CHAPTER I Context- environment to which nursing act takes place

INTRODUCTION Content- subject of theory

Process- method by which nurse acts in nursing theory
Nursing
- geared on realizing & restoring patient’s biophysical wellbeing & NURSING
assisting them to live a dignified & normal life  American Nursing Association (ANA)
- Nursing Theory explains Science & Art of Nursing (melting pot of “Diagnosis & treatment of human responses to
knowledge, creeds, backgrounds of care collected & preserved) actual/potential health problems”
 International Council of Nurses (ICN)
THEORY “autonomous & collaborative care of individuals of all ages,
- organized system of accepted knowledge composed of concepts, families, groups, & communities, sick or well in all settings.
propositions, definitions, & assumptions to explain a fact, event, Nursing includes promotion of health, illness prevention,
or phenomena. and care of ill, disabled, & dying. Advocacy, promotion of
Concept- idea formulated by mind/experience perceived & safe environment, research, participation in shaping health
observed (justice, love, war, disease) policy & inpatient & health systems management, and
Proposition- explain relationships of diff. concepts education are also key nursing roles”
Definition – descriptions conveying general meaning &  Virginia Henderson
reduces vagueness in understanding concepts “to assist clients in performance of activities contributing to
Assumption- statement specifying relationship of factual health, its recovery/peaceful death clients will perform
concept/phenomena unaided, if they had necessary will, strength, knowledge”
- “creative & rigorous structuring of ideas that projects tentative,  Association of Deans of Philippine Colleges of Nursing (ADPCN)
purposeful, & systematic view of phenomena” (Chinn & Kramer, “dynamic discipline. It’s an art & science of caring for
1991) individuals, families, communities toward promotion &
restoration of health, illness prevention, alleviation of
suffering, & assisting clients to face death w/ dignity &
peace. It’s focused on assisting client as they respond to
health-illness situations, utilizing nursing process & guided
by ethico-legal moral principles”
 Focused in supporting communities, families, individuals in
maintaining, restoring, achieving state of optimum health &
functioning. It’s both science & art concerned with quality
of life defined by clients.

NURSING PARADIGMS
-patterns/models showing clear relationship
among existing theoretical works in nursing
- metaparadigms  “meta” (with) & “paradeigma” (pattern)
-focused on relationships among 4 major concepts
(metaparadigms) that establish better direction & understanding
of nursing:
Person- recipient of nursing care (individuals) (client, patient)
Ex: Nightingale proposed that physical, intellectual, &
spiritual being of person isn’t capable of manipulating
environment to promote health
Environment- external/internal life aspects influencing a person
Ex: Nightingale focused on ventilation, warmth, noise, light, cleanly
NURSING THEORY Health- holistic degree of wellness/illness a person experiences
- group of interrelated concepts developed from related studies Ex: Nightingale defined nursing as “profession for women within goal
- aims to view essence of nursing care “to discover & use laws governing health in service of humanity”,
- articulated & communicated conceptualization of believing all nursing activity’s goal should promote client’s health
invented/discovered reality (central phenomena & relationships) Nursing- interventions of nurse rendering care in support
in pertaining to nursing for purpose of describing, explaining, of/cooperation with client
predicting, of prescribing nursing care” (Meleis, 1991) independent, dependent, interdependent
 express nursing theory to provide direction to nursing care Ex: Nurse is responsible in promoting clients’ wellbeing by
manipulating environment (Nightingale)

- acc. to Barnum (1994), complete nursing theory has:

 - Nursing Metaparadigm embodies knowledge base, theory,
philosophy, research, practice, & educational experience &
literature identified w/ nursing.
THEORISTS
FLORENCE NIGHTINGALE

JEAN WATSON
Philosophy & Theory of Transpersonal Caring CARITAS PROCESSES
- based on 10 carative factors (has dynamic phenomenological “Practice of loving-kindness & equanimity within context
component relative to individuals involved in relationship as of caring consciousness”
encompassed by nursing)
- later expanded/translated into caritas processes (decidedly “Being authentically present & enabling & sustaining deep
spiritual dimension & overt evocation of love & caring) belief system & subjective life-world of self & one being
cared for”
CARATIVE FACTORS
1. Formation of Humanistic Altruistic System of Values
- learned early in life but can be influenced by nurse educators
- satisfaction through giving & extension of sense of self
2. Instillation of Faith-Hope “Cultivation of one’s own spiritual practices & transpersonal
- incorporating humanistic & altruistic values, facilitates self going beyond ego self”
promotion of holistic nursing care & positive health within
patient population
- describes nurse’s role in developing effective nurse-patient
interrelationships & in promoting wellness by helping patient “Developing and sustaining a helping trusting authentic
adopt health-seeking behaviors caring relationship”
3. Cultivation of Sensitivity to Self & Others
- recognizing feelings leads to self-actualization through self-
acceptance for nurse & patient
- as nurses acknowledge their sensitivity & feelings, they become
more genuine, authentic, & sensitive to others
4. Development of Helping-Trust Relationship
- crucial for transpersonal caring
- trusting relationship promotes & accepts expression of positive
& negative feelings
- involves: “Being present to & supportive of expression of positive &
congruence (honest, genuine, authentic) negative feelings as a connection w/ deeper spirit & self &
empathy (experience & understand other’s perceptions & one-being-cared for”
feelings and communicate it)
nonpossessive warmth (moderate speaking volume, relaxed “Creative use of self & all ways of knowing as part of caring
open posture, facial expressions congruent process; to engage in artistry of caring-healing practices”
w/other communications)
effective communication (cognitive, affective, behavior response)
5. Promotion & Acceptance of Positive/Negative Feelings Expression
- sharing of feelings is risk-taking experience for nurse & patient
- nurse must recognize that intellectual & emotional understandings
of a situation differ’ “Engaging in genuine teaching-learning experience that
6. Systematic Use of Scientific Problem-Solving Method for attends to unity of being & meaning, attempting to stay
Decision Making within others’ frame of reference”
- nursing process brings a scientific problem-solving approach to
nursing care, dispelling traditional image of a nurse as doctor’s
handmaiden
- nursing process is similar to research process (systematic &
organized
7. Promotion of Interpersonal Teaching-Learning
- separates caring from curing
- allows patient to be informed & shifts responsibility
for wellness & health to patient
- nurse facilitates this w/ teaching-learning techniques designed
to enable patients to provide self-care, determine personal 8. Provision for Supportive, Protective, & Corrective Mental,
needs, & provide opportunities for their personal growth Physical, Sociocultural, & Spiritual Environment
 - nurses must recognize internal/external environments’ influence
on persons’ health & illness
- internal environment (mental & spiritual well-being,
sociocultural beliefs)
- external variables (comfort, privacy, safety, clean, aesthetic
surroundings
9. Assistance with Gratification of Human Needs
- nurse recognizes biophysical, psychophysical, psychosocial, “Creating healing environment at all levels (physical &
intrapersonal needs of self & patient nonphysical, subtle environment of energy & consciousness,
- Patients must satisfy lower-order needs before attempting to whereby wholeness, beauty, comfort, dignity, & peace are
attain higher-order needs potentiated)”
LO biophysical needs (Food, elimination, ventilation)
LO psychophysical “ (activity, inactivity, sexuality)
HO psychosocial “ (achievement, affiliation)
HO intrapersonal-intrapersonal “ (Self-actualization)
10. Allowance for Existential-Phenomenological Forces “Assisting with basic needs, with an intentional caring con-
- Phenomenology describes data of immediate situation that sciousness, administering ‘human care essentials,’ which
help people understand phenomena in question potentiate alignment of mind body spirit, wholeness, &
- Existential psychology is science of human existence that unity of being in all aspects of care”
uses phenomenological analysis, which Watson considers
difficult to understand (includes to provide a thought-
provoking experience, leading to better understanding of
self & others)
- nurses have responsibility to go beyond carative factors &
facilitate patients’ development in health promotion through “Opening & attending to spiritual-mysterious & existential
preventive health actions, accomplished by teaching patients dimensions of one’s own life-death; soul care for self &
personal changes to promote health, provide situational one-being-cared for”
support, teach problem-solving methods, & recognize coping
skills & adaptation to loss
 INTRODUCTION GRADUATE EDUCATION ERA
- developed w/ research era; transition from vocation to profession
Nursing Theory - nursing Master’s programs emerged to meet public need for specialized
- geared on realizing & restoring patient’s biophysical wellbeing & clinical nursing practice
- explains Science & Art of Nursing (melting pot of knowledge, creeds, Concepts: 1. Concept development 3. Early nursing theorist
backgrounds of care collected & preserved) 2. Nursing models 4. Knowledge development process
- nursing actions focus on restoring clients’ whole being - Baccalaureate degree gained wider acceptance as:
- core: grounded w/ scientific truth to provide safe & quality
a. Educational level for professional nursing
b. Academic discipline in higher education
Theory
- explains person’s manifestation - Nurse researchers develop & clarify specialized body of nursing knowledge
- acceptable general principle to explain phenomena procedure followed w/ following goals:
Phenomena- actions that can be seen a. Improving quality of patient care
Theory of Nightingale - core of practice; restore towards near maximal function of patient
- envisioned nurses as educated women; nursing would be open b. Providing professional style of practice
- strong emphasis on practice; worked throughout century toward c. Achieving recognition as a profession
development of nursing as profession - nursing practice to be based on nursing science based on debates
Nurse- holistic approach of care to patients - (Meleis, 2007) “ theory is not a luxury in nursing discipline of but an
- signs (seen by nurse); symptoms (by patient) integral part of nursing lexicon in education, administration & practice”
Doctor- diagnose & order medication actions; treat - important precursor was acceptance of nursing as profession & academic
discipline in its own right

