TFN FINALS REVIEWER
NURSING
NURSE
 Nutrire (Latin) – to nourish
 Nurice (French) – to nourish
 16th century – a person, but usually
a woman, who waits upon or tends
to the sick
 19th century – training of those who
tend to the sick and carrying out
such duties UNDER THE DIRECTION
OF A PHYSICIAN
 Yet the spirit of nursing has NO
sexual boundaries
 Human beings of both sexes have a
natural tendency to respond to
helplessness or a threat to life from
disease or injury
 NUNS were the first nurses
FLORENCE NIGHTINGALE
 Lady with the Lamp – served soldiers
during the Crimean War
 Nightingale lamp: Nursing symbol
 Considered nursing as an art
NURSING
A. Based on American Nurses
Association (ANA)
 PROTECTION & PROMOTION of
health
 PREVENTION of illness
 ALLEVIATION of suffering through
treatment
 ADVOCACY in the care of clients:
individuals, family, community,
population
 Communication: most important
skill for promotion
 Protection: of wellness, health
 Advocacy: speak in their behalf
 Basic knowledge on Alleviation
and Treatment
B. Based on the International Council
of Nurses (ICN)
 Nursing encompasses
AUTONOMOUS and
COLLABORATIVE care
- Promotion of health, Prevention
of illness, Care of ill, disabled,
and dying people
- Advocacy and Promotion of safe
environment
- Research and Participation in
shaping health policies
- Health systems management
- Education is also key in nursing
roles
C. Occupation or Profession?
 Occupation: job or career, earn just
for money, earn money to live (goal)
 Profession:
- learned vocation or occupation
that has a status of superiority
- beneficial for members of the
society
- characteristics – (knowledge-
based, power and authority over
training and education)
- altruistic service
- code of ethics
- autonomy
- accountable to the public
 Misconceptions:
- Nursing subservient to medicine
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- Nursing education not  Nursing Theory: a group of

standardized – somewhat true: interrelated concepts that are
true when talking about developed from various studies of
different countries, but in the PH disciplines and related experiences;
only one curriculum is used in all AIM: view essence of nursing care
3 islands Theory Nursing Theory
- Autonomy is incomplete; Describe DEPP
dependent on medicine to direct Explain +
much of its practice – partly true Predict Nursing care
Prescribe (guide)
because nursing borrowed some
Terms related to Theory
concepts from medicine
 Nursing is an aspiring, evolving 1. Phenomenon
profession – nurse practitioner, - Can be perceived through the
nurse anaesthetist use of senses
- A fact or a situation that’s
STRUCTURE OF A THEORY observed to exist or happen
- Represents the subject matter of
THEORY
a discipline
 Theoria (Greek) – to speculate 2. Ideas
 A group of related concepts that - Intellectual thought
propose an action that guides - A thought or a suggestion
practice – a systematic explanation - NOT ABSTRACT
of an event 3. Concepts
- Mental image
- Label
relationships - ABSTRACT
CONCEPTS identified - Abstract Concept: can’t be
identified
proposes guides measured (ex. Love, hope)
action practice
- Concrete Concept: measurable
(ex. Height)
4. Assumption
 NURSING MANAGEMENT
- Assumed to be TRUE
Nursing Nursing - Based on intuition
Theory Practice - A proposed explanation based
on limited evidence
5. Principle
Nursing - Truth built on FACTS
Research
- FOUNDATION to other truths

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6. Propositions - Written rules

- Relational statements - Built on FACTS and PRINCIPLES
- FORMAL STATEMENT that is
HISTORY OF NURSING
either TRUE/FALSE
7. Hypothesis A. Ancient Times
- Translate propositions into  Health beliefs have influenced the
FORMAL STATEMENTS that can provision care
be PROVEN/DISPROVEN  Illnesses as caused by supernatural
8. Research beings
- Inquiry or investigation  Medicine men or women:
- To prove a hypothesis or answer - uses herbs, heat, cold, touch,
a specific question chanting rituals
Research Hypothesis - drive evil spirits
Extensively YET to be - nursing care performed by
tested tested
family members
Predicts SPECIFIC B. Historical Perspectives
GENERAL Predictions  Factors that influenced nursing
events practice in the past
Speculative 1. Women’s Roles
Generally guess or what - Care and nurturing role
accepted – you expect to - Cared for infants and children –
evidence- happen next
roots in the home
based practice
- SUBSERVIENT and dependent
Arises from role – called to care for others
repeated (sick and wounded), for physical
observation maintenance and comfort
What you gain from Research 2. Religion
- Christian value – love thy
 KNOWLEDGE – main purpose, want
neighbor as thyself
to prove/disprove, an understanding
- Good Samaritan
acquired through learning or
- 3rd-4th century
investigation, may be based on FACT
o Fabiola: wealthy matrons
or it may be theoretical-based
who converted to
 FACT – a doing, TRUE,
Christianity and provided
observations consistently proved
houses of healing and
TRUE over time, what actually
care
happened
o Cruscades: orders of
9. Law
knights who provide

