THEORETICAL  Belief of the root of illness is due to evil

spirits
FOUNDATIONS IN  Shamans and witch doctores are
believed to heal by using magic,
NURSING charms, dances, etc.
Nursing as an Art and Science  Trephination/Trephinning- drilling a hole
in the skull with a rock or stone without
Nursing as an Art anesthesia (Last resort to drive evil
spirit)
 It is the art of caring forthe sick and CODE OF HAMMURABI
well individual.
 First recorded on the medical practice
 It refers to the dynamic skills and
 Established the medical fees
method in assissting sick and well
 Discouraged experimentation
individual in their recovery and in
promotion and maintenance of health  Specific doctor for each diseases
 Right of patient to choose treatment
 It is the way nursing knowledge is
between the use of charms, medicine or
expressed.
surgical procedure
 It is the heart of nursing.
ART OF EMBALMING
 It involves feeling gained by experience.
 Mummification, removing the internal
 Sensitivity and emphathy is important organs of the dead body, instillation of
facet of this definition herbs and salt to the dead
 Enable the nurse to be aware of the  Used to enhance their knowledge of the
client’s perspective and be attentive to human anatomy
verbal and non verbal cues to the  Documentations about 250 diseases
client’s psychological state. and treatment
Nursing as Science  Slaves and patient’s families nursed the
 It is the scientific knowledge and skills sick
in assissting individual achieve optimal TEACHINGS OF MOSES
health.  Moses is The Father of Sanitation and he
wrote 5 books in the Old Testament. He
 It is the diagnosis and treatment of
emphasized the practice of Hospitality
human responses to actual potential
and Charity.
problem.
 Laws of control of spread of
 Cognitive brain of nursing
communicable diseases and the ritual of
 Include knowledge from nursing
circumcision of male child were also
research
established and nurses are reffered as
 Facts and information necessary for midwives, wet nurse or child nurse
performing technical skills MATERIA MEDICA (CHINA)
 Interpersonal relationships and  Book that indicates pharmacologic
communication is a part drugs used for treatment
 Sociocultural and developmental factors  No knowledge on anatomy
affect client’s behavior  Use of wax to preserve the body of the
Historical Perspective dead
 Use pharmacologic drugs
1. Intuitive Nursing (Medieval Period) SUSHURUTU (INDIA)
2. Apprentice Period (Middle Ages)  First recording on the nursing practice
3. Period of Educated Nursing (Nightingale  Hampered by Taboos due to social
Era 19th-20th Century) structures and practices of animal
4. Contemporary Nursing worship
 Medicine men built hospital
INTUITIVE NURSING  They use intuitive form of asepsis
 The ability to understand something  There was no proficient practice of
immediately, without the need for medicine and surgery
concious reasoning CADUCEUS
 Nursing was untaught and instinctive  Insignia of Medicine
 Women Role: to take care of their child, HIPPOCRATES
sick and aged  Also defined the concept of medicine. He
 No training program is called as The Father of
 Practice of nursing is based on Scientific/Modern Medicine. He was the
observation and experience first to reject the idea that diseases are
 caused by evil spirits and to apply o Nursing evolved as an art and
assessment. He also practiced medical science
ethics. o Formal education and service
APPRENTICE PERIOD begun
FLORENCE NIGHTINGALE
 Care was done by Crusaders, Prisoners,
“Nursing is an art: and if it is to be made an
Religious Orders
art, it requires an exclusive devotion as hard a
 No formal education for nursing
preparation as any painters’ or sculptors’
 Attitudes towards nurses reflected thru
work; for what is the having to do with dead
the writings of Charles Dickens through
canvas or dead marble, compared with having
his character Sairy Gamp
to do with the living body, the temple of God’s
 She cared for thr sick by neglecting
Spirit? It is one of the Fine Arts: I had almost
them, stealing from them and physically
said the finest of fine arts” –Florence
abusing them
Nightingale
 Nursing went down to the lowest level
 Wrath of Protestantism confiscated  Born May 12,1820
properties of hospitals and schools Concides with international nurses day
connected with Catholic Church  Was born to a wealthy and intelligent
 Pastor Theodore Fliender and his wife family
Federika established the first training
schoolfor nurses in Kaiserswerth She believed she was “called by God to
Germany help others...and to improve the well-
 Kaiserswerth Institution of Deaconesses being of mankind”
where Nightingale received her 3-month LADY WITH THE LAMP
course in nursing Improved the standards for the care of
FABIOLA war casualties in Crimea
 A wealthy matron of the Roman Empire ANGEL OF CRIMEA
converted to Christianity and used  Political Nurse: Reforms in hospital and
wealth to provide houses of care and production and implementation of
healing public health policies.
THE CRUSADERS
 Knights of St. John of Jerusalem
 Nursing’s First Scientist Theorist
-“Notes on Nursing, What it is and What
(Knights Hospitalers)
is not?”
 Teutonic Knights
DEFINITION OF NURSING
 Knights of St. Lazarus (Cared people
with leprosy, syphilis, and skin  “ Act of UTILIZING the ENVIRONMENT
conditions) of the patient to ASSIST him in his
RECOVERY” –Florence Nightingale
PERIOD OF EDUCATED
CONTEMPORARY NURSING
NURSING  Licensure of nurses started
 Development of nursing is greatly  Training of nurses in Diploma program
influenced by: (associate degrees 2 years)
o the aftermath of Crimean War  Development of Baccalaureate (BSN 4
and Civil War years) and advance degree program
(PhDN, MSN, MAN, MPH)
o arousal of social consciousness  Scientific and technical advancement
o increased educational o Health is percieved as a human
opportunities for women right
 1860- Nightingale Training School for o Community involvement of nurses
Nurses (St. Thomas Hospital) o Disposable supplies and
o Served as model for other training equipments
school o Expanded roles of nurses
o Nightingale system was more on o WHO established by United
developing profession within the Nations
hospital o Use of computers and
o Curriculum includes theory and sophisticated machines on
practice hospitals
o First school of nursing provide VIRGINIA HENDERSON
theory-based knowledge and  One of the first modern nurse to define
clinical skill building nursing
 “The unique functions of the nurses is to Nursing During Philippine
assist the individual, sick or well, in the
peformance of those activities contributing to Revolution
health or its recovery (or to peaceful death) WOMEN OF THE WAR
that he would perform unaided if he had the  JOSEPHINE BRACKEN
necessary strength, will or knowledge, and - Wife of Jose Rizal
to do this in such a way as to help him gain - Installed a field hospital in an estate
independence as rapidly as possible.” house in Tejeros
(Henderson, 1966) - She provided nursing care to the
History of Nursing in the wounded night and day
 ROSA SEVILLA DE ALVERO
Philippines - Converted their house into quarters
EARLY BELIEFS for the Filipino soldiers during the
 Illness was believed to be caused by Philippine-American War broke out
mangkukulam or mangangaway in 1899
 Herbicheros- practice witchcraft  DONA HILARIA DE AGUINALDO
 Mabuting hilot (good midwife) attends - Wife of Emilio Aguinaldo
childbirth - Organized the Filipino Red Cross
HEALTH CARE DURING SPANISH REGIME under the inspiration of Mabini
 Babaylan (Priest Physician) and  DONA MARIA AGONCILLA DE
Albularyo (Herb Doctor) care for sick AGUINALDO
individuals - Second wife of Emilio Aguinaldo
 1578 male nurses were acknowledge by - Provided nursing care to Filipino
Spanish friars (Practicante/Enfermo) soldiers during the revolution
 Religious orders exerted their efforts to - President of the Filipino Red Cross
care for the sick by building hospitals in branch in Batangas
different parts of the Philippines  MELCHORA AQUINO aka TANDANG
EARLY HOSPITALS SORA