HISTORY THEORY ERA

- began w/ Florence Nightingale - natural outgrowth of research & graduation education eras
- (1950’s) nursing profession leaders began discussing need to develop - emphasis on theory development & testing
nursing knowledge to guide nursing practice - accelerated due to recognition of early works developed as curricula
- Nursing as science nursing practice; based on principles & traditions framework & advanced practice guides
handed down through apprenticeship model of education & individual - Fawcett’s 4 global nursing concepts as nursing metaparadigm 
hospital procedure manual organizing structure for nursing frameworks & introduced way of organizing
- Nursing Practice is reflected: individual theoretical works in meaningful structure
Vocation- calling & passion; service by heart Metaparadigm Concepts:
Profession- monetary; academic knowledge; degree
Person- recipient of nursing care (client, patient)
CURRICULUM ERA Ex: Nightingale proposed that physical, intellectual, & spiritual being
of person isn’t capable of manipulating environment to promote health
- address question of what content nurse should study to be a nurse
- course selection & content for nursing programs; gave way to Research E. Environment- external/internal life aspects influencing a person
- (1930s) standardized curriculum (scope of nursing practice) - internal (emotions); external (noise, surroundings)
Ex: Nightingale focused on ventilation, warmth, noise, light, cleanly
CHED  Technical Committee on Nursing Edu. (regulate nursing crclm)
Past: Hospital-based diploma Present: College & University Health- holistic degree of wellness/illness a person experience
GN (Graduate Nurse)  BSN  Masters’  Doctorate
Ex: Nightingale believed nursing’s goal should promote client’s health
Nursing- interventions/actions of nurse on providing care
Actions: Dependent – no medical order; sound judgment from nurse
Independent- require direction
Interdependent/Collaborative- nurse + medical practitioners
RESEARCH ERA
- focused on research process & acquire substantive knowledge to guide
nursing practice; must be aligned w/ profession/practice
- research courses were included in nursing curricula
- (mid-1970s,) nursing studies lacked conceptual connections &
theoretical frameworks, accentuating need for the development for - clarified & improved knowledge comprehension development by positioning
specialized nursing knowledge theorists’ works in larger context, helping growth of nursing science
- awareness for need of concept & theory devt coincided w/ 2 milestones:
- (20th century) emphasis shifted from learning about theorist to use of
1. Standardization of curricula for nursing master’s education by theoretical works to generate:
National League for Nursing accreditation criteria for baccalaureate a. Research questions c. Organize curricula
& high-degree programs b. Guide practice
2. Decision that doctoral education for nurses should be in nursing - (Kuhn’s, 1970)-observation of nursing theory dev’t progress bring description
Nurse Leaders- embraced higher education of normal science to life
Research- from assumptions in past; answer questions from practice a. His philosophy of science clarifies understanding of evolution of nursing
theory through paradigm science.
3 areas: Nursing Education (academe); Nursing Practice, Research
b. Need to understand that what we view collectively today as nursing
models & theories is work of who originally published their ideas &
conceptualization of nursing
- Theory development emerged as process & product of professional
scholarship & growth & sought higher education among:
a. Nurse leaders c. Educators (academic)
b. Administrators (head) d. Practitioners
 Leaders recognized theory limitations from other disciplines to
describe, explain, predict nursing outcomes
 labored to establish scientific basis for nursing curricula, practice,
research & management

NURSING THEORY ERA

- use of theory to convey organizing structure & meaning for processes to
convergence of ideas
- (Fitzpatrick & Whall, 1983) “Nursing is on a brink of exciting new era”

THEORY UTILIZATION ERA

- emphasized theory application in nursing practice, research, education &
administration; produce evidence for professional practice
- restored balance between research & knowledge development in nursing

Theoretical Work Types:

Nursing Philosophy
- sets forth meaning of nursing phenomena through analysis, reasoning,
logical presentation
- contributed to knowledge development by providing directions or a basis
for subsequent development
Nursing Conceptual Methods
- nursing works by theorist (pioneers in nursing)
Nursing Theory
- from nursing philosophies, conceptual models/abstract nursing theories SIGNIFICANCE OF NURSING THEORY
- developed from conceptual framework; more specific than framework Discipline- cognitive/knowledge domain; academia
- theories may be specific to particular aspect/setting of nursing practice - rule/system governing a conduct/activity
Middle Range Theory Profession- application of theory knowledge; action/practice-based
- more specific focus & concrete than nursing theory in abstraction level - found upon theoretical structure of science/knowledge of abilities
- more precise; focus on answering specific nursing practice questions - principal calling, vocation, employment
- address specifics of nursing situations within model/theory perspective Why is it important for nursing profession  basis for nursing knowledge
Factors:
age group of patient health condition action of the nurse Significance for Discipline
family situation patient location - “discipline is dependent on theory for its continued existence”
- functional focus (nurse action) to patient focus (nurse knowledge)
Forms of basis in recognizing nursing as discipline:
a. Knowledge of person b. Health c. Environment
- every discipline includes theoretical knowledge
- Nursing as academic discipline depends on existence of nursing knowledge
Batey (1977)
- called attention to importance of nursing conceptualization in research
process & role of conceptual framework for science production
- led into theory development era, moving nursing toward goal developing
nursing knowledge to guide nursing practice
Fawcett (1978)
- double helix metaphor on interdependent relationship of theory & research
Henderson, Nightingale, Orlando, Peplau & Wiedenbach
- relevant nature of their earlier theoretical writings developed by educators
as frameworks to structure curriculum content/guide course content
Orlando’s (1961, 1972)
- derived from early nationally funded research project to study nursing
Donaldson & Crowley (1978) Concept- idea, belief, notion, thought, perception, impression
- reopened discussion of nature of nursing science & nature of knowledge for - building blocks of theories
discipline & profession - enhances one’s capacity to understand phenomena as it
- classic reference in recognizing difference between discipline & profession helps define meaning
- discipline & profession are inextricably linked; failure to recognize & Types: Abstract- indirectly observed; independent on time & place
separate them anchors nursing in vocational than a professional view - love, care, freedom
- Nursing conceptual frameworks were used to organize curricula in nursing Concrete- directly observed; specific to time & place
programs; recognized as models that address nursing values & concepts
Proposition- explains relationships of different concepts
Ex: Children don’t want to stay in hospital due to fear of injections.
Significance for Profession Definition- convey general meaning
- Theory is essential for existence of nursing as academic discipline; vital to - reduces vagueness in understanding set of concepts
practice of professional nursing; Higher degree nursing = profession Assumption- specifies relationship/connection of factual concepts/ phenom
- emphasize relationship of nursing theoretical works & profession achievement Ex: All patients not able to take care of themselves need nurses.
- use of substantive knowledge for theory-based evidence for nursing  qualityPhenomenon- fact/occurrence that can be observed
- commitment to theory-based evidence for practice  guides systematic, - notable; excites people’s interest & curiosity
knowledgeable care Philosophy- beliefs/values about humans & their world
Criteria for development of professional nursing status: - concerned w/purpose of life, nature of being &reality, theory &
1. Utilizes in its practice a well-defined &organized body of specialized limits of knowledge
knowledge that’s on intellectual level of higher learning. Concept, Proposition,
Assumption Definitions
 Theory  Phenomena
2. Constantly enlarges body of knowledge & improves educ. Techniques
& service through scientific method.
3. Entrust practitioners’ education to institutions of higher education THEORY
4. Applies body of knowledge in practical services for human & social welfare. Characteristics
5. Functions autonomously in formulation of professional policy, in control 1. of Can correlate concepts to generate a way of looking at fact/phenomenon
professional activity.
2. Must be logical in nature
6. Attracts individuals w/ intellectual & personal qualities of exalting service - Interrelationships of concepts must be sequential & consistently used
above personal gain who recognize chosen occupation as life work. within theory
7. Strives to compensate its practitioners by providing freedom of action, 3. Should be simple but generally broad in nature
opportunity for continuous professional growth, economic security. - Parsimonious  simple terms that describe/explains/predicts phenomena
Styles (1982) 4. Can be source of hypotheses that can be tested for it to be elaborated
- Described distinction of collective nursing profession & individual 5. Contribute in enriching general body of knowledge through studies
professional nurse; called for internal developments for new endowment implemented to validate them
based nursing ideas & beliefs 6. Can be used by practitioners to direct/enhance their practice
- profession needed new, positive approach for future that was devoid of 7. Consistent w/ other validated theories, laws, principles but will leave
past problems, if progress in professional development was to continue open unanswered questions that need to be tested

Nursing theory is a tool for: Types

a. Reasoning b. Critical Thinking Descriptive/Factor Isolating Theories
c. Decision-making for quality nursing practice - to know properties & workings of a discipline
- don’t explain relationship of concepts
Explanatory/Factor Relating Theories
TERMINOLOGIES - examine how properties relate & thus affect discipline
Predictive/Situation Relating Theories
Science- latin scientia (“knowledge”) - calculate relationships between properties & how they occur
- systematically organized body of knowledge about a subject
Prescriptive/Situation Producing Theories
- performing process of observation, description, experimental, - identify under which conditions relationships occur
investigation, & theoretical explanation of natural phenomenon
Knowledge- general awareness, understanding; possession of information, Components
facts, ideas, truths, principles Context- environment to which nursing act occur
- info, skills, expertise acquired by person through experiences/ Content- subject of theory
formal/informal learning Process- method by which nurse acts in using nursing theory
Sources: Traditional- nursing practice passed down in generations Nursing Theory & Models
Authoritative- idea by person/authority perceived as true due to - provide info on: definitions of nursing & nursing practice
his/ her expertise : principles that form basis of practice
Scientific- from scientific method through research : goals & functions of nursing
Theory- organized system of accepted knowledge composed of concepts, - derived from concepts; based on nursing metaparadigm
propositions, definitions, assumptions to explain fact/event/phenomena.Nursing Metaparadigm- pattern/model used to show clear relationship among
- group of related concepts that propose actions that guide practice existing nursing theoretical works
Metaparadigm- (Greek) Meta (“with”); Paradeigma (“pattern”) FLORENCE NIGHTINGALE (ENVIRONMENTAL THEORY)
- main concepts encompassing subject matter & scope of discipline
Theory basis: interrelationship of healthful environment w/ nursing
- organizing conceptual/philosophical framework of discipline/profession
- defines & describes relationships among major ideas/values - external conditions prevent, suppress, contribute to disease/death
Theory goal: nurse help patients retain their own vitality by meeting their
basic needs through control of environment
Nursing focus: environment control for individuals, families, communities

Types of Environment:
Physical- affects all other environment aspects
- environment cleanliness related directly to disease prevention &
patient mortality
Psychological- provide positive stress-free surrounding
- affected by negative physical env., causing stress
- communication w/person, about person, about other people
Social- collecting data about illness & disease prevention
Importance of Nursing Theory - person’s home/room, total community that affect’s patient’s env.
- helps to decide what nurses know & need to know - stress-free surroundings
- better patient care, enhanced professional status, improved Major Components of Healthful Environment
communication between nurses
1. Proper ventilation 3. Sufficient warmth 5. Effluvia control
- guides nursing research & education
2. Adequate Light 4. Noise Control
Purpose if Nursing Theory
Nightingale’s 13 Canons
Research:
Ventilation & Warmth- body & room temp, foul odors, air must be pure
a. Offers framework for generating knowledge & new ideas
Light- create & implement adequate light (sunlight)
b. Assist in knowledge discovery in specific field of study
c. Offer systematic approach to identify questions for scaling, variables Cleanliness- free from dust, dampness, dirt
selection, interpretation of findings Health of Houses- pure air, pure water, efficient drainage, cleanliness, light
- remove garbage, stagnant water
Clinical Practice:
Noise- avoid startling noise; keep noise to minimum; avoid whispering
a. Assist nurses to describe, explain, predict experiences
Bed & Bedding- keep it dry, wrinkle-free, lowest height for comfort
b. Guide nursing care assessment, implementation, evaluation
Personal Cleanliness- keep patient dry/clean; assess patient’s skin integrity
c. Provide rationale for collecting reliable/valid data about clients’ health
status for effective decision-making & implementation Variety- diversional therapy (puzzles, flowers, books, cards)
d. Helps establish criteria to measure quality of nursing care. - encourage relatives to engage in stimulating activity to avoid boredom
e. Build common nursing terms in communicating w/other health programs Chattering Hopes & Advices- fact-based; avoid personal talk
f. Assist in clarifying beliefs, values, goals Food- preferences/restrictions; client always has food/drink to enjoy
g. Define unique contributions of nursing care to clients Taking Food- check client’s diet; record food & fluids ingested in every meal
h. Enhance autonomy in nursing Petty Management- ensures care continuity
- record care plan & evaluate outcomes to ensure continuity
Nursing Education:
Observation of the Sick- observe client’s env.; make changes if needed
a. Provide general focus for curriculum design
b. Guide curricular decision making Metaparadigms acc. to Nightingale
Person- “patient”; human w/ reparative powers acted upon by nurse/
Research/Theory/Practice Cycle affected by environment
- recovery is in patient’s power
Relationships
Environment- external conditions/forces affecting life & development
Theory & Research- Research validates & modifies theory
- nurse’s appropriate aura; proper nurse-patient interaction
- Theory stimulates exploration
- nurse must uplift patient’s social status by improving living conditions
Theory & Practice- Theory guides practice & provide insights about nursing
- person’s food to nurse’s verbal/nonverbal interactions w/ person
practice situations
- Practice shapes theory Health- maintain well-being using patient’s powers to fullest extent
Research & Practice- Research develops practice - disease: reparative process instituted by nature when patient didn’t
attend to health concerns
- nurse must help client through healing process
Nursing- provide basic essentials (air, light, warmth, diet, cleanliness)
- facilitate reparative by ensuring best possible environment
- nurse influences env. To affect health