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nursing care to their sick o Sojourner Truth:

and injured comrades; Women’s right advocate,
KNIGHTS OF ST. LAZARUS African-American, nurse
– cared for people with for 4 years
leprosy and chronic skin - World War I
diseases (Leprosy – o American, British, French
Hansen’s disease) women rushing to
- Religious values dominated volunteer their nursing
nursing services
o Spiritual calling  Endured harsh
o Devotion to duty environments and
o Hard work treated injuries
- Inappropriate to expect not seen before
economic gain from their o Monument was created:
“calling” – therefore all services The Spirit of Nursing
are FREE (Arlington National
3. War Cemetery)
- Crimean War - World War II
o Russia lost alliance o Acute shortage of
o Inadequate care given to caregivers
soldiers that lead to  Cadet Nurse
public outcry in Great Corps was
Britain established
o Florence Nightingale: o Practical nurses, aides,
asked by Sir Sidney and technicians under
Herbert, transformed the supervision of better
military hospitals by prepared nurses
setting up sanitation - Vietnam War
practices such as hand o 90% of the 1100
washing, washing clothes American military women
regularly, reduced were nurses
mortality rate - CADET NURSE CORPS
- American Civil War (1861 – o Formed in 1943*
1865) o Designed to educate
o Harriet Tubman: Moses graduate nurses, train
of her people, African- nurses’ aides, provide
American incentives for inactive
nurses

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4. Societal Attitudes Clara Barton Founded

- Before mid-1800s (1812–1912) American Red
o Nursing was w/o org, Cross at age 60
educ, or social status Linda US 1st trained
Richards nurse; nurse’s
o Prevailing attitude:
(1841–1930) notes and
women’s place at home doctor’s orders;
- Role: wife and mom white uniform
- Any education obtained was for Mary 1st African-
the purpose of making her a Mahoney American nurse
pleasant companion to her (1845–1926)
husband and a responsible mom Lilian Wald Founder of
(1867–1940) Public Health
to her kids
Nursing (NY
- Nurses during these times: slums)
o Poorly educated Lavinia Dock Campaigned for
o Imprisoned criminals (1858–1956) legislation;
 Neglected, steal, allowing nurses
and physically to control their
abuse their profession
Margaret Planned
parents
Sanger parenthood –
o DARKEST ERA OF (1879–1966) “birth control”
NURSING Mary Founder of the
- Latter part of the 19th century: Breckinridge Frontier Nursing
o Guardian angel/angel of (1881–1965) Service; nurse-
mercy image* midwife
 NIGHTINGALE – NURSING THEORY
brought
 Systematic: shows relationships
respectability
th
among concepts
- Early 19 century:
 DEPP – nursing care
o Doctor’s handmaiden
 FRAMEWORK designed to organize
image*
knowledge and explain phenomena
 Medicine was
in nursing
viewed as a male
PARADIGM METAPARADIGM
domain
Viewpoint Core
5. Visionary Nursing Leadership
NURSING CONTRIBUTION “worldview” Major concepts in
LEADERS a discipline that
Florence Lady w the DESCRIBES NAMES the
Nightingale Lamp; standards work to be phenomena of
(1820–1910) of care

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done and concern  Environment: place or

FRAMES an community where care is
orientation Nursing: CARING – provided
w/in which the main component
 Nursing: actions; interactions of
work will be
accomplished the nurse w/ the client
METAPARADIGM
USES OF NURSING THEORY
 “meta”: with, “paradeigma”: pattern
 Education: provides FOCUS for
(Greek)
curriculum design
 A certain discipline has to have a
 Research: offers FRAMEWORK for
pattern
generating knowledge and new
IN NURSING: ideas
 Practice: ASSIST nurses to DEPP,
- Summarize the intellectual and SERVE to guide assessment,
social missions of NURSING and intervention, and evaluate
place boundary on the subject
matter of nursing LEVELS OF THEORY

REQUIREMENTS:  ABSTRACT: difficult to

understand
- Domain: area or territory  Formulating general concepts by
ex. Healthcare abstracting
- Phenomena: interest particular 1. Metatheory
to a discipline - “meta”: beyond
ex. Nursing - Beyond the definition
- Neutral Perspective: w/o - “theory of all theories”
incorporating one’s own - Most abstract; highest level
prejudice – NOT JUDGMENTAL - Difficult to understand
- International: do not reflect a - FOCUS: to generate knowledge
particular nationality, culture, or ex. Metamathematics
ethnic beliefs – no bias – 2. Grand Theory
TRANSNATIONAL - “macro” theory
4 METAPARADIGMS IN NURSING - Most complex
- Less abstract to metatheory
 Person: Client - Not designed for testing
 Health: continuum of wellness - Provides framework
to terminal illness - Broadest in scope
- FOCUS: generate broad and
general ideas

