NAELGAS, GLENN MARK O.

BACHELOR OF SCIENCE IN NURSING B

NCM100: THEORETICAL FOUNDATIONS

IN NURSING
MR. RICHARD MAURICIO, RN, MAN.
FULL TRANSCRIPTION

Catalyzed by Orem and Nightingale

OUTLINE ▪ Person: recipient of nursing care
I.DEFINITION OF TERMS III.NURSING THEORIES ▪ Environment: internal and external surrounds that
A. Nursing Metaparadigm A. Overview affect the client/patient
B. Roles of Nursing B. Needs/ Problem-oriented ▪ Health: degree of wellness or wellbeing that a
C. Aims of Nursing Theories client/patient experienced
C. System Oriented ▪ Nursing: collaborative care in all setting
II.HISTORY OF NURSING Theories
A. Nursing in the Philippines D. Interaction Oriented
B. Ancient Medical Practices Theories
C. The Four Patterns of E. Energy Field Theories
Nursing Knowledge
IV.Filipino Nursing Theorists

V.Other Theories
A. Relevant to Nursing

I.DEFINITION OF TERMS
▪ THEORIES
Explaining a phenomenon.
A belief, policy, or procedure proposed, or followed as basis of
action
To describe, predict, control phenomena
▪ NURSING
Science and Art
Promoting health, prevention of illness, and care of ill disabled,
and dying people
Collaborative care in all setting
▪ NURSING THEORY
Concept that describes, explains, predicts, or prescribe nursing
care
Knowledge defining what is nursing, what nursing do, and why
they do it.
Guide the practice of nursing at concrete/specific level
▪ PARADIGM
Natural phenomena
Philosophical assumptions
▪ METAPARADIGM
Statements identifying a relevant phenomenon
▪ HOLISTIC APPROACH
Physiological, psychological, spiritual, social needs dues given to
a patient

