THEORY  “taken for granted” statements

 determine the nature of the concepts,

 A set of interrelated concepts that give a
definitions purpose, relationships and structure
systematic view of a phenomenon (observable fact
of the theory.
or event) that is explanatory & predictive in nature
4. PRINCIPLE
 describe, explain, or predict relationships among
 basic generalization
concepts (Power & Knapp, 1995)
 accepted as true
 well-substantiated comprehensive explanation of
 basis for reasoning and conduct
some aspect of the natural world
NURSING THEORY
 an organized system of accepted knowledge that
 describes, predicts /explains nursing and is
applies in a variety of situations/hypotheses
used to support nursing practice
 repeatedly confirmed by observation and
 organized & articulation related to questions in
experimentation
the discipline of nursing
 gained general acceptance within the scientific
NURSING
community
THEORY:
 has not been yet decisively proven  Explains
NURSING CARE
HYPOTHESIS  Describes
 Predicts
 Expectation of what should happen, barring  Prescribes
unforeseen circumstances
 Coherent statement or set of statements to CHARACTERISTICS OF A THEORY
explain observed phenomena
1. Interrelating concepts in such a way as to create a
 Not scientifically tested
different way of looking at a particular
 Translates a res question into a prediction of phenomenon
outcomes 2. Logical in nature
3. Generalizable
 Predicted answer
4. Basis for hypothesis
5. Increasing the general body of knowledge within
COMPONENTS OF NURSING THEORY
the discipline through the research implemented to
validate them 
1. CONCEPT
6. Used by the practitioners to guide and improve
 idea of a phenomenon formed in mind their practice
 comprehensive generalization 7. Consistent with other validated theories, laws, and
principles but will leave open unanswered
 brings diverse elements into a basic
questions that need to be investigated.
relationship
 unit of thought PHILOSOPHY
 describe/label phenomena  most basic beliefs, concepts, and attitudes of
 understood or retained in the mind, from an indiv and group
experience, reasoning, and/or imagination; a  analysis of grounds expressing fundamental
generalization or abstraction of a particular set beliefs
of instances or occurrences.  next knowledge level after metaparadigm
• Examples: person, health, environment,  specifies the definition of metaparadigm
nursing concepts
2. DEFINITIONS  search for a general understanding of values &
 conveys general meaning of the concepts that reality by speculative rather than observational
it fits the theory means
 describE to measure the constructs, CONCEPTUAL MODELS/FRAMEWORKS
relationships, or variables within a theory  representations of an idea based on own
3. ASSUMPTIONS understanding/ perception of person on certain
 describe/connect factual concepts topic
  represents mental image of phenomenon  constitutes legitimate contributions to a
 CM of nursing identify concepts and describe field
their relationships to the discipline: person, RESEARCH
environment, health & nursing  creative & systematic work undertaken to
THEORETICAL MODELS/FRAMEWORK increase knowledge to devise new applications
 Highly established set of concepts that are
testable IMPORTANCE OF NURSING THEORY
 helps distinguish what should form the basis of
The Person
practice by explicitly describing nursing
Therapeutic use
of self  seen as an attempt by the nursing profession

dg
“The Core” to maintain its professional boundaries
 provides the foundations of knowledge and
indicate in which direction nursing should

d
The Disease
The Body develop in the future
Seeing the

ghd
Intimate bodily patient and  it helps us to decide what we know and what
care d family through we need to know
“The Care” medical care  Provides a basis of nursing practice.
“The Cure”
 important to nurses because it helps to
interpret data, make decisions based on
SCIENCE relevant information, plan for care, and predict
 Organized body of knowledge gained through and evaluate outcomes.
research  helps to differentiate nursing from other
SCIENTIFIC METHOD disciplines
1. Observation Why do we study nursing theory?
2. Gathering data  Everyday practice enriches theory
3. Forming Hypothesis  Both prac and theory are guided by values
4. Experimental Investigation and beliefs
5. Conclusion/ Theoretical Explanation  Theory guides use of ideas & techniques
KNOWLEDGE  Theory can close the gap b/w theory &
 Info, skills, & expertise acquired by a person research
thru formal/informal learning  Envision potentialities
PHENOMENON
 sets of empirical data/experiences that can be AREAS OF NURSING
physically observed/ tangible a. Education
 caring, self-care & client response to stress  was used primarily to establish the
profession’s place in the univ
 provide a general focus for curriculum
NURSING design
 autonomous & collaborative care of indivs all
 guide curricular decision making
ages, fams, groups & communities, sick/well
b. Research
 promotion of health, prevention of illness, &
 nursing research identifies the
care of ill, disabled& dying people
philosophical assumptions/ theoretical
PARADIGM
frameworks from which it proceeds
 set of concepts or thought patterns
 offer a framework for generating knowledge
 theories, res methods, postulates, &
& new ideas
standards
 assist in discovering knowledge gaps in
specific field of study
  offer a systematic approach to identify o provides a conceptual framework under
questions for study, select variables, which the key concepts & principles of
interpret findings and validate nursing the discipline can be identified
interventions o broad and complex
c. Practice 3. Mid-range nursing theory
 the primary contribution of nursing theory o more precise & only analysis, a
when employed in a clinical particular situation w/ limited # of
setting is the facilitation of reflection, variables
questioning, and thinking about o address specific phenomena & reflect
what nurses do practice
 assist nurses to describe, explain, and 4. Nursing Practice Theories
predict everyday experiences. o Explores one particular situation found
 serve to guide assessment, intervention, in nursing
and evaluation of nursing care. o Identifies explicit goals & details how
 provide a rationale for collecting reliable these goals will be achieved
and valid data about the health 5. Descriptive Theories
 status of clients, which are essential for o first level of theory development
effective decision making and 6. Prescriptive Theories
implementation. o address nursing interventions & predict
NURSING PARADIGM their consequences
 a pattern or model used to show a clear
HISTORY OF NURSING
relationship among the existing theoretical works
in nursing. Florence Nightingale
4 MAJOR CONCEPTS:
 began the history of professional nursing
 Health – the degree of wellness or well-being that
 before, envisioned nurses as a body of
the patient experiences. State of complete
educated women at a time when women were
physical, mental, emotional, social, spiritual
neither educated nor employed in public
wellbeing and not necessarily the absence of
service.
disease or infirmity.
 Following her service of organizing and caring
 Environment – internal and external surroundings
for the wounded in Scutari, during the Crimean
that affect the patient. This includes people in the
War, her vision and establishment of a School
physical environment, such as families, friends
of Nursing in St. Thomas' School London
and significant others
marked the birth of modern nursing.
 Person – the recipient of nursing care (includes
 pioneering activities in nursing practice and
individuals, families, groups and communities)
subsequent writings describing nursing
 Nursing – the attributes, characteristics and
education became a guide for establishing
actions of the nurse providing care on behalf of, or
nursing schools in the US at the beginning of
in conjunction with the patient.
the 20th century
TYPES OF NURSING THEORY HISTORICAL ERAS