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ex. Orem’s Self-Care Theory –
CARE: very general
3. Middle-Range Theory
- Limited # of variables
- Narrower in scope; specific to
nursing
- Target specific phenomena or
concepts
- Simple to understand and apply
- No measurement/subjective
- Testable
ex. Pain, sadness
4. Practice Theory
- “micro” theory
- Most limited scope and level of
abstraction
- VERY specific
- Developed for use within a
specific range of nursing
situations
- Addresses a desired goal and
specific actions needed to
COMPONENTS IN ANALYZING NURSING
achieve it
THEORY
- Limited to specific populations
ex. OB-GYNE, cancer, children
CATEGORIES OF THEORY
1. Needs Theories
- Helping individuals fulfill
physical/mental needs
- VERY medical
- Criticized for being too
dependent; relies too much on
the medical model of health
2. Interaction Theories
- Revolve around relationships
nurses form w/ patients
- Criticized for ignoring medical
model of health and not
attending to basic physical needs
3. Outcome Theories
- Nurses acts as a changing force
that establishes individual
- Criticized for being too abstract
and difficult to implement
4. Humanistic Theory
- Capacity for self-actualization
- Contains w/in himself the
potential for healthy and
creative growth
- Fosters mental and emotional
health in addition to physical
health
- Humanistic approach
ex. Carl Rogers* - humanistic
psychologist; uniqueness of
individual – person-centered
approach
1. Clarity
- How consistent the ideas are
conceptualized
- Clearly stated
- Logical flow
2. Simplicity
- Focuses on FEWER concepts
- Clean and light
3. Generality
- Applicable BROADLY
4. Accessibility/Empirical Precision
- TESTABLE
- RESEARCHABLE
- EMPIRICAL: must be observed
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- MEASURABLE
5. Derivable Consequence
NEEDS
- Valuable
METAPARADIGMS OF NURSING
 Provides structure of how a
discipline should function
1. PERSON
o Biological beings
o Inseparable mind and body
who share certain
fundamental needs
o Multidimensional
o Recipient of nursing care
 Nurse’s goal: NURTURE, EMPOWER,
AND MOTIVATE to manage their
OWN health*
MOTIVATION
 A driving force; a general desire to
do something
 Impulse to optimize well-being
 May be rooted in: physiological,
behavioral, and social
MASLOW’S HIERARCHY
o BASIC: physiologic, safety
o PSYCHOLOGICAL: love,
esteem
o SELF-FULFILLMENT: self-
actualization
 People are always motivated by
unsatisfied needs
 Needs are arranged in order of
importance to human life (PSLES)
 From basic to complex
 The more the progress up the
hierarchy, humanness will show
 The more individuality – self-
actualized
2. HEALTH
 Multidimensional, viewed on a
broader perspective
 Lifespan; physical, emotional,
intellectual, social, and spiritual
well-being is integrated
 Absence of disease doesn’t mean
you are healthy
 Ability to function independently
(goal-directed behavior) – HEALTHY
 Nurses are in the BEST position
o ASSIST clients in achieving
and maintaining optimal
levels of health
o Identify risk factors that
predisposes a person to
illness
o Nurses need models
MODELS OF HEALTH
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 Models: theoretical way of (BHNM)

understanding a concept or idea Elements Physical,
– provides ways of approaching necessary for emotional, and
human spiritual well-
issues
survival being
HEALTH BELIEF HEALTH (important)
MODEL (HBM) PROMOTION Ex. Maslow’s
MODEL (HPM) hierarchy* Clients involved
FOCUS: Pender: health in their healing
Person’s beliefs as a positive process
dynamic state (responsibility)
Based on the
understanding Directed at Recognizes the
that a person increasing healing abilities
will take a client’s level of of the body
health-related well-being
action if a he: Ex. Touch
- feels that Providing therapy
negative health positive 3. ENVIRONMENT
condition can resources to
 Types: INTERNAL & EXTERNAL
be avoided help patient
- has positive achieve  Refers to everything around patients
expectation w/ behavior that could impact their illness and
a specific recovery
recommended changes  Includes internal and social factors:
action mental state, personal relationship,
- believes he Desired
CULTURE
can do the outcome:
action health- SUBCOMPONENTS
successfully promoting
behavior A. Spirituality
(SELF-  Nurses provide holistic care
MANAGERS)*
 Spiritual/geriatric nursing –
Better QOL at elective
all stages  Goes BEYOND religion
 Latin word “spiritus”*
In line with o To blow or to breathe
nursing  Gives life or
essence to being
BASIC HOLISTIC
human
HUMAN HEALTH MODEL
NEEDS (HHM)
MODEL

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 BELIEF in a relationship with health, illness, and

someone of higher power, practices
DIVINE BEING C. Family
 Internal CONNECTION with other  Basic unit of society
people  Provide an environment
 Includes the ff: conducive to physical and
o Meaning – having psychosocial growth and health
purpose  MOST important
o Value – having beliefs  As a client:
and standards o Nurse assess and plan
o Connecting – relating health care for 3 types of
with others clients:
 Words reflective of spirituality:  Individual
Cheer, Hope, Faith*  Family
B. Culture  Community
 Values, beliefs, attitudes, and o Nurse determines
customs HEALTH STATUS of family
 SHARED and its individual
 In nursing: members
o To provide quality care o Family members
 Nurses become INFLUENCE one another’s
informed about health beliefs and
and be sensitive practices
to the culturally 4. NURSING
diverse subjective  DELIVERY of optimal health
meanings of outcomes for the patient through a
health and MUTUAL RELATIONSHIP in a safe
practice and caring environment
 Awareness about a given group bioethics (life
ETHICS morals) MAN
sharing beliefs and values
 Factors:  Method of inquiry that helps
o Age, gender, people to understand the
socioeconomic, area of morality of human behavior
origin (rural or urban),  Expected standards of moral
religion behavior of a particular group
o Such factors influence o Code of ethics
client’s beliefs about