A. Nursing Metaparadigm

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 ▪ Early civilizations believed that illness was due to
Three More Definitions of Nursing supernatural causes
▪ “the act of utilizing the environment of the patient to ▪ ANIMISM is based on the belief that everything in nature is
assist him in his recovery” – Florence Nightingale alive with invisible forces
▪ “Nursing is the use of Clinical Judgement and the ▪ Good spirits brought health; evil spirits causes illness and
provision of care to enable people to promote, improve, maintain, death
or recover health; or when death is inevitable, to die peacefully” – ▪ Nursing was usually done by the mother and provides
Royal College of Nursing (2002) physical care and herbal remedies
▪ Male and Female nursing orders were founded during the
▪ “Nursing is the protection, promotion, and optimization of Christian era
health, and abilities; prevention of illness and injury; facilitation of ▪ Hospitals were built due to the number of pilgrims needing
healing; alleviation of suffering through the diagnosis and care
treatment of human response; and advocacy in the care of ▪ Religion and Nursing were intertwined as healing was mostly
individuals, families, group, communities, and population” – done by priests and nursing care done by sisters/nuns
American Nursing Association
A. Nursing in the Philippines
Philippine Nursing Act of 2002 ▪ Belief in encantos and spirits cause illnesses and
⎯ Republic Act No. 9173 An Act Providing for a More disease (i.e. duendes, tikbalang)
Responsive Nursing Profession, Repealing for the Purpose ▪ Evil people (mangkukulam/mambabarang etc) can
⎯ REPUBLIC ACT NO. 7164, otherwise known as "The cause illnesses
Philippine Nursing Act of 1991" and for other purposes ▪ Albularyo/Herbularyo can cure illnesses
▪ Spanish colonizers introduced the first hospitals in
The Philippine Board of Nursing is an administrative body the Philippines, at first to treat only Spanish citizens but later
under the Professional Regulation Commission that accepting Filipino patients
regulates the practice of nursing in the Philippines. ▪ Hospital Real de Manila (1577) – first hospital
established in the Philippines
B. Roles of Nursing ▪ San Lazaro Hospital (1578) – built to treat patients
with leprosy
1. To engage in the general scope of nursing practice, ▪ Most early hospitals during the Spanish regime were
including promotion of health, prevention of illness, and care run by the Church
of physically ill, mentally ill, and disabled people of all ages ▪ Iloilo Mission Hospital School of Nursing (Iloilo
and in all health care and other community settings; City, 1906) – first hospital to offer formal training to nurses
2. To carry out health care teaching; ▪ Rose Nicolet - First superintendent for nurses
3. To participate fully as a member of the healthcare ▪ Saint Paul’s Hospital School of Nursing (Manila,
team; 1907)
4. To supervise and train nursing and healthcare ▪ Philippine General Hospital School of Nursing
auxiliaries; and (Manila, 1907)
5. To be involved in research
Traditional Medicine: Traditional and Alternative Medicine Act
C. Aims of Nursing (TAMA) of 1997
▪ Promote Health
o Health is the state of optimal function of a 1. Akapulko (Cassia alata) – treat ringworms
human being. It is not merely the absence of disease and skin fungal infection
but the optimal fuction of a person’s physical, social
and mental components. 2. Ampalaya (Momordica charantia) –
o Health is subjective. A patient’s view of his treatment of diabetes (diabetes mellitus), for the
health must be taken into consideration. non-insulin dependent patients.
o A person’s level of health is affected by 3. Bawang (Allium sativum) – reduces
several factors that includes, genetic inheritance, cholesterol in the blood; helps control blood
cognitive abilities, educational level, race/ethnicity, pressure.
culture, age and gender, socioeconomic status.
4. Bayabas (Psidium guajava) – antiseptic,
▪ Preventing Illness to disinfect wounds; wash to treat tooth decay and
o Reduce the risk of illness in a person gum infection.
o Maintain optimal function of a person’s
body 5. Lagundi (Vitex negundo) – relief of
o Avoid illness/injury coughs and asthma.
o Early Detection of an illness 6. Niyog-niyogan (Quisqualis indica L.) –
elimination of intestinal worms, particularly the
▪ Restoring Health Ascaris and Trichina. Only the dried matured
o Diagnosis and assessment of an ill patient seeds are medicinal
o Referring the patient to the proper health 7. Sambong (Blumea balsamifera) - helps in
professional after assessment the excretion of urinary stones. It can also be used
o Direct nursing care as an edema.
8. Tsaang Gubat (Ehretia microphylla Lam.)
▪ Facilitating Coping with Death/Disability – Prepared like tea; treating intestinal motility;
o End of Life Care mouth wash since the leaves of this shrub has high
o Care in a Hospice Setting fluoride content.
o Help patient with pain control/symptom 9. Ulasimang Bato | Pansit- pansitan (Peperomia
control pellucida) –fighting arthritis and gout. The leaves can
o Help the family through the grieving be eaten fresh (about a cupful) as salad or like tea.
process For the decoction, boil a cup of clean chopped leaves
in 2 cups of water. Boil for 15 to 20 minutes. Strain, let
cool and drink a cup after meals (3 times day).
II.HISTORY OF NURSING

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 10. Yerba Buena (Clinopodium douglasii) – ▪ PERSONAL KNOWING: comes to us through the
commonly known as Peppermint; analgesic to relive process of observation, reflection, and self-actualization.
body aches and pain. It can be taken internally as a ▪ EMPIRICAL KNOWING: evidenced-based practice;
decoction or externally by pounding the leaves and research and objective facts; systematically organized into
applied directly on the afflicted area general laws and theories.
▪ ETHICAL KNOWING: moral code; sense of
B. Ancient Medical Practices knowing what is right and wrong; The “Code of Ethics for
Nurses” (American Nurses Association, 2015) can guide us
A. Trepanation: Holes were drilled into a as we develop and refine our moral code.
person who was behaving in what was considered ▪ AESTHETIC KNOWING: nursing is an art;
an abnormal way to let out what people believed combined three patterns
were evil spirits.
III.NURSING THEORIES
▪ EDUCATION: explain the fundamental implication of
B. Lobotomy: A surgical the profession and to enhance the status of the profession
procedure in which the nerve ▪ RESEARCH: creating and testing phenomena of
pathways in a lobe of the brain are interest
severed from those in other areas. ▪ CLINICAL PRACTICE: answers the q’s: what, why,
The procedure was formerly used how
as a radical therapeutic measure
to help grossly disturbed patients A. Overview
with schizophrenia, manic
depression and mania (bipolar ▪ Florence Nightingale:
disorder), and other mental Environmental Theory
illnesses. “The act of utilizing the environment
C. Humours: medieval science and of the patient to assist him in his recovery.”
medicine, the four chief fluids of the body,
blood, phlegm, yellow bile (choler), and
black bile (melancholy), that were thought
to determine a person's physical and ▪ Hildegard
mental qualities by the relative proportions Peplau: Theory of
in which they were present. Interpersonal Relations
“Nurse-client relationship as the
foundation of nursing practice”