1. Meta-Theory CURRICULUM ERA

o theory of theory
 Moving nursing education from hospital-based
o specific phenomena thru abstract
diploma programs into college and universities
concepts
RESEARCH ERA
2. Grand Nursing Theory
 Research is the path to new knowledge
 Part of the curricula of developing graduate nurses?
programs
GRAD EDUCATION ERA Resear 8. What is Role of Problem 9.
ch the focus nurses studies Problem
 Masters program in nursing emerged to meet the
Era: for nursing and and studies
need for nurses with specialized education in
1950 – research? what to studies of and
nursing
1970s research nurses studies
THEORY ERA
of nurses
 Outgrowth of research era
 Research without theory produced isolated Gradua What Carving Nurses 10.
te knowledge out have Nurses
information; however research and theory
Educati is needed an an have an
produced nursing science
on for the advanced important importan
Era: practice of role and role in t role in
MID 1970s
1950 – nursing? basis for health health
 Evaluation of 25 years of nursing research 1970s nursing care care
revealed that nursing lacked conceptual practice
connections and theoretical frameworks
11. How do There are 12.
 MILESTONES:
Theory these many Nursing Theories
1. Standardization of curricula for nursing
Era: framework ways theoretic guide
master’s education
1980 to s to think al works nursing
2. Decision that doctoral education for nurses
1990s guide about shift the research
should be in nursing  research nursing focus to and
 Transition from vocation to profession and the practice
 Nursing practice is based on Nursing Science. practice? patient

MID 1980s
Theory What new Nursing Middle- Nursing
 Preparadigm to Paradigm period
Utilizati theories theory range framework
 Introduced an organizational structure for nursing on are guides theory s
knowledge development to the nursing literature Era: needed to research may produce
 Utilization phase of the Theory Era – emphasis 21st produce , be from knowledg
shifts from the development to the use and Century evidence practice, quantitati e
application of what is known. of educatio ve (evidence)

1st Conference Nursing Theory (1969) quality n, and or for quality

care? administ qualitativ care
Brought leading scholars & theorists to discuss
ration e
& debate on issues regarding nursing science
approach
& theory development
es
HISTO- MAJOR EMPHAS OUTCO EMERGI
RICAL QUESTIO IS MES NG
CHANGES OF EDUC IN NURSING
ERAS N GOAL
1874 – the St. Catherine Training School was the first
6. What Courses 7.Standa Develop hospital diploma school in Canada where the nursing
Curric curriculum included rdized specialize program went from an apprenticeship to an
ulum content in curricula d
educational model.
Era: should nursing for knowledg
1881 – the school for Nurses at the Toronto General
1900 –  student programs diploma e
Hospital was established.
1940 nurses’ program and
1896 – Mary Agnes Snively developed 3-year course
study to s higher
be education with 84 hours of practical nursing and 119 hours of
instruction by the medical staff
1918 - following World War 1, the widespread 1. University baccalaureate programs
influenza pandemic led to support for public health proliferated, masters programs in nursing were
programs and new patterns of health care delivery. developed, and the curricula began to be
1919 – year the first undergraduate nursing degree standardized through accreditation process
program was established at the University of British 2. Attention to the importance of nursing
Columbia. conceptualizations for the research process
1932 – demanded for transfer of responsibility for and the role of a conceptual framework in the
nursing education to general educational system. purpose and design of research production of
1950’s and 1960’s – experiments with two-year science and nursing theoretical works also
programs for nursing began and the movement to began to publish
separate nursing education from the authority of 3. Works began to be recognized for their
hospitals began. theoretical nature, such as Henderson,
1967 – Laurentian University started student intake. Nightingale, and Orlando, Peplau, and
2000 – all professional nurses are required to have a Widenbach were recognized for the theoretical
bachelor at degree. nature of their earlier writings
 Process of knowledge development. Nursing
Significance of Nursing Theory: Discipline & practice, theory, and research are
Profession interdependent.
 At the beginning of the 20th century, nursing  Nursing theory development and nursing
was not recognized as an academic discipline/ research activities are directed toward
profession developing nursing practice standards.

Theoretical Works Have Taken Nursing To A

Discipline Higher Level
- specific to academia & a branch of educ, a  have moved from the functional focus,
dept of learning or field or knowledge  what nurses know
Profession  how they use what they know for thinking and
- specialized field of practice, w/c is founded decision making while concentrating on the
upon the theoretical structure of the science or patient
knowledge of that discipline & the  Nursing Theoretical Works represents the most
accompanying practice abilities comprehensive ideas and systematic
knowledge about nursing.
DISCIPLINE PROFESSION  Therefore, nursing theoretical works are vital to
DEFINITION Branch of Type of work that the future of both the discipline and the
knowledge needs special profession of nursing.
usually studied in training or PROFESSION
higher educ particular skill to
 An occupation w/ ethical components, i.e,
perform
devoted to the promotion of human & social
KNOWLEDGE Generates Applies
welfare
knowledge knowledge to the
 based on specialized skills
practical world
PRODUCT Focuses on how Focuses on the  occupations possessing combination of
the product is final product characteristics
being created CRITERIA FOR PROFESSION
EXAMPLES Math, biology, Doctor, lawyer, Bixler and Bixler Criteria for Profession
physics, art teacher, nurse  Genevieve and Roy Bixler who were against
the status of Nursing as a profession 1945,
Significance of Nursing Theory As A Discipline
 1. Utilizes in its practice a well-defined &  professionals deal in matters of vital
well-organized body of knowledge, w/c is importance to clients
on the higher learning  entrusted w/ grave responsibilities &
2. Constantly enlarges the body of obligations
knowledge its uses and improves its  carelessness, inadequate skill or
techniques of education & service by the breach of ethics-> damaging to client
use of the scientific method 2. Accountability
3. Entrusts the education of its practitioners  professionals hold themselves
to institutions of higher educ ultimately accountable for the quality of
4. Applies its body of knowledge in practical their work w/ the client
service, w/c is vital to human beings &  profession may /not have mechanisms
social welfare in place to reinforce & ensure
5. Functions autonomously in the formulation adherence to its principle among its
of professional policy & in control of members
professional activities thereby 3. Based on specialized, theoretical
6. Attracts individuals of intellectual and knowledge
personal qualities who exalt service above  Specialized services based on theory,
personal gain and who can recognize their knowledge, and skills
chosen profession as life work  Sometimes, this specialization will
7. Strives to compensate its practitioners by extend to access to the tools and tech
providing freedom of action, opportunity for 4. Institutional Preparation
continuous professional growth and  Hands on, practical experience in
economic security protected company of senior members
Abraham Flexner’s Criteria for profession  After provisional period, ongoing educ
1. Basically intellectual & w/ high degree of toward professional development is
responsibility compulsory
2. Based on refreshed and refined through  A profession may /not require formal
research credentials for admission
3. Practical & theoretical 5. Autonomy
4. Taught through a highly specialized  control & responsibility of own work
professional education 6. Clients rather than customers
5. Strong internal organization of members and  Discrimination in choosing clients
group consciousness rather than simply accepting any
6. Motivated by altruism(desire to help others) interested party as a customer
&who are responsive to human interests (merchants)
Kelley’s criteria 7. Direct working relationships
 expanded Flexner’s criteria  Professionals habitually work directly
1. services are vital to humanity & welfare of with their clients rather than through
society intermediate or proxies
2. special body of knowledge is enlarged through 8. Ethical constraints
research  Code of conduct/ethics
3. intellectual activities; indiv  Uncompromising regard for the client’s
responsibility(accountability) is a strong feature benefit and best interests
4. educated in institutions of higher learning 9. Merit-based
CHARACTERISTICS OF PROFESSIONAL  Must attract clients & profits due to
1. Great Responsibility merits of his work
  Absence of this, issues of RATIONALISM EMPIRICISM
responsibility, accountability, and based on the use of based on experience
ethical constraints become irrelevant reason or logic and experimentation
HISTORY & PHILOSOPHY OF SCIENCE Mathematics- paradigm Experimental science-
Ontology (what is real?) of knowledge paradigm knowledge
Epistemology (what is knowable?) Genuinely knowledge is Experiment &
Ethics (is this just?) certain experience rarely
Aesthetics (is there an art to caring?) Believes in intuition Doesn’t believe in
Nursing as a Science intuition
1. Science is logical, systematic, & coherent way Aims @ discovering the Aims @ analyzing
to solve problems and answer questions. language of mind language as it occurs
2. It is a collection of facts known in area and the Assigns categories to Assigns probabilities to
process used to obtain that knowledge language units language units
Nursing and Philosophy
 Philosophy studies concepts that structure
thought processes , foundations, & to reason that a