 HOSPITAL REAL DE MANILA (1577) - Nursed the wounded Filipino soldiers
- It was established mainly to care for and gave them shelter and food
the Spanish King’s soldiers, but also  CAPITAN SALOME
admitted spanish civillians; - Revolutionary leader in Nueva Ecija
- Founded by Gov. Francisco de Sande - Provided nursing care to wounded
 SAN LAZARO HOSPITAL (1578) when not in combat
- Founded by Br. Juan Clemente and  AGUEDA KAHABAGAN
was administered for many years by - Revolutionary leader in Laguna
the Hospitalliers of San Juan De - Also provided nursing services to her
Dios troops
- Built exclusively for patients with  TRINIDAD TECSON (Ina ng Biak-na-Bato)
Leprosy - Stayed in the hospital at Biak na
 HOSPITAL DE INDIOS (1586) Bato to care for wounded soldiers
- Established by the Franciscan Order Hospitals & Nursing Schools
- Service was in general supported by
alms contribution from charitable 1907- Training of nursing students by
person Americans
 HOSPITAL de AGUAS SANTAS (1590) - Filipino students studied the same
- Established in Laguna, near subject than that of the American
medicinal spring but is believed that the curriculum
- Founded by Br. J. Bautista of was never the “mirror image of the
franciscan Order American Nursing Curriculum”
 SAN JUAN DE DIOS (1596) Hospital School of Nursing’s
- Founded by the brotherhood of
Misericordia and administered by the Formal Training (1901-1911)
Hospitalliers of San Juan de Dios  ILO-ILO MISSION HOSPITAL SCHOOL OF
- Support was delivered from alms and NURSING (JARO, ILOILO CITY,1906)
rents - By the Baptist Foreign Mission
- Rendered general health service to Society of America
the public - April 1944 graduate nurses took the
first Nurses Board Examination at
Iloilo Mission Hospital
  SAINT PAUL’S HOSPITAL SCHOOL OF ESTABLISHMENT OF
NURSING (MANILA, 1907)
- Established by the Archbishop of PROFESSIONAL ORGANIZATION
Manila, Jeremiah Harty under the ACCREDITED PROFESSIONAL
supervision of Sisters of St. Paul de ORGANIZATION
Chartres located in Intramuros  The Filipino Nurses Association was
- Training school for nurses opened established
1908  ACT 3025
 PHILIPPINE GENERAL HOSPITAL - An act regulating the practice of
SCHOOL OF NURSING (MANILA, 1907) nursing profession in the Philippine
- Opened nursing classes with Islands
Admission bases on Entrance - Amendment of Act 2808
Examination - Yearly registration for nurses
- Applicant must have completed PUBLIC HEALTH IN NURSING
elementary education to the 7th grade DEVELOPMENT 1931-1941
 ST. LUKE’S HOSPITAL ACHOOL OF  Nursing institution has increased their
NURSING (QUEZON CITY,1907) requirement
- School opened with 3 girls admitted  Applicant must be able to complete
- These 3 girls had their first year in secondary education
combined classes with the PGH  University of the Philippines School of
School of Nursing and St. Paul’s Public Health Nursing
Hospital School of Nursing - First collegiate nursing graduates of
 MARY JOHNSTON HOSPITAL & SCHOOL the Philippines
OF NURSING (MANILA,1907) OTHER NURSING SCHOOLS
- Funded by the Methodist Mission for 1. Zamboanga General Hospital School of
the relief of suffering among women Nursing (1921)
and children 2. Chinese General Hospital School of
- Nurses’ training course began with 3 Nursing (1921)
Filipino young girls fresh from 3. Baguio General Hospital School of
elementary as their first students Nursing (1923)
 MARY CHILES HOSPITAL SCHOOL OF 4. Mamila Sanitarium Hospital and School
NURSING ( MANILA, 1911) of Nursing (1930)
- Miss Mary Chiles of Montana 5. St. Paul School of Nursing in Iloilo City
donated a large sum of money with (1946)
which the present building at 6. North General Hospital and School of
Gastambide was bought Nursing (1946)
 FRANK DUNN MEMORIAL HOSPITAL 7. Siliman University School of Nursing
(VIGAN, ILOCOS SUR 1912) (1947)
 SAN JUAN DE DIOS HOSPITAL SCHOOL NURSING DURING WORLD WAR II
OF NURSING (MANILA 1913)  Public health nurses joined the guerillas
 EMMANUEL HOSPITAL SCHOOL OF or went to hide in themountains during
NURSING (CAPIZ 1913) this time
 SOUTHERN ISLAND HOSPITAL SCHOOL THE DEGREE OF BACHELOR OF SCIENCE
OF NURSING (CEBU 1918) IN NURSING: 1941-1951
The Start of Nursing Practice  JULITA V. SOTEJO – presented in her
dissertation that tackles on the
(1911-1921) development of a nursing education
ACT 2493 within a University-based College of
- Amends Medical Law nursing which become the basis of
- (Act no. 310) allowing the regulation Nursing Curriculum in the Philippines
of nursing practice  Nursing became a Baccalaureate Course
FIRST TRUE NURSING LAW (ACT 2808)  College of Nursing was created
- Board of Examiners for nursing was THE FIRST COLLEGES OF NURSING IN
created THE PHILIPPINES
- First Nursing board exam was given 1. UST College of Nursing
on 1920 - First college of nursing in the
- First executive officer of the Board Philippines
Examiners for nurses is a Physician 2. MCU College of Nursing
- June 1947 (First college who offered
BSN 4year program)
 3. UP College of Nursing  Care of the Dying
- June 1948 ROLES & FUNCTION OF THE NURSE
4. FEU Institute of Nursing  CAREGIVER
- June 1955 - Activities that assist the client
5. UE College of Nursing physically and psychologically while
- October 1958 preserving the client’s dignity
FURTHER CHANGES IN NURSING LAW:  COMMUNICATOR
2001-PRESENT - Nurses communicate patients’
 Philippine Nursing Act of 1991: identified problems to other members
RA 7164 of health care team
 Philippine Nursing Act of 2002:  TEACHER
RA 9173 - Nurses helps client about their
 Comprehensive Nursing Law of 2015 health and health care procedures
TIMELINE they need to perform to restore or
 1909- 3 female graduated as “qualified maitain health
medical-surgical nurses.  CLIENT ADVOCATE
 1919- The first nurses law (Act of 2808) - ACTS TO PROTECT THE CLIENT.
was enacted regulating the practice of Nurses may represesnts the clients’
the nursing profession in the Philippine need and wishes to other health
Islands. It also provided the holding professional
exam for the practice of nursing on the  COUNSELOR
2nd Monday of June and December of - Process of helping the client
each year. recognize and cope with stressful
 1920- First board examination for psychologic or social problems, to
nurses was conducted by the Board of develop improved interpersonal
Examiners, 93 candidates took the relationships, and to promote
exam, 68 passed with the highest rating personal growth
of 93.5%- Anna Dahlgren  CHANGE AGENT
- Theoretical exam was held at the UP - Assisting client to make
amphitheater of the College of modifications in their behavior
Medicine and Surgery. Practical  LEADER
exam at the PGH Library - Influences others to work together to
 1921- Philippine Nurses Assosiation accomplish a specific goal
Building  MANAGER
- Filipino Nurses Assosiation was - Delegates nursing activities to
established (now PNA) as the ancillary workers and other nurses,
national organization of Filipino and supervisesand evaluate their
nurses performance
- PNA: 1st President  CASE MANAGER
o Rosario Delgado - Works with multidisciplinary
- Founder: healthcare team to measure the
o Anastacia Giron-Tupas effectiveness of the case management
SCOPE OF NURSING plan and monitor outcomes
 RESEARCH CONSUMER
RECIPIENT OF NURSING EXPANDED CAREER ROLES
 CONSUMER  Nurse Practitioner
- Individual, group of people, or  Clinical Nurse Specialist
community that uses a service or  Nurse Anaesthetist
commodity  Nurse Midwife
 PATIENT  Nurse Researcher
- Person who is waiting for or  Nurse Administrator
undergoing medical treatment and  Nurse Educator
care  Nurse Entrepreneur
 CLIENT
- Person who engages the advice or ETHICS IN NURSING
services of another who is qualified PRINCIPLES OF ETHICS
to provide this service  BENEFICENCE
SCOPE OF NURSING - All actions must benefit the client
 Promoting Health and Wellness - To do good
 Preventing Illness  NON MALEFICENCE
 Restoring Health - To do no harm
 - To choose the lesser evil - Enforces duties and rights among
 AUTONOMY private individuals that are not
- Act on your own without coercion based on contractual agreement.
