TFN Nursing Theories 2018

FLORENCE
NIGHTINGALE
“Environmental
Theory”
May 12, 1820 – August 13, 1910

Born on12 May 1820
in Florence, Italy
In 1837, when she was 17,

she felt a “calling” to help
people.
At the age of 31, she entered the

Deaconesses School at
Kaisserwerth Institute and
received her 3 months “training”
in nursing.
After training at Kaiserwerth Institute she
studied at Paris with the Sisters of
Charity.
In 1854, during the Crimean War,
Florence was invited by her friend Sir
Sydney Herbert to take a group of 38
female nurses to work in hospitals
during the Crimea War.
“LADY with a LAMP

CONTRIBUTIONS OF FLORENCE
NIGHTINGALE DURING THE CRIMEAN WAR
She cared for the soldiers during night time by

using her LAMP that obtained her title “LADY
with a LAMP”
She used her superb statistical & managerial

skills to lower the mortality rate of soldiers and
victims of war.
She utilized the environment in helping the

soldiers.
After the war Florence went back to
England, a grateful English public
gave her an honorarium of £4,500.
She used the money to develop the

NIGHTINGALE TRAINING SCHOOL
FOR NURSES, which opened in 1860.
The school served as model
for other training school.
Nightingale focus more on

developing the profession
within the hospital.
The first school that provided

both theory based knowledge
and clinical skills building.
Nursing evolved as an art &

science.
Formal nursing education and

nursing service begun.
Compiled notes of
her visits to
hospitals & her
observations of
the sanitary
facilities, social
problems of the
places she visited.
Not contended with the
social custom imposed
upon her as a Victorian
Lady, she developed
her self-appointed goal:
“TO CHANGE THE

PROFILE OF NURSING”
Advocated for
care of those
afflicted with
diseases
caused by lack
of hygienic
practices.
Recognized as
Nursing’s first
SCIENTIST-THEORIST
for her work:
“NOTES ON NURSING:
What It Is, and What It
Is Not”
Disapproved of the
restrictions on admission of
patients & considered this
unchristian & incompatible
with health care.
ORDER OF MERIT
OTHER AWARDS
She was the first woman to be

granted the Order of Merit
(OM) and the Royal Red Cross
(RCC) by Queen Victoria of
ROYAL RED CROSS Great Britain
Her birthday marks the

International Nurses Day
celebration each year
NIGHTINGALE’S ENVIRONMENTAL THEORY
Defined nursing as “act of utilizing

the environment of the patient to
assist him in his recovery.
She linked health with FIVE
ENVIRONMENTAL FACTORS.
1. Pure fresh air
2. Pure water
3. Efficient drainage
4. Cleanliness
5. Light (direct sunlight)
 PERSON
-She referred to the person

as a patient
- They are defined in

relationship to their
environment and the impact
of the environment upon
them
 HEALTH
- She defined health as being

well and using every power
that the person has to the
fullest extent
- She envisioned the

maintenance of health
through prevention of
disease via environmental
control
 ENVIRONMENT
- Florence believed that the sick,

poor people would benefit from
environmental improvements
that addressed their physical
and mental aspects.
-She stressed that nurses could

have special role in uplifting the
social status of the poor by
improving their living situations
 NURSING
- having responsibility for

someone else’s health
- Nightingale stated that nursing
“ought to signify the proper use
of fresh air, light, warmth,
cleanliness, quiet, and the
proper selection and
administration of diet – all at the
least expense of vital power to
the patient.”
NIGHTINGALE CANONS
Canon means a rule or law. These canons were found in
Notes on Nursing (1860/1946)
Nightingale’s Nursing process & Thought

Canons
-Check patient’s body temperature, room
temperature & ventilation.
1. Ventilation &
-Create a plan to keep the room well-ventilated &
Warmth
free of odor while maintaining the patient’s body
temperature
-Check room for adequate light. Sunlight is
2. Light beneficial to the patient.
-Create & implement adequate light in the room
without placing the patient in direct light.
Canons
-Check room for dust, dampness
& dirt.
3. Cleanliness
-Keep room free from dust, dirt &
dampness
-Check surrounding environment
for fresh, pure water, drainage,
4. Health of cleanliness & light.
Houses
-Remove garbage, stagnant water
& ensure clean water & fresh air.
Canons
-Check noise level in the room
5. Noise and surroundings.
-Attempt to keep noise level in

minimum
-Check bed & bedding for
6. Bed & dampness, wrinkles & soiling.
Bedding
-Keep the bed dry, wrinkle-free
& lowest height to ensure
comfort.
Canons
-Attempt to keep the patient dry &
clean at all times.
7. Personal
-Frequent assessment of the
Cleanliness
patient’s skin is essential to
maintain good skin integrity.
-Attempt to accomplish variety in
the room & with the client.
8. Variety -This is done with cards, flowers,
pictures & books. Also encourage
friends & relatives.
Nightingale’ Nursing process &
s Canons Thought
-Avoid giving false advices
9. Chattering
Hopes & -Respect the patient as a
Advices person and avoid personal
talk.
-Check diet of the patient.
10. Taking Note the amount of food and
Food fluid ingested by the patient
at every meal
Canons
-This ensures continuity of care.
11. Petty
-Document the plan of care &
Management
evaluate the outcomes to ensure
continuity.
-Observe & record anything
about the patient.
12.
-Continue observation in the
Observation of
patient’s environment and make
the Sick
changes in the plan of care if
needed.
HILDEGARD PEPLAU
September 1, 1909 - March 17, 1999

• Regarded as “mother of psychiatric
nursing”
• Born in 1909, Reading, Pennsylvania
• Graduated from a diploma program in

Pottstown, Pennsylvania in 1931
• BA in interpersonal psychology from

Bennington College in 1943
• MA in psychiatric nursing from Colombia

University, New York in 1947
• EdD in curriculum development in 1953
• Professor emeritus from Rutgers University

– Started first post baccalaureate program
in psychiatric nursing
• Certified in psychoanalysis by William

Alanson White Institute of New York City
• Worked as executive director and president

of ANA
• Worked with WHO, NIMH and nurse corps
• Died in 1999
Publications
• In 1952 published Interpersonal

Relations in Nursing
– Originally delayed because of no
physician co-author
– Credited with transformation of

nursing from a group of skilled
workers to a profession
Historical Evolution of the Theory
• 1943-45 served in the Army Nurse Corps
– 312th Field Station Hospital in England
• American School of Military Psychiatry
• Worked with leading figures in British and

American psychiatry
• After war worked to reshape mental health

system in U.S.
– Passage of National Mental Health Act of
1946
Purpose
• The purpose of this theory is
to facilitate the development
of problem solving skills,
within the context of the
interpersonal relationship
between nurse and client,
using education and
therapeutic interactions
Person
 A developing organism that tries to
reduce anxiety caused by needs
 An individual is made of physiological,

psychological and social spheres
striving towards equilibrium in life
Environment
• Being and occurring in the context of
the nurse client relationship
• Existing forces outside of the individual

Nursing
• An educative and therapeutic

relationship in which the nurse
makes the client a partner in their
health care and promotion
• A significant therapeutic
interpersonal process
FOUR PHASES OF A NURSE CLIENT
RELATIONSHIP
 ORIENTATION
 IDENTIFICATION
 EXPLOITATION
 RESOLUTION
Orientation Phase
Nurse and patient meet as two
strangers
 Individual has a felt need
 Seeks professional assistance
Trust and empowerment
Encourage active participation
Nurse determines what help client
needs Let’s REVIEW
If you are a nurse
and patient comes
to you for the first
time, how do you
entertain the
client/patient?
Factors influencing the blending of the
nurse-patient relationship
Identification Phase
Identify problems to be worked on
during the relationship
Clarify perceptions and expectations
Level of dependence/independence
Capability to deal with identified

problem/s
Decreases helplessness and
hopelessness
ExploitationPhase
Goals are implemented by the nurse

but power is shifted to the patient
as these goals would be achieved
through personal or self-effort
Dependent person becomes

independent.
ResolutionPhase
Client needs met, patient earns full

independence from the relationship
Mutual termination of relationship
Goal, support systems, problem

prevention
ExploitationPhase
 Readiness is one of the most

important factors in the learning
process and learning is initiated
by a need or purpose.
 Termination occurs only with the

successful completion of the
previous phases.
NURSING ROLES
“Nursing roles are different
roles that the nurse
assumes which empower
her in meeting the needs of
the patient”
Role of the Stranger
 Nurse should treat the patient
courteously.
 Nurse should not prejudged

the patient.
 Nurse should treat the patient as

emotionally able.
Role of the Resource Person
 Nurse provides specific answers
to questions by determining the
level of understanding of the
patient:
- Health information
- Advices
- Explanation of the health care
team’s course of care
Teaching Role
 Nurse must determine how
the patient understands the
subject at hand.
Nurse must develop her discussion

around the interest of the patient
& ability of using the information
provided.
Leadership Role
 Involves the democratic process
 Nurse helps the patient meet the

tasks at hand through a:
- relationship of cooperation
- active participation
Surrogate Role
 The patient dependency for his
care gives the nurse a surrogate
(temporary care giver) role.
The nurse must assist the patient

to accept that her surrogate role is
different & only temporary
Counseling Role
 Has the greatest emphasis in psychiatric
nursing
 Nurse becomes a listening friend, an

understanding family member, and
someone who gives sound & emphatic
advises
 Interpersonal techniques – help the