presumptions
approach for thinking abt the nature of people,
lack of social
the methods that should be used to create a
scientific knowledge & the ethics involved
support
 denotes a perspective, implying a certain (cause) results in
broad, “taken for granted” assumptions
Epistemology hospital readmission
-
-
nature and scope of knowledge
“theory of knowledge”
(effect).
Rationalism to reason that a
lack of social
 use of the rational senses in ensuring
the truthfulness of a phenomenon
 To reason that a lack of social support
(cause) results in hospital readmission
support
(effect). (cause) results in
hospital readmission
 This causal reasoning is a theoretical
assertion until tested and disproven.
 The traditional approach proceeds by
explaining hospitalization with a
(effect).
systematic explanation (theory) of a to reason that a
lack of social
given phenomenon
 Theory-then-research strategy
Empiricism
 way of looking at reality using 5 senses
support
 inductive method (cause) results in
 collection of facts precedes attempts to
formulate generalization
hospital readmission


research-then- theory strategy
formulating diagnosis
(effect)
to reason that a (cause) results in
lack of social hospital readmission
support (effect)
(cause) results in to reason that a
hospital readmission lack of social
(effect) support
to reason that a (cause) results in
lack of social hospital readmission
support (effect)
(cause) results in to reason that a
hospital readmission lack of social
(effect) support
to reason that a (cause) results in
lack of social hospital readmission
support (effect)
(cause) results in to reason that a
hospital readmission lack of social
(effect) support
to reason that a (cause) results in
lack of social hospital readmission
support (effect)
(cause) results in to reason that a
hospital readmission lack of social
(effect) support
to reason that a (cause) results in
lack of social hospital readmission
support (effect)
to reason that a
2. Acceptance of scientific hypothesis through
research depends on the appraisal of the

lack of social coherence of theory

3. Dubin identified when scientific consensus is

support necessary
Issues in Nursing Philosophy & Science
(cause) results in Development

hospital readmission 4 FUNDAMENTAL PATTERNS OF KNOWLEDGE IN

NURSING:

(effect) 1. Empirical knowledge - science of nursing

- Based on the assumption that what is known
to reason that a is accessible through the physical senses:

lack of social seeing, touching and hearing.

- Reality exists and truths about it can be

support understood
2. Esthetic knowledge - art of nursing
(cause) results in - Expressed through:

hospital readmissio
o Actions, bearing, conduct, attitudes,
narrative and interaction
Early 12th Century Views Of Science & Theory
o Knowing what to do without conscious
 focused on the analysis of theory structure
deliberation
whereas,
3. Ethical knowledge - moral knowledge in nursing
o focused of empirical research
- Guides and directs how nurses conduct their
o positivism (experience)
practice
 derived from logical & mathematical treatments - Requires:
 reports of sensory experience is the exclusive o Experiential knowledge of social values
source of all authoritative knowledge o Ethical reasoning
4. Personal knowledge - acceptance of self that is
Emergent Views in the Late 20th Century Science &
grounded in self-knowledge and confidence
Theory
- Concerned with becoming self-aware
 Brown stated that theories play a significant role in
- Self–awareness that grows over time through
determining what the scientist will observe and
interactions with others
how it will be interpreted
- therapeutic use of self in practice
 Relationship b/w theories & observation
o Scientific competence, moral/ethical practice,
1. Scientists are merely passive observers of
insight and experience of personal knowing
occurrences in the empirical world,
- Personal reflection
observable data are objective data waiting
o Informed by the response of others
to be discovered
- Openness to experience
2. Theories structure what the scientists
perceived
1980s - Further acceptance of nursing theory and its
3. Presupposed theories & observable data
incorporation in the
interact in the process of scientific
nursing curricula; publication of several nursing journal
investigation
1990s - Nursing as a basic science, an applied
Interdependence b/w Theory & Research
science, or a practical science Progress in the
1. Theory should be judged based on the basis of
Discipline of Nursing (Meleis)
scientific consensus
• Practice
• Education and Administration
 and external
• Research
• Development of Nursing Theory
Peplau developed the first theory of nursing practice
in her book , Interpersonal Relations in Nursing (1952)
Journal of Nursing Research (1952)
surroundings
1960s and 1970s – analysis and debate on the
metatheoretical issues related to theory development
that affect the
Postpositivism - focuses on discovering the patterns
that may describe a phenomenon. client
3. health – the
Interpretive paradigm - address the meanings the
participants social interaction that emphasize situation,

degree of
context and multiple cognitive constructions that
individuals create on everyday events.
Critical paradigm - knowledge development in
nursing,
- provides framework for inquiring about the
wellness or well-
interaction between the social,
economic, gender and cultural factors and
political,
being that client
experiences of health and illness

