 Involves a patient’s life experiences and ongoing assessments of internal

and external environment stressors through the use of resources available
for the patient to maximize their daily living potential.

3. ENVIRONMENT

 The atmosphere where human interaction takes place.

a. Internal: patient’s inner coping skills to adjust with the external
environments conditions.
b. External: patient’s surroundings such as the nurse.

4. NURSING

• Goal of nurse: ―To help individuals to maintain their health so they can
function in their roles.‖
• Domain of nurse: ―includes promoting, maintaining, and restoring health,
and caring for the sick, injured and dying.
• Function of professional nurse: ―To interpret information in nursing
process to plan, implement and evaluate nursing care.

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GOAL ATTAINMENT THEORY

Proposition of King’s Goal Attainment Theory

• If a continuous accuracy is currently is a nurse-patient interaction, a

transaction will happen.
• If nurse and patient will build a transaction, goals will be attained.
• If goals are achieved, satisfaction will happen
• If goals are met, efficient nursing care will happen
• If transaction are done in a nurse-client interaction, growth and
development will increase
• If role anticipation and performance in the nurse and patient are the same,
transaction will happen.
• If role disagreement happens in both nurse and patient, stress would be
the result
• If nurse with exceptional skill and knowledge correspond adequate
information to patient, the same goals and accomplishment will happen.

Action
• Means of behavior or activities that are towards the accomplishment of
certain act.
• Both physical and mental.
• Are aimed towards setting goals.

Reaction
• Not specified but somehow relates reaction as part of action.

Interaction
• Any situation wherein the nurse relates and deals with a client or patient.

Open System
• The absence of boundary existence.

SUMMARY

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• The Goal Attainment Theory is based on philosophy of human beings and

a conceptual system.
• The goal of nursing is to help individuals and groups attain, maintain, and
regain a healthy state.
• King’s theory uses concepts of self, perception, communication,
interaction, transaction, role, and decision making.
• This theory is Widely generalizable and relevant in different health care
situations
• Each individual brings a different set of values, ideas, attitudes, perception
to exchange.

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LESSON 16 SELF-CARE DEFICIT THEORY By

DOROTHEA E. OREM

Background of the theorist:

• Born in Baltimore, Maryland in 1914  One of

America’s foremost nursing theorists
• 1939 – BS Nursing Education
• 1945 – Master of Science in Nursing
• Staff nurse, Private duty nurse, Nurse educator, Administrator and Nurse
consultant
• 1976 – Doctor of Science Degree
• Recognized the need to continue developing a conceptualization of
Nursing
• 1971 – ―Nursing: Concepts of Practice‖
• 1980 – second formal articulation of her idea
• 1995 – recent formal articulation of her idea
• Developed the SCDNT (Self-Care Deficit Nursing Theory)
• Died on June 22, 2007 at age 92

Metaparadigm of Nursing:

1. Person
• Distinguished from other living things by their capacity to:

 Reflect upon themselves and their environment.

 Symbolize what they experience.
 Use symbolic creations (ideas, words) in thinking, in
communicating, and in guiding efforts to do and to make things that
are beneficial for themselves or others‖.
 Integrated human functioning includes physical, psychological,
interpersonal, and social aspects.

• Orem believes that individuals have the potential for learning and
developing.

2. ENVIRONMENT

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 An external source of influence in the internal interaction of a person’s

different aspects.

3. Health
• Orem supports the WHO’s definition of health as ―a state of physical,
mental, and social well-being and not merely the absence of disease or
infirmity‖.
• She states that ―the physical, psychological, interpersonal and social
aspects of health are inseparable in the individual‖.
• Orem also presents health based on the concept of preventive health care.
• Helping clients to establish or identify ways to perform self-care activities

4. NURSING
• Nursing actions are geared towards independence of the client. If the
client is highly dependent, there is a need for the nurse to assist and
address the needs of the client. Nursing is a distinguished human service
since its focus is on persons with inabilities to maintain continuous
provision of health care. Nursing is based on values.

SELF-CARE DEFICIT THEORY OF NURSING

Dorothea Orem’s theory is based on the belief that the individual has a need
for self-care actions and that nursing can assist the person in meeting that need
to maintain life, health, and well-being. This is a general theory composed of 3
related theories:

1. THE THEORY OF SELF-CARE.

2. THE THEORY OF SELF-CARE DEFICIT.
3. THE THEORY OF NURSING SYSTEMS.

THE THEORY OF SELF-CARE

• To understand the theory of self-care one must first understand the

concepts of:

 SELF-CARE - consists of activities that individuals carry out on their own

behalf. These actions are deliberate, have pattern and sequence, and are
developed from day-to-day living.
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 SELF-CARE AGENCY - the human’s acquired ability or power to engage

in self-care. This ability to engage in self-care is affected by basic
conditioning factors (age, gender, developmental state, health state,
socio- cultural, health care system, and family system, patterns of living,
environmental and resource adequacy and availability). For instance,
infants and children, as well as aged, ill, and disabled people, require help
with self-care activities.
 SELF-CARE REQUISITES - can be defined as ―the reasons for which
self-care is undertaken; they express the intended or desired results‖.
Orem presents three categories of self-care requisites, or requirements,
as:
 Universal Self-Care Requisites - universally set goals that must be
undertaken in order for an individual to function in scope of healthy living.
Common to all human beings during all stages of the life cycle and should
be viewed as interrelated factors, each affecting the others. Orem
identifies universal self-requisites as follows:

1. The maintenance of a sufficient intake of air.

2. The maintenance of a sufficient intake of water.
3. The maintenance of a sufficient intake of food.
4. The provision of care associated with elimination.
5. The maintenance of balance between activity and rest.
6. The maintenance of a balance solitude and social interaction.
7. The prevention of hazards to human life, human functioning, and
human well-being.
8. The promotion of human functioning and development.

 Developmental Self-Care Requisites - actions to be undertaken that will

provide developmental growth, provision of conditions that promote
development, engagement in self-development, and prevention of the
effects of human conditions that threatens life.
 Health Deviation Self-Care Requisites - required in illness or injury or as
a result of medical tests or treatments to correct a condition (e.g. right
upper quadrant abdominal pain when foods with a high fat content are
eaten, or learning to walk using crutches following a casting of a fractured
leg).

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THE THEORY OF SELF-CARE DEFICIT

• The basic element of Orem’s (2001) general theory of nursing because it

delineates when nursing is needed
• Nursing is required when adults (or in the case of a dependent, the parent
or guardian) are incapable of or limited in their ability to provide continuous
effective self-care.
• Orem (2001) identifies the following five methods of helping that nurses
may use:

1. Acting for or doing for another.

2. Guiding and directing.
3. Providing physical or psychological support.
4. Providing and maintaining an environment that supports personal
development.
5. Teaching.

THE THEORY OF NURSING SYSTEMS

• Designed by the nurse, is based on the assessment of an individual’s self-

care needs and on the assessment of the abilities of the patient to perform
self-care activities.
• Describes how the patient’s self-care needs will be met by the nurse, the
patient, or both.
• Nursing agency - a complex property or attribute of people educated and
trained as nurses that enable them to act, to know, and to help others meet
their therapeutic self-care demands by exercising or developing their own
self-care agency. It is similar to self-care agency in that both symbolize
characteristics and abilities for specific types of deliberate action.
• Nursing agency vs. Self-care agency

a. Nursing agency – carried out for the benefit and well-being of others.
b. Self-care agency – is employed for one’s own benefit.

• Orem (2001) has identified three classifications of nursing systems to

meet the self-care requisites of the patient:

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a. Wholly compensatory - the nurse gives total care to meet all needs.
b. Partly compensatory - both nurse and patient perform care
measures or other actions.
c. Supportive-Educative - the person can carry out self- care activities
but requires assistance. This is also known as supportive-
developmental system. The ―patient’s requirements for help are
confined to decision making, behavior control, and acquiring
knowledge and skills‖. The nurse’s role, then, is to promote the patient
as a self-care agent.

LESSON 17

TWENTY - ONE NURSING PROBLEMS BY FAYE GLEEN

ABDELLAH

Background of the theorist:

• Born: March 13, 1919 in New York City

• Education: Columbia University
• Hall of fame induction:2000
• Died: 24 February 2017

Metaparadigm of Nursing

1. PERSON

 Describes the recipients of nursing as individuals (and families, and thus,

society), but does not delineate her beliefs or assumptions about the
nature of human beings.

2. HEALTH
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 Although Abdellah does not give a definition of health, she speaks to ―total
health needs‖ and ―a healthy state of mind and body‖ in her description
of nursing as a comprehensive service.

3. ENVIRONMENT

• Included in ―planning for optimum health on local, state, national, and

international levels‖.
• She indicates that by providing service to individuals and families, society
is served but does not discuss society as a patient nor define society.

4. NURSING

•Abdellah considers nursing to be a comprehensive service that is based

on an art and science and aims to help people, sick or well, cope with their
health needs.
• Broadly grouped into the 21 problem areas to guide care and promote the
use of nursing judgment.
ABDELLAH’S THEORY

• States that nursing is the use of the problem-solving approach with key
nursing problems related to the health needs of people.

NURSING PROBLEMS

• The patient’s health needs can be viewed as problems, which may be

overt as an apparent condition, or covert as a hidden or concealed one.
• Nursing problem presented by a patient is a condition faced by the
patient or patient’s family that the nurse, through the performance of
professional functions, can assist them to meet.
• Abdellah’s use of the term nursing problems can be interpreted as more
consistent with ―nursing functions‖ or ―nursing goals‖ than with patient-
centered problems; this viewpoint could lead to an orientation that is more
nursing- centered than patient-centered.

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• In her typology of basic nursing problems presented by patients, she

includes three columns: basic nursing problems presented by the
patient, specific problem of patient, and common conditions

THE TWENTY-ONE NURSING PROBLEMS

• The crucial element within Abdellah’s theory is the correct identification of

nursing problems.
• These 21 nursing problems focus on the physical, biological, and socio-
psychological needs of the patient and attempt to provide a more
meaningful basis for organization than the categories of the systems of the
body.

ABDELLAH’S 21 NURSING PROBLEMS

1. To maintain good hygiene and physical comfort.

2. To promote optimal activity; exercise, rest and sleep.
3. To promote safety though the 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 deformities.
5. To facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition of all body cells.
7. To facilitate the maintenance of elimination.
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 regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory functions.
12. To identify and accept positive and negative expressions, feelings and
reactions.
13. To identify and accept the interrelatedness of emotions and organic
illness.
14. To facilitate the maintenance of effective verbal and non-verbal
communication.
15. To promote the development of productive interpersonal relationships.

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16. To facilitate progress toward achievement of personal spiritual goals.

17. To create and/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.

ENRICHMENT ACTIVITIES

A. Let’s dig MORE!!! Instruction:

• This activity aims to explore the use of information literacy tools in

creating a storybook about a selected nursing theorist. It is an opportunity
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for each of you to study and create an in depth work on a nursing theorist
and their influence on the profession of nursing.
• Choose at least one nursing theory from this module and provide three
detailed applications of the said theory to nursing profession (practice,
education, administration, and research).
• Your presentation must include substantial explanatory text, and should
also include additional media creativity of your choice to enrich and
support your information.
• The presentation must not exceed with 5 minutes presentation.
• Submit your output using the guidelines or means (e.g. e-mail, Facebook
messenger, Google classroom) provided by your respective professors in
this course.

FORMATIVE ASSESSMENT

3. Let’s test your knowledge and understanding! Instruction:

Case: Maria Isabelle is a 42 year old patient who is a known case of Diabetes
Mellitus and Hypertension. She is a hard smoker and can consume at least 5
packs of cigarettes a day. Maria Isabelle dislikes taking her prescribed
maintenance medications according to her daughter. Her lifestyle is very poor
and loves to eat both salty and sugar-rich foods despite of her health condition.

1. Identify at least three (3) nursing activities appropriate for the case of Maria
Isabelle in order to help her from getting her problem into worst condition
such as developing complications of both DM and HTN then explain your
rationale why such activities are necessary for the case of Maria Isabelle.
2. Submit your output using the guidelines or means (e.g. e-mail, Facebook
messenger, Google classroom) provided by your respective professors in
this course.

REFERENCES

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Alligood, M. R. (2018). Nursing Theorists and Their Work, 9th Edition. Elsevier
(Singapore) Pte. Ltd. Incorporated, 3 Killiney Road, winsland House I,
239519 Singapore.

Berman, A., Snyder, S., Frandsen, G. (2016). Kozier and Erb’s Fundamentals of
Nursing: Concepts, Process and Practice, 10th Edition. Pearson Education
Incorporated, 221 River Street, Hoboken, New Jersey, 07030.

Octaviano, E. F., Balita, C. E. (2020). Theoretical Foundations of Nursing: The

Philippine Perspective: National Nursing Core Competency Standards
Aligned Outcomes-Based Approach, 2020 Edition. Ultimate Learning Series,
2nd Floor Carmen Building, Sampaloc, Metro Manila, Philippines.

Octaviano, E. F., Balita, C. E. (2008). Theoretical Foundations of Nursing: The

Philippine Perspective, 2008 Edition. Ultimate Learning Series, 2nd Floor
Carmen Building, Sampaloc, Metro Manila, Philippines.

Smith, M. C., Parker, M. E. (2015). Nursing Theories and Nursing Practice, 4th
Edition. F.A. Davies Company, 1915 Arch Street Philadelphia, PA 19103

Udan, J. Q. (2011). Theoretical Foundations of Nursing, 1st Edition. Educational

Publishing House, 526-528 United Nations Avenue, Ermita, Manila,
Philippines.

Udan, J. Q. (2009). Mastering Fundamentals of Nursing Concepts and Clinical

Application, 3rd Edition. Educational Publishing House, 526-528 United
Nations Avenue, Ermita, Manila, Philippines.

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MODULE FIVE

DEVELOPMENTAL THEORIES

Learning Objectives:

After going through this module, the students are expected to be able to:

1. Explain and describe the history and roots of the Developmental Theories
in Nursing by Sister Callista Roy, Madeleine Leininger, Margaret Jean
Watson, and Patricia Benner.
2. Explain, describe, and apply the principles and concepts of the
Developmental Theories in Nursing by Sister Callista Roy, Madeleine
Leininger, Margaret Jean Watson, and Patricia Benner.
3. Describe the respective views of the developmental theorists in the four
metaparadigms of nursing, and empower the students in reciting their own
values and beliefs in relation to the patient, environment, health and
nursing.
4. Describe the impact of the Developmental Theories in Nursing by Sister
Callista Roy, Madeleine Leininger, Margaret Jean Watson, and Patricia
Benner to the nursing profession.
5. Empower the students to call on their classmates to recite own values and
beliefs in relation to the patient, environment, health and nursing.
6. Recall the definitions of nursing used by the different theorists.

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LESSON 18

ADAPTATION MODEL BY SISTER CALLISTA ROY

Background of the theorist:

• Born October 14, 1939.
• Nursing theorist, professor, and author.
• She is known for her groundbreaking work in
creating the Adaptation Model of Nursing.
• Roy received her Bachelor of Arts Major in Nursing from Mount Saint
Mary’s College in Los Angeles in 1963 and her master’s degree in nursing
from the University of California in 1966.
• After earning her nursing degrees, Roy began her education in sociology,
receiving both a master’s degree in sociology in 1973 and a doctorate
degree in sociology in 1977 from the University of California.
• Roy worked as a pediatric nurse and noticed a great resiliency of children
and their ability to adapt in response to major physical and psychological
changes.
• Roy was an associate professor and chairperson of the Department of
Nursing at Mount Saint Mary’s College until 1982 and was promoted to the
rank of professor in 1983 at both Mount Saint Mary’s College and the
University of Portland.
• She helped initiate and taught in a summer master’s program at the
University of Portland.
• In 1987 to present, Roy began the newly created position of resident nurse
theorist at Boston College School of Nursing where she teaches doctoral,
master’s, and undergraduate students.
• In 1991, she founded the Boston Based Adaptation Research in Nursing
Society (BBARNS), which would later be renamed the Roy Adaptation
Association.

Metaparadigm of Nursing:

1. PERSON
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• An adaptive system with coping mechanisms manifested by the adaptive

modes: physiologic, self-concept, role function and interdependence
Physiologic adaptive mode

• Behavior pertaining to the physical aspect of the human system

• Determined by physiologic needs, e.g., sleeping after a day's work. In the
physiologic mode, the focus is on five needs (oxygenation, nutrition,
elimination, activity, rest and protection) and on four regulatory processes
(the senses, fluids and electrolytes, neurologic, and endocrine functions).

Self-concept 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)
• Determined by interaction with others. For example, it's nice to hear
someone say, ―you’re beautiful in your suit."

Role function mode

• Set of expectations about how a person occupying one position behaves

toward another occupying another position.
• Refers to the performance of duties based on given societal norms or
expectations.
• Basic need: social integrity, the need to know who one is in relation to
others so that one can act.
• The need for role clarity of all participants in group, example: in today's
society, a ―mothering" role often includes being a breadwinner and so a
working woman needs to return to her work soon after the delivery of her
baby.

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

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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.
• Involves ways of seeking help, affection, and attention. It is also the ability
to love, respect, value and accepts.

• Includes people as individuals or in groups-families, organizations,

communities, and society as a whole

2. ENVIRONMENT

• Encompasses all conditions, circumstances, and influences surrounding

and affecting the development and behavior of humans as adaptive
systems, with particular consideration of person and earth resources.
• Elements: represented by stimuli from within the human adaptive system
and stimuli from around the system.

3. HEALTH
• A state and a process of being and becoming an integrated whole human
being. Conversely, illness is lack of integration.
• Integrity – soundness or an unimpaired condition leading to wholeness.

4. NURSING

• The science and practice that expands adaptive abilities and enhances
person and environment transformation
• An external regulatory force that can modify stimuli, which produce
adaptations.
• Stimulus - something that provokes a response, point of interaction for the
human system and the environment
• Nursing can either maintain, increase or decrease stimuli. The
consequence of nursing is the person's adaptation to these stimuli
depending on his position on the health-illness continuum.
• Goal: to promote adaptation for individuals and groups in the four adaptive
modes, thus contributing to health, quality of life, and dying with dignity by
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assessing behaviors and factors that influence adaptive abilities and by

intervening to enhance environmental interactions.