“patient remember and understand
fully the experience & how it be
integrated into his daily life”.
Case Analysis
Scenario:
Mario, a street vendor was

hit by a car and obtained
multiple injuries in his body.
He was brought in the
hospital for treatment.
 ORIENTATION PHASE
- During admission/Assessment
Role of a stranger
- Nurse accepts client regardless of the
economic status.
- Establish Trust & Rapport
-Courteously asks questions to gather

data
 IDENTIFICATION PHASE
- Problem Identification
- Nursing Diagnosis/Planning
Problem Identified: Multiple injuries (Risk for
infection)
Counseling Role
- Nurse listens to the client and gives
emphatic advises
- Nurse helps client understand problems by
explaining the fracture obtained as well as
the multiple injuries
 IDENTIFICATION PHASE
Problem Identified: Multiple injuries (Risk
for infection)
- Nurse & client together plan for the
activities that help the client in his
recovery
Example:
- Ways of preventing of infection
- Procedures ordered by doctor (x-ray)
- Medications (ordered by doctor)
 Exploitation Phase (Implementation)
Leadership Role
- Nurse motivates the patient to
actively participate and cooperate in
all the activities rendered by nurses and
physicians
Teaching Role
-Nurse teaches and demonstrates to
the client proper hand washing to
prevent infection.
 Exploitation Phase (Implementation)
Resource person
-Courteously explain to the client the
reasons why client has to undergo x-ray
-Explains the importance of the
medications and how it could help in his
recovery
Surrogate Role
-Nurse serves as the temporary care giver
and treats the client like his own family
- Nurse attends to his need
 Resolutiontion Phase
- Evaluation, Recovery & Discharge

-Nurse evaluate the effectiveness of the
nursing actions/interventions
implemented
Example:
- Evaluate the understanding of the
client regarding his condition
- Evaluate if client learned about hand
washing
Example:
- Evaluate if client understand the

purpose why he needs to undergo x-
ray
- Evaluate If client understand why he
needs to take the medications
“If Client recovers from his previous

condition then recovery takes place and
discharge is ordered by the physician”
Overlapping phases in nurse-patient relationships
Admission/
ORIENTATION Assessment
IDENTIFICATION Nursing Diagnosis/

Planning
EXPLOITATION Implementation
RESOLUTION Evaluation/
Termination/Discharge/
VIRGINIA HENDERSON
“14 Basic Human Needs”
November 30, 1897 – March 19, 1996

BACKGROUND
Virginia Henderson has been called:

“The First Lady of Nursing”
“First Truly International Nurse”
She was born in Kansas City, Missouri on March

30, 1897
She graduated from the Army School of Nursing,

Washington, D.C. in 1921.
She graduated from Teachers College, Columbia

University with a M.A. degree in nursing
education.
BACKGROUND
The International Council of Nurses presented

her with the first Christianne Reimann Prize in
June 1985, aged 87.
She was also an honorary fellow of the UK's

Royal College of Nursing.
American Nurse Association Hall of Fame
Virginia Historical Nurse Leadership Award (1988)
Halloran (nurse theorist) wrote,

“Henderson was to the 20th century as
Nightingale was to the 19th. Both wrote
extensive works that have influenced
the world”
HENDERSON’S DEFINITION OF NURSING (1955):
“Nursing is primarily assisting the

individual (sick or well) in the
performance of those activities
contributing to health, or its
recovery (or peaceful death) that he
would perform unaided if he had the
necessary strength, will knowledge.
It is likewise the unique contribution
of nursing to help the individual to
be independent of such assistance as
soon as possible.”
4 METAPARADIGM IN NURSING
 PERSON
Referred person as the patient
that requires assistance to
achieve health & independence
and/or peaceful death
The mind and body of the person
are inseparable.
He must maintain physiological
and emotional balance to function
efficiently.
 HEALTH
 Health is a quality of life and is basic
to for a person to function fully
Health requires independence and

interdependence
Promotion of health is more important

than care of the sick.
Individuals will achieve or maintain

health if they have the necessary
strength, will, or knowledge
 ENVIRONMENT
Healthy individuals may be able to
control their environment but as illness
occurs, this ability is diminished or
affected.
Nurses must be aware of the different
social customs & religious beliefs to
assess dangers.
Nurses should protect patients from

injury.
 NURSING
The nurse functions independently
from the physician, but promotes the
plan prescribed by the physician.
Care must be provided from all walks of

life and empower the patient to gain
independence.
Nurse must be knowledgeable in both

biological and social sciences.
Must have the ability to assess basic

human needs
14 BASIC HUMAN NEEDS
1. Breathe normally.
2. Eat and drink adequately.
3. Eliminate body waste.
4. Move and maintain desirable postures.
5. Sleep and rest.
6. Select suitable clothes

7. Maintain body temperature within
normal range by adjusting clothing and
modifying the environment.
8. Keep the body clean and well groomed

and protects the integument.
9. Avoid dangers in the environment and

avoid injuring others.
10. Communicate with others in

expressing emotions, needs, fears, or
opinions.
11. Worship according to one s faith.
12. Work in such a way that one feels a

sense of accomplishment.
13. Play or participate in various forms of

recreation.
14. Learn, discover, or satisfy the curiosity

that leads to normal development and
health and use of the available health
facilities.
NURSE-PATIENT
RELATIONSHIP
“ Virginia Henderson
stated that there are
THREE LEVELS
compromising the
NURSE-PATIENT
RELATIONSHIP”.
Nurse as a
SUBSTITUTE for the patient
“Nurse acts as a substitute as

to what the patient lacks such
as knowledge, will and strength
in order to make him complete,
whole and independent once
again”.
Nurse as a HELPER to the patient
 Nurse helps the client to

accomplish the basic needs
that the patient cannot meet
regain independence
as quickly as possible..
Nurse as a PARTNER with the patient
 The nurse and the patient

formulate the care plan together.
 Nurse acts as both an advocate

and a resource person.
 Nurse can empower the patient to

make effective decisions regarding
his care plans.
Relationship to Nursing
Process
 ASSESSMENT PHASE
The nurse would assess the 14

fundamental needs of the patient and
check which one is lacking or fully met.
Gathers data by observing, smelling,

feeling and hearing.
The nurse uses critical thinking and

analyzes every data collected to come
up with a clear picture of the condition
of the patient.
Example:
 During assessment you have noted that
the patient abdomen in distended.
During interview your patient mentioned
she has not passed stool for 4 days
She drinks 4-5 glasses of water a day
Likes to eat meat and poultry products only
Has no form of exercise
Analysis: Constipation
According to Henderson‘s 14 basic needs the problem
fall under “Eliminating body waste”
 PLANNING PHASE
Involves giving the plan of
care to meet the needs and
personality of the patient.
Must serve as a record and

at the same time must fit in
the prescribed plan made by
the physician.
Example:
Analysis: Constipation
According to Henderson‘s 14 basic needs the
problem fall under “Eliminating body waste”
Plan:
Goal: Help client eliminate body waste
Objective:
- Increase water intake
- High fiber diet
- Exercise
 IMPLEMENTATION PHASE
The nurse uses the 14 basic needs in

answering the factors that are
contributing to the illness state of the
patient.
These interventions are focused on

maintaining health, to recover from
illness, or to aid in peaceful death.
Performs activities that are directed in

helping patient attain his
independence.
Example: IMPLEMENTATION
- Encourage the patient to increase fluid intake from

4-6 to 8-10 glasses of water a day
- Inform the client and relatives that eating high fiber
diet such as green leafy vegetables fruits and root
crops (kamote, ube, gabi) helps in digestion and
elimination of waste products
- Encourage the patient and relatives to have

simple forms of daily exercises such as walking,
doing household chores such as sweeping the
floor
 EVALUATION PHASE
 The nurse and the patient review

the relationship and decides
whether the goals are met or not.
 Nurse also assess if the patient

attained independence and if
health is achieved.
Example: EVALUATION
- Evaluate the elimination pattern of

your patient
-Did the patient follow your health

teachings?
-Is the patient able to pass stool?

JOYCE TRAVELBEE
“Human to Human Relationship”
1926 - 1973
Background
-Born in 1926
-Finished her BS Nursing in 1954 Lousiana State

University
-MSN in 1959 at Yale University
-1952 she started as an instructor focusing in

psychiatric nursing
-1966, published her first book entitled

Interpersonal Aspects of Nursing
-1969 published her second book entitled

Intervention in Psychiatric Nursing: Process in the
One-to-One Relationship
Background
- Through her observations and

experiences working from different
institutions, she concluded that
nursing
care rendered to patients lack
COMPASSION.
-She believed that nursing needed a

“HUMANISTIC REVOLUTION” a
return to focus on the caring function
towards the ill person.
Background
“ A nurse does not only seek

to alleviate physical pain or
render physical care – she
ministers to the whole person.
The existence of suffering,
whether physical, mental or
spiritual is the proper concern
of the nurse”
 PERSON
- She defined person as human being
- Unique, irreplaceable individual who

is in continuous process of
becoming, evolving, and changing.
HEALTH
Health is measured by subjective & objective

health
Subjective Health – individually defined state of

well being
Objective Health – is the absence disease,

disability or defect as measured by physical
examination, laboratory test, spiritual director
or psychological counselor
ENVIRONMENT
- Not clearly defined but he associated illness,
pain, or sufferings to the environment
NURSING
- Defined nursing as an “interpersonal process
whereby the nurse assist 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
Henderson said:
In human-to-human relationship model, the

nurse and the patient undergoes the following
series of
INTERACTIONAL PHASES:
1. Original Encounter
2. Emerging Identities
3. Empathy
4. Sympathy
4. Rapport
1. ORIGINAL ENCOUNTER
 Initial interaction between the

nurse and the patient
Characterized as the first

impressions by the nurse of the ill
person and vice versa
 Both perceived each other in

stereotyped/traditional roles
2. EMERGING IDENTITIES
 Characterized by the nurse and the

patient perceiving each other as
unique individuals
 Bond of a relationship is beginning

to form
3. EMPATHY
 The ability to co-experience and relate
to the thoughts, emotions, or experience of
another without them being communicated
directly by the individual
 Result of Empathic process is the