Nightingale’s Assumptions
1. Nursing is separate from medicine.
2. Nurses should be trained.
3. Environment is important to nursing.
4. Disease process isn’t important to nursing.
5. Nursing should support environment to assist patient in healing. Proficient
6. Research is utilized by observation & empirics to define nursing discipline. - perceive situation as whole than in terms of aspects
7. Nursing is empirical science & art - guided by maxims (cryptic instructions that make sense only if there’s
8. Nursing’s concern is w/ person & environment. already deep understanding of situation; fundamental truth)
9. Person is interacting w/ environment. - recognize salient aspects; intuitive grasp of situation based on understanding
10. Sick & well are governed by same health laws. - increased confidence in knowledge & abilities
11. Nurse should be observant & confidential - recognition & implementation of skilled responses to situations
- key word: perception (3-5 years experience in same area)
Expert
PATRICIA BENNER (FROM NOVICE TO EXPERT THEORY) - no longer relies on analytic principle (rule, guideline, maxim) to connect [
understanding of situation to appropriate action
Metaparadigms acc. to Benner:
- operates from deep understanding of total situation
Person- “self-interpreting being, person doesn’t come into world predefined but
- intuitive grasp of problem w/o losing time
gets defined through living a life”
- immediately continue management based on diagnostics
Major aspects of understanding person deals with: - qualitative change: nurse knows patient as a whole (patterns/responses)
1. Role of Situation 3. “ of Personal Concerns - focus on patient’s actual concerns & needs (5+ years experience)
2. “ of Body 4. “ of Temporality
Key aspects: Demonstrate clinical grasp & resource-based practice
Health- what can be assessed Possess embodied knowledge
- well-being (human experience of health/wholeness) Seeing big picture
- illness (human experience of loss/dysfunction) Seeing the unexpected
- disease (what can be assessed at physical level)
7 Domains of Nursing Practice
Environment- situation (suggests social environment w/social meaning
 person’s engagement, interaction, interpretation, understanding about
1. Helping role
situation (person enters situation w/their own meaning) 2. Diagnostic client-monitoring function
3. Effective management of rapidly changing situations
Nursing- caring relationship; enabling condition of connection & concern”
- care & study of lived experience of health, illness, disease as well as 4. Administer & monitor therapeutic interventions & regimens
their relationship 5. Monitor & ensure quality health care practices
- clinical practice; nurse give care based on skill & experience 6. Organizational & work-role performance
7. Teaching/coaching function
Benner’s Stages of Clinical Competence

Novice
- no experience of situations they’re involved
- learn context-free rules to guide action (stimulus-response thinking)
- difficulty in discerning what’s relevant, priority, etc.
- rule-governed behavior; inflexible
Advanced Beginner
- demonstrate marginally acceptable performance
- can identify recurring meaningful situations & apply these in new situation
- goal: task completion; unable to see entirety of new situation
- feel more responsible in patient care but still rely on mentors
- clinical situations are viewed as test of abilities & its demands be placed on
them rather than in terms of patient needs & responses
Competent
- consistency, predictability, time mngmnt is important in competent
performance
- sense of mastery is acquired through planning & predictability
- increased efficiency; focus on time management & task organization than
timing in terms of patient needs (2-3 years experience)
- critical stage (nurse recognize patterns; identify prioritization)
 MARTHA ROGER (SCIENCE OF UNITARY HUMAN BEING) Nursing Education
- emphasize on understanding of patient & self, energy f., environment
- focus on concepts & principles of homeodynamics:
- training focuses on teaching non-invasive modalities (therapeutic touch,
Homeodynamics- balance between dynamic life process & env
meditation, humor, regular in-service edu. program)
Roger’s Assumptions Nursing Research
1. Human is a whole which can’t be viewed as subjects - Rogerian theory is testable & applicable in research
2. Human’s life process is irreparable & one way (birth to death)
Nursing Process acc to Theory
3. Health & illness are life process’ continuous expression
1. Pattern Appraisal
4. Energy flows freely between individual & environment
- inclusive assessment of human & env energy fields, energy f. organization,
5. Human possesses ability to think, imagine, sense, feel, & use language for
& identification of areas of dissonance
expression
- nurse validates entire appraisal along w/ client
6. Humans have ability to adapt acc to new changes in env
7. All humans are viewed as integral part of universe 2. Mutual Patterning
- proper patterning of energy f. between human & env
8. Humans & environment have energy field; nursing action is directed
towards patterning & maintaining energy fields - mutual interaction between client & nurse
- done by suggesting alternatives, educating, empowering, encouraging
4 Concepts of Homeodynamics (depend on client’s condition & needs)
Energy Fields- inevitable; energy can freely flow between human & env - nutrition appraisal, rest & sleep, exercise, discomfort, relation w/others
Openness- no boundary that inhibits energy flow between human & env, - patterning activities (therapeutic touch, meditation, humor, imaginery)
leading to continuous energy movement/matter
3. Evaluation
Pattern- energy field’s distinguishing character - done by repeating pattern appraisal after mutual patterning to determine
Pandimensional- undeviating field not constricted by space/time extents of dissonance & harmony
- infinite domain w/o boundary

Principle of Homeodynamics  help view human as unitary being Martha Elizabeth Rogers
- born May 12, 1914 (Dallas, Texas); died March 13, 1994
Integrality
- (1936) nursing diploma in Knoxville General Hospital School of Nursing
- energy fields are dynamic & constantly interact w/ human & env, affecting
our env (vice-versa) - (1937) BS from George Peabody College
- (1945) MA public health nursing supervision in Teachers College, Columbia Uni
- where meditation & humor works to produce positive env
- (1952) MPH & (1954) ScD from Johns Hopkins University
Resonancy - formed Society of Rogerian Scholars & published Rogerian Nurs. Science News
- ordered arrangement of rhythm characterizing human & env fields - American Nurses Association Hall of Fame (posthumous) (1996)
- constant change in e. field’s way/pattern from lower to higher frequency
- energy movement is made by human touch, guided imagery activities,
drawing, storytelling (imagination)
Heliecy
- any minute change in env leading to ripple effect, results to larger changes
in other field
- change is constant & unpredictable; many factors interact & cause change

Metaparadigms acc to Roger

Person- unitary human b. is open system that continuously interact w/ env
Environment- entire energy field other than a person
- energy f. are irreducible, not limited by space/time, identified by its
pattern & organization
Health- not clearly defined by Roger
- determined by interaction between energy fields (human & env)
- bad interaction/misplacing of energy leads to illness
Nursing- science & art; maintains energy f. which is conducive for patient
- directs interaction of person & env to maximize health potential