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o Nursing viewed as the
most ethical profession
(2005)
BIOETHICS
A. Autonomy – right to make one’s
decision
B. Nonmaleficence – duty to do no
harm
C. Beneficence – doing good
D. Justice – fairness
E. Fidelity – faithful to agreements
and promises
HIGHLIGHTS
F. Veracity – telling the truth
 Linked health with 5 environmental
NURSING THEORISTS
FLORENCE NIGHTINGALE
 ENVIRONMENTAL THEORY
 Germ Theory: influence
 Lady w/ the Lamp: originated in
Turkey
 Hospital’s very 1st requirement: do
the sick NO HARM
 Notes on Nursing: what it is and
what it is not**
OVERVIEW
 Considered as the first nurse
theorist
 Patient Care Theory: alteration
of the patient’s environment**
 The act of utilizing the
environment of the patient to
assist him in his recovery
 BASICALLY manipulate your
environment
 Cleanliness > Ventilation >
Noise > Air > Nutrition > Light >
Bedding > Variety > Health of
Houses > Chattering Hopes >
Cleanliness (Cycle)
 Focuses on observation and data
collection
 Initiated to improve hygiene,
sanitary conditions
 Crimean War: recruited a group
of nurses
 Vital assessment for saving life
factors:
1. Pure air
2. Pure water
3. Efficient drainage
4. Light (direct sunlight)
5. Cleanliness – dirty environment
is a source of infection
o Deficiencies in these
factors produced illness
 Attained
significance
because of
SANITATION
CONDITIONS
KINDS OF ENVIRONMENT
1. Physical – elements like
cleanliness
2. Psychological – communication
3. Social – home or hospital or
entire community
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 GENERAL CONCEPTS: an individual who is sick or in need

Ventilation, cleanliness, quiet, of health care
warmth, and diet  Taught graduate psychiatric nursing
in Columbia University
HER MAJOR ASSUMPTIONS
 Mother of Psychiatric Nursing
 NURSING:
OVERVIEW
 Being responsible of/for
someone’s health  A psychiatric nurse
 Nurse: should provide guidelines  Introduced the concept of
for caring their loved ones Interpersonal Relations in 1952
 PERSON:  Central to her theory
 Patient o Use of therapeutic
o Passive in behavior relationship between
o Self-care if possible nurse and client
 Nurse to ask preference of the  Focuses on the individual, the
patient (value of patient as an nurse, and the interaction
individual)  Communication + interaction =
o Timing and substance of Relationship
meals  Interpersonal Relations in
 Nurse in CONTROL of and Nursing (1952): first theory book
responsible for the patient’s since Nightingales’s*****
surroundings
 HEALTH:
 Being well special
 Prevention of disease through need
ENVIRONMENTAL CONTROL Client
nursing:
 ENVIRONMENT: interpersonal &
 To assist nature in healing the Peplau's therapeutic process
Theory
patient
 Create a therapeutic educate to reach
mature
environment that would Goal
personality
enhance comfort and recovery development
and maintain it

HILDEGARD PEPLAU
o If legal age: debouche
 Nursing: a therapeutic process
info to client before
because it is a healing art, assisting
family