ability to predict the behavior of the
individual.
 Two qualities that enhanced

empathic process:
 similarities of experience
 desire to understand another
person
4. SYMPATHY
 The ability to understand and to support
the emotional situation or experience of
another being with compassion and
sensitivity
Occurs when the nurse desires to
alleviate the cause of the patient’s
illness or suffering
 The nurse is to create a:
Helpful Nursing Action
=
Disciplined Intellectual Approach +
Therapeutic Use of Self
RAPPORT
- Relationship, especially one of mutual trust or
emotional affinity.
 The ill person exhibits both trust and

confidence in the nurse
 A nurse is able to establish rapport
because:
she is able to perceive, respond to,
and appreciate the uniqueness of
the ill
KEY THEORETICAL CONCEPTS
Illness
Suffering
Pain
Hope
Communication
Interaction
Empathy
Sympathy
Rapport
Therapeutic Use-of-Self
Therapeutic Use of Self
 is the ability to use one’s personality

consciously and in full awareness in an
attempt to establish relatedness and to
nurture nursing intervention
 it requires:
 self-insight
 self-understanding
 an understanding dynamics of human
behavior
 ability to interpret one’s own behavior
and others
 ability to intervene effectively in nursing
situations
Example:
Maria, a 24 year old sales lady is confined in the
hospital because of depression brought by the
break up with her boyfriend.
Original Encounter:
Maria & the nurse meet for the first time and both
are not yet comfortable talking and expressing
deep thoughts & feelings.
Emerging Identities:
Closeness between the nurse and Maria is being
established. They are both aware of their
differences in thoughts and feelings
Example:
Empathy:
This phase depicts Maria’s experiences
that were shared to the nurse. Similarities
such as their age and gender will give a
deeper understanding on the patient’s
behavior and help the relationship to
become therapeutic.
Example:
Sympathy:
The nurse will use intellectual approach and
therapeutic use of self to alleviate the distress of
Maria
Rapport:
All actions that lessen the Maria’s distress have
been implemented, thus result would be a good
and trusting relationship and achievement of the
therapeutic goal by the nurse
Nurse
&
Patient
Nurse Patient
Sympathy
Nurse
Empathy Patient
Nurse
Emerging Identities Patient
Nurse Original Encounter Patient

BETTY NEUMAN
“Systems Model”
Born in 1924, Ohio USA

“ Health is a condition
in which all parts and
subparts are in
harmony with the
whole of the client.”
--- Betty Neuman
 PERSON
- An individual, family, group,
community or society
- Dynamic composite of
interrelationships among
physiological, psychological,
socio-cultural, developmental,
and spiritual factors
 PERSON
- Neuman sees a person as an
open system that works
together with other parts of its
body as it interact with the
environment.
 HEALTH
- The state of wellness exists when all

the part or system of a person works
harmoniously.
-Disharmonious system reflects illness

as a result of unmet needs of a person.
-The state of health varies according to

the degree of reaction a person has to
environmental forces
 HEALTH
- “If a person successfully

copes with the environmental
influences and is able to
maintain adequate level of
health, the person can
preserve the integrity of all the
parts of its system”
 ENVIRONMENT
- Environment can be an internal, external
forces that interacts which a person
exists.
-These forces are what Neuman termed
as stressors.
-Stressors are tensions that produce
alterations in the normal flow of the
environment:
Intrapersonal – occurs within the self
Interpersonal – occurs between individuals
 NURSING
-Nursing requires a holistic

approach, an approach that
considers all factors affecting a
client’s health.
-The nurse considers that a client’s

physical, physiological, mental,
social, cultural, developmental and
spiritual well-being
SYSTEM MODEL IN
NURSING PRACTICE
BASIC STRUCTURE
Basic factors common

Flexible Line
of Defense
to all organisms ex:
- Normal temperature
- Genetic Structure
Normal Line of
Defense Basic
- Response Pattern
structure - Organ Strength or
energy Weakness
sources - Ego Structure
Lines of Resistance
Note:
Physiologic,
psychologic,
sociologic,
developmental, &
spiritual
FLEXIBLE LINE OF
DEFENSE
Flexible Line
of Defense
Flexible line is dynamic

Normal Line
of Defense & can rapidly altered.
It is the protective
Basic
structure
buffer that prevents
energy stressors from
sources penetrating the normal
Lines of
Resistance
lines of defense.
Ex: sleep deprivation
(stressor)
NORMAL LINE OF DEFENSE Normal line of defense represents
the person’s state of equilibrium or
Flexible Line the state of adaptation developed
of Defense
& maintained over time &
considered normal for that person.
Normal Line
of Defense
Individual’s reaction to
stressors depends on the
Basic strength of normal lines of
structure
energy
defense
sources Ex: 5 hours sleep/day
Lines of
Resistance -People who are used to it are
“stress free” (able to adapt)
-People who may not adapt to the
stressors (5 hours sleep) may
cause headache, lack of appetite,
lack of focus
LINES OF RESISTANCE Lines of resistance
Flexible Line
represents internal factor
of Defense that help client defend
against stressors.
Normal Line
of Defense
Reaction are the
outcomes or produced
Basic result of certain stressors
structure in the line of defense it
energy
can be positive of
sources
negative
Lines of
Resistance
REACTIONS:
Negentropy – towards
stability
Examples: increase in the body’s leukocyte Egentropy – towards
counts to combat an infection. disorganization
Prevention
- Is used to attain balance within the
continuum of health
Nursing interventions focus on retaining

or maintaining system stability.
These interventions are carried out on

three preventive levels.
1. PRIMARY PREVENTION
2. SECONDARY PREVENTION
3. TERTIARY PREVENTION
1. PRIMARY PREVENTION
-To encourage optimal health and to
increase the person’s resistance to illness.
- Health promotion
Activities include the following:
Quit smoking
Avoid/limit alcohol intake
Exercise regularly
Eat well balanced diet
Reduce fat and increase fiber intake
Take adequate fluids
Wear hazards device in work site
Complete immunization program
2. SECONDARY PREVENTION
-Health maintenance
- Seeking to identify specific illnesses or condition at
an early stage with prompt intervention to prevent
or limit disability.
- Early diagnosis/detection/screening
Activities include the following:
- Have annual physical examination
- Regular Pap smear test
- Monthly BSE for women 20 years & above
- Sputum examination for tuberculosis
- Annual Stool Guaiac Test and Rectal
examination for clients over age 40 years
- Testicular Self Examination (TSE) for early
detection of testicular cancer for clients
age 15-35 year old
Richard Sagasag,RN, MAN
- To support client’s achievement of

successful adaptation to known allergies, to
known risk, optimal reconstitution, and or
establishment of a higher level wellness.
- Occurs after a disease or disability has

occurred and recovery process has begun
- Intent is to halt the disease or injury

process and assist the person in obtaining
an optimal health status.
- Rehabilitation
Activities include:
•Physical therapy after CVA (stroke)
• Cardiac rehabilitation after MI ( Myocardial

Infarction or heart attack)
• Attending self –management education for

diabetes
•Undergoing speech therapy after

laryngectomy
Reconstitution
- Adjustment state from the degree of

reaction.
- It is a state of going back to the actual

state of health before the illness occurred.
APPLICATION OF NEUMAN’S
SYSTEM MODEL
Pedro is a 17 year-old nursing student, who is very studious
and often times isolate himself from his classmate to give
himself time in reading his books.
He works hard on quizzes, term exams and requirements

given by his clinical instructors with high expectations. If
these expectations are not met, he responds with pressure
and intimidating remarks.
Quite often, Pedro exhibit weird mannerisms and behaviors

which appear strange to people around him.
He misses breakfast and lunch very often & sleeps late in

the night studying his lessons.
Two days after the term exam where he got a low grade
because he did not follow the instruction set in the test
paper, her family reported having seen Pedro with sudden
outburst of laughter with known reason, staring blankly on
the wall, and refusing to eat. This prompted his family to
bring him in the hospital for confinement.
ASSESSMENT:
The nurse utilizing Neuman’s System Model,

assessed the stressors (work, personality, and
attitude) that are contributing to Pedro’s condition.
The nurse found out that Pedro is not able to

handle the stressors thereby stretching the line of
defense. Without seeking help from his support
system, he was not able to maintain his flexible
lines of defense.
The nurse concluded that the root cause of the

client’s illness is his failure to maintain the
different lines that serves as shock absorber to
various stressors & balance of health variables.
PLANNING:
Since Pedro is not emotionally stable to formulate

for his goals with the nurse, the healthcare team,
in coordination with his family, took initiative to
direct adequate care. Thus, there is a restoration
of his lines of defense.
IMPLEMENTATION:
a. Establish trust as first step towards significant

nurse-patient relationship
b. Explore gaps and alterations on his lines of

defense, thus pin-pointing stressors where the
patient failed to cope.
c. Utilize accepted clinical interventions to restore
and strengthen the lines of defense such as
therapies, stress-management activities and
relaxation techniques, and anger-management
exercises.
d. Assist Pedro a less stressing normal and to make

appropriate lifestyle changes.
e. Re-assess Pedro’s ability to independently

perform and maintain the sphere/variables of
health: physiological, sociocultural, developmental
and spiritual
EVALUATION:
Evaluate the result of the nursing interventions
that the nurse implemented.
Goal is met if the Pedro recovered from his illness

DOROTHY JOHNSON
“Behavioral System Model”
Born August 21, 1919, in Savannah, Georgia, USA