Theory Applications
Clinical Practice
- nursing action is focused on unitary human b. & change energy field
between human & env
- nursing interventions include noninvasive actions (guided imaginary,
humor, therapeutic touch, music) to increase human’s potential
- prioritize on pain mgmt, supportive psychotherapy, human rehabilitation
 - brings scientific, problem-solving approach to nursing care
MARGARET JEAN WATSON (PHILOSOPHY & SCIENCE OF CARING) 7. Promotion of interpersonal teaching-learning
- gives client maximum health control to provide info & alternatives
Caring- immeasurable; promote self-actualization; caring > curing
- distinguish caring from curing by assigning health responsibility to client
- focus: Promotion of health (holistic approach) - enables client to provide self-care by deciding for themselves
“Caring is central in nursing practice, therefore better than curing”
8. Provision for supportive, protective & corrective mental, physical,
Metapradigms acc to Watson sociocultural & spiritual environment
Person- valued, respected, nurtured, understood, assisted - assess & facilitate client’s coping abilities to support & protect mental &
- viewed acc to client’s development physical wellbeing
5 Conditions of Caring: Awareness & knowledge of one’s needs for care - must understand person’s background/diversity by providing best env
Intention to act 9. Assisting w/ gratification of human needs
Positive change as a result of caring - address nurse’s & client’s needs
Underlying value & moral commitment - must meet lower-order needs before higher-order needs
Will to care Lev 1: Physiological Needs (food, warmth, water, rest
Environment- society w/influences; norm (values of how one behaves & 2: Safety N. (security, safety)
what goals one should strive) 3: Belongingness & Love N. (intimate relationship, friends)
- sensitive to client’s social, cultural, spiritual aspect 4. Esteem N. (prestige; accomplishment feeling)
Health- unity & harmony in mind, body & soul 5. Self-actualization (achieve full potential)
3 elements: higher level of overall physical, mental, social functioning 10. Allowance for Existential-Phenomenological forces
general adaptive- maintenance level of daily functioning - experiences shape one’s individual perceptions
absence of illness/presence of efforts that lead to its absence - leads to better understanding of oneself & others through performing
nursing process
Nursing- holistic health care
- human science of people & health-illness experiences by
professional, personal, scientific, aesthetic, ethical care transactions
MARGARET JEAN HARMAN WATSON, PhD, RN, AHN-BC, FAAN
Watson’s Major Assumptions - June 10, 1940 (West Virginia, USA)
1. Caring is demonstrated & practiced only Interpersonally - Lewis Gale School of Nursing, Roanoke, Virgina (graduated 1961)
2. Caring has carative factors resulting in human needs satisfaction - nursing educ & graduate studies at Univ. of Colorado
3. Effective caring promotes health & individual/family growth - baccalaureate degree in nursing (1964) at Boulder campus
- master’s in psychiatric–mental health nursing (1966) at Health Sciences campus
4. Caring env accepts person as he is & looks to what he may become
- doctorate in educational psychology & counseling (1973) at Graduate School,
5. Caring env offers development of potential while allowing person to
Boulder campus.
choose best action for himself/herself at a given time
- established Center for Human Caring at Univ of Colorado (nation’s 1st
6. Caring is more “healthogenic” than is curing. Caring integrates interdisciplinary center committed to using human caring knowledge for clinical
biophysical knowledge w/ human behavior knowledge to generate practice, scholarship, administration, & leadership)
/promote health & provide ministrations of sick
- found Board of Boulder County Hospice
7. Science of caring is complementary to science of curing.
8. Caring is central to nursing
10 Carative Factors
1. Forming Humanistic-Altruistic value system
- occurs early in life but can be influenced by nursing educators
- accomplished by examining one’s views, beliefs, interactions w/cultures
& personal growth experiences
- provides satisfaction through giving & extending oneself
2. Instillation of faith-hope
- nurse’s role in effective nurse-patient interrelationships & wellness
- accomplished by helping client adopt health seeking behaviors
(instinct/volunteer to seek care by himself) by positively using powers
of suggestion & supporting them
3. Cultivating sensitivity to self & others
- recognition of feelings leads to self-actualization through self-
acceptance for nurse & patient
- nurse become more genuine, authentic & sensitive to others
4. Development of helping-trust relationship
- establishes rapport & caring; expression of positive & negative feelings
- accomplished through congruence, empathy, nonpossesive warmth, &
effective communication
5. Promotion & Acceptance of Positive/Negative feelings expression
- sharing of feelings; being prepared for positive & negative feelings
- nurse = good listener
6. Systematic use of scientific problem-solving method for decision-making
- research, defining discipline & developing scientific knowledge base
 8. Promotion of human functioning & development.
DOROTHA E. OREM (SELF-CARE DEFICIT THEORY)
B. Developmental Self-care requisites
- address client’s self-care needs
- result from maturation; conditions (adjusting to change in body
- make clients perform self-care activities to live independently image/loss of a spouse)
- patients recover better when they maintain INDEPENDENCE to provide - promote maturation; prevent conditions deleterious to maturation
own self-care
C. Health Deviation Self-care requisites
Self-care need- goal-oriented activities set towards generating interest in
- result from illness or its treatment; seeking medical assistance, carrying out
client’s part to maintain life & health development
prescribed treatment; learning to live w/ effects of illness or treatment
Metaparadigms acc to Orem: - set standards to which degree of self-care demand is needed.
Person
- patient: functions biologically, symbolically & socially; has potential 2. THEORY OF SELF-CARE DEFICIT
for learning & development - why people can be helped through nursing
- subject to nature forces; capacity for self-knowledge; engage in deliberate Self-care deficit: arises when self-care agency can’t meet self-care requisites
action, interpret experiences & perform beneficial actions Helping Methods: Acting / doing for another
- can learn to meet self-care requisites Guiding & directing
Providing physical / psychological support
Health
Teaching
- Orem supports WHO’s definition: “state of physical, mental, social Provide & maintain env that supports personal development
wellbeing & not merely absence of disease or infirmity”.
- physical, psychological, interpersonal & social aspects (inseparable) 3. THEORY OF NURSING SYSTEMS
- health promotion & maintenance, illness treatment, complication - relationships must be brought about & maintained for nursing to be produced
prevention - series of actions nurse takes to meet patient’s self-care requisites
Environment Nursing Agency: established capabilities of nurse who can legitimately perform
- environmental factors, elements, conditions (external physical & activities of care for client.
psychosocial surroundings) & developmental environment (personal : helps person achieve their health care demand.
dev’t promotion through motivation to establish goals & adjust behavior Nursing Design: prof. functions performed by nurse in to meet client’s needs
to meet goals: formation/change in attitudes & values, creativity, self
: guideline of needed & foreseen results in nursing production
concept & physical development)
toward achievement of nursing goals
Nursing
3 Types of Nursing Systems:
- help clients establish/identify ways to perform self-care activities.
- actions geared towards client independence; - based on values - each system describes nursing responsibilities, nurse & patient roles,
rationales for nurse-patient relationship; types of actions to meet patient’s
- human service focusing on persons w/ inabilities to maintain continuous
self-care agency & therapeutic self-care demand
provision of healthcare
1. A wholly compensatory nursing system
3 related theories: - used when patient’s self-care agency is so limited that they depend on
1. THEORY OF SELF-CARE others for well-being
- why & how people care for themselves 2. A partly compensatory NS
Self- Care: activities one performs independently to promote & maintain - used when patient can meet some requisites but needs nurse meet others
personal well-being - nurse & patient have roles in performing self-care
Self- Care Agency: complex acquired ability of mature & maturing persons 3. Supportive – Educative NS
to know & meet their continuing requirements for - used when patient can meet requisites but needs assistance w/ decision
action to regulate their functioning & development Making, behavior control, knowledge acquisition skills
agent- engage in meeting person’s need; facilitate what’s been done
&needs to be done (nurse)
self-care agent- provides self-care (patient)
dependent care agent- person other than self-care agents (family)
Therapeutic SC Demand: activities to meet existing self-care requisites
: use of actions to maintain health & well-being,
: each patient’s demands varies in life
Self-care requisites/Needs: requirements one must meet & perform to
achieve well-being.
Categories
A. Universal Self-care requisites
- universally set goals done for person to function in healthy living
1. Maintenance of sufficient air intake
2. “ “ “ food intake
3. “ “ “ water intake
4. Provision of care associated w/ elimination
5. Maintenance of balance between activity & rest.
6. “ “ “ “ solitude & social interaction.
7. Prevention of hazards to human life, functioning, & wellbeing
 f. Reaction- outcomes of stressors; actions of line of resistance
BETTY NEUMAN (SYSTEMS THEORY) - depends on degree of reaction produced to adjust & adapt w/
situation
“Health is a condition in which al parts & subparts are in harmony w/ whole
Negentropy- towards stability/wellness (positive)
life of client”
Egentropy- “ disorganization of system, producing illness (negative)
FOCUS: Person as a complete system, subparts of which are interrelated
factors: g. Degree of Reaction- energy amount required to adjust to stressor
Physiological (basic needs) 3 Levels of Prevention
Psychological cognitive process towards env) 1. Primary- intervention before reaction occurs; performed when stressor is
Sociocultural (interaction/sensitive to people’s preference) suspected/identified
Spiritual- beliefs - strengthen capacity to maintain optimum level of functioning while
Developmental- age-related interacting w/env (health promotion/disease prevention))
- deals w/ stress & stress reduction; effects of stress on health 2. Secondary- after reaction occurs
Metaparadigms acc to Neuman - alleviate actual existing effects that altered health balance
Person- multidimensional (complex), dynamic (continuous) system - reduce env influences that leads to decline of functioning level &
strengthen/restore resistance after illness exposure
- individual, group, community
3. Tertiary- after system has been treated through secondary
- open system (interaction & reaction; exchange of info) working
together w/other parts as it interacts w/env - actual treatment/adjustment to strengthen person after being
exposed to illness
- basic core (genetic features; strength & weakness of system
parts), physiological, sociocultural, developmental, &
i. Reconstitution- adjustment state from degree of reaction
spiritual variables
- state of going back to actual health state before illness
Health- equated w/wellness; “condition in which all parts & subparts/
variables are in harmony w/ client’s whole
- continuum of wellness to illness that’s dynamic & changing
Environment- internal (within client) & external (outside) factors
that surround/interact w/person & client
Nursing- whole person (holistic approach), approach that considers all
factors affecting client’s health status
- unique profession concerned w/ all variables affecting person’s
response to stress

Systems Model in Nursing Practice

a. Client Variables- physio, psycho, sociocultural, spiritual, developmental
b. Lines of Resistance- internal resources/factors that help defend against
stressor (immune system)
- facilitate coping to overcome stressors in person 1. Person exposed to stress flexible LOD is alarmed to protect normal LOD to
c. Normal Line of Defense- state of stability/wellness/health keep system free from stressor reactors
- maintained overtime by lifestyle; standard to assess deviations 2. If person is continuously exposed to stress & flexible LOD can’t cope up
in usual wellness  normal LOD is altered; there will be threat to wall protecting person’s
- if stressor did enter, perform prompt diagnosis to prevent basic structure, causing instability of systems  ILLNESS
further complications
d. Flexible Line of Def.- protective barrier to prevent stressors from
breaking through normal line of defense
- dynamic; change rapidly over short time

BETTY NEUMAN
- born 1924; Lowell, Ohio
` - (1947) RN Diploma: Peoples Hospital School of Nursing, Akron, Ohio
- moved to Cali as hospital/staff/head/school/industrial nurse, CI in
medical-surgical, critical care, communicable disease
- (1972) model published in Nursing Research as “Model for teaching
total person approach to patient problems”
- developed model to teach introductory nursing course
- model based on philosophical views, Gestalt Theory, Hans Selye’s
e. Stressors- produce tension/alteration, causing instability in client Stress Theory, & General System’s Theory
Intrapersonal- within person (emotions, feelings)
Interpersonal – between persons (pressure on role expectation)
Extrapersonal- outside person (job/financial pressure)
 5. If transaction’s made in N-C int, growth & dev’t will be enhanced
IMOGENE KING (GOAL ATTAINMENT THEORY) 6. If role expectation & role performance perceived by N & C are
“Dynamic interpersonal relationship as person grows & develops to congruent, transactions will occur
attain goals” 7. If role conflict is experienced by N&C, stress in N-C interaction will occur
- nurse & patient mutual communication to establish goals & take action 8. If nurses w/ special knowledge & skills communicate appropriate info to
to obtain goals clients, mutual goal setting & goal attainment will occur
- nurse & patient are strangers coming together in health care org to
help/be helped to mutual state of health Metaparadigms acc to King:
Person- spiritual being (morality; ethics); capacity to think, know, make choices,
Goals: Nurse’s goal to patient ; Patient’s goal to oneself
select alternative courses
Central focus: MAN (dynamic; perceptions of object, person, events
- ability through language & symbols to record their history & preserve
influence his behavior, social interaction, health)
culture; open system in transaction w/environment
3 basic premises: Reactive- aware; responsive to stimuli - unique & holistic; intrinsic worth & capable of rational thinking &
Time-oriented- influenced by past actions decision making in most situations
Social- continuous exchange w/persons in env 3 fundamental health needs
- language is social link & facilitate interpersonal comm
1. Need for information (medical info)
3 Interacting Systems 2. “ “ care for illness prevention
PERSONAL- individual 3. “ “ total care when one have no capacity to help themselves
- how nurse view & integrate self-based from personal goal & beliefs Health- dynamic state in life cycle; illness (interference in life cycle)
Concepts: Individual’s Perception- representation of reality; unique - continuous adjustment to stress in int/ext. env using personal
Self- subjective env, value, idea, attitude, commitment resources to achieve optimal daily living
Growth & Dev’t- cellular, molecular, behavioral changes Environment- process of balance in int/ext interaction in social system
- predictable; dev’t milestones - from General Systems Theory as open system w/permeable
Body Image- body perception; reaction of others on their body boundaries allowing exchange of matter, energy, info
Space- immediate physical territory lived by person & behavior - promote chance to understand, learn, etc
Time- order of events & relationship to each other Nursing- help client identify existing health condition; exploring & agreeing on
activities promoting health
INTERPERSONAL- group; how nurse interrelates to coworker/patient
- nurse-patient relationship - promote health/prevent illness by health educ; maintain client’s self-worth
Concepts: Interaction- nurse relates & deals w/patient - palliative care (supportive care depends on client’s ability to reciprocate
Communication- indire/directly transmit info between persons - goal of nurse: Maintain health by health promotion & maintenance
Transaction- person & env interaction to attain goal; communicati Restoration & caring for sick & dying
Role- person’s expected behaviors in specific position & to
rules governing position & affect interaction between persons IMOGENE KING
Stress- positive/nega energy exchange between person & env - born in 1923, youngest of 3 children; died 2007
- (1946) St. John's Hospital School of Nursing, St Louis, Missouri
SOCIAL- society/organization (family, school, workplace, religious group)
- (1948) BS Nursing Education; (1957) MS in Nursing: St. Louis University
- nurse interact w/ coworkers, superiors, subordinates, client env
- (1961) EdD ; Postdoctoral in research design, statistics, computers:
- comprises: Social Roles, Behavior (prof. ethics), Practices (culture)
Teachers College, Columbia University, New York
Concepts: Organization- group w/similar interest who prescribed role &
Expertise: adult medical-surgical nursing
position; use resources to achieve personal/organiz. goal
Experience: administrator, educator, practitioner
Authority- observable behavior; provide guidance & order
- being responsible for actions
Power- ability to use resources to achieve goal
- means of influencing others
Status- person/group position; accomplished by duty/privilege
Decision-Making- from developing & acting on perceived
choices for goal attainment

