THEORY knowledge of that discipline and accompanying practice

- ​Set of logically interrelated concepts that provide a abilities.

systematic explanatory and predictive view of Significance:
phenomena. - Nursing theory is a useful tool for reasoning,
Nursing Theory - a​ framework designed to organize critical thinking, and decision-making in
knowledge and explain phenomena in nursing. nursing practice.
- Nursing theoretical works provide a
HISTORY OF NURSING perspective of the patient.
- began with Florence Nightingale. - Nursing theory provides more direction for
- During the Crimean War, establishment of a school of nursing practice.
nursing at St. Thomas’ Hospital in London marked the - The conceptual models of nursing are
birth of Modern Nursing. comprehensive and reader to the specifics of
- It was during the mid-1800's that Nightingale practice.
recognized the nique focus of nursing and declared - Middle range theories contain the specifics of
nursing knowledge distinct from medical knowledge. nursing practice.
- Nightingale set forth of the following: that the care of
the sick is based on knowledge of persons and their HISTORY OF PHILOSOPHY AND SCIENCE
surroundings - a different knowledge than that used by - Two competing philosophical foundations of science,
the physicians in their practice. rationalism (power of reason) and empiricism (power of
- Until the emergence of nursing as science in the 1950’s sensory experience), have evolved in the era of modern
nursing practice was based on principles and traditions science with several variations.
handed down through an apprenticeship model of
education and in individual hospital procedure manuals. Rationalism (power of reason)
- Some nursing leaders aspired for nursing to be - Rationalist epistemology (scope of knowledge)
recognized as a profession and become an academic emphasizes the importance of a priori reasoning as the
discipline. appropriate method for advancing knowledge.
- Nurses began to develop a body of specialized Empiricism (power of sensory experience)
knowledge on which to base nursing practice. - based on the central idea that scientific knowledge can
Curriculum Era - ​addressed the question of what be derived only from sensory experience.
content nurses should study to learn how to be a nurse.
- As nurses increasingly sought degrees in higher THE STRUCTURE OF SPECIALIZED NURSING
education, the research emphasis era began to emerge. KNOWLEDGE
- In the mid-1970’s, an evaluation of the first 25 years of Metaparadigm
the journal Nursing Research revealed that nursing
studies lacked conceptual connections and theoretical
frameworks, accentuating development of specialized
nursing knowledge.

SIGNIFICANCE OF NURSING THEORY

Theory, research, and practice are bound together in a
continuous interactive relationship.

Discipline - ​specific to the academia

- refers to a branch of education, a department
of learning, or a domain of knowledge.
Significance:
- Theoretical works have taken nursing to a
higher level.
- The emphasis has shifted from a focus on Philosophy
knowledge about how nurses function which - Most abstract type
concentrated on the nursing process, to focus - Sets forth the meaning of nursing phenomena
on what nurses know and how they use through analysis, reasoning, and logical
knowledge to guide their thinking and decision presentation.
making while concentrating on the patient. Conceptual Model
- Provides a distinct frame of reference for its
adherents that tells them how to observe and
interpret the phenomena of interest for the
discipline.
Profession - ​refers to a specialized field of practice, Nursing Theory
founded upon the theoretical structure of the science or - Comprises works derived from nursing
philosophies, conceptual models, abstract
nursing theories, or works in other disciplines.
1 | Theoretical Foundations in Nursing
Middle-Range Theory 12 CANONS
- Most specific focus is concrete in its level of
abstraction.
- Precise and answer specific nursing practice
questions.

TYPES OF NURSING THEORETICAL WORKS

Philosophies: ​Nightingale, Watson, Ray, Benner,
Martinsen, Eriksson

Conceptual Models: ​Levine, Rogers, Orem, King,

Neuman, Roy, Johnson
5 Essential Components of Environmental Health
Nursing Theories: ​Boykin and Shoenhofer, Melesis, - Pure air
Pender, Leininger, Newman, Parson, Erickson, - Pure water
Tomlin and Swain, Husted and Husted - Efficient drainage
- Cleanliness
Middle-Range Theories: ​Mercer, Mishel, Reed, - Light
Wiener and Dodd, Eakes, Burke and Hainsworth,
Barker, Kolcaba, Beck, Swanson, Roland and Moore ASSUMPTIONS
- Nursing should support the environment to
assist the patient in healing.
________________________________________ - Research should be utilized through
observation and empirics to define the nursing
discipline.
ENVIRONMENT THEORY: Florence - The person is interacting with the
Nightingale environment,
The Theorist
- born May 12, 1820 in Florence, Italy. METAPARADIGM
- At the age of 17, she felt the ‘calling; to fulfill a useful Nursing
role in the society - Different from medicine and the goal of nursing is
- At the age of 31, she decided to be a nurse. to place the patient in the best possible condition
- In 1851, for 3 months, she trained as a nurse in a for nature to act.
hospital in Kaiserworth, Germany. - “Activities that promote health which occur in any
- In November 1854, she led a group of trained nurses to caregiving situation. They can be done by
the Crimean War. anyone.”
- In 1859, she wrote ​Notes on Nursing: What it is and - Being responsible for someone else’s health.
What is Not. Person
- Died August 13, 1920 in London, while asleep. - In most of her writings, Nightingale referred to the
- She was known as the ​‘Lady with the Lamp’ and the person as a patient.
‘Mother of Modern Nursing’​. - People are multidimensional, composed of
biological, psychological, social and spiritual
​The Theory components.
- Nightingale’s environmental model focuses on the - Nightingale saw each patient as an individual.
manipulation of physical and social factors that affects Health
the health and illness. - “Not only to be well, but to be able to use well
- Her book was written for women who were responsible every power we have.”
for the health of their family members, not necessarily - Health is being well and using every power
just for nurses. (resource) to the fullest extent in living life.
- Nightingale viewed the physical environment as a Environment
critical component in both health and illness. - “Poor or difficult environments led to poor health
- She enumerated 12 concepts - ​The Canons ​consistent and disease.”
with the mid-19th century healthcare when surgery was - “Environment could be altered to improve
performed in kitchen tables in many instances and conditions so that the natural laws would allow
hospitals primarily housed the dying and the homeless. healing to occur.”
- Nightingale’s concept of environment emphasized
that nursing was to assist nature in healing the
patient.

2 | Theoretical Foundations in Nursing

 THEORY OF HUMAN CARING: Margaret
MAJOR CONCEPTS Jean Harman Watson
- Nightingale’s emphasis on proper ventilation
The Theory
indicates that she recognized the surroundings as a
source of disease and recovery. - The theory of Human caring was developed
between 1975 and 1979.
- Manipulation of the surroundings to maintain
ventilation and patient warmth by using a good - Initial attempt to bring meaning and focus to
nursing as an emerging discipline and distinct
fire, opening windows, and properly positioning
the patient in the room. health profession that has its own unique values,
knowledge, and practices, and its own ethic and
- Direct sunlight as a particular need of patients.
- Dirty environment (floors, carpets, walls, and bed mission to society.
linens) was a source of infection through the
organic matter it contained. METAPARADIGM
Nursing
- Appropriate handling and disposal of bodily
excretions and sewage were required to prevent - Centered around helping the patient achieve a
higher degree of harmony in a holistic manner
contamination of the environment.
- Bathing patients on a frequent, even daily basis at (mind, body and soul).
Person
a time when this practice was not the norm.
- Nurses are also to bathe daily, that their clothing - (Human) Viewed as greater than and different
from the sum of his/her parts.
be clean, and that they wash their hands
frequently. Health
- High level of overall physical, mental and social
- Noise created by physical activities in the areas
around a patient’s room was to be avoided functioning and the absence of illness.
Environment
because it could harm the patient.
- Nurse to assess not only dietary intake, but also - Caring and nursing has existed in every society.
- The nurse is part of the environment.
the meal schedule and its effect on the patient.
- Petty management (nursing administration) - the - Nurses should ensure a caring-healing
environment capable of transformative measures.
nurse is in control of the environment both
physically and administratively.
ASSUMPTIONS
- The nurse was to protect the patient from
receiving upsetting news, seeing visitors who - Caring can be effectively demonstrated and
practiced only interpersonally.
could negatively affect recovery, and experiencing
sudden disruptions of sleep. - Caring consists of carative factors that result in the
satisfaction of certain human needs.
- Nightingale recognized that pet visits (small
animals) might be of comfort to the patient. - Effective caring promotes health and individual or
family growth.
PURPOSE - Caring responses accept a person not only as he or
she is now but as what he or she may become.
- Describe, explain, explore and predict the role of the
environment on the health of the client. - A caring environment is one that offers the
development of potential while allowing the
person to choose the best action for himself at a
given point in time.
- Caring is more ‘healthogenic’ than is curing.
- A science of caring is complementary to the
science of curing.
- The practice of caring is central to nursing.