Introduction
Dorothy E. Johnson was born August 21,

1919, in Savannah, Georgia.
B. S. N. from Vanderbilt University in

Nashville, Tennessee, in 1942; and her
M.P.H. from Harvard University in Boston in
1948.
From 1949 until her retirement in 1978 she

was an assistant professor of pediatric
nursing, an associate professor of nursing,
and a professor of nursing at the University
of California in Los Angeles
Introduction
Dorothy Johnson has had an influence

on nursing through her publications since
the 1950s. Throughout her career, Johnson
has stressed the importance of
research-based knowledge about the effect
of nursing care on clients.
OVERVIEW OF THE THEORY
Johnson's theory of nursing

believes that humans are
behavioral systems made up of
seven subsystems.
“ Each individual has a

redisposition to act with
reference to the goal, in
certain ways rather than in
other ways.”
BEHAVIOR
 Output of intraorganismic
structures and processes as
they are coordinated and
articulated by and responsive to
changes in sensory stimulation.
SYSTEM
 Is a whole that functions as a
whole by virtue of the
interdependence of its parts
 There is “ organization, interaction,

interdependency, and integration
of the parts and elements” --- Chinn
 adjustments + adaptations
= balance
BEHAVIORAL SYSTEM
 Encompasses the patterned,
repetitive, and purposeful ways of
behaving = organized and
integrated functional unit
 A person is a behavioral system

tries to achieve stability and
balance
 System is usually flexible enough

rac/2008
 PERSON
Johnson views “human being” as having

two major systems:
Biological System – It is the role of

medicine to focus on biological system
Behavioral System – Focus of nursing

 HEALTH
Health is a state that is affected by social,

psychological, biological & physiological.
Individual is striving to retain some balance or

equilibrium.
Individual’s goal is to sustain the entire

behavioral system efficiently & effectively to
return to an acceptable balance if malfunction
disrupts the original balance.
 ENVIRONMENT
Individual’s behavior is influenced by

all the events in the environment.
Cultural influences on the

individual’s behavior are viewed as
profound.
 NURSING
Nursing implementations may focus

on correction of a behavior that is
not concerned to maintaining
equilibrium for the individual.
SEVEN BEHAVIORAL SYSTEM
“The seven subsystems are

considered to be interrelated,
thus changes in one changes in
one subsystem affect all
subsystem”
ATTACHMENT / AFFILIATIVE
 Most critical = basis for all social
organization
 Provides survival and security
 Consequences:
 social inclusion
 intimacy
 formation and maintenance of
strong social bond
DEPENDENCY
 Promotes helping behavior that
calls for a nurturing response
 Consequences:
 approval/consent
 attention or recognition
 physical assistance
INGESTIVE
 Relates to the behaviors surrounding
the ingestion of food.
 “Has to do with when, how, what,
how much, and under what
conditions we eat”
 It serves the broad function of
appetitive satisfaction
 Associated with social, psychological
and biological considerations
ELIMINATIVE
 Relates to the behaviors surrounding

the excretion of waste products from
the body
Human cultures have defined

different socially acceptable behaviors
for excretion of waste.
SEXUAL
 Has the dual functions of
procreation and gratification
 Begins with the development of

gender role identity and includes
broad range of sex-role behaviors
ACHIEVEMENT
 Contains behaviors that attempt

to control he environment.
 Areas of achievement:
 intellectual
 physical
 creative
 mechanical
 social
AGGRESSIVE
 Relates to behaviors concerned
with defense & self preservation
 It does not include those

behaviors with primary purpose
of injuring other individual, but
rather those whose purpose is to
PROTECT & CONSERVE SELF &
SOCIETY
Johnson’s Model
IMOGENE KING
“Goal Attainment Theory”
OVERVIEW
IMOGENE KING’S Theory derived
from her conceptual framework
which shows the relationship of
personal systems (individuals),
interpersonal systems (nurse-
patient), social systems
(educational system, health care
system)
OVERVIEW
King’s Theory offers insight to
nurse’s interactions with individuals
and groups w/in the environment.
It highlights the importance of

client’s participation in decision,
that influence care and focuses on
both the process of nurse-client
interaction and the outcomes of
care.
INTRODUCTION
Imogene King was born in 1923.
Completed her Bachelor in science of nursing

from St. Louis University in 1948
Completed her Master of science in nursing

from St. Louis University in 1957
Completed her Doctorate from Teacher’s

college, Columbia University
 PERSON
- is social being who has the ability to :
Perceive
Think
Feel
Choose
Set goals
Select means to achieve goals and
To make decision
 PERSON
- is social being who has the ability to :
Perceive
Think
Feel
Choose
Set goals
Select means to achieve goals and
To make decision
 PERSON
According to King, human being has three
fundamental needs:
(a) The need for the health information
(b) Need for care for illness prevention
(c) The need for care when human beings are

unable to help themselves.
 HEALTH
Health is viewed as ability of a

person to adjust to the stressors
that the internal or external
environment expose to the
client
 ENVIRONMENT
Process of balance involving internal &
external interactions inside the social
system.
External environment is the factor that

exist outside the boundary.
Internal environment transforms energy

to enable person to adjust to continuous
external environmental changes.
 NURSING
An act wherein the nurse interacts and

communicates with the client.
The goal of the nurse is to help the client

maintain health through health
promotion & maintenance, restoration,
caring for the sick and dying.
INTERACTING SYSTEM FRAMEWORK
Personal – how the nurse views and
integrates self based from personal
goals & beliefs
Interpersonal – how the nurse interrelates

with co-worker or patient, particularly
in a nurse-relationship
Social – how the nurse interacts with co-

workers, superiors, subordinates and
the client environment in general
Action – means of behavior or activities

that are towards the accomplishment of
certain act.
The accomplishment of a task begins

with mental action whereby a person
seeks or formulates plan of activities and
proceeded by physical action
Actions are aimed towards setting goals
through communication between the
nurse and the client then exploring and
agreeing means to perform thereby
achieving the set goals
Reaction
In her theory reaction is not specified
but somehow relate reaction as part of
action or a form of response to a certain
stimuli
Interaction
Any situation wherein the nurse relates
& deals with a client or patient
Open System
The absence of boundary existence,
where a dynamic interaction between
the internal & external environment can
exchange information without barriers
or hindrances.
KING’S GOAL ATTAINMENT THEORY
10 essential KNOWLEDGE for use by nurses in concrete situations:
Self, Role, Perception, Communication, Interaction, Transaction, Growth &
Development, Stress, Time & Personal Space
Perception Feedback
Judgment
Action
Nurse
Reaction Interaction Transaction
Patient
Action
Judgment
Perception
Feedback
DOROTHEA OREM
“Self Care Theory”
Born: 1914, Baltimore, Maryland, USA.

N
Introduction
One of foremost nursing theorists.
Dorothea Orem earned her Bachelor of

science in nursing education in 1939 and
Master of science in nursing in 1945
During her professional career ,she worked as

a staff nurse ,private duty nurse ,nurse
educator and administrator and nurse
consultant
Received honorary Doctor of Science degree in

1976
Introduction
Dorothea Orem as a member of a curriculum

subcommittee at Catholic University,
recognized the need to continue in developing
a conceptualization of nursing.
Published first formal articulation of her ideas

in Nursing: Concepts of Practice in 1971.
Second in 1980,and finally in 1995
Reference:
http://currentnursing.com/nursing_theory/self_care_deficit_theory.
html
Orem’s general theory of nursing in
three related parts:
Theory of self care

Theory of self care deficit
Theory of nursing system
Theory of Self Care
Self-Care
The performance or practice

of activities that individuals
initiate and perform on their
own behalf to maintain life,
health and well-being
Self-Care Agency
Human ability which is "the
ability in engaging self
care" -conditioned by age,
developmental state, life
experience, socio-cultural
orientation, health and
available resources.
Self-Care Requisites
 Actions directed towards provision
of self care.
Categories of Self-Care Requisites:

1.Universal Self-Care Requisite
- Universally set goals that must
be provided to function in scope
of healthy living
8 Self-Care Requisites common in men,
women and children:
a. Maintenance of sufficient intake of air
b. Maintenance of sufficient intake of
food
c. Maintenance of sufficient intake of
water
d. Provision of care associated with
elimination
e. Maintenance of balance between
activity & rest
8 Self-Care Requisites common in
men, women and children:
a. Maintenance of balance between
solitude & social interaction
b. Prevention of hazards to human

life, human functioning & human
well-being
c. Promotion of human functioning &

development
2. Developmental Self-Care Requisites
- Provision of conditions that promote
health
- Prevention of the effects of human
conditions that threatens life
Health deviation Requisites

Required in conditions of illness,
injury, or disease . These include:
Seeking and securing appropriate

medical assistance
Health deviation Requisites
Being aware of and attending to the

effects and results of pathologic
conditions
Effectively carrying out medically
prescribed measures
Learning to live with effects of
pathologic conditions
Therapeutic Self-Care Demand
 These are summation of all the

activities needed to alleviate the
existing disease or illness
Theory of Self Care Deficit
- Specifies when nursing is needed
- Nursing is required when a person is
incapable or limited in the provision of
continuous effective self care.
Orem identifies 5 methods of helping:

Acting for and doing for others
Guiding others
Supporting another
Providing an environment promoting
personal development in relation to
meet future demands
Teaching another
- Specifies when nursing is needed
- Nursing is required when a person is
incapable or limited in the provision of
continuous effective self care.
Orem identifies 5 methods of helping:
Acting for and doing for others
Guiding others
Supporting another
Providing an environment promoting
personal development in relation to
meet future demands
Teaching another
Theory of Nursing Systems
Theory of Nursing Systems
Describes how the patient’s self care
needs will be met by the nurse , the
patient, or both
Identifies 3 classifications of nursing

system to meet the self care requisites
of the patient:
a. Wholly compensatory system

b. Partly compensatory system
c. Supportive – educative system
Basic Nursing Systems
WHOLLY COMPENSATION SYSTEM
Accomplishes patient’s Patient’s

therapeutic self-care action
limited
Compensates for
Nurse
patient’s inability to
Action
engage in self-care
Supports & protects
patient
Partly compensatory system
Performs some self-care
measure for patient
Compensates for self-care
Nurse limitations of patient
Action
Assists patient as required
Performs some self-care

measure
Patient’s
Regulates self-care agency action
Accepts care & assistance
from nurse
Support-Educative System
Accomplishes self-care
Patient’s
action
Nurse Regulates the exercise &
Action development of self-care
agency
FAYE GLEN ABDELLAH
“Twenty-one Nursing Problems”
INTRODUCTION
Faye Glenn Abdellah, pioneer nursing
researcher, helped transform nursing theory,
nursing care and nursing education
Birth:1919
Dr Abdellah worked as Deputy Surgeon General
Former Chief Nurse Officer for the US Public