 JUSTICE CATEGORY EXAMPLE
- Stands for equality Constitutional Due process
 PRIVACY Equal protection
- Respecting privacy Statutory Nurse Practice Acts
 CONFIDENTIALITY (Legislative) Good Samaritan Acts
 FIDELITY Child&Adult Abuse Law
- Sticking with your patient Living Wills
- Loyalty Criminal (Public) Theft
 VERACITY Arson
- Always telling the truth Active Euthanasia
LEGAL ASPECTS OF NURSING Sexual Assault
Contracts Nurse & Client
LAW
(Private/Civil) Nurse & Employment
 “The sum total rules and regulations by
Nurse & Insurance
which a society is governed. As such,
Client & Agency
law is created by people and exists to
Torts Negligence/Malpractice
regulate all persons.” –Guido,2006
(Private/Civil) Invasion of Privacy
FUNCTIONS OF THE LAW IN NURSING
Assault & Battery
 It provides a framework for establishing
False Imprisonment
which nursing actions in the care of
KINDS OF LEGAL ACTIONS
clients are legal
 CIVIL ACTIONS
 It differentiates the nurse’s
- Deal with relationships among
responsibility from those of other health
individuals in society
professionals
Ex. A case filed for someone who cheats
 It helps establish the boundaries of
- If found guilty: Payment
independent nursing action
 CRIMINAL ACTIONS
SOURCES OF LAW
- Deal with disputes between an
 CONSTITUTIONAL LAW
individual and the society as a whole
- Supreme law of the country
Ex. A man shoots a person (society
 LEGISLATION (STATUTORY LAW)
brings him to trial)
- Law enacted by legislative body
- If found guilty: May lose money, be
 ADMINISTRATIVE LAW
jailed, or executed
- Rules and regulation created by an
NURSE AS A WITNESS
authorized administrative agency to
 SUBPOENA DUCES TECUM
enforce statutory law
- A wit ordering a personto attend a
 COMMON LAW
court and bring important
- Law evolving from court decisions
documents.
TYPES OF LAW
CHART- legal document that is accepted
 PUBLIC LAW
at the court.
- Body of law that deals with
 SUBPOENA AD TESTIFICANDUM
relationships between individuals
- A wit commanding a person to
and the government and
appear in court to testify as a
governmental agencies
witness
 Criminal Law
 EXPERT WITNESS
- Deals with actions against the safety
- Trained, experienced, and skilled in
and welfare of the public
a relevant area and is allowed by the
 PRIVATE LAW
court to offer an opinion on some
- Body of law that deals with
issue within his/her area of
relationships among private
expertise.
individuals
REGULATION OF NURSING PRACTICE
 NURSING PRACTICE ACTS
 Contract Law
 RA 7164 (Philippine Nursing Act of
- Enforcement of agreements among
1991)
private individuals or the payment of
- By Senator Heherson Alvares
compensation for failure to fullfil the
- Redefinition of the scope of Nursing
agreement
Practice
 Tort Law
 - Use of nursing process as a scientific  Includes:
discipline in arriving at an - Name of procedure
appropriate nursing action and care - Name of MD
- Teaching, management, leadership, - Name of witness (RN)
and decision-making roles of the - Date
nurse - Potential complications/
 RA 9173 (Philippine Nursing Act of Disfigurement
2002)  Requires for Validity:
- Composition of Board 1 Chair + 6 - Written consent made by the client
Members - No signs of pressure
- Qualifications of Board Members - No sedation
o Master’s Degree Holder - 24 hours before elective surgery
(majority: M’s DH in Nursing) - Legal age and mentally capable
o Chair > M’s DH in Nursing - 2 surgeons signed the consent in
o 10 years continuous practice emergency
o Adopt and regulate Code of - Emancipated Minor*
Ethics and Code of Technical - Authorized Representative*
Standards  Emancipated Minor:
o Recognize Specialty - A college student living away from
Organization in coordination home
with APO (Accredited - In military service
Professional Organization) - Pregnant
o Faculty > at least 1 year - Anybody who has given birth
experience  Authorized Representative:
o Dean > at least 5 years - Minor
experience - Unconscious
o Nursing Practice - Psychologically incapacitated
o Special training for suturing
lacerated perineum
AREAS OF POTENTIAL LIABILITY
 Comprehensive Nursing Act of 2015 IN NURSING
CONTRACTUAL AGREEMENTS IN NURSING
CRIME & TORTS
 CONTRACT
 CRIME
- An agreement between two or more
- An act committed in violation of
competent persons, on sufficient
public (criminal) law and punishable
consideration to do or not to do some
by a fine or imprisonment
lawful acts.
- Does not have to be intended to be a
 Oral Contract
crime
o Equally binding as a written
 Felony
contract (difficult to prove in a
- Is a crime of a serious nature
court)
Ex.Murder
 Implied Contract
 Misdemeanor
o Not explicitly agreed to by the
- An offense of less serious nature
parties but the law nevertheless
Ex.Slapping of client
considers to exist
 TORTS
 INFORMED CONSENT
- A civil wrong committed against a
 A.K.A Operative Permit / Surgical
person or a person’s property
Consent
- Usually litigated in court
- Patient’s autonomous decision about
 Unintentional Torts
whether to undergo certain
o Negligence
diagnostic procedure, therapeutic
- Misconduct or practice that is below
measures, or surgical procedure
the standard expected of an
 Purpose:
ordinary, reasonable and prudent
- The client understands the nature of
person that places another person at
the treatment and its advantages
risk or harm
and disadvantages
o Malpractice
- To indicate that NO COERCION was
- “Professional Negligence”
made before signing
- Negligence that occured while the
- To PROTECT the client against
person was performing as a
unauthorized procedure
professional
- To PROTECT the surgeon and the
- 6 Elements To Prove Malpractice
hospital against legal actions
 1. Duty  Health
2. Breach of Duty (Ommission/  Nursing
Commission) PHILISOPHY
3. Foreseeability (existing link between - Is the theorist’s viewpoint: what the
act and injury) theorist assumes, believes, and
4. Causation values, or hold to be true
5. Harm or Injury CONCEPT
6. Damages - An idea formulated by the mind or
*Respondeat Superior an experience perceived and
*Res Ipsa Loquitor (the thing speaks for itself) observed
 Intentional Torts - Formulated in words that enable
o Assault people to communicate their
- An attempt or threat to touch meanings
another person unjustifiably Ex. Love, Mass, Energy
o Battery  Abstract Concepts – intangible
- Wilful touching of a person (or the  Concrete Concepts – tangible
person’s clothes or even something
the person is carrying that may or
may not cause harm) DEFINITIONS
o False Imprisonment - Various descriptions which convey a
- Unjustifiable detention of a person general meaning and reduce
without legal warrant to confine a vagueness in understanding a set of
person concepts
o Invasion of Privacy PROPOSITIONS
- Injures feelings of a person - Explain the relationships of different
- Direct wrong of a personal nature concepts
o Defamation Ex. Children do not want to stay in
- Communication that is false, or hospitals because they fear injections
made with a careless disregard for ASSUMPTIONS
the truth, and results in the injury of - Is a statement that specifies the
the person’s reputation reltionship or connection of factual
 Libel- defamation by means of concepts or phenomena
print, writing or pictures Ex. All ill patients cannot take good care
 Slader- defamation by the of his/herself and that they need nurses
spoken word, stating to do so
unprivilaged or false words
that damages reputation
HISTORY OF NURSING THEORY
 Professional nursing began with
NURSING THEORY Florence Nightingale
THEORY  Nightingale’s establishment of nursing
- Supposition or system of ideas that school in St. Thomas Hospital marked
is proposed to explain a given the birth of MODERN NURSING
phenomenon  Development of nursing as a
CONCEPT PROFESSION
- Building blocks of theory conceptul  Curriculum Era
framework  Research Emphasis Era
- Group of related ideas, statements,  Graduate Education Era
or concepts  Theory Era
PARADIGM *Research and Theory era produced Nursing
- Pattern of shared understanding and Science
assumptions about reality and the  Pervading questions each era:
world  What is the nature of the
METAPARADIGM
knowledge that is needed for the
- Concepts that can be super-imposed practice of nursing?
on almost any work in nursing  FLORENCE NIGHTINGALE:
 Meta- with
 Nursing knowledge is distinct
 Paradigm- pattern from medical knowledge
Four Concepts in Nursing  Nurse’s Function: putting the
(Except Nightingale) patient in the best condition for
 Person nature (God) to act upon him/her.