MAJOR CONCEPTUAL ELEMENTS

Caring Occasion/Caring Moment
- A caring occasion is the moment when the nurse
and another person come together for human
caring.
- Both people come together in human-human
transactions.
- The one caring for and the one being cared for are
influenced by the choices and actions decided
_____________________________________________ within the relationships.
Transpersonal Caring Relationship
- Transpersonal describes an intersubjective, human
to human relationship that encompasses two
individuals in a given moment (patient and nurse)

3 | Theoretical Foundations in Nursing

 - A special kind of human care relationship - a NURSING NEED THEORY: Viirginia
union with another person with high regard for the Henderson
whole person and their being in the world.
METAPARADIGM
- Watson (2013) describes a transpersonal nurse as
Nursing
one who ‘has the ability to center consciousness
- The unique function of the nurse is to assist the
and intentionality on caring, healing, and
wholeness, rather than on disease, illness and individual, sick or well, in the performance of
activities contributing to health or its recovery.
pathology’.
Person
Caring Healing Modalities
- A complete and independent being with
10 Carative Factors
biological, sociological, and spiritual components.
Health
- The ability to perform independently the 14 basic
needs.
- Health is basic to human functioning and that
promotion of health is more important than the
care of the sick.
Environment
- The aggregate of the external conditions and
influences affecting the life and development of
an organism.
- The effects of 7 components (light, temperature,
air movement, atmospheric pressure, proper waste
disposal, absence of injurious chemicals, and
cleanliness of surroundings) on the life and
development of a person.

14 BASIC HUMAN NEEDS

APPLICATION TO NURSING PRACTICE

- Establishing a caring relationship with patients.
- Treat patients as holistic beings,
- Display unconditional acceptance.
- Treat patients with positive regard.
- Promote health through knowledge and THEORY APPLICATION
intervention. Nursing Practice
- Spend uninterrupted time with the patient. - Assists nurses to describe, explain, and predict
everyday experiences.
_____________________________________________ - Serve to guide assessment, interventions, and
evaluations of nursing care.
- Provide a rationale for collecting reliable and
valid data about the health status of clients, which
are essential for effective decision-making and
implementation.
- Helps build a common nursing terminology to use
in communicating with other health professionals.
- Ideas are developed and words are identified.

4 | Theoretical Foundations in Nursing

 - Enhance autonomy (independence and - A person also has an effortless and noneffective
self-governance) of nursing through defining its understanding of the self in the world.
own independent functions.
- The person is viewed as a participant in common
Nursing Education
- Provides a general focus for curriculum design. meanings.
- Guide a curricular decision-making. Health
Nursing Research - Defined as what can be assessed, whereas
- Offer a framework for generating knowledge and well-being is the human experience of health or
new ideas.
wholeness.
- Assist in discovering knowledge gaps in the
specific field of study. Environment
- Offer a systematic approach to identify questions - Also referred to as a situation.
for study, select variables, interpret findings, and - A situation rather than an environment, because a
validate nursing interventions. situation conveys a social environment with a
- Approaches to developing nursing theory.
social definition and meaningfulness.
- Borrowing conceptual frameworks from other
disciplines.
- Inductively looking at nursing practice to discover STAGES OF NURSING EXPERTISE (Novice to
theories/concepts to explain phenomena, Expert Model)
- Deductively looking for the compatibility of a
- The model is situation-based and is not
general nursing theory with nursing practice.
- Questions from practicing nurses about using trait-based.
nursing theory. - The level of performance is not an individual
characteristic of an individual performer, but
_____________________________________________ instead is a function of a given nurse;s familiarity
with a particular situation in combination with
CARING, CLINICAL WISDOM, AND
their educational background.
ETHICS IN NURSING PRACTICE: Patricia
Benner
OVERVIEW
- Benner studies clinical nursing practice in an
attempt to discover and describe the knowledge
embedded in nursing practice.
- Knowledge accrues over time in a particular
discipline and is developed through experiential
learning and situated thinking and reflection on
practice in particular practice situations.
- Benner acknowledges that her thinking in nursing Novice
has been influenced greatly by Virginia - The person has no background experience of the
Henderson. situation in which he is involved.
- Context-free rules and objective attributes must be
METAPARADIGM given to guide performance.
Nursing - This level applies to students of nursing.
- A caring relationship, an ‘enabling condition of Advanced Beginner
connection and concern’. - Person can demonstrate marginally acceptable
- “Caring is primarily because caring sets up the performance, having coped with enough real
possibility of giving help and receiving help.” situations to note.
- “Nursing is viewed as a caring practice whose - Has enough experience to grasp aspects of the
science is guided by the moral art and ethics of situation.
responsibility.” - They require experience based on recognition in
Person the context of the situation.
- A person is a self-interpreting being, that is, the - Nurses functioning at this level are guided by
person does not come into the world predefined rules and are oriented by task completion.
but gets defined in the course of living a life. - They have difficulty grasping the current patient
situation in terms of larger perspectives.

5 | Theoretical Foundations in Nursing

 - Feel highly responsible for managing patient care, - Focused in promoting adaptation and maintaining
yet they still rely on the help of those who are wholeness using the principles of conservation.
most experienced. - Guides the nurse to focus on the influences and
Competent responses at the organismic level.
- Considerable conscious and deliberate planning - The nurse accomplishes the goals of the model
that determines which aspects of current and through the conservation of energy, structure, and
future situations are important and which can be personal and social integrity.
ignored. ADAPTATION
- Consistency, predictability, and time management. - Process of change whereby the individual retains
- Sense of mastery is acquired through planning and his integrity within the realities of his
predictability. environments.
- Level of efficiency is increased. - Critical conserving wholeness.
- Devises new rules and reasoning procedures for a - Basic to survival.
plab, while applying learned rules for action on - Expression of the integration of the entire
the basis of relevant facts of that situation. organism.
Proficient ​WHOLENESS (HOLISM)
- Performers perceive the situation as a whole (the - ‘Health’ = ‘hal’ (anglosaxon word) - ‘whole’
total picture) rather than in terms of aspects, and - Wholeness emphasizes a sound, organic,
the performance is guided by maxims. progressive mutuality between diversified
- Demonstrate a new ability to see changing functions and parts within an entirety, the
relevance in a situation, including recognition and boundaries of which are open and fluent.
implementation of skilled responses to the - Exploring the parts of the whole to understand the
situation as it evolves. whole.
- Increased confidence in their knowledge and - Conserving the integrity of the individual is the
abilities. hallmark of nursing intervention.
Expert CONSERVATION
- The expert performer no longer relies on - Product of adaptation.
analytical principal (i.e., rule, guideline, maxim) - Describes the way complexes are able to continue
to connect an understanding of the situation to an to function even when severely challenged.
appropriate action. - Through conservation, individuals are able to
- Demonstrating a clinical grasp and resource-based confront obstacles, adapt accordingly and
practice. maintain their uniqueness.
- Possessing embodied know-how. - The goal of conservation is health and the strength
- Sees the big picture to confront disability.
- Thinks and sees the unexpected. - Primary focus of conservation is keeping together
the wholeness of the individual.
SIGNIFICANCE OF THE THEORY - Although nursing interventions may deal with one
- The theory changed the profession’s particular conservation principle, nurses must also
understanding of what it means to be an expert, recognize the influence of the other conservation
placing this designation not on the nurse with the principles.
most highly paid or most prestigious position, but ORGANISMIC RESPONSE
on the nurse who provided the most exquisite - Change in the behavior of an individual during an
nursing care. attempt to the environment.
- Help individuals to protect and maintain their
integrity.

TYPES OF ORGANISMIC RESPONSE

CONSERVATION THEORY: Myra Estrine 1. Fight or Flight
Levin - Most primitive response
THE CONSERVATION MODEL - Instantaneous response to real or managed threat.
2. Inflammatory

6 | Theoretical Foundations in Nursing

 - Response intended to provide for structural - E.g. Patient’s change in temperature.
integrity and the promotion of healing. Operational Level
- Protects the organism from environmental irritants - Things that affect individuals physically.
and pathogens. - Cannot be directly perceived such as
3. Stress microorganisms.
- Response developed over time and influenced by - E.g. Environmental pollutants, and
each stressful experience encountered by the infections.
person. Conceptual Level
4. Perceptual - Environment is constructed from cultural
- Involves gathering information from the patterns.
environment and converting it into a meaningful - Characterized by spiritual existence and
experience. mediated by the symbols of language,
thought, and history.
METAPARADIGMS - E.g. own belief, traditions to health,
Nursing rituals, patient’s ability to decide his own
- A human interaction. treatment.
- The nurse participates actively in every patient’s
environment and much of what she does supports MAJOR ASSUMPTIONS
his adjustments as he struggles in the predicament - The person can be understood only in the context
of illness. of his/her environment.
- The goal of nursing is to promote adaptation and - Every self-sustaining system monitors its own
maintain wholeness. behavior by conserving the use of resources
Person required to define its unique identity.
- Person is described as a holistic being; wholeness is - Human beings respond in a singular, yet,
integrity. Integrity means that the person has integrated fashion.
freedom of choice and movement. The person has a - A holistic approach to care of all people, well or
sense of identity and self-worth. sick.
Health
- Health is socially determined by the ability to KEY CONCEPTS: Conservation Principles
function in a reasonably normal manner. - The core concept of Levine’s theory is
- Health is not just an absence of pathological conservation.
conditions. - When a person is in a state of conservation, it
- Health is the return to self; individuals are free and means that individual adaptive responses conform
able to pursue their own interests within the context change productively, and with the least
of their own resources. expenditure of effort, while preserving optimal
Environment function and identity.
- Conceptualized as the context in which individuals - Conservation is achieved through successful
live their lives. activation of adaptive pathways and behaviors that
- The individual actively participates in his are appropriate for the whole range of responses
environment. required by functioning human beings.
- Individuals have their own environment, both - The principles focus on conserving an individual’s
internally and externally. wholeness.
- Nurses can relate to the internal environment as the
physiological and pathophysiological aspects of the Conservation of Energy
patient. - Individuals require a balance of energy and a
- External environment is divided into 3: Perceptual constant renewal of energy to maintain life
Level, Operational Level, and Conceptual Level. activities.
Perceptual Level - E.g. Availability of adequate rest, maintenance of
- Aspects of the world that individuals are adequate nutrition.
able to intercept and interpret with their
sense organs.

