THEORETICAL FOUNDATION OF NURSING (NCM100)

BSN – 1 | Sources: Lectures & Books

INTRODUCTION TO NURSING THEORY ✓ increasing the general body of knowledge within
I. Theory & Theorist the discipline through the research implemented to
i. Characteristics of a Theory validate them
✓ used by the practitioners to guide and improve their
ii. Four Components of a Theory
practice
iii. Types of Theories ✓ consistent with other validated theories, laws and
iv. Purposes of Theories (in Practice, principles but will leave open
Education, & Research ✓ unanswered questions that need to be investigated
v. Principle and Concepts
II. Nursing Four Components of a Theory
i. Nursing as an Art and Science 1. Concepts 2. Definitions
ii. Nursing Theory - help to describe or - used to convey the
iii. Importance of Nursing Theories label phenomena general meaning
III. Nursing Paradigm - is composed on of the concepts in
i. Four Major Concepts of Nursing interrelated a manner that fits
IV. Different Views of Non-Nursing Theories concepts the theory
i. General System Theory - also describe the
activity necessary
ii. Change Theory
to measure the
iii. Developmental Theory constructs,
relationships, and
Theories variables, with in
➢ a set of statements that tentatively describe, theory
explain, or predict relationships among concepts 3. Assumptions / 4. Phenomenon
that have been systematically selected and Propositions - aspect of reality
organized as an abstract representation of some - statements that that can be
phenomenon (Power and Knapp, 1995) describe concepts consciously
➢ an expectation of what should happen, barring or connect two sensed or
unforeseen circumstances concepts that are experienced
➢ a well-substantiated explanation of some aspect of factual
the natural world; an organized system of accepted - the "taken-for-
knowledge that applies in a variety of situations or granted
hypotheses statements” that
➢ a coherent statement or sets of statements that determine the
attempts to explain observed phenomena nature of concepts,
➢ an explanation for some phenomena that is based definitions,
on observation, experimentation, and reasoning purpose
➢ a comprehensive explanation of a given set of data relationships, and
that has been repeatedly confirmed by observation structure of the
and experimentation and has gained general theory
acceptance within the scientific community but has
not been yet decisively proven
➢ a construct that account for or organizes some
phenomena

Theorist
➢ someone who develops an abstract idea or set of
ideas about a particular subject to explain it

Characteristics of a Theory
✓ interrelating concepts in such a way as to create a
different way of looking at a particular phenomenon
Diagram of
✓ logical in nature and simple but generalizable Components
✓ basis for hypotheses that can be tested of a Theory

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Types of Theories o assists in discovering knowledge gaps in
1. Meta Theories – theories whose subject matters specific field of study
are some other theories; these are theories about o offer a systematic approach to identify
theories questions for study, select variables, interpret
2. Grand Theories – broad in scope and complex; findings, validate nursing interventions
require further specification through research
before they can be fully tested; intended to provide Principle and Concept
structural framework for broad, abstract ideas Principle
about nursing ➢ a basic generalization that is accepted as true and
3. Middle-Range Theories – have more limited scope, that can used as a basis for reasoning or conduct
less abstraction, address specific phenomena or
concepts, and reflect practice (in administration, Concept
clinical, or teaching); phenomena or concepts tend ➢ a mental idea of a phenomenon
to cross different nursing fields, and reflect wide ➢ a comprehensive idea or generalization
variety of nursing care situations ➢ an idea that brings diverse elements into a basic
4. Descriptive Theories – the first-level of theory relationship
development; describe phenomena, speculate on ➢ a unit of knowledge and though abstracted from a
why phenomena occur and describe the set of characteristics attributed to a class of objects,
consequences of phenomena; can explain, relate, relations, or entities
and predict nursing phenomena in some situations ➢ a general idea formed in mind
5. Prescriptive Theories – address nursing ➢ something that is understood or retained in mind
interventions and predict consequences of specific for experiences, reasoning, and/or imagination
nursing interventions; are action-oriented which ➢ generalization or abstraction of a particular set of
test the validity and predictability of a nursing instances or occurrences
intervention
Nursing
Purposes of Theories (In Practice, Education, ➢ According to American Nursing Association
and Research) (ANA), Nursing is the “diagnosis and treatment of
A. In Practice human responses to actual or potential health
o assist nurse to describe, explain, and predict problems”.
everyday experiences ➢ Defined by the International Council of Nurses
o serve to guide assessment, intervention, and (ICN), Nursing encompasses "autonomous and
evaluation of nursing care collaborative care of individuals of all ages, families,
o provide a rationale for collecting reliable and groups and communities, sick or well and in all
valid data about the health status of clients, settings. Nursing includes the promotion of health,
which are essential for effective decision- prevention of illness, and the care of ill, disabled and
making and implementation dying people. Advocacy, promotion of a safe
o help to establish criteria to measure the quality environment, research, participation in shaping
of nursing care health policy and in patient and health systems
o help to build a common nursing terminology to management, and education are also key nursing
use in communicating with other health roles".
professionals. ideas are developed and words ➢ Henderson's definition of Nursing is "to assist
defined clients in the performance of activities contributing
o enhanced autonomy (independence and self- to health, its recovery or peaceful death that clients
governance) of nursing by defining its own will perform unaided, if they had the necessary will,
independent functions strength or knowledge".