 Environment
  Care of the sick based on looking at a certain fact or
knowledge of persons and their phenomenon.
surroundings – different 2. Theories must be logical in nature.
knowledge base than what 3. Theories should be simple but generally
physician used. broad in nature.
 100 years later, nursing profession 4. Theories can be the source of
began to engaged in NURSING THEORY hypothesis that can be tested for it to be
 Transition from vocation to profession elaborated.
 “Will nursing be other-discipline 5. Theories contribute in enriching the
based ot nursing-based?” general body of knowledge through
 History records the answer: studies implemented to validate them.
- Nursing practice needs to be based 6. Theories can be used by practitioners to
on nursing science. direct and enhance their practice.
SIGNIFICANCE OF NURSING THEORY 7. Theories must be consistent with other
 DISCIPLINE validated theories, laws, and principle.
- Specific to academia and refers to a EXAMPLE:
branch of education, a department of “THEORY OF LETTING GO”
learning, or domain of knowledge. -Mark Billy L. Perpetua
 PROFESSION  Agressive Stage
- Refers to a specialized field of - do everything that you can do
practice, founded upon the  Ambivalence Stage
theoretical structure of the science or - It is hard in our part
knowledge of that discipline and  Collaboration Stage
accompanying practice abilities. - We’ll talk about it, give us time
ANALYSIS & CRITIQUE OF THEORY  Revalidation Stage
 CLARITY - Is the chance really low?
- How clear is this theory?  Letting Go Stage
- Meaning of terms speaks to - We did everything we can, it’s about
definition time to let go
 SIMPLICITY METAPARADIGM
- How simple is this theory?  NURSING
- Useful theory provides the greatest - Maintenance of internal and external
sense of understanding milieu across the life span for the
 GENERALITY attainment of the highest quality of
- How general is this theory? life as possible
- The broader the scope, the greater  HEALTH
the significance of the theory - The balance between all sorts of
 EMPIRICAL PRECISION assaults (physical, mental,
- How accessible is this theory? emotional, spiritual) and individuals
- Linked to the testability and ultimate responses for maintanining
use of a theory homeostasis
- Refers to the extent that the defined  ENVIRONMENT
concepts are grounded in observable - The totality of all the systems a
reality person is interacting to, which
 DERIVABLE CONSEQUENCES influences health in a positive or
- How important is this theory? negative side
- Theory should develop and guide  PERSON
profession - An adaptive unit in continous action
MOSBY (2006) and interaction with its environment
“[It is] a statement formulated to predict, to achieve optimum level of
explain or describe the relationships among functioning.
concepts, constructs, or events. It is tested by NURSING THEORY
observation and research using factual data.”  Group of interrelated concepts that are
KOZIER (2008) developed from various studies of
“A theory is a supposition or system of ideas disciplines and related experiences
that is proposed to explain a given  This aims to view the ESSENCE of
phenomenon.” nursing care
CHARACTERISTICS OF A THEORY  Florence Nightingale taught us that
1. Theories can correlate concepts in such nursing theories describe and explain
a way as to generate a different way of what is and what is not nursing.
(Nightingale, 1859-1992)
MELEIS (1991) - The holistic level of wellness that the
“An articulated and communicated person experiences.
conceptualization of invented or discovered EX. Nightingale defined nursing as “a
reality (central phenomena and relationships) profession of women (a calling) with the
in or pertaining to nursing for the purpose of goal to discover and use the laws
describing, explaining, predicting or governing health in the service of
prescribing nursing care.” humanity.” She believed that the goal of
all nursing activity should promote
T Describes client health
NURSING
H - The interventions of the nurse
Explains
E Nursing Care rendering care in support of, or in
cooperation with the client.
O Predicts EX. Nightingale emphasized that a
R nurse is responsible in promoting well-
Prescribes being of clients by manipulating the
Y environment
CLASSIFICATION OF THEORY
PURPOSES OF NURSING THEORY
 DESCRIPTIVE
 It guides nursing practice and generates
“Factor Isolating Theory”
knowledge
- Known to be the primary level of
 It helps to describe and explain nursing
theory development
 It enable nurse to know what they are
- Theory identifies and describes the
doing and why they are doing
major concepts of phenomena but
NURSING PARADIGMS
does not explain how or why the
 Models that show relationship among
concepts are related
existing theoretical works in nursing
- Purpose is to present a phenomenon
FOUR CONCEPTS CENTRAL TO NURSING
based on the 5 senses together with
(METAPARADIGM)
their corresponding meaning
 PERSON
- Recipient of nursing care (individual,  Conceptual definition-
families, groups, communities) definition of words that
 ENVIRONMENT appears in the dictionary.
- Internal and external surroundings  Operative definition- definition
that affect the client based on the context
 HEALTH  Definition must be similar to
- Degree of wellness or well-being that each other.
the client experiences  EXPLANATORY
 NURSING “ Factor Relating Theory”
- Attribute, characteristics, and - Cause and effect
actions of the nurse providing care - They examine how properties relate
on behalf of, or in conjunction with and thus affect the discipline
the client - They present relationship among
PERSON concepts and propositions
- The recipient of nursing care like - Aim to provide knowledge on how or
individuals, families and why concepts are related
communities  PREDICTIVE
EX. Nightingale proposed that the “Situation Relation Theory”
physical, intellectual, and spiritual - To calculate relationships between
being of a person is not capable of properties and how they occur
manipulating the environment to - Achieved when the relationships of
promote health. This means that a concepts under a certain conditions
person is a passive recipient of care. are able to describe future outcomes
ENVIRONMENT consistently.
- The externat and internal aspects of  PRESCRIPTIVE
life that influences the person. “Situation Producing Phenomena”
EX. Physical environment is emphasized - To identify under which conditions
by Nightingale in her theory. She relationships occur
focused on ventilation, warmth, noise, - Deals with nursing actions
light, and cleanliness - Test the validity and certainty of a
HEALTH specific nursing interventions
 - Commonly used in testing new -
Used by those who believed that
interventions theories must evolved from research
TYPES OF NURSING THEORY findings
 GRAND THEORY - This is also known as the inductive
- Grand theories have the broadest method
scope and present general concepts - Theory – Research – Theory
and propositions - With this method, theories developed
- Theories at this level may both reflect by other disciplines are utilized but
and provide insight useful for given a unique nursing perspective
practice but are not designed for - Conceptual or theoretical framework
empirical testing in nursing research studies are
- This limits the use of grand theories adapted from these theories
for directing, explaining,and DEVELOPMENT OF NURSING THEORY
predicting nursing in particular
situations
- Theories at this level are intended to Research Theory
be pertinent to all instances of
nursing
 MIDDLE-RANGE NURSING THEORY
- Robert Merton 1986 Practice
- Provides theories that are BROAD
ENOUGH to be useful in complex
situations THEORY RESEARCH AND PRACTICE
- Difficulty in assessing the grand  Primary use of theory is to guide
theory research
Narrow in scope  “effective bridge”  Theory interacts with and guide practice
 Research validates and modifies theory
Presents concepts and propositions at a lower and changes practices
level of abstraction  The science of nursing incorporates the
 NURSING PRACTICE THEORY study of relationships among nurses,
and level of abstraction clients and environment within the
Limited scope context of health
Specific Range of Nursing  The art of nursing is the interpersonal
Situations relationship between the person and the
nurse within a social environment
Questions Action Procedure Direct impact during the delivery of nursing care
s  The science and art of nursing are
Framework  Prediction  Impact integrated within the nursing process
THEORY DEVELOPMENT
NURSING THEORIST AND THEIR
 Meleis (1985) identified 4 strategies of
theory development in nursing. These WORKS
are:
FLORENCE NIGHTINGALE
- Theory – Practice – Theory
Modern Nursing
- Implies that theory development in
[Environmental Theory]
nursing is based on theories
 Nightingale: BACKGROUND
developed by other disciplines and
