Theoretical Foundation in Nursing

I am a NURSE

Nursing Definition:

NURSING (as an art)

- Is the art of caring sick and well individual. It refers to the dynamic skills and
methods in assisting sick and well individual in their recovery and in the promotion
and maintenance of health. It involves the creative application of knowledge in the
service of people.

NURSING (as a science)

• It is the “body of abstract knowledge” arrived through scientific research and
logical analysis
• Is the scientific knowledge and skills in assisting individual to achieve optimal
health. It is the diagnosis and treatment of human responses to actual or potential
problem.

NURSING (as a profession)

• Profession- a calling in which its members profess to have acquired
- special knowledge by training or experience, or both so that they may
- guide, advise or save others in that special field.

FLORENCE NIGHTINGALE
• Nursing is the act of utilizing the environment of the patient to assist him in
his recovery.

VIRGINIA HENDERSON
• Nursing is the act of assisting the individual, sick or well, in the performance
of those activities contributing to health or its recovery (or to a peaceful
death) that he would perform unaided if he had the necessary strength, will,
or knowledge, and to do this in such a way as to help him gain independence
as rapidly as possible.

CANADIAN NURSES ASSOCIATION

(CNA)
• Nursing is a dynamic, caring, helping relationship in which the nurse assists the client to
achieve and obtain optimal health. – 1987

• THEMES THAT ARE COMMON TO THESE

DEFINITION:
• Nursing is caring
• Nursing is an art
• Nursing is a science
• Nursing is client-centered
• Nursing is holistic
• Nursing is adaptive
• Nursing is concerned with health promotion, health maintenance, and
health restoration
• Nursing is a helping profession

AMERICAN NURSES ASSOCIATION (ANA)

• 1973
• Nursing is direct, goal oriented, and adaptable to the needs of the individual, the family, and
community during health and illness.
• 1980
• Nursing is the diagnosis and treatment of human responses to actual or potential health
problems.
• 1995
• ANA acknowledges FOUR ESSENTIAL FEATURES OF
CONTEMPORARY NURSING PRACTICE:
• Attention to the full range of human experiences and responses to health and illness without
restriction to a problem-focused orientation.
• Integration of objective data with knowledge gained from understanding of the client or group’s
subjective experience.
• Application of scientific knowledge to the processes of diagnosis and treatment.
• Provision of caring relationship that facilitates health and healing.

NURSE
• Comes from a Latin word “to nourish” or “to cherish
• One who cares for the sick, the injured, and the physically, mentally,
and emotionally
disabled
• One who advise and instruct individuals, families, groups and
communities in the prevention, treatment of illness and diseases and in
the promotion of health.
• An essential member of a health team who cares for individuals,
families and communities in disease and illness prevention and in the
promotion of health and healthy environment.
NURSE
- is a person who cares for the sick or infirm; specifically: a licensed
health-care professional who practice independently or supervised
by a physician, surgeon, or dentist and who is skilled in promoting
and maintaining health (Merriam-Webster)

The word "nurse" originally came from the Latin word "nutrire",
meaning to suckle, referring to a wet-nurse; only in the late 16th
century did it attain its modern meaning of a person who cares for
the infirm. (Wikipedia)

PATIENT
• Comes from a Latin word, “to Suffer” or “to Bear”
• An individual who is in the state of physical, mental, and
emotional imbalance
• An individual who seeks for nursing assistance, medical
assistance, or for surgery due to illness or a disease.
• Is an individual who is waiting or undergoing medical or
surgical care. One who is physically or mentally disabled.
Responsibilities of Nurses
✓ Assess patient’s needs and problems
✓ Health maintenance of healthy o individuals
✓ Treatment, safety, and recovery of o acutely or chronically ill or injured people
✓ Research and non-clinical functions
✓ Teaching and mentoring other nurses
✓ Scope of Work of RNs
✓ Promote health, prevent disease
✓ Advocate and educate patients
✓ Work with physicians
✓ Administer medications
✓ Assist clients in convalescence and rehabilitation
✓ Formulate, implement, and evaluate

NURSING DEFINITION:
“A dynamic discipline. It is an art and science of caring for
individuals, families, groups and communities geared
toward promotion and restoration of health, prevention of
illness, alleviation of suffering, and assisting clients to face
death with dignity and peace. It is focused on assisting the
client as he or she responds to health-illness situations,
utilizing the nursing processes and guided by ethico-legal
and moral principles.” ----Associations of Deans of
Philippine Colleges of Nursing (ADPCN).
American Nursing Association (ANA) – “Nursing is
the protection promotion, and optimization of
health and abilities, prevention of illness and
injury, alleviation of suffering through diagnosis
and treatment of human response. Nursing is
giving direct care and advocacy in the care off
individuals, families, communities, and
populations.”
International Council of Nurses (ICN) “Nursing
encompasses autonomous and collaborative care of
individuals of all ages, families, groups and
communities, sick or well and in all settings. Nursing
includes the promotion of health, prevention of illness,
and the care of ill, disabled and dying people. Other
key nursing roles include advocacy, promotion of safe
environment, research, participation in shaping health
policies and in patient and health systems
management and education.”

“NURSING is the art and science of caring”

Nursing as an Art – use of imagination and
creativity in caring
Nursing as a Science – expansion of body
knowledge; health profession that
establishes itself as separate form practice
of medicine.

Nursing in Primary Care Setting Nursing in Secondary Care Setting

1. Public health nursing Institutional nursing: Hospital nursing
2. Occupational nursing • Flight nurse
3. Clinic nursing • Director of nursing
4. School nursing • Infection-surveillance nurse
5. Private duty nursing • Clinical coordinator
6. Military nursing • Head nurse
7. Ambulatory care nursing
8. Nursing in correctional facilities • Staff nurse
• Nursing in primary care setting • OB-Gyne nursing
• Primary- initial health care for general • Pediatric nursing
complaints • Orthopedic nursing
• Usually the person’s 1st contacts with the • OR nursing
health care • Med-surgical nursing
delivery system • Psychiatric nursing
• Managing current health care needs, and • ER nursing
• Critical care nursing
preventing further problems.

