NURSING

THEORISTS
Hello!
We are the Group 3.
Borja, Dianne Louise Dinolan, John Erik
Haim, Hejara Torillo, Marjorie
Telin, Criselda Sambitory, Johaida
Villanueva, Laivy Gamba, Dien Mitzie
Layso, Flora Mae

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HILDEGARD PEPLAU’S
INTERPERSONAL RELATIONS MODEL
Hildegard Peplau, a psychiatric nurse,
introduced her interpersonal concepts
in 1952. Central to Peplau’s theory is the
existence of a therapeutic relationship
between the nurse and the client.
Nurses enter into a personal
relationship with an individual when a
need is present.

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HILDEGARD PEPLAU’S
INTERPERSONAL RELATIONS MODEL
○ The nurse–client relationship evolves in four phases:
1. Orientation. The client seeks help and the nurse assists the
client to understand the problem and the extent of the need for
help.
2. Identification. The client assumes a posture of dependence,
interdependence, or independence in relation to the nurse
(relatedness). The nurse’s focus is on ensuring the individual that
the nurse understands the interpersonal meaning of the client’s
situation.
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HILDEGARD PEPLAU’S
INTERPERSONAL RELATIONS MODEL
3. Exploitation. The client derives full value from what the nurse
offers through the relationship. The client uses available services
based on self-interest and needs. Power shifts from the nurse to
the client.
4. Resolution. In the final phase, old needs and goals are put aside
and new ones adopted. Once older needs are resolved, newer and
more mature ones emerge.

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IMOGENE KING’S
GOAL ATTAINMENT THEORY
Imogene King’s theory of goal
attainment (1981) was derived from
her conceptual framework. King’s
framework shows the relationship of
personal systems (individuals),
interpersonal systems (groups such
as nurse–client), and social systems
(such as educational system, health
care system).

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IMOGENE KING’S
GOAL ATTAINMENT THEORY
King’s theory offers insight into nurses’ interactions with
individuals and groups within the environment. It highlights the
importance of a client’s participation in decisions that influence
care and focuses on both the process of nurse–client interaction
and the outcomes of care. King believes that her theory, used in
evidence theory-based practice, blends the art and the science of
nursing.

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JEAN WATSON’S
HUMAN CARING THEORY
Jean Watson believes the practice of
caring is central to nursing; it is the
unifying focus for practice. Nursing
interventions related to human care
originally referred to as carative
factors have now been translated into
10 clinical caritas processes (Watson,
2013):

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JEAN WATSON’S
HUMAN CARING THEORY
1. Embrace altruistic values and practice loving kindness with self
and others.
2. Instill faith and hope and honor others.
3. Be sensitive to self and others by nurturing individual beliefs and
practices.
4. Develop helping–trusting, human caring relationships.
5. Promote and accept positive and negative feelings as you
authentically listen to another’s story.

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JEAN WATSON’S
HUMAN CARING THEORY
6. Use creative scientific problem-solving methods for caring
decision making.
7. Share teaching and learning that addresses the individual needs
and comprehension styles.
8. Create a healing environment for the physical and spiritual self
which respects human dignity.
9. Assist with basic physical, emotional, and spiritual human needs.
10. Open to mystery and allow miracles to enter.

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ABRAHAM MASLOW’S
HIERARCHY OF NEEDS
U.S. Psychologist Abraham Maslow
was a practitioner of humanistic
psychology. He is known for his theory
of “self-actualization.” In the books
Motivation and Personality and
Toward a Psychology of Being, Maslow
argued that each person has a
hierarchy of needs that must be
satisfied.

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THEORIES and
PRINCIPLES of
HEALTH ETHICS
I.
ETHICAL
THEORIES

DEONTOLOGY • TELEOLOGY • UTILITARIANISM

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 “
Integrity is telling myself the truth.
And honesty is telling the truth to
other people.

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DELEONTOLOGY
○ Its foundations come from the work of Immanuel Kant (1724-
1804).
○ It defines actions as right or wrong based on their “right-
making characteristics”.
○ It does not look to consequences of actions to determine right
or wrong; instead, it examines a situation for the existence of
essential right or wrong
○ If an act is just, respects autonomy, and provides good, it will be
right, and it will be ethical according to this philosophy.
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APPLICATION TO BIOETHICS
For example, if you try to make a decision about the ethics of a
controversial medical procedure, deontology guides you to focus
on how the procedure ensures fidelity to the patient, truthfulness,
justice, and beneficence. You focus less on the consequences
(ethically speaking).