7 | Theoretical Foundations in Nursing

Conservation of Structural Integrity
- Refers to maintaining or restoring the structure of _____________________________________________
the body preventing physical breakdown (integrity)
and promoting healing. UNITARY HUMAN BEINGS: Martha E.
- E.g. Nurses can limit the amount of tissue involved Rogers
in a disease by early recognition of functional MAJOR CONCEPTS
changes and by nursing interventions; Assists - Wholeness, openness, unidirectionality, pattern,
patients in range of motion exercise; Maintenance
and organization, sentence, and thought
of patient’s personal hygiene. characterized the life process.
Conservation of Personal Integrity - Human beings are dynamic energy fields that are
- Recognizes the individual as one who strives for
integral with environmental fields.
recognition, respect, self-awareness, selfhood and - Both human and environmental fields are identified
determination. by pattern and characterized by a universe of open
- Self-worth and a sense of identity are important.
systems.
- E.g. Nurses can show patients respect by calling
them by name, respecting their wishes, valuing ENERGY FIELD
personal possessions, providing privacy during
- Fundamental unit of both the living and the
procedure, supporting their defenses, and teaching non-living.
them. - Ability to create change.
Conservation of Social Integrity
- Infinite and pandimensional (across all dimensions)
- Social integrity is reflected in dynamic - Two fields are identified: the human field and the
relationships among human beings. environmental field.
- Life gains meaning through social communities and
Unitary Human Being (Human Field)
health is socially determined. - Defined as irreducible, indivisible,
- E.g. Nurses fulfill professional roles, provide for pandimensional energy fields identified
family members, assist with religious needs, and
by pattern and manifesting characteristics
use interpersonal relationships to converse social that are specific to the whole and that
integrity. cannot be predicted from knowledge of
the parts.
NURSING PROCESS Environmental Field
- Assessment - Defined as an irreducible,
- Trophicognosis - scientific approach to
pandimensional energy field identified by
determination of an individual patient’s nursing pattern and integral with the human field.
care needs. Each environmental field is specific to its
- Hypothesis
given human field.
- Interventions
- Evaluation UNIVERSE OF OPEN SYSTEMS
- Energy fields are infinite, open, and integral with
SYNTHESIS one another.
- Levine expressed the view that within the - The human and environmental fields are in
nurse-patient relationship, a patient’s state of health
continuous process and are open systems.
is dependent on the nurse-supported process of PATTERN
adaptation. - Identifies energy fields.
- This guides nurses to focus on the influences and
- The nature of pattern changes continuously and
responses of a client to promote wholeness through innovatively, and these changes give identity to the
the conservation principles. energy field.
- The goal of this model is to accomplish this
- Manifestations emerge as a human-environmental
through the conservation of energy, structural, mutual process.
personal, and social integrity. The goal of nursing is - Pattern is changing continually and may manifest
to recognize, assist, promote, and support adaptive
disease, illness, or well-being.
processes that benefit the patient.

8 | Theoretical Foundations in Nursing

 - Events manifested in the life process indicates the
PANDIMENSIONALITY extent to which a human being achieves maximum
- Nonlinear domain without spatial or temporal health according to some value system.
attributes. - Passive health - symbolizes wellness and the
- Essentially a spaceless and timeless reality. absence of disease and major illness.
- Provides an infinite domain without limit. Environment
- Best express the idea of a unitary whole. - Irreducible, pandimensional energy field identified
by pattern and manifesting characteristics different
NURSING PROCESS from those of the parts.
Assessment - Each environmental field is specific to its given
Areas of assessment: human field. Both changes continuously and
- Total pattern of events at any given point in creatively.
space-time. - Environmental fields are infinite, and change is
- Simultaneous state of the patient and his/her continuously innovative, unpredictable, and
environment. characterized by increasing diversity.
- Rhythms of the life processes.
- Supplementary data. ASSUMPTIONS
- Categorical disease entities. - The principles of hemodynamics postulate a way of
- Subsystem pathology. perceiving unitary human beings.
- Pattern appraisal. Principles of Change
The assessment should be a comprehensive 1. Helicy ​- spiral development in
assessment of the human and environmental continuous, non-repeating, and
fields. innovative patterning.
Voluntary Mutual Patterning 2. Resonancy - patterning changes
Evaluation with the development from lower to
higher frequency.
METAPARADIGM 3. Synchrony ​- stresses the continuous
Nursing mutual process of person and
- Learned profession and is both a science and an art. environment.
- Focuses on concern with people and the world in Wholeness
which they live- a natural fit for nursing care, as it - Human beings are considered as a united whole.
encompasses people and their environments. Openness
- Purpose of nursing is to promote health and - A person and his environment are continuously
well-being for all people. exchanging energy with each other.
- Nursing exists for the care of people and the life
process of humans. Unidirectionality
Person - The life process of human being evolves
- An open system in continuous process with the irreversibly and unidirectional (birth to death)
open system that is the environment. Pattern and Organization
- Defines unitary human-being as an ‘irreducible, - Pattern identifies individuals and reflects their
indivisible, pandimensional energy field identified innovative wholeness
by pattern and manifesting characteristics that are Sentence and Thought
specific to the whole’. - Humans are the only organism able to think,
- Human beings ‘are not disembodied entities, nor imagine, have language and emotions.
are they mechanical aggregates. Man is a unified
whole possessing his own integrity and manifesting APPLICATION
characteristics that are more than and different from - Plan and implement nursing practice in a
the sum of his parts’. continuous process (of voluntary mutual patterning)
Health whereby the nurse assists clients to freely choose
- A value term defined by the culture or the with awareness ways to participate in their
individual. well-being.

9 | Theoretical Foundations in Nursing

- Noninvasive patterning modalities used within Theory of Nursing Systems
Rogerian practice: Acupuncture, Aromatherapy, - Describes and explains relationships that must be
Therapeutic Touch, Massage, Guided Imagery, brought about and maintained for nursing to be
Meditation, Self-reflection, Humor, Sleep, Music, produced.
and Physical Exercise.
KEY CONCEPTS
_____________________________________________ Self-Care
- Activities that a person does to achieve health.
SELF CARE DEFICIT THEORY: Dorothea E. Self-Care Agency
Orem - Innate ability of a person to accomplish self-care.
Self-Care Demand
- Care needed of a person at a specific time to meet
self-care requisites.
Self-Care Requisites
- Action directed towards provision of self-care.
Self-Care Deficit
- Occurs when an individual is unable to meet
self-care requisites.
- Impaired ability to perform self-care.
Nursing Agency
- Knowledge and abilities of the nurse to meet the
client’s self-care demand.
Nursing Systems
- Classification on actions of the nurse consistent to
the self-care demands of the client.
METAPARADIGM - Wholly Compensatory, Partially Compensatory,
Nursing Supportive Educative
- It is helping clients to establish or identify ways to
perform self-care activities (nursing agency).
Person
- Has the capacity to regulate own functioning and
development (self-care agency)

Health
- structurally/functionally whole or sound
- One must be able to perform self-care activities
(illness is having a self-care deficit).
Environment
- It is an external source of influence in the internal
interaction of the person’s different aspects.

RELATED THEORIES
Theory of Self-Care
- describes why and how people care for themselves.
Theory of Dependent-Care
- explains how family members and/or friends
provide dependent-care for a person who is socially
dependent.
Theory of Self-Care Deficit
- Describes and explains why people can be helped
through nursing.
10 | Theoretical Foundations in Nursing
 - Describes a dynamic, interpersonal relationship in
which a person grows and develops to attain
certain life goals.
- Factors which affect the attainment of a goal are:
roles, stress, space, and time.

ASSUMPTIONS
- Nursing focus is the care of a human being.
- Nursing goals are the health care of individuals
and groups.
- Human beings are open systems interacting
constantly within their environment.
- Nurse and client communicate information, set
goals mutually and then act to attain these goals, is
also the basic assumption of the nursing process.
- “Each human being perceives the world as a total
person in making transactions with individuals
and things in the environment.”
- “Transaction represents a life situation in which
the perceiver and the object perceived are
encountered and in which person enters the
situation as an active participant and each is
changed in the process of these experiences.”
- Used systems approach in constructing her
PROPOSITIONS conceptual system and theory of goal attainment.
- The individual is capable of providing self-care to
meet some health needs.
- The nurse compensates for the patient’s inability
to engage in self-care by providing care.
- The patient resumes self-care actions as s/he
regains ability to do so.

