ANGELES UNIVERSITY FOUNDATION

Angeles City
COLLEGE OF NURSING

NCM 0100
THEORETICAL FOUNDATION IN NURSING
1st Semester, A.Y. 2020-2021

MODULE 4
Different Views of Person, Health, Environment, and Nursing
Nursing Theories

Module Overview
The metaparadigm for nursing is a framework for the discipline that sets forth the
phenomena of interest and the propositions, principles, and methods of discipline. The
metaparadigm is very general and is intended to reflect agreement among the different
concepts in nursing practice. It is considered as the most abstract level of nursing
knowledge and closely mirrors beliefs held about nursing. The metaparadigm offers a
context for developing conceptual models and theories. Much of the theoretical work in
nursing focused on articulating relationships among the four major concepts: person,
environment, health, and nursing.
Different nursing theorists from different times and ages have specifically contributed to
Nursing Theories. Nursing theory was primarily used to develop and guide nursing
education in universities. Today, nursing theories are known to give direction and
purpose to nurse practitioners; it guides critical thinking and decision-making in clinical
nursing practice. Nursing theories ensure adequate and quality nursing delivery, and to
clarify and improve the status of Nursing as a profession.

Learning Outcomes
Upon completion of this module, the student should be able to:
1. Provide appropriate evidence-based nursing care based on variety of theories and
standards relevant to health and healing
2. Ensure a working relationship with the client and/or support system based on patient
care competencies through safe and quality nursing care, communication,
collaboration and teamwork, and health education
3. Customize nursing interventions based on Philippine culture and values

Learning Objectives
At the end of the discussion, the students will be able to answer the following
questions: 1. What is a nursing theory?
2. Who is Faye Glenn Abdellah? What are the 21 Nursing Problems? What are the five
steps to the problem-solving process? How do we use it in nursing practice today?
How did she define the metaparadigm in nursing?
3. Who is Virginia Henderson? What are the 14 Human Needs? What made her
definition of nursing become the universally accepted definition of what nursing is?
How is it different from Abdellah’s 21 Nursing Problems? How did she define the
metaparadigm in nursing?

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4. Who is Lydia Hall? What is the Care, Core, Cure Model? Which of the three concepts
(care, core, cure) is the nurse’s primary responsibility? How did she define the
metaparadigm in nursing?
5. Who is Ernestine Wiedenbach? What is the Helping Art of Clinical Nursing? How
important is the central purpose? What are the three parameters to say that an action
is voluntary? What are the five realities in the situation? How did she define the
metaparadigm in nursing?
6. Who is Ida Jean Orlando? What is the Theory of Deliberative Nursing Process?
When does a need for help arise? What is the nursing process? Which is more
important - automatic or deliberative nursing actions? How did she define the
metaparadigm in nursing?
7. Who is Myra Estrin Levine? What are the Conservation Principles? How is
wholeness/holism attained? How did she define the metaparadigm in nursing? 8. Who
is Madeleine Leininger? What is the Theory of Culture, Care Diversity and
Universality? How does culture care diversity differ from culture care universality? How
can nurses provide trans-culturally sensitive nursing care? How did she define the
metaparadigm in nursing?
9. Who is Margaret Newman? What is the Theory of Health as Expanding
Consciousness? How did she define the metaparadigm in nursing? 10. Who is
Hildegard Peplau? What is the Theory of Interpersonal Relationship? What are three
phases in a nurse-patient relationship? What are the different nursing roles during the
nurse-patient relationship? How did she define the metaparadigm in nursing?
11. Who is Joyce Travelbee? What Human to Human Relationship Model? How can
nurses ease the suffering and provide hope for their patients? How did she define the
metaparadigm in nursing?

Definition of Key Terms

Before going through this module, the student is advised to read the following terms:
Caring - the essence of nursing and the dominant, unifying, and distinctive feature of
nursing".

Communication - the process of sharing information or the process of generating and

transmitting meanings

Environment - the external and internal surroundings that influence or affect the
person

Grand theory -broad in scope and composed of concepts representing global and
extremely complex phenomena.

Health - a state of complete physical, mental, and social well-being, not merely the
absence of disease or infirmity that is influenced by political, economic, socio-cultural,
and environmental factors

Middle-range theories -address more concrete and more narrowly defined

phenomena or have more concrete and narrower focus than a grand theory.

Nursing - the art and science of caring for individuals, families, groups, or
community
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Person - the recipients of care; can be an individual, family, or community

C. Nursing Theories

Faye Glenn Abdellah

About the Author
Faye Glenn Abdellah was born in New York City on May 13, 1919. She graduated
magna cum laude from Fitkin Memorial Hospital School of Nursing in Neptune, New
Jersey in 1942. She received her B.S. degree in 1945, M.A. in 1947, and EdD in 1955
from Teachers College, Columbia University. She has more than 140 publications and
received 11 honorary doctorates from various institutions. These honors recognized her
work in nursing research, development of the first nurse scientist training program,
expertise in health policy, as well as her outstanding contributions to health. In 1960,
influenced by the desire to promote patient-centered comprehensive nursing care,
Abdellah came up with her theory of the Twenty-One Nursing Problems.

Concepts of "Twenty-One Nursing Problems"

In her theory, Abdellah stated that nursing is the use of the problem-solving approach
with key nursing problems related to the health needs of people. The problem solving
process involves (1) identifying the problem (2) selecting the relevant data (3)
formulating the hypothesis (4) testing the hypothesis through collection of data (5)
revising the hypothesis when necessary on the basis of conclusions obtained from the
data. The process emphasizes that the correct identification of nursing problems
influences the nurse’s judgment in selecting the next steps in solving the patient’s
nursing problems.

Abdellah's Twenty-One Nursing Problems:

Basic to All Patients:
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest and sleep.
3. To promote safety through prevention of accidents, injury or other trauma and
through the prevention of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformity.

Sustenal Care Needs:

5. To facilitate the maintenance of a supply of oxygen to all body
cells. 6. To facilitate the maintenance of nutrition of all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiological responses of the body to disease conditions -
pathological, physiological and compensatory.
10. To facilitate the maintenance of the regulatory mechanism and
functions.
11. To facilitate the maintenance of sensory functions.