Nursing in Tertiary Care Setting

1. Skilled care setting
2. Rehabilitation setting
3. Advanced practice nursing
(APN)
• Clinical nurse specialist
• Nurse anesthetist
• Nurse educator
• Nurse administrator
• Nurse researcher

ROLES OF A NURSE
Caregiver
• Primary goal
• TYPES OF CARE
• Full Care -for completely dependent patient
• Partial Care -for partially dependent patient
• Supportive-Educative care -to assist clients in attaining their highest possible level of health
and wellness; for learnings
Communicator stressful psychologic or social problems, to
• Integral to all nursing roles develop improved interpersonal relationships,
• Nurses communicate with the client, and to promote personal growth.
support • Involves providing emotional, intellectual and
persons, other health professionals, and psychologic support.
people in the community • Nurses counsel primarily healthy individuals
• Nurses identify client problems and then with normal adjustment difficulties and focuses
communicate these verbally or in writing to on helping the person develop new attitudes,
other members of the health team feelings, behaviors by encouraging the client to
look at alternative behaviors, recognizing the
Teacher choices, and develop sense of control.
• Nurses help clients learn about their health
and the health care procedure they need to Change Agent
perform to restore or maintain their health. • Assisting others to make modifications in their
• Nurses assesses the client’s learning own behavior.
needs and readiness to learn, sets specific • Nurses also often act to make changes in a
learning goals in conjunction with the client, system if it is not helping client return to health.
enacts teaching strategies, and measures
learning.
• Nurses also teaches unlicensed assistive Leader
personnel to whom they delegate care, and • Influences others to work together to
they share their expertise with other nurses accomplish a specific goal.
and health professionals. • Can be employed at different levels:
individual client, family, groups of clients,
Client Advocate colleagues, or the community
• Acts to protect the client
• Nurse may represent the client’s needs Case Manager
and wishes to other health professionals, • Work with the multidisciplinary health care
such as relaying the client’s wishes for team to measure the effectiveness of the
information to the physician. case management plan and to monitor
• Nurses assist clients in exercising their outcomes.
rights and help them speak up for • Works with primary or staff nurses to
themselves oversee the care of a specific caseload.
• Primary nurse or provides some level of
direct care to the client and family
Counselor • Helps ensure that care is oriented to the
• Helping a client recognize and cope with client, while controlling costs.

Research Consumer • Be a discriminating consumer of research

• Often use research to improve client care findings
• Have some awareness of the process and
language of research
Role Model
• Be sensitive to issues related to protecting • Has good physical appearance
the rights of human subjects • Practices proper hygiene
• Participate in the identification of • Practices healthy lifestyle
significant researchable problems Administrator
• Assumes middle management position
• Connects the patient to other services of • Nurse practitioner, clinical nurse specialist,
the hospital nurse midwife, nurse educator, nurse
researcher, and nurse anesthetist
Expanded Career Roles • All of which allow greater independence
and autonomy.
NURSING as a PROFESSION

CONCEPT OF PROFESSION (Marie Jahoda)

• An organization of an occupational group based on the application of special knowledge which
establishes its own rules and standards for the protection of the public and the professionals.
• A profession implies that the quality of work done by its members is of greater importance in its
own eyes and the society than the economic rewards they earn.
• Serves all of society and not the specific interests of a group
CHARACTERISTICS AND ATTRIBUTES OF A PROFESSIONAL
PERSON
• Is concerned with quality. -ksa
• Is self-directed, responsible and accountable for his actions.
• Is able to make independent and sound judgment including high moral judgment.
• Is dedicated to the improvement of human life.
- Is committed to the spirit of inquiry.
NURSING AS A PROFESSION
Primary Characteristics:
• Education
• Theory
• Service
• Autonomy
• Code of Ethics
• Caring

Professional Nursing
- art and science, dominated by an ideal of service in which certain principles are applied in
skillful care of the well and ill, and through relationship with the client, significant others and
other members of the health team.
• Professional Nurse
- A person who has completed a basic nursing education program and is licensed in his country
or state to practice professional nursing.