B. In Education Nursing as an Integration of Science and Arts

o provide a general focus for curriculum design Art – it “requires exclusive devotion, empathetic
o guide curricular decision-making communication, compassion, and caring”; includes
clinical practice
C. In Research
o offer a framework for generating knowledge Science – it is a “melting-pot of the different knowledge,
and new ideas creeds, and backgrounds of care and healing that has
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been collected and preserved since the dawn of time”; affect the patient, the physical environment, such as
governed by laws and theories that has been families, friends, and significant others, and the
scientifically proven to be relevant to the performance setting for where they go for their healthcare
of nursing 3. Health – holistic level of wellness that the person
experiences; may have different meanings for each
“The art of nursing is grounded in scientific principles.” patient, the clinical setting, and the health care
provider
Nursing Theory 4. Nursing – interventions of the nurse rendering care
➢ a body of knowledge that describes or explains in support of, or in cooperation with the client
nursing and is used to support nursing practice
➢ an organized and systematic articulation of a set of Different Views of Non-Nursing Theories
statements related to questions in the discipline of ❖ Nursing theories are often based on and influenced
nursing by broadly applicable processes and theories.
➢ a set of concepts, definitions, relationships and
assumptions or propositions derived from nursing General System Theory
models or from other disciplines and project a ➢ includes purpose, content, and process, breaking
purposive systematic view of phenomena by down the “whole”, and analyzing the parts
designing specific interrelationships among ➢ the relationships between the parts of the whole are
concepts for the purpose of describing, explaining, examined to learn how they work together
predicting and/or prescribing ➢ a system is made up separate components; the parts
rely on one another, are interrelated, share a
Importance of Nursing Theories common purpose, and together form a whole
✓ Aim to describe, predict, and explain the ➢ input is the information that enters the system
phenomenon of nursing (Chinn and Jacobs, 1978). ➢ output is the end-product of a system
✓ Provide the foundations of nursing practice, help to ➢ feedback is the process through which the output is
generate further knowledge, and indicate in which returned to the system
direction nursing should develop in the future
(Brown, 1994). Ludwig von Bertalanffy (1969, 1976) developed
✓ Help to distinguish what should form the basis of General Systems Theory, which has the following
practice by explicitly describing nursing. assumptions:
✓ Help provide better patient care, enhanced a. All systems must be goal directed.
professional status for nurses, improved b. A system is more than the sum of its parts.
communication between nurses, and guidance for c. A system is everchanging and any change in one
research and education (Nolan, 1996). part affects the whole.
✓ The main exponent of nursing – caring – cannot be d. Boundaries are implicit and human systems are
measured. It is vital to have the theory to analyze open and dynamic.
and explain what nurses do.
✓ Establish a unique body of knowledge Nursing Models based on Systems Theory
✓ Maintain professional boundaries in nursing ✓ Imogene King’s Systems Interaction Model
✓ Betty Neuman’s Health Care Systems Model
Nursing Paradigm ✓ Dorothy Johnson’s Behavioral System Model
➢ patterns or models used to show a clear
relationship among the existing theoretical works in Change Theory
nursing ➢ Kurt Lewin develops this theory, and he is
➢ metaparadigms come from Greek word "meta" considered the “Father of Social Psychology”
meaning with and "paradeigma” means pattern ➢ this theory was his most influential theory
➢ he theorized a three-stage model of change known
Four Metaparadigms of Nursing as unfreezing-change-refreeze model that requires
1. Person (Human Being / Client) – recipient of prior learning to be rejected and replaced
nursing care like individuals, families, and
communities Three Major Concepts of The Change Theory
2. Environment (Situation) – external and internal 1. Driving Forces – those that push in a direction that
aspects of life that influence the person; these causes change to occur; cause a shift in the
includes all positive or negative conditions that equilibrium towards change
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2. Restraining Forces – those forces that counter the with different pleasurable zones serving as the
driving forces and hinder change because they push focus for gratification and bodily pleasure (oral,
the patient in the opposite direction; cause a shift in anal, phallic, latency, genital)
the equilibrium that opposes change
3. Equilibrium – a state of being where driving forces Stage 1: Oral (birth to 18 months) – major
equal restraining forces, and no change occurs; can site of tension and gratification is the mouth,
be raised or lowered by changes that occur between lips, and tongue
the driving and restraining forces Stage 2: Anal (12 to 18 months to 3 years) –
anus and surrounding area are major source of
Three States of Change interest
1. Unfreezing – the recognition of the need for change Stage 3: Phallic or Oedipal (3 to 6 years) –
and the dissolution of previously held patterns of genital focus of interest, stimulation, and
behavior excitement
2. Change – the shift of behavior toward a new and Stage 4: Latency (6 to 12 years) – resolution
more healthful pattern; also called the moving to a of oedipal complex
new level or movement Stage 5: Genital (Puberty through
3. Refreezing – the long-term solidification of the new Adulthood) – begins with puberty and the
pattern of behavior biologic capacity for orgasm; involves the
capacity for true intimacy
Six Components of The Change Theory
1. Recognition of the area where change is needed. B. Erik Erikson’s Psychosocial Model – in his
2. Analysis of a situation to determine what forces view, psychosocial growth occurs in sequential
exist to maintain the situation & what forces are phases, and each stage is dependent on
working to change it. completion of the previous stage and life task
3. Identification of methods by which change can a. Trust vs Mistrust (birth to 1 year) [hope]
occur. – viewing the world as safe; relationships as
4. Recognition of the influence of group mores or nurturing, stable, and dependable
customs on change. b. Autonomy vs Sense of Shame and Doubt
5. Identification of the methods that the reference (1 to 3 years) [will] – achieving a sense of
group uses to bring about change. control and free will
6. The actual process of change. c. Initiative vs Guilt (3 to 6 years) [purpose]
– beginning development of a conscience;
Developmental Theory learning to manage conflict and anxiety
d. Industry vs Inferiority (6 to 11 years)
➢ Human growth and development are an orderly
[competence] – emerging confidence in own
predictive process that begins with conception and
abilities; taking pleasure in
continues through death.
accomplishments
e. Identify vs Role Confusion
Four Main Areas of Developmental Theory (Puberty/Adolescence) [fidelity] –
A. Biophysical Development – attempts to describe formulating a sense of self and belonging
the way our physical bodies grow and change f. Intimacy vs Isolation (Young Adult)
[love] – forming adult, loving relationships,
B. Psychoanalytic / Psychosocial Development – and meaningful attachment to others
attempts to describe the development of the human g. Generativity vs Self-Absorption and
personality, behavior, and emotions; this Stagnation (Middle Age) [care] – being
development is thought to occur with varying creative and productive; establishing the
degrees of influence from internal biological forces next generation
and external societal/cultural forces h. Integrity vs Despair (Old Age) [wisdom] –
accepting responsibility for one’s self and
A. Sigmund Freud’s Psychoanalytic Model of life
Personality Development – theory believes
that two internal forces essentially drive C. Cognitive Development – is focused on reasoning
psychological change in the child: sexual and thinking processes, including the changes in
(libido) and aggressive energies; has five how people come to perform intellectual
psychosexual developmental stages associated
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operations; these operations are related to the ways
persons learn to understand the world in which
they live