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TELEOLOGY
○ from the Greek word telos, meaning “end,” or the study of ends
or final causes
○ John Stuart Mill (1806-1873), a British philosopher, first
proposed its philosophical foundations.
○ looks to the presence of principle regardless of outcome.
○ Also called Consequence-Based Theories, look to the outcomes
(consequences) of an action in judging whether that action is
right or wrong.
○ Teleological theories focus on issues of fairness.
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UTILITARIANISM
○ A one form of consequentialist theory, it views a good act as
one that is the most useful—that is, one that brings the most
good and the least harm to the greatest number of people. This
is called the principle of utility.
○ The Principle of Utility says: a person should choose that action
which produce the greatest good for the greatest number of
people affected by the alternatives open to him.
○ This approach is often used in making decisions about the
funding and delivery of health care.
○ Utilitarianism measures the effect that an act will have. 18
APPLICATION TO BIOETHICS
In August 2000, conjoined twins, named Mary and Jodie were born
in a hospital in Manchester England. Their spines were fused, and
they had one heart and one pair of lungs between them. Jodie, the
stronger one, was providing blood for her sister. The prognosis
was that without intervention, both girls would die within six
months. The only hope was an operation to separate them. This
would save Jodie, but Mary would die immediately. Thus, there
were two options:
(a) Not intervene and see both babies die, or
(b) Intervene and save one life, Jodie.
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APPLICATION TO BIOETHICS (cont.)
What is the acceptable course of action?
○ According to utilitarian, we need to decide which course of
action will produce the greatest good for the greatest number
of people affected by the action. It is plausible to interpret
utilitarianism as supporting alternative (b). Surely it is better to
save one life rather than not.

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21
II.
VIRTUE ETHICS

VIRTUE ETHICS IN NURSING • CORE VALUES OF A

PROFESSIONAL

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VIRTUE ETHICS IN NURSING
○ Virtue ethics is ethics based on character. Its fundamental idea
is that a person who has acquired the proper set of dispositions
will do what is right when faced with a situation involving a
moral choice.
○ Thus, virtue ethics doesn’t involve invoking principles or rules to
guide actions.
○ The virtuous person is both the basic concept and the goal of
virtue ethics. The virtuous person is one who acts right, because
she is just that sort of person.
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VIRTUE ETHICS IN NURSING
○ Right actions flow out of character, and the virtuous person has
a disposition to do the right thing. Rules need not be consulted,
calculations need not be performed, abstract duties need not
be considered.
○ In medical contexts, virtue ethics calls attention to the central
role which such virtues as courage, loyalty, integrity,
compassion, and benevolence, along with determination and
intelligence, should play in the practices of medical providers.

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CORE VALUES OF A PROFESSIONAL
○ Core values are a set of fundamental beliefs, ideals or practices
that inform how you conduct your life, both personally and
professionally.
○ Values are learned through observation and experience. As a
result, they are heavily influenced by a person’s sociocultural
environment— that is, by societal traditions; by cultural, ethnic,
and religious groups; and by family and peer groups.
○ Nurses should keep in mind the influence of values on health.
For example, some cultures value treatment by a folk healer
over that by a physician.
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CORE VALUES OF A PROFESSIONAL
○ People derive values from society and their individual
subgroups, they internalize some or all of these values as
personal values. People need societal values to feel accepted,
and they need personal values to have a sense of individuality.
○ Nurses’ professional values are acquired during socialization
into nursing from codes of ethics, nursing experiences,
teachers, and peers.
○ The American Association of Colleges of Nursing (2008)
identified five values essential for the professional nurse:
altruism, autonomy, human dignity, integrity, and social
justice. 26
III.
ETHICAL
PRINCIPLES

AUTONOMY • CONFIDENTIALITY • VERACITY • FIDELITY

• JUSTICE • BENEFICENCE • NON-MALEFICENCE

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 “
Ethical behavior is contextual—what is
an ethical action or decision in one
situation may not be ethical in a
different situation.