STRUCTURES OF NURSING KNOWLEDGE

experiences
1. Metaparadigm 4. nursing- the
attributes,
» global concepts that identify the phenomena of
central interest to a discipline
» the global propositions that describe the concepts
» state the relations between the concepts.
» extremely abstract and provide no definitive direction
characteristics
for such activities as research and practice
» identify the basic subject matter of the discipline
and actions of
» specifies main concepts that includes subject &
scope of discipline the nurse
Concepts of providing care
Metaparadigm on behalf of in
1. person – the conjunction with
recipient of the client
nursing care Concepts of
2. environment Metaparadigm
– the internal
1. person – the on behalf of in
recipient of conjunction with
nursing care the client
2. environment Concepts of
– the internal Metaparadigm
and external 1. person – the
surroundings recipient of
that affect the nursing care
client 2. environment
3. health – the – the internal
degree of and external
wellness or well- surroundings
being that client that affect the
experiences client
4. nursing- the 3. health – the
attributes, degree of
characteristics wellness or well-
and actions of being that client
the nurse experiences
providing care 4. nursing- the
attributes,
characteristics
- Are comprehensive, and each addresses the
metaparadigm concepts of person,
environment, health and nursing

and actions of - broad frame of  reference for systematic

approaches to the phenomena with which the

the nurse -
discipline is concerned  
Theorists who developed nursing

providing care conceptual models often proposed a grand

theory from their model.

on behalf of in 4. Grand Theory

- Derives from the conceptual model and

conjunction with
proposes an abstract testable theory
- These theories have the capacity to threaten

the client
the solvency of the conceptual model from
which they are derived, because they test the
Concepts of Metaparadigm major premise of the conceptual model.
1. person – the recipient of nursing care - Example: Roy’s theory of the person as an
2. environment – the internal and external
adaptive system, King’s theory of goal
surroundings that affect the client
3. health – the degree of wellness or well-being that attainment, and Neuman’s theory of optimal
client experiences client stability.
4. nursing- the attributes, characteristics and actions
5. Theory
of the nurse providing care on behalf of in conjunction
- Comprises works derived from nursing
with the client
philosophies, conceptual models, grand
2. Philosophy theories, abstract nursing theories, or works in
- abstract type that sets forth the meaning of other discipline.
nursing phenomena through analysis, - A work classified as nursing theory is
reasoning, and logical presentation. developed from some conceptual framework or
- forming a basis for professional scholarship that grand theory and is generally not as specific as
leads to new theoretical understanding a middle range theory.
- Represents early works predating the theory era - Maybe specific to a particular aspect or setting
and contemporary works of a philosophical of nursing practice.
nature - Example: Meleis’ transition theory which is
- provide broad understandings that advance the specific to changes in a
discipline of nursing and its professional o person’s life process in health and
applications. illness.
- approach to nursing, usually created by 6. Middle-Range Theory
individual nurses in their own daily practice in - Has the most specific focus and is concrete in
the field its level of abstraction.
d. Example: Nightingale’s philosophy - Propose precise testable nursing practice
3. Conceptual Models questions.
- Comprises nursing works by theorists referred - They address the specifics of nursing
to by some as pioneers in nursing situations within the perspective of the model,
- address phenomena central to nursing in grand theory, or theory from which they
propositions that explain relationships among originate.
them - Focus on a limited aspect of reality
- Propositions may be tested through research.
- Middle range theory may be:
 o A description of a particular phenomenon INFLUENCES
o An explanation of the relationship between
phenomena – Education provided by her Father.
o Prediction of the effects of one – Family’s aristocratic social status
phenomenon or another – Exposure to political process of the
- The specifics in these theories are:
Victorian England
o Age group of the patient
– The Industrial Age
o Family situation
– Charles Dickens’ social commentaries
o Patient’s health condition
and novels
o Location of the patient – Dialogues with many political leaders
o Action of the nurse – Unitarian religious affiliation
o “The art of nursing is the creative use of  nursing “ought to signify the proper use of
the science of nursing for human fresh air, light, warmth, cleanliness, quiet, and
betterment.” the proper selection and administration of diet
-Rogers, 1990, p.5 – all at the least expense of vital power to the
patient.”
 ENVIRONMENTAL FACTORS
NURSING THEORISTS AND THEIR WORKS 1. Pure/Fresh air
Nursing Philosophies 2. Pure water
- Beliefs of nurses on how to relate or how it can 3. Efficient drainage
help nursing profession
4. Cleanliness
- Approach to nursing created by individual
nurses in their own daily practice in their field 5. Light
- To explain what they believe nursing is, the  TYPES OF ENVIRONMENT
role nursing plays in healthcare and they 1. Physical (where patient is being
interaction with patients
treated)
- Address nursing ethics and how are they
related to practice of nursing o Cleanliness
o Water
- Guides a nurse as they practice each day o Water o Bedding
I. ENVIRONMENTAL THEORY
o Air o Drainage
(Florence Nightingale) o Diet
o Light
 Nursing “is an act of utilizing the environment
of the patient to assist him in his recovery” o Noise

 Nightingale 2. Psychological (affected by negative

Biography physical environment --> stress)

– First Nursing theorists & Mother of o Communication

Modern Nursing o Advice

– Born in May 12, 1820 in Florence, Italy 3. Social (person’s home/hospital room)
to a wealthy British Family o Mortality data
– In 1853, she accepted the position of o Prevention of disease
superintendent at the institute of the  13 CANONS
Care of Sick Gentlewomen in Upper 1. Variety
Harley Street, London 2. Health of houses
– Crimean War 3. Food
– “Lady with the Lamp” because of her 4. Bed & bedding
night rounds 5. Chattering hope & advices
– After the Crimean war, she established 6. Petty management
a nursing school at St. Thomas’ 7. Personal cleanliness
Hospital and King’s College in London 8. Noise
in 1860 9. Ventilation & Warmth
 VENTILATION & WARMTH  Implement adequate light without placing
 Keeping patient’s room warm direct light
 well ventilated and free of odors  PERSONAL CLEANLINESS
 air within as pure as the air external  Bathing patients daily basis
air/without noxious smells  Nurses should wash hands regularly
 HEALTH OF HOUSES  Patient clean & dry
 A healthy house should have 5  Frequent assessment of client’s skin
environmental factors  CLEANLINESS OF ROOMS
 Removing garbage or stagnant waters  Assess room for dampness, darkness &
 PETTY MANAGEMENT dust/mildew
 Continuity of care when nurse is absent  Keep environment clean
 Document plan of care and evaluation  CHATTERING HOPE & ADVICES
 NOISE  giving inspirational words is fine to boost
 Avoidance of sudden noise their morale
 Keep noise to minimum  sick should hear good news to assist them
 VARIETY in becoming healthier
 Provide variety to avoid boredom &  OBSERVATION OF THE SICK
depression  Making observations also to client’s
 Flowers, pics, books, puzzles etc surroundings
(diversional therapy)  4 MAJOR CONCEPTS OF ENVI THEORY
 Encourage signi others to engage w/ client 1. Person
 FOOD INTAKE – Patient who is acted on by nurse

 Assess client’s diet – Emphasized that the Nurse has in

 Document amt of foods & liquids ingested control of the patient’s environment.