- Requested to go to Crimea to
used in nursing situations
provide trained nurses to care for
- Practice – Theory
wounded soldiers
- Based upon and evolved from clinical
- She addressed:
practice
- Lack of sanitation
- The theoriests develops his/her ideas
- Presence of filth chamber pots
through actual observations or
- Contaminated water, sheets and
experiences in the clinical area,
blankets
either as a care-giver herself or as an
- Soldier’s exposure, frostbite, lice
observer of other care givers
infestations and other oportunistic
- From the data collected, concepts are
diseases
developed and relationships are
 “Angel of Crimea”
defined to form propositions
- Research – Theory  “The Lady with the Lamp”-ward
rounds at night
 Awarded funds for her works:
 -Establishment of Nightingale training a universal template for nursing
School for Nurses (St. Thomas schools
Hospital)  Research
 Founder of MODERN NURSING - Her efficient use of statistics and
 Named after her birthplace: graphical representations of data
Florence Italy (Polar Diagrams) paved the way to
 Tutored in Mathematics, scientific inquiry in nursing
Languages, Religion, and  Critique
Philosophy  Simplicity
 Though an aristocrat, developed - 3 Major Concepts
the sense that her life should be  Environment to Patient
useful  Nurse to Environment
 Wrote in her DIARY: “God spoke  Nurse to Patient
to me and called me to his  Generality
service” - Provided general guidelines for
 Entered the Kaiserswerth nurses for the last 150 years
Institute of the Deaconesses - Relation concepts is applicable in all
(Germany) for 3 months where nursing settings
she was declared to be a trained  Empirical Precision
nurse - Stated implicitly and presented as
 Returned in England and started truth rather than testable statements
to examine hospitals, facilities,  Derivable Consequences
etc. - Directed nurses to act on behalf of
 Became the superintendent of patient and the nurse
Hospital for Invalid Gentlewomen - “Provide physicians with, not your
in London opinion, however respectfully given,
 Metaparadigm but your facts”
 Nursing - She advised, “if you cannot give the
- Women’s role in nursing habit of observation one way or
- Provision of guidelines for women in other, you had better give up being
providing nursing care the nurse, for it is not your calling,
- “Act of utilizing the environment of however king and anxious you may
the individual to assist him in his be”
recovery” ERNESTINE WEIDENBACH
 Person (The helping of clinical nursing)
- Referred to the person as “Patient”  WEIDENBACH: BACKGROUND
- Emphasized that the nurse was in  Greatly admired private duty
control of the patient’s environment nurses who cared for her
 Health grandmother
- Defines health as being well and  Studied at john Hopkins hospital
using every power that the person school of nursing
has to the fullest extent  Teachers college (Columbia
- Diseases: reparative process that university) – masters degree and
nature instituted from a want of certificate in public health
attention  Maternity center association –
- Health: maintained through completed a program for nurse-
prevention of diseases via midwife
environmental control  Taught advanced maternity
 Environment nursing (teacher’s college)
- Elements external to and which  Writings:
affect the health of the sick and - Family-centered maternity nursing
healthy person - Published classic articles about
 Acceptance by Nursing Community theory In practice
 Practice  Metaparadigm
- The applicability of Nightingale’s  Nursing
theory is still apparent in modern - Philosophy of nursing:
nursing a. Reverence for the gift of life
 Education b. Respect for the dignity, worth,
- Nightingale’s principle of nursing autonomy, and individuality of
training (scientific-practical) provided each human being
 c. Resolution to act dynamically in - Member of a medical team
relation to one’s belief - Nurse functions independently of the
- “The reason she has come into being physician, but promotes their plan in
is that there is a patient who needs their attendance
her help.” - Knowledgeable in both biological and
 Person social science
- “An individual should want to be - Nurses can assess basic human
healthy, comfortable and capable, needs
and when unimpeded, he strives by - “The unique function of the nurse is
his own efforts to achieve such to assist the individual, sick or well,
states.” in the performance of those activities
 Health contributing to health or it’s recovery
- Neither defined nor disscused in (or to peaceful death) that he would
Weidenbach’s model. perform unaided if he had the
 Environment necessary strength, will or
- Does not specifically address the knowledge, and to do this in such a
concept of environment way as to help him gain
 Theoretical Assertions independence as rapidly as possible”
 Critique (Henderson,1966)
 Clarity  14 Basic Needs
- Concepts and definitions are clear, 1. Breathe normally
consistent and intelligible. 2. Eat and drink adequately
 Simplicity 3. Eliminate body wastes
- Some concepts are difficult to 4. Move and maintain desirable
diagram postures
 Generality 5. Sleep and rest
- Concepts are broad and 6. Select suitable clothes- dress and
generalizable undress
- Not applicable in some patients 7. Maintain body temperature within
(infants, comatose, etc.) normal range by adjusting clothing
 Derivable Consequences and modifying environment
- Describes professional consequences 8. Keep the body clean and well-
- Influenced other theorist’s works groomed and protect the integument
VIRGINIA HENDERSON 9. Avoid dangers in the environment
Definition of nursing and avoid injuring others
(14 Basic needs) 10. Communicate with others in
 HENDERSON: BACKGROUND expressing emotions, needs, fears, or
- BORN: November 30, 1897 opinions
- Kansas city, Missouri 11. Worship according to one’s faith
- She was the fifth of eight children born 12. Work in such a way that there is
to Lucy Abott Henderson and Daniel B. a sense of accomplishment
Henderson 13. Play or participate in various form
- Army School of Nursing at washington of recreation
D.C. in 1921 where she earned her 14. Learn, discover or satisfy the
diploma curiosity that leads to normal
- Henry street visiting nurse service (staff development and health and use the
nurse) available health facilities
- Teachers college – BS degree and FAYE GLENN ABDELLAH
masters degree Twenty-one nursing problems
 ABDELLAH: BACKGROUND
 Publications:
- Basic principles of nursing care  Born in new York in 1919
(published for international council  Graduated magna cum laude
of nurses and was translated In more (Fitkin memorial hospital school
than 20 languages) of nursing)
- The nature of nursing (describes  BSN, MAN, Ed.D (teachers college
nursing’s primary unique function) at Columbia university)
- Principles and practice of nursing  Recognized as: one of the
 Metaparadigm country’s leading and best known
 Nursing researchers in health and public
- Nurse’s unique function is to help policy
sick or well individuals
  Staff nurse, head nurse, faculty conditions – pathological,
member (Yale university and physiological and compensatory.
Columbia university) 10. To facilitate the maintenance of
 Public health nurse, researcher, regulatory mechanism and functions
and book author 11. To facilitate the maintenance of
 Appointed as chief nurse officer sensory functions
and later on the deputy surgeon 12. To identify and accept positive
general of US public health and negative expressions, feelings,
service (USPHS) and reactions
 Recipient of more than 79 13. To identify and accept
academic honors and professional interrelatedness of emotions and
awards organic illness.
 Metaparadigm 14. To facilitate the maintenance of
 Nursing effective verbal and non-verbal
- Nursing is a helping profession communication
- Nursing care is doing something to 15. To promote the development and
or for the person or providing productive interpersonal
information to the person with the relationships
goal of meeting needs, increasing or 16. To facilitate the progress toward
restoring their self-help ability, or achievement and personal spiritual
alleviating an impairment goals
 Person 17. To create or maintain a
- People with physical, emotional, and therapeutic environment
sociological needs 18. To facilitate awareness of self as
- OVERT: Physical Needs an individual with varying physical,
- COVERT: Emotional and Social emotional, and developmental needs
Needs 19. To accept the optimum possible
- The only justification for the goals in the light of limitations,
existence of nursing physical and emotional
 Health 20. To use community resources as
- State when the individual has no an aid in resolving problems arising
unmet needs and no anticipated or from illness
actual impairments 21. To understand the role of social
 Environment problems as influencing factors in
the cause of illness.