Health Service , Department of Health and
human services, Washington, D.C.
“ I never wanted to be a
medical doctor because
I could do all I wanted
to do in nursing, which
is a caring profession.”
ABDELLAH’S THEORY
 HEALTH
 NURSING PROBLEMS
 PROBLEM SOLVING
Nursing Problems
 A condition faced by the

patient or family which the
nurse can assist him or them
to meet through the
performance of professional
functioning.
Nursing Problems
 Overt (Objective)
 Apparent, obvious or can-be-
seen condition
 Covert (Subjective)
 Concealed, hidden, unseen or
masked one
Typology of 21 Nursing Problems
 Identification and classification of

problem
 3 areas:
 Physical, sociological and emotional
needs of the patient
 Types of interpersonal relationships
between the nurse and the patient
 Common elements of patient care
Problem Solving
 Problem solving process

a. Identifying the overt & covert
problem: (ASSESSMENT)
-Interviews
-Physical assessment
-Laboratory results
b. Selecting relevant data (DIAGNOSIS)
- Interpret & analyze the problem
Problem Solving
c. Devising hypothesis (PLANNING)
- Nurse & patient formulate a plan
of care based on the identified
problems
d. Testing hypothesis through the
assortment of data (INTERVENTIONS/
IMPLEMENTATIONS)
- Nursing actions provided to the
client that leads to solving the
problem .
Problem Solving
e. Revising hypothesis (EVALUATION)
- Evaluate the client’s response to
nursing interventions and compare
to your goals & desired outcomes
Note: if the client has a positive response

to the interventions = RECOVERY
(problem is resolved)
If the problem is not resolved it needs

revision.
10 steps to identify the client’s
problems
N
TEN steps to identify the client’s problems
1. Learn to know the patient
2. Sort out relevant and significant data
3. Make generalizations about available data in
relation to similar nursing problems
presented by other patients
4. Identify the therapeutic plan
5. Test generalizations with the patient and
make additional generalizations
6. Validate the patient’s conclusions about his
nursing problems
10 steps to identify the client’s problems
7. Continue to observe and evaluate the
patient over a period of time to identify any
attitudes and clues affecting his behavior
8. Explore the patient’s and family’s reaction to

the therapeutic plan and involve them in the
plan
9. Identify how the nurses feels about the

patient’s nursing problems
10. Discuss and develop a comprehensive

nursing care plan
Typology of 21 Nursing Problems
1. To maintain good hygiene and
physical comfort
2. To promote optimal activity: exercise,

rest and sleep
3. To promote safety through the

prevention of accidents, injury, or
other trauma and through the
prevention of the spread of infection
4. To maintain good body mechanics

and prevent and correct deformity
5. To facilitate the maintenance of a supply of
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
10. To facilitate the maintenance of regulatory
mechanisms and functions
11. To facilitate the maintenance of sensory

function.
12. To identify and accept positive and negative

expressions, feelings, and reactions
13. To identify and accept 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
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 case of illness
SISTER CALLISTA ROY
“Adaptation Model”
INTRODUCTION
Born at Los Angeles on October 14,

1939 as the 2nd child of Mr. and Mrs.
Fabien Roy
At age 14 she began working at a large

general hospital, first as a pantry girl,
then as a maid, and finally as a nurse's
aid.
She entered the Sisters of Saint Joseph

of Carondelet.
She earned a Bachelor of Arts with a
major in nursing from Mount St.
Mary's College, Los Angeles in 1963.
A master's degree program in

pediatric nursing at the University of
California ,Los Angeles in 1966.
She also earned a master’s & PhD in

Sociology in 1973 & 1977, respectively
Sr. Callista had the significant
opportunity of working with Dorothy
E. Johnson
Johnson's work with focusing
knowledge for the discipline of nursing
convinced Sr. Callista of the
importance of describing the nature of
nursing as a service to society and
prompted her to begin developing her
model with the goal of nursing being
to promote adaptation.
http://currentnursing.com/nursing_theory/application_Roy's_adaptatio
n_model.html
“Roy's theory sees the person
as "a bio-psycho-social being in
constant interaction with a
changing environment"
(Rambo, 1984). The person is
an open, adaptive system who
uses coping skills to deal with
stressors”
Terms used in the
Roy Adaptation Model (RAM)
System-a set of parts connected to
function as a whole for some purpose.
Stimulus-something that provokes a

response, point of interaction for the
human system and the environment
Three types of STIMULI:

- Focal Stimuli
- Contextual Stimuli
- Residual Stimuli
Focal Stimuli-internal or external
stimulus immediately affecting the
system. Ex: Immobility
Contextual Stimulus-all other stimulus

present in the situation.
Ex: Amputation of the Limb
Residual Stimulus-environmental factor,

that can affect the focal stimulus but
the effects are unclear.
The adaptation level is modulated by
persons coping mechanism & control
process. Thus person does not respond
passively to environmental stimuli.
Two categories of COPING MECHANISMS:

a. Regulator subsystem
b. Cognator subsystem
Regulator Subsystem- automatic
response to stimulus transpires through
neural, chemical, and endocrine.
Ex: (increase vital signs)
Cognator Subsystem - responds through

four cognitive-emotional channels:
perceptual and information processing,
learning, judgment and emotion.
“The Four Adaptive Modes are
interrelated through perception. An
adaptive response in one mode can
influence adaptation in the other
modes” ….Sister Callista Roy
1. Physiological-Physical Adaptive Mode
Goal: Physiological Integrity
-The way the person responds as a

physical well-being to stimuli from the
environment
-Nurse must be knowledgeable about
normal processes
-Five Physiologic Needs (Oxygenation,
Nutrition, Elimination, Activity & Rest,
and Protection)
2. Self Concept-Group Identity Adaptive Mode
Goal: Psychological Integrity
Psychological & spiritual characteristics of the

person consist of all beliefs & feelings that
one has formed about oneself.
two components:
Physical Self = body sensation & body image
Personal Self = self consistency, self ideal &
moral ethical spiritual self
3. Role Function Adaptive Mode
-Different roles that a person performs in
the society
A role is a set of expectations about how a

person occupying ones position behaves
towards a person occupying another
position.
Goal: Social Integrity

4. Interdependence Adaptive Mode
Coping mechanism from close relationship
which results to giving & receiving of love,
respect and value.
Occurs between the person & the most

significant other or support system.
Goal: Affectional adequacy

Ex: giving & receiving love, respect &
value through effective communication
Nursing Process:
Step 1: Assessment of the behavior

- gather data about the behavior of the person
as an adaptive system in each of the adaptive
mode
Observable behavior (Overt/Objective)
Non-observable (Covert/Subjective)
Step 2. Assessment of Stimuli

Focal
Contextual
Residual
Nursing Process:
Step 3: Nursing Diagnosis

- formulation of statements that interpret data
about the adaptation status of the person,
including the behavior and most relevant
stimuli.
Step 4: Goal Setting

- Establishment of statements of the
behavioral outcomes for nursing care which is
realistic and attainable. This is done together
with the client.
Nursing Process:
Step 5: Intervention
- determination of how best to assist the
person in attaining the established goals
Step 6: Evaluation
- Judging the effectiveness of the nursing
intervention in relation to the behavior after
it was performed in comparison with the goal
established.
Application of Roy’s
Adaptation Theory utilizing
the Nursing Process
Mang Goryo, a 50-year-old driver has
diabetes for 5 years and has not followed
the prescribed treatment regimen.
He has a non-healing would on his right

foot which prompted the surgeon to
perform above-knee amputation to
prevent further complication.
His past health history revealed that Mang

Goryo seldom visit his doctor for his check
up. He smokes approximately two packs
of cigarretes per day for the past 10 years
and also drinks alcohol
In addition Mang Goryo is the bread-winner
In the family. He has 6 children & described his
wife as verbally abusive (bungangera) at times
because of financial instability.
A day after the surgery Mang Goryo said.

“Namatay ang tatay at nanay ko dahil s
diabetes. Bakit pa ako magbabago kun
mamamatay rin lang ako”.
When the nurse explored his feelings, Mang

Goryo become extremely tearful and
expressed his concern about about him being
worthless, the future of his family. He believes
that the Illness is a punishment for his past life.
Physiologic Adaptive Mode
Step 1. Assessment of the behavior

- Mang Goryo had undergone amputation of
the leg, his mobility is impaired.
Step 2. Assessment of the stimuli
- Bacause of amputation the patient has
impaired mobility
Focal Stimulus is immobility
Contextual Stimulus is amputation of the limb
Step 3. Nursing Diagnosis

Impaired mobility related to amputation of the
right leg
Step 4. Goal Setting

“ Mang Goryo should be able to verbalize
understanding of the situation & rehabilitation
treatment regimen & safety measures.
Step 5. Intervention
a. Encourage to participate in self-care
activities & rehabilitation
b. Demonstrate proper use of crutches
c. Allow Mang Goryo to do return
demonstration of proper use of crutches
d. Emphasize safety measures in using the
assistive device
Step 6. Evaluation
a. Mang Goryo was able to verbalize
understanding of the importance of
rehabilitation
b. Mang Goryo is able to properly

demonstrate crutch walking
CONTROL EFFECTOR
INPUT OUTPUT
PROCESS
Physiological Adaptive
or
Coping Mechanism: Self-Concept
Stimuli ineffective
Adaptation Role Function responses
a. Regulator
level
b.Cognator Interdependence
FEEDBACK
MADELEINE LEININGER
“Transcultural Theory”
(Current Title: Culture Care or Culture
Care Diversity & Universality
Madeleine Leininger was born in Sutton,
Nebraska
In 1948, she received her

diploma in nursing from St. Anthony’s School
of Nursing in Denver, Colorado.
In 1950, she earned a B.S. from St. Scholastica

(Benedictine College) in Atchison, Kansas.
In 1954 earned an M.S. in psychiatric and
mental health nursing from the Catholic
University of America in Washington, D.C.
 In 1965, she was awarded a Ph.D. in cultural

and social anthropology from the University
of Washington, Seattle
(Tomey and Alligood, 2001).