D. Blood-letting: The ▪ Virginia Henderson: Nursing Need Theory

practice of withdrawing blood “The nurse’s role as assisting sick or
from a person’s veins for healthy individuals to gain independence in
therapeutic reasons meeting 14 fundamental needs”
“Purging the wet and warm
humor that was the blood both
cooled and ventilated the
patient’s core and was used as ▪ Faye Abdellah: Typology
a prophylactic insurance of 21 Nursing Problems
against illness to come: It could prepare the body for predicted “Shifted the focus of nursing from a
future biological shifts or seasonal changes that might push it into disease-centered approach to a patient-
misalignment” - Medieval Bodies: Life, Death and Art in the centered approach”
Middle Ages, Dr. Jack Hartnell
▪ Ida Jean Orlando: reciprocal relationship
between patient and nurse and viewed the
E. Leeches: the application of a living leech
professional function of nursing as finding out
to the skin to initiate blood flow or deplete blood and meeting the patient’s immediate need for
from a localized area of the body. Through the help.
19th century leeching was frequently practiced
in Europe, Asia, and America to deplete the
body of quantities of blood, in a manner like
bloodletting.
▪ Dorothy Johnson: Behavioral System Model
“Upheld the fostering of efficient and
F. Mercury: Mercury is effective behavioral functioning in the patient to
notorious for its toxic properties, prevent illnes”
but it was once used as a
common elixir and topical
medicine. The ancient Persians ▪ Martha Rogers: viewed
nursing as both a science and an art
and Greeks considered it a
“It provides a way to view the
useful ointment, and second- unitary human being, who is integral with the
century Chinese alchemists prized liquid mercury, or “quicksilver,” universe”
and red mercury sulfide for their supposed ability to increase
lifespan and vitality. Some healers even promised that by
consuming noxious brews containing poisonous mercury, sulfur ▪ Dorothea Orem: nursing care is required if
and arsenic, their patients would gain eternal life and the ability to the client is unable to fulfill biological, psychological,
walk on water. developmental, or social needs.

C. The Four Patterns of Nursing Knowledge

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 ▪ Dorethea Orem: Self-
Care Deficit
▪ Imogene King: Theory of Goal ⎯ People should be
Attainment self-reliant, and
“The nurse is considered part of responsible for
the patient’s environment and the nurse-
their care, as well
patient relationship is for meeting goals
towards good health”
as others in their
family who need
care.
▪ Betty Neuman: Stress reduction is the goal
⎯ People are distinct individuals.
of the system model of nursing practice.
“Many needs exist, and each may disrupt
client balance or stability”

▪ Sr. Callista Roy: set of

interrelated systems
“Strives to maintain the balance
between these various stimuli”

▪ Jean Watson: philosophy of caring

highlighted humanistic aspects of nursing
“They intertwine with scientific knowledge
and nursing practice”’