Characteristics of Man
a. Ability to Perceive d. “ Choose between alternative course of action
b. “ “ Think e. “ “ Set goals
c. “ “ Feel f. “ “ Select means of accomplishing goals

Propositions of Theory
1. If perceptual accuracy is present in nurse-client interaction,
transactions will occur.
2. If nurse & client make transactions, goals will be attained
3. If goals are attained, satisfactions will occur
4. If goals are attained, effective nursing care will occur
 DOROTHY E. JOHNSON (BEHAVIORAL SYSTEM MODEL) LYDIA ELOISE HALL (CARE, CURE, CORE THEORY)
“Person experiencing a disease is more important than disease itself”
- aka Three Cs of Lydia Hall
- person is a behavioral system made of set of organized, interactive, - size of each circle varies & depends on patient’s state
interdependent, & integrated subsystems - emphasizes total patient than 1 part; depends
- Constancy is maintained by actions & behaviors regulated & controlled by on all 3 components working together.
biological (physio), psychological (mental/cognitive state), sociological
(interaction) factors
“To look at & listen to self is often too difficult
Focus: Monitor patient’s effective/effiicient behavioral functioning w/o help of significant figure (nurturer) who
(patterns, outcomes) before, during, after illness has learned how to hold up a mirror & sounding
board to invite behaver to look & listen to himself. If he accepts it, he will explore
Metaparadigms acc to Johnson concerns in his acts & as he listens to his exploration through nurse’s reflection, he may
Person- have 2 major systems: biological (physiological; survival needs) & uncover in sequence his difficulties, problem area, problem, & threat which is dictating
his out-of-control behavior.”
behavioral (patterned, repetitive, purposeful ways of behaving,
linking person to env) Metaparadigms acc to Hall
- strives to maintain steady state by adapting & adjusting to env forces Person/Individual- 16 y/o + older past acute stage of long-term illness (focus)
that cause imbalance - individual/person care recipient is energy source & motivation
- when imbalance/health problem occurs, physical, social, or rather than health care provider
psychological integrity is threatened - emphasize importance of person as unique, capable of growth
- lower resistance = disturb behavioral system = threaten integrity & learning, requiring total person approach

Health- affected by social, biological, psychological, physiological factors Health- state of self-awareness w/conscious selection of optimal behaviors
- persons strives to maintain stability in factors - emphasize need to help person explore their behavior meaning to
identify & overcome problems by dev’t of self-identity & maturity
Environment- consists of all factors not part of behavioral system, but
Environment- dealt related w/ person; conducive to self-development
influence this system
- nurse’s focus of action is individual, so any actions taken in relation to
- behavior is influenced by all events in env & varies in culture society/environment are for assisting individual attain personal goal
- can be manipulated by nurse to attain health goal Nursing- “participation in patient care’s care, core, & cure aspects CARE is
Nursing- external force acting to preserve organization of patient’s nurse’s sole function, CORE & CURE are shared w/other health team.”
behavior by imposing regulatory mechanisms/providing - care’s major is to achieve interpersonal relationship w/ person that
resources while patient is under stress facilitate core’s dev’t
- steady state is maintained by adjust & adapt to int & external forces
Subconcepts: The Circle
7 Subsystems CARE (Body) (“Intimate bodily care”)
1. Attachment/ Affiliative – most critical, basis for all social organization - circle represents nurse’s role; focused on task of nurturing patients
- promotes survival & provides sense of security - Nurturing: concept of mothering (care & comfort) & provide teaching-learning activities
- results in social inclusion, intimacy, form strong bond - defines prof nurse’s primary role to provide patient bodily care, helping them complete
basic daily biological functions, educating them
2. Dependency- promotes helping/nurturing behavior from others
- nurse & patient has opportunity for closeness. As closeness develops, patient can share
- results in approval, attention, recognition, physical assistance & explore feelings w/nurse.
3. Ingestive- food intake - when providing care, nurse’s goal is patient’s comfort
- relates to biological need for food & psychological meanings &
CORE (Person) (“Therapeutic use of self”)
structures of social events around food consumption
- patient receiving nurse care
- results in appetite satisfaction
- has goals set by oneself than by others & behaves acc to one’s feelings & values;
4. Eliminative- behavior around waste excretion from body involves therapeutic use of self, shared w/health team
- psychological meanings & structures of socially acceptable - emphasizes patient’s social, emotional, spiritual, intellectual needs related to family,
behaviors for waste elimination institution, community, world
- helps patient verbally express feelings about disease process & its effects using
5. Sexual- behavior in procreation & sexual gratification reflective technique.
- psychologically & socially acceptable behaviors (courtship & mating) - through expression, patient can gain self-identity & develop maturity
- results in dev’t of sex role identity & sex role behavior
Reflective technique- used by nurse where they act as mirror to patient to help explore
6. Aggressive- behavior in self- protection & preservation self & society their feelings about current health status & lifestyle changes
- belief that aggression is learned & harmful; people & property Motivations- discovered by process of being aware of feelings experienced
must be respected & protected - w/ awareness, patient can make conscious decisions based on
7. Achievement- behavior in env manipulation to gain mastery & control understood & accepted feelings & motivation
over aspect of oneself/env
CURE (Disease) (“Seeing patient & family through medical care”)
- control is measured against standard of excellence - administer medication/treatment; shared by nurse w/ health professionals
- interventions/actions toward treating patient for illness he’s suffering
3 Functional Requirements of Humans
- nurse is an active advocate of patient
a. to be protected from noxious influences where person can’t cope
b. “ “ nurtured through input of supplies from env (factors)
c. “ “ stimulated to enhance growth & prevent stagnation
 Cognator S. - 4 cognitive-emotive channels: perceptual & info processing;
learning; judgment & emotion
ex: effects of prolonged hospitalization for 4 y/o child
CALLISTA ROY (ADAPTATION MODEL)
Control Process
Key Concepts stabilizer s. – similar to regulator; concerned w/ stability
- person is adapting in stable interaction w/ internal/external env innovator s. - similar to cognator; “ “ creativity, change, growth
- person’s major task is to maintain integrity in facing stimuli.
DEFENSE MECHANISM- unconscious (projection- blaming others for one’s anxiety)
INTEGRITY- degree of wholeness achieved by adapting to need changes
SYSTEM- set of parts connected to function as a whole by virtue of Adaptation Level
interdependence of its parts
INTEGRATED- structures/functions are working as whole to meet human needs
employs feedback cycle of:
ex: Stable process of ventilation, breathing (exchange air between lungs & atmosphere
Input- stimuli coming from environment/within person
COMPENSATORY- cognator & regulator are activated by challenge/stimulus
Throughput- uses person’s:
ex: grieving, role transition
processes (control mechanism used as adaptive system)
effectors (physiologic function (automatic), self-concept, role function COMPROMISED- result from inadequate integrated & compensatory life
in adaptation) processes; adaptation problem
ex: Hypoxia, ventilatory impairment, unresolved loss, abusive relationship
Output- system’s outcome, person’s behaviors (if system is a person)
adaptive response- promote integrity in human system’s goal
Adaptive Modes
of adaptation
ineffective “ – don’t contribute to integrity “ “ “ - behavior categories to adapt to stimuli; determine person’s adaptation level
- identify adaptive/ineffective responses by observing person’s behavior in
Metaparadigms acc to Roy: relation to adaptive modes
Person- recipient of nursing care; main focus of nursing 1. PHYSIOLOGICAL- survival; response as physical being to stimuli from env
- biopsychosocial being in constant interaction w/changing env - goal: Physiological Integrity
- open adaptive system who use coping skills (cognator, regulator) to 5 Physiologic needs: oxygen, nutrition, activity & rest, elimination & protection
deal w/ stressors
4 Complex Processes: senses; fluids, electrolytes & acid-base balance;
- people as individual/group (famiy, org, community, nation, society) neurologic function; endocrine function
Environment- conditions, circumstances, influences that surround & affect
person’s dev’t & behavior 2. SELF-CONCEPT/GROUP IDENTITY MODE
- internal & external, provide input in form of stimuli - focus specifically on human system’s psychological & spiritual aspects
Health- Roy: “health-illness continuum; health & illness as inevitable 2 components: physical self (body sensation & body image)
dimension of person’s life” personal “ (self-consistency, self-ideal, moral ethical spiritual self)
- process of being & becoming integrated & whole person.
- reflection of adaptation (interaction of person & env) GROUP IDENTITY- how people in groups perceive themselves
- goal: Psychological Integrity
Nursing- science & practice that expands adaptive abilities & enhances
person & env transformation
3. ROLE FUNCTION MODE- role is set of expectations about person’s behavior in a
- Roy’s goal of nursing: promotion of adaptation in each of 4 modes, position towards a person of another position
contributing to health, quality of life, & dying w/dignity
- roles are carried out w/instrumental & expressive behaviors
- goal: Social Integrity
Types of Stimuli (Helson, 1964)
FOCAL- int/external stimulus primarily/ immediately confronting person person performs ff roles:
- attracts most attention Primary- determines majority of behavior by person in particular period of life
ex: (smoker) addiction to smoking Secondary- person assumes to complete task associated w/ developmental
stage & primary role
CONTEXTUAL- all other stimuli in situation that strengthens/contribute
effect of focal stimulus Tertiary- related to primarily to secondary roles; persons meet their role
ex: gratification, relaxation associated obligations (civic/organizational roles)