“For a nurse to successfully provide care
for a client of a different cultural or
ethnic to background, effective
intercultural communication must take
place.
Intercultural communication occurs

when each person attempts to
understand the other’s point of view
from his or her own cultural frame of
reference”
CONCEPT OF CULTURE
Culture is learned by each generation through
both formal and informal life experiences.
Language is primary through means of

transmitting culture. The practices of particular
culture often arise because of the group's social
and physical environment.
Culture practice and beliefs are adapted over

time but they mainly remain constant as long as
they satisfy needs.
PURPOSES OF KNOWING THE
PATIENTS CULTURE AND RELIGION
FOR HEALTH CARE PERSONNEL
“Cultural background affect a person's health

in all dimensions, so the nurse should
consider the client's cultural background
when planning care. Although basic human
needs are the same for all people, the way a
person seeks to meet those needs is
influenced by culture.”
a. To heighten awareness of ways in which
their own faith system. Provides resources
for encounters with illness, suffering and
death.
b. To foster understanding, respect and

appreciation for the individuality and
diversity of patients beliefs, values,
spirituality and culture regarding illness, its
meaning, cause, treatment, and outcome.
Culturally Congruent Care
Care that fits the people's valued life patterns

and set of meanings -which is generated from
the people themselves, rather than based on
predetermined criteria.
Discovering client's culture care values,

meanings, beliefs and practices as they relate
to nursing and health care requires nurses to
assumes the roles of learners of client’s culture
and co-partners with client's and families in
defining the characteristics of meaningful and
beneficial care.(Leininger,2002)
Culturally Competent Care
The ability of the nurse to bridge cultural gaps

in caring, work with cultural differences and
enable clients and families to achieve
meaningful and supportive caring.
Culturally competent care requires specific

knowledge, skills, and attitudes in the delivery
of culturally congruent care and awareness.
Nursing Decisions (Nursing Actions)
Three modes of professional decisions and

actions are aimed to assist, support, facilitate,
or enable people of particular cultures to
achieve culturally congruent care.
1. Cultural preservation or maintenance
2. Cultural care accommodation or

negotiation
3. Cultural care repatterning or restructuring

Nursing Decisions (Nursing Actions)
1. Cultural Preservation or Maintenance:
Retain and or preserve relevant care values
so that clients can maintain their well-being.
2. Cultural Care Accommodation or

Negotiation: Adapt or negotiate with the
others for a beneficial or satisfying health
outcome
3. Cultural Care Repatterning or Restructuring

Records, change, or greatly modify client’s
life ways for a new, different and beneficial
health care pattern
SUNRISE MODEL
Cultural values
& life-ways
Influences care
patterns and
expressions
Health (well-being)
of
Individuals, families, groups, and institutions
Diverse Health Systems

Folk Professional
Nursing
systems systems
Nursing care decisions and actions

Cultural care preservation/maintenance
Cultural care accommodation/negotiation
Cultural care repatterning/restructuring
CULTURE CONGRUENT CARE

JEAN WATSON
“The Philosophy & Science of
Caring”
Introduction
Born: West Virginia
Educated: BSN, University of Colorado, 1964,

MS, University of Colorado, 1966, PhD,
University of Colorado, 1973
Dr. Jean Watson is Distinguished Professor of

Nursing and holds an endowed Chair in Caring
Science at the University of Colorado Health
Sciences Center.
Introduction
She is founder of the original Center for

Human Caring in Colorado and is a Fellow of
the American Academy of Nursing. She
previously served as Dean of Nursing at the
University Health Sciences Center and is a Past
President of the National League for Nursing
Watson believes that the main focus in nursing

is on carative factors. She believes that for
nurses to develop humanistic philosophies and
value system, a strong liberal arts background
is necessary.
Introduction
This philosophy and value system provide a

solid foundation for the science of caring.
A humanistic value system thus under grids her

construction of the science of caring.
She asserts that the caring stance that nursing

has always held is being threatened by the
tasks and technology demands of the curative
factors.
The focus of nursing is
on carative factors that
are derived from a
humanistic perspective
combined with scientific
knowledge base
-------Jean Watson
SEVEN
ASSUMPTIONS
1.Caring can be effectively
demonstrated and practiced only
interpersonally
2. Caring consists of carative factors

that result in the satisfaction of
certain human needs
3. Effective caring promotes health

and individual or family growth
4. Caring responses accept a
person not only as he/she is
now but as what he/she may
become
5. A caring environment offers

the development of potential
while allowing the person to
choose the best action for
himself at a given time
6.Caring is more “healthogenic”
than is curing. A science of
caring is therefore
complementary to the science
of curing.
7. The practice of caring is

central to nursing.
1. Formation of Humanistic-
Altruistic System of Values
 Learned in early life, but can

be greatly influenced by
nurse-educators
 Satisfaction through giving
and extension of the sense of self
2. Instillation of Faith-Hope
 Facilitates the promotion of

holistic nursing care and positive
health within the patient
population
 Describes the nurse’s role in
developing NPI and promoting
wellness by helping the patient
adopt health-seeking behavior
3. Cultivation of Sensitivity to Self
and to Others
 Recognition of feelings leads to

stabilization through self-
acceptance for both nurse and the
patient
 As nurses acknowledge their
sensitivity and feelings, they
become more genuine, authentic
and sensitive to others
4. Development of a Helping-Trust
Relationship
 Crucial for transpersonal caring

 Trusting relationship promotes
and accepts the expression of
both + and – feelings
 Involves:
 Congruence – being real,
honest, genuine, and authentic
Relationship
 Involves:
 Empathy – ability to experience and,
thereby understand the other person’s
perceptions and feelings and to
communicate those understandings
Relationship
 Involves:
 Nonpossessive warmth
 Demonstrated by a moderate
speaking volume
 A relaxed, open posture
 Facial expressions that are
congruent with other
communications
Relationship
 Involves:
 Effective communication
– has cognitive, affective and
behavior response
components
5. Promotion and Acceptance of the
Expression of Positive and Negative
Feelings
 Sharing of feelings – a risk-taking
experience for both nurse and patient
 Nurse must:
 Be prepared for either + or –
feelings
 Recognized that intellectual and

emotional understandings of a
situation differ
6. Systematic use of the
Scientific Problem-Solving
Method for Decision Making
 Use of the nursing process brings

scientific problem-solving approach
to nursing care
 Nursing process is similar to the

research process in that it is
systematic and organized
7. Promotion of Interpersonal
Teaching-Learning
 Important concept for nursing
 It separates caring from curing
 Allows patient to be informed and
shifts the responsibility for wellness
and health to the patient
 Nurse facilitates this with T-L
techniques that are designed to
enable patients to provide self-care
8. Provision for Supportive, Protective,
and Corrective Mental, Physical,
Sociocultural and Spiritual Environment
 Nurse must recognize the influence

that internal and external
environment have on health and
illness
 Internal environment:
 Mental and spiritual
 Sociocultural beliefs
8. Provision for Supportive, Protective,
and Corrective Mental, Physical,
Sociocultural and Spiritual Environment
 External variables:
 Comfort
 Privacy
 Safety
 Clean surroundings
9. Assistance with Gratification
of Human Needs
 Nurse recognizes the biophysical,

psychophysical, and
intrapersonal needs of self and
patient
 Patients must satisfy lower-order

needs before attempting to attain
higher-order needs
10. Allowance for Existential
Phenomenological Forces
 Phenomenology is a way of understanding

people from the way things appear to them,
from their frame of reference
Existential psychology
 Science of human existence that
uses phenomenological analysis
 Provide a thought-provoking
experience leading to a better
understanding of the self and
others
ERNESTINE WIEDENBACH
“The Helping Art of Clinical
Nursing”
Prescriptive Theory of Nursing
Richard Sagasag
RN, MAN, USRN
INTRODUCTION
Ernestine Wiedenbach was born in August 18,

1900, in Hamburg, Germany.
Wiedenbach's conceptual model of nursing is

called ' The Helping Art of Clinical Nursing".
Education:
B.A. from Wellesley College in 1922
R.N. from Johns Hopkins School of Nursing in
1925
M.A. from Teachers College, Columbia
University in 1934
Certificate in nurse-midwifery from the
Maternity Center Association School for
Nurse-Midwives in New York in 1946..
INTRODUCTION
Career:
Wiedenbach joined the Yale faculty in 1952 as
an instructor in maternity nursing.
Assistant professor of obstetric nursing in
1954 and an associate professor in 1956.
She wrote Family-Centered Maternity Nursing
in 1958.
She was influenced by Ida Orlando in her
works on the framework.
She died on March 8, 1998.

