DIVINAGRACIA`S
COMPOSURE MODEL
INTRODUCTION
• Carmelita C. Divinagracia, a member of the
Pioneer Class (1962) of the College, who
succeeded Dean Emeritus Dumlao.
• In 1960, the UERM Memorial Hospital was
established to serve as the clinical laboratory for
the Colleges of Medicine and Nursing, and, later
on, the College of Physical Therapy.
• She has been a clinic staff and head nurse,
instructor, Asst. Dean and Dean
BACKGROUND and also lectured written about
her work as a nurse and she used her hand-on
experience to develop better ways to teach
nursing.
HISTORY & BACKGROUND
• CARMELITA DIVINAGRACIA
• Filipino Nurse Theorist
• Former President of the Association
of the Philippine Colleges of Nursing
(ADPCN)
• Dean of University of the East
Ramon Magsaysay Memorial
Medical Center, Inc. (UERMMMC)
College of Nursing
HISTORY & BACKGROUND
• Member of CHED’s Technical Committee
on Nursing Education
• Expert in Research and Education
• BSN at UERMMMC in 1962
• A master in Nursing at the University of
the Philippines in 1975
• Ph. D in Nursing at Up in 2001
• Has been lauded for developing the art
and competency of teaching nursing.
• She has been a clinic nurse, staff nurse,
head nurse, instructor, Assistant Dean,
and Dean.
AWARDS & HONORS
• Bachelor's degree in Nursing at the
University of the East Ramon Magsaysay
Memorial Medical Center in 1962
• Master's degree in Nursing at the
University of the Philippines in 1975
-Doctorate's degree in Nursing at the
University of the Philippines in 2001
• Recipient of the Anastacia Giron Tupas
Award given by the Philippine Nursing
• Association (PNA) in 2008
DIVINA GRACIA’S
NURSING THEORY
Composure Behaviors
ADVANCE NURSE PRACTITIONER
• Must be a BSN Graduate
• Is licensed and have a
clinical experience of 2 years
• Has undergone special
training in specialized areas
COMPOSURE BEHAVIORS
• An acronym used by Divina
Gracias to enumerate specific
activities that must be done by
the Advance Nurse Practitioner
WELLNESS STATUS
• A condition or a state of well-
being involve in wellness
• A coordinated and integrated
living pattern that involves
wellness
DEFINITION OF TERMS
• COM- Petence
• P- resence and P-rayer
• O-pen-mindedness
• S- timulation
• U- nderstanding
• R-espect and R-elaxation
• E-mphaty
THEORY OF COMPOSURE
BEHAVIORS
• Competence
• In- depth knowledge and expertise of the
Advance Nursing Practitioner
• Consistency and congruency of word and actions
by the Nurse
• Presence and Prayer
• Carein the form of “being-there” during
desperate times
THEORY OF COMPOSURE
BEHAVIORS
• Includes therapeutic communication and active touch
• Prayer is highly recommended as it provides most
patience with assurance
• Open-mindedness
• Being receptive to new ideas and concepts
• Able to accept opinions and methods
supplied by the patient or other co-worker
THEORY OF COMPOSURE
BEHAVIORS
• Stimulation
• Provision of motivation to the patients
• Reinforcement through encouragements, affirmation,
and motivation are needed
• Understanding
• Able to grasp the situation the patient is in
and able to show concern and compassion
THEORY OF COMPOSURE
BEHAVIORS
• Respect
• Acknowledgement of the patient’s needs
• Use of “po” and “opo” as well as nods and gestures to
display courtesy
• Relaxation
• Allowance of resting periods for the patient
• Activities that allow use of certain muscles
while the others are relaxing
THEORY OF COMPOSURE
BEHAVIORS
• Empathy
• Able to relate to the hardship the patient is going through
• Can share in the joys and sorrow of the patient while not
being attached altogether.
• Once more the nurse has exhibited most, if
not all, COMPOSURE behaviors, the
outcome on the patient can be categorized
into:
• Bio behavioral
• Physiological
ACHIEVEMENT OF
COMPOSURE BEHAVIOR
• Biobehavioral
• Refers to the perceived wellness of patients in
terms of PHYSICAL, INTELLECTUAL,
EMOTIONAL, and SPIRITUAL aspects
• PHYSICAL- The patient is able to do his/ her daily
activities and functions without signs of fatigue
• INTELLECTUAL - The patient has properly applied all the
steps the Nurse has instructed the patient to do
• EMOTIONAL- The patient is able to handle the stresses
of life and can maintain and regulate his/ her feelings.
• SPIRITUAL- The patient can properly establish a values
system and act upon that system
ACHIEVEMENT OF
COMPOSURE BEHAVIOR
• Physiological
• Refers to the perceived wellness of patient in
terms of VITAL SIGNS, BONE PAIN SENSATION
and COMPLETE BLOOD COUNT
THEORETRICAL PARADIGM
ASSUMPTIONS
• The wellness outcome of a
patient will depend on the
intervention the nurse has when
administering the client.
STRENTGHS
• Divinagracia's model
proved that nursing as a
healthcare profession have
great significance in quality
performances as other
healthcare
LIMITATIONS
• The nurse who should use
this model must be an
Advanced Nurse Practitioner
only who has undergone
special training in specialized
areas.
Application to Nursing Practice,
Education & Research
• Nursing Practice
COMPOSURE behaviors inspired the principles of holistic
care where in a patient’s wellness outcome can be
achieve through series of quality attributes of nurses,
which caters every aspect of Wellness, may it be bio
behavioral or physiological
Nurses, specifically Advance Nurses Practitioners
are to be use the COMPOSURE behavior when
administering the client
Divinagracia’s COMPOSURE behavior is used
when providing care to the patient to achieve
wellness,
Application to Nursing Practice,
Education & Research
• In Education
To prepare student to use Composure
behavior for practice as member of the
professional community
To develop, hone and guide nursing
education through Composure Theory
Made as a basis of different universities in
the Philippine.
Application to Nursing Practice,
Education & Research
• In Research
Inspire nursing from different and
quality theoretical and conceptual
framework
Made as basis of other researchers.
CONCLUSION
• The socio- demographic characteristics specifically
gender, and age are related to wellness outcome of
adult cardiac patient
• A significant difference exist in the pre-test, post-
test score of the wellness outcome after the
COMPOSURE BEHAVIOR intervention in 3 groups
• Nursing Profession can actively deliver quality care
through biobehavioral caring interventions like the
COMPOSURE BEHAVIOR because regardless of
creed, social class, gender age and nationality,
each one needs humane, caring, spiritually-
oriented intervention that can facilitate wellness