ROY ADAPTATION MODEL

KEY CONCEPTS AND THEORETICAL ASSERTIONS

The goal of nursing is to promote the person's adaptation along the four
adaptive modes (physiologic, self-concept, role function, and interdependence).

Adaptation: the process and outcome whereby thinking and feeling persons,
as individuals and in groups, use conscious awareness and choice to create
human and environmental integration

Coping Process: innate or acquired ways innate or of interacting with the

changing of environment

The person is able to adapt if he is able to cope with the constantly changing
environment. There are two types of systems at work: regulators and
cognators.

• Regulator subsystem — a basic type of adaptive process that responds

automatically through neural, chemical, and endocrine coping channels;
automatic response to stimulus.
• Cognator subsystem — A major coping process involving 4 cognitive-
emotive channels: perceptual and information processing, learning,
judgment and emotion;

Adaptive Responses: responses that promotes integrity of the human

system, that is, survival, growth, reproduction, mastery, and personal and
environmental transformation

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Figure 1: Adaptive/Effective Response through Four Adaptation Models.

The level of adaptation of a person is determined by the combined effect of

stimuli, which could either be focal, contextual or residual.

Focal stimuli

• Internal or external stimulus immediately affecting the system.

• Those that immediately confront the person, e.g., pricking of skin tissue
during injection of drugs.

Contextual stimuli

 All other stimuli present or contributing factors in the situation, e.g., inability
to explain the procedure and the need for the drug.

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Residual stimuli

• Unknown factors such as beliefs, attitudes or traits that have an

intermediate effect or influence on the present situation. For example, the
false belief that a patient cannot bathe after an injection.
• Significant stimuli in all human adaptation include stage of development,
family, and culture

Ineffective Responses

 Responses that do not contribute to integrity of the human system.

Roy's model revolves around the concept of man as an adaptive system. The
person scans the environment for stimuli and ultimately adapts. The nurse, as
part of his environment, assists the person in his effort to adapt by appropriately
managing his environment.

LESSON 19

TRANSCULTURAL THEORY BY MADELEINE

LEININGER

Background of the theorist:

• 1948- Diploma in Nursing from St. Anthony’s School of Nursing Denver,

Co.1950- BS in Biological Science from Benedictine College, Atchinson,
Kansas
• 1953- MSN from Catholic University, Washington, D.C.
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• 1953- MSN from Catholic University, Washington, D.C.

• 1965- Ph. D in Anthropology from University of Seattle
• 1966- offered first course in transcultural nursing at the University of
Colorado
• Developed her theory, Culture Care Diversity and Universality from a
combination of anthropology and nursing beliefs and principles.
• 1985- first published her theory in Nursing Science Quarterly
• 1988- further explained her theory in same journal
• Madeleine Leininger was a pioneer nurse anthropologist. Appointed dean of
the University of Washington, School of Nursing in 1969, she remained in
that position until 1974.

Metaparadigm of Nursing:

1. PERSON

 Humans are believed to be caring and to be capable of being concerned

about the needs, wellbeing and survival of others. Human care is universal,
that is, seen in all cultures. Humans are universally caring beings who
survive in a diversity of cultures through their ability to provide the
universality of care in a variety of ways according to different culture, needs
and settings.

2. ENVIRONMENT

 Being represented in culture, as a major theme in Leiningers’ theory. The

totality of an event, situation or experience

3. HEALTH

 Health systems, health care practices, changing health patterns, health

promotion and health maintenance. Health is an important concept in
transcultural nursing. Health is viewed as being universal across cultures
but defined within each culture in a manner that reflects the beliefs, values
and practices of a particular culture. Health is both universal and diverse.

4. NURSING

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 Nursing as a profession has a societal mandate to serve people and as a

discipline is expected to discover, develop and use knowledge distinctive to
nursing’s focus on human care and caring.

Transcultural Nursing Model

Transcultural Nursing is how professional nursing interacts with the

concept of culture. Based in Anthropology and Nursing, it is supported by theory,
research, and practice. Leininger’s theory is to provide care measures that are in
harmony with an individual or group’s cultural beliefs, practices, and values. In
the 1960’s she coined the term culturally congruent care, which is the primary
goal of transcultural nursing practice. Culturally congruent care is possible when
the following occurs within the nurse-client relationship

Theory Assumptions

Leininger postulated several theoretical assumptions, or basic beliefs,

designed to assist researchers exploring Western and nonWestern cultures
(Leininger, 1970, 1977, 1981, 1984, 1991a, 1997b, 2006a):

1. Care is the essence and the central dominant, distinct, and unifying focus
of nursing.
2. Humanistic and scientific care are essential for human growth, well-being,
health, survival, and to face death and disabilities.
3. Care (caring) is essential to curing or healing, for there can be no curing
without caring. (This assumption was held to have profound relevance
worldwide.)
4. Culture care is the synthesis of two major constructs that guide the
researcher to discover, explain, and account for health, well-being, care
expressions, and other human conditions.
5. Culture care expressions, meanings, patterns, processes, and structural
forms are diverse; but some commonalities (universalities) exist among
and between cultures.

6. Culture care values, beliefs, and practices are influenced by and

embedded in the worldview, social structure factors (e.g., religion,

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philosophy of life, kinship, politics, economics, education, technology, and

cultural values) and the ethnohistorical and environmental contexts.
7. Every culture has generic (lay, folk, naturalistic, mainly emic) and usually
some professional (etic) care to be discovered and used for culturally
congruent care practices.
8. Culturally congruent and therapeutic care occurs when culture care values,
beliefs, expressions, and patterns are explicitly known and used
appropriately, sensitively, and meaningfully with people of diverse or similar
cultures.
9. The three modes of care o er therapeutic ways to help people of diverse
cultures.
10. Qualitative research paradigmatic methods o er important means to
discover largely embedded, covert, epistemic, and ontological culture care
knowledge and practices.
11. Transcultural nursing is a discipline with a body of knowledge and practices
to attain and maintain the goal of culturally congruent care for health and
well-being (Leininger, 2006a, pp. 18–19).

Orientational Theory Definitions

To encourage discovery of qualitative knowledge, Leininger used

orientational (not operational) definitions for her theory, to allow the researcher to
discern previously unknown phenomena or ideas. Orientational terms allow
discovery and are usually congruent with the client lifeways. They are important
in using the qualitative ethnonursing discovery method, which is focused on how
people understand and experience their world using cultural knowledge and
lifeways (Leininger, 1985, 1991a, 1997b, 1997c, 2002, 2006a). The following are
select examples:

• Culture: The learned, shared, and transmitted values, beliefs, norms, and
lifeways of a particular group that guides their thinking, decisions, and
actions in patterned ways and often intergenerationally (Leininger, 2006a,
p. 13).
• Care: Those assistive, supportive, and enabling experiences or ideas
toward others with evident or anticipated needs to ameliorate or improve a
human condition or lifeway. Caring refers to actions, attitudes, and
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practices to assist or help others toward healing and well-being (Leininger,

2006a, p. 12). Care is both an abstract and a concrete phenomenon.

• Culture care: Subjectively and objectively learned and transmitted values,

beliefs, and patterned lifeways that assist, support, facilitate, or enable
another individual or group to maintain well-being and health, to improve
their human condition and lifeway, or to deal with illness, handicaps, or
death (Leininger, 1991a, p. 47).
• Culture Care Diversity: The di erences or variabilities among human
beings with respect to culture care meanings, patterns, values, lifeways,
symbols, or other features related to providing beneficial care to clients of
a designated culture (Leininger, 2006a, p. 16).
• Culture Care Universality: The commonly shared or similar culture care
phenomena features of human beings with recurrent meanings, patterns,
values, lifeways, or symbols that serve as a guide for caregivers to provide
assistive, supportive, facilitative, or enabling people care for healthy
outcomes (Leininger, 2006a, p. 16).
• Professional (etic) care: Formal and explicit cognitively learned
professional care knowledge and practices obtained generally through
educational institutions. They are taught to nurses and others to provide
assistive, supportive, enabling, or facilitative acts for or to another
individual or group in order to improve their health, prevent illnesses, or to
help with dying or other human conditions (Leininger, 2006a, p. 14).
• Generic (emic) care: The learned and transmitted lay, indigenous,
traditional, or local folk knowledge and practices to provide assistive,
supportive, enabling, and facilitative acts for or toward others with evident
or anticipated health needs in order to improve well-being or to help with
dying or other human conditions (Leininger, 2006a, p. 14).
• Culture care preservation and/or maintenance: Those assistive,
supportive, facilitative, or enabling professional acts or decisions that help
cultures to retain, preserve, or maintain beneficial care beliefs and values
or to face handicaps and death (Leininger, 2006a, p. 8).
• Culture care accommodation and/or negotiation: Those assistive,
accommodating, facilitative, or enabling creative provider care actions or
decisions that facilitate adaptation to or negotiation with others for
culturally congruent, safe, and e ective care for their health, well-being, or
to deal with illness or dying (Leininger, 2006a, p. 8).
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• Culture care repatterning and/or restructuring: Those assistive,

supportive, facilitative, or enabling professional actions and mutual
decisions that help people to reorder, change, modify, or restructure their
lifeways and institutions for better (or beneficial) health-care patterns,
practices, or outcomes (Leininger, 2006a, p. 8). These patterns are
mutually established between caregivers and receivers.
• Ethnohistory: The past facts, events, instances, and experiences of
human beings, groups, cultures, and institutions that occur over time in
particular contexts that help explain past and current lifeways about culture
care influencers of health and well-being or the death of people (Leininger,
2006a, p. 15).
• Environmental context: The totality of an event, situation, or particular
experience that gives meaning to people’s expressions, interpretations,
and social interactions within particular geophysical, ecological, spiritual,
sociopolitical, and technological factors in specific cultural settings
(Leininger, 2006a, p. 15).
• Worldview: The way people tend to look out on their world or their
universe to form a picture or value stance about life or the world around
them (Leininger, 2006a, p. 15). [Link] and social structure factors:
religion (spirituality); kinship (social ties); politics; legal issues; education;
economics; technology; political factors; philosophy of life; and cultural
beliefs and values with gender and class di erence. The theorist has
predicted that these diverse factors must be understood as they directly or
indirectly influence health and well-being (Leininger, 2006a, p. 14).
• Culturally congruent care: Culturally based care knowledge, acts, and
decisions used in sensitive and knowledgeable ways to appropriately and
meaningfully fit the cultural values, beliefs, and lifeways of clients for their
health and well-being, or to prevent illness, disabilities, or death (Leininger,
2006a, p. 15).

The Sunrise Enabler: A Conceptual Guide to Knowledge Discovery

Leininger developed the sunrise enabler (Fig. 17-1) to provide a holistic and
comprehensive conceptual picture of the major factors influencing culture care
diversity and universality (Leininger, 1995, 1997b; Leininger & McFarland, 2002,
2006). The model can be a valuable visual guide to elucidating multiple factors
that influence human care and lifeways of di erent cultures. The enabler serves
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as a cognitive guide for the researcher to reflect on di erent predicted influences

on culturally based care.

The sunrise enabler can also be used as a valuable aid in cultural and health-
care assessment of clients. As the researcher uses the model, the di erent
factors alert him or her to find culture care phenomena. Gender, sexual
orientation, race, class, and biomedical conditions are studied as part of the
theory. These determinants tend to be embedded in the worldview and social
structure and take time to recognize. Care values and beliefs are usually lodged
into environment, religion, kinship, and daily life patterns.
The nurse can begin the discovery at any place in the enabler and follow the
informant’s ideas and experiences about care. If one starts in the upper part of
the enabler, one needs to reflect on all aspects depicted to obtain holistic or total
care data. Some nurses start with generic and professional care then look at how
religion, economics, and other influences a ect these care modes. One always
moves with the informants’, rather than the researcher’s, interest and story.
Flexibility in using the enabler promotes a total or holistic view of care.

The three transcultural care decisions and actions (in the lower part of the
figure) are very important to keep in mind. Nursing decisions and actions are
studied until one realizes the care needed. The nurse discovers with the
informant the appropriate decisions, actions, or plans for care. Throughout this
discovery process, the nurse holds his or her own etic biases in check so that the
informant’s ideas will come forth, rather than the researcher’s. Transcultural
nurses are mentored in ways to withhold their biases or wishes and to enter the
client’s worldview.

The nurse begins the study by making explicit a specific domain of inquiry.
For example, the researcher may focus on a domain of inquiry such as ―culture
care of Mexican American mothers caring for their children in their home.‖ Every
word in the domain statement is important and studied with the sunrise enabler
and the theory tenets. The nurse or researcher may have hunches about the
domain and care, but until all data have been studied with the theory tenets, she
or he cannot prove them. Informants’ viewpoints, experiences, and actions are
fully documented. Generally, informants select what they like to talk about first,
and the nurse/researcher accommodates their interest or stories about care.
During in depth study of the domain of inquiry, all areas of the sunrise enabler
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are identified and confirmed with the informants. The informants become active
participants throughout the discovery process in such a way as to feel
comfortable and willing to share their ideas.

The real challenge is to focus care meanings, beliefs, values, and practices
related to informants’ cultures so that subtle and obvious differences and
similarities about care are identified among key and general informants. The
differences and similarities are important to document with the theory. If
informants ask about the researcher’s views, the latter must be carefully and
sparsely shared. The researcher keeps in mind that some informants may want
to please the researcher by talking about professional medicines and treatments.
Professional ideas, however, often cloud or mask the client’s real interests and
views. If this occurs, the researcher must be alert to such tendencies and keep
the focus on the informant’s ideas and on the domain of inquiry studied. The
informant’s knowledge is always kept central to the discovery process about
culture care, health, and well-being. If the researcher finds some factors
unfamiliar, such as kinship, economics, and political and other considerations
depicted in the model, the researcher should listen attentively to the informant’s
ideas. Obtaining insight into the informant’s emic (insider’s) views, beliefs, and
practices is central to studying the theory (Leininger, 1985, 1991a, 1995, 1997b;
Leininger & McFarland, 2002, 2006).

Throughout the study and use of the theory, the meanings, expressions, and
patterns of culturally based care are important. The nurse/ researcher listens
attentively to informants’ accounts about care and then documents the ideas.
What informants know and practice about care or caring in their culture is
significant. Documenting ideas from the informants’ emic viewpoint is essential to
arrive at accurate culturally based care. Unknown care meanings, such as the
concepts of protection, respect, love, and many other care concepts, need to be
teased out and explored in depth, as they are the key words and ideas in
understanding care.

Such care meanings and expressions are not always readily known;
informants ponder care meanings and are often surprised that nurses are
focused on care instead of medical symptoms. Sometimes informants may be
reluctant to share ideas about social structure, religion, and economics or politics,
as they fear these ideas may not be accepted or understood by health personnel.

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Generic folk or indigenous knowledge often has rich care data and needs to be
explored. Generic care ideas need to be appropriately integrated into the three
transcultural modes of decisions and actions for culturally congruent care
outcomes. Generic and professional care are integrated so that the clients benefit
from both types of care.

The sunrise enabler was developed with the idea to ―let the sun enter the
researcher’s mind‖ and discover largely unknown care factors of cultures. Letting
the sun ―rise and shine‖ is important and offers fresh insights about care
practices. A recent metasynthesis of 24 doctoral dissertations using Leininger’s
CCT and the ethnonursing research method led to the discovery of interpretive
and explanatory culture care findings, new theoretical formulations, and
evidence-based recommendationsto guide nursing practice (McFarland et al.,
2011).

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LESSON 20

PHILOSOPHY AND SCIENCE OF CARING BY MARGARET

JEAN WATSON

Background of the theorist:

• Born in West Virginia

• Graduated BSN, MS, and PhD. In University of Colorado in 1964, 1966, and
1973, respectively
• A Distinguished Professor of Nursing with an endowed Chair in Caring
Science at the University of Colorado Health Sciences Center
• Founder of the original Center of Human Caring in Colorado, the nation’s first
interdisciplinary center committed to using human caring knowledge for
clinical practice, scholarship, administration and leadership
• She is a widely published author an recipient of several awards and honors.
 Her research has been in the area of human caring and loss
• The foundation of Jean Watson’s theory of nursing was published in 1979 in
nursing, ―The Philosophy and Science of Caring‖
• In 1988, her theory was published in ―Nursing: Human Science and Care‖
• She asserts that the caring stance that nursing has always held is being
threatened by the tasks and technology demands of the curative factors.

Metaparadigm of Nursing:

1. PERSON

 She adopts a view of the human being as: ―..... 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‖.
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2. HEALTH

 Watson believes that there are other factors that are needed to be included
in the WHO definition of health. She adds the following three elements:
a. A high level of overall physical, mental and social functioning.
b. A general adaptive-maintenance level of daily functioning.
c. The absence of illness (or the presence of efforts that leads its
absence)

3. ENVIRONMENT
• 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.

4. 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.
• A human science of persons and human health-illness experiences that
are mediated by professional, personal, scientific, esthetic and ethical
human transactions.

CARING AS THE ESSENCE OF NURSING (JEAN WATSON, 1979)

Watson viewed caring as the essence of nursing. Caring connotes

responsiveness between the nurse and the person. The nurse co-participates
with the person. The purpose of caring is to assist the person in gaining control
and becoming knowledgeable, and in the process promote health changes. If we
have thought of the concept of empowerment while reading this, yes, we can say
that it is similar to that. By allowing the client to be knowledgeable, the nurse
provides an environment for better decision-making, better self-control and,
better self-respect. The concept is common to Filipino culture: ―kakayahan" or
"patibayin ang kakayahan," meaning assisting the person in gaining control.
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While it is true that caring as an attribute in nursing has been described and
clarified by many others, there is uniqueness in Watson's science of caring.
Basic assumptions for the science of caring are supported by ten carative factors
that provide structure to the concept of caring. According to Watson, the first
three carative factors provide the philosophical foundation for the science of
caring. The remaining seven carative factors spring from the foundation laid by
these first three.