KEY ELEMENTS
KEY ELEMENTS
Wiedenbach proposes 4 main elements to

clinical nursing.
a philosophy
a purpose
a practice and
the art.
The Philosophy
The nurses' philosophy is their attitude and
belief about life and how that effected reality
for them.
Wiedenbach believed that there were 3
essential components associated with a
nursing philosophy:
Reverence for life (profound honor)
Respect for the dignity, worth, autonomy

and individuality of each human being
Resolution to act on personally and
professionally held beliefs.
The Purpose
Nurses purpose is that which the nurse
wants to accomplish through what she
does.
It is all of the activities directed towards

the overall good of the patient.
The Practice
Practice are those observable nursing
actions that are affected by beliefs and
feelings about meeting the patient’s need
for help.
The Art
The Art of nursing includes:
Understanding patients needs and
concerns
Developing goals and actions intended
to enhance patients ability and
Directing the activities related to the
medical plan to improve the patients
condition.
The nurses also focuses on prevention of
complications related to reoccurrence or
development of new concerns.
PRESCRIPTIVE THEORY
(Situation Producing Theory)
Wiedenbach's prescriptive theory is based
on three factors:
Central purpose- defines the quality of

health the nurse desires to effect what she
recognizes to be her special responsibility
Prescription- plan for client’s care. It is

directive to activity
Realities- one the nurse recognizes her

central focus and developed her
prescription, the nurse must then consider
the realities that she will provide nursing
care.
Realities
Realities
Central
Purpose in
Nursing
Prescription
Realities
MYRA ESTRINE LEVINE
“Conservation Model”
Levine’s Conservation Model is
focused in promoting adaptation and
maintaining wholeness using the
principles of conservation.
The nurse accomplishes the goals of

the model through the conservation
of energy, structure, and personal
and social integrity (Levine, 1967)
COMPOSITION OF
CONSERVATION MODEL
a. Adaptation is the process of
change, and conservation is the
outcome of adaptation.
Adaptation is the process whereby

the patient maintains integrity within
the realities of the environment
(Levine, 1966, 1989a).
b. Wholeness is based on Erikson’s
description of wholeness as an open
system: “Wholeness emphasizes a
sound, organic, progressive mutuality
between diversified functions and parts
within an entirety, the boundaries of
which are open and fluid.”
Levine stated that wholeness, exists

when the interaction or constant
adaptations to the environment, permit
ease—the assurance of integrity…in all
the dimensions of life.”
Conservation is the product of adaptation
The primary focus of conservation is

keeping together of the wholeness of the
individual.
KEY CONCEPTS
(Conservational principle)
I. 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; Maintenance of adequate
nutrition
II. 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; Maintenance of patient’s
personal hygiene
III. Conservation Of Personal
Integrity
Recognizes the individual as one

who strives for recognition,
respect, self awareness,
selfhood and self determination.
Example: Recognize and protect

patient’s space needs
IV. Conservation Of Social Integrity
An individual is recognized as some

one who resides with in 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.
ANN BOYKIN & SAVINA SCHOENHOFER
“Nursing as Caring”
Dr. Anne Boykin Dr. Savina O. Schoenhofer

R.N., Ph.D R.N., Ph.D.
The basic premise of
Nursing as Caring is that
all persons are caring.
(Boykin & Schenhofer,
1993)
Seven Major Assumptions
a. Persons are caring by virtue of their
humanness
b. Persons are caring moment to moment
c. Persons are whole or complete in the

moment
d. Personhood is a process of living

grounded in caring
e. Personhood is enhanced through

participating in nurturing relationships
with caring others
f. Nursing is both a discipline and a
profession
g. Persons are viewed as already

complete and continuously growing in
completeness, fully caring and unfolding
caring possibilities moment –to-moment
To understand the person as CARING one
needs….
To focus on VALUING
To celebrate the wholeness of human
To view humans as both living & growing in

caring
To actively seek engagement on a personal

level with others
The focus of nursing is “ nurturing
persons living caring & growing in
caring”
“The call for nursing is a call for

acknowledgement and affirmation of
the person living caring in specific in
specific ways in this immediate
situation”
The circle represents relating with
The Dance of Caring respect for and valuing of the other in
Persons the basic dance to know self and other
as caring person.
Each dancer in the circles make

contribution and moves within the
dance as the nursing situation
evolves.
There is always a room for more in the

circle and dancers may move in or out
as the nurse calls for services.
While dancers may or may not

connect by holding hands eye-to-eye
contact facilitates knowing others as
caring
JOSEPHINE PATERSON
& LORETTA ZDERAD
“Humanistic Nursing”
“Humanistic nursing practice is
developed from the lived experiences
of the nurse & the person receiving
care”
“Humanistic nursing is concerned

with the phenomenological
experiences of individuals and
exploration of human experiences”
Three Concepts that provide
the basis (or components) of
nursing
Dialogue
Community
Phenomenologic Nursology
DIALOGUE
-Nursing is a live dialogue
-Nursing is an INTERSUBJECTIVE
EXPERIENCE in which there is REAL
SHARING
a. Meeting – is the coming together of

human beings and is characterized by
expectation that there will be a nurse
and a nursed.
b. Relating – the process of nurse-

nursed “doing” with each other is
relating, being with the other
DIALOGUE
c. Presence – the quality of being open,

receptive, ready, and available to
another person in a reciprocal manner
is presence
d. Call and Response – are transactional,

sequential, & simultaneously
Nurses & clients call & respond to each

other both verbally & non-verbally, and
there is the potential to be “all at once”
COMMUNITY
-Humanistic nursing leads to community, it
occurs within a community, and is
affected by community
-Community is the experience of persons,

and it is through community, persons
relating to others , that it is possible to
become
PHENOMENOLOGIC NURSOLOGY
-Nursing, its practice & theory would not

be completed without a METHODOLOGY
called phenomenologic nursology.
Five phases in this approach:
a. Preparation of the nurse knower for

coming to know
- this involves to take risks, being open
to experiences, to one’s own view of
the world, and to another’s perceptual
framework.
b. Nurse knowing the other intuitively
- intituitive knowing requires getting
“inside”, into the rhythm of the other’s
experience, resulting in a special,
difficult to express, knowledge of the
other.
- Avoid expectations, labeling, and

judgments
c. Nurse knowing the other
scientifically
- This phase implies a separateness

from what is known
- It requires taking the all-at-once

phenomena that are known intuitively,
then looking at them, pondering,
analyzing, sorting, comparing,
contrasting, relating, interpreting,
naming, and categorizing them.
d. Nurse complementarily synthesizing
known others.
-The nurse compares and synthesizes

multiple known realities and arrives at an
expanded view.
- In this phase the nurse uses not only

personal experience but also the rich
theoretical foundation of education and
practice in order to put the clinical
situation in perspective.
e. Succession within the nurse from the
many to paradoxical one
-This phase evolves from the descriptive

process of a lived phenomenon.
-It is articulated vision of experience that

becomes expressed in a coherent
whole.
MARTHA ELIZABETH ROGERS
“Science of Unitary Human
Beings”
Concepts of Roger’s Model
Richard Sagasag
RN, MAN, USRN
1. Energy Field
- Energy field is the fundamental unit of both
the living & non-living
- This energy field “provide a way to perceive
people & environment as irreducible whole
- The energy field continuously varies in
intensity, density, and extent
2. Openness
- Human field & environmental field are
constantly exchanging their energy
3. Pattern
- Defined as the distinguishing characteristic of
an energy field perceived as a single wave
Homeodynamic Principles
-The way of perceiving unitary
human beings
a. Resonance
b. Helicy
c. Integrality
Resonance
-An ordered arrangement of rhythm
between human field & environmental field
-Field that undergoes continuous dynamic
Helicy
-Describes the unpredictable, but continuous,
non-linear evolution of energy field as
evidenced by non repeating rhythmicities
Integrality
-It covers the mutual, continuous
relationship of the human energy field and
the environmental field
-The fields are one & integrated but unique to
each other
Margaret Newman
“Health as an Expanding
Consciousness”
Background of the theory
Margaret Newman believed
human beings as unitary,
health and disease is
inseparable from each other
and they are the part of the
same entity.
Humans are open to the whole energy
system of the universe and constantly
interacting with the energy. With this
process of interaction humans are
evolving their individual pattern of whole.
According to Newman understanding the

pattern is essential. The expanding
consciousness is the pattern recognition.
 The nurse helps to understand people to
use the power within to develop the higher
level of consciousness.
 Thus it helps to realize the disease
process, its recovery and prevention.
 Time and space are the temporal pattern
(series of events) of the individual, both have
complementary relationship.
 Humans are constantly changing through
time and space and it shows unique
pattern of reality
Application of the theory
Health as expanding consciousness
is not only focus in treating the
disease but it also helps to
understanding the patient pattern of
interacting with environment and
how to move forward
Holistic Nursing:
It is the understanding of the

relationship among all the
components like biologic,
psychological, social and spiritual
dimensions of an individual and also
it involves understanding as an
integrated whole interacting with
internal and external environments.
Therapeutic touch:
It is believed that human body has

energy and produces an aura
manipulating that energy can help
in healing but it does not have any
scientific base.
ROSEMARIE RIZZO PARSE
“Theory of Human Becoming”

Three Assumptions on
Human Becoming
(updated from Parse 1992, p.38)

a. Human becoming is freely choosing
personal meaning in situations in the
intersubjective process of relating value
priorities
b. Human becoming is cocreating

rhythmical patterns of relating in open
interchange with the universe
c. Human becoming is contrascending

