THEORETICAL FOUNDATION

OF NURSING
FIRST SEMESTER - BSN 1I
WEEK 15 / PROF. SALVADOR
____________________________________________________________________________________________________________
FINALS
appointment of a nursing professor and a second discipline
OUTLINE in the United States.
● Leininger was appointed Dean of the University of
I. Madeleine Leininger
Washington, School of Nursing in 1969
A. Theory of Culture Care Diversity and
● She is considered by some to be the “Margaret Mead of
Universality
nursing” and is recognized worldwide as the founder of
II. Margaret A. Newman
transcultural nursing
A. Health as Expanding Consciousness
● Leininger served as Dean, Professor of Nursing, Adjunct
III. Rosemarie Rizzo Parse
Professor of Anthropology, and Director of the Center for
A. Human Becoming Theory
Nursing Research and the Doctoral and Transcultural
IV. Rozzano Locsin
Nursing Programs at the University of Utah College of
A. Technological Nursing as Caring
Nursing.
Model
● She was the first full-time President of the American
V. Carolina Agravante
Association of Colleges of Nursing and one of the first
A. Transformational Leadership Theory
members of the American Academy of Nursing in 1975.
VI. Carmelita Divinagracia
● Leininger’s professional career is recognized as an educator
A. Composure Model
and academic administrator from 1956 to 1995, a writer from
1961 to 1995, a lecturer from 1965 to 1995, a consultant
MADELEINE LEININGER from 1971 to 1992, and a leader in the field of transcultural
nursing from 1966 to 1995.
BIOGRAPHY ● Her official certifications read LL (Living Legend), Ph.D.
● July 13, 1925 (Doctor of Philosophy), LHD (Doctor of Human Sciences),
● Sutton, Nebraska DS (Doctor of Science), CTN (Doctor of Science), RN
● Was an internationally known educator, author, theorist, (Registered Nurse), FAAN (Fellow American Academy of
administrator, researcher, consultant, public speaker Nursing), and FRCNA (Fellow of the Royal College of
● A Certified Transcultural Nurse Nursing in Australia).
● A Fellow of the Royal College of Nursing in Australia
● A Fellow of the American Academy of Nursing THEORY
● Died: August 10, 2012 ● Transcultural Nursing Theory
● attempts to provide culturally congruent nursing care
through “cognitively based assistive, supportive, facilitative,
EDUCATION or enabling acts or decisions that are mostly tailor-made to
● Madeleine entered the Cadet Nurse Corps in 1945 fit with the individual, group’s, or institution’s cultural values,
● She earned a nursing diploma from St. Anthony’s Hospital beliefs, and lifeways.”
School of Nursing ● nursing care to fit with or have beneficial meaning and
● An undergraduate degree at Mount St. Scholastica College health outcomes for people of different or similar cultural
and Creighton University backgrounds.
● Leininger opened a psychiatric nursing service and ● cultural care worldview flows into knowledge about
educational program at Creighton University in Omaha, individuals, families, groups, communities, and institutions in
Nebraska. diverse health care systems
● She earned the equivalent of a BSN through her studies in ● Madeleine Leininger defined transcultural nursing as “a
biological sciences, nursing administration, teaching, and substantive area of study and practiced focused on
curriculum during 1951-1954. comparative cultural care (caring) values, beliefs, and
● Master of Science in Nursing from the Catholic University of practices of individuals or groups of similar or different
America in 1954. cultures to provide culture-specific and universal nursing
● She became the first professional nurse to earn a Ph.D. in care practices in promoting health or well-being or to help
anthropology. people to face unfavorable human conditions, illness, or
death in culturally meaningful ways.”

CAREER
● She also studied at the University of Cincinnati., pursuing CONCEPTS OF TRANSCULTURAL NURSING THEORY
further graduate studies in curriculum, social sciences, and
nursing ● TRANSCULTURAL NURSING
● Leininger was appointed Professor of Nursing and - defined as a learned subfield or branch of nursing that
Anthropology at the University of Colorado, the first joint focuses upon the comparative study and analysis of
cultures concerning nursing and health-illness caring
 practices, beliefs, and values to provide meaningful diverse health care systems. This knowledge provides
and efficacious nursing care services to their cultural culturally specific meanings and expressions concerning
values and health-illness context. care and health. The next focus is on the generic or folk
system, professional care systems, and nursing care.
● ETHNONURSING Information about these systems includes the characteristics
- study of nursing care beliefs, values, and practices as and the specific care features of each. This information
cognitively perceived and known by a designated allows for the identification of similarities and differences or
culture through their direct experience, beliefs, and cultural care universality and cultural care diversity.
value system (Leininger, 1979).
● Next are nursing care decisions and actions which involve
● PROFESSIONAL NURSING CARE cultural care preservation or maintenance, cultural care
- defined as formal and cognitively learned professional accommodation or negotiation, and cultural care
care knowledge and practice skills obtained through repatterning or restructuring. It is here that nursing care is
educational institutions that are used to provide delivered.
assistive, supportive, enabling, or facilitative acts to or
for another individual or group to improve a human
health condition (or wellbeing), disability, lifeway, or to
work with dying clients.