ASSUMPTIONS
- Humans require continuous, deliberate self-care
for health development and well-being.
- Individuals have the power to make decisions
about their self-care.
- Nurses maintain the capacity of individuals for
self-care and assists when s/he is unable to do so.
PURPOSE
- Describe, explain, explore, and predict when the
client needs therapeutic self-care.

_____________________________________________
- Individuals interact to set goals that result in goal
attainment.
THEORY OF GOAL ATTAINMENT: Imogene
- A human process that can be observed in many
King situations when two or more people interact, such
as in the family and in social events.
THE THEORY
- Nursing cares’ goal is to help individuals maintain
or regain health.
11 | Theoretical Foundations in Nursing
 - Nurses bring knowledge and skills that influence Internal Environment
perceptions, communications, and interactions - Transforms energy to enable a person to adjust to
performing the functions of the role. continuous external environmental changes.
- Provides the theoretical knowledge base to External Environment
implement the nursing process (ADPIE) - Involves formal and informal organizations.
- Evaluation determines whether or not goals were - Nurse is part of the patient’s environment.
attained. If not, ask why, and the process begins
again. PROPOSITIONS WITHIN KING’S THEORY OF
Action - ​sequence of behaviors involving mental and GOAL ATTAINMENT
physical action.
Reaction - ​considered as included in the sequence of
behaviors described in action.
Goal of Nurse - ​to help the individuals maintain their
health so they can function in their roles.
Domain of Nurse - ​promoting, maintaining, and
restoring health, and caring for the sick, injured, and
dying.
Function of Professional Nurse - ​interpret information
in the nursing process to plan, implement and evaluate
nursing care.

METAPARADIGMS
Nursing
- Process of action, reaction, and interaction
whereby nurse and client share information about _____________________________________________
their perceptions in the nursing situation (King,
SYSTEMS MODEL: Betty Neuman
1981)
OVERVIEW
- Observable behavior found in the healthcare
- The conceptual model was developed to explain
society.
the client-client system as an individual person for
Person
the discipline of nursing.
- Human-being
- The model can be applied to an individual, a
- Social-being who are rational and sentient.
group, a community, or a social issue and is
- Has ability to: perceive, think, feel, choose, set
appropriate for nursing and other health
goals, select means to achieve goals, and to make
disciplines.
decisions.
METAPARADIGM
Nursing
Health
- Unique profession in that it is concerned with all
- Dynamic life experiences of a human-being,
of the variables affecting an individual's response
which implies continuous adjustment to stressors
to stress.
in the internal and external environment through
Person
optimum use of one’s resources to achieve
- Open client system in reciprocal interaction with
maximum potential for daily living.
the environment.
Environment
Health
- Background for human interactions
- Continuum of wellness to illness that is dynamic
in nature and is constantly changing.
3 FUNDAMENTAL NEEDS OF HUMAN
Environment
- The need for the health information that is unable
- All the internal and external factors that surround
at the time when it is needed and can be used.
and influence the client system.
- The need for care that seeks to prevent illness.
- The need for care when human-beings are unable
MAJOR CONCEPTS
to help themselves.

12 | Theoretical Foundations in Nursing

 - Each individual client or group as a client system Secondary Prevention
is unique; each system is a composite of - Relates to symptomatology following a reaction to
commonly known factors or innate characteristics stressors, appropriate ranking of intervention
within a normal, given range of response priorities and treatment to reduce their noxious
contained within a basic structure. effects.
- The client as a system is in a dynamic, constant Tertiary Prevention
energy exchange with the environment. - Relates to the adaptive processes taking place as
- Many known, unknown, and universal reconstitution begins and maintenance factors
environmental stressors exist. move the client back in a circular manner toward
- Each differs in its potential for disturbing a primary prevention.
client’s usual stability level or normal line of Client-Client System
defense. - Five client variables occur and are considered
- The particular interrelationships of client simultaneously in each concentric circle that
variables - physiological, psychological, makes up the client-client system: Physiological,
sociocultural, developmental, and spiritual - Psychological, Sociocultural, Developmental and
at any point in time can affect the degree to Spiritual.
which a client is protected by the flexible line Central Core
of defense against possible reaction to a - Consists of basic survival factors: normal
single stressor or a combination of stressors. temperature range, genetic structure, response
- Each individual client-client system has evolved a pattern, organ strength, ego structure, knowns.
normal range of response to the environment that
is referred to as a normal line of defense, or usual
wellness/stability state.
- It represents change over time through
coping with diverse stress encounters.
- The normal line of defense can be used as a
standard from which to measure health
deviation.
- The client, whether in a state of wellness or
illness, is a dynamic composite of the
interrelationships of variables - physiological,
psychological, developmental, sociocultural, and
spiritual.
- Wellness is on a continuum of available
energy to support the system in an optimal
state of system stability.
- Implicit within each client system are internal
resistance factors known as lines of resistance.
- Functions to stabilize and return the client to
the usual wellness state (normal line of
defense) or possibly to a higher level of
stability following an environmental stressor
reaction.
Primary Prevention
- Relates to a general knowledge that is applied in Flexible Line of Defense (FLD)
client assessment and intervention in identification - Forms the outer boundary of the defined client
and reduction or mitigation of possible or actual system. (individual, family, group, community)
risk factors associated with environmental - Acts as a protective buffer system for the client’s
stressors to prevent possible reaction. normal line of defense or wellness state.
- The goal of health promotion is included in - Prevents stressor invasion of the client system.
primary prevention.

13 | Theoretical Foundations in Nursing

Normal Line of Defense (NLD) - Nursing is prevention as intervention encompasses
- The client/client system’s normal or usual wellness three dimensions: Primary, Secondary, and
level. Tertiary Intervention.
- This line represents what the client has - Primary: Reduce responsibility of encounter
become/evolved over time. with stressors. Strengthen flexible line of
- The NLD defines the stability and integrity of the defense.
client system, its ability to maintain stability and - Secondary: Early-case findings. Treatment of
integrity. symptoms.
- This normal defense line is the standard against - Tertiary: Readaptation. Re-education to
determining any variance from wellness. prevent future occurrences. Maintenance of
Lines of Resistance (LOR) stability.
- A protective mechanism that attempts to stabilize
the client system and foster a return to the usual
wellness.
- Contain certain known and unknown internal and
external resource factors that support the client’s
basic structure and normal line of defense (mobilize
WBC, activate immune system mechanisms)

Optimal System Sustainability

- Optimal wellness is the greatest possible degree of _________________________________________
system stability at a given point in time.
ADAPTATION MODEL: Callista Roy
- Optimal client system stability means the highest
possible health condition achievable at a given
point in time.
Varying from Wellness
- Varying degrees of system instability.
- The difference from the normal or usual wellness
condition.
Illness
- Illness is a state of insufficiency with disrupting
needs unsatisfied. METAPARADIGM
- Illness is an excessive expenditure of energy. Nursing
- When more energy is used by the system in its - The science and practice that expands adaptive
state of disorganization than is built and abilities and enhances person and environment
stored, the outcome may be death. transformation.
Reconstitution Person
- Is the determined energy increase related to the - Main focus in nursing.
degree of reaction to a stressor, and represents the - Recipient of nursing care.
return and maintenance of system stability - A living, complex, adaptive system.
following treatment for stress reactions. Health
- May be viewed as feedback from the input/output - State and a process of being and becoming
of secondary intervention. integrated and a whole person.
- Complete reconstitution may occur beyond the - A reflection of adaptation, that is, the interaction of
previously determined NLD or usual wellness the person and the environment,
state, may stabilize the system to a lower level, or Environment
return to the level of wellness prior to illness. - “All the conditions, circumstances, and influences
Prevention as Intervention surrounding and affecting the development and
- Basic for health promotion behavior of a person or groups, with particular
consideration of the mutuality of person and earth