Jean Piaget’ s Cognitive Stages of Development –

believed that human intelligence progresses
through a series of stages based on age, with the
child at each successive stage demonstrating a
higher level of functioning than at previous stages
a. Sensorimotor (Birth to 2 years) – the child
develops a sense of self as separate from the
environment and the concept of object
permanence; tangible objects do not cease to
exist just because they are out of sight
b. Preoperational (2 to 6 years) – the child
develops the ability to express self with
language, understands the meaning of symbolic
gestures, and begins to classify objects
c. Concrete Operations (6 to 12 years) – the
child begins to apply logic to thinking,
understands spatiality and reversibility, and is
increasingly social and able to apply rules;
thinking is still concrete
d. Formal Operations (12 to 15 years and
beyond) – the child learns to think and reason
in abstract terms, further develops logical
thinking and reasoning, and achieves cognitive
maturity

D. Moral Development – focuses on the description of

moral reasoning (Moral reasoning is how people
think about the rules of ethical and moral conduct
but does not predict what a person would do in each
situation); it is the ability of an individual to
distinguish right from wrong and to develop ethical
values on which to base his or her actions

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THEORIST AND THEIR THEORY ✓ Remove garbage, stagnant
I. List of Nursing Theorist and Their Theory water, and ensure clean
i. Florence Nightingale water and fresh air.
ii. Hildegard Peplau ✓ Check noise level in the
iii. Virginia Henderson room and surroundings.
5. Noise
iv. Faye Glenn Abdellah ✓ Attempt to keep noise level
v. Dorothy Johnson in minimum.
vi. Ida Jean Orlando ✓ Check bed and bedding for
vii. Lydia Hall dampness, wrinkles, and
viii. Betty Nueman soiling.
6. Bed and Bedding
ix. Madeleine Leininger ✓ Keep the bed dry, wrinkle-
x. Myra Estrin Levine free, and its lowest height to
xi. Dorothea Orem ensure comfort.
xii. Patricia Benner ✓ Attempt to always keep the
xiii. Imogene King client dry and clean.
xiv. Martha Rogers 7. Personal ✓ Frequent assessment of the
xv. Sister Callista Roy Cleanliness client’s skin is essential to
xvi. Nola J. Pender maintain good skin
xvii. Joyce Travelbee integrity.
xviii. Jean Watson ✓ Avoid talking without
xix. Rosemarie Rizzo Parse giving advice that is without
xx. Helen Erickson 8. Chattering Hopes a fact.
and Advices ✓ Respect the client as a
List Of Nursing Theorist and Their Theory person and avoid personal
talk.
Florence Nightingale – “Environmental Theory” ✓ Attempt to accomplish
➢ by name of “Lady with the Lamp,” “Matriarch of variety in the room and
Modern Nursing” with the client.
➢ most recognized name in the field of nursing ✓ This is done by needlework,
Nightingale’s Environmental Theory 9. Variety cleaning, reading, writing,
Nightingale’s Canon Nursing Process & Thought and many more.
✓ Check the client’s body ✓ Also encourage relatives or
temperature, room friends to join in this
temperature, ventilation, simulation activities.
and foul odors. ✓ Check the clint’s diet Note
1. Ventilation and
✓ Create a plan to keep the the amount of food and
Warmth 10. Food Intake
room well-ventilated and fluid ingested by the client
free of odor while at every meal.
maintaining the client’s ✓ Ensures continuity of care.
body temperature. ✓ Document the care plan and
11. Petty Management
✓ Check room for adequate evaluate the outcomes to
light. Sunlight is beneficial ensure continuity.
to the client. ✓ Observe and record
2. Light ✓ Create and implement anything about the client.
adequate light in the room 12. Observation of the ✓ Continue observation in the
without placing the client in Sick client’s environment and
direct light. make changes in the care
✓ Check the room and keep it plan if needed.
3. Cleanliness of
free from dust, dampness,
Rooms and Walls
and dirt.
✓ Check surroundings and
environment for fresh air,
4. Health of Houses
pure water, drainage,
cleanliness, and light.
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Hildegard Peplau – “Interpersonal Relations Theory” Faye Glenn Abdellah – “Twenty-One Nursing
➢ often regarded by many as the “Psychiatric Nurse Problems”
of the Century” Typology of Twenty-One Nursing Problems
Phases of the Interpersonal Relations Theory 1. to maintain good hygiene and physical comfort
▪ involves engaging the client 2. to promote optimal activity: exercise, rest, sleep
1. Orientation in treatment, providing 3. to promote safety by preventing accidents,
Phase explanations and information, injuries, or other trauma and preventing the
and answering questions spread of infection
▪ begins when the client works 4. to maintain good body mechanics and prevent
2. Identification interdependently with the and correct the deformity
Phase nurse, expresses feelings, and 5. to facilitate the maintenance of a supply of
begins to feel stronger oxygen to all body cells
3. Exploitation ▪ the client makes full use of 6. to facilitate the maintenance of nutrition for all
Phase the services offered body cells
▪ the client no longer needs 7. to facilitate the maintenance of elimination
professional services and 8. to facilitate the maintenance of fluid and
4. Resolution electrolyte balance
gives up dependent behavior;
Phase 9. to recognize the physiologic responses of the
termination of professional
relationship body to disease conditions—pathologic,
physiologic, and compensatory
Virginia Henderson – “Needs Theory” 10. to facilitate the maintenance of regulatory
➢ also known as “The First Lady of Nursing,” “The mechanisms and functions
Nightingale of Modern Nursing,” “Modern-Day 11. to facilitate the maintenance of sensory function
Mother of Nursing,” and “The 20th Century 12. to identify and accept positive and negative
Florence Nightingale” expressions, feelings, and reactions
Fourteen Fundamental Needs of Human 13. to identify and accept interrelatedness of
Physiological Components emotions and organic illness
1. Breathe normally 14. to facilitate the maintenance of effective verbal
2. Eat and drink adequately and nonverbal communication
3. Eliminate body wastes 15. to promote the development of productive
4. Move and maintain desirable postures interpersonal relationships
5. Sleep and rest 16. to facilitate progress toward achievement and
6. Select suitable clothes – dress and undress personal spiritual goals
7. Maintain body temperature within normal range 17. to create or maintain a therapeutic environment
by adjusting clothing and modifying environment 18. to facilitate awareness of self as an individual
8. Keep the body clean and well-groomed and with varying physical, emotional, and
protect the integument developmental needs
9. Avoid dangers in the environment and avoid 19. to accept the optimum possible goals in the light
injuring others of limitations, physical and emotional
Psychological Aspects of Communicating and 20. to use community resources as an aid in
Learning resolving problems that arise from an illness
10. Communicate with others in expressing 21. to understand the role of social problems as
emotions, needs, fears, or opinions influencing factors in the cause of illness
14. Learn, discover, or satisfy the curiosity that leads
to normal development and health and use the Dorothy Johnson – “Behavioral System Model”
available health facilities Seven Behavioral Subsystems
Spiritual and Moral 1. Attachment-Affiliative System – well-known as
11. Worship according to one’s faith the earliest response system to expand in the
Sociologically Oriented to Occupation and individual. The most favorable functioning of the
Recreation affiliative subsystem allows social inclusion,
12. Work in such a way that there is a sense of closeness, and the pattern and continuance of a
accomplishment strong public bond.
13. Play or participate in various forms of recreation 2. Dependency System – distinguished from the
attachment or affiliative subsystem. Dependency
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behaviors are actions that trigger nurturing they can be addressed, and the process starts