B. Needs/Problem-Oriented Theories

▪ Florence Nightingale: Mother of

Modern Nursing
⎯ Developed the Environmental
Theory
⎯ It states that a Nurse must use
the environment to better help the state
of the patient’s health.
⎯ Environmental factors can affect
a person’s health. These factors are fresh air, pure water,
sufficient food supplies, efficient drainage, cleanliness of
the patient and environment, and light.
⎯ The goal of nursing is to put the patient in the best
possible condition for nature to act.
⎯ She was the first to suggest that nurses be specifically
educated and trained for their positions in healthcare.
⎯ Standards of care in the field of nursing, which helped
improve overall care of patients was developed due to
Florence Nightingale.
⎯ Nursing is a form of action. It is an interaction between
two or more people.
⎯ Successfully meeting universal and development self-
care requisites is an important component of primary
care prevention and ill health.
⎯ A person’s knowledge of potential health problems is
needed for promoting self-care behaviors.
⎯ Self-care and dependent care are behaviors learned
within a socio-cultural context.
⎯ Universal self-care requisites are associated with life
processes, as well as the maintenance of the integrity of
human structure and functioning. They are also called
activities of daily living, or ADLs, as:
o the maintenance of sufficient intake of air, food,
and water
o provision of care associated with the
elimination process
o a balance between activities and rest, as well
as between solitude and social interaction
o The prevention of hazards to human life and
well-being
o The promotion of human functioning
⎯ Nursing is required when an adult is incapable or limited
in the provision of continuous, effective self-care
⎯ The nursing process in this model has three parts. First is
the assessment. The next step is the diagnosis and
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 creation of a nursing care plan. The third and final step is ⎯ The eleven nursing skills in the theory are:
implementation and evaluation. 1. observation of health status
2. skills of communication
▪ Virgina Henderson: Nursing 3. application of knowledge
Need Theory 4. teaching of patients and families
⎯ The theory emphasizes the 5. planning and organization of work
importance of increasing the patient’s 6. use of resource materials
independence so that progress after 7. use of personnel materials
hospitalization would not be delayed. 8. problem-solving
⎯ Nurses care for a patient until a 9. direction of work of others
patient can care for him or herself 10. therapeutic use of the self
⎯ Nurses will devote themselves to the patient day and 11. nursing procedure
night
⎯ Nurses should be educated
⎯ These components show a holistic approach to nursing
⎯ Components of Human Needs (14 Basic Human Needs)

▪ Jean Watson: Theory of

Transpersonal Caring
⎯ concerned on how nurses
express care to their patients
▪ Faye Abdellah: 21 Nursing Problems
⎯ stresses humanistic aspects of
⎯ The theory has interrelated the concepts of health,
nursing as they intertwine with scientific
nursing problems, and problem-solving.
knowledge and nursing practice
⎯ One of the first to introduce the concept of Nursing
⎯ Nursing is concerned with
Diagnosis which was not part of the nursing role at the
promoting health, preventing illness, caring for the sick,
time.
and restoring health.
⎯ Watson’s 10 curative factors/10 caring needs are:
Carative Factors Caritas Process
1. “The formation of a “Practice of loving-kindness and
humanistic-altruistic system equanimity within the context of
of values.” caring consciousness.”

2. “The instillation of faith- “Being authentically present and

hope.” enabling and sustaining the
deep belief system and
subjective life-world of self and
one being cared for.”

3. “The cultivation of “Cultivation of one’s own spiritual

sensitivity to one’s self and practices and transpersonal self
others.” going beyond the ego-self.”

4. “Development of a helping- “Developing and sustaining a

trust relationship” became helping trusting, authentic caring
“development of a helping- relationship.”
trusting, human caring
relation” (in 2004 Watson
website)

5. “The promotion and “Being present to, and

acceptance of the expression supportive of, the expression of
of positive and negative positive and negative feelings as
feelings.” a connection with deeper spirit

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 and self and the one-being- (3) To assist the patient who is able to benefit to the
cared for.” fullest extent during illness from the physician’s
knowledge and skill.
(4) To assist the patient whose behavior does not give
6. “The systematic use of the “Creative use of self and all evidence of unnecessary trauma as a consequence of
scientific problem-solving ways of knowing as part of the illness.
method for decision making” caring process; to engage in the
became “systematic use of a artistry of caring-healing
creative problem solving practices.”
caring process” (in 2004
Watson website)

7. “The promotion of “Engaging in genuine teaching-

transpersonal teaching- learning experience that attends
learning.” to the unity of being and
meaning, attempting to stay
within others’ frame of
reference.”