● CULTURALLY CONGRUENT NURSING CARE

- defined as those cognitively based assistive,
supportive, facilitative, or enabling acts or decisions
that are tailor-made to fit with the individual, group, or
institutional, cultural values, beliefs, and lifeways to
provide or support meaningful, beneficial, and
satisfying health care, or wellbeing services.

● WORLDVIEW
- how people look at the world, or the universe, and
form a “picture or value stance” about the world and
their lives.

● CULTURE
- earned, shared, and transmitted values, beliefs,
norms, and lifeways of a particular group that guides
their thinking, decisions, and actions in patterned
ways.

● CULTURE CARE
- defined as the subjectively and objectively learned
and transmitted values, beliefs, and patterned
lifeways that assist, support, facilitate, or enable
another individual or group to maintain their
well-being, health, improve their human condition
lifeway, or deal with illness, handicaps or death.

● CULTURE CARE DIVERSITY

- indicates the variabilities and/or differences in
meanings, patterns, values, lifeways, or symbols of
care within or between collectives related to assistive,
supportive, or enabling human care expressions.
METAPARADIGM
● NURSING
● CULTURAL CARE UNIVERSALITY
■ Nursing is defined as a learned humanistic and
- indicates the common, similar, or dominant uniform
scientific profession and discipline which is focused on
care meanings, patterns, values, lifeways, or symbols
human care phenomena and activities to assist,
manifest among many cultures and reflect assistive,
support, facilitate, or enable individuals or groups to
supportive, facilitative, or enabling ways to help
maintain or regain their well-being (or health) in
people. (Leininger, 1991).
culturally meaningful and beneficial ways, or to help
people face handicaps or death.
SUNRISE MODEL
● HEALTH
● The Sunrise Model is relevant because it enables nurses to
■ It is a state of well-being that is culturally defined,
develop critical and complex thoughts about nursing
valued, and practiced. It reflects individuals’ (or
practice. These thoughts should consider and integrate
groups) ‘ ability to perform their daily role activities in
cultural and social structure dimensions in each specific
culturally expressed, beneficial, and patterned
context, besides nursing care’s biological and psychological
lifeways.
aspects.
● The cultural care worldview flows into knowledge about
individuals, families, groups, communities, and institutions in
● PERSON (HUMAN BEINGS) ● The pattern of the individual that eventually manifests itself
■ Such are believed to be caring and capable of being as pathology is primary and exists prior to structural or
concerned about others’ needs, well-being, and functional changes
survival. Leininger also indicates that nursing as a ● Removal of the pathology in itself will not change the pattern
caring science should focus beyond traditional of the indivIdual
nurse-patient interactions and dyads to include ● If becoming ill is the only way an individual's pattern can
families, groups, communities, total cultures, and manifest itself, then that is health for that person
institutions ● Health is an expansion of consciousness.

● ENVIRONMENT (Cultural & Social Structure;

Environmental Context) MAJOR CONCEPTS AND DEFINITIONS
■ Cultural and social structure dimensions are defined as ● HEALTH
involving the dynamic patterns and features of ○ The pattern of the whole of a person and includes
interrelated structural and organizational factors of a disease as a manifest manifestation of the pattern of the
particular culture (subculture or society) which includes whole based on the premise that life is an ongoing
religious, kinship (social), political (and legal), process of expanding consciousness.
economic, educational, technological, and cultural ○ It is regarded as the evolving pattern of the person and
values, ethnohistorical factors, and how these factors environment and is viewed as an increasing ability to
may be interrelated and function to influence human perceive alternatives and respond in a variety of ways.
behavior in different environmental contexts. ○ Health is “a transformative process to more inclusive
consciousness”.