Watson’s theory has 3 Major Conceptual Elements:

1. Carative Factors – evolving toward the ―Clinical Caritas Processes‖.

2. Transpersonal Caring Moment
3. Caring Moment/ caring occasion

10 Carative Factors

1. FORMATION OF A HUMANISTIC-ALTRUISTIC VALUE SYSTEM.

 The value of altruism (regard for others as a personal action) is learned at

an early age. It is a value shared with parents. One's own life experiences
are learning opportunities to gain insights about dealing with others.
Caring based on humanistic values and altruistic behavior "can be
developed through examination of one's own views, beliefs, interactions
with various cultures and personal growth experiences." This development
is perceived necessary for the nurse's own maturation.

2. INSTALLATION OF FAITH-HOPE.

 This factor is deemed essential to both carative and curative processes. To

nurses, this provides a basis for looking into the healing power of belief, or
the spiritual dimension, when curing is not possible. The use of Faith-
Hope as a nursing intervention allows nurses to explore alternative
methods of healing, like meditation. It seems that the goal for this activity
is the provision of a sense of wellbeing through belief systems that are
meaningful to the client.

3. CULTIVATION OF SENSITIVITY TO SELF AND OTHERS.

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 Nurses promote "health and higher level functioning only when they perform
person-to-person relationships as opposed to manipulative relationships."
There is a need for the nurse to develop and examine one's own feelings.
Through this process, increased sensitivity to others is developed. The
nurse becomes honest and promotes self-growth and self-actualization.
Watson's premise further states "that at the highest level of nursing, the
nurse's human care responses, human care transactions, and presence in
the relationship transcend the physical material world." The explanation
makes it clear that interactions between the nurse and the client deal with
the person's emotional and subjective world as a means to learn the inner
self
4. DEVELOPMENT OF A HELPING-TRUST RELATIONSHIP.

 Communication, both verbal and non-verbal, is a mode of accomplishing a

helping-trust relationship to establish rapport and caring. Characteristics
common to this carative factor are congruence, empathy, warmth and
honesty. Positive acceptance of another is most often expressed by body
language, touch and tone of voice. I'm sure that given your clinical
experiences, you can think of many situations to relate to this fourth
carative factor.

5. PROMOTION AND ACCEPTANCE OF THE EXPRESSION OF POSITIVE

AND NEGATIVE FEELINGS.

 According to Watson, it is important to facilitate awareness of both negative

and positive feelings to improve on one's level of awareness. Feelings
need to be considered in a caring environment. Being aware of both
positive and negative feelings leads to better understanding of behavior.

6. SYSTEMATIC USE OF THE SCIENTIFIC PROBLEM-SOLVING METHOD

FOR DECISION MAKING.

 This factor gives notice to the limitations nurses have in assessing the issue
of developing a scientific base because most of our time is dedicated to
the performance of nursing tasks such as procedures and treatments.
Thus, recognition is given to the use of the systematic problem-solving
method in building nursing knowledge. In the same way, the argument

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extends to other methods of knowing like utilizing research-based findings

in order to improve nursing practice and provide holistic care.

7. PROMOTION OF INTERPERSONAL TEACHING-LEARNING.

 Through this factor, persons (clients) gain control over their own health
because it provides them with both information and alternatives. Learning
offers opportunities to individualize information dissemination. The caring
nurse focuses on the learning and teaching process, as well as in
understanding the client's perception of the situation. This provides for a
cognitive plan workable within the client's frame of reference.

8. PROVISIONS FOR A SUPPORTIVE, PROTECTIVE AND (OR)

CORRECTIVE MENTAL, PHYSICAL, SOCIOCULTURAL AND
SPIRITUAL ENVIRONMENT.

• There are two divisions or categorizations relative to this factor: external

variables which include physical, safety and environmental factors; and
internal variables which refer to mental, spiritual or cultural activities which
the nurse may manipulate for the person's well-being. Interdependence
exists between internal and external factors since the person perceives
the situation in the environment as either threatening or non-threatening.
There are events in a person's life that can arouse a sense of threat. The
person appraises the situation and copes to the best of his ability. The
nurse's assessment capabilities can be valuable in helping the person
appraise the situation and cope with it. The nurse's intervention is aimed
at helping, the person develop a more accurate perception to help
strengthen coping capabilities.
• Provision of comfort, safety and privacy are major aspects of this carative
factor. A clean and esthetic environment is considered a basic element.
Esthetics is deemed essential in the promotion of increased self-worth and
dignity.

9. ASSISTANCE WITH THE GRATIFICATION OF HUMAN NEEDS.

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 The hierarchy of human needs is the essence of this carative factor. It is

grounded in a hierarchy of need similar to that of the Maslow’s. Watsons
has created a hierarchy which she believes is relevant to the science of
caring in nursing. According to her, 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. ALLOWANCE FOR EXISTENTIAL-PHENOMENOLOGICAL-SPIRITUAL

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.

Transpersonal Caring Relationship

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• A special kind of human relationship that depends on:

 Nurse’s commitment on protecting and enhancing human dignity

and a deeper/higher self.
 Nurse’s caring consciousness to preserve and honor the embodied
spirit, thereby not reducing the patient to a moral status of an
object.

• The nurse’s caring and connection has potential to heal since experience,
intention, and perception are taking place.
• Nursing goes beyond an objective assessment and shows concern for the
patient’s own healthcare.
• Goal of transpersonal caring relationship protects, enhances, and
preserves human dignity, humanity, wholeness, and inner harmony.

Caring Occasion/Moment

Caring occasion is the moment when the nurse and another person come
together in such a way that an occasion for human caring is created. Both
persons come together in a human-human transaction. The one caring for and
the one being cared for are influenced by the choices and actions decided within
the relationship.
LESSON 21

NOVICE TO EXPERT BY PATRICIA BENNER

Background of the theorist:

Life:
• Patricia Benner was born in 1942 in Hampton,
Virginia. And spent her childhood in California.
• She was married to Richard benner on 1967; they have a son and a
daughter.
Professional:
• Bachelor degree in nursing from Pasadena College, in 1964.
• Master in medical-surgical nursing from the University of California, San
Francisco (UCSF), in 1970.

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• PhD - from the University of California Berkeley, in 1982.

• 1985, Benner was inducted into the american academy of nurses.
• Benner retired from full –time teaching in 2008 as professor from
university of California san Francisco (UCSF)
• She is currently a Distinguished Visiting Professor at Seattle University
School of Nursing.
• Published 9 books and numerous articles.

Metaparadigm of Nursing:

1. PERSON

 The 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 a life.

2. HEALTH

 Dr. Benner focuses on the lived experience of being healthy and being ill.
Health is defined as what can be assessed, whereas well-being is the
human experience of health or wholeness. Wellbeing and being ill are
understood as distinct ways of being in the world.

3. ENVIRONMENT

• Benner uses situation rather than environment because situation conveys

a social environment with social definition and meaningfulness.
• ―To be situated implies that one has a past, present, and future and that
all of these aspects….influence the current situation‖.

4. NURSING

• Nursing is described as a caring relationship, an ―enabling condition of

connection and concern‖.

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• ―Caring is primary because caring sets up the possibility of giving and

receiving help.‖
• Nursing is viewed as a caring practice whose science is guided by the
moral art and ethics of care and responsibility.
• Benner understands that nursing practice as the care and study of the
lived experience of health, illness, and disease and the relationships
among the three elements.

5 LEVELS OF CAPCABILITIES ACCORDING TO BENNER

1. NOVICE
 The person has no background experience of the situation in which
he or she is involved.
 There is difficulty discerning between relevant and irrelevant
aspects of the situation.
 Generally this level applies to nursing students.

2. ADVANCE BEGINNER
 The advance beginner stage develops when the person can
demonstrate marginally acceptable performance having coped with
enough real situations to note, or to have pointed out by mentor,
the recurring meaningful components of the situation.
 Nurses functioning at this level are guided by rules and oriented by
task completion.

3. COMPETENT
 The competent stage is the most pivotal in clinical learning because
the learner must begin to recognize patterns and determine which
elements of the situation warrant attention and which can be
ignored.
 The competent nurse devises new rules and reasoning procedures
for a plan while applying learned rules for action on the basis of the
relevant facts of that situation.

4. PROFICIENT

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 The performer perceives the information as a whole (total picture)

rather than in terms of aspects and performance.
 Proficient level is a qualitative leap beyond the competent.
 Nurses at this level demonstrate a new ability to see changing
relevance in a situation including the recognition and the
implementation of skilled responses to the situation as is it evolves.

5. EXPERT
 Fifth stage is achieved when ―the expert performer no longer
relies on analytical principals to connect her or his understanding of
the situation to an appropriate action.

ENRICHMENT ACTIVITIES
A. Let’s reflect! Instruction:

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1. The following are self-reflective questions that you have to ask yourself in
order to for you to understand caring as the essence of nursing profession:
a. What is the meaning of caring for you?
b. How do you express your caring consciousness and commitment to
the people around you (i.e. family and friends)?
c. How do you make a difference in people’s life around you?
2. Your answer must be brief, direct to the point and at least 100-200 words.
3. Submit your output using the guidelines or means (e.g. e-mail, Facebook
messenger, Google classroom) provided by your respective professors in
this course.

FORMATIVE ASSESSMENT
A. Let’s test your knowledge and understanding! Instruction:

1. Identify at least two (2) transcultural nursing practices in the care of sick
individuals/patients among other nations/countries (i.e. Koreans, Japanese,
Americans, Spanish) and explain the nature of these practices and how it
has affected the way of caring sick people in their respective communities.
2. Present your output in the class using a pre-recorded video presentation of
least 3 – 5 minutes.
3. Submit your output using the guidelines or means (e.g. e-mail, Facebook
messenger, Google classroom) provided by your respective professors in
this course.

REFERENCES

Alligood, M. R. (2018). Nursing Theorists and Their Work, 9th Edition. Elsevier
(Singapore) Pte. Ltd. Incorporated, 3 Killiney Road, winsland House I,
239519 Singapore.

Berman, A., Snyder, S., Frandsen, G. (2016). Kozier and Erb’s Fundamentals of
Nursing: Concepts, Process and Practice, 10 th Edition. Pearson Education
Incorporated, 221 River Street, Hoboken, New Jersey, 07030.

Octaviano, E. F., Balita, C. E. (2020). Theoretical Foundations of Nursing: The

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Philippine Perspective: National Nursing Core Competency Standards Aligned

Outcomes-Based Approach, 2020 Edition. Ultimate Learning Series, 2nd Floor
Carmen Building, Sampaloc, Metro Manila, Philippines.

Octaviano, E. F., Balita, C. E. (2008). Theoretical Foundations of Nursing: The

Philippine Perspective, 2008 Edition. Ultimate Learning Series, 2nd Floor
Carmen Building, Sampaloc, Metro Manila, Philippines.

Smith, M. C., Parker, M. E. (2015). Nursing Theories and Nursing Practice, 4th
Edition. F.A. Davies Company, 1915 Arch Street Philadelphia, PA 19103

Udan, J. Q. (2011). Theoretical Foundations of Nursing, 1st Edition. Educational

Publishing House, 526-528 United Nations Avenue, Ermita, Manila,
Philippines.

Udan, J. Q. (2009). Mastering Fundamentals of Nursing Concepts and Clinical

Application, 3rd Edition. Educational Publishing House, 526-528 United
Nations Avenue, Ermita, Manila, Philippines.

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MODULE SIX: OTHER NURSING THEORIES

Learning Objectives:

After going through this module, the students are expected to be able to:

• Explain and describe the history and roots of the other nursing theorists
presented in this module.
• Explain, describe, and apply the principles and concepts of their
respective theories and describe its application to the nursing profession.
• Describe the respective views of these theorists in the four
metaparadigms of nursing, and empower the students in reciting their own
values and beliefs in relation to the patient, environment, health and
nursing.
• Empower the students to call on their classmates to recite own values and
beliefs in relation to the patient, environment, health and nursing.
• Recall the definitions of nursing used by the different theorists.

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LESSON 22

CARE, CORE, CURE MODEL BY LYDIA HALL

Background of the theorist:

• Born on September 21, 1906 in New York City as

Lydia Eloise Williams.
• She was the eldest child of Louis V. Williams and Anna Ketterman
Williams and was named after her maternal grandmother.
• Her brother, Henry, was several years younger. At a young age, her family
decided to move to York, Pennsylvania, where her father was a physician
in general practice.
• Graduated from York Hospital School of Nursing in 1927 with a diploma in
nursing. However, she felt as if she needed more education.
• She entered Teacher’s College at Columbia University in New York and
earned a Bachelor of Science degree in public health nursing in 1932.
• After a number of years in clinical practice, she resumed her education
and received a master’s degree in the teaching of natural life sciences
from Columbia University in 1942.
• Later, she pursued a doctorate and completed all of the requirements
except for the dissertation.
• In 1945, she married Reginald A. Hall who was a native of England.
• Hall died on February 27, 1969, at Queens Hospital in New York. Genrose
Alfano continued her work at the Loeb Center until the focus of the center
was changed to that of custodial care in 1985.

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Metaparadigm of Nursing:

1. PERSON

 The individual human who is 16 years of age or older and past the acute
stage of long-term illness is the focus of nursing care in Hall’s work. The
source of energy and motivation for healing is the individual care recipient,
not the health care provider. Hall emphasizes the importance of the
individual as unique, capable of growth and learning, and requiring a total
person approach.

2. HEALTH

 Health can be inferred to be a state of self-awareness with a conscious

selection of behaviors that are optimal for that individual. Hall stresses the
need to help the person explore the meaning of his or her behavior to
identify and overcome problems through developing self-identity and
maturity.

3. ENVIRONMENT

 The concept of society or environment is dealt with in relation to the

individual. Hall is credited with developing the concept of Loeb Center
because she assumed that the hospital environment during treatment of
acute illness creates a difficult psychological experience for the ill
individual. Loeb Center focuses on providing an environment that is
conducive to self-development. In such a setting, the focus of the action of
the nurses is the individual, so that any actions taken in relation to society
or environment are for the purpose of assisting the individual in attaining a
personal goal.

4. NURSING

 Nursing is identified as consisting of participation in the care, core, and cure

aspects of patient care.

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Lydia Hall’s theory

Lydia Hall’s theory has three components which are represented by three
independent but interconnected circles. The three circles are: the core, the care,
and the cure. The size of each circle constantly varies and depends on the state
of the patient.

The Care Circle

According to the theory, nurses are focused on performing the noble task of
nurturing patients. This circle solely represents the role of nurses, and is focused
on performing the task of nurturing patients. Nurturing involves using the factors
that make up the concept of mothering (care and comfort of the person) and
provide for teaching-learning activities.
The care circle defines the primary role of a professional nurse such as providing
bodily care for the patient and helping the patient complete such basic daily
biological functions as eating, bathing, elimination, and dressing. When providing
this care, the nurse’s goal is the comfort of the patient.

Moreover, the role of the nurse also includes educating patients, and helping
a patient meet any needs he or she is unable to meet alone. This presents the
nurse and patient with an opportunity for closeness. As closeness develops, the
patient can share and explore feelings with the nurse.

The Core Circle

The core, according to Hall’s theory, is the patient receiving nursing care.
The core has goals set by him or herself rather than by any other person and
behaves according to his or her feelings and values. This involves the
therapeutic use of self and is shared with other members of the health team.

This area emphasizes the social, emotional, spiritual, and intellectual needs
of the patient in relation to family, institution, community and the world. This is
able to help the patient verbally express feelings regarding the disease process
and its effects by the use of the reflective technique. Through such expression,
the patient is able to gain self-identity and further develop maturity.
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Reflective technique is used by the professional nurse in a way the he or

she acts as a mirror to the patient to help the latter explore his or her own
feelings regarding his or her current health status and related potential changes
in lifestyle.

Motivations are discovered through the process of bringing into awareness

the feelings being experienced. With this awareness, the patient is now able to
make conscious decisions based on understood and accepted feelings and
motivation.

The Cure Circle

The cure as explained in this theory is the aspect of nursing which involves
the administration of medications and treatments. Hall explains in the model that
the cure circle is shared by the nurse with other health professionals, such as
physicians or physical therapists.
In short, these are the interventions or actions geared toward treating the
patient for whatever illness or disease he or she is suffering from. During this
aspect of nursing care, the nurse is an active advocate of the patient.

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Figure1: Lydia Hall’s diagram showing interlocking circles that may change in size and overlap.

As seen in the figure above, the three interlocking circles may change in size
and overlap in relation to the patient’s phase in the disease process. A nurse
functions in all three circles but to different degrees. For example, in the care
phase, the nurse gives hands-on bodily care to the patient in relation in relation
to the activities of daily living such as toileting and bathing. In the cure phase, the
nurse applies medical knowledge to treatment of the person, and in the core
phase, the nurse addresses the social and emotional needs of the patient for
effective communication and a comfortable environment.

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LESSON 23

Conservation Model BY MYRA ESTRIN LEVINE

Background of the theorist

• Born in Chicago, Illinois.

• Graduated from Cook Country School of Nursing
in 1944 and obtained her BS in Nursing from the University of Chicago in
1949.
• She authored 77 published articles which included ―An Introduction to
Clinical Nursing‖.
• Also received an honorary doctorate from Loyola University in 1992.  She
died on 1996.

Metaparadigm of Nursing:

1. PERSON

 It refers to the unique individual in unity and integrity, feeling, believing,

thinking, and whole.

2. ENVIRONMENT

 Includes both the internal and external environment. Three Aspects of

Environment Drawn upon Bates’ (1967) Classification:

 The operational environment consists of the undetected natural

forces and that impinge on the individual.
 The perceptual environment consists of information that is recorded
by the sensory organs.
 The conceptual environment is influenced by language, culture,
ideas, and cognition.

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3. HEALTH

• Refers to the pattern of adaptive change of the whole being.