QUALITIES AND ABILITIES OF A PROFESSIONAL NURSE

• Has faith in the fundamental values that underlie the democratic way of life:
• Respect for human dignity
• Self-sacrifice for the common good.
• Strong sense of responsibility for sharing in the solution of the problems of the society.
• Has a sense of responsibility for understanding those with whom he works or associates with
through the use of skills:
Has the basic knowledge, skills and attitudes necessary to address present day social
problems, realistic and well organized thoughts through the use of critical thinking
• Has skills in using written and spoken language, both to develop own thoughts and to
communicate them to others.
• Appreciates and understands importance of good health
• Has emotional balance.
• Accepts and tries to understand people of all sorts, regardless of race, religion and color .
5 Fold Nursing Function
 Promoting Health and Wellness
Preventing Illness
Pain/suffering alleviation
Restoring Health
Creation of a spiritual environment
PROMOTING HEALTH AND WELLNESS
• Wellness – state of well-being. Engaging in attitudes and behavior that enhance the quality of
life and maximize personal potential
• For both healthy and ill.
• Involve individual and community activities to enhance healthy lifestyle, such as improving
nutrition and physical fitness, preventing drug and alcohol misuse, restricting smoking, and
preventing accidents and injury in the home and workplace.
PREVENTING ILLNESS
• The goal is to maintain optimal health by preventing diseases
• Nursing activities includes immunizations, prenatal and infant care, and prevention of sexually
transmitted disease.
Pain/suffering Alleviation
• The goal is to provide relief from pain to promote comfortable healing process.
RESTORING HEALTH
• Focuses on the ill client
• Extends from early detection of disease to helping the client during the recovery period
NURSING ACTIVITIES:
• Providing direct care to the ill person: administering medications, baths, and specific
procedures and treatments
• Providing diagnostic and assessment procedures: measuring BP and examining feces for
occult blood
• Consulting with other health care professionals about client’s problems
• Teaching clients about recovery activities: exercise that will accelerate recovery after a stroke
• Rehabilitating clients to their optimal functional level following physical or mental illness, injury,
or chemical addiction.
Creation of a spiritual environment
• Provision of spiritual care
• Involves comforting and caring for people of all ages who are dying
• Includes helping clients live as comfortable as possible until death and helping support
persons cope with death.
• Work in homes, hospitals, and extended care facilities
• Hospices are specifically designed for this purpose.
HISTORY AND EVOLUTION OF NURSING
PERIODS OF NURSING HISTORY
• Intuitive Period
• Apprentice Period
• Educative Period
• Contemporary Period
INTUITIVE PERIOD/ MEDIEVAL PERIOD
• Prehistoric to Early Christian Era
• More on intuition
• NOMADS – travel from one place to another
• Survival of the fittest
• “Best for the most” – motto
• Sickness is due to “voodoo”
• Performed out of feeling of compassion for others
• Performed out of desire to help
• Performed out of wish to do good
• Nursing is given by the WOMEN
• SHAMAN - uses white magic to counteract the black magic
• They are the doctors during those time
• TREPHINING - drilling the skull
• Used to treat Psychotic patients.
• Psychotic patients are believed to be possessed by evil spirits.
• Growth of religion - most important thing that happened
• Growth of civilization
• Law of preservation – inspire man in search of knowledge
“Rise in Civilization”
From the mode of Nomadic life → agrarian society → gradual development of urban community
life
Existence of means of communication
Start of scientific knowledge → more complex life → increase in health problems → demand for
more nurses

Nursing as a duty of SLAVES and WIVES. NURSING DID NOT CHANGE but there was
progress in the practice of medicine.

Care of the sick was still closely allied with superstitions, religion and magic

Near East – birth place of 3 religious’ ideologist:

 Judaism
Christianity
Mohammedism or Islam

Near East culture was adopted by the Greeks and Romans combined with the wonders of
the Far East by returning crusaders and explorers improved and was carried to Europe
 during the Renaissance Period that resulted to greater knowledge then to the New World
by the Early settlers.

New World – a tiny area known as a birth of monotheism that lies between Tigris and
Euphrates River in the Nile River arose the cultures of Babylonia, Egypt and Hebrew.

MONOTHEISM – believer of one God

“Different Civilization”

Babylonians
Egyptians
Hebrew
China
India
Greece
Romans

BABYLONIANS

• CODE OF HAMMURABI
• 1st recording on the medical practice
• Established the medical fees
• Discouraged experimentation
• Specific doctor for each disease
• Right of patient to choose treatment between the use of charms, medicine, or surgical
procedure

EGYPTIANS
• ART OF EMBALMING
• Mummification
• Removing the internal organ of the dead body
• Instillation of herbs and salt to the dead
• Used to enhance their knowledge of the human anatomy. 
• Since work was done and performed on the dead, they learned nothing of Philosophy “THE
250 DISEASES”
• Documentation about 250 diseases and treatments

HEBREW
Teachings of MOSES
• Created Leviticus
• Father of sanitation
• Practice the values of “Hospitality to strangers” and the “Act of Charity” – contained in the book
of Genesis

LEVITICUS – 3rd book of the Old Testament

• Laws controlling the spread of communicable diseases
• Laws governing cleanliness
• Laws on preparation of food
• Purification of man and his food
• The ritual of CIRCUMCISION on the 8th day after birth
MOSAIC LAW
• Meant to keep Hebrews pure so that they may enter the sanctuary without affronting God
• Meant as a survival for health and hygienic reason only

CHINA
Use of pharmacologic drugs
• “MATERIA MEDICA”
 - Book that indicates the pharmacologic drug used for treatment
• No knowledge on anatomy
• Use of wax to preserve the body of the dead
• Method of paper making
• FACTOR THAT HAMPERED THE ADVANCEMENT OF MEDICINE: - Prohibits dissecting of
human body thus thwarting scientific study

INDIA

SUSHURUTO
• 1st recording on the nursing practice
• Hampered by Taboos due to social structures and practices of animal worship
• Medicine men-built hospitals
• Intuitive form of asepsis
• There was proficient practice of Medicine and Surgery
• NURSES QUALIFICATIONS: Lay Brothers, Priest Nurses, combination of Pharmacist,
Masseurs, PT, cooks
• There was also decline in medical practice due to fall of Buddhism –state religion of India

GREECE

• AESCULAPUS- Father of medicine in Greek mythology

• HIPPOCRATES- Father of modern medicine
• 1st to reject the idea that diseases are caused by evil spirits
• 1st to apply assessment
• Practice medical ethics
• CADUCEUS- Insignia of medicine
• Composed of staff of travelers intertwined with 2 serpents (the symbol of Aesculapus and his
• healing power).  At the apex of the staff are two wings of Hermes (Mercury) for speed.
• NURSES → function of untrained slaves.

NICE TO KNOW!
Hippocratic oath is an oath historically taken by the Physicians and other healthcare
professionals swearing to practice medicine honestly. It is widely believed to have been
written by Hippocrates.
Nightingale pledge- is a statement that nurses utter in order to prove their sincerity with their
profession. Nurses undertake promise in front of the experiences practitioners that they would
abide by the rules and regulations of nursing care.  Also accompanies the Candle lighting
segment ceremony (Capping & Pinning).