MARGARET A. NEWMAN ● PATTERN

○ Pattern is information that depicts the whole and
BIOGRAPHY understanding of the meaning of other relationships at
● Margaret A. Newman was born on October 10, 1933 in once. It is conceptualized as a fundamental attribute of all
Memphis, Tennessee. there is, and it gives unity in diversity. Pattern is what
● She earned a bachelor's degree in Home Economics and identifies an individual as a particular prison. Examples of
English from Baylor University in Walker, Texas and a explicit and manifestations of the pattern of a person are
second bachelor's degree in Nursing from the University of the genetic pattern that contains information that directs
Tennessee. becoming the voice pattern and the movement patterns.
● Her master’s degree in Medical-Surgical Nursing and
Teaching is from the University of California, San Francisco. ○ Characteristics of pattern include movement, diversity,
She earned her doctorate in Nursing Science and and letter. Pattern is conceptualized as being somehow
Rehabilitation Nursing in 1971 from the New York University. intimately involved in energy exchange and
She has worked at the University of Tennessee, New York transformation. According to Newman, “Whatever
University, Pennsylvania State University, University of manifests itself in a person's life is the implication of the
Minnesota, University of Minnesota. underlying implicate pattern… the phenomenon we call
● Newman is a fellow in the American Academy of Nursing. health is the manifestation of that evolving pattern”.
She has been honored as an outstanding alumna by both
the University of Tennessee and New York University. ○ In health as expanding consciousness, Newman
● She received the Distinguished Scholar in Nursing Award developed pattern as a major concept that is used to
from New York University, the Founders Award for understand the individual as a whole being.
Excellence in Nursing Research from Sigma Theta Tau
International, and the E. Louise Grant Award for Nursing ○ Newman described a paradigm shift in the field of
Excellence from the University of Minnesota. healthcare: the shift from treatment of the season comes
to search for patterns and the meaning of those patterns.

THEORY ○ Newman stated that the patterns of interaction of person

and environment constitute health.
THEORETICAL SOURCE
● CONSCIOUSNESS
● She was influenced by following theorists:
○ Consciousness is both the informational capacity of the
1. Martha Roger - Theory of Unitary Human Beings was
system and ability of the system to interact with its
the main basis of the development of her theory,
environment. Newman asserts that understanding of her
Health as Expanding Consciousness
definition of consciousness is essential to understanding
2. Itzhak Bentov – The concept of evolution of
the theory. Consciousness includes not only cognitive
consciousness
and affective awareness, but also the
3. Arthur Young – The Theory of Process
“interconnectedness of the entire living system which
4. David Bohm – The Theory of Implicate
includes physicochemical maintenance and growth
processes as well as the immune system”.
MAJOR ASSUMPTIONS
○ Newman identified three correlates of consciousness
● Health encompasses conditions heretofore described as (time, movement, and space) as manifestations of the
illness, or, in medical terms, pathology pattern of the whole. The life process is seen as a
● These pathological conditions can be considered a progression toward higher levels of consciousness.
manifestation of the total pattern of the individual
● MOVEMENT-TIME-SPACE - Nursing is seen as a partnership between the nurse
○ Newman emphasizes the importance of examining and client, with both grow in the “sense of higher
movement-space-time together as dimensions of levels of consciousness”
emerging patterns of consciousness rather than as - Newman also redefines nursing, according to her,
separate concepts of the theory. nursing is the process of recognizing the individual in
○ Time and space have a complementary relationship. relation to the environment and it is the process of
○ Movement is a means by which space and time become understanding of consciousness.
a reality.
○ Movement is a reflection of consciousness. ● HUMAN
○ Time is a function of movement. - Clients are viewed as participants in the
○ Time is a measure of consciousness transformative process.
- “The human is unitary, that is cannot be divided into
parts, and is inseparable from the larger unitary field”
NEWMAN’S THEORY OF EXPANDING CONSCIOUSNESS - “Persons as individuals, and human beings as a
● “The theory of health as expanding consciousness (HEC) species are identified by their patterns of
was stimulated by concern for those for whom health as the consciousness"
absence of disease or disability is not possible. Nurses often - “The person does not possess consciousness-the
relate to such people: people facing the uncertainty, person is consciousness”.
debilitation, loss and eventual death associated with chronic - Persons are “centers of consciousness” within an
illness. The theory has progressed to include the health of overall pattern of expanding consciousness”
all persons regardless of the presence or absence of
disease. The theory asserts that every person in every ● ENVIRONMENT
situation, no matter how disordered and hopeless it may - Environment is described as a “universe of open
seem, is part of the universal process of expanding systems”
consciousness – a process of becoming more of oneself, of - Client and environment are viewed as a unitary
finding greater meaning in life, and of reaching new evolving pattern.
dimensions of connectedness with other people and the - Disease in a human energy field is a manifestation of
world” (Newman, 2010). a unique pattern of person-environment interaction.