- “To create and/or maintain a
 Theoretical Assertions
therapeutic environment”
- Patient interact with and respond to  The nursing problems and
their environment and the nurse is nursing treatment typologies are
part of that environment. the principles of nursing practice
 Abdellah’s Typology of 21 Nursing and constitute the unique body of
Problems knowledge that is NURSING
1. To maintain good hygiene and  Correct identification of nursing
physical comfort problem influences the nurse’s
2. To promote optimal activity: exercise, judgement in selecting steps in
rest, sleep. solving the patient’s problem
3. Promote safety through prevention of  The core of nursing is the
accident, injury, or other trauma, patient/client problems that focus
and through the prevention of the on the part and his/her problems
spread of infection LYDIA HALL
4. To maintain good body mechanics Core, Care, and Cure Model
and prevent and correct deformity  BACKGROUND
5. To facilitate the maintenance of a  York Hospital School of Nursing
supply of oxygen to all body cells - Graduated
6. To facilitate the maintenance of - Faculty
nutrition of all body cells  Teachers College (Columbia University)
7. To facilitate the maintenance of - BS and MA degrees
elimination - Instructor of nursing education
8. To facilitate the maintenance of fluid  Developed Loeb Center for Nursing
and electrolyte balance - Hall’s greatest achievement
9. To recognize the physiological  Loeb center for nursing
responses of the body to the disease  Montefiore Hospital (New York)
  Established to apply her theory in  10 Carative Factors
practice  1. FORMATION OF A
 80-bed capacity HUMANISTIC_ALTRUISTIC SYSTEM
- 16 years and older (with no acute OF VALUES
biological disturbances) - Satisfaction through giving and
- Recommended by physicians and extension of the sense of health
has favorable potential for recovery  2. INSTILLATION OF FAITH-HOPE
- Professional nurse (chief therapist) - Facilitates promotion of holistic
- Patients viewed as individuals with nursing care and positive health
goals within the patient population and
 PHASES OF MEDIAL CARE promoting wellness by helping the
 Biologically-critical medicine (first patient adopt health-seeking
phase) behaviors
- Physician devise treatment plan to  3. CULTIVATION OF SENSITIVITY TO
help patient proceed to second phase SELF AND TO OTHERS
- Intensive medical care and multiple - Being aware of self and others and
diagnostic tests acknowledgment of these factors
- Lasts few days to weeks  4. DEVELOPMENT OF A HELPING
 Non-acute recovery phase (second TRUST RELATIONSHIP
phase) - Trusting relationship promotes and
- Follow-up care was given by doctor accepts the expression of both
- Conducive to learning and positive and negative feelings
rehabilitation  5. PROMOTION AND ACCEPTANCE
- Need for medical care is minimal OF EXPRESSION OF POSITIVE AND
- Ideal time for wholly professional NEGATIVE FEELINGS
nursing care - Nurse must recognize that
 Wholly professional nursing intellectual and emotional
- Nursing care given exclusively by understanding differ
professional registered nurses  6. SYSTEMATIC USE F SCIENTIFIC
educated in the behavioral sciences PROBLEM-SOLVING METHOD FOR
who take the responsibility and DECISION MAKING
opportunity to coordinate and deliver - Use of nursing process similar to
the total care of their patients research process dispels the
 NURSING CIRCLES traditional image of nurses as
 Core (therapeutic use of self) doctor’s handmaiden
 Care (intimate bodily care of nurses)  7. PROMOTION OF INTERPERSONAL
 Cure (administration of medical care) TEACHING-LEARNING
- It separates caring from curing.
 Interdependent Aspect of Nursing Nurse facilitates teaching-learning
Care techniques designed to enable
patients to provide self-care
 8. PROVISION FOR SUPPORTIVE,
JEAN WATSON PROTECTIVE, AND CORRECTIVE
Philosophy and Science of Caring MENTAL, PHYSICAL,
 BACKGROUND SOCIOCULTURAL, AND SPIRITUAL
- Born in southern West Virginia ENVIRONMENT
- Currently a professor and chair in - Nurses must recognize the influence
Caring Science at the University of of internal and external
Colorado environments on the health and
- Publications: illness of individuals
- Nursing: the Philosophy and Science  9. ASSITANCE WITH
of Caring GRATIFICATION OF HUMAN
- Nursing: Human Science and NEEDS
Human Care – A Theory of Nursing - Patients must satisfy lower-order
- Postmodern Nursing and Beyond needs before attempting to higher-
- A model of caring and healing order needs
practices that take medicine,  10. ALLOWANCE FOR
nursing, and the public beyond EXISTENTIAL-
traditional Western medicine PHENOMENOLOGICAL FORCES
- Relationship of humankind- - Included to provide a thought-
technology-nature-universe provoking experience leading to a
 better understanding of the self and - Guided by rules and are oriented by
others task completion
 Major assumptions  COMPETENT
- 1. Caring can be only effectively - Considerable conscious and
demonstrated and practiced only deliberate planning is evident
interpersonally increased level of efficiency but
- 2. Caring consists of carative factors focuses on time management
that result inn satisfaction of certain - May display hyperresponsibbility for
human needs patient, often more than realistic
- 3. Effective caring promotes health  PROFICIENT
and individual or family growth - Perceives situation as a whole rather
- 4. A caring environment offers the than in terms of aspect and
development of potential while performance is guided by maxims
allowing the person to choose the - No longer rely on preset goals
beat action fir him/herself at a given - Has increased confidence in
time knowledge and abilities
- 5. Caring responses accept a person  EXPERT
not only as he/she is now but as - No longer rely on analytical principle
what he/she may become - Has an intuitive grasp of situation
- 6. Caring is more “healthogenic” - Has the ability of pattern recognition
than in curing on the basis of deep experiential
- 7. The practice of caring is central to background
nursing  N–A–C–P–E

PATRICIA BENNER DORETHEA OREM

From Novice to Expert: Excellence and Power Self Care Deficit Theory of Nursing
in Clinical Nursing Practice  BACKGROUND
 BACKGROUND  One of America’s foremost nursing
 Clinical experience: theorist
- Acute medical-surgical  Born in Baltimore, Maryland
- Critical care  Father (construction worker who liked
- Home health care fishing)
- Held staff and head nurse  Mother (homemaker who liked reading)
positions  Diploma of Nursing (Providence Hospital
 Rich background in research School of Nursing in Washington, DC)
 Greatly influenced by Virginia  B.S.N.E. and M.S.N.E(Catholic
Henderson University of America)
 Directed a project of a federally-  Early Nursing experiences:
funded project - Operating Room Nursing
- Methods of Intraprofessional - Private duty nurse (home and
Consensus, Assessment and hospital)
Evaluation (AMICAE) that led to - Pediatrics and Medical-Surgical units
the publication of From Novice to - Emergency room
Expert using the Deyfrus Model of - biological science teaching
Skill Acquisition - Directorship (Providence Hospital-
 NOVICE nursing school and department of
- Has no background experience of the nursing)
situation - Curriculum consultant (Department
- Difficulty in discerning relevant and of Health, Education, and Welfare
irrelevant aspects of a situation - background
- Nursing students  “The condition that validates the
- Nurse exposed in a new area existence of a requirement for nursing
 ADVANCED BEGINNER in an adult is the absence of the ability
- Can demonstrate marginally to maintain continuously that amount
acceptable performance having coped and quality of self-care which is
with enough real-life situation therapeutic in sustaining life and
- Difficulty grasping the current health, in recovering from disease or
patient situation in terms of larger injury, or in coping with their effects.
perspective With children, the condition is the
inability of the parent (or guardian) to
 maintain continuously for the child the for deliberate, purposive action to
amount and quality of care that is regulate their own human
therapeutic.” (Orem, 1991) functioning and development
 Theory of self care deficit  AGENT
- Labeled as a GENERAL nursing - The person who engages in a course
theory composed of three related of action or has the power to engage
theories: in a course of action
 Theory of Self-Care
- why and how people care for  SELF-CARE DEFICIT
themselves - delineates when nursing is needed.