behaviors from other individuals in the over again for those specific problems.
environment.
3. Ingestive System – relates to the behaviors Lydia Hall – “Care, Core, and Cure Theory (Three Cs of
surrounding the ingestion of food. Lydia Hall)”
4. Eliminative System – relate to behaviors The Care Circle
surrounding the secretion of waste products ▪ nurses are focused on performing the noble task of
from the body. nurturing patients
5. Sexual Subsystem – imitates behaviors related ▪ represents the role of nurses and focused on
to procreation or reproduction. Both biological performing the task of nurturing patients
and social factors are involved behaviors in the ▪ nurturing involves using the factors that make up
sexual subsystem. the concept of mothering (care and comfort of the
6. Achievement Subsystem – contains behaviors person) and provide for teaching-learning
that attempt to control the environment. activities
Intellectual, physical imaginative, mechanical, ▪ defines a professional nurse’s primary role
and communal skills are some of the areas that (providing bodily care for the patient and helping
Johnson distinguishes. Other areas of personal the patient complete such basic daily biological
accomplishment or success may also be functions as eating, bathing, elimination, and
integrated in this subsystem. dressing)
7. Aggressive-Protective System – relates to ▪ the nurse’s goal is the comfort of the patient
behaviors concerned with defense and self- ▪ the nurse’s role also includes educating patients
preservation. This subsystem has one that and helping a patient meet any needs he or she is
creates defensive responses from the individual unable to meet alone
when life or territory is threatened. ▪ major purpose of care is to achieve an
interpersonal relationship with individual that will
Ida Jean Orlando – “Deliberative Nursing Process facilitate the development of the core
Theory”
Five Stages of the Deliberative Nursing Process The Core Circle
1. Assessment Stage – The nurse completes a ▪ the patient receiving nursing care
holistic assessment of the client's needs. This is ▪ involves the therapeutic use of self and shared
done without taking the reason for the encounter with other members of the health team
into consideration. The nurse uses a nursing ▪ this area emphasizes the patient’s social,
framework to collect both subjective and emotional, spiritual, and intellectual needs
objective data about the client. concerning family, institution, community, and the
2. Diagnosis Stage – Uses the nurse's clinical world
judgment about health problems. The diagnosis ▪ the professional nurse uses the reflective
can then be confirmed using links to defining technique to act as a mirror to the patient to help
characteristics, related factors, and risk factors the latter explore his or her own feelings regarding
found in the client's assessment. his or her current health status and related
3. Planning Stage – Addresses each of the potential changes in lifestyle
problems identified in the diagnosis. Each ▪ motivations are discovered through the process of
problem is given a specific goal or outcome, and bringing into awareness the feelings being
each goal or outcome is given nursing experienced
interventions to help achieve the goal. By the end ▪ with this awareness, the patient can now make
of this stage, the nurse will have a nursing care conscious decisions based on understood and
plan. accepted feelings and motivation
4. Implementation Stage – The nurse begins using
the nursing care plan. The Cure Circle
5. Evaluation Stage - The nurse looks at the ▪ the nurse is an active advocate of the patient
progress of the client toward the goals set in the ▪ aspect of nursing that involves the administration
nursing care plan. Changes can be made to the of medications and treatments
nursing care plan based on how well or how ▪ this circle is hared by the nurses with other
poorly the client is progressing toward the goals. healthcare professionals (like physicians or
If any new problems are identified in this stage, physical therapist)
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▪ intervention or actions geared toward treating the Stressors – any phenomenon that might penetrate
patient for illness that he is suffering from both the flexible and normal lines of defense,
resulting in either a positive or negative outcome
Betty Neuman – “Neuman System Model” • Intrapersonal Forces – occur within the client's
Major Concepts of Neuman Systems Model system and correlate with the internal
Client Variables – Neuman views the individual environment, such as conditioned responses
client holistically and considers the variables • Interpersonal Forces – occur between one or
simultaneously and comprehensively more individuals (role expectations)
• Physiological Variable – structure and functions • Extrapersonal Forces – occur outside the
of the body individual (social policy or financial
• Psychological Variable – mental processes and circumstances)
relationships
• Sociocultural Variable – system functions that Degree of Reaction – amount of system instability
relate to social and cultural expectations and resulting from stressor invasion of the normal line of
activities defense
• Developmental Variable – those processes Negentropy – an energy conservation process that
related to development over the lifespan increases organization and complexity, moving the
• Spiritual Variable – influence of spiritual beliefs system toward stability or a higher degree of
wellness
Basic Structure – referred to as the central core Egentropy – a process of energy depletion and
which is made up of the basic survival factors disorganization moving the system toward illness or
common to human beings; include the system possible death
variables, genetic features and strengths and
weaknesses of the system parts Prevention as Intervention – prevention is used to
Normal Line of Defense – to achieve the stability of attain balance within the continuum of health;
the system, the Normal Line of Defense must act in actions that generate good results or are aimed
coordination with the normal wellness state; must towards hindering negative outcomes
reflect the actual range of responses that is normally 1. Primary Prevention – focuses on foreseeing the
acted by clients in response to any stressors. It is the result of an act or situation and preventing its
baseline in determining the level of wellness of client unnecessary effects as possible; also aims to
within the continuum of health strengthen the capacity of a person to maintain
Flexible Line of Defense – serves as a boundary for an optimum level of functioning while being
the Normal Line of Defense to adjust to situations interactive with the environment
that threaten the imbalance within the client's 2. Secondary Prevention – focuses on helping
stability; expanded the range of normal defense from alleviate the actual existing effects of an action
becoming invaded by the stressors thus increasing its that altered that balance of health of a person;
protection aims to reduce environmental influences that
Lines of Resistance – act when the Normal Line of lead to the decline of the level of functioning of a
Defense is invaded by too much stressor, producing person and strengthening or restoring a person's
alterations in the client's health; acts to facilitate resistance after the illness exposure
coping to overcome the stressors that are present 3. Tertiary Prevention – focuses on actual
within the individual treatments or adjustments to facilitate the
strengthening of person after being exposed to a
Health – according to Neuman, it is a continuum of certain disease or illness; aims to prevent the
wellness to illness that is dynamic in nature; optimal regression or reoccurrence of the illness in the
wellness can only exist when the needs of the total manner of rehabilitation, as in the case of
system are completely met disability avoidance and physical therapy
Wellness – exists when all system subparts interact
in harmony with the whole system and all system
needs are being met
Illness – occurs at the opposite end of the continuum
from wellness and represents a state of instability
and energy depletion