4. Nursing

• The human interaction relying on communication, rooted in the organic

dependency of the individual human being in his relationships with other
human beings.

Nursing Theory: The Conservation Model

Levine’s conservation model believes nursing intervention is a conservation

activity, with conservation of energy as a fundamental concern, four conservation
principles of nursing. It guides nurses to concentrate on the importance and
responses at the level of the person. Nurses fulfill the theory’s purpose through
the conservation of energy, structure, and personal and social integrity.

Every patient has a different array of adaptive responses, which vary based
on personal factors including age, gender, and illness. The fundamental concept
of Myra Estrin Levine’s theory is conservation. When an individual is in a phase
of conservation, it means that the person has been able to adapt to the health
challenges, with the slightest amount of effort. The core of Levine’s Conservation
Model is to improve the physical and emotional wellbeing of a person, by
considering the four domains of conservation she set out. By proposing to
address the conservation of energy, structure, and personal and social integrity,
this nursing theory helps guide nurses in the provision of care that will help
maintain and promote the health of the patient.

What is the Conservation Model?

The core of the conservation model is to improve the physical and emotional
wellbeing of a person by considering the four domains of conservation she set
out.

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Nursing’s role in conservation is to help the person with the process of ―keeping
together‖ the total person through the least amount of effort. Levine (1989)
proposed the following four principles of conservation:

1. The conservation of energy of the individual.

2. The conservation of the structural integrity of the individual.
3. The conservation of the personal integrity of the individual.
4. The conservation of the social integrity of the individual.

The conservation principles do not, of course, operate singly and in isolation

from each other. They are joined within the individual as a cascade of life events,
churning and changing as the environmental challenge is confronted and
resolved in each individual’s unique way. The nurse as a caregiver becomes part
of that environment, bringing to every nursing opportunity his or her own
cascading repertoire of skill, knowledge, and compassion. It is a shared
enterprise and each participant is rewarded (Levine, 1989).

Conservation of Energy
• Conservation of energy refers to balancing energy input and output
to avoid excessive fatigue. It includes adequate rest, nutrition and
exercise. Examples: Availability of adequate rest; Sustenance of
adequate nutrition

Conservation of Structural Integrity

• Conservation of structural integrity refers to maintaining or
restoring the structure of body preventing physical breakdown and
promoting healing. Examples: Assist patient in ROM exercise;
Preservation of patient’s personal hygiene

Conservation of Personal Integrity

• Conservation of personal integrity recognizes the individual as
one who strives for recognition, respect, self-awareness, selfhood,
and self-determination. Example: Acknowledge and preserve
patient’s space needs

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Conservation of Social Integrity

• Conservation of social integrity exists when a patient is
recognized as someone who resides within a family, a community, a
religious group, an ethnic group, a political system, and a nation.
Example: Help the individual to preserve his or her place in a family,
community, and society.

Adaptation
• Adaptation is the process of change and integration of the organism
in which the individual retains integrity or wholeness. It is possible to
have degrees of adaptation.

Conservation
• Conservation includes joining together and is the product of
adaptation including nursing intervention and patient participation to
maintain a safe balance.

Personal Integrity
• Personal integrity is a person’s sense of identity and self-definition.
Nursing intervention is based on the conservation of the individual’s
personal integrity.

Social Integrity
• Social integrity is life’s meaning gained through interactions with
others. Nurses intervene to maintain relationships.

Structural Integrity
• Structural integrity: Healing is the process of restoring structural
integrity through nursing interventions that promote healing and
maintain structural integrity.

Sub concepts: Three Concepts of Adaptation

Historicity

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• Adaptation is a historical process, responses are based on past

experiences, both personal and genetic

Specificity
• Adaptation is also specific. Each system has very specific responses.
The physiologic responses that ―defend oxygen supply to the brain
are distinct from those that maintain the appropriate blood glucose
levels.‖ (Levine, 1989)

Redundancy
• Although the changes that occur are sequential, they should not be
viewed as linear. Rather, Levine describes them as occurring in
―cascades‖ in which there is an interacting and evolving effect in
which one sequence is not yet completed when the next begins.
Energy Conservation
• Nursing interventions based on the conservation of the patient’s
energy.

Holism
• The singular, yet integrated response of the individual to forces in the
environment.

Homeostasis
• Stable state normal alterations in physiologic parameters in response
to environmental changes; an energy sparing state, a state of
conservation.

Modes of Communication
• The many ways in which information needs and feelings are
transmitted among the patient, family, nurses, and other health care
workers.

Therapeutic Interventions
• Interventions that influence adaptation in a favorable way, enhancing
the adaptive responses available to the person.

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Assumptions

• The following are the major assumptions of The Conservation Model.

a. Assumptions about Individuals

• Each individual is an active participant in interactions with the
environment… constantly seeking information from it (Levine, 1969).
• The individual is a sentient being and the ability to interact with the
environment seems ineluctably tied to his sensory organs.
• Change is the essence of life and it is unceasing as long as life goes
on. Change is characteristic of life (Levine, 1973).

b. Assumptions about Nursing

• ―Ultimately the decisions for nursing intervention must be based on
the unique behavior of the individual patient.‖
• Patient-centered nursing care means individualized nursing care. It is
predicated on the reality of common experience: every man is a
unique individual, and as such he requires a unique constellation of
skills, techniques and ideas designed specifically for him (Levine,
1973).

c. Relationships
• Conservation of energy is based on nursing interventions to conserve
through a deliberate decision as to the balance between activity and the
person’s available energy.
• Conservation of structural integrity is the basis for nursing interventions to
limit the amount of tissue involvement.
• Conservation of personal integrity is based on nursing interventions that
permit the individual to make decisions for himself or participate in the
decisions.
• Conservation of social integrity is based on nursing interventions to
preserve the client’s interactions with the family and the social system to
which they belong.
• All nursing interventions are based on careful and continued observation
over time.
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Although there are many concepts similar to that of other nursing theories,
Levine’s concept of energy conservation makes it unique in guiding nursing
actions. Borrowed concepts from Bates regarding Levine’s view with the
environment were not translated into how it affects the individual. The necessity
of connecting incorporated concepts is crucial when trying to develop a model for
nursing so as to be applied to human care.

The concept of conservation, adaptation, and integrity can be applied to any

age group since every individual has the need to expand and reserve bodily
energy. The operational definition of homeostasis by Levine is in question since
to achieve homeostasis, energy is continuously being used by the body thus her
statement that homeostasis is an energy sparing state is quite vague in nature.
Rewording might be helpful in this part of her model.

LESSON 24

Nursing Process Discipline BY IDA JEAN ORLANDO

Background of the theorist:

• A first generation American of Italian descent was

born in 1926
• She receive her nursing diploma from New York Medical College, her BS
in public health nursing from St. John’s University, NY, and her MA in
mental health nursing from Columbia University, NY

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• Professor at Yale School of Nursing where she was Director of the

Graduate Program in Mental Health Psychiatric Nursing.
• It was from this research that she developed her theory which was publish
under 1961 book: ― The dynamic Nurse-Patient Relationship.‖
• She also developed her theory when at Mclean Hospital in Belmount, MA
as director of a research Project: Two systems of Nursing in a Psychiatric
Hospital.
• The results of the research are contain in her 1972 book titled: the
discipline and teaching of nursing processes.
• Orlando held various positions in the Boston area, was a board member of
Harvard Community Health Plan, and served as both a national and
international consultant.
• She is a frequent lecturer and conducted numerous seminars on nursing
process.
• Orlando’s theory was develop in the late 1950’s from observation she
recorded between nurse and patient.
• Despite to her efforts, she was only able to categorize the records as
―good‖ or ―bad‖ nursing
• It then dawned on her that both the formulations for ―good‖ or ―bad‖
nursing contained in the records. From these observations she formulated
the deliberative nursing process.

Metaparadigm of Nursing:

1. PERSON
• A developmental being with needs.
• Nursing clients are patients who are under medical care and who cannot
deal with their needs or who cannot carry out medical treatment.

2. Environment
 Not defined directly in Orlando's Theory but implicity in the immediate
context for a patient.

3. Health
• A sense of adequacy or wellbeing.
• Fulfilled needs.  Sense comfort.
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4. NURSING
• A dynamic nurse-patient relationship.
• Responsive to individuals who suffer or anticipate a sense of
helplessness.
• The goal of nursing is increased sense of wellbeing, increase in ability,
adequacy in better care of self and improvement in patient's behavior.
• Nursing therapeutics are composed of direct function indirect function,
discipline and professional activities and automatic activities.

Orlando’s Deliberative Nursing Process Theory

One important thing that nurses do is converse with the patients and let them
know what the plan of care for the day is going to be. However, regardless of
how well thought out a nursing care plan is for a patient, unexpected problems to
the patient’s recovery may arise at any time. With these, the job of the nurse is to
know how to deal with those problems so the patient can continue to get back
and reclaim his or her well-being. Ida Jean Orlando developed her Deliberative
Nursing Process that allows nurses to formulate an effective nursing care plan
that can also be easily adapted when and if any complexity comes up with the
patient.

Ida Jean Orlando’s nursing theory stresses the reciprocal relationship

between patient and nurse. It emphasizes the critical importance of the patient’s
participation in the nursing process. Orlando also considered nursing as a distinct
profession and separated it from medicine where nurses as determining nursing
action rather than being prompted by physician’s orders, organizational needs
and past personal experiences. She believed that the physician’s orders are for
patients and not for nurses.

She proposed that “patients have their own meanings and interpretations of
situations and therefore nurses must validate their inferences and analyses with
patients before drawing conclusions”.
Goal

Ida Jean Orlando’s goal is to develop a theory of effective nursing practice.

The theory explains that the role of the nurse is to find out and meet the patient’s
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immediate needs for help. According to the theory, all patient behavior can be a
cry for help. Through these, the nurse’s job is to find out the nature of the
patient’s distress and provide the help he or she needs.

Assumptions

Ida Jean Orlando’s model of nursing makes the following assumptions:

• When patients are unable to cope with their needs on their own, they
become distressed by feelings of helplessness.
• In its professional character, nursing adds to the distress of the patient.
• Patients are unique and individual in how they respond.
• Nursing offers mothering and nursing analogous to an adult who mothers
and nurtures a child.
• The practice of nursing deals with people, environment, and health.
• Patients need help communicating their needs; they are uncomfortable
and ambivalent about their dependency needs.
• People are able to be secretive or explicit about their needs, perceptions,
thoughts, and feelings.
• The nurse-patient situation is dynamic; actions and reactions are
influenced by both the nurse and the patient.
• People attach meanings to situations and actions that aren’t apparent to
others.
• Patients enter into nursing care through medicine.
• The patient is unable to state the nature and meaning of his or her distress
without the help of the nurse, or without him or her first having established
a helpful relationship with the patient.
• Any observation shared and observed with the patient is immediately
helpful in ascertaining and meeting his or her need, or finding out that he
or she is not in need at that time.
• Nurses are concerned with the needs the patient is unable to meet on his
or her own.

Sub concepts
Ida Jean Orlando described her model as revolving around the following five
major interrelated concepts: the function of professional nursing, presenting
behavior, immediate reaction, nursing process discipline, and improvement.

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Function of Professional Nursing

The function of professional nursing is the organizing principle. This means

finding out and meeting the patient’s immediate needs for help. According to
Orlando, nursing is responsive to individuals who suffer, or who anticipate a
sense of helplessness. It is focused on the process of care in an immediate
experience, and is concerned with providing direct assistance to a patient in
whatever setting they are found in for the purpose of avoiding, relieving,
diminishing, or curing the sense of helplessness in the patient. The Nursing
Process Discipline Theory labels the purpose of nursing to supply the help a
patient needs for his or her needs to be met. That is, if the patient has an
immediate need for help, and the nurse discovers and meets that need, the
purpose of nursing has been achieved.

Presenting Behavior

• Presenting behavior is the patient’s problematic situation. Through the

presenting behavior, the nurse finds the patient’s immediate need for help.
To do this, the nurse must first recognize the situation as problematic.
Regardless of how the presenting behavior appears, it may represent a
cry for help from the patient. The presenting behavior of the patient, which
is considered the stimulus, causes an automatic internal response in the
nurse, which in turn causes a response in the patient.

Distress

• The patient’s behavior reflects distress when the patient experiences a

need that he cannot resolve, a sense of helplessness occurs.

Immediate Reaction

• The immediate reaction is the internal response. The patient perceives

objects with his or her five senses. These perceptions stimulate automatic
thought, and each thought stimulates an automatic feeling, causing the
patient to act. These three items are the patient’s immediate response.
The immediate response reflects how the nurse experiences his or her
participation in the nurse-patient relationship.
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Nurse Reaction
• The patient behavior stimulated a nurse reaction, which marks the
beginning of the nursing process discipline.

Nurse’s Action

• When the nurse acts, an action process transpires. This action process by
the nurse in a nurse-patient contact is called nursing process. The nurse’s
action may be automatic or deliberative.

 Automatic Nursing Actions are nursing actions decided upon for

reasons other than the patient’s immediate need.
 Deliberative Nursing Actions are actions decided upon after
ascertaining a need and then meeting this need

• The following list identifies the criteria for deliberative actions:

 Deliberative actions result from the correct identification of patient needs
by validation of the nurse’s reaction to patient behavior.
 The nurse explores the meaning of the action with the patient and its
relevance to meeting his need.
 The nurse validates the action’s effectiveness immediately after
completing it.
 The nurse is free of stimuli unrelated to the patient’s need when she acts.

Nursing Process Discipline

The nursing process discipline is the investigation into the patient’s needs.
Any observation shared and explored with the patient is immediately useful in
ascertaining and meeting his or her need, or finding out he or she has no needs
at that time. The nurse cannot assume that any aspect of his or her reaction to
the patient is correct, helpful, or appropriate until he or she checks the validity of
it by exploring it with the patient. The nurse initiates this exploration to determine
how the patient is affected by what he or she says and does. Automatic reactions
are ineffective because the nurse’s action is determined for reasons other than
the meaning of the patient’s behavior or the patient’s immediate need for help.
When the nurse doesn’t explore the patient’s reaction with him or her, it is
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reasonably certain that effective communication between nurse and patient

stops.

The nurse decides on an appropriate action to resolve the need in

cooperation with the patient. This action is evaluated after it is carried out. If the
patient behavior improves, the action was successful and the process is
completed. If there is no change or the behavior gets worse, the process recycles
with new efforts to clarify the patient’s behavior or the appropriate nursing action.

The action process in a person-to-person contact functioning in secret. The

perceptions, thoughts, and feelings of each individual are not directly available to
the perception of the other individual through the observable action.

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The action process in a person-to-person contact functioning by open

disclosure. The perceptions, thoughts, and feelings of each individual are
directly available to the perception of the other individual through the observable
action.

Improvement

 Improvement is the resolution to the patient’s situation. In the resolution, the

nurse’s actions are not evaluated. Instead, the results of his or her actions
are evaluated to determine whether his or her actions served to help the
patient communicate his or her need for help and how it was met. In each
contact, the nurse repeats a process of learning how he or she can help
the patient. The nurse’s own individuality, as well as that of the patient,
requires going through this each time the nurse is called upon to render
service to those who need him or her.

5 Stages of the Deliberative Nursing Process

• The Deliberative Nursing Process has five stages: assessment, diagnosis,
planning, implementation, and evaluation.

1. Assessment
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• In the assessment stage, the nurse completes a holistic assessment of the

patient’s needs. This is done without taking the reason for the encounter
into consideration. The nurse uses a nursing framework to collect both
subjective and objective data about the patient.

5. Diagnosis  The diagnosis stage uses the nurse’s clinical judgment about
health problems. The diagnosis can then be confirmed using links to defining
characteristics, related factors, and risk factors found in the patient’s
assessment.

3. Planning
• The planning stage addresses each of the problems identified in the
diagnosis. Each problem is given a specific goal or outcome, and each
goal or outcome is given nursing interventions to help achieve the goal. By
the end of this stage, the nurse will have a nursing care plan.

4. Implementation
• In the implementation stage, the nurse begins using the nursing care plan.

5. Evaluation
• Finally, in the evaluation stage, the nurse looks at the progress of the
patient toward the goals set in the nursing care plan. Changes can be
made to the nursing care plan based on how well (or poorly) the patient is
progressing toward the goals. If any new problems are identified in the
evaluation stage, they can be addressed, and the process starts over
again for those specific problems.

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LESSON 25

Health Promotion Model of Nursing BY NOLA PENDER

Background of the theorist:

• Born on August 16, 1941.

• Earned her BS and MA from Michigan State University on 1964 and 1965
consecutively.
• Former professor of nursing at the University of Michigan
• She married Albert Pender, a business and economics professor.
• She was named a Living Legend of the American Academy of Nursing.
• She created the Health Promotion Model (HPM).
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• She has also written the textbook, Health Promotion in Nursing Practice.

Nola Pender’s Health Promotion Model

Have you ever noticed advertisements in malls, grocery stores, or schools

that advocate healthy-eating or regular exercise? Have you gone to your local
centers or hospitals promoting physical activities and smoking cessation
programs such as ―quit‖ activities and ―brief interventions?‖ These are all
examples of health promotion. The Health Promotion Model, developed by
nursing theorist Nola Pender, has provided healthcare a new path. According to
Nola J. Pender, Health Promotion and Disease Prevention should be the
principal focus in health care, and when health promotion and prevention fail to
anticipate predicaments and problems, then care in illness becomes the
subsequent priority.

What is Health Promotion Model?

The Health Promotion Model notes that each person has unique personal
characteristics and experiences that affect subsequent actions. The set of
variables for behavioral specific knowledge and affect have important
motivational significance. These variables can be modified through nursing
actions. Health promoting behavior is the desired behavioral outcome and is the
endpoint in the Health Promotion Model. Health promoting behaviors should
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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
health-promoting actions.