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1. AUTONOMY
○ Autonomy refers to the right to make one’s own decisions.
○ Honoring the principle of autonomy means that the nurse
respects a client’s right to make decisions even when those
choices seem to the nurse not to be in the client’s best interest.

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 ⚖
️
PATIENT’S RIGHTS

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 ⚖
️
PATIENT’S BILL OF
RIGHTS
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The following rights of the patient shall be respected by all those
involved in his care:
1. Right to Appropriate Medical Care and Humane Treatment.
2. Right to Informed Consent.
3. Right to Privacy and Confidentiality.
4. Right to Information.
5. The Right to Choose Health Care Provider and Facility.
6. Right to Self-Determination.
7. Right to Religious Belief.
8. Right to Medical Records.
9. Right to Leave.
10.Right to Refuse Participation in Medical Research.
11.Right to Correspondence and to Receive Visitors.
12.Right to Express Grievances.
13.Right to be Informed of His Rights and Obligations as a Patient.

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 ⚖
️
INFORMED
CONSENT
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INFORMED CONSENT

"Consent given by a competent individual who:

- Has received the necessary information (verbally and in writing).
- Has adequately understood the information.
- After considering the information, has arrived at a voluntary
decision without having been subjected to undue influence or
inducement, or intimidation."

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CREATION OF CONSENT DOCUMENTS

○ Use local language

○ Write to appropriate reading level
○ Illustrate with appropriate concepts, drawings, images or
videos
○ In cases of emergency, interventions to save the life of the
patient can be done without the patient’s consent.

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ESSENTIAL ELEMENT OF INFORMED
CONSENT
○ Procedure Description
○ Alternatives
○ Benefits
○ Risks
○ Confidentiality
○ Voluntary approval or refusal
○ Documentation
○ Contact Persons
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What should occur if the patient
cannot give informed consent?
○ If the patient is incapacitated/incompetent, a surrogate
decision maker must speak for him.
○ There is a specific hierarchy of appropriate decision makers
defined by law.
○ If no appropriate surrogate decision maker is available, the
physicians are expected to act in the best interest of the
patient until a surrogate is found or appointed.

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These include a ranking order and act
in a person’s best interests:
○ Personal care guardian
○ Attorney for personal care
○ Representative appointed by Consent and Capacity Board
○ Spouse or partner
○ Child or parent or individual/agency entitled to give or refuse consent
instead of parent
○ Parent with right of access only
○ Brother or sister
○ Any other relative
○ Public guardian and Trustee
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What is the scope of consent? Generally,
limited to specific procedure. Extending. Caution advised when treatment exceeds the
scope of consent.

○ General Consent. When a patient consent to treatment of a

CONDITION rather than a specific procedure, the scope of
treatment involves all measures reasonably necessary to treat
the condition.
○ Unexpected Circumstances. When an unexpected condition
arises while performing a consented procedure and the
patient is unable to grant consent, the doctor must use
medical JUDGEMENT to decide on the appropriate action. If
time allows the doctor should consult the FAMILY or other
LEGAL representative.
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What is the scope of consent? Generally,
limited to specific procedure. Extending. Caution advised when treatment exceeds the
scope of consent.

Limiting
1. Limited to a particular procedure or prohibit a particular
procedure.
2. Except in emergency, the doctor is bound by these limits.
3. The doctor should try to convince the patient to forgo
such limitations when in his medical judgment such
procedure might be necessary.

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Who may consent?
○ The law presumes that patients 18 and over are competent to
give consent to treatment.
○ For minors the doctor must look to the parents or legal
guardian for consent.
○ Substituted consent must also be sought for incompetent
adults and for those whose judgment is impaired by their
condition or medication.