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Remedial Care Needs:
12. To identify and accept positive and negative expressions, feelings and
reactions
13. To identify and accept interrelatedness of emotions and organic illness. 14. To
facilitate maintenance of effective verbal and non verbal communications.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement and personal spiritual goals.
17. To create or maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and
developmental needs.

Restorative Care Needs:

19. To accept the optimum possible goals in the light of limitations, physical and
emotional.
20. To use community resources as an aid in resolving problems arising from illness.
21. To understand the role of social problems as influencing factors in the cause of
illness.

Abdellah's 4 Major Concepts

Person Health Environment Nursing

She describes the In her The The concept of nursing in

recipients of nursing Patient environment is this theory is generally
care as individuals, Centered the least grouped into 21 problem
families and society. Approaches discussed areas for nurses to work
to Nursing, concept. out their judgment and
Her 21 nursing health is a Society is appropriate care.
problems deal with state that is included in Adbellah considers
biological, mutually "planning for nursing to be a
psychological and exclusive of optimum comprehensive service
social areas of illness. health on that is based on the
individuals - She implicitly local, state, disciplines of art and
describing people defined national and science and aims to help
as having physical, health as a international people, sick or well, cope
emotional and state when levels. with their health needs.
sociological needs. the individual As she further Nursing care is doing
has no unmet delineates her something to or for the
The needs of the needs and ideas, the person or providing
individual may be no anticipated focus of information to the person
overt - physical or actual nursing with the goals of meeting
needs or covert - impairments. service is the needs, increasing or
emotional and individual. restoring self-help ability,
social needs. or alleviating impairment.

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Virginia Henderson
About the Author
Virginia Henderson was born on March 19, 1897 in Kansas City, Missouri. Henderson’s
interest in nursing evolved during World War I from her desire to help the sick and
wounded military personnel. She enrolled in the Army School of Nursing in Washington
D.C., and graduated in 1921. In 1932, she completed her B.S. degree and in 1934, her
M.A. degree in nursing education at Columbia University Teachers College. Henderson
was the recipient of numerous recognitions for her outstanding contributions to nursing.
Her writings are far-reaching and have made an impact on nursing throughout the
world. In 1955, she worked with a Canadian nurse named Bertha Harmer to revise a
book entitled Textbook of the Principles and Practice of Nursing, where she gave her
first definition of nursing. Later in 1966, Henderson published another book entitled The
Nature of Nursing, and it is in this book where Henderson’s ultimate definition of nursing
was written. Henderson died at the age of 98 on November 30, 1996.

Concepts of "Fourteen Fundamental Human Needs"

Virginia Henderson’s focus on individual care is evident when she stressed on the idea
of assisting individuals with essential activities to maintain health, to recover, or to
achieve peaceful death. She proposed 14 components of basic nursing care to
enhance her definition of nursing. The definition of nursing and the 14 components
together outline the functions the nurse can initiate and control. She also considered
the biological, psychological, sociological, and spiritual components of the individual.

CONCEPTS:
1. Fourteen fundamental human needs:
1. Breathe normally
2. Eat and drink adequately
3. Eliminate Body Waste
4. Move and maintain desirable posture
5. Sleep and rest
6. Select Suitable clothes
7. Maintain normal body temperature
8. Keep the body clean and well-groomed to protect the
integument
9. Avoid dangers in the environment and avoid injuring
others.
10. Communicate with others in expressing emotions, needs, fears, or
opinions.
11. Worship according to one's faith.
12. Work in such a way that there is a sense of accomplishment
13. Play and participate in various forms of recreation.
14. Learn, discover, or satisfy the curiosity that leads to normal development and
health and use the available health facilities.
*1-9: physiological
10 & 14: psychological
11: spiritual and moral
12 & 13: occupation and recreation

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2. Biophysiological concept
-biological knowledge is the basis to determine appropriate care needed to alleviate the
illness or injury.

3. Concept of culture
-learned from the family and other social groups.

4. Interaction-communication
-the ability to react and understand the patient's thoughts, feelings, and
responses.

Henderson's 4 Major Concepts

Person Health Environment Nursing

Henderson Henderson viewed All external Henderson asserted

referred to a health as a quality of conditions and that nurses function
person as a life and is very basic influences that independently from
patient. for a person to function affect life and the physician but in
fully. As a vital need, development. coordination with the
She stated health requires The therapeutic plan
that the independence and environment is developed by the
person is an interdependence composed of health team.
individual (Alligood, 2018). the following Another special role
who requires components: of the nurse is to
assistance to The level of health is 1. biological help both sick and
achieve directly related to the -all living well individuals.
health and patient’s ability to things Care must include
independenc independently satisfy 2. physical people from all
e or in some his or her basic needs -sphere in walks of life, from
cases, a (Masters, 2012). which all the well to the sick,
peaceful living things and from the
death Since health is a operate (ex: newborn to the
multifactor sunlight, dying. The care
For a person phenomenon, it is water, given by the nurse,
to function to influenced by both oxygen, as Henderson
the utmost, internal and external nutrients) stressed, must
he must be factors which play 3. behavioral empower the
able to independent and -social patient to gain
maintain interdependent roles in interactions, independence as
physiological achieving health. customs, rapidly as possible.
and economic,
emotional She also gave political, and Henderson's
balance. emphasis in prioritizing religious definition of nursing
health promotion as systems was considered as
more important than (Masters, 2012) the "signature " of
care of the sick. the profession.

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Lydia Hall
About the Author
Lydia Hall received her basic nursing education at York Hospital School of Nursing in
York, Pennsylvania, and graduated in 1927. She received her B.S. in Public Health
Nursing in 1937 and M.A. in teaching Natural Sciences in 1942 at Teachers College,
Columbia University in New York. Hall was the first director of the Loeb Center for
Nursing and Rehabilitation and continued in that position until her death in 1969. Her
experience in nursing spans the clinical, educational, research, and supervisory
components.