Nola Pender’s Health Promotion Model theory was originally published in

1982 and later improved in 1996 and 2002. It has been used for nursing
research, education, and practice. Applying this nursing theory and the body of
knowledge that has been collected through observation and research, nurses are
in the top profession to enable people to improve their well-being with self-care
and positive health behaviors.

The Health Promotion Model was designed to be a ―complementary

counterpart to models of health protection.‖ It develops to incorporate behaviors
for improving health and applies across the life span. Its purpose is to assist
nurses in knowing and understanding the major determinants of health behaviors
as a foundation for behavioral counseling to promote well-being and healthy
lifestyles. Pender’s health promotion model defines health as ―a positive
dynamic state not merely the absence of disease.‖ Health promotion is directed
at increasing a client’s level of well-being. It describes the multi-dimensional
nature of persons as they interact within the environment to pursue health.
The model focuses on the following three areas: individual characteristics and
experiences, behavior-specific cognitions and affect, and behavioral outcomes.

Major Concepts of the Health Promotion Model

• Health promotion is defined as behavior motivated by the desire to
increase well-being and actualize human health potential. It is an approach
to wellness.
• On the other hand, health protection or illness prevention is described as
behavior motivated desire to actively avoid illness, detect it early, or
maintain functioning within the constraints of illness.
• Individual characteristics and experiences (prior related behavior and
personal factors).

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Behavior-specific cognitions and affect (perceived benefits of action,

perceived barriers to action, perceived self-efficacy, activity-related affect,
interpersonal influences, and situational influences).
• Behavioral outcomes (commitment to a plan of action, immediate
competing demands and preferences, and health-promoting behavior).

Sub-concepts of the Health Promotion Model

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 behavior being considered.

 Personal biological factors. Include variables 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.

Perceived Benefits of Action

• Anticipated positive outcomes that will occur from health behavior.

Perceived Barriers to Action

• Anticipated, imagined or real blocks and personal costs of understanding a
given behavior.

Perceived Self-Efficacy
• Judgment of personal capability to organize and execute a health-
promoting behavior. Perceived self-efficacy influences perceived barriers
to action so higher efficacy results in lowered perceptions of barriers to the
performance of the behavior.

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Activity-Related Affect
• Subjective positive or negative feeling that occurs before, during and
following behavior based on the stimulus properties of the behavior 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 a further positive affect.

Interpersonal Influences
• Cognition concerning behaviors, beliefs, or attitudes of the others.
Interpersonal influences include norms (expectations of significant others),
social support (instrumental and emotional encouragement) and modeling
(vicarious learning through observing others engaged in a particular
behavior). 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 behavior. 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 behavior.

Commitment to Plan of Action

• The concept of intention and identification of a planned strategy leads to
the implementation of health behavior

Immediate Competing Demands and Preferences

• Competing demands are those alternative behaviors over which
individuals have low control because there are environmental
contingencies such as work or family care responsibilities. Competing
preferences are alternative behaviors over which individuals exert
relatively high control, such as choice of ice cream or apple for a snack

Health-Promoting Behavior

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• A health-promoting behavior is an endpoint or action outcome that is

directed toward attaining positive health outcomes such as optimal
wellbeing, personal fulfillment, and productive living.

Major Assumptions in Health Promotion Model

• Individuals seek to actively regulate their own behavior.
• Individuals in all their bio psychosocial complexity interact with the
environment, progressively transforming the environment and being
transformed over time.
Health professionals constitute a part of the interpersonal environment,
which exerts influence on persons throughout their life span.
• Self-initiated reconfiguration of person-environment interactive patterns is
essential to behavior change.

Propositions
• Prior behavior and inherited and acquired characteristics influence beliefs,
affect, and enactment of health-promoting behavior.
• Persons commit to engaging in behaviors from which they anticipate
deriving personally valued benefits.
• Perceived barriers can constrain commitment to action, a mediator of
behavior as well as actual behavior.
• Perceived competence or self-efficacy to execute a given behavior
increases the likelihood of commitment to action and actual performance
of the behavior.
• Greater perceived self-efficacy results in fewer perceived barriers to a
specific health behavior.
• Positive affect toward a behavior results in greater perceived self-efficacy,
which can, in turn, result in increased positive affect.
• When positive emotions or affect are associated with a behavior, the
probability of commitment and action is increased.
• Persons are more likely to commit to and engage in health-promoting
behaviors when significant others model the behavior, expect the behavior
to occur, and provide assistance and support to enable the behavior.
• Families, peers, and health care providers are important sources of
interpersonal influence that can increase or decrease commitment to and
engagement in health-promoting behavior.
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• Situational influences in the external environment can increase or

decrease commitment to or participation in health-promoting behavior.
• The greater the commitments to a specific plan of action, the more likely
health-promoting behaviors are to be maintained over time.
• Commitment to a plan of action is less likely to result in the desired
behavior when competing demands over which persons have little control
require immediate attention.
• Commitment to a plan of action is less likely to result in the desired
behavior when other actions are more attractive and thus preferred over
the target behavior.
• Persons can modify cognitions, affect, and the interpersonal and physical
environment to create incentives for health actions.

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LESSON 26

Theory of Human Becoming BY ROSEMARIE RIZZO

PARSE

Background of the theorist:

• Graduate of Duquesne University.
• Master’s & Doctorate at University of Pittsburgh.
• Dean of Nursing School at Duquesne University.
• Editor of Nursing Science Quarterly.
• Two Lifetime Achievement Awards.
• Published 9 books & 100 articles.

Metaparadigm

1. Person
 Open being is more than and different from the sum of its parts.

2. Environment
 Everything in the person and his experiences.

3. Health
 Open process of being and becoming. Involves synthesis of values.

4. Nursing
• A human science and art that uses an abstract body of knowledge to
serve people.

THEORY OF HUMAN BECOMING

• Consists of three principles and nine concepts flowing from Parse’s
assumptions about humans and becoming.

NINE ASSUMPTIONS

1. Human co-exists while constituting rhythmical patterns with the universe.

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2. Human is open, freely choosing meaning in situation, bearing

responsibility for opinions.
3. Human is unitary, continuously co-constituting patterns of relating.
4. Human is transcending multi-dimensionally with the possible.

5. Becoming is unitary human-living-health.

6. Becoming rhythmically co-constituting human universe process.
7. Becoming in the human’s patterns of relating value properties.
8. Becoming is an inter-subjective process of transcending with the possible.
9. Becoming is unitary human’s emerging.

THREE PRINCIPLES

A. Principle 1
• ―Structuring meaning multi-dimensionally is co-creating reality through
the language of valuing and meaning‖.
• Includes:
 Imaging
 Valuing
 Languaging

4. Principle 2
• ―Co-creating rhythmical patterns of relating is living with paradoxical
unity of revealing-concealing while connecting-separating‖.
• Includes:
 Revealing-concealing
 Enabling-limiting
 Connecting-separating

C. Principle 3
 ―Co-transcending with the possible is powering unique ways of
originating in the process of transforming‖.  Includes:
 Powering
 Originating
 Transforming

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DIMENSIONS & PROCESSES

• Illuminating and Explicating.

• Synchronizing rhythms and Dwelling.
• Mobilizing transcendence and moving beyond.

LESSON 27

SCIENCE OF UNITARY HUMAN BEINGS BY MARTHA

ROGERS

Background of the theorist:

• Born in May 12, 1914 in Dallas, Texas.

• Nursing diploma from General Hospital School in Knoxville Tennessee in
1936.
• Bachelors in nursing from George Peabody College in Nashville in 1937.
• Master’s in public health nursing supervision from Teachers college,
Columbia University in 1954.
• Doctor of Science from Johns Hopkins University, Baltimore in 1954.
• Professor and head of nursing division at New York 1954- 1976.
• Edited nursing journal Nursing Science in 1963.
• Professor Emerita in 1979.
• Published 200 articles, 3 books.
• Passed away in 1994 at age 79.
• American Nurses Association Hall of Fame inductee in 1996.

Metaparadigm of Nursing:

1. Person

A person is defined as an indivisible, pan-dimensional energy field identified

by a pattern, and manifesting characteristics specific to the whole, and
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that can’t be predicted from knowledge of the parts. A person is also a

unified whole, having its own distinct characteristics that can’t be viewed
by looking at, describing, or summarizing the parts.

2. Health

 Rogers defines health as an expression of the life process. It is the

characteristics and behavior coming from the mutual, simultaneous
interaction of the human and environmental fields, and health and illness
are part of the same continuum. The multiple events occurring during the
life process show the extent to which a person is achieving his or her
maximum health potential. The events vary in their expressions from
greatest health to those conditions that are incompatible with the
maintaining life process.

3. Nursing

• It is the study of unitary, irreducible, indivisible human and environmental

fields: people and their world. Rogers claims that nursing exists to serve
people, and the safe practice of nursing depends on the nature and
amount of scientific nursing knowledge the nurse brings to his or her
practice

• Scope of Nursing: Nursing aims to assist people in achieving their

maximum health potential. Maintenance and promotion of health,
prevention of disease, nursing diagnosis, intervention, and rehabilitation
encompass the scope of nursing’s goals.

• Nursing is concerned with people-all people-well and sick, rich and poor,
young and old. The arenas of nursing’s services extend into all areas
where there are people: at home, at school, at work, at play; in hospital,
nursing home, and clinic; on this planet and now moving into outer space.

4. Environmental

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• ―An irreducible, indivisible, pan dimensional energy field identified by

pattern and integral with the human field.‖

• Energy Field - The energy field is the fundamental unit of both the living
and the non-living. It provides a way to view people and the environment
as irreducible wholes. The energy fields continuously vary in intensity,
density, and extent.

Rogers’ Theory of Unitary Human Beings

The belief of the coexistence of the human and the environment has greatly
influenced the process of change toward better health. In short, a patient can’t
be separated from his or her environment when addressing health and
treatment.
This view leads and opened Martha E. Rogers’ theory, known as the “Science
of Unitary Human Beings,” which allowed nursing to be considered one of the
scientific disciplines.
Rogers’ theory defined 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 nurses is to
participate in the process of change.‖

According to Rogers, the Science of Unitary Human Beings contains two

dimensions: the science of nursing, which is the knowledge specific to the field
of nursing that comes from scientific research; and the art of nursing, which
involves using the science of nursing creatively to help better the life of the
patient.

Assumptions

The assumptions of Rogers’ Theory of Unitary Human Beings are as follows:

1. Man is a unified whole possessing his own integrity and manifesting

characteristics that are more than and different from the sum of his parts.

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2. Man and environment are continuously exchanging matter and energy with
one another.
3. The life process evolves irreversibly and unidirectional along the space-
time continuum.
4. Pattern and organization identify the man and reflect his innovative
wholeness. And lastly,
5. Man is characterized by the capacity for abstraction and imagery,
language and thought sensation and emotion.

SUBCONCEPTS

Openness
• There are no boundaries that stop energy flow between the human and
environmental fields, which is the openness in Rogers’ theory. It refers to
qualities exhibited by open systems; human beings and their environment
are open systems.

Pan dimensional
• Pan-dimensionality is defined as ―non-linear domain without spatial or
temporal attributes.‖ The parameters that human’ uses in language to
describe events are arbitrary, and the present is relative; there is no
temporal ordering of lives.

Synergy
• Defined as the unique behavior of whole systems, unpredicted by any
behaviors of their component functions taken separately.  Human
behavior is synergistic.

Pattern
• Rogers defined the pattern as the distinguishing characteristic of an
energy field seen as a single wave. It is an abstraction and gives identity
to the field.

Principles of Homeodynamics

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• Homeodynamics should be understood as a dynamic version of

homeostasis (a relatively steady state of internal operation in the living
system).
• Homeodynamic principles postulate a way of viewing unitary human
beings. The three principles of homeodynamics are resonance, helicy,
and integrality.

Principle of Reciprocy
• Postulates the inseparability of man and environment and predicts that
sequential changes in life process are continuous, probabilistic revisions
occurring out of the interactions between man and environment.

Principle of Synchrony
• This principle predicts that change in human behavior will be determined
by the simultaneous interaction of the actual state of the human field and
the actual state of the environmental field at any given point in space-
time.

Principle of Integrality (Synchrony + Reciprocy)

• Because of the inseparability of human beings and their environment,
sequential changes in the life processes are continuous revisions
occurring from the interactions between human beings and their
environment.
• Between the two entities, there is a constant mutual interaction and
mutual change whereby simultaneous molding is taking place in both at
the same time.

Principle of Resonancy
• It speaks to the nature of the change occurring between human and
environmental fields. The life process in human beings is a symphony of
rhythmical vibrations oscillating at various frequencies.
• It is the identification of the human field and the environmental field by
wave patterns manifesting continuous change from longer waves of lower
frequency to shorter waves of higher frequency.

Principle of Helicy

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• The human-environment field is a dynamic, open system in which change

is continuous due to the constant interchange between the human and
environment.
• This change is also innovative. Because of constant interchange, an open
system is never exactly the same at any two moments; rather, the system
is continually new or different.

Science of Unitary Human Beings and Nursing Process

• The nursing process has three steps in Rogers’ Theory of Unitary Human
Beings: assessment, voluntary mutual patterning, and evaluation.
• The areas of assessment are: the total pattern of events at any given
point in space-time, simultaneous states of the patient and his or her
environment, rhythms of the life process, supplementary data, categorical
disease entities, subsystem pathology, and pattern appraisal. The
assessment should be a comprehensive assessment of the human and
environmental fields.

Mutual patterning of the human and environmental fields includes:

 Sharing knowledge.
 Offering choices.
 Empowering the patient.
 Fostering patterning.
 Evaluation.
 Repeat pattern appraisal, which includes nutrition, work/leisure
activities, wake/sleep cycles, relationships, pain, and fear/hopes.
 Identify dissonance and harmony.
 Validate appraisal with the patient.
 Self-reflection for the patient.

ENRICHMENT ACTIVITIES
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A. Let’s Dig More! Instruction:

• Browse your internet and do search at least two (2) published

research papers where any of the Module VI theories was used or
applied as basis of their theoretical framework or objectives then read
and understand its content from introduction to conclusion.
• Choose one of the two articles and present this in the class using a
pre-recorded video presentation while explaining how did the
researcher/s use and was guided by that nursing theory in
conceptualizing such study. At least 2 – 3 minutes video presentation.
• Submit your output using the guidelines or means (e.g. e-mail,
Facebook messenger, Google classroom) provided by your respective
professors in this course.

FORMATIVE ASSESSMENT

A. Let’s test your knowledge and understanding! Instruction:

1. Using the case of Edwin Gray as stated below, what would be your nursing
care using Ida Jean’s Orlando Nursing Process Discipline?
 Case History of Edwin Gray: Edwin gray, 19 years old College
freshmen was admitted to the hospital because of very severe
abdominal pain. He had undergone exploratory abdominal surgery
that involved splenectomy. It is his first postoperative day and he
verbalized that he prefers and feels comfortable with the room
temperature not greater than 75F. He has been resting comfortably at
this temperature and had received pain medication and a muscle
relaxant few hours ago. His vital signs have been stable. You are
assigned to care for Edwin.
2. Lydia Hall represented her theory of nursing by drawing three interlocking
circles, each circle representing a particular aspect of nursing. Cite at least
three (3) examples and explain why and how it was applicable.
3. Submit your output using the guidelines or means (e.g. e-mail, Facebook
messenger, Google classroom) provided by your respective professors in
this course.

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REFERENCES

Alligood, M. R. (2018). Nursing Theorists and Their Work, 9th Edition. Elsevier
(Singapore) Pte. Ltd. Incorporated, 3 Killiney Road, winsland House I,
239519 Singapore.

Berman, A., Snyder, S., Frandsen, G. (2016). Kozier and Erb’s Fundamentals of
Nursing: Concepts, Process and Practice, 10th Edition. Pearson Education
Incorporated, 221 River Street, Hoboken, New Jersey, 07030.

Octaviano, E. F., Balita, C. E. (2020). Theoretical Foundations of Nursing: The

Philippine Perspective: National Nursing Core Competency Standards
Aligned Outcomes-Based Approach, 2020 Edition. Ultimate Learning Series,
2nd Floor Carmen Building, Sampaloc, Metro Manila, Philippines.

Octaviano, E. F., Balita, C. E. (2008). Theoretical Foundations of Nursing: The

Philippine Perspective, 2008 Edition. Ultimate Learning Series, 2nd Floor
Carmen Building, Sampaloc, Metro Manila, Philippines.

Smith, M. C., Parker, M. E. (2015). Nursing Theories and Nursing Practice, 4th
Edition. F.A. Davies Company, 1915 Arch Street Philadelphia, PA 19103

Udan, J. Q. (2011). Theoretical Foundations of Nursing, 1st Edition. Educational

Publishing House, 526-528 United Nations Avenue, Ermita, Manila,
Philippines.

Udan, J. Q. (2009). Mastering Fundamentals of Nursing Concepts and Clinical

Application, 3rd Edition. Educational Publishing House, 526-528 United
Nations Avenue, Ermita, Manila, Philippines.

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MODULE SEVEN

LOCAL THEORIES & MODELS OF NURSING INTERVENTIONS

LEARNING OBJECTIVES

After going through this module, the students are expected to be able to:

1. Explain and describe the history and roots of Local Nursing Theories and
Models in Nursing Interventions by Rozanno C. Locin, Sister Letty G.
Kuan, Carmencita M. Abaquin, and Carmelita C. Divinagracia.
2. Explain, describe, and apply the principles and concepts of the Local
Nursing Theories and Models in Nursing Interventions by Rozanno C.
Locin, Sister Letty G. Kuan, Carmencita M. Abaquin, and Carmelita C.
Divinagracia.
3. Describe the respective views of the Local Nursing Theories and Models
in Nursing Interventions in the four metaparadigms of nursing, and
empower the students in reciting their own values and beliefs in relation to
the patient, environment, health and nursing.
4. Describe the impact of Local Nursing Theories and Models in Nursing
Interventions by Rozanno C. Locin, Sister Letty G. Kuan, Carmencita M.
Abaquin, and Carmelita C. Divinagracia. to the nursing profession.
5. Empower the students to call on their classmates to recite own values and
beliefs in relation to the patient, environment, health and nursing.
6. Recall the definitions of nursing used by the different theorists.