● Humans are open to the whole energy system of the ■ STRENGTHS

universe and constantly interacting with the energy. With this - Can be applied in any setting AND
process of interaction humans are evolving their individual “Generates caring interventions”
pattern of whole. ■ WEAKNESSES
- Abstract, Multi-dimensional, Qualitative, Little
● According to Newman, understanding the pattern is discussion on environment
essential. The expanding consciousness is the pattern
recognition.
ROSEMARIE RIZZO PARSE
● The manifestation of disease depends on the pattern of
individual so the pathology of the diseases exists before the BIOGRAPHY
symptoms appear so removal of disease symptoms does ● Rosemarie Rizzo Parse
not change the individual structure. ● Born: July 28, 1938, in Pennsylvania
● Rosemarie Rizzo Parse graduated from Duquesne
● The nurse helps to understand people to use the power University in Pittsburgh and earned her Master’s and
within to develop the higher level of consciousness. Doctoral degrees from the University of Pittsburgh.
● Thus it helps to realize the disease process, its recovery and ● Between 1983 and 1993 – she was a professor and
prevention. coordinator of the Center for Nursing Research at the City
University of New York’s Hunter College.
● Newman also explains the interrelatedness of time, space ● From 1993 until 2006 – she was also a professor and the
and movement. Niehoff Chair at Loyola University in Chicago.
● January 2007 – she has worked as a consultant and visiting
● Time and space are the temporal pattern of the individual, scholar at the New York University College of Nursing.
both have complementary relationship. ● A recipient of the New York Times nurse educator of the
year award in 2008.
● Humans are constantly changing through time and space ● A member of the American Academy of Nursing.
and it shows unique pattern of reality. ● Her awards include two Lifetime Achievement Awards given
from the Midwest Nursing Research Society and the Asian
American Pacific Islander Nurse’s Association
NURSING METAPARADIGMS
● HEALTH
- “Health and illness are synthesized as health - the THEORY
fusion on one state of being (disease) with its
opposite (non-disease) results in what can be CONTRIBUTION TO NURSING THEORY
regarded as health”.
● Human Becoming Theory
- Health is viewed as “a transformative process to more
● Parse’s Human Becoming Theory guides the practice of
inclusive consciousness”.
nurses to focus on the quality of life as it is described and
lived.
● NURSING
● Rosemarie Rizzo Parse developed the Human Becoming
- Nursing is “caring in the human health experience”.
Theory of Nursing, which educates nurses to prioritize the
 quality of life from the perspective of each individual as the ○ The human is open, freely choosing meaning in a
purpose of nursing. It offers an alternative to the majority of situation, as well as bearing responsibility for decisions
other nursing theories, which adopt a biomedical or made.
biopsychosocial-spiritual approach. ○ The human is unitary, continuously co-constituting
● First published in 1981 as the “Man-living-health Theory,” patterns of relating.
then was later on changed to the “Human Becoming Theory” ○ The human is transcending multidimensionally with the
in 1992. possibles.
● Human Becoming Theory is a combination of biological,
psychological, sociological, and spiritual factors, and states ● About becoming:
that a person is a unitary being in continuous interaction with ○ Becoming is unitary with human-living-health.
his or her environment. ○ Becoming is a rhythmically co-constituting the
human-universe process.
○ Becoming is the human’s patterns of relating value
THREE THEMES OF THE HUMAN BECOMING THEORY priorities.
● Meaning ○ Becoming is an intersubjective process of transcending
- States that Human Becoming is choosing personal with the possibles.
meaning in situations and that a person’s reality is ○ Becoming is the unitary human’s emerging.
given meaning through experiences he or she lives in
the environment.
- 3 Concepts: METAPARADIGM
1. Imaging ● PERSON
Paradoxes: Explicit-Tacit and - referred to as the “man” throughout the theory.
Reflective-Prereflective - an open being who is more than and different from the
sum of the parts.
2. Valuing
Paradox: Confirming-Not Confirming ● ENVIRONMENT
- it is everything in the person and his or her
3. Languaging experiences.
Paradoxes: Speaking-Being Silent and - inseparable from the person, as well as
Moving-Being Still complementary to and evolving with the person.

● Rhythmicity
- Explains that Human Becoming is cocreating ● HEALTH
rhythmical patterns of relating with the universe and - the open process of being and becoming, and
that a person and the environment cocreate in involves the synthesis of values.
rhythmical patterns.
- 3 Concepts: ● NURSING
1. Revealing-Concealing - described as a human science and art that uses an
- Paradox: Disclosing-Not Disclosing abstract body of knowledge to help people.