Concepts of Care, Core, Cure

Hall's theory of nursing is presented as three interlocking circles, each circle
representing a particular aspect of nursing: care, core, and cure. Hall emphasizes the
importance of total person approach. Thus, these aspects of nursing should not be
viewed as functioning independently, but as interrelated.

CONCEPTS:
1. Care: The Body
-represents the nurturing component and is exclusive to nursing. It is concerned with
bodily care (e.g. biological functions such as eating, bathing, and dressing) and
opportunity for teaching-learning activities. When providing this care, the nurse’s goal is
the comfort of the patient. At this point, the nurse and patient create a therapeutic
relationship, and as it develops, the patient can share and explore feelings with the
nurse.

2. Core: The Person

-based on social sciences,it involves the therapeutic use of self, and is shared with
other members of the health team. By developing an interpersonal relationship with the
patient, the nurse is able to help the patient verbally express feelings regarding the
disease and its effects. Through the use of reflective technique (acting as a mirror for
the patient) the nurse can help the patient look at and explore feelings regarding his
current health status and related potential changes in lifestyle. Through this, the
motivation and energy for healing that exist within the patient is discovered. The patient
becomes aware of his abilities, and he is now able to make conscious decisions based
on this motivation and energy.

3. Cure: The Disease

-based in the pathological and therapeutic sciences, and is shared with other members
of the health team. The nurse assists the doctors by doing medical tasks or functions,
and helps the patient through his medical, surgical, and rehabilitative care.

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 Hall's 4 Major Concepts
Person Health Environment Nursing

> A person is > a state of self >environment is >Nursing

someone who is awareness with dealt with the consists of
16 years or older conscious patient participation in
and past the acute selection of the care, core,
stage of a behaviors that are >any actions taken and cure
long-term illness. optimal for that in relation to aspects of
individual society or patient care.
> the source of environment are Care is the only
energy and >the need to help for the purpose of function of
motivation for the person assisting the nurses, whereas
healing explore the individual in core and cure
meaning of his attaining a are shared with
> unique, capable behavior resulting personal goal other members
of growth and to development (environment of the health
learning, and of self should be care team.
requires a total identity and maturity conducive to self
person approach development)

Ernestine Wiedenbach
About the Author
Ernestine Wiedenbach was born in Germany in 1900 and later migrated to the USA
during her early childhood. She graduated from Wellesley College in 1922 with a liberal
arts degree. Her interest in nursing had been stimulated by her ailing grandmother. She
enrolled in the Post Graduate Hospital School of Nursing, though she had been
expelled from this program after she served as the spokesperson for student
grievances. She later enrolled at the John Hopkins School of Nursing in Baltimore,
Maryland and received her nursing diploma in 1925. In 1934, she earned her Master’s
Degree and certificate in public health nursing from Teachers College, Columbia
University in New York. In 1964, she wrote Clinical Nursing – A Helping Art, in which
she described her ideas about nursing as a “concept and philosophy”. She died on
April 1, 1999 in Florida.

Concepts of "The Prescriptive Theory/ Helping Art of Clinical Nursing" Wiedenbach

postulated that clinical nursing is directed toward meeting the patient’s perceived
need-for-help. Her theory is a situation-producing theory and may be described as one
that conceptualizes both a desired situation and the prescription by which it is to be
brought about. Thus, it directs action toward a specific goal.

CONCEPTS:
1. Central purpose
-It is also known as “commitment”. It is that which the nurse wants to accomplish; the
overall goal toward which she is striving; the mission she believes is hers to
accomplish. -The central purpose defines the quality of health she desires to affect or
sustain in her patient and specifies what she recognizes to be her special responsibility
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in caring for the patient. This commitment is based on the individual nurse's
philosophy. Philosophy of the nurse motivates her to act, guides her thinking, and
influences her decisions. It is unique to each nurse and is expressed in her way of
nursing.

Three essential components for a Nursing Philosophy:

a. reverence for the gift of life
b. a respect for the dignity, worth, autonomy, and individuality of each human being
c. a resolution to act dynamically in relation to one's beliefs

2. Prescription
-It is a directive for activity that specifies both the nature of the action and the necessary
thought process. It indicates the action appropriate in implementing the basic concepts
and the kind of behavior needed to carry out those actions. These actions may be
voluntary or involuntary, where voluntary action is an intended response and involuntary
action is an unintended response.

Three Kinds of Voluntary Action

a. mutually understood and agreed upon action
b. recipient-directed action
c. practitioner-directed action

3. Realities of the situation

-Realities consist of all factors physical, physiological, psychological, emotional, and
spiritual - that are at play in a situation in which nursing actions occur at any given
moment.

The Five Realities are:

a. the agent
-it refers to the nurse or health care provider. She is considered as the propelling force
that moves the actions toward the accomplishment of the goal. The agent has the
following responsibilities: specify the objectives of her practice, practice nursing
according to her objectives, engage in activities that contribute to her self-realization &
to the improvement of nursing practice

b. the recipient
-it refers to the recipient of nursing actions. The recipient is vulnerable, dependent on
others, and risks losing individuality, dignity, worth, and autonomy.

c. the goal
-it refers to the desired outcome that the nurse wants to achieve. Identification of the
goal gives focus to the nurse’s action.

d. the means
-it refers to how the agent meets her goal. It includes skills, techniques, procedures,
and devices that may be used to meet the goal.

e. the framework

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-it refers to the surroundings that influence reality. It consists of the human,
environmental, and organizational facilities that affect the nurse’s ability to obtain her
goal.