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Madeleine Leininger – “Culture Care Theory of that is observed among many
Diversity & Universality (Transcultural Nursing cultures and reflect assistive
Theory)” ways to help people.
Major Ideas of Cultural Care Theory of Diversity & The method people seem to
Universality look out on the world and/or
The conceptual phenomena 8. Worldwide universe to form a picture of
related to helping, value perception about their
supporting, or empowering life or world around them.
1. Care experiences or behaviors The changing patterns
toward others with evident related to the
or anticipated needs to arrangement/organizational
improve human condition. factors of a particular culture
Behavior directed toward 9. Cultural and (subculture or society),
assisting another individual Social Structure which includes religious,
or group with evident or Dimensions kinship (social), political (and
2. Caring
anticipated needs to improve legal), economic, educational,
the human condition either technological, and cultural
to recover or to face death. values and ethnohistorical
The studies, shared and factors.
handed values, beliefs, The summation of an event,
norms, and lifeways of a situation or experience that
3. Culture
certain group that directs gives meaning to human
10. Environmental
their thinking, decision, and expressions, particularly
Context
actions in certain ways. physical, ecological,
The subjectively and sociopolitical and/or cultural
objectively obtained values, situations.
beliefs and outlines of the Past facts, events and
lifeways that assist, enable, experiences of individuals,
4. Culture Care support, facilitate or groups and various cultures
empower another individual and institutions that are
or group to maintain well- 11. Ethnohistory mainly people-centered
being, health and deal with (ethnic) and that explains
illness, handicaps, or death. and interprets human
Studied scientific and lifeways within cultural
humanistic profession and trends.
discipline that centers on Local, indigenous or the
human care activities that 12. Emic insider's views and values
assist, support, facilitate or about a certain phenomenon.
5. Transcultural enable individuals or groups Outsider's or more universal
Nursing to maintain or regain their 13. Etic views and values about a
well-being (or health) in certain phenomenon.
culturally meaningful and Formally educated, and
beneficial ways, or to help instructed professional care,
people face handicaps or health, illness, wellness and
deaths. related knowledge and
14. Professional
The changeable differences in practice skills that exist in
Care System
meanings, patterns, values, professional institutions
6. Cultural Care lifeways, or symbols of care usually with
Diversity within concepts that are multidisciplinary personnel
related in supporting human to give service to clients.
care. Culturally studied and given,
15. Generic (Folk or
The common, general indigenous (or traditional),
7. Cultural Care Lay) Care
definitions of care with its folk (community and home-
Universality System
patterns, values and symbols based) knowledge and skills
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used to provide assistive, healthcare or well-being
supportive, enabling, or services.
facilitative acts toward or for
another individual, groups, or Myra Estrin Levine – “The Conservation Model”
institution with evident or Four Conservation Principles
anticipated needs to 1. Conservation of Energy – refers to balancing
ameliorate or improve a energy input and output to avoid excessive
human lifeway or health fatigue; includes adequate rest, nutrition, and
condition (or well-being), or exercise
to deal with handicaps and 2. Conservation of Structural Integrity – refers to
death situations. maintaining or restoring the body’s structure,
The state of well-being that preventing physical breakdown, and promoting
defined through cultures healing
valued and practiced, and 3. Conservation of Personal Integrity – recognizes
reflects the ability of the individual as one who strives for recognition,
16. Health individuals to perform their respect, self-awareness, selfhood, and self-
daily role activities in determination
culturally expressed, 4. Conservation of Social Integrity – exists when a
beneficial and patterned patient is recognized as someone who resides
styles. within a family, a community, a religious group,
Caring skilled actions and an ethnic group, a political system, and a nation
decisions that people of a
certain culture retain Dorothea Orem – “Self-Care Deficit Theory”
17. Cultural Care
important care values so that Self-Care Deficit Theory
Preservation or
they can keep up their A. Self-Care Theory – focuses on the performance
Maintenance
wellbeing, recover from or practice of activities that individuals initiate
illness, or face handicaps or and perform on their own behalf to maintain life,
deaths. health, and well-being
The supporting, facilitative or
enabling specialized actions Self-Care Requisites – requirements can be
and decisions that help defined as actions directed toward the provision
18. Cultural Care
people of designated culture of self-care
Accommodation
to adapt to others for a a. Universal Self-Care Requisites – associated
or Negotiation
beneficiary or satisfying with life processes and the maintenance of
health outcome with the human structure and functioning
professional care providers. integrity
The supporting, facilitative or 1) maintenance of a sufficient intake of air,
enabling specialized actions water, and food
and decisions that help 2) provision of care associated with the
19. Cultural Care
people of designated culture elimination
Repatterning or
to adapt to others for a 3) maintenance of a balance between
Restructuring
beneficiary or satisfying activity and rest
health outcome with 4) maintenance of a balance between
professional care providers. solitude and social interaction
The cognitively-based 5) prevention of hazards to human life,
assistive, caring, facilitative human functioning, and human well-
or empowering acts or being
20. Culturally decisions that are made to fit 6) promotion of human functioning and
Competent with individual, group or development
Nursing Care institutional cultural values, b. Developmental Self-Care Requisites –
beliefs, and lifeways to offer actions to be undertaken that will provide
or carry meaningful, developmental growth:
beneficial, and satisfying • provision of conditions that promote
development
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• engagement in self-development ✓ the level that nursing students belong
• prevention of the effects of human ✓ Benner proposed that nurses at higher levels can
conditions that threatens life be classified as a novice if they are placed in an
c. Health Deviation Requisites – are unfamiliar situation
requisites required for a person to be Advanced Beginner
considered as sick or ill; disease affects the ✓ has a sufficient experience to easily understand
structures within the integral part of a person aspects of the situation
and its functioning; set standards to which ✓ they feel more responsible for managing patient
the degree of self-care demand is needed care, yet they still rely on the help of those who
have more experience
B. Self-Care Deficit Theory – delineates when ✓ Benner places most newly graduated nurses at
nursing is needed; nursing is required when an this level
adult (or in the case of a dependent, the parent or Competent
guardian) is incapable of or limited in providing ✓ a competent performance considers consistency,
continuous effective self-care predictability, and time management as essential
5 Methods of Helping: components
1) acting for and doing for others ✓ Benner believes that a sense of mastery is
2) guiding others acquired through planning and predictability.
3) supporting another ✓ the increase level of efficiency is evident
4) providing an environment promoting ✓ has two- or three-years’ experience on the job in
personal development about meet future the same field
demands ✓ experience may also be similar day-to-day
5) teaching another situations
✓ these nurses are more aware of long-term goals,
C. Nursing System Theory – product of a series of and they gain perspective from planning their
relations between the persons: legitimate nurse own actions, which helps them achieve greater
and legitimate client; his system is activated efficiency and organization
when the client’s therapeutic self-care demand Proficient
exceeds the available self-care agency, leading to ✓ qualitative leap beyond the competent; is the
nursing. transition into expert level
Three Types of Nursing Systems Identified by ✓ perceives and understands situations as whole
Orem: parts
1) Wholly Compensatory Nursing System – ✓ more holistic understanding of nursing, which
clients who are unable to control and improves decision-making
monitor their environment and process ✓ these nurses learn from experiences what to
information expect in certain situations, as well as how to
2) Partial Compensatory Nursing System – modify plans as needed
those clients who are unable to perform Expert
some, but not all, self-care activities ✓ performer no longer relies on analytical principle
3) Supportive-Educative (Developmental) like rules, guidelines, and maxims to connect her
System – designed for clients who need to understanding of the situation to an appropriate