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Lesson 28

TECHNOLOGICAL NURSING AS CARING MODEL BY

ROZZANO C. LOCSIN

Background of the Theorist

• Locsin is Professor Emeritus of Nursing at Florida Atlantic University’s

Christine E. Lynn College of Nursing, and inaugural International Nursing
Professor at the Institute of Health Biosciences, University of Tokushima,
in Tokushima, Japan.
• He holds baccalaureate and master’s degrees in nursing from Silliman
University in the Philippines and a Doctor of Philosophy degree from the
University of the Philippines.
• His program of research focuses on life transitions in the health–illness
experience.
• Dr. Locsin was a Fulbright Scholar in Uganda in 2000, a recipient of the
2004 to 2006 Fulbright Alumni Initiative Award to Uganda and the
Fulbright Senior Specialist in Global and Public Health and International
Development Award.
• He was inducted as a Fellow of the American Academy of Nursing in
2006, and received the prestigious Edith Moore Copeland Excellence in
Creativity Award from Sigma Theta Tau International Honor Society of
Nursing and two lifetime achievement awards from premier schools of
nursing in the Philippines.
• In addition, Locsin received the first University Researcher of the Year
Award in 2006 in the Scholarly/Creative Works category as Professor at
Florida Atlantic University.
• Published in 2001, his edited book Advancing Technology, Caring, and
Nursing introduced the germinal work of relating technology with caring in
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nursing. His middle-range nursing theory, Technological Competency as

Caring in Nursing: A Model for Practice was published by Sigma Theta
Tau International Press in 2005.
• In 2007, his coedited book Technology and Nursing: Practice, Process
and Issues illustrated the importance of technology in nursing practice. A
fourth book, A Contemporary Process of Nursing: The (Unbearable)
Weight of Knowing in Nursing was published in 2009.

Metaparadigm of Nursing

1. Person
• Patients seen as participants in their care rather than object of nurse
care.
• Describes persons as human beings who are whole and complete in
any moment.

2. Health
• Humanity is preserved by technology.
• An experience that is often expressed in terms of wellness and
illness, and may occur in the presence or absence of disease.
3. Environment
• Environment as the technological world in which we live.
4. Nursing
• Nurses value technological competency as an expression of caring in
nursing.

Technological Competency as Caring in Nursing

Technological competency as caring in nursing is a conceptual model that

presents the link between technology and caring in nursing as coexisting
harmoniously. Technological competency as caring in nursing is a middle-range
theory illustrated in the practice of nursing and grounded in the harmonious
coexistence between technologies and caring in nursing. The assumptions of the
theory are informed include the following:
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• Persons are caring by virtue of their humanness.

• Persons are whole or complete in the moment.
• Knowing persons is a process of nursing that allows for continuous
appreciation of persons moment to moment.
• Technology is used to know wholeness of persons moment to
moment.
• Nursing is a discipline and a professional practice.

The ultimate purpose of technological competency in nursing is to

acknowledge that the person is the focus of nursing and that various
technologies can and should be used in the service of knowing the person. This
acknowledgment of persons brings together the relatively abstract concept of
wholeness-of-person with the more concrete concept of technology. In this
practice of nursing, technology is used not to know the person as object to be
controlled and manipulated but rather to know who the person is as an
experiencing subject in her or his wholeness.

Appropriately, knowing person as object alludes to an expectation of

knowing empirical aspects and facts about the composite person, whereas
knowing person as subject requires the understanding of an unpredictable,
irreducible person who is more than and di erent from the sum of his or her
empirical parts. In this way, technology is used to understand the uniqueness
and individuality of persons as humans who continuously unfold and who,
therefore, require continuous knowing

The Process of Knowing Persons

Knowing persons as the process of nursing is a dynamic encounter between

the nurse and nursed in which nursing situations unfold toward an
encompassing practice of knowledge based nursing. The nurse can know the
person fully only in the moment. This knowing occurs only when the person
allows the nurse to enter his or her world. When this happens, the nurse and
nursed become vulnerable as they move toward further continuous knowing.
The following descriptions exemplify the process of knowing persons as nursing
within the theory of technological competency as caring in nursing:

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• Knowing - the process of knowing a person is guided by

technological knowing in which persons are appreciated as
participants in their care rather than as objects of care. The nurse
enters the world of the other. In this process, technology is used to
magnify the aspect of the person that requires revealing, a
representation of the real person. The person’s state may change
moment to moment, the person is dynamic and alive, and his or her
actions cannot be predicted. This provides the opportunity for nurses
to continuously know the person as whole.

• Designing - both the nurse and the one nursed (patient) plan a
mutual care process from which the nurse can organize a rewarding
nursing practice that is responsive to the patient’s desire for care.

• Participative engaging - this encounter provides a simultaneous

practice of conjoined activities that are crucial to knowing persons.
This stage of the process is characterized by alternating rhythms of
implementation and evaluation. The evidence of continuous knowing,
implementation, and participation is reflective of the cyclical but
recursive process of knowing persons.

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• Furthering knowing - the continuous, circular and recursive process

of knowing persons demonstrates the ever-changing, and dynamic
nature of fundamental ways of knowing in nursing. Knowledge about
the person that is derived from knowing, designing, and participative
engagement further informs the caring practice of the nurse, thereby
acknowledging the recursive process of knowing persons.

Technological Knowing

Technological knowing in nursing illustrates the shared practice of using

technologies to know persons as whole and using technologies of care for the
purpose of understanding persons more fully. Through technological knowing,
further knowing of persons is achieved. Because it is a circuitous and recursive
process, consequently, the practice of technological knowing begins anew.

The circuitous and recursive engagement that occurs in technological

knowing includes:

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• Appreciating the person’s humanness

• Engaging in mutual knowing between the nurse and nursed.
• Participating in dynamic relating within caring nursing relationships.
• Furthering knowing of persons.

The process of knowing persons is continuous. In this process of nursing,

with calls and responses, the nurse and nursed come to know each other more
fully as persons in the moment. Grounding the process is the appreciation of
persons as whole and complete in the moment, of human beings as
unpredictable, of technological competency as an expression of caring in
nursing, and of nursing as critical to health care.

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Lesson 29

RETIREMENT AND ROLE DISCONTINUITY MODEL BY SISTER

LETTY G. KUAN

Background of the Researcher

• Dr. Kuan is a prominent nursing leader in the Philippines.

• She had two Masters Degrees, Master of Arts in Nursing and Master of
Arts in Education – major in Guidance and Counseling culminating in
Doctor of Education – major in Guidance and Counseling.
• She was a former member of Philippine Board of Nursing (BON).
• She is a Professor Emeritus of the University of the Philippines, a title
awarded only to a few who met the strict criteria.
• She had her clinical fellowship and specialization in Neuropsychology in
University of Paris, France (Salpetriere Hospital), Neurogerontology in
Watertown, New York (Good Samaritan Hospital) and Syracuse
University, New York.
• She also had Bioethics formal training at Institute of Religion, Ethics and
Law at Baylor College of Medicine in Houston, Texas.
• She authored several books giving her insights in the areas of
Gerontology, Care of Older Persons and Bioethics.
• She is a recipient of the Metrobank Foundation Oustanding Teachers
Awards in 1995 and an Award Continuing Integrity and Excellence in
Service (ACIES) in 2004.

Retirement and Role Discontinuities

Retirement is an inevitable change in one’s life. It is evident in the increasing

statistics of aging population accompanied by related disabilities and increased
dependence. This developmental stage, even at the later part of life, must be
considered desirable and satisfying through the determination of factors that will
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help the person enjoy his remaining years of life. It is of primary importance to
prepare early in life by cultivating other role options at age 50 – 60 in order to
have a rewarding retirement period even amidst the presence of role
discontinuities experienced by this age group

Basic Assumptions and Concepts

• Physiological Age
- Refers to the endurance of cells and tissues to withstand the wear and
tear phenomenon of the human body. Some individuals are gifted with
the strong genetic affinity to stay young for a long time.

 Role
- Refers to the set of shared expectations focused upon a particular
position.
- These may include beliefs about what goals or values the position
incumbent is to pursue and the norms that will govern his behavior.
- It is also the set of shred expectations from the retiree’s socialization
experiences and the values internalized while preparing for the position
as well as the adaptations to the expectations socially defined for the
position itself.
- For every social role, there is complementary set of roles in the social
structure among which interaction constantly occurs.

 Change of life
- Refers to the period between near retirement and post – retirement
years.
- This equates with the climacteric period of adjustment and readjustment
to another tempo of life.

 Retiree

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- Refers to an individual who has left the position occupied for the past
years of productive life because he or she has reached the prescribed
retirement age or has completed the required years of service.

 Role discontinuity
- Refers to the interruption in the line of status enjoyed or role performed.
- This interruption maybe brought about by an accident, emergency, and
change of position or retirement.

 Coping approaches
- Refers to the interventions or measures applied to solve a problematic
situation or state in order to restore or maintain equilibrium and normal
functioning.

Determinant of positive perceptions in retirement and positive reactions

towards role discontinuities includes:

1. Health Status
- It refers to physiological and mental state of the respondents, classified as
either sickly or healthy.
2. Income (economic level)
- It refers to the financial affluence of the respondents which can be
classified as poor, moderate or rich.

3. Work Status
4. Family Constellation
- It means the type of family composition described either close knit or
extended family where three or more generations of family members
live under one roof; or distanced family whose members live in separate
dwelling units; or nuclear type of family where only husband, wife and
children live together.
5. Self-preparation

Findings and Recommendations

• Health status dictates the capacities and the type of role one takes both
for the present and the future.
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• Family constellation is a positive index regarding retirement positively and

also in reacting to role discontinuities.
• Income has high correlation with both the perception of retirement and
reactions toward role discontinuities. Thus, efforts must be exerted to
save and spend money wisely while still actively earning in order to have
some reserve when one grows old.
• Work status goes hand in hand with economic security that generates
decent compensation.
• Self-preparation which are said to be both therapeutic and recreational in
essence pays its worth in old age. Self-preparation is investing not in
monetary benefits but in something that gives them dignity; enhance their
feelings of self-worth and happiness.
• To cope with changes brought by retirement, one must cultivate interest in
recreational activities to channel feelings of depression or isolation and
facing realities through confrontation with some issues.
• To perceive retirement positively, it requires early socialization of the
various roles we take in life.
• Government agency should construct holistic pre-retirement preparation
program which will take care of the retirees’ finances, psychological,
emotional and social needs.
• Retirement should be recognized as the fulfillment of every individual’s
birthright and must be lived meaningfully.

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Lesson 30

PREPARE ME HOLISTIC NURSING INTERVENTIONS BY

CARMENCITA M. ABAQUIN

Background of the Researcher

• Dr. Abaquin is a prominent nursing leader in the Philippines.

• She had her Masters and Doctoral Degrees in Nursing from the University
of the Philippines College of Nursing.
• She is an expert of Medical – surgical Nursing with subspecialty in
Oncologic Nursing which made her known both here and abroad.
• She had served her alma mater, University of the Philippines College of
Nursing as faculty and held the position as Secretary of the College of
Nursing.

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• She was also appointed as Chairman of the Board of Nursing during her
time which speaks of her competence and integrity in the field she has
chosen.

PREPARE ME Interventions and the Quality of Life of Advance Progressive

Cancer Patients

During the past decade, the incidence of cancer has significantly increased not
only in the Philippines but also worldwide. Cancer has been associated with
multifaceted issues and concerns regardless of stages of development. For
patients with advanced progressive cancer, these problems are compounded,
thus the need to develop interventions that can address the needs especially
those concerning the ability to be in control and maintaining their integrity.

Basic Assumptions and Concepts

PREPARE ME (Holistic Nursing Interventions) are the nursing interventions

provided to address the multi-dimensional problems of cancer patients that can
be given in any setting where patients choose to be confined. This program
emphasizes a holistic approach to nursing care. PREPARE ME has the following
components, as follows:

 Presence
- Being with another person during the times of need. This includes
therapeutic communication, active listening, and touch.  Reminisce
Therapy
- Recall of past experiences, feelings and thoughts to facilitate adaptation
to present circumstances.

• Prayer
• Relaxation – breathing
- Techniques to encourage and elicit relaxation for the purpose of
decreasing undesirable signs and symptoms such as pain, muscle
tension, and anxiety.
 Meditation
- Encourages an elicit form of relaxation for the purpose of altering
patient’s level of awareness by focusing on an image or thought to
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facilitate inner sight which helps establish connection and relationship

with God.
- It may be done through the use of music and other relaxation
techniques.
 Values Clarification
- Assisting another individual to clarify his own values about health and
illness in order to facilitate effective decision making skills.
- The process of values clarification helps one become internally
consistent by achieving closer between what we do and what we feel.

Quality of Life is a multifaceted construct that encompasses the individual’s

capacities and abilities with an aim of enriching life when it cannot longer be
prolonged. This includes proper care of the body, mind and spirit to maintain
integrity of the whole person despite limitations brought by the present situation.
This can be seen with the following dimensions of man such as physical,
psychological, social, religious, level of independence, environment and spiritual.

Findings and Recommendations

• Terminally – ill patients require holistic approach of nursing that

encompasses the different aspects of man (physical, psychological,
social, religious, level of independence, environment and spiritual).
Cancer patients require a whole faceted care that will improve the quality
of their life.
• PREPARE ME Interventions are said to be effective in improving the
quality of life of cancer patients. It can also be promisingly introduced to
patients with acute or chronic diseases and those with prolonged hospital
stays.
• The utilization of the intervention as a basic part of care given to cancer
patients is recommended, as well as the incorporation of the intervention
in the basic nursing curriculum in the care of these patients. These
components must be introduced and focused during the training of nurses
both in academe and practice to answer the needs of this special kind of
clients.
• Development of training programs for care providers, as well as
healthcare professionals where intervention is a part of treatment
modalities, is also recommended.
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• For patients, an honest view and feedback regarding their illness and
management, and obtaining their perceptions can lead to improvement of
services and communication between patients with advanced progressive
cancer, their families and health team.
• Supportive environment where patients and families with advanced
progressive cancer and the terminally – ill patients can attain dignity of
dying with peace while their families are given the necessary support they
need to cope up with.

Lesson 31

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COMPUSORE MODEL BY CARMELITA C. DIVINAGRACIA

Background of the Researcher

• Dr. Divinagracia is a known Filipino Theorist.

• She completed her Bachelor of Science in Nursing (BSN) degree from
University of East Ramon Magsaysay Memorial Medical Center
(UERMMMC) in 1962 and earned both of her Master’s and Doctoral
degrees in nursing from the University of the Philippines Manila College of
Nursing in the year 1975 and 2001 respectively.
• She was a former Dean of UERMMC and a former President of the
Association of Deans of Philippine Colleges of Nursing Incorporated
(ADPCN, Inc.).
• Dr. Divinagracia also served as former member of the Board of Nursing
and currently a member of CHED’s Technical Committee on Nursing
Education.
• She has been a clinic nurse, staff nurse, head nurse, instructor, assistant
dean and dean.
• She has been lauded for developing the art and competency of teaching
nursing.
• She has lectured and written about her work as a nurse and has use her
hands-on experience to develop better ways to teach nursing.
• In 2008, she was a recipient of the prestigious Anastacia Giron Tupas
Award given by the Philippine Nurses Association (PNA).
• Her love for nursing and her dedication to carve out leading tools for
nursing students has been a commendable and rare field of discipline.

Advance Nurse Practitioners’ Composure Behavior and Patient’s Wellness

Outcome

This study aims to determine the effects of composure behavior of the advance
nurse practitioners on the wellness outcome of the selected cardiac patients.
Behaviors includes; COMpetence, Presence and prayer, Openmindedness,
Stimulation, Understanding, Relaxation, and Empathy.

• Competence

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- Refers to an in-depth knowledge and clinical expertise demonstrated in

caring for patients.
- This also stands for consistency and congruency of words and deeds of
the nurse.

 Presence and prayer

- Refers to a form of nursing measure which means being with another
person during times of need.
- This includes therapeutic communication, active listening, and touch.
- It is also a form of nursing measure which is demonstrated through
reciting a prayer with the patient and concretized through the nurse’s
personal relationship and faith in God.

 Open-mindedness
- Refers to a form of nursing measure which means being receptive to
new ideas or to reason.
- It conveys a manner of considering patient’s preferences and opinions
related to his current health condition and practices and demonstrate the
flexibility of the nurse to accommodate patient’s views.

 Stimulation
- It is a form of nursing measure demonstrated by means of providing
encouragement that conveys hope and strength, guidance in the form of
giving explanation and supervision when doing certain procedures to
patient, use of complimentary words or praise and smile whenever
appropriate.
- Appreciation of what patient can do is reinforced through positive
encouraging remarks and this is done with kind and approving
behavioral approach.

 Understanding
- According to Dr. Divinagracia, it conveys interest and acceptance not
only of patient’s condition but also his entire being.
- This is manifested through concerned and affable facial approach, and a
way of making the patient feel more important and unique.

 Respect
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- Acknowledging the 31 patient’s presence.

- Used of preferred naming in addressing the patient, po and opo, is a
sign of regard.
- It is also shown through respectful nods and recognition of the patient as
someone important.

 Relaxation
- It entails a form of exercise that involves alternate tension and relaxation
of selected group of muscles.

 Empathy
- Senses accurately other person’s inner experience.
- The empathic nurse perceives the current tension and relaxation through
and feelings and communicates by putting himself in the patient’s place.

Through the COMPOSURE behaviors of the nurse, holism is guaranteed to

the patient. Divinagracia (2001) stated that nursing is a profession that
surpasses time and aspects of the individual as one of its clients. From the time
the nurse admits a patient to the time of his discharge, the nurse’s presence
becomes a meaningful occasion for the two parties to develop mutual trust,
acceptance, and eventually satisfying relationships.