8. “The provision of the “Creating healing environment at

supportive, protective, and all levels (physical as well as the
(or) corrective mental, nonphysical, subtle environment ▪ Betty Neuman: Nueman
physical, societal, and of energy and consciousness,
System Model
spiritual environment.” whereby wholeness, beauty,
⎯ Prevention is the primary
comfort, dignity, and peace are
intervention
potentiated)”
⎯ Health promotion and
maintaining wellness is
9. “The assistance with the “Assisting with basic needs, with key
gratification of human needs.” an intentional caring ⎯ a comprehensive holistic
consciousness, administering and system-based
‘human care essentials,’ which approach to nursing
potentiate alignment of mind- ⎯ The theory focuses on the response of the patient to
body-spirit, wholeness, and unity actual or potential environmental stressors and the use of
of being in all aspects of care.” primary, secondary, and tertiary nursing interventions.
⎯ Each patient is unique
⎯ Many known, unknown, and universal stressors exist.
10. “The allowance for “Opening and attending to ⎯ Each patient has evolved a normal range of responses to
existential-phenomenological spiritual-mysterious and environmental stressors
forces” became “allowance existential dimensions of one’s ⎯ Primary prevention is applied in patient assessment and
for existential- own life-death; soul care for self intervention, in identification and reduction of possible or
phenomenological spiritual and the one-being-cared for” actual risk factors.
forces” (in 2004 Watson ⎯ Secondary prevention relates to symptomatology
website) following a reaction to stressors, appropriate ranking of
intervention priorities, and treatment to reduce their
effects.
⎯ Tertiary prevention relates to adjustive processes taking
place as reconstitution begins, and maintenance factors
C. System Oriented Theories move them back in a cycle toward primary prevention.
▪ Dorothy Johnson: Behavioral ▪ Sr. Callista Roy: Adaptation
System Model Model of Nursing
⎯ “Each individual has patterned, ⎯ Adaptation occurs when people
purposeful, repetitive ways of acting respond positively to environmental
that comprises a behavioral system changes
specific to that individual.” ⎯ Health is also described as a
⎯ Human beings have two major state and process of being and
systems: the biological system and the becoming integrated and whole.
behavioral system. It is the role of medicine to focus on
the biological system, whereas nursing’s focus is the
behavioral system.
⎯ It advocates the fostering of efficient and effective
behavioral functioning in the patient to prevent illness.
⎯ seven behavioral subsystems: affiliative, dependency,
ingestive, eliminative, sexual, aggressive, and
achievement.
⎯ The goals of nursing are fourfold, according to the
Behavior System Model:
(1) To assist the patient whose behavior is proportional to
social demands.
(2) To assist the patient who is able to modify his
behavior in ways that it supports biological imperatives.

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 D. Interaction Oriented Theories ▪ Ida Jean Orlando: Nursing
Process Discipline Theory
▪ Hildegard Peplau: Interpersonal ⎯ The role of the nurse is
Relation Theory to find out and meet the
⎯ Became the crux of psychiatric patient’s immediate
nursing needs
⎯ There are four components of ⎯ reciprocal relationship
the theory: between patient and
⎯ 1.Person, which is a developing nurse
organism that tries to reduce anxiety ⎯ The concepts of the theory are: (1.)function of
caused by needs; professional nursing, (2.) presenting behavior, (3.)
⎯ 2. Environment, which consists of existing forces outside immediate reaction, (4.) nursing process discipline, and
of the person, and put in the context of culture; (5.) improvement.
⎯ 3. Health, which is a word symbol that implies forward
movement of personality and other
⎯ 4. Other human processes toward creative, constructive,
productive, personal, and community living.
⎯ The nursing model identifies four sequential phases in
the interpersonal relationship: (1) orientation, (2)
identification, (3) exploitation, and (4) resolution.