14 | Theoretical Foundations in Nursing

 resources that includes focal, contextual, and Secondary - effector subsystem that consists of
residual stimuli” four adaptive modes.
a. Physiological Needs -
PERSON AS AN ADAPTIVE SYSTEM physiological-physical mode. Physical
response to the environment through
physiological processes to meet the basic
needs of oxygenation, nutrition,
elimination, activity and rest, and
protection.
b. Self-Concept - self-concept group identity
adaptive mode. Person’s thoughts, beliefs,
or feelings about himself. An individual’s
- Response may either be an ​adaptive or an self-concept is composed of the physical
ineffective​ response. self (body sensation and body image) and
- Adaptation occurs when a person responds the personal self (self-consistency,
positively to environmental changes. self-ideal, and moral-ethical-spiritual self)
- Ineffective responses to stimuli lead to disruption c. Role Function - social integrity of for one
of the integrity of the person. to know how to behave and what is
expected of him in the society.
KEY CONCEPTS d. Interdependence - relationships among
1. STIMULI people. Major task is for people to receive
Focal Stimuli - most immediate response that love, respect, and value.
confronts the individual and demands the most
attention and adaptive energy.
Contextual Stimuli - all other stimuli present in
the situation that contribute to the strength of
the focal stimulus may it be positive or
negative.
Residual Stimuli - environmental factors of which
the effects are unclear in a given situation.
2. ADAPTATION LEVEL
Integrated - the structures and functions of life
processes that are working as a whole to meet
human needs.
Compensatory - coping mechanisms that have
been activated by a challenge to the integrated
life process.
Compromised - results from inadequate integrated
and compensatory life processes, and is an
adaptation problem. PROPOSITIONS
3. COPING MECHANISMS - Nursing actions promote effective adaptive
Primary - control processes subsystem that
responses by the patient.
consists of regulator and cognator.
- Nursing actions decrease ineffective adaptive
a. Regulator - major coping process
responses.
involving the neural, chemical, and
- Nursing actions modify the stimuli so that the
endocrine system. person can adapt.
b. Cognator - major coping process involving
four cognitive-emotive channels:
NURSING PROCESS
perceptual information processing,
1. Assessment of behavior 4. Goal setting
learning, judgement, and emotion.
2. Assessment of stimuli 5. Intervention
3. Nursing diagnosis 6. Evaluation
15 | Theoretical Foundations in Nursing
 temporary regulatory or control mechanisms
ASSUMPTIONS through resources.
- The person is able to adapt. Person
- Adaptation occurs when the person is able to - A behavioral system with patterned, repetitive,
respond to changes in the environment. and purposeful ways of behaving that links the
- Positive adaptation means returning to health. person to the environment.
_____________________________________________ Health
BEHAVIORAL SYSTEMS MODEL: Dorothy E. - Elusive, dynamic state influenced by biological,
Johnson psychological and social factors.
Environment
THE THEORIST - Factors that are not part of a person’s behavioral
- born on August 21, 1919 in Savannah, Georgia system but have influence on the behavioral
- BSN Degree from Vanderbilt University in Nashville, system.
Tennessee (1942)
- Master of Public Health Degree on Harvard University
in Boston (1948)
- professional experience: mostly teaching GOALS OF NURSING
- Staff Nurse at the Chatham Savannah Health Council - To assist the patient whose behavior is proportional to
(1943-1944) social demands.
- Chairperson on the Committee of California Nurses - To assist the patient who is able to modify his behavior
Association ( 1965-1967) in ways that it supports biological imperatives.
- Published 4 books, more than 30 articles on periodicals - To assist the patient who is able to benefit to the fullest
- died in February 1999 at the age of 80 extent during illness from the physician’s knowledge
and skill.
THEORETICAL SOURCES - To assist the patient whose behavior does not give
- Influenced heavily by Florence Nightingale’s evidence of unnecessary trauma as a consequence of
book, ​Notes on Nursing​. illness.
- Used the work of behavioral scientist, psychology,
sociology, and ethnology to form her seven
subsystems.
- Also relied on the system theory and used
concepts and definitions from Rapport, Chin, von
Bertalanffy, and Buckley.

OVERVIEW
- First proposed in 1968
- Advocates the fostering of the efficient and
effective behavioral functioning of the patient to
prevent illness.
- The patient is defined as a behavioral system
composed of seven behavioral subsystems.
- Each subsystem consists of four structural
characteristics.
- An imbalance in each result in disequilibrium.
- A nurse's role is to help the patient maintain their
equilibrium.
THEORETICAL SOURCES
METAPARADIGM
- Each of the 7 subsystems gas the same 3 functional
Nursing
requirements: protection, nurturance, stimulation.
- Goal is to maintain and restore an individual’s
behavioral systems balance through imposing

16 | Theoretical Foundations in Nursing

- These functional requirements must be met through - Functions of procreation and gratification
the person’s own efforts, or with the outside - Courting and mating
assistance of the nurse. - Begins with the development of gender role
- For the subsystems to develop and maintain identity and includes the broad range of sex
stability, each must have a constant supply of role behaviors.
functional requirements that are usually supplied by
the government. 6. Aggressive-Protective
- During illness or when the potential for illness - Protection and preservation
poses a threat, the nurse may become a source of - Aggressive behavior is not only learned but
functional requirement. has primary intent to harm others.
- Society demands that limits be placed on
THEORETICAL ASSERTIONS modes of self-protection and that people and
- The response by the subsystems are developed their property be respected and protected.
through motivation, experience, and learning and
are influenced by biological, psychological, and
social factors. 7. Achievement
- The behavioral system attempts to achieve balance - Attempts to manipulate the environment.
by adapting to internal and environmental stimuli. - Control or mastery of an aspect of self or
- The behavioral system manages its relationship environment to some standard excellence
with its environment. The nurse is external to and - Intellectual, physical, creative, mechanical,
interactive with the behavioral system. and social skills.
- Incorporation of the nursing process.
NURSING PROCESS
THE SEVEN SUBSYSTEMS - Identification of the source of the problem in the
1. Attachment or Affliative system leads to appropriate nursing action that
- Survival and security results in the maintenance or restoration of
- Consequences are social inclusion, intimacy, behavioral system balance.
and formation and maintenance of a strong - Nursing interventions can be in such general forms
social bond. as: repairing structural units, temporarily imposing
2. Dependency external regulatory or control measures, supplying
- Promotes helping behavior that calls for a environmental conditions or resources, providing
nurturing response. stimulation to the extent that any problem can be
- Consequences are approval, attention, or anticipated, and preventive nursing action is in
recognition and physical assistance. order.
- A certain amount of interdependence is
essential for the survival of social groups. _____________________________________________
3. Ingestive
- “Has to do with when, what, how much, and THEORY OF INTERPERSONAL
under what conditions we eat” RELATIONSHIP: Hildegard Peplau
- Function of appetitive satisfaction
- Associated with social, psychological, and
biological considerations.
4. Eliminative
- “When, how, and under what conditions we
eliminate”
- As with ingestive subsystem, the social and
psychological factors are viewed as
influencing the biological aspects of this
subsystem and may be, at times, in conflict
with the eliminative subsystem. The first model to suggest that nurse and patient acts
5. Sexual as ​partners ​to initiate change rather than the patient

17 | Theoretical Foundations in Nursing

 PHASES OF NURSE-PATIENT RELATIONSHIP
passively receiving treatment and the nurse simply
acting on orders from the physician. 1. Orientation
- Problem defining phase
- Starts when the client meets the nurse as a
ASSUMPTIONS
stranger.
- The nurse and patient can interact.
- Defining problems and deciding what type of
- Both the patient and nurse mature as the result of
service needed.
the therapeutic interaction.
- Client seeks assistance, conveys needs, asks
- Communication and interviewing skills remain
questions, shares preconceptions and
fundamental nursing tools.
expectations of past experiences.
- Nurses must clearly understand themselves to
- Nurse responds, explains roles to clients, helps to
promote their client’s growth and to avoid limiting
identify problems and to use available resources
client’s choices to those that nurses value.
and services.
- Get acquainted phase
EFFECTIVE COMMUNICATION CAUSES
- Parameters are established and met
NURSE TO TAKE ON NUMEROUS ROLES:
- Early levels of trust are developed
- Stranger - Teacher - Surrogate
- Roles begin to be understood.
- Resource person - Leader - Counselor
2. Identification
- Technical expert
- Selection of appropriate professional assistance
- Patient begins to have a feeling of belonging and
METAPARADIGMS
capability of dealing with the problem which
Nursing
decreases the feeling of helplessness and
- A significant therapeutic process.
hopelessness.
- It functions cooperatively with other human
- The client begins to identify the problems to be
processes that make health possible for individuals
worked on within the relationship.
in communities.
- The goal of the nurse is to help the patient
Human
recognize their own interdependent/participation
- An organism that thrives in its own way to reduce
role and promote responsibility for self.
tension generated by needs.
3. Exploitation
- The client is an individual with felt and need.
- Use of professional assistance for problem
Health
solving alternatives.
- Word symbol that implies forward movement of
- Advantages of services are used based on the
personality and other ongoing human processes in
needs and interests of the patient.
the direction of creative, productive, personal and
- Individual feels as an integral part of the helping
community living.
environment
Environment
- They may make minor requests or attention
- Existing forces outside the organism and in the
getting techniques.
context of culture.
- The principles of interview techniques must be
used in order to explore, understand and
THERAPEUTIC RELATIONSHIP
adequately deal with the underlying problems.
- A professional and planned relationship between
- Patient may fluctuate on independence
the patient and nurse that focuses on the patient’s
- Nurse must be aware about the various phases of
needs, feelings, concepts, and ideas.
communication
- Nursing involves interaction between two or more
- Nurse aids the patient in exploiting all avenues of
individuals with a common goal.
help and progress is made towards the final step.
- The attainment of this goal or any goal is achieved
- Client’s trust of the nurse reached full potential.
through a series of steps following a sequential
- Client making full use of nursing services.
pattern.
- Solving immediate problems.
- Identifying and orienting self to discharge goals.