Wiedenbach's 4 Major Concepts

Person Health Environment Nursing

>any individual Wiedenbach In >the practice of

who is receiving does not define Wiedenbach's identification of a
help the concept of work, she patient's need for help >if
health, incorporates the the need for help requires
>possesses however, she environment intervention, the nurse
unique supports within the facilitates the medical plan
potential, strives WHO's realities - a of care and also creates
toward self definition of major and implements it based
direction and health as a component of on needs and desires of
needs state of her theory. One the patient > a
stimulation. complete element of the goal-directed activity
Whatever the physical, realities is the requiring the application of
individual does mental, and framework - a knowledge and skill
represents his or social complex of toward meeting a need
her best well-being, and extraneous for help >the practice of
judgment at the not merely the factors and nursing comprises:
moment. Self absence of circumstances 1. identification of the
awareness and disease and that are present patient's need for help
self acceptance infirmity. in every -nurse observes the
are essential to nursing patient, determines the
the individual's situation. The cause of problem, and
sense of framework may confirms need for help
integrity and self include objects 2. administration of the
worth. such as help needed -nurse
Wiedenback "policies, gives advice and
believes these setting, and carries out a therapeutic
characteristics atmosphere, action
require respect time of day, 3. validation
from the nurse. humans and -the nurse verifies if the
happenings." actions were helpful

Ida Jean Orlando

About the Author
Ida Jean Orlando was born on August 12, 1926. She received a diploma in nursing
from New York Medical College in 1947. In 1951, she received a B.S. in public health
nursing from St. John’s University in Brooklyn in New York. Later, she earned an M.A.
degree in mental health consultation from Columbia University Teachers College. From
then on, she worked as a staff nurse in obstetrical, medical, surgical, and emergency
nursing services. In 1958, she worked as a research associate and principal
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investigator of "Integration of Mental Health Concepts in Basic Curriculum". This
project focused on identifying factors that influence the integration of mental health
principles in a basic nursing curriculum. She reported her findings in her book entitled
The Dynamic Nurse Patient Relationship: Function, Process, and Principles of
Professional Nursing Practice, which was published in 1961. Her theory has substantial
merit for its application to practice, research, education, and administration. (Alligood,
2018)

Concepts of The Nursing Process Theory/ Dynamic Nurse-Patient Relationship Theory

Orlando was the first nurse to develop her theory from actual nurse-patient situations. It
reflects her belief that practice should be based on needs of the patient and that
communication with the patient is essential to understanding needs and providing
effective nursing care. Evidence of relieving the patient’s distress (needs) is determined
by positive changes in his behavior, and that nursing actions are geared towards
improvement in the patient’s behavior. (Alligood, 2018)

CONCEPTS:
1. Professional function of nursing
-a well-defined function of the profession should be clearly stated to prevent conflicts.
Nursing activity is professional only when it deliberately achieves the purpose of helping
the patient.

2. Behavior of the patient

-any observable verbal or nonverbal behavior of the patient must be considered as an
expression of need for help (Alligood, 2018). Verbal behavior encompasses the
patient’s use of language. Nonverbal behavior includes physiological manifestations,
motor activity, and vocal tone.
- a need for help arises when a patient:
a. experiences a need that he cannot resolve
-in this case, a sense of helplessness occurs and the patient’s behavior reflects this
distress. It may stem from physical limitations caused by incomplete development and
temporary or permanent disability. It can also be caused by adverse reaction to the
setting, which comes in as a result of incorrect or inadequate understanding of the
experience.
b. is unable to communicate his needs effectively
-this may be due to ambivalence, embarrassment related to the need, lack of trust in
the nurse, and inability to state the need precisely (George, 2014).
-at times, the behavior may not effectively communicate the need. This ineffective
behavior prevents the nurse from carrying out her concerns for the patient’s care.
Resolution of this ineffective patient behavior deserves high priority.

3. Immediate reaction of the nurse

-this marks the beginning of the nursing process. The nurse should not assume that her
reaction to the patient is correct; she must clearly communicate with the patient about
her reaction to obtain verification or validity.
-this reaction is comprised of three sequential parts:
a. the nurse perceives the behavior
b. the perception leads to automatic thought
c. the thought produces an automatic feeling
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-this concept, thus, includes the nurse's perceptions, thoughts, and feelings.
Perception, thought, and feeling occur automatically & almost simultaneously.
Therefore, the nurse must learn to identify each part of her reaction as this will help her
analyze her reaction and response to the situation. Thus, the process becomes “logical
& disciplined” rather than intuitive.

4. Nursing process
-includes identifying the needs of the patient, response of the nurse, and nursing action.
The nurse can only proceed in doing her actions when she has correctly validated her
thoughts about the patient’s behavior. The nursing action can be carried out in two
ways:

a. automatic
-those actions decided upon for reasons other than the patient's immediate need. It
most likely fails to meet the needs of the patient, and is primarily concerned with
carrying out physician’s orders, routine patient care, and general principles for health.

b. deliberative
-those actions that ascertain and meet the needs of the patient. The following are
criteria for deliberative actions:
b.1. results from correct identification of patient needs by validation
b.2. the nurse explores the meaning of the action with the patient
b.3. the nurse validates the action’s effectiveness
5. Improvement

Orlando's 4 Major Concepts

Person Health Environment Nursing

>humans are the >freedom from >a nursing >the function of

focus of nursing mental or physical situation occurs professional nursing
practice discomfort and when there is a is conceptualized as
feelings of nurse-patient finding out and
>persons adequacy and contact and that meeting the
behave verbally well being both the nurse patient's immediate
or nonverbally contribute to and the patient need for help
>people are health perceive, think,
sometimes able feel, and act in >providing direct
to meet their >repeated the immediate assistance to
own needs and experiences of situation individuals in
that nurses having been whatever setting for
should be helped culminate the purpose of
concerned only over periods of avoiding, relieving,
with those who time in greater diminishing, or
are unable to degrees of curing the person's
meet their improvement sense of
needs helplessness
independently.