ROMANS
•Proper turnover for the sick people
• “if you’re strong, you’re healthy” – motto
•Transition from Pagan to Christianity
• FABIOLA—was converted to Christian and later she converted her home to a hospital and
used her wealth for the sick.  (Roman Matron)- high rank women
• 1st hospital in the Christian world.

APPRENTICE PERIOD/MIDDLE AGES

 11th century → 1836
On-the-job training period
-Refers to a beginner (on-the-job training). It means care performed by people who are
directed by more experienced nurses
•Starts from the founding of Religious Orders in the 6th century (1836 – when the
deaconesses School of Nursing was established in Kaiserweith,
• Germany by Pastor THEODORE FLEIDNER)
 • There was a struggle for religious, political, and economic power
• Crusades took place in order to gain religious, political, and economic power or for
adventure.
• During the Crusade in this period, it happened as an attempt to recapture the Holy
Land from the Turk who obtained and gain control of the region as a result of power
struggle. Christians were divided due to several religious war and Christians were
denied visit to The Holy Sepulcher.
MILITARY RELIGIOUS ORDERS AND THEIR WORKS
KNIGHTS OF ST. JOHN OF JERUSALEM (ITALIAN)
 Also called as “Knights of the Hospitalers”
Established to give care
TEUTONIC KIGHTS (GERMAN)
Took subsequent wars in the Holy Land
Cared for the injured and established hospitals in the military camps

KNIGHTS OF ST. LAZARUS

Care for those who suffered Leprosy, syphilis, and chronic skin diseases
(Alexian Brothers School of Nursing)

ALEXIAN BROTHERS- A monastery order founded in 1348. They established the Alexian
Brothers
School of Nursing, the largest school under religious auspices exclusively in US and it closed
down in 1969. 
ST. VINCENT DE PAUL- SISTERS OF CHARITY
LOUISE de GRAS-patron saint of sick people, widows and orphans in 1960s.
Prior to Florence Nightingale

Is the Dark Age for Nursing because…

Nursing is considered as:
A very low job in terms of social hierarchy.
A job for the uneducated and poor.
A desperate occupation.

Who are the nurses?

• Women of lowest social standing

• Wayward women of low status, instead of going to prison, they were asked to serve as
nurses.
• monastic women or untrained helpers of low repute.
• Poor unmarried woman with no family or no chance of getting married.
The Dark Period of Nursing

From 17th century – 19th century

Also called the Period of Reformation
until the American Civil War Hospitals were closed
Nursing were the works of the least desirable people (criminals, prostitutes, drunkards, slaves,
and opportunists)
Nurses were uneducated, filthy, harsh, ill-fed, overworked
Mass exodus for nurses
(Martin Luther)
The American civil war was led by Martin Luther; the war was a religious upheaval that resulted
to the destruction in the unity of Christians.

The conflict swept everything connected to Roman Catholicism in schools, orphanages, and
hospitals.
THEODORE FLIEDNER
(a pastor) reconstituted the deaconesses and later be established the School of Nursing at
Kaiserswerth, Germany where Florence Nightingale had her 1st formal training for 3 months as
nurse.
FLORENCE NIGHTINGLE
An English lady from a wealthy family during the Victorian era
During the Crimean War- known to be the “Lady with the Lamp”
A nursing theorist, writer and statistician
Changed the image of nursing
Dubbed as the “Lady with the Lamp”

NOTES on NURSING (1859)

“What it is and What it is not”

EDUCATIVE PERIOD/NIGHTINGALE ERA
Florence Nightingale School of Nursing)
- Began in June 15, 1860 when Florence Nightingale School of Nursing opened at St. Thomas
Hospital in London England, where 1st program for formal education of Nurses began and
contributed growth of Nursing in the US.
School of Nursing
In 1860, Nightingale laid the foundation of professional nursing when the first school of nursing
was established.
Nightingale Training School at St. Thomas’ Hospital

FACTORS THAT INFLUENCED DEVELOPMENT OF NURSING EDUCATION:

• Social forces
• Trends resulting from war
• Emancipation of women
• Increased educational opportunities
Florence Nightingale
• Mother of modern Nursing
• Born on May 12, 1820 in Florence, Italy
• Her SELF-APPOINTED GOAL – to change the profile of Nursing
• She complied notes of her visit to hospitals, her observations of sanitation practices and
entered Deaconesses School of Nursing at Kaiserswerth Germany for 3 months.
• Became the Superintendent of the Establishment for Gentle Women during the illness (refers
to the ill governess or instructors of Nursing).
• She disapproved restriction on admission of patient and considered this unchristian and
contrary to health care.
• Upgraded the practice of Nursing and made Nursing a honorable profession
• Led other nurses in taking care of the wounded and sick soldiers during the Crimean War
• She was designated as Superintendent of the Female Establishment of English General
Hospital in Turkey during the Crimean War
• She reduced the casualties of war by 42% - 2% thru her effort by improving the practice of
sanitation techniques and procedure in the military barracks.
THE CONCEPT OF FLORENCE NIGHTINGALE ON NURSING SCHOOL:
• School of Nursing should be self – supporting not subject to the whimps of the Hospital.
• Have decent living quarters for students and pay Nurse instructors
• Correlate theories to practice
• Support Nursing research and promote continuing education for nurses
• Introduce teaching knowledge that disease could be eliminated by cleanliness and sanitation
and Florence Nightingale likewise did not believe in the Germ Theory of Bacteriology.
OTHER SCHOOLS OF NURSING
LINDA RICHARDS – the first graduate nurse in United States Graduated in September 1, 1873
- the first American trained Nurse (1870) became a great nursing pioneer in USA and Japan.
2 NUSING ASSOCIATION / ORGANIZATION THAT UPGRADED NURSING PRACTICE IN
US:
-American Nurses Association
-National League for Nursing Education

CONTEMPORARY PERIOD

World War II – present

• This refers to the period after World
• War I and the changes and development in the trends and practice of Nursing occurring since
1945 after World War II.
• Includes scientific and technological development, social changes occurring after the war.
• Nursing is offered in College and Universities.
FACTORS AFFECTING NURSING TODAY:

 • Economics
• Consumer’s Demand
• Family Structure
• Information and Telecommunications
• Legislation

HISTORY OF NURSING (PHILIPPINE SETTING)

EARLY BELIEFS AND PRACTICES

Beliefs about Causation of diseases:

-Caused or inflicted by other person (enemy or witch)
-Evil spirits
-Beliefs that evil spirits could be driven off by person with powers to expel bad spirits:
-Believed in Gods of Healing
Word doctors – priest physicians
HERBULARIOS – herb doctors

EARLY CARE FOR THE SICK

-HERBICHEROS – herb men who practice Witchcraft

-MANGKUKULAM / MANGANGAWAY – a suffering from disease without any identified cause

and were believed bewitched by such

-Difficult child birth and some diseases attributed to (NONO) midwives

-Difficult child birth, witches were supposed to be the cause, gunpowder exploded from a
bamboo pole close to the head of the mother to drive evil spirits.

EARLY HOSPITALS

Hospital Real de Manila – 1577- 1st hospital established

Gov. Francisco de Sande to give service to the king’s Spaniard soldiers

San Lazaro Hospital – 1578

- Fray Juan Clemente
-Named after the Knights of St. Lazarus
- Hospital for the lepers

Hospital de Indios – 1586

- Franciscan Orders
- Hospital for the poor Filipino people

Hospital de Aguas Santas – 1590

- Fray Juan Bautista
- Named after its location (near spring) because people believed that spring has a healing
power.

San Juan de Dios Hospital – 1596

- For poor people
- Located at Roxas Boulevard

PERSONAGES
Dona Hilaria de Aguinaldo
- 1st wife of Emilio Aguinaldo
- Established Philippine Red Cross – February, 17 1899
Dona Maria Agoncillo de Aguinaldo
- 2nd wife of Emilio Aguinaldo
- 1st president of Philippine Red Cross (Batangas Chapter)
Josephine Bracken
- Helped Rizal in treating sick people
Melchora Aquino
- Took care of the wounded Katipuneros
Anastacia Giron Tupas
- Founder of Filipino Nurses Association – established on October 15, 1922
- 1st Filipino chief nurse of PGH
- 1st Filipino Superintendent of Nurses in the Philippines
Cesaria Tan
- 1st Filipino to receive Masteral Degree in Nursing abroad
Socorro Sirilan
- Pioneer in social service at San Lazaro Hospital
- Also the Chief Nurse
Francisco Delgado

- 1st president of Filipino Nurses Association

Socorro Diaz

- 1st editor of PNA magaziine called, “The Message”

Conchita Ruiz

- Full time editor of the PNA newly named magazine, “The Filipino Nurse”

Sor Ricarda Mendoza

- Pioneer in Nursing Education

Loreto Tupaz

- “Dean of the Philippine Nursing”

Florence of Iloilo

EARLY Nursing Schools

Iloilo Mission Hospital School of Nursing

Established in 1906 under the supervision of Rose Nicolet (American)

Nursing course – 3 years
Produced 1st batch of nursing graduates in 1909 – 22 nurses

1st TRAINED NURSES

- Nicasia Cada
- Felipa dela Pena
- Dorotea Caldito

April 1946 – 1st nursing board exam at Iloilo Mission Hospital

Mary Johnson School of Nursing

PGH School of Nursing – 1907

St. Paul’s Hospital School of

Nursing (Manila, 1907)

 - The hospital was established by the Archbishop of Manila, the most Reverend, Jeremiah
Harty under the supervision of the sisters of St. Paul the charters.
- Located in the Intramuros, and it provided general hospital services.
- 1908 – operated its training school for nurses with Rev. Mother Melanie as
superintendent and Miss E Chambers as principal.

Philippine General Hospital

School of Nursing (1907)

- Anastacia Giron Tupas – first

- Filipino nurse to occupy the position of chief nurse and superintendent.

St. Luke’s Hospital School of Nursing (Quezon city, 1907)

1907 – the school opened with three Filipino girls admitted. These girls had their first year
in Combined classes with the PGH Hospital School of Nursing and St. Paul’s Hospital
School of Nursing. Vitaliana Beltran was the first Filipino superintendent of nurse.
First Colleges of Nursing in the Philippines
University of Santo Tomas College of Nursing

- February 11, 1941 – the college began as the UST school of nursing education
- Sor Taciana Trinanes was its first Directress.

Manila Central University College of Nursing

- In 1947, offered the BSN course

- Miss Consuelo Gimeno was its first principal

University of the Philippines

College of Nursing

- The idea of opening the college began in conference between Miss Julita
- Soteja and the UP President Gonzales
- In 1948, the university council approved the curriculum, and the board of regents
recognized the profession as having equal standing as medicine, law, engineering, etc.
- Miss Julita Sotejo was its first dean.

NURSING THEORIES
THEORY – ORIGIN: “THEORIA”- SPECULATE (GREEK WORD)
THEORIES – are a set of interrelated concepts that give a systematic view of a phenomenon
(an observable fact or event) that is explanatory & predictive in nature.

THEORY is a “creative and rigorous structuring of ideas that projects a tentative, purposeful,
and systematic view of phenomena”. (Chinn and Kramer 1999).
1. Theories are composed of concepts, definitions, models, propositions & are based on
assumptions.
2. They are derived through two principal methods; deductive reasoning and inductive
reasoning
3. A theory makes it possible to “organize the relationship among the concepts to describe,
explain, predict, and control practice” (Torres, 1986, p.21). Torres (1990, pp.6-9)

NURSING THEORY
- Defined as a belief, policy, or procedure proposed or followed as the basis of action. It
as an organized framework of concepts and purposes designed to guide the practice of
nursing.
CHARACTERISTICS OF THEORIES
1. Theories can interrelate concepts in such a way as to create a different way of looking at
a particular phenomenon.
2. Theories must be logical in nature.
3. Theories should be relatively simple yet generalizable
4. Theories can be the bases for hypotheses
5. Theories contribute too and assist in increasing the general body of knowledge within
the discipline through the research implemented to validate them.
6. Theories can be used by the practitioners to guide and improve their practice.
7. Theories must be consistent with other validated theories, laws, and principles but will
leave open unanswered questions that need to be investigated.
HISTORICAL ERAS

CURRICULUM ERA – moving nursing education from hospital-based diploma programs into
college and universities.