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 ⚖
PROXY CONSENT /
️
LEGALLY ACCEPTABLE
REPRESENTATIVE

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Proxy consent is the process by which people with the legal right to
consent to medical treatment for themselves or for a minor or a ward
delegate that right to another person. There are three fundamental
constraints on this delegation:
1. The person making the delegation must have the right to consent.
2. The person must be legally and medically competent to delegate
the right to consent.
3. The right to consent must be delegated to a legally and medically
competent adult.
There are two types of proxy consent for adults. The first, the power
of attorney to consent to medical care, is usually used by patients
who want medical care but are concerned about who will consent if
they are rendered temporarily incompetent by the medical care. A
power of attorney to consent to medical care delegates the right to
consent to a specific person. The second type is the living will.
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 ⚖
️
CONFIDENTIALITY

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o The concept of confidentiality in health care is widely respected.
Federal legislation known as the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) mandates the protection of
patients’ personal health information. The legislation defines the
rights and privileges of patients for protection of privacy. It
establishes fines for violations.

o Confidentiality protects private patient information once it has

been disclosed in health care settings. Patient confidentiality is a
sacred trust. Nurses help organizations protect patients’ rights to
confidentiality.

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 ⚖
️
PRIVACY

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o The Health Insurance Portability and Accountability Act of 1996
(HIPAA) represents one of the more recent federal statutory acts
affecting nursing care. This law provides rights to patients and
protects employees.
o In the privacy section of the HIPAA, there are standards regarding
accountability in the health care setting. These rules create patient
rights to consent to the use and disclosure of their protected health
information, to inspect and copy one’s medical record, and to
amend mistaken or incomplete information. It limits who is able to
access a patient’s record. It establishes the basis for privacy and
confidentiality concerns, viewed as two basic rights within the U.S.
health care setting.
o Privacy is the right of patients to keep personal information from
being disclosed.
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2. CONFIDENTIALITY
○ Confidentiality means that any information a participant relates
will not be made public or available to others without the
participant’s consent.

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3. VERACITY
a) Truth Telling and Right to Information

○ Veracity refers to telling the truth. Although this seems

straight- forward, in practice, choices are not always clear.
Should a nurse tell the truth when it is known that it will cause
harm? Does a nurse tell a lie when it is known that the lie will
relieve anxiety and fear? Lying to sick or dying people is rarely
justified. The loss of trust in the nurse and the anxiety caused
by not knowing the truth, for example, usually outweigh any
benefits derived from lying.
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3. VERACITY (cont.)
a) Truth Telling and Right to Information

○ For example, clients may not value truth-telling for life-

threatening conditions, because this may eliminate hope and,
therefore, hasten death. Family members may request that the
client not be told of his or her diagnosis. (Ethic/cultural
variation)

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4. FIDELITY
○ It means to be faithful to agreements and promises.
○ By virtue of their standing as professional caregivers, nurses
have responsibilities to clients, employers, government, and
society, as well as to themselves.
○ Nurses often make promises such as “I’ll be right back with your
pain medication” or “I’ll find out for you.”
○ Clients take such promises seriously, and so should nurses.

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5. JUSTICE
○ It is frequently referred to as fairness. Nurses often face
decisions in which a sense of justice should prevail.
○ For example, a nurse making home visits finds one client tearful
and depressed and knows she could help by staying for 30
more minutes to talk. However, that would take time from her
next client, who has diabetes and needs a great deal of teaching
and observation. The nurse will need to weigh the facts carefully
in order to divide her time justly among her clients.

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6. BENEFICENCE
○ It means “doing good.”
○ Nurses are obligated to do good, that is, to implement actions
that benefit clients and their support persons. However, doing
good can also pose a risk of doing harm.
○ For example, a nurse may advise a client about a strenuous
exercise program to improve general health but should not do
so if the client is at risk of a heart attack.

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7. NON-MALEFICENCE
○ It is the duty to “do no harm”.
○ Harm can mean intentionally causing harm, placing someone at
risk of harm, and unintentionally causing harm. In nursing,
intentional harm is never acceptable. However, placing a person
at risk of harm has many facets. A client may be at risk of harm
as a known consequence of a nursing intervention that is
intended to be helpful.

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7. NON-MALEFICENCE (cont.)
○ For example, a client may react adversely to a medication.
Unintentional harm occurs when the risk could not have been
anticipated.
○ For example, while catching a client who is falling, the nurse
grips the client tightly enough to cause bruises to the client’s
arm. Caregivers do not always agree on the degree of risk that
is morally permissible in order to attempt the beneficial result.

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THANKS!
no questions!

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