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o Doctor has the only right
to debouche client’s
info/condition
 Nurses must
know their
responsibility
INTERPERSONAL RELATIONS OF NURSING
PHASES OF NURSE-PATIENT RELATIONSHIP
1. ORIENTATION
- Client seeks help
- Meeting of the nurse-client
- Focus: Problem-definition
2. IDENTIFICATION
- Client addresses personal
feelings about the experience;
assumes posture of dependence
- Nurse assures client that she
understands client’s situation
- Focus: Selection of appropriate
professional assistance
3. EXPLOITATION
- Client attempts to explore,
understand, and deal with
problem
- Client uses available services
(power shifts from the nurse to
the client)
- Focus: use of professional
assistance for problem-solving
services
4. TERMINATION
- A newer and more mature self
emerges
- Termination of the therapeutic
relationship to prevent
dependence
- Old needs/goals set aside, new
ones adopted
- Focus: termination of the
professional relationship
NURSING ROLES
1. Stranger: courtesy (acceptance w/
respect)
2. Teacher: convey knowledge
3. Resource person: concepts of health
4. Surrogate: temporary caregiver; act
in behalf of patient’s best interest
5. Counselor: listen
6. Leader: sound and emphatic advice
VIRGINIA HENDERSON
 From Missouri, USA
 First lady of nursing
 First truly international nurse
 Nightingale of nursing
OVERVIEW
 Focus on patient needs
o Patient as a sum of parts
w/ bio-psycho-social
needs
 GOAL: increase patient’s
INDEPENDENCE*
 1955: Textbook of the Principles
& Practice of Nursing
 1960: Basic Principles of Nursing
Care
 1966: The Nature of Nursing
14 BASIC NEEDS
CONCEPT
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 Unique function of a nurse:
assist the individual
 Performance of activities
contributing to health and
recovery
 Perform unaided
 Do not limit only to illness care
 Maintain supportive
environment
 Nurse: attend to all 14 activities
until the patient becomes
independent
 Goal: independence***
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable
postures
5. Sleep and rest
6. Select suitable clothes – dress
and undress
7. Maintain body temperature
within normal range by adjusting
clothing and modifying the
environment
8. Keep the body clean and well
groomed and protect the
integument
9. Avoid dangers in the
environment and avoid injuring
others
10. Communicate with others in
expressing emotions, needs,
fears, or opinions
11. Worship according to one’s faith
12. Work in such a way that there is
a sense of accomplishment
13. Play or participate in various
forms of recreation
14. Learn, discover, or satisfy the
curiosity that leads to normal
development and health and use
the available health facilities
METAPARDIGM
 Health promotion as more than care
of the sick
 Nurse to help the patient manage
the environment to protect him
from any harm
 Knowledgeable in both biological
and social sciences
 Nurses function independently but
promote the treatment plan of the
doctor
 Mind and body are inseparable
NURSE-PATIENT RELATIONSHIP
LEVELS
 Nurse as SUBSTITUTE
o If cannot function fully
 Nurse as HELPER
o Help to accomplish and
meet his needs
 Nurse as PARTNER
o Formulate care plan
together
BETTY NEUMAN
 Born in Ohio, USA
 1957 – BS Public Health Nursing
(UCLA)
 Pioneer in Community Mental
Health
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 The Neuman Systems Model (1982)
OVERVIEW
 Uses SYSTEMS approach
o Living organisms as
OPEN SYSTEMS
o Interaction with each
other and with the
environment
o Human beings as client, a
composite of variables,
forming the wholeness of
the client
 Holistic to WHOLISTIC***
o Need 5 variables
o Enhance understanding,
referring to the term
WHOLE person
THE NEUMAN SYSTEMS MODEL
1. Basic Structure
- Central core
- Surrounded and is protected by
circles
o For retention
o Maintenance of system
stability
o Integrity
2. Client Variables
- Physiological: body
- Psychological: mind
- Sociocultural
- Developmental: age-related
- Spiritual: beliefs
3. Lines of Resistance
- Innermost protection
- Protects the basic structure
- If effective: reconstitute –
increase in energy
- Resulting energy depletion may
lead to death
Ex. Immune system
4. Normal Line of Defense
- Activated when flexible line is
broken
- Changes over time as a result of
coping with stress
- Represents stability over time
5. Flexible Line of Defense
- Outermost protection
- Initial response to stressors
- Increase in distance = increase in
protection
6. Stressors
- Stimuli that produce tensions
and have the potential for
causing system instability
- Intrapersonal: within the client
Ex. Autoimmune response
- Interpersonal: proximal to the
system
Ex. Roles
- Extrapersonal: at a greater
distance
Ex. Financial resources
7. Prevention*****
- Used to attain, retain, and
maintain system balance
- Primary:
o REDUCE the possibility of
encounters with stressors
o Includes health
promotion and
maintenance of wellness
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o Focus: strengthen flexible o Drives

line of defense  Focal point
o Ex. Exercise around behaviors
- Secondary:  To achieve
o Treat symptoms specific goals
o To regain optimal system o Behavior*
stability and to conserve  Output
energy  Responses to
o Focus: strengthen changes
internal lines of o Subsystems
resistance  Mini-system w/
o MOST FATAL – may lead goal and function
to death if unsuccessful  Can be
o Ex. Use of analgesics maintained as
- Tertiary: long as it is not
o Rehabilitation disturbed
o Purpose: protect the o Interactive
client system  Interdependent
rehabilitation systems
o Ex. Rehab program  Maintain balance
of system through
DOROTHY JOHNSON control and
 Born in Savannah, Georgia regulation
 Behavioral Systems Model RELATIONSHIPS
 Pediatric nurse
 Inspired by Notes on Nursing  Johnson delineated seven
 Faculty in UCLA – developed the first subsystems to which the model
4-yr. basic nursing program applied

OVERVIEW SUBSYSTEMS

 JBSM*
o Modified and adapted
concepts from other
disciplines
o Applied specifically to
nursing situations –
middle ranged
 4 Assumptions
1. Attachment-Affiliative –
security/social bonds/inclusion
2. Dependency – get attention/helping
behavior/physical assistance
3. Ingestive – food and fluid intake
4. Eliminative – excretion (body waste)
5. Sexual – procreation/gratification

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6. Aggressive-Protective – self- o Controlling, purposeful:

protection/preservation having a goal in life
7. Achievement – efforts to gain o Action- & time-oriented
mastery and control; feel self-
NURSE CLIENT INTERACTIONS
fulfillment
NURSE-CLIENT
USEFULNESS
 Goals, needs, and values
 Used to direct nursing practice
 Right to: knowledge, participate
ex. Elderly person w/ fear
in decisions, to accept and reject
(illness) – dependency,
care (client)
eliminative, ingestive
(subsystems affected)  Goals of both may not be
congruent – communication is
 Can be tested – realistic
option
ex. Perception of environment –
aggressive-protective INTERACTING SYSTEMS