learn to perform to self-care measures and action
needs assistance to do so ✓ Benner viewed as possessing an intuitive grasp of
the problem without losing time considering a
Patricia Benner – “Novice to Expert Theory (Skill range of alternative diagnosis and solutions.
Acquisition in Nursing)” ✓ their performances are fluid, flexible, and highly-
Skill Acquisition in Nursing proficient
Novice
✓ has no background experience of the situation in Imogene King – “Goal Attainment Theory”
which he or she is involved Goal Attainment Theory
✓ to guide performance, context free rules and Action – a means of behavior or activities that are
objective attributes must be given towards the accomplishment of a certain act
✓ also has difficulty discriminating between (physical and mental); accomplishment of a task
relevant and irrelevant aspects of a situation. begins with mental action, a person seeks or
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formulates plan of activities and followed by physical human and environmental fields,
action; aimed towards setting goals through which is the openness in Rogers'
communication between the nurse and the client theory. It refers to qualities
then exploring and agreeing means to perform them, exhibited by open systems such
achieving the set goal as human beings and their
Reaction – not specified but somehow relates environment.
reaction as part of action; a form of reacting or a Pan-dimensionality is defined as
response to a certain stimulus non-linear domain without
Interaction – any situation wherein the nurse relates spatial or temporal attributes:
and deals with a clientele 5. Pan- The parameters that humans use
Transaction: process of interaction in which human dimensional in language to describe events
beings communicate with the environment to achieve are arbitrary, and the present is
goals that are valued and goal-directed human relative, there is no temporal
behaviors ordering of lives.
Open System – the absence of boundary existence, The unique behavior of whole
where a dynamic interaction between the internal systems, unpredicted by any
and external environment can exchange information behaviors of their component
6. Synergy
without barriers or hindrances functions taken separately.
Human behavior is considered
Interacting Systems of Goal Attainment Theory synergistic.
A. Personal Systems – how the nurse views and The distinguishing characteristic
integrates self-based from personal goals and of an energy field seen as a single
7. Pattern
beliefs wave. It is an abstraction and
B. Interpersonal Systems – how the nurse gives identity to the field.
interrelates with a co-worker or client, Homeodynamics should be
particularly in a nurse-client relationship understood as a dynamic version
C. Social Systems – how the nurse interacts with of homeostasis (a relatively
co-workers, superiors, subordinates, and the steady state of internal operation
client environment in general 8. Principles of in the living system). This
Homeodynamics principle postulates a way of
Martha Rogers – “Science of Unitary Human Beings” viewing unitary human beings.
Major Concepts of Science of Unitary Human Beings The three principles of
A person is defined as an homeodynamics are resonancy,
indivisible, pan-dimensional helicy, and integrality.
energy field identified by a Postulates the inseparability of
1. Human-Unitary pattern, and manifesting man and environment and
Human Being characteristics specific to the predicts that sequential changes
9. Principles of
whole, and that cannot be in life process are continuous,
Reciprocy
predicted from knowledge of the probabilistic revisions occurring
parts. out of the interactions between
An irreducible, indivisible, pan- man and environment
2. Environmental dimensional energy field This principle predicts that
Field identified by pattern and integral change in human behavior will
with the human field. be determined by the
The energy field is the 10. Principles of simultaneous interaction of the
fundamental unit of both the Synchrony actual state of the human field
living and non-living. It provides and the actual state of
a way to view people and the environmental field at any given
3. Energy Field point in space-time continuum.
environment as reducible
wholes. The energy fields Because of the inseparability of
11. Principles of
continuously vary in intensity. human beings and their
Integrity
density, and extent. environment. Sequential changes
(Synchrony +
There are no boundaries that in the life processes are
4. Openness Reciprocy)
stop energy flow between the continuous revisions occurring
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from the interactions between Five
human beings and their Physiological
environment. Between the two Needs:
entities. there is a constant oxygenation,
mutual interaction and mutual nutrition,
change whereby simultaneous elimination, Operating
molding is taking place in both at activity and Resources:
the same time. rest; and participants,
Speaks to the nature of the protection capacities,
change occurring between Four Complex physical facilities,
human and environmental fields. Processes: and fiscal
The life process in human beings senses, fluid resources
is a symphony of rhythmical and acid-base
vibrations oscillating at various balance,
12. Principle of frequencies. It is the neurologic and
Resonancy identification of the human field endocrine
and the environmental field by function
wave patterns manifesting Psychological and spiritual
continuous change from longer characteristics of the person
waves of lower frequency to consists of all beliefs and feelings
shorter waves of higher that one has formed about oneself.
frequency. They incorporate two components:
The human-environment field is physical self (body sensation and
a dynamic, open system in which body image) and personal self
change is continuous due to the (self-consistency, self-ideal and
constant interchange between moral-ethical spiritual self).
the human and environment. Goal: Psychological Integrity
13. Principle of
This change is also innovative. Self-Concept- Need is group
Helicy
Because of constant interchange, Group Mode Need is a identity integrity
an open system is never the psychic and through shared
same at any two moments; spiritual relations, goals
rather, the system is continually integrity so that values and co-
new or different. one can be or responsibility for
exist with a achievement
Sister Callista Roy – “Roy Adaption Model” sense of unity, implies honest
Two Categories of Coping Mechanism meaning, and soundness and
Regulator Subsystem Cognator Subsystem purposefulness completeness of
a person’s physiological a person’s mental coping in the universe identifications
coping mechanism; the mechanism; person uses with the group
body attempts to adapt via his brain to cope via self- Primary, secondary, or tertiary roles
regulation of our bodily concept, interdependence, that a person performs in the
processes (neurochemical and role function adaptive society. According to Roy and
and endocrine systems) modes Andrews (1991), a role is a set of
expectations about how a person
Roy’s Four Adaptive Model occupying one's position behaves
Adaptive Mode Individual Group towards a person occupying another
Role Function
The way a person responds as a position.
Mode
Physiological- physical being to stimuli from the Goal: Social Integrity
Physical Mode environment Need is social Need is role
Goal: Physiological Integrity integrity, clarity
knowing one understanding
who is in and committing
relation to to fulfil expected
others so one tasks so group
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can act role set can achieve a. Personal Biological Factors – include
is the complex common goals variables such as age, gender, body mass
of positions process of index, pubertal status, aerobic capacity.
individuals integrating roles strength, agility, or balance
hold; involves in managing b. Personal Psychological Factors – include
role different roles variables such as self-esteem, self-
development, and their motivation, personal competence, perceived
instrumental expectations health status, and definition of health
and expressive complementary c. Personal Socio-Cultural Factors – include
behaviors, and roles are variables such as race, ethnicity, socio-
role taking regulated. culturation, education, and socioeconomic
process. status; behavior specific cognition and affect
Coping mechanism from close 2. Perceived Benefits of Action – anticipated,
relationship which results to giving positive outcomes that will occur from health
and receiving of love, respect, and behavior
value. Occurs between the person 3. Perceived Barriers to Action – anticipated,
and the most significant other or imagined, or real blocks and personal costs of
between the person and support understanding a given behavior
system. 4. Perceived Self-Efficacy – judgment of personal
Goal: Affectional Adequacy capability to organize and execute a health-
Need is to achieve promoting behavior; influences perceived
Need is to
relational barriers to action, so higher efficacy results in
achieve
integrity using lowered perceptions of barriers to the behavior’s
relational
Interdependence processes performance
integrity using
Mode developmental 5. Activity-Related Affect – subjective positive or
process of
and resource negative feeling occurs before, during, and