@ every meal – Affected by environment

 FOOD NUTRITION – Passive yet has reparative powers

2. Nursing
 Nightingale addressed food presented
– Nursing "ought to signify the proper
to the patients and discussed the
use of fresh air, light, warmth,
importance of variety in the food presented.
cleanliness, quiet, and the proper
 try to include patient’s food preferences.
selection and administration of diet
 Attempt to ensure that the client always
— all at the least expense of vital
has some food or drink available that
power to the patient."
he/she enjoys
– She wrote her Notes on Nursing to
provide women how to "Think like a
Nurse."
 BED & BEDDINGS
3. Environment
 Keeping bed dry, wrinkle free and lowest
– Foundation of theory
height
– Included everything, physical,
 dirty environment (floors, carpets, walls
psychological and social
&bed linens) was a source of infection
– Nurses are instruments to change
through the organic matter it contained.
the social status of the poor by
 appropriate handling and disposal of bodily
improving their living conditions
excretions and sewage was required to
4. Health
prevent contamination of the environment.
– balance between human and
 LIGHT
his/her environment
 Beneficial effects- Vit D
 – being well and using every power  Human Caring Science: A Theory of Nursing is
(resource) to the fullest extent in the title of Jean Watson's latest work, it was
living life renamed to convey a deeper human to human
– disease and illness – reparative involvement and connection.
process that nature instituted when  EXPLICIT ASSUMPTIONS
a person did not attend to health  An ontologic assumption of oneness,
concerns wholeness, unity, relatedness and
– health maintenance through connectedness
prevention of disease via  An epistemologic assumption that there are
environmental control and social multiple ways of knowing
responsibility  Diversity of knowing assumes all, and
 IMPORTANCE OF ENVI THEORY various forms of evidence can be included
1. Nursing Practice  A caring science model makes these
a) Disease Control diverse perspectives explicitly and directly.
b) Sanitation and water treatment  Moral-metaphysical integration with
c) Utilized modern architecture in the science evokes spirit; this orientation is not
prevention of "sick building only possible but also necessary for our
syndrome" applying the principles of science, humanity, society-civilization, and
ventilation and good lighting. world-planet.
d) Waste disposal  A caring science emergence, founded on
e) Control of room temperature new assumptions, makes explicit an
f) Noise management expanding unitary, energetic worldview with
2. Nursing Education a relational human caring ethic and
a) Principles of nursing training. Better ontology as its starting point.
practice result from better  MAJOR ELEMENTS
education. 1. Carative Factors
b) Skills measurement through a) Formation of a humanistic- altruistic
licensing by the use of testing system of values.
methods, the case studies.  Loving, kindness &equanimity
3. Nursing Research b) The installation of faith-hope
a) Use of graphical representations  “Being authentically present and
like the bar, diagrams. enabling and sustaining the
b) Notes on nursing deep belief system and
subjective lifeworld of self and
one being cared for.”
II. HUMAN CARING THEORY c) The cultivation of sensitivity to one’s
(Jean Watson) self and to others.
 Watson  sensitivity encourages self-
Biography growth and self-actualization, in
- Born in West Virginia, currently living in
Colorado. both the nurse and those with
- B.Sc. in 1964, MS in Psychiatric Nursing in whom the nurse interacts.
1966 and PhD in Educational Psychology d) The development of helping- trust
and Counseling in 1973.
relationship.
- Founder of the Center for Human Caring in
Colorado  Building rapport or NPI (Nurse
 Caring is Human-to-human process Patient Interaction) to gain trust
demonstrated through a therapeutic  Congruent, empathy, warmth &
interpersonal interactions communication
e) The promotion and acceptance of the j) The allowance for existential-
expression of positive and negative phenomenological forces
feelings  To reconcile the incongruity
 Feelings alter thoughts and  Assist the patient to confront
behaviors life and death
f) The systematic use of the scientific 2. Transpersonal caring relationship
problem-solution method for decision – Mutuality of 2 persons involved –nurse
making. & patient
 Problem solving -- only method – Describes how the nurse goes beyond
that allows prediction and self- the objective assessment to show
correction concern toward the person’s
 Values relative nature of nursing subjective/deeper meaning of their
and support the need to healthcare situation Involves mutuality
examine and develop other between the two individuals involved
methods knowing to provide 3. Caring occasion/ caring movements
holistic perspective – moment when the nurse and another
 Science of caring should not be person come together that an occasion
always neutral or objective for human caring is created.
g) The promotion of interpersonal – human-human transaction-- caring for
teaching-learning. & one being cared for are influenced by
 Must focus in learning process the choices and actions decided within
as much as teaching process the relationship
 Patient’s perception of situation  4 CONCEPTS OF HUMAN CARING THEORY
to assist to prepare cognitive 1. Person
plan – human being as “a valued person in
h) The provision for a supportive, and of him or herself to be cared
protective and/or corrective mental, for, respected, nurtured, understood
physical, socio-cultural and spiritual and assisted; in general a
environment philosophical view of a person as a
 Must provide comfort, privacy & fully
security 2. Health
 Each need is equally important – unity and harmony within the mind,
in optimal health body, and soul
i) Assistance with the gratification of – associated with the degree of
human need congruence between the self and
 Watson’s ordering of needs the self as experienced
 Lower order needs ( – high level of overall physical,
biophysical)
mental, and social functioning
o Food/fluid
o Elimination – a general adaptive maintenance
o Ventilation level of daily functioning
 Lower order needs – absence of illness, or the presence
(psychophysical)
of efforts leading to the absence of
o Activity-inactivity
o Sexuality illness
 Psychosocial needs 3. Environment/Society
o Achievement – Caring (and nursing) has existed in
o Affiliation
every society
 Self-actualization
– Not transmitted from gen to gen
 – transmitted by the culture of the 2. The teaching-coaching function
profession as a unique way of 3. Diagnostic client-monitoring function
4. Effective management of rapidly changing
coping with its environment
situations
4. Nursing 5. Administering and monitoring therapeutic
– concerned with promoting health, interventions and regimens
6. Monitoring and ensuring quality of health
preventing illness, caring for the
care practices
sick and restoring health 7. Organizational and work-role competencies
– focuses on health promotion &  5 STAGES OF ACQUIRING EXPERTISE
treatment of disease 1) Novice
– holistic health care is central to the – no background experience
practice of caring in nursing – inexperienced nurses function at the
 Establishing a caring relationship with patients. level of instruction from nursing school
 Treat patients as holistic beings. – unable to make the leap from the
 Display unconditional acceptance. classroom lecture to individual patients
 Treat patients with positive regard. – unable to discern individual patient
 Promote health through knowledge and needs
intervention. – limited ability of what might happen to
 Spend uninterrupted time with patient patients
III. STAGES OF NURSING EXPERTISE – usually new graduates, or those nurses
(Patricia Benner) who return to the workplace after a long
Biography absence and are re-educated in
– was born in Hampton, Virginia refresher programs
– received her prof educ in Cali 2) Advanced Beginner
 Novice to Expert model, aka Benner’s Stages – No depth experience
of Clinical Competence – person can demonstrate marginally
 adapted from the Dreyfus Model of Skill acceptable performance having coped
Acquisition. with enough real situations to note,
 Skill acquisition – to have pointed out by mentor, the
- utility of the concept of skill acquisition lies in recurring meaningful components of the
helping the teacher understand how to assist situation
the learner in advancing to the next level – guided by rules and oriented by task
 experience in the clinical setting is key to completion
nursing because it allows a nurse to – requires mentor or experienced nurse
continuously expand their knowledge base and to assist with defining situations, to set
to provide holistic, competent care to the priorities, and to integrate practical
patient knowledge
 aimed at discovering if there were 3) Competent
distinguishable, characteristic differences in – 2 to 3 years in the same area of nursing
the novice’s and expert’s descriptions of the – most pivotal in clinical learning
same clinical incident – begin to recognize patterns and
 6 AREAS OF PRACTICAL KNOWLEDGE determine which elements of the
1. Graded qualitative distinctions situation warrant attention and which
2. Common meanings
can be ignored
3. Assumptions, expectations and sets
4. Paradigm cases and personal knowledge – devises new rules
5. Maxims – lack the speed and flexibility
6. Unplanned practices
– reasoning procedures for a plan while
 7 DOMAINS OF NURSING PRACTICE
1. Helping role
 – applying learned rules for action on the conveys a social environment with
basis social definition
– of the relevant facts of that situation – one has a past, present, and
4) Proficient future and that all of these
– 3 to 5 years in the same area of nursing aspects… influence the current
– possesses a deep understanding of situation
situations as they occur, less conscious 4. Nursing
planning is necessary, critical thinking – caring relationship, an “enabling
and decision-making skills have condition of connection and
developed concern.”
– perceives the information as a whole – “Caring is primary because caring
– qualitative leap beyond the competent sets up the possibility of giving
– new ability to see changing relevance and receiving help.”
in a situation including the recognition & – caring practice whose science is
implementation of skilled responses to guided by the moral art and ethics
the situation as is it evolves. of care and responsibility.
5) Expert – care and study of the lived
– 5 years or greater experience of health, illness, and
– no longer relies on an analytic principle disease and the relationships
to connect her or his understanding of among the three elements
the situation to an appropriate action IV. CARITATIVE CARING THEORY
– intuitive grasp of each situation and (Katie Eriksson)
zeroes in on the accurate region of the  Eriksson
problem without wasteful consideration Biography
of a large range of unfruitful, alternative – Nov. 18, 1943 in Jakobstad, Finland
diagnoses and solutions – 1965 graduate of the Helsinki Swedish
– operates from a deep understanding of School of Nursing
the total situation – 1967, she completed her public health
 4 MAJORS OF CONCEPTS nursing specialty education
1. Person  distinguishes between caring ethics, the
– Self-interpreting being, practical relationship between the patient and
– does not come into the world the nurse, and nursing ethics
predefined but gets defined in the  Nursing ethics are the ethical principles that
course of living a life guide a nurse’s decision-making abilities
2. Health  consists of love and charity, which is also
– Lived experience of being healthy known as caritas, and respect and reverence
and being ill for human holiness and dignity
– what can be assessed, whereas  suffering that occurs as a result of a lack of
well-being is the human caritative care is a violation of human dignity
experience of health or wholeness  caritas -- love and charity
– Well-being and being ill are – eros and agapé are united
– understood as distinct ways of – unconditional love
being in the world – fundamental motive of caring science
3. Environment – an endeavor to mediate faith, hope,
– uses situation rather than and love through tending, playing, and
environment because situation learning.
 Caring communion-- context of the meaning when the human being’s holiness &
of caring and is the structure that determines dignity appear
caring reality – unique, isolated total experience and is
– form of intimate connection that not synonymous with pain
characterizes caring  reconciliation- drama of suffering
– meeting in time and space, an – who suffers wants to confirm their
absolute, lasting presence suffering
– characterized by intensity and – change through w/c a new wholeness
– vitality, and by warmth, closeness, rest, is formed of the person has lost in
respect, honesty, and tolerance suffering
– source of strength & meaning in caring  caring culture -- Eriksson uses instead of
 act of caring -- contains the caring elements environment
(faith, hope, love, tending, playing, and – characterizes the total caring reality
learning), involves the categories of infinity and and is based on cultural elements such
eternity, and invites to deep communion as traditions, rituals, and basic values
– art of making something very special – transmits an inner
out of something less special – order of value preferences or ethos, &
 caritative caring ethics -- core of which is the different constructions of culture
determined by the caritas motive have their basis in the changes of value
– basic relation between the patient and that ethos undergoes
the nurse—the way in which the nurse  Axioms
meets the patient in an ethical sense - Truths that we all know
– approach toward patient o The human being is fundamentally an
 dignity -- one of the basic concepts of entity of body, soul, and spirit.
caritative caring ethics o The human being is fundamentally a
– privacy to preserve dignity religious being.
– Absolute dignity is granted the human o The human being is fundamentally
being through creation holy. Human dignity means accepting
– Relative dignity is influenced and the human obligation of serving with
formed through culture and external love, of existing for the sake of others.
contexts o Communion is the basis for all
– absolute dignity involves the right to be humanity. Human beings are
confirmed as a unique human being fundamentally interrelated to an
– approach we have toward the patient abstract and/or concrete other in a
 invitation -- act that occurs when the carer communion
welcomes the patient to the caring communion o Caring is something human by nature,
– finds room for a place where the human a call to serve in love.
being is allowed to rest, a place that o Suffering is an inseparable part of life.
breathes genuine hospitality, and
Suffering and health are each other’s
where the patient’s appeal for charity
prerequisites.
meets with a response
o Health is more than the absence of
 suffering -- human being’s struggle between
illness. Health implies wholeness and
good and evil in a state of becoming
holiness.
– sense dying away from something, and
o The human being lives in a reality that
through reconciliation, the wholeness of
is characterized by mystery, infinity,
body, soul, and spirit is re-created,
and eternity
 Theses
 - Statement that are tested through
basic research explained by science
(fact)
 Ethos confers ultimate meaning on the caring
context.
 The basic motive of caring is the caritas motive
 The basic category of caring is suffering
 Caring communion forms the context of
meaning of caring and derives its origin from
the ethos of love, responsibility, and sacrifice,
namely, caritative ethics
 Health means a movement in becoming, being,
and doing while striving for wholeness and
holiness, which is compatible with endurable
suffering
 Caring implies alleviation of suffering in charity,
love, faith, and hope. Natural basic caring is
expressed through tending, playing, and
learning in a sustained caring relationship,
which is asymmetrical by nature