2. Enabling-Limiting
Paradox: Potentiating-Restricting

3. Connecting-Separating ROZZANO LOCSIN

Paradox: Attending-Distancing
BIOGRAPHY
● Transcendence ● Born in 1954 in the Philippines
- States that Human Becoming refers to reaching ● Filipino-American Professor (Tokushima University, Japan)
beyond the limits a person sets and that a person is and a registered nurse
constantly transforming him or herself. ● Graduated BSN at Siliman University, Dumaguete,
- 3 Concepts: Philippines
1. Powering ● Authored and Published Technological Competency as
Paradoxes: Pushing-Resisting, Affirming-Not Caring in Nursing: A Model for Practice
Affirming, and Being-Nonbeing

2. Originating THEORY
Paradoxes: Certainty-Uncertainty and ● Technological Nursing as Caring Model
Confirming-Not Confirming ○ Guides nurses to know persons as a whole through
various technologies to deliver human care. The role of
3. Transforming nursing is described to know and care for the patient fully
Paradox: Familiar-Unfamiliar rather than fixing the ‘broken’ patient or labeling them as
sick.
○ The process of knowing a person is guided by
ASSUMPTIONS technological knowledge in which persons are
● About man: appreciated as participants in their care rather than as
○ The human is coexistent while co-constituting rhythmical objects of care.
patterns with the universe.
ASSUMPTIONS the technologies of health care to apply the practice of
● Persons are caring by their virtue of humanness knowing persons. This is derived from the process of
(Boykin & Schoenhofer, 2001) - Caring is more than mere technological knowing, designing, and participative
emotion or act; it directs the nature of nursing and is engagement.
understood as the discipline of knowledge and is
fundamental in the practice of nursing. ○ This is the knowledge gained about the person that is
derived from knowing, designing, and implementing
● The ideal of wholeness is a perspective of unity (Locsin, further information about the nurse and the patient.
2005) - The concept of ‘wholeness’ acknowledges human
beings as complete regardless of their ‘parts’. This allows
nurses to view nursing as the lived experience shared DIMENSIONS OF TECHNOLOGICAL VALUE
between a nurse and the person being cared for rather than ● Technology as/to:
looking for the ‘parts’ that a person lacks (i.e being sick ○ Completing human beings: complements the ideals of
therefore lacking something). a human by providing replacement parts that are
mechanical (prosthetics) and organic (transferring of
● Knowing persons is a multidimensional process organs).
(Locsin, 2005) - Human caring allows nurses and patients
to develop a mutual understanding and recognition as ○ Machine technologies: using computers and other
dynamic participants in the process while focusing on gadgets to assist nursing activities that provide care to
appreciation, affirming, celebrating, and supporting each patients such as machinery used in operations (the da
other. Vinci system).

● Technologies of health and nursing are elements for ○ Mimic human beings and activities: the development
caring (Locsin, 2005) - Allowing nurses to know humans as of cyborgs and robots to meet the needs and demands of
contributors in caring, rather than objects. nursing care activities. to meet the demands of nursing
care practices, e.g. cyborgs (cybernetic organisms) or
● Nursing as a discipline and professional practice anthropomorphic machines and robots such as
(Boykin & Schoenhofer, 2001) - The discipline of nursing ‘nursebots’
provides an opportunity to engage in academic practice
within the field of technology.
METAPARADIGM
● The above mentioned assumptions provide the essential ● Locsin has described each of the elements – person,
framework for Technological Nursing as a Caring Model environment, health, and nursing, with a relation to
Theory. technology and caring and how these two are related to
each other.
THE NURSING PROCESS ○ Person - a ‘whole’ being– meaning that they are in the
● Technological knowing moment, continuously growing, and responding to
○ Understanding people through technologies of health and changes. Locsin believes that a person is appreciated
human care allows the nurse to know the person through through the data that is acquired about them through
other means. Technology is utilized as a method that technology. However, a disadvantage of using technology
magnifies the aspect of a person; the nurse enters the in the practice is that nurses may easily fall into the
world of the patient and knowing them as participants of objectification of their clients and see nursing as a task
care rather than objects. Since a person’s status often instead of caring for and fully knowing their clients.
changes, the nurse acknowledges that a person is
dynamic and living, therefore they are unpredictable. ○ Environment - mainly pertains to the world of
technology; technology allows access to a deeper
● Designing understanding of one’s state of health. Being competent
○ a process that involves both the nurse and the patient in technological knowledge allows a person to accomplish
wherein they create a satisfying care process that is tasks with ease and mastery. Technology is only a tool for
tailored to the patient’s desire for human care. optimal patient care and the focus of care is knowing the
person as a whole.
○ This is where the nurse and the patient plan a mutual
care process wherein the nurse can organize a rewarding ○ Health - allows people to develop themselves and
nursing practice that is responsive to the patient’s desire progress. This acknowledges that each person is unique
for care. and has their own individualities; that each person has
their own definition of health that purely relies on their
● Participative Engagement own interpretation rather than considering them as
○ Elaborates the simultaneous and various activities that predictable individuals.
are deemed crucial to knowing persons. Implementation
and evaluation repeatedly occur in which the nurse ○ Nursing - The function of a nurse is to be present by their
continuously ‘knows’ their patient. patients and aid them in pursuing their health goals
through caring and interpersonal relationships. Locsin
○ The simultaneous practice of conjoined activities which stated that nursing is not dependent on the knowledge of
are crucial to knowing persons. a nurse; it is the intention and authenticity of the nurse
that allows them to know a person as a whole.
● Verifying knowledge Compassion, confidence, commitment, and conscience
○ the cyclical process that informs the nurse of the are the elements of caring in nursing
ever-changing dynamic of a person where the nurse and
the patient create a mutual experience of nursing using
 APPLICATION 2. Self-Mastery
● The theory may be applied to the various aspects of nursing - Expressed in care complex variables
such as: possessed to a certain degree by an
○ Nursing education: Technology and caring must individual that have been through formal
complement each other to prepare nursing students for studies in a caregiving profession. It involves
changes that may happen in the healthcare profession. a person's self-awareness of the nursing
Nurses who show competency in using technology may practices.
help their patients by improving their skills and creating
new strategies to further know and care for their patients. 3. Special Expertise
- The enactment of caring and being proactive
○ Nursing research: The theory may be applied to present in face of challenges for the profession. It is
the significant contribution and impact of technology on shown in 5C's of transformational leadership
the advancement of nursing. Due to the advancement of namely: (1) Creative, (2) Caring, (3) Critical,
technology, technology practices may lead to further (4) Contemplative and (5) Collegial Teaching
inquiry, theoretical development, and ethical of the nurse faculty who is directly involved
consideration in comparison to older periods. with the formation of the nursing. It is the
guide designed to form the new professional
○ Practice: The theory elaborates on how a nurse may nurses
show their competency in caring through the use of
technology. Technology acts as a bridge between nurse
and their patient; including it enhances the quality of care
that a patient receives while they improve holistically.
Incorporating technology in practice means that nurses
should always be up to date and go through necessary
training (i.e how to properly handle equipment) to improve
the healthcare system.