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Myra Estrin Levine
About the Author
Myra Estrin Levine was born in Chicago in 1920 (Masters, 2012). She obtained a
diploma from Cook County School of Nursing in 1944. She later earned a degree of
BSN in 1949 from the University of Chicago and MSN degree from Wayne State
University in 1962. Levine held positions as a private duty nurse, civilian nurse, surgical
supervisor, and director of nursing. She is the first recipient of Sigma Theta Tau's
Elizabeth Russell Belford Award for teaching excellence (Alligood, 2018).
Although she never intended to develop theory, she provided an organizational
structure for teaching medical-surgical nursing. Her famous work “The Four
Conservation Principles” was formulated in 1967. Later, in 1989, Levine published the
changes and clarifications in her theory. She received an honorary doctorate from
Loyola University in 1992. Levine died on March 20, 1996 (Alligood, 2018).
Concepts of the Conservation Principle
Levine believed that the foundational belief of the sanctity of life provided the structure
for all moral systems and that all of the efforts of the healing sciences were founded
upon the holiness and wholeness of the human being. She used the term conservation
to label the framework because it was derived from the Latin word meaning “to keep
together” (Masters, 2012).
Levine viewed adaptation as the process by which conservation is achieved (George,
2014). The goal of the conservation model is to promote adaptation and maintain
wholeness using the principles of conservation (Alligood, 2018).

CONCEPTS:
1. Adaptation
-Levine defined adaptation as the process whereby the patient maintains integrity within
the realities of the environment; it is the result of interaction between the person and his
internal and external environment (Alligood, 2018). The physiological and behavioral
responses of each individual are different under different conditions. Therefore, it is
possible to anticipate certain kinds of reactions, but the individuality or uniqueness of
responses vary.
-Adaptation includes the following characteristics:

a. historicity - adaptation is a historical process, responses are based on past

experiences and genetic pattern

b. specificity - each system has very specific responses in relation to a particular

challenge

c. redundancy - represents the options available to the individual to ensure continued

adaptation; if one system does not adapt, another can take over

2. Conservation
-It is the product of adaptation. It describes the way complex systems are able to
continue to function even when severely challenged. It is through conservation that
persons are able to face challenges, adapt, and maintain their uniqueness (Masters,
2012). It focuses on achieving a balance of energy supply and demand within the
biological realities unique to the individual (Tomey & Alligood, 2010).
-The goals of conservation model are achieved through interventions geared toward the
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"Four Conservation Principles" (Masters, 2012):
a. Conservation of Energy
-the individual requires a balance of energy and a constant renewal of energy to
maintain life activities

b. Conservation of Structural Integrity

-it focuses on the healing process. It involves maintaining or restoring the structure of
the body by preventing physical breakdown and promoting health. Nursing activities
are geared towards limiting injury.

c. Conservation of Personal Integrity

-includes recognition of the wholeness of each person; seeing the individual as one who
strives for recognition, respect, self-awareness, and self-determination. It encompasses
the ideas that self-worth and self-identity are important and, therefore, nurses should
show patients respect.
d. Conservation of Social Integrity
-life gains meaning through social communities and health is socially determined.
Individuals use their relationships to define themselves, and one’s identity is connected
to his social circles (ex: family, community, workplace, school, religion). Nurses fulfill
professional roles and use interpersonal relationships to conserve social integrity.

3. Wholeness (Holism)
-wholeness emphasizes a sound, organic, progressive, mutuality between diversified
functions and parts within an entirety, the boundaries of which are open and fluent. It
exists when the interaction or constant adaptations to the environment permit ease.

Levine's 4 Major Concepts

Person Health Environment Nursing

>A holistic being; >socially >the context in >takes place

cannot be understood determined which we live our wherever there is
outside the context of by the ability lives an individual
the to function in who needs care
place and time in which a reasonable 3 Aspects of to some degree
he is functioning, or manner Environment:
separated from the 1. operational >a human
influence of everything >NOT just -undetected interaction; it
that is happening the absence natural forces becomes
around him. of that interrupt therapeutic when
pathological the individual nursing
>human beings that conditions 2. perceptual interventions
are continually -information that is influences
adapting in their >health is recorded by the adaptation
interactions with the return to self sensory organs favorably or
environment. The 3. conceptual results to
process of adaptation -influenced by renewed social
results in conservation. language, culture, well being of the
ideas, and client
cognition

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Madeleine Leininger
About the Author
Madeleine Leininger was born in Nebraska in 1925. She began her nursing career after
she graduated with a diploma from St. Anthony’s School of Nursing in Denver,
Colorado. In 1950, she received a bachelor’s degree in biological science with a minor
in philosophy and humanistic studies from Benedictine College in Kansas. She then
worked as an instructor, staff nurse, and head nurse on a medical-surgical unit and
opened a new psychiatric unit as a director of nursing services in Nebraska. In 1954,
Leininger received a master’s degree in psychiatric nursing from Catholic University of
America in Washington, D.C. (Masters, 2012).
It was during her time in the University of Cincinnati that Leininger noticed a lack of
understanding among staff related to cultural factors influencing the behavior of
children. She observed differences in responses to care and treatments among children
from diverse cultural backgrounds. Later, Leininger taught the first course in
transcultural nursing at the University of Colorado in 1966 (Masters, 2012).

Concepts of Transcultural Nursing

The culture care diversity and universality theory has features that distinctly set it apart
from other nursing theories. It is the only theory that focuses on holistic and
comprehensive culture care. It can be used in any culture because it includes multiple
holistic factors that are universally found across cultures (Masters, 2012).

CONCEPTS:
1. Culture
-refers to the patterned lifeways, values, beliefs, norms, symbols, and practices of
individuals that are learned, shared, and usually transmitted from one generation to the
other (Alligood, 2018).
-it is learned by each generation through both formal and informal life experiences. The
practices of a particular culture often arise because of the group’s social and physical
environment. These practices and beliefs are adapted over time, but they remain
constant as long as they satisfy needs.
-the term culture awareness refers to an in-depth self-examination of one's own
background, recognizing biases and prejudices and assumptions about other people

2. Culture care
-the subjectively or objectively learned and transmitted values, beliefs, and patterned
ways of life that assist, support, or facilitate another individual to maintain well-being
and health or to deal with illness, handicaps, or death.