affectional
adequacy. following behavior based on the stimulus
adequacy.
Example: learning properties of the behavior itself; affects
Example: giving
and maturing in influences perceived self-efficacy, which means
and receiving
relationships and the more positive the subjective feeling, the
love, respect,
achieving needs greater its efficacy; increased feelings of efficacy
and value
for food shelter, can generate a further positive affect
through
health, and 6. Interpersonal Influences – cognition
effective
security through concerning behaviors, beliefs, or attitudes of
relations and
interdependence others; influences include norms (expectations of
communication
with others significant others), social support (instrumental
and emotional encouragement), and modeling
Two Control Processes (vicarious learning through observing others
Stabilizer Subsystem Innovator Subsystem engaged in a particular behavior); primary
associated with system sources of interpersonal influences: families,
maintenance and involving peers, and healthcare providers
established structures, allows the person to 7. Situational Influences – personal perceptions
values, and daily activities change higher levels of and cognitions of any given situation or context
whereby participants in a potential through cognitive can facilitate or impede behavior; include
group accomplish the and emotional strategies perceptions of options available, demand
purpose of the social characteristics, and aesthetic features of the
system environment in which given health-promoting is
proposed to take place; may have direct or
Nola J. Pender – “Health Promotion Model” indirect influences on health behavior
Concepts of Health Promotion Model 8. Commitment to Plan
1. Personal Factors – categorized as biological, of Action – concept of
psychological, and socio-cultural; factors that are Behavioral Outcomes intention and
predictive of a given behavior and shaped by the identification of a
nature of the target behavior being considered planned strategy leads
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to the implementation sick person are relating as human being to
of health behavior human being; sick person shows trust and
9. Immediate confidence in the nurse
Competing Demands
and Preferences – Jean Watson – ”Philosophy and Theory of
competing demands Transpersonal Caring”
are those alternative Ten Carative Factors of Philosophy and Theory of
behaviors over which Transpersonal Caring
individuals have low 1. Formation of a
control because of Satisfaction through
humanistic-
environmental giving and extension of
altruistic system of
contingencies such as the sense of self
values
work or family care Describes the nurse's
responsibilities; role in developing
competing effective nurse-client
preferences are 2. Instillation of faith- interrelationships and in
alternative behaviors hope promoting wellness by
over which helping the client learn
individuals exert and adopt health-seeking
relatively high control, behaviors.
such as choice of ice To provide a genuine,
cream or apple for a authentic, and sensitive
snack client care, nurses should
10. Health-Promoting Behavior – an endpoint or 3. Cultivation of acknowledge Their
action-outcome directed toward attaining sensitivity to one's sensitivity and feelings.
positive health outcomes such as optimal well- self and to others The recognition of
being, personal fulfillment, and productive living feelings leads to self-
actualization through
Joyce Travelbee – “Human-to-Human Relationship self-acceptance for both
Model” the client and the nurse.
Five Interactional Phases of Human-To-Human A trusting relationship
Relationship Model promotes and accepts the
1. Original Encounter – described as the first 4. Development of a
expression of both
impression by the nurse of the sick person and helping-trusting,
positive and negative
vice versa; nurse and patient see each other in human caring
feelings which is
stereotyped or traditional roles relationship
essential for
2. Emerging Identities – described by the nurse transpersonal caring.
and patient perceiving each other as unique Intellectual and
individuals; the link of relationship begins to emotional understanding
form of a phenomenon or
3. Empathy – described as the ability to share in the 5. Promotion and
situation vary from
person's experience; result of the empathic acceptance of the
person to person and this
process is the ability to expect the behavior of the expression of
must be recognized by
individual with whom he or she empathized; she positive and
the nurse. The nurse
proposed that two qualities that enhance the negative feelings
must be prepared for
empathy process are similarities of experience either positive or
and the desire to understand another person negative feelings.
4. Sympathy – happens when the nurse wants to The use of the nursing
lessen the cause of the client's suffering; goes 6. Systematic use of a
process brings a
beyond empathy; nurse should use a disciplined creative problem-
scientific problem-
intellectual approach together with therapeutic solving caring
solving approach to
use of self to make helpful nursing actions process
nursing care.
5. Rapport – described as nursing interventions
that lessens the client's suffering; nurse and the
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This factor separates Rosemarie Rizzo Parse – “Human-Becoming Theory”
caring from curing. It Three Abiding Themes of Human-Becoming
allows the client to be Theory
informed and transfers Meaning – human becoming is freely choosing
the responsibility for personal meaning in different situations and
7. Promotion of
wellness and health to priorities in life. Man's reality is given meaning
transpersonal
the client. Teaching- through lived experiences. This theme is co creating
teaching-learning
learning techniques are reality through: valuing, imaging, and languaging
designed to enable a. Valuing – the process of choosing and embracing
clients to provide self- what is important
care, determine personal b. Imaging – the creation of one's own reality and
needs and provide one's reality reflects who one is as a unitary
opportunities for their person
personal growth. c. Languaging – the ways people express
8. Provision for a themselves to the world; it may be verbally,
Nurses must recognize
supportive, written or in their actions
the influence that
protective, and Rhythmicity – human becoming is co-creating
internal and external
corrective mental, rhythmical patterns of relating in mutual process
environments have on
physical, societal, with the universe. Man, and environment co-create in
the health and illness of
and spiritual rhythmical patterns. These patterns would include:
clients.
environment. revealing-concealing, enabling-limiting, connecting-
Biophysical, separating
psychological, a. Revealing-concealing – the process humans use
psychosocial, and to show and/or hide personal evolution or
intrapersonal needs are becoming
9. Assistance with basic to humans. Clients b. Enabling-limiting – opportunities or restrictions
gratification of must satisfy lower-order that occur daily; it is making choices and living
human needs needs such as food and with the consequences of our actions
ventilation before c. Connecting-separating – the patterns of
attempting to attain connecting and separating with people, things,
higher-order needs like and places
achievement and self-
actualization. Transcendence – human-becoming is co-
Included to provide a transcending multi-dimensionally with emerging
10. Allowance for
thought-provoking possibilities. It refers to reaching out and beyond the
existential-
experience, leading to a limits a person sets, and that one constantly
phenomenological-
better understanding of transforms. Sub-themes under transcendence
spiritual forces.
the self and others. encompasses: powering, originating, transforming
a. Powering – the pushing resisting process that
Transpersonal Caring Relationship propels people in life through difficult times
is an intersubjective human-to-human relationship in b. Originating – about human uniqueness and the
which the nurse affects and is affected by the other ways people create their own becoming as they
person. Both are fully present in the moment and feel choose from all possibilities that could be
a union with the other; they share a phenomenal field c. Transforming – about integrating unfamiliar
that becomes part of both a life story ideas or activities into one's life; changing for the
better and becoming a new entity
Caring Occasion / Caring Moment
involves actions and choices by the nurse and the Four Postulates of the Three Abiding Themes of
individual. The moment of coming together on a Human-Becoming Theory
caring occasion presents the two persons with the Illimitability – “The indivisible unbounded knowing
opportunity to decide how to be in the relationship – extended to infinity, the all-at-once remembering and
what to do with the moment prospecting with the moment."
Paradox – “An intricate rhythm expressed as a pattern
preference." Paradoxes are not "opposites to be
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reconciled or dilemmas to be overcome but, rather,
lived rhythms."
Freedom – “Contextually construed liberation."
People are free to continuously choose ways of being
with their situations.
Mystery – “The unexplainable, that which cannot be
completely known.”