CAROLINA AGRAVANTE

BIOGRAPHY
● Carolina Agravante is famous for being the first Filipina
theorist for writing the CASAGRA Transformative
Leadership Model. The title of the theory was derived from
her name, CArolina S. AGRAvante. METAPARADIGM
● PERSON
■ Person is not clearly stated in the theory however the
THEORY "client" was mentioned in the care complex theory of
● The effect of the CASAGRA Transformative Leadership Agravante.
Model is derived from the concept of leadership from a ■ It simply denotes that the caring behavior learned by
psycho-spiritual point of view. This was formulated to lead to the new nurses from their nursing educators will
a radical change from apathy or indifference to becoming a clearly affect the state of being of their clients or
spiritual person. patients in the future.

● The model is a Three-Fold Transformation Leadership ● ENVIRONMENT

Concept rolled into one, consisting of the following ■ Environment indicated was the world wherein there is
elements: (1) Servant-Leader Spirituality, (2) Self-Mastery always development.
(Care Complex), (3) Special Expertise (Transformative ■ Theory was focused on the type of leadership in
Teaching). These mirror the behavior and personality of the nursing needed to cope with the changing world.
modern professional nurse who will challenge the demands Whether in technology use (machines, computers,
of these critical times in the society today. etc.), changes in physical surroundings (buildings,
infrastructure, etc.) and situations (pandemic,
1. Servant-Leader Spirituality COVID-19 lockdown, etc.). The theory was made for
- Prescribed to run side by side with the the nursing faculty to strengthen its foundation and
general components of the transformative take on responsibilities in line with the environment
leadership model. This formula consists of: they’re placed in.
- a spiritual exercise
- the resolution of the care complex in the ● HEALTH
personality of an individual; and ■ Health is abstractly discussed as the aim of why the
- a seminar-workshop on transformative nursing faculty should educate and lead new nurses
teaching with caring behavior; to improve practice by positively
- The method used comprises a spiritual influencing the health and quality of life of
retreat that undergoes the process of patients.
awareness, reflection, storytelling,
contemplation and finally commitment to ● NURSING
become servant-leaders in the footsteps of ■ The attributes of a nursing leader should be competent
Jesus. with a dream of what nursing can be and an individual
whose aim is to provide care and service to those who
are competent in nursing. Worldwide leadership crisis
 demanded the nursing educators and leaders to revisit patients at the Philippine Heart Center. Behavior include:
their basic responsibility of educating and forming competence, presence and prayer, open mindedness,
our future nursing leaders who are responsive to stimulation, understanding, respect and relaxation, and
technological, educational and social changes empathy. Hence, the nursing profession can actively deliver
happening in the environment we live in. quality care through COMPOSURE Behavior caring
interventions.