-Leininger believe that cultures have both health practices that are specific to one
culture and prevailing patterns that are common across cultures that’s why she came
up with the terms diversity and universality

a. Culture care diversity

-refers to cultural variability or differences in care beliefs, meanings, patterns, values,
and lifeways within the culture (Alligood, 2018)

b. Culture care universality

-refers to the common, similar, or dominant care beliefs, meanings, patterns, values,
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and lifeways that are manifest among many cultures

3. Transcultural nursing
-refers to a formal area of humanistic and scientific knowledge and practices focused on
holistic culture care and competencies to assist individuals or groups to maintain or
regain their health and to deal with disabilities or other human conditions in culturally
congruent and beneficial ways (Alligood, 2018).
-Leininger identified three modalities that guide nursing judgments, decisions, and
actions so that the nurse can provide culturally congruent care that is beneficial,
satisfying, and meaningful to the persons the nurse serves (Masters, 2012). These 3
modalities are: a. Cultural care preservation or maintenance
-refers to those assistive, supportive, facilitative, or enabling professional actions and
decisions that help people of a particular culture to retain or maintain care values and
lifeways (Alligood, 2018)
-it retain and or preserve relevant care values so that clients can maintain their
well-being, recover from illness, or face handicaps and/or death
b. Cultural care accommodation or negotiation
-refers to assistive, supportive, facilitative, or enabling professional actions and
decisions that help people of a particular culture to adapt or negotiate with the others
for a beneficial or satisfying health outcome (Alligood, 2018)

c. Cultural care repatterning or restructuring

- refers to assistive, supportive, facilitative, or enabling professional actions and
decisions that help people of a particular culture to reorder, change, or modify life ways
for a new, different and beneficial health care pattern (Alligood, 2018)

-in providing transcultural nursing, the nurse should consider the following
concepts: a. Culturally congruent care
-care that fits the people's valued life patterns and set of meanings -which is generated
from the people themselves, rather than based on predetermined criteria. It requires
the nurse to assume the role of a learner of the client’s culture and co-partners with the
client in defining care. It is also assumed that when culturally based nursing care is
beneficial and healthy, it contributes to the well
being of the client; in contrast, when care is not culturally congruent, the client will
demonstrate signs of stress, noncompliance, cultural conflict, or ethical concerns.

b. Culturally competent care

-refers to the ability of the practitioner to bridge cultural gaps in caring, work with
cultural differences and enable clients and families to achieve meaningful and
supportive caring. Culturally competent care requires specific knowledge, skills,
and attitudes in the delivery of culturally congruent care and awareness.

-when planning nursing care for a patient, nurses must remember that the care that will
be provided must be culture specific. Oftentimes even the meticulously planned
intervention fails not because the nurse is incompetent, but simply because it is not
culture specific. The following steps can guide the nurse in providing a trans culturally
competent care:
A-dministration of medications must take into consideration some of the patient’s
beliefs and practices
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Examples:
1. Catholics usually will fast on Ash Wednesday and Good Friday except for sick
patients
2. Muslims will fast during Ramadan
3. Jehovah’s witness-medications are acceptable to the extent necessary

B-e familiar with some diseases which are common in a specific race
Examples:
1. Africans- sickle cell anemia, hypertension
2. Asian- osteoporosis
3. Blacks- cervical cancer (female) prostate cancer(male)
4. Jewish- breast cancer
5. Whites- testicular cancer

C-ommunicate properly and be familiar with common communication process across

cultures
Examples:
1. Asians- rarely communicate their need for analgesics since they were taught
self-restraint
2. Hispanic women- discussions pertaining to the reproductive organs with male
relatives or health care providers are considered impolite.
3. Muslim women- prefer to talk to female doctors on matters related to reproductive
problems.

D-ietary modifications must be considered when planning nursing care!

Examples:

1. Chinese- cold desserts (yin yang) are served after surgery

2. Europeans- main meal is served midday and is usually followed by coffee 3.
Jewish- Kosher diet ( no meat and dairy products at the same time) 4. Muslim- Halal
diet ( no pork)

Evaluation continues throughout the nursing process and should include feedback from
the client and family. Self-evaluation by the nurse is crucial as he or she increases
skills for interaction. The nurse should consider questions such as the following:
1. Am I open to understanding ways in which the client's values differ from mine? 2.
Have I given sufficient attention to communicating with the client with limited language
skills?
3. Have I had a successful client's family in the nursing process?
4. Am I incorporating the client's traditional beliefs and practices into nursing therapies?
5. Is my therapeutic relationship with the client grounded on respect for the client
regardless of cultural differences?

Margaret Newman
About the Author
Margaret Newman was born in 1933 in Memphis, Tennessee. She earned a bachelor’s
degree in home economics and English from Baylor University and second bachelor’s
degree in nursing from the University of Tennessee in Memphis. Newman earned a

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master’s degree in medical-surgical nursing and teaching from the University of
California, San Francisco. In 1971, she received her PhD in nursing science and
rehabilitation nursing from New York University (Masters, 2012).
Prior to her studying nursing, Newman was the primary caregiver for her mother who
has amyotrophic lateral sclerosis (ALS). During this time, she became interested in
nursing. Her theory of health as expanding consciousness was first published in 1979,
and over the course of her career she published several books, chapters, and articles
on the theory (Masters, 2012).
She received the Distinguished Scholar in Nursing Award from New York University,
the Founders Award for Excellence in Nursing Research from Sigma Theta Tau
International, and the E. Louise Grant Award for Nursing Excellence from the
University of Minnesota. The Zeta Chapter of Sigma Theta Tau International has
established the Margaret Newman Scholar award to support doctoral students whose
research extends Dr. Newman’s theory. Dr. Newman has been included in Who’s Who
in American Women since 1983 and was appointed to Who’s Who in America in 1996
(Alligood, 2018).

Concepts of the Theory of Health as Expanding Consciousness

Martha Roger’s theory of Unitary Human Beings was the main basis of the
development of Newman’s theory. It proposes the view that health is a unidirectional,
unitary process of development – an expansion of consciousness that is seen as the
ability of the person to interact with the environment (Masters, 2012).

CONCEPTS:
1. Health
-encompasses disease and non disease. It can be regarded as the evolving pattern of
the person and the environment. It is a process of developing awareness of self and
environment together with an increasing ability to perceive alternatives and respond in a
variety of ways (Alligood, 2018).