COMPOSURE
Behaviors
COMpetence Wellness Outcome
Presence and Prayer
Open-mindedness
Stimulation
Understanding Physiologic Biobehavioral
Respect and Relaxation Outcome Outcome
Empathy Vital Signs Physical
Chest pain Emotional
Hemoglobin Intellectual
Spiritual

Figure 1: COMPOSURE Model Theoretical Framework

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The study’s framework represents the orthopedic patients, COMPOSURE

behaviors of novice nurses, and the patients’ wellness outcome such as
physiologic and biobehavioral. The innermost part of the oval is the orthopedic
patients. Being the recipient of care, they are being influenced by many factors
and of those are the behaviors of nurses in implementing quality nursing care. as
the COMPOSURE behaviors of novice nurses envelopes the orthopedic
patients, the researcher believe that there will be an essential improvement in
the patient wellness outcome, may it be on physiologic and or biobehavioral
wellness outcome.

 Patient Wellness Outcome

- This refers to the perceived wellness of selected orthopedic patients after
receiving nursing care in terms of physiologic and biobehavioral.

These patient wellness outcomes reflect their needs as their illness turn to
recovery and rehabilitation. These needs must be met through high quality
nursing care, none other than through COMPOSURE behaviors. COMPOSURE
behaviors have been inspired to the principle of holistic care wherein a patient
wellness outcome can be achieved through series of quality attributes of nurses,
which caters to every aspect of patient wellness, may it be biobehavioral or
physiologic wellness outcome.

 Physiologic Wellness Outcome

- This refers to the perceived wellness of selected orthopedic patients after
receiving nursing care in terms of vital signs, bone pain sensation, and
complete blood count.
 Biobehavioral Wellness Outcome
- This refers to the perceived wellness of selected orthopedic patients after
receiving nursing care in terms of physical, intellectual, emotional, and
spiritual.

Findings

Optimal health includes many areas thus the term holistic (total) is appropriate.
In fact, the work health originates from the word meaning ―wholeness‖. The
holistic nurse is an embodiment of the care she renders. The nurse creates the
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calm environment in any setting that facilitates treatment, healing and recovery
from nay pain or discomfort. In terms of COMPOSURE behaviors of advanced
beginner nurses:

A. Competence
 They always manifest good interpersonal and communication skills in
dealing with patients and able to extract significant information to aid
in planning and delivery of effective nursing care. However, they
rarely develop health education plan based on the assessed and
anticipated needs of the patients.

B. Prayer
 The advanced beginner nurses always allows some moment of
silence. But they rarely pray with the patient.
C. Presence
 Indeed, the advanced beginner nurses often establish the purpose of
the patient interaction and often display interest to the 279 patient.
Moreover, they sometimes spend time with patient even in silence.

D. Open-mindedness
 The advance beginner nurses often create an environment of trust
and rapport. On the other hand, they sometimes listen attentively to
patient

E. Stimulation
 They always tell patient what he can do, what he is supposed to do,
and how to do it. More so, they often encourage the patient to
evaluate his action.

F. Understanding
 They often encourage the patient to feel comfortable in feedback.

G. Respect
 They always call the patient by his or her preferred name and utilize
―po‖ and ―opo‖ when being asked and they provide options before
making decisions.

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H. Relaxation
 They always evaluate and document the patient’s response to the
intervention, observe his or her breathing, and ask if he or she is
feeling relaxed yet they sometimes take note of facial expression of
feelings, focus on verbal and non-verbal behavior and often provide
continuous feedback.

ENRICHMENT ACTIVITIES

A. Let’s get to know more! Instruction:

• Browse your internet and search at least 4 extraordinary Filipino nursing

leaders and researchers who have contributed in the generation of
evidence-based nursing knowledge and share their respective research
contributions in the class by taking a prerecorded video presentation of
about 2 – 3 minutes.
• Submit your output through the guidelines or means (e.g. e-mail,
Facebook messenger, Google classroom) provided by your respective
professors in this course.

FORMATIVE ASSESSMENT

A. Let’s test your knowledge and understanding!

Instruction: Do you want to become one of the renowned Filipino nursing
theorists? Let’s try now how much you have learned and if you could
apply them basically to construct a theory. Given the set of case study
below, try to formulate a conceptual framework of your propose research
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study and explain its purpose and objectives. Submit your output through
the guidelines or means (e.g. e-mail, Facebook messenger, Google
classroom) provided by your respective professors in this course.
PLAGIARISM is a big NO!

Case Study:

Nurse Moses is a fresh graduate and has recently passed the board
exam. He went to the different hospitals to apply for a clinical experience.
At the same time, he was focusing on all his options to go abroad as soon
as possible because he believes that the salaries here as a staff nurse is
not enough to fulfill his dreams and aspirations which only working abroad
could provide. He noticed that all people he know are doing the same
thing, preparing requirements for exams abroad, reviewing for foreign
language and licensure exams and consulting manpower agencies.
Applicants with friends or families working in institutions are preferred that
well qualified nursing graduates. The turn-over is fast-paced and nurses
are taking whatever opportunity is available for them to survive, even if it
means stooping down low.

REFERENCES

Locsin, R. C., Kongsuwan, C. (2018). The Evolution of the Theory of

Technological Competency as Caring in Nursing: A Middle – Range Theory
of Nursing, 1st Edition. Published by Rozaano C. Locsin, Chanmuan press,
111/13 village no. 11, Khlong – Hae, Hatyai, Songkhla, Thailand 90110.

Octaviano, E. F., Balita, C. E. (2020). Theoretical Foundations of Nursing: The

Philippine Perspective: National Nursing Core Competency Standards
Aligned Outcomes-Based Approach, 2020 Edition. Ultimate Learning Series,
2nd Floor Carmen Building, Sampaloc, Metro Manila, Philippines.

Octaviano, E. F., Balita, C. E. (2008). Theoretical Foundations of Nursing: The

Philippine Perspective, 2008 Edition. Ultimate Learning Series, 2nd Floor
Carmen Building, Sampaloc, Metro Manila, Philippines.

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MODULE EIGHT

THEORIES RELEVANT TO NURSING PRACTICE

Learning Objectives

After going through this module, the students are expected to be able to:

• Explain and describe the history and roots of the different non-nursing
theorists and their theory that is relevant to nursing profession.
• Explain, describe, and apply the principles and concepts of the
nonnursing theories to nursing profession.
• Describe the impact and application of the selected non-nursing theories
in the nursing profession particularly in practice.
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LESSON 32

MASLOW’S HUMAN NEEDS THEORY BY ABRAHAM

MASLOW
Background of the theorist:

• An American psychologist who developed a hierarchy of needs to explain

human motivation.
• His theory suggested that people have a number of basic needs that must
be met before people move up the hierarchy to pursue more social,
emotional, and self-actualizing needs.

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• Abraham Maslow was born on April 1, 1908, in Brooklyn, New York,

where he grew up the first of seven children born to his Jewish parents
who emigrated from Russia.
• Maslow later described his early childhood as unhappy and lonely. He
spent much of his time in the library immersed in books.
• Maslow studied law at City College of New York (CCNY).
• After developing an interest in psychology, he switched to the University
of Wisconsin and found a mentor in psychologist Harry Harlow who
served as his doctoral advisor.
• Maslow earned all three of his degrees in psychology (a bachelor's,
master's, and doctorate) from the University of Wisconsin.
• Abraham Maslow began teaching at Brooklyn College in 1937 and
continued to work as a member of the school's faculty until 1951.
• During this time, he was heavily influenced by Gestalt psychologist Max
Wertheimer and anthropologist Ruth Benedict.

Maslow's Hierarchy of Needs

Maslow first introduced his concept of a hierarchy of needs in his 1943 paper
"A Theory of Human Motivation" and his subsequent book Motivation and
Personality. This hierarchy suggests that people are motivated to fulfill basic
needs before moving on to other, more advanced needs.

While some of the existing schools of thought at the time (such as

psychoanalysis and behaviorism) tended to focus on problematic behaviors,
Maslow was much more interested in learning about what makes people happy
and the things that they do to achieve that aim.

As a humanist, Maslow believed that people have an inborn desire to be

self-actualized, that is, to be all they can be. In order to achieve these ultimate
goals, however, a number of more basic needs must be met such as the need
for food, safety, love, and self-esteem.1

There are five different levels of Maslow’s hierarchy of needs. Let's take a
closer look at Maslow’s needs starting at the lowest level, known as
physiological needs.

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Overview of Needs

Maslow's hierarchy is most often displayed as a pyramid. The lowest levels

of the pyramid are made up of the most basic needs, while the most complex
needs are at the top of the pyramid. Needs at the bottom of the pyramid are
basic physical requirements including the need for food, water, sleep, and
warmth. Once these lower-level needs have been met, people can move on to
the next level of needs, which are for safety and security.

Further up the pyramid, the need for personal esteem and feelings of
accomplishment take priority. Like Carl Rogers, Maslow emphasized the
importance of self-actualization, which is a process of growing and developing
as a person in order to achieve individual potential.

Deficiency Needs vs. Growth Needs

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Maslow believed that these needs are similar to instincts and play a major
role in motivating behaviour. Physiological, security, social, and esteem needs
are deficiency needs, which arise due to deprivation. Satisfying these lower-level
needs is important in order to avoid unpleasant feelings or consequences.
Maslow termed the highest level of the pyramid as growth needs. These needs
don't stem from a lack of something, but rather from a desire to grow as a
person.

While the theory is generally portrayed as a fairly rigid hierarchy, Maslow

noted that the order in which these needs are fulfilled does not always follow this
standard progression. For example, he noted that for some individuals, the need
for self-esteem is more important than the need for love. For others, the need for
creative fulfilment may supersede even the most basic needs.

Physiological Needs
• The basic physiological needs are probably fairly apparent—these include
the things that are vital to our survival. Some examples of physiological
needs include: food, water, breathing, and homeostasis.
• In addition to the basic requirements of nutrition, air and temperature
regulation, the physiological needs also include such things as shelter and
clothing. Maslow also included sexual reproduction in this level of the
hierarchy of needs since it is essential to the survival and propagation of
the species.

Security and Safety Needs

• As we move up to the second level of Maslow’s hierarchy of needs, the
requirements start to become a bit more complex. At this level, the needs
for security and safety become primary.
• People want control and order in their lives. So, this need for safety and
security contributes largely to behaviors at this level. Some of the basic
security and safety needs include: financial security, health and wellness,
safety against accidents and injury.
• Finding a job, obtaining health insurance and health care, contributing
money to a savings account, and moving into a safer neighbourhood are
all examples of actions motivated by the security and safety needs.

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• Together, the safety and physiological levels of the hierarchy make up

what is often referred to as the basic needs.

Social Needs
• The social needs in Maslow’s hierarchy include such things as love,
acceptance, and belonging. At this level, the need for emotional
relationships drives human behavior. Some of the things that satisfy this
need include: friendships, romantic attachments, family, social groups,
community groups, and churches &religious organizations.
• In order to avoid problems such as loneliness, depression, and anxiety, it
is important for people to feel loved and accepted by other people.
Personal relationships with friends, family, and lovers play an important
role, as does involvement in other groups that might include religious
groups, sports teams, book clubs, and other group activities.

Esteem Needs
• At the fourth level in Maslow’s hierarchy is the need for appreciation and
respect. When the needs at the bottom three levels have been satisfied,
the esteem needs begin to play a more prominent role in motivating
behavior.
• At this point, it becomes increasingly important to gain the respect and
appreciation of others. People have a need to accomplish things and then
have their efforts recognized. In addition to the need for feelings of
accomplishment and prestige, esteem needs include such things as self-
esteem and personal worth.
 People need to sense that they are valued and by others and feel that they
are making a contribution to the world.
• Participation in professional activities, academic accomplishments,
athletic or team participation, and personal hobbies can all play a role in
fulfilling the esteem needs. People who are able to satisfy the esteem
needs by achieving good self-esteem and the recognition of others tend to
feel confident in their abilities.
• Those who lack self-esteem and the respect of others can develop
feelings of inferiority. Together, the esteem and social levels make up
what is known as the psychological needs of the hierarchy.

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Self-Actualization Needs  At the very peak of Maslow’s hierarchy are the self-
actualization needs. "What a man can be, he must be," Maslow explained,
referring to the need people have to achieve their full potential as human
beings.

• According to Maslow’s definition of self-actualization, "It may be loosely

described as the full use and exploitation of talents, capabilities,
potentialities, etc. Such people seem to be fulfilling themselves and to be
doing the best that they are capable of doing. They are people who have
developed or are developing to the full stature of which they capable."
• Self-actualizing people are self-aware, concerned with personal growth,
less concerned with the opinions of others, and interested in fulfilling their
potential.

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LESSON 33

PSYCHOSOCIAL DEVELOPMENT
BY ERIK ERICKSON

Background of the theorist:

• Born on June 15, 1902, in Frankfurt, Germany.

• His young Jewish mother, Karla Abrahamsen, raised Erik by herself for a
time before marrying a physician, Dr. Theodore Homberger.
• The fact that Homberger was not his biological father was concealed from
Erikson for many years.
• When he finally did learn the truth, Erikson was left with a feeling of
confusion about who he really was.
• It's interesting to note that Erikson never received a formal degree in
medicine or psychology.
• While studying at the Das Humanistische Gymnasium, he was primarily
interested in subjects such as history, Latin, and art.
• His stepfather, a doctor, wanted him to go to medical school, but Erikson
instead did a brief stint in art school. He soon dropped out and spent time
wandering Europe with friends and contemplating his identity.
• Erikson met a Canadian dance instructor named Joan Serson who was
also teaching at the school where he worked.
• The couple married in 1930 and went on to have three children. His son,
Kai T. Erikson, is a noted American sociologist.
• Erikson moved to the United States in 1933 and, despite having no formal
degree, was offered a teaching position at Harvard Medical School.

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• He also changed his name from Erik Homberger to Erik H. Erikson,

perhaps as a way to forge his own identity.
• In addition to his position at Harvard, he also had a private practice in
child psychoanalysis.

Erik Erikson's Stages of Psychosocial Development

• Erik Erikson was an ego psychologist who developed one of the most
popular and influential theories of development. While his theory was
impacted by psychoanalyst Sigmund Freud's work, Erikson's theory
centered on psychosocial development rather than psychosexual
development.

• The stages that make up his theory are as follows:

Stage 1: Trust vs. Mistrust

Stage 2: Autonomy vs. Shame and Doubt
Stage 3: Initiative vs. Guilt
Stage 4: Industry vs. Inferiority
Stage 5: Identity vs. Confusion
Stage 6: Intimacy vs. Isolation
Stage 7: Generativity vs. Stagnation

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Stage 8: Integrity vs. Despair

Overview

• So what exactly did Erikson's theory of psychosocial development entail?

Much like Sigmund Freud, Erikson believed that personality developed in
a series of stages.
• Unlike Freud’s theory of psychosexual stages, however, Erikson’s theory
described the impact of social experience across the whole lifespan.
Erikson was interested in how social interaction and relationships played
a role in the development and growth of human beings.

Conflict during Each Stage

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• Each stage in Erikson's theory builds on the preceding stages and paves
the way for following periods of development. In each stage, Erikson
believed people experience a conflict that serves as a turning point in
development.
• In Erikson's view, these conflicts are centered on either developing a
psychological quality or failing to develop that quality. During these times,
the potential for personal growth is high but so is the potential for failure.
• If people successfully deal with the conflict, they emerge from the stage
with psychological strengths that will serve them well for the rest of their
lives.3 If they fail to deal effectively with these conflicts, they may not
develop the essential skills needed for a strong sense of self.

Mastery Leads to Ego Strength

• Erikson also believed that a sense of competence motivates behaviors

and actions. Each stage in Erikson's theory is concerned with becoming
competent in an area of life.
• If the stage is handled well, the person will feel a sense of mastery, which
is sometimes referred to as ego strength or ego quality. If the stage is
managed poorly, the person will emerge with a sense of inadequacy in
that aspect of development.

PSYCHOSOCIAL STAGES

B. Stage 1: Trust vs. Mistrust

• The first stage of Erikson's theory of psychosocial development occurs
between birth and 1 year of age and is the most fundamental stage in life.
Because an infant is utterly dependent, developing trust is based on the
dependability and quality of the child's caregivers.
• At this point in development, the child is utterly dependent upon adult
caregivers for everything they need to survive including food, love,
warmth, safety, and nurturing. If a caregiver fails to provide adequate care
and love, the child will come to feel that they cannot trust or depend upon
the adults in their life.
• Outcomes: If a child successfully develops trust, the child will feel safe
and secure in the world. Caregivers who are inconsistent, emotionally
unavailable, or rejecting contribute to feelings of mistrust in the children
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under their care. Failure to develop trust will result in fear and a belief that
the world is inconsistent and unpredictable.
• During the first stage of psychosocial development, children develop a
sense of trust when caregivers provide reliability, care, and affection. A
lack of this will lead to mistrust.
• No child is going to develop a sense of 100% trust or 100% doubt.
Erikson believed that successful development was all about striking a
balance between the two opposing sides. When this happens, children
acquire hope, which Erikson described as openness to experience
tempered by some wariness that danger may be present.
• Subsequent work by researchers including John Bowlby and Mary
Ainsworth demonstrated the importance of trust in forming healthy
attachments during childhood and adulthood.