 Theory of Self-Care Deficit Nursing is required when an adult
- why people can be helped through (or in the case of a dependent, the
nursing parent or guardian) is incapable of or
 Theory of Nursing Systems limited in the provision of
- relationships that must be continuous effective self-care
maintained for nursing to exist  NURSING AGENCY
 CONCEPTS AND DEFINITIONS - is a complex property or attribute of
 SELF CARE people educated and trained as
- The practice of activities that nurses that enables them to act, to
maturing and mature persons know, and to help others meet their
initiate and perform within time therapeutic self-care demands by
frames, on their own behalf, to exercising or developing their own
maintain life and health and well self-care agency.
being  THEORY OF NURSING SYTEMS
 SELF-CARE REQUISITES - BASIC NURSING SYSTEMS
- actions directed toward the provision o 1. (Wholly compensatory nursing
of self-care. system)
- Three Categories: - Nurse acts for the patient: PATIENT
- Universal self-care requisites has NO ACTIVE ROLE
- Developmental self-care o 2. (Partly compensatory nursing
requisites systems)
- Health deviation self-care - BOTH nurse and patient perform
requisites care measures
 Universal self-care requisites o 3. (Supportive-Educative nursing
- associated with life processes and systems)
the maintenance of the integrity of - patient is able to perform
human structure and functioning  THEORY OF SELF-CARE DEFICIT
- -Sufficient intake of air, water, and - Central idea is that the requirements
food of a persons for nursing are
- -Satisfactory eliminative functions associated with the subjectivity of
- -Activity balanced with rest mature and maturing persons to
- -Social life health-related or health care-related
- -prevention of danger to self action limitations
- -Normalcy - LIMITATIONS render persons
 Developmental Self-Care Requisites completely or partially UNABLE to
- “either specialized expressions of manage regulatory functioning
universal self-care requisites that  THEORY OF SELF-CARE
have been particularized for - Self-care as a human regulatory
developmental processes or they are function is DISTINCT from other
new requisites derived from a types of human regulatory
condition or associated with an functi0ning and development
event.” (neuroendocrine regulation)
 Health deviation self-care requisites - Self-care must be learned and it
- required in conditions of illness, must be performed deliberately and
injury, or disease or may result from continuously in time and in
medical measures required to conformity with the regulatory
diagnose and correct the condition. requirements
 SELF CARE AGENCY
- Complex acquired ability of mature
and maturing persons to know and
meet their continuing requirements
MYRA ESTRIN LEVINE - Pandimensionality
The Conservation Model  ENERGY FIELD
- conservation - Fundamental unit of both living and
- Latin word: conservation – keep non-living
together  Human field:
- Describes the way complex systems - Unitary Human Being, an
are able to continue to function even irreducible, indivisible, and the sum
when severely challenged is greater than its parts
- Primary focus is keeping together of  Environmental fields:
the wholeness of the individual - identified by pattern and integral to
- Stresses nursing interactions and human field
interventions that are intended to  UNIVERSE OF OPEN SYSTEM
keep together the unique and - Energy fields are infinite, open, and
individual resources that each integral with one another
individual brings to his predicament - Human and environmental field are
 CONSERVATION PRINCIPLES in continuous process and are open
 The goals of Conservation Model are system
achieved through interventions that  PATTERN
attend to CONSERVATION PRINCIPLES: - The distinguishing characteristic of
- CONSERVATION OF ENERGY an energy field and is perceived as a
- CONSERVATION OF STRUCTURAL single wave
INTERGRITY - Continuously changing and may
- CONSERVATION OD PERSONAL manifest as disease, illness, feelings,
INTERGRITY or pain
- CONSERVATION OF SOCIAL  PANDIMENSIONALITY
INTEGRITY - Infinite domain without limit
- Conservation PRINCIPLES - Best expresses the idea of a unitary
 CONSERVATION OF ENERGY whole
- Nursing interventions should focus  Major Assumptions
on provision of care that makes the - “Man is unified whole possessing his
last additional demand possible own integrity and manifesting
 CONSERVATION OF STRUCTURAL characteristics more than and
INTEGRITY different from the sum of its parts”
- Nurses can limit the amount of (energy field)
tissue involved in disease by early - “Man and environment are
recognition of functional change and continuously exchanging matter and
by nursing interventions energy with one another” (openness)
 CONSERVATION OF PERSONAL - “Pattern and organization identify
INTEGRITY man and reflect his innovative
- Nurses can show patients respect by wholeness” (pattern and
calling them by name, respecting organization)
wishes, valuing personal - “Man is characterized by the capacity
possessions, providing privacy for abstraction and imagery,
during procedures, etc. language and thought, sensation,
 CONSERVATION OF SOCIAL and emotion:
INTERGRITY
- Nurses can assist patients through
collaborations with family, assisting DOROTHY JOHNSON
with spiritual needs, and use Behavioral System Model
interpersonal relationships  CONCEPTS AND DEFINITION
 BEHAVIOR
- output of intraorganismic structure
MARTHA ROGERS and processes as they are
Unitary Human Beings coordinated and articulated by and
 Rogers postulates that human beings responsive to change in sensory
are dynamic energy fields integral with stimulation
environment fields  SYSTEM
 FOUR BUILDING BLOCKS: - is a whole that functions as a whole
- Energy field by virtue of interdependence of its
- Universe of Open System parts
- Pattern  BEHAVIORAL SYSTEM
 - the patterned, repetitive, and degree of instability are called
purposeful ways of behaving stressors
 SUBSYSTEM - Concepts and definitions
- a minisystem with its own particular - Three functional requirements of
goal and function that can be humans(Johnson, 1980)
maintained as long as its -
relationship to the other subsystems - 1. To be protected from noxious
or the environment is not disturbed influences with which the person
 SEVEN SUBSYSTEM cannot cope
- Attachment/Affiliative -
- Dependency - 2. To be nurtured through the input
- Ingestive of supplies from the environment
- Eliminative -
- Sexual - 3. To be stimulated to enhance
- Achievement growth and prevent stagnation
- Aggressive/Protective - Concepts and definitions
- Concepts and definitions - A system “tends to achieve a balance
- Attachment/Affiliative among the various forces operating
- serves the need for security through within and upon it (Chin, 1961), and
social inclusion or intimacy that man strives continually to
- 2. Dependency maintain a behavioral system
- behaviors designed to get attention, balance and steady states by more or
recognition, and physical assistance less automatic adjustments and
- Total dependency on others to a adaptations to the ‘natural’ forces
greater degree of dependence on self impinging upon him.”
- Concepts and definitions SISTER CALLISTA ROY
- 3. Ingestive Adaptation Model
- has to do with when, how, what,  BACKGROUND
how much, and under what - Member of the Sisters of Saint
condition we eat Joseph of Carondelet
- Appetitive satisfaction - Challenged in a seminar with
- Associated with social, psychological, Dorothy Johnson to develop a
and biological considerations conceptual model for nursing
- 4. Eliminative - Influenced by her observation of
- addresses when, how, and under pediatric patient’s resiliency and
what conditions we eliminate their ability to adap
- Concepts and definitions - SYSTEM
- 5. Sexual - A set of parts connected to function
- has the dual function of procreation as a whole for some purpose
and gratification - Has inputs, outputs, and control and
- Including but not limited to, courting feedback processes
and mating - ADAPTATION LEVEL
- 6. Achievement - three levels:
- Its function is control or mastery of - Integrated
an aspect of self or environment to - Compensatory
some standard of excellence - Compromised
- 7. Aggressive/Protective - Concepts and definitions
- for protection and preservation - FOCAL STIMULUS
- Concepts and definitions - Internal or external stimulus most
- EQUILIBRIUM immediately confronting the human
- a stabilized but more or less system
transitory, resting state in which the - CONTEXTUAL STIMULUS
individual is in harmony with himself - Other stimulus present in a situation
and the environment - RESIDUAL STIMULUS
- TENSION - Environmental factors within or
- a state of being stretched or strained without the human system with
and can be viewed as an end product effects in the current situation that
of a disturbance in equilibrium are unclear
- STRESSOR - INNATE COPING MECHANISMS
- internal or external stimuli that - genetically determined or common to
produce tension and result in a the species
 - Automatic responses: human do not - Interacting Systems Framework and
have to think Theory of Goal Attainment
- ACQUIRED COPING MECHANISMS - Concepts and definitions
- Developed through strategies such - Open systems framework
as learning - Human beings are open systems in
- ADAPTIVE RESPONSES constant interaction with the
- Those that promote integrity in terms environment
of the goals of human system - Personal System
- INEFFECTIVE RESPONSES - Interpersonal
- Those that do not contribute to the - Society
integrity in terms of the goals of - Personal System
human needs - Individual; perception, self, growth,
BETTY NEUMAN development, time space, body image
Systems Model - Interpersonal
- Concepts and definitions - Socialization; interaction,
- STRESSORS communication and transaction
- Tension-producing stimuli occurring - Society
within the boundaries of the client - Family, religious groups, schools,
system work, peers
- Intrapersonal - Each individual brings a different set
- Interpersonal of values, ideas, attitudes,
- Extrapersonal perceptions to exchange
- STABILITY - The nurse and patient mutually
- the client system successfully copes communicate, establish goals and
with stressors take action to attain goals
- Concepts and definitions - HildedardPeplau
- WELLNESS - Psychodynamic Nursing
- Exists when parts of the client - Backgound
system interact in harmony (systems - Born September 1, 1909
needs are met) - Reading, Pennsylvania
- ILLNESS - Graduated BSN 1931
- Disharmony among parts - Worked tirelessly to advance nursing
- NORMAL LINE OF DEFENSE education and practice
- Represents stability state for the - INTERPERSONAL RELATIONSHIPS
individual system IN NURSING – emphasized the
- Maintained over time and serves as importance of the nurse patient
standard to assess deviation relationship in providing healthcare
- Concepts and definitions - “Psychiatric nurse of the century”
- FLEXIBLE LINE OF DEFENSE - Died March 7, 1999
- Dynamic and can be rapidly altered - Backgound
- Outer broken ring - Nursing is a healing art of “human
- LINES OF RESISTANCE relationship between an individual
- Rings that represent resource factors who is sick, or in need of health
that help the client defend against services, and a nurse especially
stressors educated to recognize and to respond
- DEGREE OF REACTION to the need for help.”