2. Pattern
-depicts the whole, and understanding of the meaning of all relationships at once.
Whatever manifests itself in a person’s life is the explication of the underlying pattern
within the person (Alligood, 2018).
-pattern recognition occurs within the observer. Although we may predict the next event
in a sequence on the basis of knowledge of the sequence, we cannot make such
predictions with certainty because additional information is needed. Newman suggests
that more of the pattern is revealed as the time frame is expanded.

3. Consciousness
-the informational capacity of the system and the ability of the system to interact with
the environment. It includes not only cognitive and affective awareness, such as
thinking and feeling, but also the interconnectedness of the entire system that includes
biochemical maintenance and growth processes (Alligood, 2018).
-as human beings develop, consciousness grows or expands; as consciousness
expands, the more it coexists with the universe.

4. Movement-Space-Time
-it is important to examine movement-space-time as dimensions of emerging patterns of
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consciousness (Alligood, 2018).
-movement is an essential property of matter and the change that occurs between two
states of rest (George, 2008). It is a reflection of consciousness that indicates inner
organization or disorganization of persons; it communicates the harmony or a person’s
pattern with the environment (Masters, 2012).
-time and timing is considered as an index of consciousness. It is important that one is
fully present in the moment because all experiences are manifestations of the process
of higher consciousness (Masters, 2012).
-space is discussed in conjunction with time and movement.

Newman’s 4 Major Concepts

Person Health Environment Nursing

>“The human is unitary, that is >“Health and >Environment >Nursing is

cannot be divided into parts, illness are is described “caring in the
and is inseparable from the synthesized as a human health
larger unitary field” as health - “universe of experience”.
the fusion on open >Nursing is
>“Persons as individuals, and one state of systems” seen as a
human beings as a species being partnership
are identified by their (disease) with between the
patterns of consciousness” its opposite nurse and
(non client, with
>“The person does not disease) both grow in the
possess results in “sense of
consciousness-the person is what can be higher levels of
consciousness”. regarded as consciousness”
health”.
>Persons are “centers of
consciousness” within an
overall pattern of expanding
consciousness”

Hildegard Peplau
About the Author
Hildegard Peplau was born in 1900 in Pennsylvania as the daughter of immigrant
parents. She graduated with a diploma from Pottstown Hospital School of Nursing in
1931. In 1943, she received a bachelor of arts degree in interpersonal psychology from
Bennington College, Vermont, followed by a master of arts degree in psychiatric nursing
from Teachers College, Columbia University in 1947. In 1953, she received an EdD in
curriculum development, also from Columbia University (Masters, 2012).

Peplau is considered the mother of psychiatric nursing. She participated in the

development of the National Mental Act of 1946. Her theory was built upon her personal
and practice experiences, including her experiences with professionals from psychiatry,
medicine, education, and sociology. This theory was influenced by Freud, Maslow, and
Sullivan’s interpersonal relationship theories, and by the psychoanalytical model

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(Masters, 2012).
Peplau was honored for her many contributions to the profession of nursing and was
elected fellow in the American Academy of Nurses and Sigma Theta Tau. Peplau died
at the age of 89 in 1999 in her home in California (Masters, 2012).

Concepts of the Interpersonal Relations Theory

The theory of Interpersonal Relations focuses on the relationship between the nurse
and the patient. Peplau addresses all of nursing’s metaparadigm concepts, but remains
primarily concerned with one aspect of nursing: how persons relate to one another.
According to Peplau, the nurse-patient relationship is the center of nursing (Masters,
2012).

CONCEPTS:
1. Phases in nurse-patient relationships
a. Orientation phase
-This is the initial interaction between the nurse and the patient wherein the latter has a
felt need and expresses the desire for personal assistance.
-in some cases, this need may not be readily identified or understood by the individuals
who are involved. It is in this phase that the nurse needs to assist the patient to realize
what is happening.
-at the end of this phase, the nurse and the patient concurrently strive to identify the
problem and are becoming more comfortable with one another

b. Working phase
-phase where perceptions and expectations of both the nurse and patient take place.
Throughout this phase, both the patient and nurse must clarify each other’s perceptions
and expectations.
-the patient’s response to the nurse can be one of the three:
b.1. participate with and be interdependent with the nurse
b.2. be autonomous and independent from the nurse
b.3. be passive and dependent on the nurse
-Throughout this phase, the patient works collaboratively with the nurse to meet
challenges and work toward maximum health. Thus, the nurse aids the patient in using
services to help solve the problem.

c. Termination phase
-this is where the nurse and the patient terminate their therapeutic relationship as the
patient’s needs have already been met by the collaborative efforts between the nurse
and the patient.
-the patient becomes independent from the nurse.
-occurs only with the successful completion of the previous phases.

2. Nursing roles
-Peplau originally described these roles that emerge during the phases of the nurse
patient relationship (Masters, 2012):

a. Teacher
-one who imparts knowledge concerning a need or interests
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b. Counselor
-this role strengthens the nurse-patient relationship as the nurse becomes a listening
friend, an understanding family member, and someone who gives sound and empathic
advises

c. Leader
-one who carries out the process of initiation and maintenance of group goals through
interaction

d. Resource person
-the nurse provides specific answers to questions, especially health information, and
interprets the treatment or medical plan of care

e. Surrogate
-one who takes the place of another

f. Technical expert
-the nurse provides physical care using clinical skills

3. Pattern integration
-identification of patterns within the interpersonal relationship between two or more
persons that link or bind them and enable them to transform energy into patterns of
action that bring satisfaction or security in the face of a recurring problem. Four types
of integrating patterns are possible (Masters, 2012).
a. Complementary
-occurs when the behavior of one person fits with and complements the behavior of the
other

b. Mutual
-occurs when the same or similar behaviors are used by both persons

c. Alternating

-occurs when different behaviors used by two persons alternate between the two persons

d. Antagonistic
-occurs if the behaviors of two persons do not fit but the relationship continues

Peplau’s 4 Major Concepts

Person Health Environment Nursing

A person is an “Health” is a word Peplau has a narrow Nursing is a human

organism that that symbolizes perception of the relationship
lives in an movement of environment, which is between an
unstable personality and a major limitation of individual who is
equilibrium. other ongoing her theory. She sick, and a nurse
human processes implicitly defined it as who is educated to
that directs the “forces existing outside recognize and to

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 person towards the organism and in respond to the need
creative, the context of culture for help.
constructive, and from which norms,
productive customs, and beliefs
community living. are acquired.”