NURSING CONCEPTUAL MODELS

I. Science of Unitary Human Being’s Model
(Martha Rogers)
 Two dimensions:
1. The Science of Nursing – knowledge
specific to nursing comes from scientific
research
2. The Art of Nursing – creative use
 Assumptions
o Wholeness (unified whole)
o Openness (person and environment is
exchanging energy continuously)
o Unidirectionality (life process)
o Pattern & Organization (identifies
individual and his innovative
wholeness)
o Sentence & Thought (capacity to think,
emotion, etc )
 Major concepts
o Energy Field (open, free flowing)
o Openness (no boundaries)
o Pattern (single wave&abstraction)
o Pan Dimensionality (non-linear& 3d)
 Homeodynamic Principles
  Homeodynamics - balance between the - manifesting characteristics different
dynamic life process and environment from those of the parts are infinite, and
 help to view human as unitary human being change is continuously innovative,
 Three principle of homeodynamics: unpredictable, and characterized by
o Resonancy – continuous change from increasing diversity
lower to higher frequency wave II. SELF-CARE DEFICIT MODEL
patterns in hum & envi fields (Dorothea Orem)
o Helicy - continuous innovative,  Inability of patients to take care of
unpredictable, increasing diversity of themselves
hum & envi field patterns  Entitled to bring their capability after
o Integrality (Synchrony+Reciprocy ) being sick