- Amount of energy required for the - Nursing is viewed as an
client to adjust to the stressors interpersonal process because it
- Concepts and definitions involves interaction between two or
- PREVENTION as INTERVENTION more individuals with a common
- PRIMARY goal.
- Carried out when stressors are - Nursing is a maturing force and an
suspected or identified educative instrument.
- SECONDARY - Nurse-patient relationship
- Interventions and treatments - Orientation
initiated after symptoms from stress - Identification
occur - Exploitation
- TERTIARY - Resolution
- Focuses on readjustment toward - Orientation
optimal stability
- Imogene King
- Individual / family has a “felt need” - “a listening friend” and an
and seeks professional assistance of “understanding family member”
a nurse ( who is a stranger ). - Sound and emphatic advises
- PROBLEM IDENTIFICATION PHASE - To remember and to understand the
- Identification experience and how it could be
- The patients begins to have feelings integrated into his daily life
of belonging and a capacity for - Ida Jean Orlando
dealing with the problem, - Nursing Process Theory
- The SELECTION OF APPROPRIATE - Deliberative Nursing Process
PROFESSIONAL ASSISTANCE - The deliberative nursing process is
- Working phase set in motion by the patient’s
- Exploitation behavior
- The nurse uses communication tools - All behavior may represent a cry for
to offer services to the patient, who is help. Patient’s behavior can be
expected to take advantage of all verbal or non-verbal.
services. - The nurse reacts to patient’s
- Resolution behavior and forms basis for
- Where patients needs have already determining nurse’s acts.
been met by the collaborative efforts - Perception, thought, feeling
between the patient and the nurse. - Nurses’ actions should be
- THERAPEUTIC RELATIONSHIP IS deliberative, rather than automatic
TERMINATED - Deliberative actions explore the
- Nursing Roles meaning and relevance of an action.
- ROLE OF THE STRANGER - Three sequential parts to the nurse’s
- nurse and the patient are strangers reaction
to one another - -The nurse perceives the behavior
- Address patients with COURTESY through any of her senses.
- COINCIDES WITH THE - -The perception leads to automatic
IDENTIFICATION PHASE thought.
- ROLE OF THE RESOURCE PERSON - -The thought produces an automatic
- As the person assumes the feeling.
dependent role, the nurse provides - the nurse does not assume, but
specific answers to his queries which rather validates observations.
include health information, advices, - once the nurse has validated the
and a simple explanation of the patient’s behavior through
healthcare teams course. exploration, then the nurse’s
- TEACHING ROLE deliberative action follows.
- the nurse helps the patient - Patient has a need
understand the therapeutic plan - Patient Behavior: Sense of
- in assuming this role the nurse must Helplessness
understand the subject at hand - Nurse validates to correctly identify
- she must develop her discussion on the problem
the interest of the patient - Nurse Reaction: Exploration with the
- LEADERSHIP ROLE Patient
- The nurse must act on behalf of the - Nurse performs a deliberative action
patient’s best interest and at the interactive, disciplined, requires
same time enable him to make training
decisions over his own care. - Nurse Action: Deliberative Approach
- COOPERATION AND ACTIVE - The need for help is relieved
PARTICIPATION - Resolution: Improvement in Health
- SURROGATE ROLE - Joyce Travelbee
- Because of the dependency of patient - Human-to-Human Relationship
to the nurse Model
- The nurse must ensure that the - A psychiatric nurse, educator and
feeling is only temporary writer
- Nursing Roles - 1956, she completed her BSN degree
- COUNSELING ROLE at Louisiana State University
- Peplau believed that this is the - 1959, she completed her Master of
greatest role Science Degree in Nursing at Yale
- Has importance and emphasis in University
nursing
- 1952, Psychiatric Nursing Instructor a particular group that guides their
at Depaul Hospital Affilliate School, thinking, decisions and actions in
New Orleans. patterned ways.”
- Human-to-Human Relationship - CULTURAL DIVERSITY
Model - Differences or variations that can be
- INTERACTIONAL PHASES found both between and among
- 1. Original Encounter different cultures
- First impression by the nurse of the - CULTURAL UNIVERSALITY
sick person and vice-versa. - Refers to the commonalities or
- Stereotyped or traditional roles similarities that exist in different
- 2. Emerging Identities cultures.
- the time when relationship begins - Culture care theory
- the nurse and patient perceives - Purpose is to discover human care
each others uniqueness similarities (universality) and
- 3. Empathy differences (diversity) in relation to
- the ability to share in the person's the worldview, social structure and
experience other dimensions.
- 4. Sympathy - Goal is to improve and provide
- when the nurse wants to lessen the culturally congruent care that is
cause of patient’s suffering. beneficial, fitting, and useful to the
- - it goes beyond empathy—“When client, family or culture group
one sympathizes, one is involved but - Cultural care life experiences are
not incapacitated by the influenced by specific cultural
involvement.” values, language, social structure
- - therapeutic use of self factors, ethnohistory, environmental
- 5. Rapport context and health care system.
- Rapport is described as nursing - Madeleine Leininger
interventions that lessens the - Culture Care Diversity
patient’s suffering. - Modes of nursing action
- Relation as human being to human - Cultural care preservation
being - help maintain or preserve health,
- “A nurse is able to establish rapport recover from illness, or face death
because she possesses the necessary - Cultural care accommodation
knowledge and skills required to - help adapt to or negotiate for a
assist ill persons and because she is beneficial health status, or face
able to perceive, respond to and death
appreciate the uniqueness of the ill - Cultural care re-patterning
human being.” - help restructure or change lifestyles
- that are culturally meaningful
- Katharine Kolcaba - Rosemarie Rizzo Parse
- Theory of Comfort - Human Becoming
- Madeleine Leininger - Human Becoming Theory includes
- Culture Care: Diversity and Totality Paradigm
Universality Theory - Man is a combination of biological,
- Based on transcultural nursing, psychological, sociological and
whose goal is to provide care spiritual factors
congruent with cultural values, - Simultaneity Paradigm
beliefs, and practices - Man is a unitary being in
- CULTURE Leininger, 1985 continuous, mutual interaction with
- “Learned, shared, transmitted environment
values, beliefs, norms and lifeways of - Originally Man-Living-Health Theory
a particular group that guides their - Parse’s Three Principles
thinking, decisions and actions in - Meaning
patterned ways.” - Man’s reality is given meaning
- Based on transcultural nursing, through lived experiences
whose goal is to provide care - Man and environment cocreate
congruent with cultural values, - Rhythmicity
beliefs, and practices - Man and environment cocreate (
- CULTURE Leininger, 1985 imaging, valuing, languaging) in
- “Learned, shared, transmitted rhythmical patterns
values, beliefs, norms and lifeways of - Cotranscendence
 - Refers to reaching out and beyond
the limits that a person sets
- One constantly transforms
-
- Relation concept is applicable in all
nursing settings
 Empirical Precision
- Stated implicitly and presented as
truth rather than testable statements

 Derivable Consequences
ERNESTINE WEIDENBACH
[The Helping Art of Clinical Nursing]
 Weidenbach: Background
 Greatly admired private duty
nurses who cared for her
grandmother
 Studied at John Hopkins Hospital
School of Nursing
 Teachers College (Columbia
University)- masters degree and
certificate in public health
 Maternity Center Association-
completed a program for nurse-
midwife
 Taught advanced maternity
nursing (Teachers College)
 Writings:
- Family-centered maternity nursing
- Published classic articles about
theory in practice