RESEARCH ERA – research is the path to new knowledge.

- Part of the curricula of developing graduate programs.
GRADUATION (GRAD.) EDUCATION (EDU.) ERA
- Masters program in nursing emerged to meet the need for nurse with specialized
education in nursing.
- Nursing theory and Nursing Conceptual models were included as courses in the study of
Nursing.
THEORY ERA
- Outgrowth of research era
- Research without theory produced isolated information; however, research and theory
produced nursing science.
NIGHTINGALE 1860:
- To facilitate “the body’s reparative processes” by manipulating client’s environment.
PEPLAU 1952:
- Nursing is; therapeutic interpersonal process

HENDERSON 1955:
 - The needs often called Henderson’s 14 basic needs
ABDELLAH 1960:
- Delivering nursing care for the whole person to meet the physical, emotional, intellectual, social,
and spiritual needs of the client family.
ORLANDO 1962:
- The client is an individual; with a need; that, when met, diminishes, distress, increases adequacy,
or enhances well-being.
JOHNSON’S THEORY 1968:
- Focuses on how the client adapts to illness and how actual or potential stress can affect the ability
to adapt. The goal of nursing is to reduce stress so that; the client can move more easily through
recovery.
ROGER 1970:
- Maintain and promote health, prevent illness and care for and rehabilitate ill and disabled client
through “humanistic science of nursing”
OREM 1971:
- Self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill
biological, psychological, develop mental, or social needs.
KING 1971
- Use communication to help client reestablish positive adaptation environment.
NEUMAN 1972
- Stress reduction is goal of system model of nursing practice.
ROY 1979
- This adaptation model is based on the physiological, psychological, sociological, and dependence
-independence adaptive modes.
WATSON’S THEORY 1979
- Defines the outcome of nursing activity in regard to the; humanistic aspects of life.

TERMINOLOGY

CONCEPTS
- Vehicles of thought that involves image. Are words that describe objects, properties, or events &
are basic components of theory.
Types:
- Empirical Concepts
- Inferential Concepts
- Abstract Concepts
METAPARADIGM
- Specifies the main concepts that encompass the subject matter and the scope of discipline.
- “There is a general agreement that nursing’s metaparadigm consists of the central concepts of
person, environment, health and nursing.” (Powers and Knapp)
METAPARADIGM CONCEPTS
- The person
- The environment
- Health
- Nursing (goals, roles, functions)
PHILOSOPHY
- Specifies the definitions of the metaparadigm concepts in each of the conceptual models of
nursing.
MODELS

- representations of the interaction among and between the

concepts showing patterns.

VERBAL MODELS

– worded statements, a form of closely related knowledge development.

SCHEMATIC MODELS

-diagrams, drawings, graphs and pictures that facilitate understanding.

PROPOSITION

- statements that explain the relationship between the concepts.

PROCESS
- a series of actions, changes or functions intended to bring about a desired result.
CONCEPTUAL FRAMEWORK

- The delivery of nursing care within the nursing process is directed by the way specific conceptual
frameworks & theories define the person (patient), the environment, health & nursing.

- outlines possible courses of action or to present a preferred approach to an idea or thought.

THEORITICAL FRAMEWORK – is a theory in the form of a model/paradigm that serves as the basis for
the study. It mentions the proponents of the study and their results.

CONCEPTUAL FRAMEWORK – is the researcher’s own model illustrating variables that specify the
problem and gives direction to the study. It may be an adaptation of a model in an early theory, with
modifications to suit the inquiry.

THE DEVELOPMENT OF NURSING THEORIES

GENERAL SYSTEMS THEORY – describes how to break whole things into parts and then to learn how
the parts work together in “systems”.

ADAPTATION THEORY
- defines adaptation as the adjustment of living matter to other living things & to environmental
conditions.
- is a continuously occurring process that effects change & involves & response.

HUMAN ADAPTION OCCURS ON THREE LEVELS;

1. The internal (self)
2. The social (others) &
3. The physical (biochemical reactions)

DEVELOPMENTAL THEORY
 - it outlines the process of growth and development of humans as orderly & predictable, beginning
with conception & ending with death.

- The progress & behaviors of an individual within each stage are unique

- the growth & development of an individual are influenced by heredity, temperament, emotional, &
physical environment, life experiences & health status.

TYPES ACCORDING TO SCOPE (NURSING THEORIES)

GRAND THEORY – It is the broadest in scope, represents the most abstract level of development,
and addresses the broad phenomena of concern within the discipline.

MIDDLE-RANGE THEORY – theory that addresses more concrete and more narrowly defined
phenomena. It is intended to answer questions about nursing phenomena, yet they do not cover the
full range of phenomena of concern to the discipline.

MICRO-RANGE THEORY – concrete and narrow in scope. It explains a specific phenomenon of

concern to the discipline.
TYPES ACCORDING TO KNOWLEDGE BASE AND CHARACTERISTICS

1. NURSING PHILOSOPHY

- Meaning of nursing phenomenon through analysis, reasoning, and logical argument.

- It includes works which predate or introduce the nursing theory era and have contributed to the
knowledge development in nursing.

2. NURSING CONCEPTUAL MODELS

- Works of grand theorists or pioneers in Nursing.