– continuous mutual; human&  Orem’s general theory of nursing’s three

environmental field processes related parts:

 METAPARADIGM o Theory of self-care

1. Nursing o Theory of self-care deficit

- is both a science and an art o Theory of nursing system
- focuses on concern with people and the  Theory of Self Care
world in which they live—a natural fit for  Two agents: self-care agent &
nursing care, as it encompasses people dependent care agent (loved ones)
and their environments o SELF CARE – practice of activities that an
- promote symphonic interaction individual initiates and performs on his/her
between human and environmental own behalf in maintaining life, health and
fields well being
- to strengthen the integrity of the human o SELF CARE AGENCY – is a human ability
field which is "the ability for engaging in self-
- direct and redirect patterning of the care“; conditioned by age, developmental
human and environmental fields for state, life experience, sociocultural
realization of maximum health orientation, health, and available resources
potential” o SELF CARE REQUISITES - action directed
2. Person towards provision of self-care.
- an open system in continuous 3 categories of self-care requisites are:
process with the open system that 1) Universal self-care requisites
is the environment (integrality) - requisites/needs that are common to all
- defines unitary human being as an individuals (physiological needs)
“irreducible, indivisible, - Air, water, food, elimination, rest,
pandimensional energy field activity
identified by pattern and 2) Developmental self-care requisites -
manifesting characteristics that are needs resulting from maturation or
specific to the whole” develop due to a condition or even
3. Health (puberty)
- passive health to symbolize 3) Health deviation self-care requisites -
wellness needs resulting from illness, injury &
- the absence of disease and major disease or its treatment
illness  Theory of Self Care Deficit
4. Environment  Specifies when nursing is needed
- “an irreducible, pandimensional energy
field identified by pattern
  Nursing is required when an adult (or in the  BODY IMAGE—a person's perceptions of
case of a dependent, the parent) is his or her body.
incapable or limited in the provision of  TIME—the duration between the
continuous effective self-care. occurrence of one event and the
 Theory of Nursing Systems occurrence of another event.
 how patient’s self-care needs will be met by  SPACE—the physical area called territory
the nurse , the patient, or both that exists in all directions.
 plan goals that should be achieved  LEARNING—gaining knowledge
 3 classifications of nursing system to meet b. Interpersonal System
the self-care requisites of the patient:  shows how the nurse interrelates with a co-
o Wholly compensatory system (total worker or patient, particularly in a nurse-
inability that nurse should fulfill) patient relationship
o Partly compensatory system (both  Communication b/w the nurse & the client

nurse &patient actions) can be verbal or nonverbal

o Supportive – educative system  Collaboration between the Dyads (nurse-

(patients can do but need patient) triad 3 indiv, 4 or more small group,

assistance) is very important for the attainment of the

III. GOAL ATTAINMENT THEORY goal

(Imogene King)  INTERACTIONS—the acts of two or more

 3 INTERACTING SYSTEMS persons in mutual presence; a sequence

a. Personal/ Individual System of verbal and nonverbal behaviors that are

 Concepts: perception, self, growth and goal directed.

development, body image, space, and time  COMMUNICATION—the vehicle by which

 Fundamentals in understanding human human relations are developed and

being because this refers to how the nurse maintained; encompasses intrapersonal,

views and integrates self-based from interpersonal, verbal, and nonverbal

personal goals and beliefs communication.

 most important is perception as it  TRANSACTION—a process of interaction

influences behavior in which human beings communicate with

 PERCEPTION— a process of organizing, the environment to achieve goals that are

interpreting, and transforming information valued; goal-directed human behaviors.

from sense data and memory that gives  ROLE — a set of behaviors expected of a

meaning to one's experience, represents person occupying a position in a social

one's image of reality, and influences system.

one's behavior  STRESS — a dynamic state whereby a

 SELF— a composite of thoughts and human being interacts with the

feelings that constitute a person's environment to maintain balance for

awareness of individual existence, of who growth, development, and performance,

and what he or she is. involving an exchange of energy and

 GROWTH AND DEVELOPMENT information between the person and the

— cellular, molecular, and behavioral environment for regulation and control of

changes in human beings that are a stressors.

function of genetic endowment,  COPING—a way of dealing with stress.

meaningful and satisfying experiences, c. Social System

and an environment conducive to helping  final interacting system - social system

individuals move toward maturity.