18 | Theoretical Foundations in Nursing

4. Resolution
- Client met needs
- Mutual termination of relationship
- Sense of security is formed
- Patient is less reliant on the nurse
- Increased self reliance to with the their own
problems
- The patient gradually puts aside old goals and
adapts new goals. This is a process in which the
OVERVIEW
patient frees himself from identification with the
- Used human because it is unique and equivalent
nurse.
- Caring, in the human-to-human relationship
model, involves the dynamic, reciprocal,
interpersonal connection between the nurse and
patient, developed through communication and the
mutual commitment to perceive self and others as
unique and valued.
- Through the therapeutic use of self and the
integration of evidence-based knowledge, the
nurse provides quality patient care that can foster
the patient’s trust and confidence in the nurse.
- The human-to-human relationship ‘refers to an
experience or series of experiences between the
human being who is a nurse and an ill person’,
culminating in the nurse meeting the ill person’s
unique needs.
- All human beings endure suffering, though the
experience of suffering differs from one individual
to another.
- Hope helps the suffering person to cope and it is
an assumption of Travelbee’s (1971) that ​“the
_____________________________________________
role of the nurse is to assist the ill person to
experience hope in order to cope with the stress of
HUMAN-TO-HUMAN RELATIONSHIP THEORY:
illness and suffering”.​
Joyce Travelbee
- Nursing care, according to Travelbee (1971), is
delivered through five stages: observation,
interpretation, decision-making, action or nursing
intervention, appraisal or evaluation.
- The goals of communication in the nursing
process are: to know the person, to ascertain and
meet the nursing needs of ill person, and to fulfill
the purpose of nursing

5 PHASES OF HUMAN-TO-HUMAN
RELATIONSHIP

19 | Theoretical Foundations in Nursing

Original Encounter
- She was one of the first nursing leaders to identify
- The nurse and ill person form judgements about each
and emphasize the elements of the nursing process
other that will guide and shape future nurse-person
and the critical importance of the patient’s
interactions.
participation in the nursing process.
Emerging Identities
- A bond begins to form between nurse and person as
OVERVIEW
each individual begins to ‘appreciate the uniqueness of
- Finding out and meeting the patient’s immediate
the other’.
needs for help.
- Practice should be based on needs of the patient
and that communication with the patient is essential
Empathy
to understanding needs and providing effective
- The nurse begins to see the individual ‘beyond outward
nursing care.
behavior and sense accurately another’s inner experience
- Orlando’s theory stresses the reciprocal relationship
at a given point in time’,
between patient and nurse. What the nurse and the
- Empathy enables the nurse to predict what the person
patient say and do affects them both.
is experiencing and requires acceptance, as empathy
- Focuses on how to produce improvement in the
involves the ‘intellectual and emotional comprehension
patient’s behavior.
of another person’.
- Development of nurses as logical thinkers.
Sympathy
- A demonstration to the person that he is not carrying
NURSING PROCESS
the burden of illness alone.
- Trust develops between the nurse and person in the
phase of sympathy, and the person’s distress is
diminished.
Rapport
- A process of happening, and experience, or series of
experiences, undergone simultaneously by the nurse and
the recipient of care.
- Composed of a: cluster of interrelated thoughts and
feelings, interest in and concern for others, empathy,
compassion, and sympathy, a non-judgemental attitude METAPARADIGM
and respect for each individual as a unique human being. Nursing
- Through the establishment of rapport, the nurse is able - Process of care in an immediate experience for
to foster a meaningful relationship with the ill person avoiding, relieving, diminishing or curing the
during multiple points of contact in the care setting. individuals sense of helplessness.
- Goal of nursing is to increase sense of well-being,
_____________________________________________ increase in ability, adequacy in better care of self,
and improvement in patients’ behavior.
NURSING PROCESS THEORY: Ida Jean Orlando Human
- Developmental beings with needs.

20 | Theoretical Foundations in Nursing

- Individuals have their own subjective perceptions OVERVIEW
and feelings that may not be observable directly. - Culture care diversity and universality theory was
Health first introduced in the 1960s to provide culturally
- Sense of adequacy or well-being. congruent and competent nursing care.
- Fulfilled needs. - Developed to establish a substance knowledge
- Sense of comfort. based to guide nurses in discovery and use of
Environment transcultural nursing practices.
- Not defined directly. - During the post-World War II period, Dr.
Leininger realized nurses would need transcultural
ASSUMPTIONS knowledge and practices to function with people
- Persons become patients who require nursing care of diverse cultures worldwide.
when they have needs for help that cannot be met
independently.
- Patients experience distress or feelings of
helplessness as the result of unmet needs for help.
- When individuals are able to meet their own needs,
they do not feel distress and do not require care
from a professional nurse.
- Human beings are able to be secretive or explicit
about their needs, perceptions, thoughts and
feelings. Transcultural Nursing - ​comparative study of cultures
- The nurse-patient situation is dynamic, actions and to understand similarities (culture universal) and
reactions are influenced by both the nurse and the difference (culture-specific) across human groups.
patient. Culture - ​the learned, shared, and transmitted values,
- Human beings attach meanings to situations and beliefs, norms, and lifeways of a particular group that
actions that are not apparent to others. guides their thinking, decisions, and actions in patterned
- Nurses are concerned with needs that patients ways.
cannot meet on their own. Care ​- abstract and concrete phenomena related to
assisting, supporting, or enabling experiences toward or
for others with evident or anticipated care needs to
ameliorate or improve a human condition or lifeway.
- ‘Caring’ refers generally to care actions and
activities.
Culture Care Diversity - variability and/or differences
in meanings, patterns, values, lifeways, or symbols of
care within or between cultures that demonstrate
assistive, supportive, or enabling human care
expressions.
Culture Care Universality ​- common, similar, or
_____________________________________________
dominant uniform care meaning, patterns, values,
lifeways, or symbols that manifest with cultures and
THEORY OF CULTURE CARE DIVERSITY AND
reflect assistive, supportive, facilitative, or enabling
UNIVERSALITY: Madeleine Leininger
ways to help people.
Culture Shock - ​state of being disoriented or unable to
respond to a different cultural environment because of
its sudden strangeness, unfamiliarity, and
incompatibility to the stranger’s perceptions and
expectations is differentiated from others by symbolic
markers (cultures, biology, territory, religion).
Culturally Congruent Care - care that fits the people’s
valued life patterns and set of meanings.
21 | Theoretical Foundations in Nursing
Culturally Competent Care - ability of the practitioner patterns are known and used explicitly for
to bridge the cultural gaps in caring, work with cultural appropriate, safe, and meaningful care.
differences and enable clients and families to achieve Environment
meaningful and supportive caring. - Cultural conflicts, cultural impositions practices,
cultural stresses, and cultural pain reflects the lack
METAPARADIGM & ASSUMPTIONS of cultural care knowledge to provide culturally
Nursing congruent, responsible, safe, and sensitive care.
- Care is the essence of nursing. - The ethnonursing qualitative research method
- Culturally based care is essential for well-being, provides an important means to accurately discover
growth, and survival, and to face handicaps or even and interpret local and universal values.
death.
- Culturally based care is the most comprehensive
and holistic means to know, explain, interpret, and
predict nursing care phenomena and to guide
nursing decisions and actions.
- Transcultural nursing is a humanistic and scientific
care discipline and profession.
- Culturally based caring is essential to curing and
healing.
- Culture care concepts, meanings, expressions,
patterns, processes, and structural forms of care
vary transculturally with diversities (differences)
and some universalities (similarities).
- Beneficial, healthy and satisfying culturally based
care influences the health and well-being of
individuals, families, groups, and communities
within their environmental contexts.
- Culturally congruent and beneficial nursing care
can occur only when care values, expressions, or
patterns are known and used explicitly for
appropriate, safe, and meaningful care. CONCEPTS:
- Culture care differences and similarities exist - The health concepts held by many cultural groups
between professional and client-generic care in may result in people choosing not to seek modern
human cultures worldwide. medical treatment procedures.
Person - Healthcare providers need to be flexible in the
- Every human culture has generic care knowledge design of programs, policies, and services to meet
and practices and usually professional care the needs and concerns of the culturally diverse
knowledge and practices, which vary population, groups that are likely to be
transculturally and individually. encountered.
- Culture care values, beliefs, and practices are - The use of traditional or alternate models of
influenced by and tends to be embedded in the: healthcare delivery is widely carried and may come
worldview, language, philosophy, religion (and into conflict with western models of healthcare
spirituality), kinship, social, politics, legal, practice.
educational, economic, technological, NURSING DECISION
ethnohistorical, and environmental contexts of - The decision and action modes to achieve culturally
cultures. congruent care are: cultural preservation or
Health maintenance, cultural care accommodation, cultural
- Beneficial, healthy and satisfying culturally based care repatterning or restructuring.
care influences the health and well-being.
- Culturally congruent and beneficial nursing care
can occur only when care values, expressions, or