Joyce Travelbee
About the Author
She postulated the Interpersonal Aspects of Nursing Model. She advocated the goal of
nursing individuals or families in preventing or coping with illness, regaining health,
finding meaning in illness, or maintaining maximal degree of health.
She further viewed that interpersonal process is a human-to-human relationship
formed during illness and “experience of suffering.” She believed that a person is a
unique, irreplaceable individual who is in a continuous process of becoming, evolving
and changing.

Concepts of the Human-to-Human Relationship Model

Travelbee based the assumptions of her theory on the concepts of existentialism by
Soren Kierkegaard and logotherapy by Viktor Frankl. Existential theory believes that
humans are constantly faced with choices and conflicts and are accountable to the
choices we make in life.

CONCEPTS:
1. Suffering
-"An experience that varies in intensity, duration and depth ... a feeling of unease,
ranging from mild, transient mental, physical or mental discomfort to extreme pain and
extreme tortured ..."

2. Meaning
-Meaning is the reason as oneself attributes

3. Nursing
-is to help man to find meaning in the experience of illness and suffering; has a
responsibility to help individuals and their families to find meaning. The nurses' spiritual
and ethical choices, and perceptions of illness and suffering, is crucial to helping to find
meaning.

4. Hope
-Nurse's job is to help the patient to maintain hope and avoid hopelessness. -Hope is a
faith that can and will be changed that would bring something better with it. -Hope's
core lies in a fundamental trust in the outside world, and a belief that others will help
someone when you need it.
-Six important factors characteristics of hope are:
a. It is strongly associated with dependence on other people.
b. It is future oriented.
c. It is linked to elections from several alternatives or escape routes out of its situation.
d. The desire to possess any object or condition, to complete a task or have an
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experience.
e. Confidence that others will be there for one when you need them.
f. The hoping person is in possession of courage to be able to acknowledge its
shortcomings and fears and go forward towards its goal

5. Communications
-"a strict necessity for good nursing care"

6. Using himself therapeutic

-"one is able to use itself as a therapeutic."
-Self-awareness and self-understanding, understanding of human behavior, the ability
to predict one's own and others' behavior are important in this process.

7. Targeted intellectual approach

-Nurse must have a systematic intellectual approach to the patient's situation.

In her human-to-human relationship model, the nurse and the patient undergo the
following series of interactional phases:
a. Original Encounter- this is described as the first impression by the nurse of the sick
person and viceversa the nurse and patient see each other in stereotyped or traditional
roles.

b. Emerging Identities- this phase is described by the nurse and patient perceiving
each other as unique individuals. At this time, the link of a relationship begins to form.

c. Empathy- this phase is described as the ability to share in the person’s experience.

d. Sympathy- It happens when the nurse wants to lessen the cause of the patient’s
suffering. It goes beyond empathy. The nurse at this time should use a disciplined
intellectual approach together with therapeutic use of self to make helpful nursing
actions.

e. Rapport- this is described as nursing interventions that lessens the patient’s

suffering. The nurse and the sick person are relating as human beings to human
beings. The sick person shows trust and confidence in the nurse.

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 Travelbee’s 4 Major Concepts
Person Health Environment Nursing

Person is >Health is subjective and >Environment >"an

defined as objective. is not clearly interpersonal
a human >Subjective health is an defined. process
being. individually defined state of well whereby the
Both the being in accord with professional
nurse and self-appraisal of nurse
the physical-emotional spiritual practitioner
patient are status. assists an
human individual,
beings. >Objective health is an absence of family or
discernible disease, disability of community to
defect as measured by physical prevent or
examination, cope with
laboratory tests and assessment experience or
by spiritual director or illness and
psychological suffering, and
counselor. if necessary,
to find
meaning in
these
experiences.

REFERENCES
Alligood, M.R. (2018) Nursing theorists and their work. 9th Edition. Elsevier Singapore Pte. Ltd
Butts, J.B. and Rich K.L. (2018) Philosophies and theories for advanced nursing practice. 3rd
Edition. Jones and Bartlett Pub.; Sudbury, MA.
Chinn, Peggy L. (2015) Knowledge development in nursing: theory and process. 9th Edition.
Mosby Elsevier.
George, J.B. (2014) Nursing theories: the base for professional nursing practice. 6th Edition.
Pearson Education, Inc. Phil. Ed.
Johnson, Betty M. (2015) An introduction to theory and reasoning in nursing. 4 th Edition. Mosby
Elsevier.
Masters, K. (2012) Nursing theories: a framework for professional practice. Jones and Bartlett
Learning; Sudbury, MA.
Mc Kenna, Hugh P. (2014) Fundamentals of nursing models, theories, and practice. 2nd Edition.
Mosby Elsevier.
Meleis, A.I. (2018) Theoretical nursing: development & progress. 6 th Edition. Lippincott Williams
& Wilkins.
Peterson, Sandra J. Middle range theories: application to nursing research and practice. 4th
Edition. Mosby Elsevier.
Sitzman, K. (2017) Understanding the work of nurse theorist: a creative beginning. 3rd Edition.
Jones & Bartlett Publishers; Sudbury, MA.
Walker, L. and Avant K. (2019) Strategies for theory construction in nursing. 6 th Edition. Prentice
Hall; Boston, USA.

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Prepared by:

Sarah S. Nares, R.N., M.N.

Instructor NCM 0100

Peer Reviewed by:

Rochelle G. Gumabon R.N., M.N.

NCM 0100 Instructor

Reviewed by:

Mary Angelica P. Bagaoisan, RN., MAN

Level I Coordinator

Debbie Q. Ramirez, R.N., Ph.D.

Assistant Dean, College of Nursing

Approved by:

Zenaida S. Fernandez, R.N., Ph.D.

Dean, College of Nursing

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