WHY IS IT IMPORTANT?
● The present day demands in the nursing profession MAJOR CONCEPTS AND DEFINITION
challenge nursing educators to revisit their basic ● She describe the qualities of the Advanced Nurse
responsibility of educating professional nurses who are Practitioner as someone who:
responsive to technological, educational and social changes ○ Graduated with a degree of BSN
happening in the Philippines society today. ○ Licensed and has clinical experience of at least 2 yrs in
● The reopening of the doors of foreign market to Filipino the clinical area.
nurses, migration made easy, attractive salaries and benefits ○ Has undergone special training in critical area Has set
way beyond what hospitals can afford to give. behaviors or nursing measures that a nurse
● Nursing education is faced with a new concern that is demonstrates to the selected patients.
globalization of nursing services for the international market
therefore a need to develop globalization of care with focus
on developing caring nurses. The formation of new nursing ● COMPOSURE Behavior is determined by Dr.
leaders is urgently needed; leaders with new vision who will Divinagracia as
venture new traits and who have gone through new ○ A set of behavior or nursing measures that would be
formation in order to serve the society as professional demonstrated by advanced nurse practitioners to
nurses selected patients.
○ A condition being in a state of well-being, a coordinated
and integrated living pattern that involves dimension of
CARMELITA DIVINAGRACIA wellness.
○ COMPOSURE Behavior is an acronym which stands for:
BIOGRAPHY COMpetence, Presence and Prayer, Openmindedness
● Filipino Nurse Theorist Stimulation, Understanding, Respect and Relaxation,
● Former President of Association of the Deans Philippines Empathy.
College of Nursing (ADPCN) ● COMPETENCE
● Dean of University of the East Ramon Magsaysay Memorial ○ Nurses should have in-depth knowledge and
Medical Center, Inc. College of Nursing clinical expertise. It may also pertain to the
● She was also a member of CHED's Technical Committee on consistency and congruence of words and
Nursing Education actions demonstrated in caring for patients by the
● Became a clinic staff and head nurse, as well as instructor, nurse.
assistant dean and dean ● PRESENCE AND PRAYER
● Has also lectured and written about her work as a nurse and ○ This pertains to the nursing measures which
used her hands- on experience to create better ways to means being there in times of need for their
teach nursing. patients, or it can also be defined as utilizing a
● Has been lauded for developing the art and competency of therapeutic communication through active
teaching nursing. listening and touch, as well as demonstrating
● Has teamed up with the Commission on Higher Education nursing measures through prayers and faith in
for the drafting of a higher standard of competency in god as this will provide most patients an
nursing schools in the Philippines. assurance.
● Her love for nursing and her dedication to carving out
learning tools for nursing students has been a commendable ● OPEN MINDEDNESS
and rare field of discipline. ○ A form of nursing measure which means being
● She has also been awarded the “ Anastacia Giron Tupas receptive to new ideas or to reason. It conveys in
Award” that was given by the Philippine Nursing Association a manner of knowing the patient’s preferences
last 2008. and opinions related to his/her current health
condition,and being flexible as a nurse to practice
and demonstrate accommodating the patient’s
EDUCATION views as well as others.
● She graduated with Bachelor of Science in Nursing at the
● STIMULATION
University of the East Ramon Magsaysay Memorial Medical
○ A form of nursing measure demonstrated through
Center in 1962
an act of providing encouragement that conveys
● She is a degree holder of Master of Nursing at University of
hope and strength, guidance in the form of giving
the Philippines in 1975
explanation and supervision when doing certain
● Finished her Doctoral of Philosophy in Nursing at University
procedures to patients The use of complimentary
of the Philippines in 2001
words or praise and smile whenever appropriate
is highly recommended.
THEORY
● UNDERSTANDING
● “Advanced Nurse Practitioner’s COMPOSURE Behavior
○ It conveys interest and acceptance not only of the
and Patient’s Wellness Outcome
patient’s condition but also to the patient’s holistic
● determine the effects of COMPOSURE behavior of the
and entire being.
advanced nurse practitioner on the recovery of selected
 ● HEALTH
● RESPECT and RELAXATION ○ Not determined in Divinagracia’s dissertation.
○ A form of nursing measure that is done through
acknowledging every patient’s presence and ● ENVIRONMENT
showing positive regards by using the preferred ○ Not determined in Divinagracia’s dissertation.
naming in addressing the patient as well as the
use of po and opo and through recognition of the ● NURSING CARE
patient as someone important. It also entails a ○ Divinagracia believes that the quality of Nursing Care
form of exercise that involves alternate tension could be improved using an intervention like the
and relaxation of selected groups of muscles. COMPOSURE behavior.