22 | Theoretical Foundations in Nursing

_____________________________________________
CORE, CARE, CURE MODEL: Lydia Hall

MAJOR CONCEPTS
- A nurse functions in all three circles but to different
degrees.
- Nurses also share the circles with other healthcare
METAPARADIGM providers.
Nursing CORE: THE PERSON (​Therapeutic use of self;
- It is helping others to move in the direction of Social Sciences)
self-awareness. - Represents the inner feelings and management of
- Nursing is identified as consisting of participation the person.
in the care, core, and cure aspects of patient care. - The core has goals set by himself rather than by any
Person other person, and behaves according to his feelings
- It is composed of three elements: body, disease, and and values.
person. - This involves the therapeutic use of self, and is
- The focus of nursing care. shared with other members of the health team.
Health - Example: The nurse addresses the social and
- It is the state of being able to achieve emotional needs of the patient for the effective
self-awareness thereby releasing their own power to communication and a comfortable
heal. environment.
Environment CARE: THE BODY ​(Innate Bodily Care; Natural and
- It is the hospital services that are organized to Biological Sciences)
accomplish tasks efficiently. - Represents the patient’s body.
- The concept of society or environment is dealt with - The care circle defines the primary role of the
in relation to the individual. professional nurse such as providing bodily care for
the patient and helping the patient complete such
basic daily biological functions.
- When providing this care, the nurse’s goal is the
comfort of the patient.
- Example: The nurse gives hands on bodily
care to the patient in relation to activities of
daily living such as toileting and bathing.

23 | Theoretical Foundations in Nursing

CURE: THE DISEASE ​(Seeing the patient and necessary resources that serve to minimize
family through medical care; Pathologic and vulnerabilities.
Therapeutic Sciences) Environment
- These are the interventions or actions geared - Home or community from which the patient comes.
toward treating the patient for whatever illness or
disease they are suffering from. MAJOR CONCEPTS
- During this aspect of nursing care, the nurse is an - Abdellah’s model or nursing was progressive for
active advocate of the patient. the time in that it refers to a nursing diagnosis
- Example: the nurse applies medical during a time in which nurses were taught that
knowledge to treatment of the patient. diagnoses were not part of their role in health care.
- The theory has combined the concepts of health,
ASSUMPTIONS nursing problems, and problem solving.
- Human beings have the capacity to decide on their - Problem-solving is an activity that is inherently
behalf. logical in nature.
- Nursing should be done only by a professional and - The framework focuses on nursing practice and
educated nurse. individual patients.
- Core followed by Care should be the most
dominant circle in the practice of nursing.

_____________________________________________
21 NURSING PROBLEMS THEORY: Faye G.
Abdellah

THE THEORIST
- Dissertation focused on improving clinical teaching
in nursing (1955).
- She developed a clinical evaluation tool for
undergraduate nursing programs. 10 STEPS TO IDENTIFY THE PROBLEM
- Nursing had to develop a strong scientific base in 1. Learn to know the patient.
order to gain professional status. 2. Sort out relevant and significant data.
- Classified medical diagnoses into 58 categories 3. Make generalizations about available data in
representing nursing problems. relation to similar nursing problems presented by
- Typology of 21 Nursing Problems. other patients.
4. Identify the therapeutic plan.
METAPARADIGM 5. Test generalizations with the patient and make
Nursing additional generalizations.
- Nursing care is doing something to or for the 6. Validate the patient’s conclusions about his nursing
person or providing information to the person with problems.
the goals of meeting needs, increasing or restoring 7. Continue to observe and evaluate the patient over a
self-help ability, or alleviating impairment. period of time to identify any attitudes and clues
Person affecting his behavior.
- Abdellah describes people as having physical, 8. Explore the patient’s family’s reaction to the
emotional, and sociological needs. therapeutic plan and involve them in the plan.
- Patients are described as the only justification for 9. Identify how the nurses feel about the patient’s
the existence of nursing. nursing problems.
- Individuals (and families) are the recipients of 10. Discuss and develop a comprehensive nursing care
nursing. plan.
Health
- The dynamic pattern of functioning whereby there 11 SKILLS IN DEVELOPING NURSING CARE
is a continued interaction with the internal and PLAN
external forces that results in the optimal use of

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21 NURSING PROBLEMS
- The 21 nursing problems fall into three categories:
- Physical, sociological, and emotional needs of
patients
- Types of interpersonal relationships between
the patient and nurse.
- Common elements of patient care.
- The needs of patients are divided into four
categories:
- Basic to all Needs
- Sustenal Care Needs
- Remedial Care Needs
- Restorative Care Needs

THEORETICAL ASSERTIONS
- The nursing problem and nursing treatment
typologies are principles of nursing practice and
constitute the unique body of knowledge that is
nursing.
- Correct identification of the nursing problem
influences the nurse’s judgement in selecting steps
in solving the patient’s problem.
- The core of nursing is patient/client problems that
focus on the patient and their problems.

_____________________________________________

HIERARCHY OF NEEDS: Abraham Maslow

THE THEORIST

HIERARCHY OF NEEDS
- Maslow’s hierarchy of needs is a motivational
theory in psychology comprising a five-tier model
of human needs.

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- Maslow (1943, 1954) stated that people are - Directed entity that has the characteristics of
motivated to achieve certain needs and that some direction, focus, and strength.
needs take precedence over others. - Lewin states that change is a move from the status
- Maslow noted that the order of needs might be quo that results in a disruption in the balance of
flexible based on external circumstances or forces or disequilibrium between opposing factors.
individual differences. 2 Forces
- For example, he notes that for some individuals, the Driving Force - encourages or facilitates
need for self-esteem is more important than the movement to a new direction, goal or
need for love. For others, the need for creative outcome.
fulfillment may supersede even the most basic - It should be identified and accentuated.
needs. Restraining Force - block or impede progress
- Human beings are motivated by a hierarchy of towards the goal.
needs. - It should also be identified and
minimized to achieve the desired
outcome or change.

_____________________________________________ 3 PHASES OF PLANNED CHANGE

THEORY OF PLANNED CHANGE: Kurt Lewin

THE THEORIST
- A German psychologist
- Proposed a method of planned change which is
controlled change or change by design.

OVERVIEW
- Lewin described a method in his field theory that 1. Unfreezing
provides a basis for considering the process of - Individuals involved must be informed of the
planned change. need for change and should agree that change is
- Planned change occurs by design, as opposed to needed.
change that is spontaneous or that occurs by - Change, particularly in the work environment,
instance or by accident. often leads to feelings of uneasiness, uncertainty,
- When Lewin’s process is used correctly in its and loss of control.
entirety by a group or a system, effective change - Change, just for the sake of change, is viewed by
is implemented. most individuals as stressful and unnecessary.
2. Change/Movement
CONCEPTS - Driving forces should exceed restraining forces.
- Lewin describes effective change as the return to - The initiator of the change, the change agent,
equilibrium as a result of balancing opposing should recognize that change takes time, should
forces. be accomplished gradually, and should be
Field thoughtfully and comprehensively planned
- A field can be viewed as a system before implementation.
- When change occurs in one part or aspect of the 3. Refreezing
system, the whole system must be examined to - Stabilization occurs.
determine the effect of that change. - If stabilization is successful, the change is
Force assimilated into the system.

26 | Theoretical Foundations in Nursing

 - Change disrupts the comfort of the status quo; it Autonomy vs. Shame & Doubt
leads to disequilibrium. Therefore, resistance to - Infant until 3 years of age
change should always be anticipated and - Children must learn to be ‘autonomous’ - to feed
expected. and dress themselves, to look after and doubt their
own hygiene, and so on.
_____________________________________________ - Failure to achieve this independence may force
the child to doubt his or her own abilities and feel
THEORY OF PSYCHOSOCIAL DEVELOPMENT: ashamed.
Erik Erikson - Parents are the key social agents.
Initiative vs. Guilt
KEY POINTS - 3 to 6 years of age
- Erik Erikson (1902-1994) was a stage theorist - Children attempt to act grown up and will try to
who took Freud’s controversial psychosexual accept responsibilities that are beyond their
theory and modified it into an eight-stage capacity to handle.
psychosocial theory of development. - They sometimes undertake goals or activities that
- During each of Erikson’s eight development conflict with those of parents and other family
stages, two conflicting ideas must be resolved members, and these conflicts may make them feel
successfully in order for a person to become a guilty.
confident, contributing member of society. - Successful resolution of this crisis requires a
- Failure to master these tasks leads to feelings of balance: the child must retain a sense of initiative
inadequacy. and yet learn not to impinge on the rights,
- Critical difference between Erikson and Freud is privileges, or goals of others.
that Erikson places much less emphasis on the - The family is the key social agent.
sexual urges and far more emphasis on social and Industry vs. Inferiority
cultural influences than that Freud did. - 6 to 12 years of age
- During each of Erikson’s stages, there is a - Children must master important social and
psychological conflict that must be successfully academic skills.
overcome in order for a child to develop into a - This period when the child compares themselves
healthy, well-adjusted adult. with peers.
- If sufficiently industrious, children acquire the
ERIKSON’S STAGE OF DEVELOPMENT social and academic skills to feel self-assured.
- Failure to acquire these important attributes leads
to feelings of inferiority.
- Significant social agents are teachers and peers.
Identity vs. Role Confusion
- 12 to 20 years of age
- This is the crossroad between childhood and
maturity.
- The adolescent grapples with the question ‘Who
am I?’
- Adolescents must establish basic social and
occupational identities, or they will remain
confused about the roles they should play as
Trust vs. Mistrust adults.
- Infants until 1 year - The key social agent is the society of peers.
- Infants must learn to trust others to care for their Intimacy vs. Isolation
basic needs. - 20 to 40 years of age
- If caregivers are rejecting inconsistent, the infant - The primary task at this stage is to form strong
may view the world as a dangerous place filled friendships and to achieve a sense of love and
with untrustworthy and unreliable people. companionship (or a shared identity) with another
- The primary caregiver is the key social agent. person.