- “Provides a distinct frame or reference for its adherents that tells them how to observe and
interpret the phenomena of interest to the discipline.”

NURSING THEORIES AND MIDDLE-RANGE THEORIES

- Addresses the specifics of nursing situations within the perspective of the model or theory from
which they are derived.
TYPES ACCORDING TO FUNCTION (Polit et. al 2001)
Descriptive – to identify the properties and workings of a discipline.
Explanatory – to examine how properties relate and thus affect the discipline
Predictive - to calculate relationships between properties and how they occur
Prescriptive – to identify under which conditions relationship occur

Based on the philosophical underpinnings of the theories:

1. “Needs” theories
- are based around helping individuals to fulfill their physical and mental needs.
2. “Interaction” theories
 - As described by Peplau (1988), these theories revolve around the relationship’s nurses
form with patients.
3. “Outcomes” theories
- Portray the nurse as the changing force, who enables individuals to adapt to or cope with ill.
4. “Humanistic” theories
- Are developed in response to the psychoanalytic thought that a person’s destiny was determined
in early life and also emphasize a person’s capacity for self-actualization.
Carl Rogers developed a person - centered model of psychotherapy that emphasizes that
uniqueness of the individual.
CLARITY

“HOW CLEAR IS YOUR THEORY?”

- concepts and their definitions are identified.
“The danger of lost meaning when terms are borrowed from other disciplines and used in a different
context.” (Ellis) Diagrams and examples may facilitate clarity and should be consistent.

SIMPLICITY

“How simple is this theory?”

- Nurse in practice need simple theory, such as middle-range theory to guide practice. (Chinn and
Kramer).

- The most useful theory provides the greatest sense of understanding.” (Reynolds).

- “Elegant in its simplicity, even though it

may be broad in content.” (Walker and
Avant)
- “Elegant in its simplicity, even though it
may be broad in content.” (Walker and
Avant)
- “Elegant in its simplicity, even though it may be broad in content.” (Walker and Avant).
GENERALITY

“How general is this theory?”

- Scopes of concepts and goals within the theory are examined.
- The situations the theory applies to should not be limited.
- “The broader the scope, the greater the significance of the theory.” (Chinn and Kramer)
EMPIRICAL PRECISION

“How accessible is this theory?”

- How well the evidence supports the theory is indicative of empirical adequacy.” (Hardy)
- Other scientists should be able to evaluate and verify results by themselves.
 DERIVABLE CONSEQUENCE

“How important is this theory?”

- “It is essential for a theory to develop and guide practice...Theories should reveal what
knowledge nurses must and should, spend time pursuing.”

SIGNIFICANCE OF THEORY FOR NURSING

DISCIPLINE
Specific to the academia and refers to a branch of education, a department of learning or a domain of
knowledge.
PROFESSION

 A specialized field of practice, which is founded upon the theoretical structure of the science or knowledge
of the discipline and the accompanying practice abilities.

NURSING AS A DISCIPLINE
Theories provided frameworks to structure curriculum content or to guide the teaching of nursing practice in
nursing programs.

Discipline is dependent upon theory

Focus on knowledge about how nurses’ function which concentrated on the nursing process to a
focus on what nurses know and how they use knowledge to guide their thinking and decision making
while concentrating on the patient.

  New nursing science is developed through theory-based research studies.

NURSING AS A PROFESSION
Criteria of a profession by Bixler and Bixler published in the American Journal of Nursing 1959
1. Utilizes in its practice a well-defined and well- organized body of specialized knowledge that is on the
intellectual level of higher learning.
2. Constantly enlarges the body of knowledge it uses and improves its techniques of education and service by the
use of the scientific method.
3. Entrusts the education of its practioners to institutions of higher education.

4. Applies its body of knowledge in practical services that are vital to human and social welfare.

5. Functions autonomously in the formulation of professional policy and in the control of profession activity
thereby.

6. Attracts individuals of intellectual and personal qualities who exalt service above personal gain and
who recognize their chosen occupation as a life work.

7. Strives to compensate its practitioners by providing them freedom of action, opportunity for
continuous professional growth, and economic security.

Presented specific goals and achievements of the profession

- Nurses are recognized for the contribution they make in healthcare and society.
- Nursing theory is a useful tool for reasoning, critical thinking, and decision making in the
nursing practice.

NURSING THEORY AND THE PRACTICE OF NURSING

Theory assists the practicing nurse to:
•Organize patient data
 •Understand patient data
•Analyze patient data
•Make decisions about nursing interventions
•Plan patient care
•Predict outcomes of care
•Evaluate patient outcomes

Professional practice requires a systematic approach that is focused on the patient. Nursing theoretical works
provide a perspective of the patient.
IMPORTANCE OF NURSING THEORIES
- aims to describe, predict and explain the phenomenon of nursing (Chinn and
Jacobs1978).
- provides the foundations of nursing practice, help to generate further knowledge and
indicate in which direction nursing should develop in the future (Brown 1964).
- helps us to decide what we know and what we need to know (Parsons1949).
- helps to distinguish what should form the basis of practice by explicitly describing nursing.

The benefits of having a defined body of theory in nursing include better patient care, enhanced
professional status for nurses, improved communication between nurses, and guidance for research and
education (Nolan 1996).

The main exponent of nursing – caring – cannot be measured, it is vital to have the theory to analyze and
explain what nurses do.