ASSESSMENT ORIENTATION
⎯ Continuous data ⎯ Non-continuous data
collection and analysis collection
⎯ May not be a felt need ⎯ Felt need
⎯ Definite needs
NURSING DIAGNOSIS & IDENTIFICATION
PLANNING ⎯ Interdependent goal setting
⎯ Mutually set goals
Implementation Exploitation
⎯ Plans initiated towards ⎯ Patient actively seeking and
achievement of mutually set drawing help
goals ⎯ Patient-initiated
⎯ May be accomplished by
patient, nurse, or significant ⎯ nursing is responsive to individuals who suffer, or who
other. anticipate a sense of helplessness
EVALUATION RESOLUTION ⎯ concerned with providing direct assistance to a patient
⎯ Based on mutually ⎯ Occurs after other phases ⎯ if the patient has an immediate need for help, and the
expected behaviors are completed successfully nurse discovers and meets that need, the purpose of
nursing has been achieved.
⎯ May led to termination and ⎯ Leads to termination
initiation of new plans.
▪ Imogene King: Goal Attainment
⎯ A dynamic, interpersonal
relationship in which a patient grows
and develops to attain certain life goals
⎯ A human being has three
fundamental needs: the need for health
information; the need for care that
seeks to prevent illness; and the need
for care when he or she is unable to help him or herself.
⎯ The steps of the nursing process are: assessment,
nursing diagnosis, planning, implementations, and
evaluation.

⎯ Orientation phase defines the problem.

⎯ The Identification phase includes the selection of the
appropriate assistance by a professional.
⎯ The Exploitation phase is the implementation of the
nursing plan.
⎯ The Resolution Phase is the termination of the
professional relationship since the patient’s needs have
been met.

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 ⎯ nursing is a profession that surpasses time and aspects
of the individual as one of its clients

V. Other Theories

A. Relevant to Nursing

▪ Abraham Maslow: Hierarchy of Needs

E. Energy Fields Theories

▪ Martha Rogers: Unitary Human

Beings
⎯ The purpose of nurses is to
promote health and well-being for all
persons
⎯ Two dimensions: the science of
nursing, which is the knowledge
specific to the field of nursing that
comes from scientific research; and the
art of nursing, which involves using the science of
nursing creatively to help better the life of the patient.
⎯ Nursing aims to assist people in achieving their
maximum health potential ⎯ This theory is about the motivation of people in achieving
⎯ Nursing is concerned with people-all people-well and certain needs and that certain needs are more important
sick, rich and poor, young and old. than others.
⎯ The arenas of nursing’s services extend into all areas ⎯ The lower part of the pyramid shows basic needs. These
where there are people: at home, at school, at work, at are considered the most important needs for survival.
play; in hospital, nursing home, and clinic; on this planet ⎯ The middle part shows the psychological needs. These
and now moving into outer space. are the needs of a person to function well in society.
⎯ A patient can’t be separated from his or her environment ⎯ The top of the pyramid shows the self-fulfillment needs.
when addressing health and treatment. This is the stage where a person achieves his full
potential. This is what we, as a person, aims to be.
IV. FILIPINO NURSING THEORIESTS

▪ Letty Kuan: Retirement and

Role Discontinuities
⎯ Graceful Aging
⎯ If you have a very happy and
nice childhood, you will have a very
fruitful aging, happy retirement and
ultimately Legacy.
⎯ The role of the nurse is to put
back what they have missed during
childhood and to fill this gap.
⎯ The role of the nurse is to
become a therapeutic self and spiritual
self by showing empathy and
compassion.
⎯ Nursing is preparing the person to have fulfillment in their
retirement years, and assisting them in their elderly years
in leaving a legacy.
⎯ The nurse helps the person survive the struggles and
crisis in life to lead the person in attaining graceful aging.

▪ Carmelita Divinagracia:
COMPOSURE Behavior Theory
⎯ COMpetence
⎯ Presence and Prayer
⎯ Openmindedness
⎯ Stimulation
⎯ Understanding
⎯ Respect and Relaxation
⎯ Empathy