(moving beyond/stooping) multidimensionally
with the unfolding possibilities.
PRINCIPLES
Meaning
Rhythmicity
Transcendence
Meaning
- Refers to the linguistic and imagined
content of something & the interpretation
that one gives to something
Rhythmicity
- Refers to the paced, paradoxical
patterning of the human-universe mutual
process
Transcendence
- Described as reaching beyond with
possibilities – the hopes & dreams as
seen in multidimensional experiences
- options from which to choose personal
ways of becoming
LYDIA HALL
“Care, Core, Cure”
CARE CORE CURE
CARE CORE CURE
The care circle represents the nurturing component

and is exclusive to nursing.
Refers to the independent roles & functions of the

nurse insofar as her knowledge & skills about the
patient’s condition will allow her to carry on with her
nursing responsibilities.
CARE CORE CURE
The core circle of patient is based in the social

sciences, involves the therapeutic use of self, and is
shared with other members of the health team
The nurse makes sure that the patient receives the

highest level of care by collaborating, coordinating &
cooperating with other health care team
CARE CORE CURE
The cure circle of patient care is based in the

pathological and therapeutic sciences and is shared
with other members of the health team
It delineates nursing functions that are dependent

on the members of the medical profession
Example: medication administration, diagnostic

procedure
IDA JEAN ORLANDO
“The Nursing Process Theory”
The nursing process discipline is
based on the “process by which
any individuals acts”.
The purpose of the process

discipline, when it is used between
a nurse & patient, is to meet the
patient’s immediate need for help
Patient Behavior
All patient behavior, no matter how insignificant,

must be considered an expression of need for
help until its meaning to a particular patient in the
immediate situation is understood.
Verbal (complaints, requests, questions, refusal,

demands, comments or statements
Nonverbal ( heart rate, perspiration, edema,

urination, motor activity, avoiding eye contact)
Nurse Reaction
Patient’s behavior stimulates a nurse reaction.
Three sequential parts:

a. Nurse perceives the behavior through any
senses
b. Perception leads to automatic thought
c. Finally, the thought produces an automatic
feeling
Example:
Nurse sees the patient grimacing. Shen then
thinks that patient is in pain. Then feels
concern about the feelings of the patient
Nurse Action
Once the nurse has validated or corrected her

reaction to the patient’s behavior through
exploration with him, she can complete the
nursing process discipline with the nurse’s action.
Orlando said that only what the nurse says or

does with or for the benefit of the patient as
“professional nursing action”
The nurse must be certain that her action is

appropriate to meet the patient’s need for help.
JOYCE FITZPATRICK
“Rhythm Model”
The primary purpose of nursing is
the promotion and maintenance
of an optimal level of wellness.
The professional nurse participates in

a multi-disciplinary approach to
health in assessing, planning,
implementing, and evaluating
programs in regards to how they
affect optimum wellness for
patients.
When assessing health care needs,
the professional nurse
incorporates the physical,
emotional, social, environmental
and spiritual aspects of the
profession into her daily routine.
FOUR CONTENT CONCEPTS:
 Person
 Health
 Wellness-Illness
 Metaparadigm
Person
The term person integrates the concepts

of both self and others, and recognizes
individuals as having unique biological,
psychological, emotional, social, cultural,
and spiritual attitudes.
Throughout a person’s life, many factors

develop within a social setting and interact
with a multitude of environments that can
significantly influence that person’s health
and wellness
Health:
Health is a dynamic state of being that

results from the interaction of person and
the environment.
Optimum health is the actualization of

both innate and obtained human potential
gleaned from rewarding relationships with
others, goal directed behavior, and expert
personal care.
Wellness-Illness
Professional nursing is rooted in the

promotion of wellness practices, the
attentive treatment of those who are
acutely or chronically ill or dying, and
restorative care of people during
convalescence and rehabilitation
Nursing is a practice discipline and a

profession that is based upon a
synthesized body of knowledge.
Metaparadigm
Transition is one of the core concepts of

nursing theory, derived from and related
to the basic metaparadigm concepts of
person, environment, health and
nursing.
PATRICIA BENNER
“Novice to Expert”
Richard Sagasag
RN, MAN, USRN
Introduction
Dr Patricia Benner introduced the

concept that expert nurses develop skills
and understanding of patient care over
time through a sound educational base
as well as a multitude of experiences.
She proposed that one could gain

knowledge and skills ("knowing how")
without ever learning the theory
("knowing that").
Introduction
She further explains that the development of
knowledge in applied disciplines such as
medicine and nursing is composed of the
extension of practical knowledge (know how)
through research and the characterization and
understanding of the "know how" of clinical
experience.
She conceptualizes in her writing about nursing
skills as experience is a prerequisite for becoming
an expert.
Levels of Nursing experience
She described 5 levels of nursing experience as;
Novice
Advanced beginner
Competent
Proficient
Expert
These levels reflect:
Movement from reliance on past abstract
principles to the use of past concrete
experience as paradigms and
Change in perception of situation as a

complete whole in which certain parts are
relevant
NOVICE
Novice Stage describes that a person has no

background experience of the situation in
which he/she is involved.
To guide performance, context free rules and

objective attributes must be given.
The novice has also difficulty discriminating

between relevant and irrelevant aspects of a
situation.
Examples: Students or nurses placed in an

unfamiliar situation
ADVANCE BEGINNER
Advance beginner has sufficient experience to

easily understand aspects of the situation.
It requires experience based on recognition in

the background of the situation.
Nurse at this stage feel more responsible for

managing patient care, yet still rely on the
help of those more experienced.
Example:
Newly graduate nurses
COMPETENT
2-3 years experience
Competent performance considers

consistency predictability, and time
management as essential components.
The sense of mastery is acquired through

planning and predictability.
Increased level of efficiency is evident.

However time management & the nurses
organization of the task are more important
than on timing in relation to the patients
needs.
PROFICIENT
Has 3-5 experience
According to Dreyfus model, the performer of

this stage perceives the situation as a whole
rather than in terms of aspects, and
performance is guided by maxims (rule of
conduct).
The proficient level is qualitative leap beyond

the competent. – the performer identifies the
most significant aspects and has a better
understanding of the situation based on
background understanding.
PROFICIENT
They no longer rely on preset goals for

organization , and they show an increased
confidence in their knowledge and skills.
There is much involvement of the patient &
family.
EXPERT
Dreyfus said that in the expert stage is

accomplished when the expert performer no
longer relies on analytical principle like rules,
guidelines and maxims to connect her
understanding of the situation to an
appropriate action.
Benner viewed an expert nurse as

possessing an intuitive grasp of the problem
without losing time considering a range of
alternative diagnosis and solutions.
EXPERT
Dreyfus said that in the expert stage is accomplished

when the expert performer no longer relies on analytical
principle like rules, guidelines and maxims to connect her
understanding of the situation to an appropriate action.
Benner viewed an expert nurse as possessing an intuitive

grasp of the problem without losing time considering a
range of alternative diagnosis and solutions.
CARMENCITA M. ABAQUIN
“PREPARE ME” interventions & the
Quality of Life of Advance
Progressive Cancer Patients
Biographic Sketch
Carmencita M. Abaquin
- is a nurse with Master's and Doctoral

Degree in Nursing obtained 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 UP college of
nursing, her alma mater, as faculty
and held the position as secretary of
the college of nursing.
Her latest appointment as chairman

of the board of nursing speaks of her
competence and integrity in the field
she has chosen.
PREPARE ME Interventions are said
to be effective in improving the
quality of life of cancer patients.
This can be further applied not
only with terminally- ill patients
but also promisingly introduced to
those patients with acute and
chronic diseases and those with
prolonged hospital stays.
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 emphasizes a holistic approach to nursing
care. PREPARE ME has the ff. components:
• 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 facilitate inner sight which helps
establish connection and
relationship with God.
It may be done through the use of

music and other relaxation
techniques.
Values clarification- assisting another
individual to clarify his own values
about health and illness in order to
facilitate effective decision making
skills. Through this, the patient
develops an open mind that will
facilitate acceptance of disease state
or may be help deepen or enhance
values. The process of values
clarification helps one become
internally between what we do and
what we consistent by achieving
closer 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 ff. dimensions of
man – physical, psychological, social,
religious, level of independence,
environment, and spiritual.
SISTER LETTY KUAN
““Retirement and Role

Discontinuities”
Basic Assumptions and
Concepts
Retirement
 Leaving of job or career
 The act of leaving a job or

career at or near the usual
age for doing so, or the state
of having left a job or career
Time after having stopped
working
the time that follows the end
of somebody's working life.
Being away from busy life

a state of being withdrawn
from the rest of the world or
from a former busy life.
Physiologic Age
 Is the endurance of cells and

tissues to withstands 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.
Change of Life
Is the period between near

retirement and post
retirement years.
Retiree
Is an individual who has left

the position occupied for the
past years of productive life
because he/she has reached
the prescribed retirement age
or has completed the required
years of service.
Role Discontinuity
Is the interruption in the line

status enjoyed or role
performed. The interruption
may be brought about an
accident, emergency and
change of position or
retirement.
Coping Approaches
Refer to the interventions or

measure applied to solve a
problematic situation or state
in order to restore or maintain
equilibrium and normal
functioning.
Health Status
Refer to the physiologic

and mental state of the
respondents classified as
either sickly or healthy.
Richard Sagasag
RN, MAN, USRN
Income (economic level)
Refers to the financial

affluence of the respondents
which can be classified as
poor, moderate, and rich.

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FLORENCE

May 12, 1820 – August 13, 1910

In 1837, when she was 17,

At the age of 31, she entered the

“LADY with a LAMP

She cared for the soldiers during night time by

She used her superb statistical & managerial

She utilized the environment in helping the

She used the money to develop the

Nightingale focus more on

The first school that provided

Nursing evolved as an art &

Formal nursing education and

“TO CHANGE THE

She was the first woman to be

Her birthday marks the

Defined nursing as “act of utilizing

-She referred to the person

- They are defined in

- She defined health as being

- She envisioned the

- Florence believed that the sick,

-She stressed that nurses could

- having responsibility for

Nightingale’s Nursing process & Thought

-Attempt to keep noise level in

September 1, 1909 - March 17, 1999

• Born in 1909, Reading, Pennsylvania

• Graduated from a diploma program in

• BA in interpersonal psychology from

• MA in psychiatric nursing from Colombia

• Professor emeritus from Rutgers University

• Certified in psychoanalysis by William

• Worked as executive director and president

• Worked with WHO, NIMH and nurse corps

• In 1952 published Interpersonal

– Credited with transformation of

• Worked with leading figures in British and

• After war worked to reshape mental health

 An individual is made of physiological,

• Existing forces outside of the individual

• An educative and therapeutic

Capability to deal with identified

Goals are implemented by the nurse

Dependent person becomes

Client needs met, patient earns full

Mutual termination of relationship

Goal, support systems, problem

 Readiness is one of the most

 Termination occurs only with the

 Nurse should not prejudged

 Nurse should treat the patient as

Nurse must develop her discussion

 Involves the democratic process

 Nurse helps the patient meet the

The nurse must assist the patient

 Nurse becomes a listening friend, an

 Interpersonal techniques – help the

Mario, a street vendor was

- Establish Trust & Rapport

-Courteously asks questions to gather

- Evaluation, Recovery & Discharge

- Evaluate if client understand the

“If Client recovers from his previous