RESIDUAL - affect focal stimulus but effects are unclear 3. INTERDEPENDENCE MODE- focus on close relationships between significant others
ex: perceived increase masculinity, body image, etc - result to sense of belongingness
 3 stimuli act together & influence adaptation level (ability to respond - goal: Affectional Adequacy
positively in a situation)
Goal of Nursing in RAM: Promote adaptation in each of 4 adaptive modes
Coping Mechanism & Control Process Person as Adaptive System: INPUT  Control Process  Effectors  OUTPUT
COPING MECHANISM- processes person uses for self-control (conscious)
- innate/acquired ways of interacting w/changing environment
NURSING PROCESS- problem-solving approach for gathering data, identifying
Innate CM- genetically determined/common to species
capacities &needs of human adaptive system, selecting & implementing
- genetically viewed as automatic process
approaches for nursing care, evaluation of outcome of care provided
Acquired CM- developed through strategies like learning
6 Steps:
categories:
Regulatory Subsystem- automatic response, neural, chemical, & endocrine 1. Assessment of Behavior- data gathering about person’s behavior as adaptive
system in each of adaptive modes
ex: increase in vital signs- sympathetic response to stress
observable behavior- vital signs; objective; signs
 non-observable b.- feelings; subjective; symptoms Person- man as organism living in unstable balance of a given system
Health-
2. “ “ Stimuli- stimulus: change in int/ext env that induces response in symbolizes
adaptive s. movement of personality & human processes directing
- focal, contextual, residual person towards creative, constructive, productive, community living
3. Nursing Diagnosis- statement formulation that interpret data about - for one’s health to be achieved & maintained, his needs must be met
adaptation on person status (behavior & most relevant stimuli) Environment- forces outside organism & in context of socially approved way
of living (norms, customs, beliefs)
4. Goal Setting- clear statements/design of behavioral outcomes
for nursing care which is realistic & attainable Nursing- significant, therapeutic interpersonal process (sequential nursing process)
- done together w/ client - relationship of person who’s sick & a nurse educated to respond to need
- achieve its goal by promoting patient’s skill development to deal w/ problems
5. Intervention- determination of how best to assist person in attaining
& achieve health
established goals
6. Evaluation- assess effectiveness of nursing intervention related to behavior Nursing Roles
after it was performed in comparison w/ goal established
a. Role of Stranger- nurse treat patient w/ utmost courtesy
- acceptance of patient as person & respect over his individuality
CALLISTA ROY b. Role of Resource Person- nurse provides specific answers to questions (health info,
- born 10/14/1939, LA, California advices) & simple explanation of healthcare
- (1963) BSN: St. Mary College, LA
c. Teaching Role- combination of all roles
- (1966) MA in Pediatric Nursing; (1977) Doctorate in Sociology: UCLA - give instructions & provide training; analysis & synthesis of experience
- 4 honorary doctorate from 4 institutions; nurse theorist & professor
d. Leadership R.- nurse as advocate for patient’s best interest & enable him to
- fellow in American Academy of Nursing (honorary nursing society that
make decisions over his care through cooperation & participation
elects nursing leaders annually)
Introduction to Nursing: An Adaptation Model e. Surrogate R.- nurse as substitute due to patient’s dependency for care (pediatrics)
Essentials of the Roy Adaptation Model - helps patient see differences between nurse’s role & actual relative
Theory Construction in Nursing: An Adaptation Model f. Counseling R.- greatest importance & emphasis in nursing
Essentials of the Roy Adaptation Model - strengthens nurse-patient relationship as nurse becomes a listening
Roy Adaptation Model: The Definitive Statemen friend, understanding family member, & gives sound & emphatic advises

HILDEGARD PEPLAU (THEORY OF INTERPERSONAL RELATIONS) FAYE ABDELLAH (21 NURSING PROBLEMS)
- based on psychodynamic nursing (understanding one’s behavior to help others
identify their difficulties) - theoretical statement can be created by utilizing her 3 chief concepts of Health,
Nursing Problems, & Problem Solving
Focus: PATIENT
- proposed that nursing is “utilization of problem-solving techniques w/ chief nursing
problems related to health requirements of clients.
- importance on problem-solving as medium for nursing problems as client is geared
in direction of health (outcome)
Phases of Nurse-Patient Relationship
a. ORIENTATION- defining phase; person felt need & seeks professional assistance Metaparadigms acc to Abdellah
- nurse helps patient recognize & understand problem & know help Person- nursing care recipient; family/individiuals
- patient exhibit trust & cooperation - has physical, emotional, sociological needs, helping these needs is nursing’s
- collaborative clarifying & defining of problem only justification
- Abdellah: typology of nursing problems evolve from recognition of need for
affecting factors:
patient-centered approaches to nursing
- capable of learning & of self-help to varying degrees
Health- center & purpose of nursing services; state excluding illness
- “total health needs” & “healthy state of mind & body”
- state where person has no unmet needs & no actual impairments
Environment- least discussed concept in Abdellah’s model
- atmosphere of a client’s room, home & community
b. IDENTIFICATION- patient relates w/ who can help them (self-belongingness)
Nursing- helping profession
- nurse help patient recognize his role
- strengthen positive forces in personality & provide satisfaction - all-inclusive service based on art & science disciplines that serves individuals
sick or well, cope w/ their health needs
c. EXPLOITATION- explore new avenues of health (patient must have full trust) - uses nursing process, a problem-solving approach
- patient moves on from dependent to independent role - use 21 nursing problems as guide from nursing care
- nurse project new goals to be achieved by personal effort (interview)
- power shifts from nurse to patient NURSING PROBLEM
d. RESOLUTION- after patient’s needs are met, therapeutic relations ends - condition presented/faced by client/family where nurse can offer assistance
- patient earns independence over his care as he gradually puts - health needs seen as problems: overt (obvious/seen) covert (unseen/masked)
aside old goals & formulates new goal - Abdellah: practice of competent nursing care in future is for nursing student to realize
- difficult phase that identifying & answering overt & covert problems is core of Nursing

Metaparadigms acc to Peplau: Typology of 21 Nursing Problems- identification & classification of problems
 Division: a. physical, sociological & emotional needs of patient Nursing- intentional assessment of comfort needs; comfort design interventions
b. types of interpersonal relationship between nurse & patient address needs;
c. common elements of patient care - reassessment of comfort levels after implementation compared w/baseline
- use nursing process; subj/objective

1. To maintain good hygiene & physical comfort Types

2. To promote optimal activity: exercise, rest, sleep
RELIEF- patient’s state who has its specific need met
3. “ “ safety through preventing accident, injury, trauma & spread of infection
EASE- state of calmness/contentment
4. To maintain good body mechanics & prevent & correct deformity
TRANSCENDENCE- where one rises above one’s problem/pain
5. To facilitate maintenance of oxygen supply to all body cells
6. “ “ “ of nutrition of all body cells Context
7. “ “ “ of elimination. PHYSICAL- bodily sensations (verbalization, expression)
8. “ “ “ of fluid & electrolyte balance PSYCHOSPIRITUAL- internal self-awareness (self-esteem, beliefs)
9. To recognize body’s physiological responses to disease conditions ENVIRONMENTAL- external surroundings, condition, influence
(pathological, physiological & compensatory) SOCIAL- interpersonal, family, societal relationship (communication/interaction)
10. To facilitate maintenance of regulatory mechanisms & functions
11. “ “ “ of sensory function. Taxonomic Structure of
12. To identify & accept positive & negative expression, feelings & reactions.
Comfort
13. “ “ “ interrelatedness of emotions & organic illness
14.To facilitate maintenance of effective verbal & nonverbal communication.
15. To promote development of productive interpersonal relationships
16. To facilitate progress toward achievement & personal spiritual goals
17.To create/maintain a therapeutic environment
18.To facilitate awareness of self as individual w/ diff physical, emotional &
developmental needs
19. To accept optimum possible goals in light of limitation, physical & emotional
20. To use community resources as aid in resolving problems from illness
21. To understand social problems’ role as influencing factors in illness’ cause

PROBLEM SOLVING Major Concepts

- process of identifying overt & covert nursing problems
HEALTH CARE NEEDS- arose from stressful health care situations that can’t be met by
- interpreting, analyzing, & selecting appropriate actions to solve problems recipient’s traditional support system
- steps resemble pace of Nursing process of Assessment, Diagnosis, Planning,
COMFORT INTERVENTION- nursing actions to address specific comfort needs (in/dependent)
Implementation, & Evaluation
INTERVENING VARIABLES- interacting forces influence patient’s perceptions of total comf
Process: 1. Identifying problem 5. Revising hypo on basis of - can’t be controlled; hinder/strengthen
2. Selecting relevant data conclusions from data
COMFORT- state experienced by comfort intervention
3. Devising hypotheses
4. Testing hypotheses through data assessment HEALTH-SEEKING BEHAVIOR- outcomes of pursuit of health defined in nurse consultation
- synthesized by Schlotfeldt (1975), proposed to be int, external, peaceful death
BEST PRACTICES-use evidence-based healthcare interv. to produce best outcome
FAYE ABDELLAH INSTITUTIONAL INTEGRITY- possess qualities of being complete, whole, sound, appealing,
- born 3/13/1919, NYC ethical, sincere (corporation, community, hospital)
- (1942) Diploma in Nursing: Fitkin Memorial Hospital School of Nursing, BEST POLICIES- institutional/regional policies; protocol for procedures & medical conditions
Neptune, New Jersey - access & delivery of healthcare
- (1945) BSN; (1947) MA; (1955) EdD: Teacher's College, Columbia University,
NYC 4 Major Theoretical Proposition
- 1st nurse & 1st woman as Deputy Surgeon General of United States 1. Comfort is generally state-specific
- (2000) inducted into US National Women’s Hall of Fame in 2000 for 2. Outcome of comfort is sensitive to changes over time
contributions in Education & Nursing 3. Any consistently applied holistic nursing interv w/established history for effectiveness
- motivated to develop her typology by desire to promote comprehensive, client- enhances comfort over time
centered nursing care; used problem solving approach as basis for typology 4. Total comfort is greater than sum of its parts
- (1960) published typology of Nursing problems in Patient Centered Approaches
Major Assumptions
in Nursing
1. Humans have holistic responses to complex stimuli
2. Comfort of desirable holistic outcome germane to nursing discipline
KATHARINE KOLKABA (THEORY OF COMFORT) 3. Comfort is basic need which person strive to meet (active endeavor)
COMFORT- antidote to stressors in health care situations; fundamental 4. Enhanced comfort strengthens patient to engage in health-seeking behavior
- when enhanced, patients/families are strengthened 5. Patients empowered to engage in HS behavior are satisfied w/their healthcare
- enhanced by health-seeking behavior; 1st & last consideration 6. Institutional integrity is based on value system oriented to patients. Of equal
- nurses are more satisfied w/their care importance is orientation to health-promoting, holistic setting for family/care provider
Metaparadigms acc to Kolkata
Conceptual Framework of Theory
Person- patient; recipient of care; individual, family, community in need of health care
Health- optimal functioning as defined by patient/group
Environment- aspect of patient, family, institutional setting manipulated by nurse,
relatives, institution to enhance comfort
 Theory explains that nurse’s role is to find out & meet patient’s need of help
All patient behavior can be cry of help
Nurse’s job is to find out nature of patient’s distress & provide help they need