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 - Feelings of loneliness or isolation are likely to Example: When hungry or wet, young infants
result from an inability to form friendships or an fuss and cry until their needs are met.
intimate relationship. Ego
- Key social agents are lover, spouses, and close - Conscious, rational component of the personality
friends (of both sexes). that reflects the child’s emerging abilities to
Generativity vs. Stagnation perceive, learn, remember, and reason.
- 40 to 65 years of age - Reality principle
- At this stage adults face the tasks of becoming - Responsible for dealing with reality.
productive in their work and raising their families - Exists in the conscious mind.
or otherwise looking after the needs of young - As egos mature, children become better at
people. controlling their irrational Ids and finding
- These standards of ‘generativity’ are defined by appropriate ways to gratify their needs.
one’s culture. Superego
- Those who are unable or unwilling to assume - Develops from 5 to 6.
these responsibilities become stagnant and - Opposite of the Id.
self-centered. - Operates on moral principle.
- Significant social agents are the spouse, children, - Differentiate between good and bad.
and cultural norms. - If we follow it, we feel proud and if not, we feel
guilt.
Ego Integrity vs. Despair
- Old age
- The older adult looks back at life, viewing it as
either a meaningful, productive, and happy
experience or a major disappointment full of
unfulfilled promises and unrealized goals.
- One’s life experiences, particularly social
experiences, determine the outcome of this final
life crisis.

_____________________________________________

PSYCHOSEXUAL THEORY: Sigmund Freud

THE THEORIST
- Sigmund Freud (1856-1939) was a theorist who
had a great impact on Western thought.
- Freud’s theory states that maturation of the sex
instinct underlies stages of personality
development, and that the manner in which
parents manage children’s instinctual impulses
determines the traits that children display.
Oral (0-1yr old)
- Mouth is the pleasure center for development.
3 COMPONENTS OF PERSONALITY
- Freud believed this is why infants are born with a
Id
sucking reflex and desire their mother’s breasts.
- Only the Id is present at birth
- If a child’s oral needs are not met during infancy,
- Animalistic and childish desires and no values.
they may develop negative habits such as nail
- Operates on pleasure principle, to gain pleasure
biting or thumb sucking to meet this basic need.
and avoid pain.
Anal (1-3yrs old)
- Immediate satisfaction
- Toddlers and preschool-aged children begin to
- I want it, and I want it right now!
experiment with urine and feces.

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- The control they learn to exert over their bodily - One must progress through the stages in order,
functions is manifested in toilet-training. and one cannot get to a higher stage without
- Improper resolution of this stage, such as parents passing through the stage immediately preceding
toilet-training their children too early, can result in it.
a child who is uptight and overly obsessed with - Kohlberg assumes that each succeeding stage
order. evolves from and replaces its predecessor, once
Phallic (3-6yrs old) the individual has attained a higher stage of moral
- Preschoolers take pleasure in their genitals and, reasoning, he or she should never regress to earlier
according to Freud, begins to struggle with sexual stages.
desires toward the opposite sex parent. (boys to
their mothers and girls to their fathers
- Electra Complex is a girl's desire to replace her
mother and sees her as a rival.
- Oedipus Complex is a boy’s desire to replace their
father and sees him as a rival.
- Castration Anxiety - the fear of a child to be
punished by feeling the desire to replace their
father/mother.
Latency (6-12 yrs of old) Level 1:Preconventional Morality
- Sexual instincts subside, and children begin to - Rules are truly external to the self rather than
further develop the superego, or conscience. internalized.
- Children begin to behave in morally acceptable - The child conforms to rules imposed by authority
ways and adopt the values of their parents and figures to avoid punishment or obtain personal
other important adults. rewards.
Genital (12+ yrs old) - Morality is self-serving; what is right is what one
- Sexual impulses reemerge. can get away with or what is personally
- If other stages have been successfully met, satisfying.
adolescents engage in appropriate sexual behavior, - The reasoning is based on the physical
which may lead to marriage and childbirth. consequences of actions.
Stage 1: Punishment and Obedience Orientation
KEY POINTS - The child/individual is good in order to avoid
- Each stage of psychosexual development must be being punished. If a person is punished, they
met successfully for proper development. must have done something wrong.
- If we lack proper nurturing and parenting during a Stage 2: Naive Hedonism
stage, we may become stuck in, or fixated on, that - Children recognize that there is not just one right
stage. view that is handed down by the authorities.
- Freud’s psychosexual theory has been seriously Different individuals have different viewpoints.
criticized for the past few decades and is now Level 2: Conventional Morality
considered largely outdated. - The individual now strives to obey rules and
social norms in order to win others’ approval or
_____________________________________________ to maintain social order.
- Social praise and the avoidance of blame have
MORAL DEVELOPMENT THEORY: Lawrence now replaced tangible rewards and punishments
Kohlberg as motivation of ethical conduct. The
THE THEORIST perspectives of other people are clearly
- Lawrence Kohlberg was, for many years, a recognized and given careful consideration.
professor at Harvard University. - Children continue to accept the rules of authority
- He started as a developmental psychologist and figures, but this is now due to their belief that
then moved to the field of moral education. this is necessary to ensure positive relationships
and societal order.
OVERVIEW Stage 3: ‘Good Boy’ or ‘Good Girl’ Orientation

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 - The individual is good in order to be seen as
being a good person by others. Therefore,
answers relate to the approval of others.
Stage 4: Social Order Maintaining Morality
- The individual becomes aware of the wider rules
of society so judgement concerns obeying the
rules in order to uphold the law and to avoid
guilt.
Level 3: Post-Conventional Morality
- A person at his highest level of moral reasoning
defines right and wrong in terms of broad
principles of justice that could conflict with Schema - mental model of the world. The basic building
written laws or with the dictates of authority block of intelligent behavior. A set of linked mental
figures. representations of the world, which we use both to
- Morally right and legally proper are not always understand and to respond to situations.
one and the same. Assimilation - using the existing schema to deal with a
- Most people take their moral views from those new object or situation. Adding new experiences.
around them and only a minority thinks through Accommodation - happens when the existing schema
ethical principles for themselves. does not work, and needs to be changed to deal with a
Stage 5: The Social-Contract Orientation new object or situation.
- The individual becomes aware that while rules Equilibration - the force which moves development
and laws might exist for the good of the greater along. Occurs when a child’s schemas can deal with
number, there are times when they will work most new information through assimilation.
against the interest of particular individuals.
Stage 6: Morality of Individual Principles of Conscience
- People at this stage have developed their own set
of moral guidelines which may or may not fit the
law.

_____________________________________________

COGNITIVE DEVELOPMENT THEORY:Jean

Piaget
THE THEORIST Sensorimotor Stage
- A swiss scholar who began to study intellectual - Infants use sensory and motor capabilities to
development during the 1920s. explore and gain basic understanding of the
- Focused on the growth of children’s knowledge environment.
and reasoning skills. - Infants ‘think’ by means of their senses and motor
- Had three children whom he studied infancy. actions.
- Infants continually touch, manipulate, look, listen
COGNITIVE DEVELOPMENT to, and even bite and chew objects.
- Refers to the manner in which people learn to - Object Permanence is the ability to know that an
think, and use language. It involves a person’s object still exists even if it's hidden.
intelligence, perceptual skills, and the ability to Preoperational Stage
process information. - Children use symbolism (images and language) to
- Piaget believed that children are naturally represent and understand various aspects of the
curious explorers who are constantly trying to environment.
make sense of their surroundings. - Children become imaginative in their play
THE SCIENCE OF CHILDCARE activities.

30 | Theoretical Foundations in Nursing

 - Egocentric thinking wherein children have
inability to see a situation from another person’s
point of view.
Concrete Operational Stage
- Children are no longer fooled by appearances.
- They are becoming much more proficient at
inferring motives by observing others’ behavior
and the circumstances in which it occurs.
- It marks the beginning of logical or operational
thought. The child can work things out internally
in their head.
Formal Operational Stage
- Adolescent’s cognitive operations are reorganized
in a way that permits them to operate on
operations (think about thinking).
- Think more about moral, philosophical, ethical,
social and political issues that require theoretical
and abstract reasoning and test their hypothesis.

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