IMOGENE KING 1. Personal – Personal views, goals,

and beliefs (nurse), Client:
 From Missouri, USA
individual
 Goal Attainment Theory
2. Interpersonal – nurse interrelates
 Columbia University (NYC) – Doctor
with coworkers or patient, Client:
of Education
group
 Toward a Theory for Nursing
3. Social – nurse interacts with co-
(1971)*****
workers, superiors, and the client in
ASSUMPTIONS general, Client: society

 Von Bertalanffy General Systems USEFULNESS

Model – basis for King’s
 Goal attainment
work*****
o Action is needed
 Open systems framework – used
(behaviors that are
to establish a nurse-client
towards accomplishment
relationship
of certain act)
 Individuals
 Can be applied in both
o Social, sentient – we can
emergency nursing and rural
feel all things
health care
o Rational and reacting
beings IN SUMMARY

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 The patient and nurse mutually - If performed effectively:

communicate, establish goals maintain structural integrity and
and take action to attain human functioning
- SELF-CARE AGENCY: Ability to
DOROTHEA OREM engage in self-care*****
 Born in Baltimore, Maryland - CONDITIONING FACTORS:
 Self-care Deficit Theory (1971) affected by conditioning factors
 SELF-CARE: activities that individuals – age, gender, and health
initiate and perform on their own state*****
behalf to maintain life, health, and - SELF-CARE REQUISITES: reasons
well-being for which self-care is
 Private duty nurse, ER nurse, OR, undertaken***
Pediatric nurse, Adult nurse, CATEGORIES
Medical-surgical nurse, Nurse- o Universal: life processes
consultant (air, water)
o Developmental: human
OVERVIEW growth and development
(hair loss, new job)
 Source of her ideas: her
o Health deviation: genetic,
experience in nursing
defects, and
 REFLECTIVE PRACTITIONER
structural/functional
o Was able to identify
deviations (learning to
focus of nursing
walk w/ crutches)
 Nursing is helping clients to
2. Theory of Self-Care Deficit
establish or identify ways to self-
- Basic element: when clients are
care activities
incapable or limited in their
 Teach to become SELF-RELIANT ability
& RESPONSIBLE for themselves* o Nursing is REQUIRED – to
 GOAL: help client perform self- provide self-care
care***** - Methods:
o Nursing is most necessary o Acting for
if client is unable to fulfill o Guiding and directing
needs o Providing psychological
(3) INTERRELATED THEORIES and physical support
o Providing and
1. Theory of Self-Care maintaining an
environment that

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supports personal
development
o Teaching
3. Theory of Nursing Systems*****
- To meet self-care requisites of
the patient
CLASSIFICATIONS
A. Wholly-Compensatory
o Unable to do self-care
requisites of the patients
o Ex. Coma, w/ fractures,
mentally retarded
B. Partly-Compensatory
OVERVIEW
o Both nurse and patient
perform care measures
o Ex. Patient who had
surgery – can do some
self-care except change
dressing
C. Supportive-Educative
o Patient is able to perform
all self-care (nurse can be
educator on special
cases)
 3 types may be used with a
single patient
FAYE ABDELLAH
NURSING PROBLEMS
 Born in NYC
 21 Nursing Problems
 Doctor of Education
 77 academic honors
 11 honorary doctorate degrees
 Deputy surgeon general (8 years) –
1st nurse and woman to do so
 2-star rear admiral
 US Public Health Service
PROCESS PROBLEM-SOLVING
 Standards of NURSING HOMES in
the US
 Pioneered Geriatric nursing
 Book: Better Patient Care through
Nursing Research – pioneer nurse
researcher
 Made to teach 120 principles of
nursing practice in Yale
 Hated books w/o scientific basis
o Why she became frustrated
and burned the textbooks
 EBP: evidence-based practice
 Nursing as a SERVICE to
individuals, family, and society
o Key NURSING PROBLEMS
related to health needs
 Health needs can be:
o Overt (apparent; can be
seen)
o Covert (hidden;
concealed)
 Can be emotional,
interpersonal
 Can be perceived
incorrectly
 Problems that are experienced
by the patient that the nurse can
help meet
o NURSES as PROBLEM
SOLVERS
o Social, physical and
emotional, relationships
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1. Identify
2. Select data
3. Formulate hypothesis
4. Test hypothesis through collection
of data
5. Revise hypothesis if needed
 Identify and solve OVERT & COVERT
problems – Quality Nursing Care
21 NURSING PROBLEMS
CATEGORIES
1. Basic – focus: PREVENTIVE
2. Sustenal – most crucial/critical
3. Remedial – emotional; focus:
interpersonal difficulties
4. Restorative – society and
community resources
PROBLEMS
1. To maintain good hygiene and
physical comfort
2. To promote optimal activity:
exercise, rest, sleep
3. To promote safety through
prevention of accident, injury, or
other trauma and through
prevention of the spread of infection
4. To maintain good body mechanics
and prevent and correct deformity
5. To facilitate the maintenance of a
supply of oxygen to all body cells
6. To facilitate the maintenance of
nutrition of all body cells
7. To facilitate the maintenance of
elimination
8. To facilitate the maintenance of
fluid and electrolyte balance
9. To recognize the physiologic
responses of the body to disease
conditions—pathologic, physiologic,
and compensatory
10. To facilitate the maintenance of
regulatory mechanisms and
functions
11. To facilitate the maintenance of
sensory function
12. To identify and accept positive and
negative expressions, feelings, and
reactions
13. To identify and accept
interrelatedness of emotions and
organic illness
14. To facilitate the maintenance of
effective verbal and nonverbal
communication
15. To promote the development of
productive interpersonal
relationships
16. To facilitate progress toward
achievement and personal spiritual
goals
17. To create or maintain a therapeutic
environment
18. To facilitate awareness of self as an
individual with varying physical,
emotional, and developmental
needs
19. To accept the optimum possible
goals in the light of limitations,
physical and emotional
20. To use community resources as an
aid in resolving problems that arise
from illness
21. To understand the role of social
problems as influencing factors in
the cause of illness
USEFULNESS
 Transformed the focus of
nursing from disease-centered
to PATIENT-CENTERED
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 21 nursing problems 1. Physiologic – body’s basic