Acceptance of Theory Assumptions

PRACTICE 1. When patients are can’t cope w/needs on own, they are distressed by helplessness
- theory as guiding framework for studies (perioperative nursing, hospice, etc) 2. In its professional character, nursing adds to patient’s distress
3. Patients are unique & individual in how they respond
- when nurses ask patient/family to rate comfort 0-10 before & after intervention/at
regular intervals, they produce documented evidence that comfort work is done 4. Nursing offer mothering & nursing analogous to adult who nurtures child
5. Nursing practice deals w/people, env, & health
- used by Perianesthesia nurses into Clinical Practice Guidelines for comfort mngmt:
6. Patients need help communicating their needs; they’re uncomfy & ambivalent about
1. Assess comfort needs related to current surgery/pain issues dependency needs
2. Create comfort contract w/patient prior to surgery 7. People can be secretive/explicit about needs, perceptions, feelings
3. Facilitate comfortable positioning, temp, comfort factors during surgery 8. Nurse-patient situation is dynamic; actions & reaction influenced by nurse & patient
4. Continue comfort management & measurement post-surgery 9.People attach meanings to situations & actions that aren’t apparent to others
EDUCATION 10. Patients enter nursing care through medicine
11. Patient can’t state nature & meaning of distress w/o nurse or w/o them first having
- applied to role-model a supportive learning partnership w/students
established helpful relationship w/patient
- assist students to transform to professionals for comfort roles/lifelong learning
12. Any observation shared/observed w/patient is helpful in ascertaining & meeting
- used in any clinical setting facilitated by using Kolakaba’s Comfort Care Plans needs/finding out that they’re not in need at that time
- theory’s taxonomic structure & conceptual framework guided ways of being 13. Nurse is concerned w/patient’s needs unable to meet on their own
comforting faculty member
- help students by: Terms
1. Obtain relief from heavy coursework by helping questions to clinical problems DISTRESS- patient experience whose need hasn’t been met
2. Maintain ease w/curriculum by trusting faculty NURSING ROLE- discover & meet patient’s immediate need for help
3. Achieve transcendence from stressors through self-comforting techniques - patient’s behavior may not represent true need
RESEARCH - nurse validates their understanding of patient’s need
- nurse provide evidence to influence decision-making at institutional, community, NURSING ACTION- directly/indirectly provide for patient’s immediate need
legislative levels through studies demonstrating effectiveness of comforting care OUTCOME- patient’s behavior change indicating relief from distress/unmet need
- use taxonomic structure of comfort as guide; Kolkaba made General Comfort - observable verbally/nonverbally
Questionnaire to measure holistic comfort in hospital/community participants
- researchers make comfort questionnaires; verbal rating scales from Kolkaba’s Concepts
website where she responds to inquiries PROF. NURSING FUNCTION (Organizing Principle)
- finding out & meeting patients’ immediate need for help
- “nursing is responsive to persons who suffer helplessness; focused on process of care
in immediate experience”
IDA JEAN ORLANDO (NURSING PROCESS THEORY)
- concerned w/providing direct assistance to persons for purpose of avoiding, relieving,
- interrelated; allows nurse to formulate effective nursing care plan easily adapted diminishing, curing their helplessness (Orlando)
when there’s complexity comes up w/patient
- emphasizes reciprocal relationship between patient & nurse PRESENTING BEHAVIOR (Problematic Situation)
- emphasize critical importance of patient’s participation in nursing process - nurse must 1st recognize situation as problematic to find out immediate need for help
- patient’s presenting behavior may represent plea for help
- nursing as distinct profession & separated it from medicine where nurse as
determining nursing action than being prompted by physician’s orders, organizational - stimulus (patient’s present behavior) cause autonomic internal response in nurse &
needs, & past personal experience nurse’s behavior causes response in patient
- physician’s orders are for patients, not for nurses IMMEDIATE REACTION (Internal Response)
3 processes: person perceives using any of 5 sense organs as object
Metaparadigms acc to Orlando perceptions stimulate automatic thought
Person- human; emphasize individuality & dynamic nature of nurse-patient relationship each thought stimulate automatic feeling
- focus of nursing practice: humans in need
NURSING PROCESS DISCIPLINE (Investigation)
Health- sense of helplessness as initiator of necessity for nursing
- any observation shared & explored w/patient is useful in ascertaining & meeting his
- nursing deals w/persons who need help
need/finding out that he’s not in need at that time
Environment- completely disregarded; focused on patient’s immediate need - nurse doesn’t assume that any of her reaction’s aspect to patient is correct, helpful/
- relationship & actions between nurse & patient appropriate until she checks its validity in exploration w/patient
Nursing- unique & independent in its concerns for person’s need for help
IMPROVEMENT (Resolution)
- efforts to meet need for help are done in interactive situation & disciplined
- it’s not nurse’s activity that’s evaluated but its result: whether activity serves to help
manner that required proper training
patient communicate their need for help & how it’s met
Major Dimensions - in each contact, nurse repeats process of learning how to help patient
a. Nurse’s role is to find out & meet patient’s immediate need for help
Nursing Process
b. Patient’s presenting behavior may be plea for help; help needed may not be what it
appears to be 1. ASSESSMENT- nurse completes holistic assessment of patient’s needs
- done w/o considering reason for encounter
c. Nurses need to use perception, thoughts on perception, feeling endangered from
thoughts to explore patient’s behavior meaning 2. DIAGNOSIS- use nurse’s clinical judgment about health problems
d. This process help nurse find out nature of distress & what help patient needs - confirmed using links to defining characteristics, related factors, & risk
factors found in patient’s assessment
Goals
3. PLANNING- address each problem identified in diagnosis
1. Develop theory of effective nursing practice
 - each problem is given specific goal/outcome confidence for young mother, mouthpiece for those too weak/withdrawn to speak, &
- each outcome is given nursing interventions to help achievesogoal
on.”
4. IMPLEMENTATION- nurse begins to use nursing care plan
5. EVALUATION- nurse looks at patient’s progress toward goals set in nursing care plan
- changes can be made to plan based on patient’s progression to goals
VIRGINIA AVENEL HENDERSON (BASIC HUMAN NEED THEORY)
A. PHYSIOLOGICAL NOLA J. PENDER (HEALTH PROMOTION THEORY)
1. Breathe normally 6. Select suitable clothes (dress/undress) - each person has unique personal characteristics/experience affecting subsequent acts
2. Eat and drink adequately 7. Maintain body temp within by adjusting - health promoting behavior: desired behavioral outcome; endpoint in HP model
3. Eliminate body wastes clothing & modifying env : result in improved health, enhanced functional ability, better quality
4. Move & maintain desirable posture 8. Keep body clean, well groomed, protect skin of life at all dev’t stages
5. Sleep & rest 9. Avoid dangers in env; avoid injuring others - final behavioral demand influenced by immediate competing demand & preference,
B. PSYCHOLOGICAL which can derail intended health-promoting actions
10. Communicate in expressing emotions, needs, fears, opinions - health: positive dynamic state than simply disease absence
- health promotion: directed at increasing patient’s level of wellbeing
C. SPIRITUAL - person’s multidimensional nature as they interact within env to pursue health
11. Worship according to one’s faith - designed to be complementary counterpart to models of health protection
D. SOCIOLOGICAL - incorporate behaviors for improving health & applies across lifespan
12. Work in a way that there’s a sense of accomplishment Goal: Nurse assist in knowing & understanding major determinants of health behavior
13. Play/participate in recreation
Subconcepts
E. PSYCHOLOGICAL
PERSONAL FACTORS- biological, psychological, sociocultural
14. Learn, discover, satisfy curiosity that leads to normal dev’t & health; use available - predictive of given behavior; shaped by target behavior’s nature
health facilities
PERCEIVED BENEFITS OF ACTION- anticipated positive outcomes from health behavior
 Henderson emphasized need to view patient & his family as a single unit
“ BARRIERS TO ACTION- anticipated/imagined/real blocks & personal costs of
 For patient to achieve health, he must meet need for support system (by family)
understanding given behavior
Metaparadigms acc to Henderson: “ SELF-EFFICACY- judgment of personal capability to organize & execute HP behavior
Person- patient; require assistance to achieve health & independence/peaceful death ACTIVITY-RELATED AFFECT- subjective pos/neg feeling before, during, following behavior
- person & family viewed as a unit; mind & body are inseparable based on behavior’s stimulus properties
- must maintain physiological & emotional balance - influence perceived self-efficacy
- more positive subjective feeling = greater feeling of efficacy
Health- quality of life basic to human functioning
- requires independence & interdependence INTERPERSONAL INFLUENCE- cognition on others’ behavior, belief, attitudes
- its promotion is more important than care - norms, social support, modelling
- primary source: family, peers, healthcare providers
- maintained if they have necessary strength, will, knowledge
SITUATIONAL “ - situation’s personal perception/cognition that facilitate/impede behavior
Environment- not specifically defined; relationship w/family, community & its
responsibility for providing health care. COMMITMENT TO PLAN OF ACTION- intention & identification of planned strategy leads to
- Henderson: society wants & expects nurses to provide service for persons health behavior implementation
incapable of functioning independently IMMEDIATE COMPETING DEMANDS & PREFERENCES
Nursing- “unique nurse’s function is to assist individual, sick or well in performance of Competing Demands- alternative behaviors where persons have low control due to env
activities contributing to health/recovery/peaceful death; that they can contingencies (work/family responsibilities)
perform unaided if they had necessary strength, will, knowledge. To do this Competing Preference- exert relatively high control (choice of snack)
in a way that help him gain independence as rapidly as possible.” HEALTH-PROMOTING BEHAVIOR- endpoint/act outcome toward positive health outcome
- requires working interdependently w/ health care team - optimal wellbeing, personal fulfillment, productive living
- nurse functions independently of physician but uses latter’s plan of care to
provide holistic care Major Assumptions
 Nurse functions in relation w/patient, physician, & members of health team 1. Persons seek to actively regulate own behavior
2. Persons, in all their biopsychosocial complexity, interact w/env, progressively transforming
Nurse-Patient Relationship env & being transformed over time
a. Nurse as substitute for patient 3. Health professionals is part of interpersonal env, exerting influence on people
- making up for what patient lacks to be whole & independent again 4. Self-initiated reconfiguration of personal env interactive patters is for changing behavior
b. Nurse as helper to patient
14 Theoretical Assertions
- institute medical interventions to assist patient meet basic needs
1. Prior behavior & inherited/acquired characteristics influence belief, affect, & enactment of
c. Nurse as partner w/patient
HP behavior
- foster therapeutic relationship w/ patient; function as member of health care team
2. Persons engage in behaviors where they anticipate deriving personally valued benefit
Nurse-Physician Relationship 3. Perceived barriers can constrain commitment to action, mediator & actual behaviors
- nurses function independently from physicians 4. “ competence/self-efficacy to execute behavior increase likelihood of action
- plan of care must be implemented in a way that promotes physician’s prescribed commitment & actual behavior performance
therapeutic plan 5. Family, peers, healthcare providers are important sources of interpersonal influence that
increase/decrease commitment & engagement in HP behavior
Nurse as Member of Healthcare Team
6. Situational influence in ext env inc/decrease commitment/participation to HP behavior
- every member work interdependently
7. Greater commitment to plan of action=more likely HP behaviors maintained over time
- nurse works & contributes in carrying out total program of care
8. Plan of action commitment is less likely to result in desired behavior when competing
demands where persons have little control require immediate attention
“She is temporarily consciousness of unconscious, love of life for suicidal, leg of
amputee, eyes of newly blind, means of locomotion for infant, knowledge & 9. “ “ “ “ “ when other actions are more attractive & preferred over target behavior
 10. Persons can modify cognition, affect, interpersonal, physical env to create
WORLD
incentives
VIEW-foroutlook to form value perception about life/world around person
health actions Social Structure- culture’s organizational factors (religion, educ, economics) & how
these give meaning & order to culture
Environmental Context- totality of event, situation, experience that give meaning
to expression, interpretation & social interaction in physical,
ecological, sociopolitical, cultural settings