● EMPATHY
○ A nurse who is empathic is someone who senses ASSUMPTION
another person’s inner experience accurately. A ● The wellness outcome of a patient will depend on the
nurse who is empathic also perceives the current intervention that the nurse has when administering the client
positive thoughts and feelings of the patient and
communicates by putting himself in the patient's
place. CONCEPTUAL FRAMEWORK
● Moreover, here is the conceptual framework of
Divinagracia’s Advanced Nurse Practitioner’s COMPOSURE
MAIN UNITS Behavior and Patient’s Wellness Outcome wherein the
● the following main points of Carmelita Divinagracia ’ s COMPOSURE behavior of the advanced nurse practitioners
disquisition. effects on the overall wellness outcome of the patient can be
seen in line with the biobehavioral and physiologic outcome
○ AIM OF NURSING are observed.
■ Divinagracia’s disquisition would want to prove how
nursing as a healthcare profession can be as excellent
and as worthy in quality with other healthcare WELLNESS OUTCOME
professions. ● The researcher believes that there will be an essential
improvement on the patient wellness outcome may it be
○ ROLES OF NURSES physiologic and/or biobehavioral wellness outcome.
■ Advanced Nurse Practitioners resort to Composure
behavior when administering the client. ■ PATIENT WELLNESS OUTCOME
● This refers to the perceived wellness after receiving
○ CLIENT/PATIENT nursing care in terms of physiologic and
■ Her study population consisted of admitted and biobehavioral.
confined Adult Cardiac Patients at the Philippine Heart
Center, Coronary Care Unit.
○ SOURCES OF PROBLEMS
■ Clients who are inadequate to receive quality care will ■ PHYSIOLOGIC OUTCOME
hence result in poor wellness outcomes. ● This refers to the perceived wellness of patients
after receiving nursing care in terms of vital signs,
○ WAYS OF INTERVENTION chest pain and complete blood count.
■ Divinagracia’s composure behavior is utilized when ○ Vital signs - clinical measurements that are done
providing care to the patient. to indicate the state of a patient’s essential body
functions.
○ FOCUS OF INTERVENTION ○ Chest pain - Pain that a patient feels in between
■ The intervention focuses on the patients in the the neck and the abdomen.
Coronary Care Unit which should convey the quality ○ Hemoglobin - blood count of the patient.
care given by the advanced nurse practitioners.
■ BEHAVIORAL OUTCOME
○ RESULTS ● This refers to the perceived wellness of selected
■ The nursing profession has the ability to carry out patients after receiving nursing care in terms
quality care through the means of biobehavioral caring physical, intellectual, emotional, and spiritual.
interventions including like COMPOSURE Behavior
irrespective of creed, social class, gender,age and ○ Physical Wellness
nationality, everyone deserves to receive a humane, ■ Refers to the person’s ability to function and
caring, spiritually-oriented interventions that can use free time effectively in meeting with the
facilitate wellness. demands of the day’s work. It includes good
physical fitness and the possession of useful
motor skills.
METAPARADIGM
● INDIVIDUAL ○ Intellectual Wellness
○ Each individual needs humane, caring, ■ The ability of a person to learn and use
spirituality-oriented intervention that can facilitate information in order to improve the quality of
wellness regardless of creed, social class, gender, age daily living and optimal functioning. The person
and nationality. with intellectual wellness is characterized as
informed, and as opposite to ignorant.
 ○ Emotional Wellness
■ Capacity to cope with the daily circumstances
and deal with his or her personal feelings in a
positive, optimistic, and constructive manner. A
person with emotional wellness is generally
characterized as happy, as opposed to
depressed.

○ Spiritual Wellness
■ It refers to a person’s capacity to establish a
values system and act on the system of
beliefs, as well as to establish and carry out
meaningful and constructive lifetime goals. It is
often based on a belief in a force greater than
the individual that helps one contribute to an
improved quality of life for all people. They are
generally characterized as fulfilled as opposed
to unfulfilled.

APPLICATION
● NURSING PRACTICE
○ The COMPOSURE behavior inspired the principle of
holistic care that an advanced nurse practitioner gives to
the patient in order to achieve their wellness outcome
through a series of quality care that caters every aspect
of wellness may it be biobehavioral or physiological.
○ COMPOSURE Model is used when providing care to
patients to achieve the wellness of the client.

● EDUCATION
○ The COMPOSURE behavior can be used by the students
to prepare and practice as a member of the professional
community as it develops, hone and guides the nursing
education through this theory.

● RESEARCH
○ The COMPOSURE model allowed nurses and future
people who are in the professional community to further
explore the effects of nurse’s COMPOSURE behavior on
the wellness outcome of a patient and inspired nursing
from different and quality frameworks