o Made nurses look at
patients’ problems and
come up with nursing
care plan
SISTER CALLISTA ROY
 California
 Roy Adaptation Model, 1976 – most
employed nursing theory
 Congregation of the Sisters of St.
Joseph of Carondelet*
 Compelled by Dorothy Johnson
 American Academy of Nursing
 Pediatric Nursing (Masters),
Sociology (Masters and Doctorate)
OVERVIEW
METAPARADIGMS
 Adaptation as process and
outcome
 Individual
o As a bio-psychosocial
adaptive system
 Employs feedback
cycle
 Input (stimuli),
USEFULNESS
throughput
(process), output
(behaviors and
adaptive
responses)
 GOAL: enhance life processes
through adaptation in (4)
adaptive modes
ADAPTIVE MODES
physiologic needs and ways of
adapting with regard to fluid and
electrolytes, activities and rest
2. Self-concept – 2 components:
physical self (sensation, body
image), personal self (self-ideal,
inner)
3. Role function – need for social
integrity and performance of duties
based on given positions within
society
4. Interdependence – one’s relations
with significant others and support
systems that provide help, affection,
and attention
 GOAL: promotion of adaptation
 Person (adapts)
o Adapt to maintain
integrity
 Environment – stimuli
 Health – reflection of adaptation
 Nurse – to facilitate adaptation
 Persons are in constant
interaction with the
environment
o Source of stimuli
 For survival
o Human adaptive system
must respond positively
to environment stimuli
 Adaptive systems

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o Promote growth,
reproduction, mastery
MADELEINE LEININGER
 Nebraska, USA
 Culture Care Diversity and
Universality Theory*****
 First ever nurse anthropologist
 Book: Culture Care Diversity and
Universality Theory of Nursing, 1991
 GOAL (of nurse): Provide culturally
congruent wholistic care (coined the
word)
 Transcultural Nursing (Concept),
1950s
 Living legend of the American
Academy of Nursing (1998)
CONCEPTS
 CARE is the essence of nursing
o Dominant feature of
nursing
 Human caring
o Varies among CULTURES
 CARE – actions and activities
directed toward assisting,
supporting or enabling individual
to improve a human condition;
always occurs in a cultural
context
 CULTURE – lifeways of an
individual or a group*****;
beliefs, values, norms, patterns,
and practices
 CULTURE CARE – synthesized
and culturally constituted
assistive, supportive, enabling or
facilitative CARING acts towards
self or others
(3) MODES OF NURSING ACTIONS
1. Cultural Care Preservation (CCP)*
- Help people of a particular
culture to maintain or prevent
death, recover from illness or
face death
- Acknowledge
Ex. Nurses shouldn’t be
judgmental and shouldn’t tell
them that heir way is wrong
2. Cultural Care Accommodation
(CCA)*
- Help to ADAPT TO OR
NEGOTIATE with healthcare
providers for a satisfying health
outcome
Ex. Saying “is it working for you
or are you getting better?”
instead of “it won’t help you”
3. Cultural Care Re-patterning (CCR-
P)*
- Help restructure or change
lifestyles that are culturally
meaningful (respect)
- Provide additional info
Ex. Show a new medicine and
give info about its effectiveness
 These modes influenced nurse’s
ability to provide CULTURALLY
CONGRUENT NURSING CARE and
making them culturally-competent
nurses
 Used by the nurse in meaningful
ways
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 Only happens when values,  Nurse: co-participant w/ the patient,

expressions, beliefs are known agent of change
 Book: Caring Science as Sacred
HOW TO BE A CULTURALLY COMPETENT
Science*
NURSE?
CONCEPTS
1. Ask cultural practices and
preferences (with compassion)  Love and caring are universal
o Culture affects nurse- and mysterious “cosmic forces”
client exchanges  Practice of caring
2. Incorporate personal, social, o Central to nursing
environmental, and CULTURAL in o Unifying focus of practice
the plan of care for the patient  Nursing interventions related to
3. Respect cultural diversity and strive human care
to increase cultural sensitivity  10 Carative Factors
(interventions)*****
SUMMARY
 Transpersonal Caring
 Culture care is valued worldwide Relationship*****
o Globalization  Caring Occasion/Moment*****
 A THEORY of today and
TRANSPERSONAL CARING RELATIONSHIP
tomorrow
o Growing increasingly in a  Human-to-human
multicultural world connectedness
 Nurses are part of o In a nurse-patient
a diverse health encounter
care force o Multidimensial, not time-
and space-bounded
JEAN WATSON
 How the nurse GOES BEYOND
 West Virginia, USA the objective assessment to
 Transpersonal Caring Theory show concern toward the
 MS in Psychiatric and Mental Health person’s subjective/deeper
Nursing meaning of their healthcare
 PhD in Educational Psychology and situation
Counseling o Dig deeper – more
 Mental-spiritual growth for self and meaning
other, finding meaning in one’s own  Can’t if the
existence and experiences person doesn’t