Helen Erickson – “Modeling and Role-Modeling: A

Theory and Paradigm for Nurses”
Theoretical Components of Modeling and Role-
Modeling Theory
Humans have inherent holistic abilities needed to
cope, grow, develop, self-actualize.
1. Stress, effected by stressors, is a part of everyday
life
2. Our ability to cope and adapt determines our
ability to mobilize resources needed to work
through epigenetic developmental tasks.
3. The resources needed to cope are created by
repeated needs satisfaction.
4. Attachment objects, those things that repeatedly
meet our needs, are associated with
developmental tasks.
5. Loss of attachment objects is both normal and
situational and results in a grief process.
6. Unresolved attachment-loss-attachment results
in morbid grieving and affects needs status
7. As tasks are resolved, the residual that remains
affects future task resolution

Practice Paradigm of Modeling and Role-Modeling

Theory
1. A description of the situation, expectations for
the future, resource potential, and goals
(immediate and long-term).
2. The client is always the primary source of
information, significant other(s) are secondary,
and other professionals are third.
3. Data are analyzed within context of theoretical
premises
4. Interventions are:
a. based on coping ability and affiliated-
individuation status, and
b. framed within the context of six aims:
✓ nurses’ self-preparation needed to create
sacred space and initiate person-
centered holistic caring
✓ establish a trusting, functional
relationship
✓ promote a positive orientation
✓ promote a sense of perceived control
✓ affirm and promote strengths
✓ set health directed, mutual goals
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