  shows how the nurse interacts with co- - Can be altered over time; Protective buffer
workers, superiors, subordinates and the for preventing stressors from breaking
client environment in general through usual wellness state
 boundaries systems of social roles, - Dependent on
behaviors to maintain values o amount of sleep,
 AUTHORITY — a transactional o nutritional status,
process characterized by active, o quality and quantity of stress
reciprocal relations in which  Normal Lines of Defense
members' values, backgrounds, and - Model’s outer solid circle
perceptions play a role in defining, - Represents client’s usual wellness level
validating, and accepting the authority - Change in response to coping or
of individuals within an organization responding to the environment.
- Right to give orders  Lines of Resistance
 POWER — the process whereby one - innermost boundary - protects the basic
or more persons influence other structure
persons in a situation. - activated when envi stressors invade
 STATUS — the position of an the normal line of defense
individual in a group or a group in - WBC and immune system
relation to other groups in an  Stressors
organization - any environmental force which can
 DECISION MAKING — a dynamic potentially affect the stability of the
and systematic process by which system
goal-directed choice of perceived - Produce either a positive or negative
alternatives is made and acted upon effect on the client system
by individuals or groups to answer a  Reconstitution
question and attain a goal - return or maintenance of system
 CONTROL — being in charge stability following the treatment for
5. SYSTEMS THEORY MODEL stressor reaction.
(Betty Neumann) - Occurs after treatment for stressor
 Universal stressors reaction
 Line of defenses  Open System
 Responses to stressors  FUNCTION OR PROCESS - Client as a
 Wellness/ illness system exchanges energy, information and
 Central Core matter with the environment as it uses
Made up of the basic survival factors available energy resources to move toward
common to all stability and wholeness
o Normal temperature range  INPUT OR OUTPUT - Matter, energy, and
o Genetic structure ◦Response pattern information that are exchanged between
o Organ strength or weakness the client and the environment
o Ego structure  FEEDBACK - System output in the form of
o Knowns or commonalities matter, energy, and information for
Variables of each circle corrective action to change, enhance or
- Physiological, psychological, stabilize the system
sociocultural, spiritual,  NEGENTROPY - energy conservation
developmental utilization that assists system profession
 Flexible Lines of Defense toward stability or wellness
- Model’s outer broken ring
  ENTROPY –energy depletion and  RESIDUAL STIMULI – factors that may
disorganization moving the system toward be affecting behavior but whose efforts
illness or possible death are not validated
 STABILITY - Dynamic and desired state of  Subsystems
balance. Copes with stressors to maintain  REGULATOR – subsystem coping
an optimal level of health and integrity mechanism which responds
 Prevention as Intervention automatically through neural- chemical-
- Purposeful actions to help client maintain endocrine processes.
system stability  COGNATOR - subsystem coping
- Levels of Prevention: mechanism which responds to complex
1) Primary: Used when stressor is suspected processes of perception and
or identified; Degree of risk in known information processing, judgment, and
o Health prevention& promotion emotion
2) Secondary: Involves interventions or  Responses
treatment initiated after symptoms  ADAPTIVE RESPONSES – responses
occurred that promote integrity of the person in
- Screening and treatment terms of goals of survival, growth,
3) Tertiary: Occurs after active treatment; reproduction, and mastery
maintenance  INEFFECTIVE RESPONSES –
IV. ADAPTATION THEORY responses that do not contribute to
(Sr. Callista Roy) adaptive goals, that is, survival, growth,
 “Nursing is to help the person adapt to change reproduction, and mastery
in physiological needs, self-concepts, role
function and interdependent relations during  Adaptive models
health and illness 1) PHYSIOLOGICAL MODE
 System – involve the body’s basic needs and ways
- A set of units so related or connected as to of dealing with adaptation
form a unity or whole and characterized by 2) SELF-CONCEPT MODE
inputs, outputs, and control and feedback – the composite of beliefs and feelings
processes that one holds about oneself at a given
 Adaptation Level time. It is formed from perceptions,
- A constantly changing point, made up of particularly of other’s reactions, and
focal, contextual and residual stimuli, which directs one’s behavior.
represent the person’s own standard of the 3) ROLE PERFORMANCE MODE
range of stimuli to which one can respond – role function is the performance of
with ordinary adaptive responses duties based on given positions in society.
 Stimulus 4) INTERDEPENDENCE MODE
 FOCAL STIMULUS – the degree of – involves one’s relations with significant
change or stimulus most immediately others and support systems. In this mode
confronting the person and the one to one maintains psychic integrity by meeting
which the person must make an needs for nurturance and affection.
adaptive response, that is, the factor  Levels of Adaptation
that precipitates behavior  Integrated Process: The various modes
 CONTEXTUAL STIMULI – all other and subsystems meet the needs of the
stimuli present that contribute to the environment.
behavior caused or precipitated by the  Compensatory Process: The cognator and
focal stimuli regulator are challenged by the needs of
 the environment, but are working to meet o real or potential threat in the
the needs environment for the purpose of
 Compromised Process: The modes and ensuring survival.
subsystems are inadequately meeting the o Protection of self through direct or
environmental challenge) indirect acts.
V. BEHAVIORAL SYSTEM THEORY o Identification of potential danger
(Dorothy Johnson) o Self-preservation
 Three Categories 7. Achievement
1. Systems o Behaviour associated with mastery of
2. Structure
oneself and one’s environment for the
3. Functions
purpose of producing a desired effect.
 Subsystems
o Includes problem solving activity
1. Affiliative/Attachment
o Knowledge of personal strengths and
o “social inclusion intimacy and the
weaknesses
formation and attachment of a
 Subconcepts
strong social bond.”
 STRUCTURE
o the basis for all social organization
- The parts of the system that make
o provides survival and security.
up the whole.
2. Dependency  VARIABLES
o “approval, attention or recognition - Factors outside the system that
and physical assistance.” influence the system’s behavior, but
o promotes helping behavior that calls which the system lacks power to
for a nurturing response change.
o interdependence is  BOUNDARIES
o essential for the survival of social - The point that differentiates the
groups interior of the system from the
3. Ingestive exterior
o intake of needed resources from the  HOMEOSTASIS.
external environments - Process of maintaining stability
o food, fluid, information, knowledge  STABILITY.
and objects for propose of - Balance or steady-state in
establishing an effective maintaining balance of behavior
relationship with the environment. within an acceptable range.
4. Eliminative  STRESSOR
o Behaviour associated with the release - A stimulus from the internal or
of physical waste products from the external world that results in stress
body. or instability.
o Express feelings  TENSION

5. Sexual - The system’s adjustment to

o specific gender based identity for the demands, change or growth, or to

purpose of ensuring actual disruptions

pleasure/procreation, and knowledge  INSTABILITY

and behavior being congruent with - State in which the system output of

biological sex energy depletes the energy needed

6. Aggressive Protective to maintain stability.

 SET
 - The predisposition to act. It implies 3. STRESS: developed over time and
that despite having only a few influenced by each stressful experience
alternatives from which to select a encountered by person
behavioral response, the individual
4. PERCEPTUAL: Involved gathering
will rank those options and choose
information from the environment and
the option considered most
converting it in to a meaning experience
desirable.
 FUNCTION  Principles of Adaptation
- Consequences or purposes of action
1. Conservation of Energy
VI. CONSERVATIONAL THEORY
(Myra Levine) - Refers to balancing energy input and
 ADAPTATION output to avoid excessive fatigue. It
 process whereby the patient maintains includes adequate rest, nutrition and
integrity within the realities of the exercise.
environment
 WHOLENESS
 Exist when the interaction or constant
2. Conservation of Structural Integrity
adaptations to the environment permits the
assurance of integrity - Refers to maintaining or restoring
 CONSERVATION the structure of body preventing
 Product of adaptation physical breakdown and promoting
 Characteristics of Adaptation healing.

1. HISTORICITY - Adaptation is a historical 3. Conservation of Personal Integrity

process, responses are based on past
- Recognizes the individual as one
experiences, both personal and genetic
who strives for recognition, respect,
2. SPECIFICITY – Individual responses and their self-awareness, selfhood and self-
adaptive pattern varies on the base of specific determination.
genetic structure
4. Conservation of Social Integrity
3. REDUNDANCY – Safe and fail options
- An individual is recognized as
available to the individual to ensure continued
someone who resides with in a
adaptation
family,: a community, a religious
4. ORGANISMIC RESPONSE – A change in group, an ethnic group, a political
behavior of an individual during an attempt to system and a nation.
adapt to the environment

 Four Types of Organismic Response

1. FLIGHT OR FIGHT: an instantaneous

response to real or imagined threat, most
primitive response

2. INFLAMMATORY: response intended to

provide for structural integrity and the
promotion of healing