NURSING THEORISTS AND THEIR WORKS

FLORENCE NIGHTINGLE
- Modern Nursing and Environmental Theory
- Nursing “is an act of utilizing the environment of the patient to assist him in his
recovery.”
BIOGRAPHY:
- First nursing theorists and the mother of Modern Nursing
- Born in May 12, 1820 in Italy to a wealthy British family.
- In 1853, she accepted the position of superintendent at the Institute for the care of sick
gentlewomen in Upper Harley Street, London.
- She tended to wounded soldiers during the Crimean War. She became known as the "Lady with
the Lamp" because of her night rounds.  Immortalized in the poem “Santa Filomena” by Henry
Wadsworth Longfellow
- After the Crimean War, she established a nursing school at St.  Thomas’ Hospital and King’s
College in London in 1860.
- Nightingale wrote Notes on Nursing (1859), which was the foundation of the curriculum for her
nursing school and other nursing schools.
- Notes on Matters Affecting the Health, Efficiency and Hospital
- Administration of the British Army
- Notes on Hospitals Report on Measures Adopted for Sanitary Improvements in India from June
1869 to June 1870.
- “She helped to pioneer the revolutionary notion that social phenomena could be objectively
measured and subjected to mathematical analysis.” (Cohen)
- Nightingale’s research skills:
- Recording, Communicating, ordering, coding, conceptualizing, inferring, analyzing and
synthesizing (Palmer)
 - Nightingale emphasized the concurrent use of observation and the performance of tasks in the
education of nurses.
- In 1883 - Royal Red Cross by Queen Victoria.
- In 1907 - the Order of Merit.
- In 1908 - Honorary Freedom of the City of London.
- She was able to work into her eighties and died in her sleep on August 13, 1910 at age 90
- International Nurses Day is celebrated on her birthday.
INFLUENCES
 EDUCATION PROVIDED BY HER FATHER
 FAMILY’S ARISTOCRATIC SOCIAL STATUS.
  EXPOSURE TO POLITICAL PROCESS OF THE VICTORIAN ENGLAND
 THE INDUSTRIAL AGE
 CHARLES DICKENS’ SOCIAL COMMENTARIES AND NOVELS
 DIALOGUES WITH MANY POLITICAL LEADERS
 UNITARIAN RELIGIOUS AFFILIATION.

ENVIRONMENTAL THEORY
NIGHTINGALE’S MAJOR CONCEPTS
1. Person
- Patient who is acted on by nurse
-   Emphasized that the Nurse has in control of the patient’s environment.
- Affected by environment
- Passive yet has reparative powers
2. Environment
- Foundation of Theory
- Included everything, physical, psychological, and social.
- Nurses are instruments to changes the social status of the poor by improving their living
conditions.
3. Health
- “We know nothing of health, the positive of which pathology is the negative, except from the
observation and experience.”
- Given her definition that of the art of nursing is to “unmake what God had made disease,” then
the goal of all nursing activities should be client health.
- Nursing should provide care to the healthy as well as the ill and discussed health promotion as an
activity in which nurses should engage.
- Envisioned maintenance of health through prevention of disease via environmental control.
4. Nursing
- “What nursing has to do…is to put the patient in the best condition for nature to act upon him”
(Nightingale, 1859/1992).
- Nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper
selection and administration of diet – all at the least expense of vital power to the patient.”
- Nursing is having the responsibility for someone else’s health
 - She wrote her notes on nursing to provide women how to “think like a Nurse”

Ventilation and warming

 Light and noise
Health of houses
Bed and bedding
 Personal cleanliness
Variety
Chattering hope and advices
Food

VENTILATION AND WARMING

- “Keep the air as he breathes as pure as the external air, without chilling him.”
- Recognized this environmental component as a source of disease and recovery
- Provided description for measuring the    patient’s body temperature through palpation of
extremities.
- Nurses were instructed to manipulate the environment to maintain both ventilation and
patient warm by good fire, opening windows and properly positioning patient in the
room.
LIGHT
- “Light has quite as real and tangible effects upon the human body…who has not observed the
purifying effect of light, and especially of direct sunlight, upon the air of the room?”
NOISE
- Noises created by physical activities in the environment (room) was to be avoided by the
nurse.
CLEANLINESS
- Bathing of patients on a frequent, even daily, basis.
- Nurses should wash their hands regularly
BEDS AND BEDDINGS
- Noted that a dirty environment (floors, carpets, walls and bed linens) was a source of infection
through the organic matter it contained.
- Noted that a dirty environment (floors, carpets, walls, and bed linens) was a source of infection
through the organic matter it contained.
- The appropriate handling and disposal of bodily excretions and sewage was required to
prevent contamination of the environment.
HEALTH OF HOUSES
- “Badly constructed houses do for the healthy what badly constructed hospitals do for the
sick.”
VARIETY
- “To any but an old nurse, or an old patient, the degree would be quite inconceivable to which the
nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings
during a long confinement to one or two rooms”
 FOOD
- Instructed nurses to assess dietary intake, meal schedules and its effect on the patient.
CHATTERING OF HOPE AND ADVICES
- Protects patient from receiving upsetting new, seeing visitors who can affect the patient’s
recovery negatively and from suddenly receiving disruptions from sleep.
ASSUMPTIONS
 Nightingale (1860/1957/1969) believed that five points were essential in achieving a healthful house:
“pure air, pure water, efficient drainage, cleanliness and light.”

A healthy environment is essential for healing. She stated that “nature alone cures.”

Nurses must make accurate observations of their patients and be able to report the state of the patient to
the physician in an orderly manner.

Nursing is an art, whereas medicine is a science.

Nurses are to be loyal to the medical plan, but not servile.

Disease is a reparative process. Disease is nature’s effort to remedy a process of poisoning or decay, or a
reaction against the conditions in which a person was placed.
Nature is synonymous with God.
Committed to nursing education (nursing) Women were to be specifically trained to provide care
for the sick and that nurses requiring preventive healthcare requires more training,

Nurses should use common sense, observation, perseverance and ingenuity.

Persons desired good health and that they would cooperate with the nurse.

Did not embrace germ theory but clearly understood the concept of contagion and contamination through
organic materials from patients and the environment.

🢖  Committed to nursing education (training.) Women were to be specifically trained to provide care
for the sick and that nurses requiring preventive healthcare requires more training.