ETHNOHISTORY- past events/experience of cultures; people-centered

MADEILINE LEININGER (CULTURAL CARE DIVERSITY & UNIVERSALITY) - explain, interpret human lifeways within cultural trends
- defines theory differently from other theorists GENERIC (FOLK/LAY) CARE SYSTEM
- theory must consider cultural belief, caring, behavior, & values to provide effective, - culturally learned/transmitted; indigenous (traditional), folk (community/home-based)
satisfying, & culturally congruent nursing care knowledge & skills to provide assistive, supportive, enabling acts towards others
w/evident needs to improve lifeway/health condition (wellbeing) or deal w/handicaps &
Metaparadigms acc to Leininger: death situations
Person- human being; caring & can be concerned about desires, welfare, others’
continued existence PROFESSIONAL CARE SYSTEM
- although care is universal; ways of caring varies across cultures - formally taught/transmitted prof care, health, illness, wellness & related knowledge &
practice skills prevailing in professional institutions w/multidisciplinary personnel to give
Health- state of wellbeing culturally defined, valued, practiced service to others
- reflects persons’ ability to perform daily roles; health system, practice, pattern
Environment
Environmental Framework: totality of event, situation, experience giving meaning
to human expression, interpretation, social interaction on
physical, ecological, sociopolitical, cultural settings
CARMENCITA M. ABAQUIN (PREPARE ME THEORY)
Culture: groups & patterning of actions, thoughts, decisions occurring as result of
“learned, shared, & transmitted belief, norm, lifeways” - “PREPARE ME” interventions & Quality of Life of Advance Progressive Cancer Patients
Nursing- learning humanistic art & science focusing on personalized behavior, - framework on nonpharmacologic, non-surgical care approach to advanced cancer cases
function, process to promote & maintain health/recovery - nurse not seen as mere caregivers but facilitators of peaceful acceptance of condition

3 modes of nursing action Focus:assist patient explore humanity & internal serenity facing life & death than cure
- culturally-based, consistent w/client’s needs/values PRESENCE- during times of need; therapeutic communication, active listening, touch
- assistive, supporting, facilitative, enabling professional acts & decisions REMINISCE THERAPY- recall of past experiences, feelings, thoughts to facilitate adaptation
a. Cultural care Preservation / Maintenance to present circumstances
- help people w/culture to retain/preserve relevant care values to they can PRAYER- praying to God
maintain wellbeing, recover from illness, face handicaps/death
RELAXATION-BREATHING- encourage relaxation to decrease undesirable signs & symptoms
b. “ “ Accommodation / Negotiation
MEDITATION- relaxation to alter patient’s level of awareness by focusing on image/thought
- help those to adapt/negotiate w/others for beneficial/satisfying health outcome
to help inner sight which establish connection & relationship w/ God
w/prof care providers
VALUES CLARIFICATION- clarify values on health & illness to help effective decision making
c. “ “ Repatterning / Restructuring - patient develops open mind for disease state acceptance/enhance values
- help client change/modify lifeways for new, diff, beneficial healthcare pattern - helps one become internally consistent by achieving closer between what we
while respecting their cultural value & belief & providing beneficial/healthier do & what we feed
lifeway before changes were laid out
Metaparadigms acc to Abaquin:
About Theory
Person- patient in advanced stages of cancer; holistic being w/ physical, psycho, social,
- assumptions supporting her claim that “diff cultures perceive, know, & practice care religious, level of independence, & environmental aspects.
in diff ways, yet there’s commonalities among cultures in world”
- terminally-ill/incurable diseases must be approached in multifaceted care
Transcultural Nursing Model to improve quality of life
Transcultural Nursing- learned branch of nursing about comparative study & analysis Health- focus on illness (cancer) & provision of holistic care to improve life quality
of cultures as they apply to nursing & health-illness practice, belief, values despite terminal cases
- knowing & understanding culture w/respect to nursing & health-illness practice Quality of Life- multifaceted construct encompassing persons capabilities of
Goal: provide care congruent w/cultural values, beliefs, practices enriching life when it can no longer be prolonged.
- includes proper care & maintaining body integrity, mind, spirit
CARE- assist, support, enable behaviors that ease/improve condition
- diff meanings in diff cultures determined by examining person’s world view, Environment- not defined accurately; aspect/ dimension integrated to cancer patient
social structure, language Nursing- goal of care: quality of life improvement for advance stage cancer patients
CARING- actions/activities toward assisting, supporting, enabling person w/
evident/anticipated needs to improve condition to recover/face death
CULTURE- learned, shared, transmitted values, belief, norms, lifeways
- guides thinking, decisions, actions
- basis for cultural values which identify ways of thinking/acting
- values are held for long time & guide decision-making in culture
- exhibit diversity (perceive, know, practice care in diff ways) &
universality (care commonalities)
CULTURAL CARE- subjectively & objectively obtained value, belief, outline of lifeway
- assist, support, facilitate, empower others to maintain wellbeing,
health, & deal w/illness, handicaps, death
CC Diversity- diff belief, value, symbols of care within concepts related in
supporting, assisting human care (role of sick person)
CC Universality- similarities in cultures & reflect assistive ways to help
 Health- expressed in wellness/illness Nursing- expression of caring

Assumptions
Persons are caring by virtue of humanness; whole/complete in the moment.
knowing persons is process of nursing allowing for continuous appreciation of person
moment to moment.
echnology is used to know wholeness of persons moment to moment.
Nursing is a discipline & professional practice
SR. LETTY KUAN (RETIREMENT & ROLE DISCONTINUITIES THEORY) Technological Competency as Caring in Nursing
Retirement- require adjustments; a. Harmonious coexistence between technologies & caring in nursing.
- there are some roles that person has already learned to play for many years. b. Harmonization of concepts places practice of nursing within context of modern
- now that role has to be discontinued, there’s period of adjustment so person can healthcare & acknowledges that concepts can co-exist
adjust to another new role in life c. Technology brings patient closer to nurse. Technology increase gap of nurse & nursed
d. When technology is used to know persons continuously, process of nursing is lived
Basic Assumptions & Concepts:
PHYSIOLOGICAL AGE- endurance of cells/tissues to withstand wear-&-tear Dimensions of Technological Value in Theory
ROLE- shared expectations focused on a position - Technology as completing human beings to reformulate ideal human (organic/ mechanical
- beliefs on goals/ values to pursue; norms that govern behavior. replacement parts)
- shared expectations from retiree’s socialization experiences & values - “ as machine technologies (computers, gadgets)
internalized while preparing for position; adaptations to expectations socially - “ that mimic humans & human activities to meet demands of nursing care practices
defined for position itself
Nursing Process
- for every social role, there’s complementary roles in social structure
1. KNOWING- guided by tech knowing which persons are appreciated as participants in
CHANGE OF LIFE- between near retirement & post retirement years their care than as objects of care; nurse enters world of other:
- (medico-physiologic terms) climacteric period of adjustment & readjustment
- technology is used to magnify person’s aspect that requires revealing
to another tempo of life
(representation of real person)
RETIREE- left productive years & completed required years of service
2. DESIGNING- nurse & nursed plan a mutual care process where nurse organize a
ROLE DISCONTINUITY- interruption in status/role enjoyed rewarding nursing practice responsive to patient’s desire for care
- brought about by accident, emergency, change of position/retirement
3. PARTICIPATION IN APPRECIATION- simultaneous practice of conjoined activities for
COPING APPROACH- restore/maintain equilibrium & normal functioning knowing persons.
- alternating rhythm of implementation & evaluation.
Determinants (Positive Perceptions in Retirement & Reactions to Role Discontinuity
- evidence of continuous knowing, implementation, & participation is reflective
HEALTH STATUS- physiological & mental state; classified as sickly/healthy of cyclical process of knowing persons.
INCOME/ECONOMIC LEVEL- financial affluence; “ “ poor/moderate/ 4. VERIFYING KNOWLEDGE- continuous, circular process demonstrates ever-changing,
WORK STATUS- acc to one’s work dynamic nature of knowing in nursing
FAMILY CONSTELLATION- family composition - Knowledge about person derived from knowing, designing,
- close knit/extended (3 or more generations under 1 roof) implementing further informs nurse and nursed
- distanced (member in separate house; nuclear (parents & children)
SELF-PREPARATION- prepare self to possible outcome in life Nursing Informatics
- info systems in healthcare include people, structures, process, & manual as well as
Findings & Recommendations automated tools that collect, store, interpret, transform, report practice & mngmt info
1. HEALTH STATUS- dictates capacity & role type for present & future
- fits for everyone to maintain & promote health at all ages
2. FAMILY CONSTELLATION- positive index on retirement & role discontinuity
- Philippines: family as security/trusting bank
- when one retires, shock of role discontinuity is softened due to family & bc it
offers gainful substitutes (provide monetary support, absorb emotional strains)
3. INCOME- high correlation w/retirement perception & reaction to role discontinuity
- retirement pensions must be adjusted; to have more relevant & realistic pension
4. WORK STATUS- works w/economic security that generates decent compensation
- retirement shouldn’t be a period of no work since function get sharpened
- work enhances self-esteem & contributes to wellness even at old age
5. SELF-PREPARATION- therapeutic/recreational; professionalism/expertise, benevolent work
- investing in what gives dignity, self-worth, happiness than in money
7. To perceive retirement positively, it requires early socialization, full participation. Fellow
retirees must recognize & appreciate knowledge, wisdom, experience, values (social
assets that make retired age & custodians’folk wisdom)
8. Gov’t agency to construct holistic pre-retirement preparation program
9. Retirement must be recognized as fulfilment of one’s birthright & meaningful life
“I have grown & sown, now I can reap reward & blessing of life lived in joy & love, for I too
have made others grow” (Letty Gurdiel Kuan)

ROZZANO LOCSIN (TECHNOLOGICAL COMPETENCY AS CARING IN NURSING)

- is a middle range theory grounded in Nursing as Caring
- nursing practice grounded in harmonious coexistence of technology & nurse caring

Metaparadigm acc to Locsin

Person- participants Environment- technological world