Psychosocial Stages: A Summary Chart

Age Conflict Important Outcome

Events
Infancy Trust vs. Mistrust Feeding Hope
(birth to 18 months)
Early Childhood Autonomy vs. Shame Toilet Training Will
(2 to 3 years) and Doubt
Preschool Initiative vs. Guilt Exploration Purpose
(3 to 5 years)
School Age Industry vs. Inferiority School Confidence
(6 to 11 years)
Adolescence Identity vs. Social Fidelity
(12 to 18 years) Role Confusion Relationships
Young Adulthood Intimacy vs. Isolation Relationships Love
(19 to 40 years)
Middle Adulthood Generativity vs. Work and Care
(40 to 65 years) Stagnation Parenthood
Maturity Ego Integrity vs. Despair Reflection on Wisdom
(65 to death) Life

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C. Stage 2: Autonomy vs. Shame and Doubt

• The second stage of Erikson's theory of psychosocial development takes
place during early childhood and is focused on children developing a
greater sense of personal control.
• The Role of Independence: At this point in development, children are
just starting to gain a little independence. They are starting to perform
basic actions on their own and making simple decisions about what they
prefer. By allowing kids to make choices and gain control, parents and
caregivers can help children develop a sense of autonomy.
• Potty Training: The essential theme of this stage is that children need to
develop a sense of personal control over physical skills and a sense of
independence. Potty training plays an important role in helping children
develop this sense of autonomy.
• Like Freud, Erikson believed that toilet training was a vital part of this
process. However, Erikson's reasoning was quite different than that of
Freud's. Erikson believed that learning to control one's bodily functions
leads to a feeling of control and a sense of independence. Other
important events include gaining more control over food choices, toy
preferences, and clothing selection.
• Outcomes: Children who struggle and who are shamed for their accidents
may be left without a sense of personal control. Success during this stage
of psychosocial development leads to feelings of autonomy; failure results
in feelings of shame and doubt.
• Children who successfully complete this stage feel secure and confident,
while those who do not are left with a sense of inadequacy and self-doubt.
Erikson believed that achieving a balance between autonomy and shame
and doubt would lead to will, which is the belief that children can act with
intention, within reason and limits.

C. Stage 3: Initiative vs. Guilt

• The third stage of psychosocial development takes place during the
preschool years. At this point in psychosocial development, children begin
to assert their power and control over the world through directing play and
other social interactions.

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• Children who are successful at this stage feel capable and able to lead
others. Those who fail to acquire these skills are left with a sense of guilt,
self-doubt, and lack of initiative.
• Outcomes: The major theme of the third stage of psychosocial
development is that children need to begin asserting control and power
over the environment. Success in this stage leads to a sense of purpose.
Children who try to exert too much power experience disapproval,
resulting in a sense of guilt.
• When an ideal balance of individual initiative and a willingness to work
with others is achieved, the ego quality known as purpose emerges.

C. Stage 4: Industry vs. Inferiority

• The fourth psychosocial stage takes place during the early school years
from approximately ages 5 to 11. Through social interactions, children
begin to develop a sense of pride in their accomplishments and abilities.
• Children need to cope with new social and academic demands. Success
leads to a sense of competence, while failure results in feelings of
inferiority.
• Outcomes: Children who are encouraged and commended by parents
and teachers develop a feeling of competence and belief in their skills.
Those who receive little or no encouragement from parents, teachers, or
peers will doubt their abilities to be successful.
 Successfully finding a balance at this stage of psychosocial development
leads to the strength known as competence, in which children develop a
belief in their abilities to handle the tasks set before them.

• Stage 5: Identity vs. Confusion

• The fifth psychosocial stage takes place during the often turbulent
teenage years. This stage plays an essential role in developing a sense of
personal identity which will continue to influence behavior and
development for the rest of a person's life. Teens need to develop a sense
of self and personal identity. Success leads to an ability to stay true to
yourself, while failure leads to role confusion and a weak sense of self.
• During adolescence, children explore their independence and develop a
sense of self. Those who receive proper encouragement and
reinforcement through personal exploration will emerge from this stage
with a strong sense of self and feelings of independence and control.
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Those who remain unsure of their beliefs and desires will feel insecure
and confused about themselves and the future.
• What Is Identity? When psychologists talk about identity, they are referring
to all of the beliefs, ideals, and values that help shape and guide a
person's behavior. Completing this stage successfully leads to fidelity,
which Erikson described as an ability to live by society's standards and
expectations.
• While Erikson believed that each stage of psychosocial development was
important, he placed a particular emphasis on the development of ego
identity. Ego identity is the conscious sense of self that we develop
through social interaction and becomes a central focus during the identity
versus confusion stage of psychosocial development.
• According to Erikson, our ego identity constantly changes due to new
experiences and information we acquire in our daily interactions with
others. As we have new experiences, we also take on challenges that can
help or hinder the development of identity.
 Why Identity Is Important? Our personal identity gives each of us an
integrated and cohesive sense of self that endures through our lives. Our
sense of personal identity is shaped by our experiences and interactions
with others, and it is this identity that helps guide our actions, beliefs, and
behaviors as we age.

• Stage 6: Intimacy vs. Isolation

• Young adults need to form intimate, loving relationships with other people.
Success leads to strong relationships, while failure results in loneliness
and isolation. This stage covers the period of early adulthood when
people are exploring personal relationships.
• Erikson believed it was vital that people develop close, committed
relationships with other people. Those who are successful at this step will
form relationships that are enduring and secure.
• Building on Earlier Stages: Remember that each step builds on skills
learned in previous steps. Erikson believed that a strong sense of
personal identity was important for developing intimate relationships.
Studies have demonstrated that those with a poor sense of self tend to
have less committed relationships and are more likely to struggler with
emotional isolation, loneliness, and depression.
 Successful resolution of this stage results in the virtue known as love. It is

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marked by the ability to form lasting, meaningful relationships with other

people.

• Stage 7: Generativity vs. Stagnation

• Adults need to create or nurture things that will outlast them, often by
having children or creating a positive change that benefits other people.
Success leads to feelings of usefulness and accomplishment, while failure
results in shallow involvement in the world.
• During adulthood, we continue to build our lives, focusing on our career
and family. Those who are successful during this phase will feel that they
are contributing to the world by being active in their home and community.
Those who fail to attain this skill will feel unproductive and uninvolved in
the world.
 Care is the virtue achieved when this stage is handled successfully. Being
proud of your accomplishments, watching your children grow into adults,
and developing a sense of unity with your life partner are important
accomplishments of this stage.

• Stage 8: Integrity vs. Despair

• The final psychosocial stage occurs during old age and is focused on
reflecting back on life.
• At this point in development, people look back on the events of their lives
and determine if they are happy with the life that they lived or if they regret
the things they did or didn't do.
• Erikson's theory differed from many others because it addressed
development throughout the entire lifespan, including old age. Older
adults need to look back on life and feel a sense of fulfillment. Success at
this stage leads to feelings of wisdom, while failure results in regret,
bitterness, and despair.
• At this stage, people reflect back on the events of their lives and take
stock. Those who look back on a life they feel was well-lived will feel
satisfied and ready to face the end of their lives with a sense of peace.
Those who look back and only feel regret will instead feel fearful that their
lives will end without accomplishing the things they feel they should have.

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• Outcomes: Those who are unsuccessful during this stage will feel that
their life has been wasted and may experience many regrets. The person
will be left with feelings of bitterness and despair.
• Those who feel proud of their accomplishments will feel a sense of
integrity. Successfully completing this phase means looking back with few
regrets and a general feeling of satisfaction. These individuals will attain
wisdom, even when confronting death.

LESSON 34

KOHLBERG’S MORAL DEVELOPMENT

BY LAWRENCE KOHLBERG

Background of the theorist:

• American psychologist
• Born October 25, 1927, Bronxville, New York, U.S.
• Died January 17, 1987, Boston, Massachusetts), American psychologist
and educator known for his theory of moral development.
• Kohlberg was the youngest of four children of Alfred Kohlberg, a
successful silk merchant of Jewish ancestry, and Charlotte Albrecht
Kohlberg, a Protestant and a skilled amateur chemist.
• When the couple divorced in 1932 after 11 years of marriage, each of the
children was required by a court order to choose which parent he or she
would live with.

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• The two younger children chose their father and the older ones chose
their mother.
• Kohlberg graduated from Phillips Academy in Andover, Massachusetts, in
1945. After serving in the U.S. merchant marine, he worked on a ship that
had been hired by Haganah, the Zionist military organization, to smuggle
Jewish war refugees into Palestine, past the British blockade.
• The ship was intercepted, however, and Kohlberg was imprisoned in a
British internment camp in Cyprus.
• Returning to the U.S. in 1948, he enrolled at the University of Chicago,
where he completed a B.A. in psychology in one year and a Ph.D. in
psychology in 1958. He subsequently held teaching positions at various
institutions before settling at Harvard University in 1968.

Kohlberg's Theory of Moral Development

• Kohlberg classified their reasoning into the stages of his theory of moral
development.

C. Level 1: Pre conventional Morality

• The earliest stages of moral development, obedience and punishment,
are especially common in young children, but adults are also capable of
expressing this type of reasoning. At this stage, Kohlberg says, people
see rules as fixed and absolute. Obeying the rules is important because it
is a means to avoid punishment.
• At the individualism and exchange stage of moral development, children
account for individual points of view and judge actions based on how they
serve individual needs. In the Heinz dilemma, children argued that the
best course of action was the choice that best served Heinz’s needs.
Reciprocity is possible at this point in moral development, but only if it
serves one's own interests.

A. Level 2: Conventional Morality

• Often referred to as the "good boy-good girl" orientation, the stage of the
interpersonal relationship of moral development is focused on living up to
social expectations and roles. There is an emphasis on conformity, being
"nice," and consideration of how choices influence relationships.

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• This stage is focused on maintaining social order. At this stage of moral

development, people begin to consider society as a whole when making
judgments. The focus is on maintaining law and order by following the
rules, doing one’s duty, and respecting authority.

C. Level 3: Post conventional Morality

• The ideas of a social contract and individual rights cause people in the
next stage to begin to account for the differing values, opinions, and
beliefs of other people. Rules of law are important for maintaining a
society, but members of the society should agree upon these standards.
• Kohlberg’s final level of moral reasoning is based on universal ethical
principles and abstract reasoning. At this stage, people follow these
internalized principles of justice, even if they conflict with laws and rules.

ENRICHMENT ACTIVITIES

A. Let’s Dig More!

Instruction:

Social interaction shapes personality development, according to Danish

psychoanalyst Erik Erikson's theory of psychosocial development. From birth, a
child creates an emotional repertoire tied to her perceptions of her world’s

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safety. Fear of new experiences battles with exploratory instincts, and the winner
depends on whether a child feels safe.

• Group yourselves into five (5) and share your experiences of success and
failures in life (as a student and a son or daughter). Then, identify what
are the strategies you have done to cope with such failures you have
encountered in your life and the ways you have manage your emotions.
• Pre-record your video-teleconferencing and submit your output using the
guidelines or means (e.g. e-mail, Facebook messenger, Google
classroom) provided by your respective professors in this course.

FORMATIVE ASSESSMENT

A. Let’s test your group understanding!

Instruction:

1. Group yourselves into five (5) groups with 10 or more members in each
group and each group should be assigned with one of the needs of
Maslow’s Hierarchy.
2. Have each group brainstorm a list of needs that corresponds to their
assigned level of hierarchy and in what way those needs can be met via
online mode of communication (i.e. messenger, group message etc.).
3. Have the group present their findings via pre-recorded video presentation
for about 5 – 10 minutes and share this to the class using the guidelines or
means (e.g. e-mail, Facebook messenger, Google classroom) provided by
your respective professors in this course.

REFERENCES

Berman, A., Snyder, S., Frandsen, G. (2016). Kozier and Erb’s Fundamentals of
Nursing. pp. 499-507. Copyright © 2016, 2012, 2008 by Pearson Education,
Inc. 221 River Street, Hoboken, New Jersey, 07030.
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Dewey, J., Stages, P. S., & Moral, O. F. (1985). CHAPTER SEVEN KOHLBERG
’ S STAGES OF MORAL DEVELOPMENT. 1–18.

Pilliteri, A. (2010). Maternal & Child Health Nursing: Care of the Childbearing &
Childrearing Family, 6th Edition. Lippincott Williams & Wilkins, 530 Wallnut
Street, Philadelphia PA 19106.

McLeod, S. (2014). Maslow's Hierarchy of Needs. Simply Psychology.

[Link]

(n.d.). Erikson's Theory of Psychosocial Development

MODULE NINE

CORE COMPETENCIES IN NURSING

LEARNING OBJECTIVES:

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After going through this module, the students are expected to be able to:

1. Identify and explain the 2012 National Nursing Core Competency

Standards of the Philippine Professional Nursing Practice Standards
(PPNPS).

2. Identify appropriate indicators in each of the nurses’ responsibilities

identified in the 2012 National Nursing Core Competency Standards.

3. Describe the application and relevance of the 2012 National Nursing Core
Competency Standards in the different areas of nursing profession
(education, practice, administration, and research).

LESSON 35

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2012 NATIONAL NURSING CORE COMPETENCY STANDARDS

Introduction

As defined by American Nurses Association (ANA) in 2012, the Standards of

Professional Nursing Practice are authoritative statements of the duties that all
registered nurses, regardless of role, population or specialty are expected to
perform competently. However, standards can change as the dynamics of
professional nursing evolve and that specific clinical circumstances or conditions
might affect the application of the standards at any given time.

2012 National Nursing Core Competency Standards (NNCCS)

The 2012 National Nursing Core Competency Standards (NNCCS) identified

the three (3) major roles of nurses which can be applied to the practice of
professional nurses and can serve as guide for nursing specialty practice and
under each role are nurses’ responsibilities.

1. Beginning Nurses’ Role in Client Care,

2. Beginning Nurses’ Role in Leadership and Management, and
3. Beginning Nurses’ Role in Research.

ROLES 14 RESPONSIBILITIES

1. Practice in accordance with legal principles and code

of ethics in making personal and professional
judgment.
2. Utilizes the nursing process in the interdisciplinary
Beginning Nurses’ care of clients that empowers the clients and
Role in Client Care promotes safe quality care.
3. Maintains complete, accurate and up-to-date
recording and reporting system.
4. Establishes a collaborative relationship with
colleagues and other members of the team to
enhance nursing and other health care services.
5. Promotes professional and personal growth and
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development.

1. Demonstrate management and leadership skills to

provide safe and quality acre.
Beginning Nurses’ 2. Demonstrate accountability for safe nursing practice.
Role in Leadership 3. Demonstrate management and leadership skills to
and Management deliver health programs and services effectively to
specific client groups in the community setting.
4. Manages a community/village based health facility
component of a health program or a nursing service.
5. Demonstrate ability to lead and supervise nursing
support staff.
6. Utilizes appropriate mechanisms of networking,
linkage building and referrals.

1. Engage in nursing or health related research with or

under the supervision of an experienced researcher.
Beginning Nurses’ 2. Evaluates a research study/report using guidelines in
Role in Research the conduct of a written research critique.
3. Applies the research process in improving patient
care in partnership with a quality improvement/quality
assurance/nursing audit.

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ENRICHMENT ACTIVITIES

A. Open your internet and search for the CHED Memorandum No. 5, series
of 2008 on Article IV about the Key Areas of Responsibilities of Nurses
then critically analyze and compare its similarities and differences with the
Professional 2012 National Nursing Core Competency Standards
(NNCCS) under the Regulatory Board of Nursing Resolution No. 22,
series of 2017. Share your output in the class by taking a pre-recorded
video presentation of about 2 – 3 minutes.
B. Submit your output using the guidelines or means (e.g. e-mail, Facebook
messenger, Google classroom) provided by your respective professors in
this course.

FORMATIVE ASSESSMENT

A. Let’s test your knowledge and understanding! Instruction:

1. In a short bond paper, identify at least 2 indicators in each of the

responsibilities of nurses stated under the 2012 National Nursing Core
Competency Standards (NNCCS).
2. Submit your output using the guidelines or means (e.g. e-mail,
Facebook messenger, Google classroom) provided by your respective
professors in this course.

REFERENCES

ADPCN Inc. (2018). Resource Manual for Bachelor of Science in Nursing

Outcome – Based Education curriculum, volume 1. Copyright by
Association of Deans of Philippine Colleges of Nursing Incorporated.
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PRC (2017). Promulgation of the Philippine Professional Nursing Practice

Standards (PPNPS). Professional Regulatory Board of Nursing Resolution
No. 22, series of 2017.

BIOGRAPHY OF THE CONTRIBUTORS

Email Address:
(a) [Link]@[Link]
(b) jonaidsadang@[Link]
(c) sadangjonaid@[Link]

Mobile Contact Number: (a) +639-123-795-

594
(b) +639-959-740-524

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Prof. Jonaid M. Sadang, RN, RM, LPT, MAN, Ph.D. h.c. is currently
affiliated at Mindanao State University – Main Campus, Marawi City, Philippines
where he obtained both of his Bachelor of Science in Nursing (BSN) and Master
of Arts in Nursing (MAN) – major in Nursing Administration degrees. He was also
a recipient of Doctor of Philosophy in Nursing – major in Public Health &
Community Service honoris causa degree in 2016. Prior to his employment as a
faculty of the said University, he was a former Specialized Surgical Nurse
Clinician at King Abdullah Medical City, Kingdom of Saudi Arabia and a Public
Health Nurse – II at Integrated Provincial Health Office, Lanao del Sur. During
the time of conceptualizing this module, he is serving and designated as College
Secretary and a con-current Adviser of Diabetes Mellitus and Hypertension
Advocates Club. As researcher, he was able to present his papers both in
national and international conferences in the Philippines, Malaysia and
Indonesia. He has been also awarded and recognized as best oral and poster
presenter in most of his research presentations. Prof. Sadang has authored and
co-authored various scientific papers published in an international peer-
reviewed, ISI and Scopus Journals. His research interest is on Diabetes –
Mellitus, Hypertension, HIV/AIDS, Gerontology Nursing, and Nursing Informatics.
Presently, he is completing his terminal degree in Nursing, Doctor of Science in
Gerontology Nursing at Cebu Normal University, Cebu City, Philippines.

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Email Address:
(a) [Link]@[Link]

Mobile Contact Number:

(a) +639-614-577-728

Prof. Namera T. Datumanong, RN, MAN is currently affiliated at Mindanao

State University – Main Campus, Marawi City, Philippines. She obtained her
Bachelor of Science in Nursing (BSN) and Master of Arts in Nursing (MAN) –
major in Nursing Administration degrees in the same institution. Currently, she is
taking up her terminal degree in Nursing, Doctor of Science in Nursing – major in
Gerontology Nursing at Cebu Normal University, Cebu City, Philippines..

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