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allow you to,
though
10 CARATIVE FACTORS
1. Forming a humanistic-altruistic
system of values
o authentic caring
2. Enabling and sustaining faith-hope
o Nurse needs to have
religion
3. Being sensitive to self and others
o Sensitive to culture
4. Developing a helping-trusting, caring
relationship (seeking transpersonal
connections)
o Nurse-patient
5. Promoting and accepting the
expression of positive and negative
feelings and emotions
o Be open and flexible
6. Engaging in creative, individualized,
problem-solving caring processes
o Every problem should be
personalized – different
care plan for each patient
7. Promoting transpersonal teaching-
learning.
o Client can also educate
8. Attending to supportive, protective,
and/or corrective mental, physical,
societal, and spiritual environments.
9. Assisting with gratification of basic
human needs while preserving
human dignity and wholeness.
o Assist NOT provide
10. Allowing for, and being open to,
existential-phenomenological and
spiritual dimensions of caring and
healing that cannot be fully
explained scientifically through
modern Western medicine.
o Be open to tradition (ex.
Acai berry)
CARING OCCASION/MOMENT
 Human-to-human transaction
o Caring process begins →
healing happens
 Nurse and another patient come
together in such a way that an
occasion for human caring is
CREATED
PATRICIA BENNER
 “how do nurses learn to do nursing”
 Book: From Novice to Expert – also
her theory
 Mentor: Virginia Henderson
 Living legend of American Academy
of Nursing (2011)
 Worked in the ICU
 Worked at UC-San Francisco as a
nurse researcher
CONCEPTS
 Nurses develop skills and
understanding of patient care
over time through:
o Proper education
background
o Multitude of
EXPERIENCES
 Borrowed concept from Dreyfus
bros – Theory of Skill
Acquisition*
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 Dreyfus: development of skill
moves through 5 levels of
proficiency
 For Benner: as a nurse moves
into higher levels of skill
performance, a more holistic
approach is utilized in practice
CLINICAL CONTEXT
 Goal: become an expert
1. Novice
- No experience; to develop skills
LYDIA HALL
(put into situations)
- Practice is very limited, not
flexible
- Cannot separate relevant pieces
of situation; seen all situation as
EQUAL
2. Advance Beginner
- Can demonstrate marginally
acceptable performance
OVERVIEW
- Coped with sufficient REAL
situations
- Begins to develop principles
based on experience
Ex. Nurse who worked for 1-2
years
3. Competent
- 2-3 years of experience in the
SAME work area
- Can now plan in terms of long-
range goals (competent)
- Still lacks speed and flexibility
4. Proficient
- Not time-bounded
- Perceives situation as a WHOLE
instead of aspects
- Holistic understanding (improve
decision-making capability)
- Learned from EXPERIENCES
Ex. Nurse Manager
5. Expert
- Deep connection and
understanding of the situation
- No longer relies on principle but
INTUITION
- Fluid and flexible performance
Ex. Director of nursing
 Born in NYC
 Care Core Cure Theory
 York Hospital School of Nursing
 Columbia University (Masters)
 Pioneer for Rehabilitative
Nursing***** - role of the nurse in
the patient’s recovery and welfare
 Nursing as
o Participation in 3C’s
aspect of patient care
o Care is the sole function
of nursing***
o Core and Cure: shared
with other members of
the health team
o Assumptions: the
motivation and energy
necessary for healing
exist within the patient,
rather in the healthcare
team
 3 Aspects of Nursing
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o Shouldn’t be viewed as  Core: goals set by the patient

function independently;
interrelated
o CIRCLES: interact, change
size depending on the
patient’s total course of
progress
himself
 Involves therapeutic use of self with
other members of health team
 Making patient able to express
feelings regarding illness and its
effect

Person (focus)

therapeutic use of self

CORE

Disease
Body

Seeing the patient

intimate bodily
and family through
care
med care

CARE
CURE

THE CARE CIRCLE  Gain self-identity

 Develop maturity
 Primary role of nurses
o Nurture THE CURE CIRCLE
o Mothering
 Administration of medications and
 Comfort measures
treatments
 Provide patient
 Done by medical professionals to
instruction*
patients
 Helping*
 Goal: eliminate illness and disease
 Goal: COMFORT of patient*****
 During this aspect: nurse is a patient
THE CORE CIRCLE advocate
 Shared by the nurse with members
 Patient: receiving care
of the health team

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 Actions done are geared towards

treating the patient

APPLICATION

 Cure Circle (limited; as instructed

by the physician)
 Care Circle (exclusive to nursing)
 Core Circle ( shared with social
coworkers, psychologists)
^process is in that order

©Ia Valenton