THEORETICAL FOUNDATIONS OF NURSING

Concept -
 Often called the building blocks of theories
 Abstract & concrete concepts
 Mental formulation of an object or event that come from individual perceptual experience.
 Is a generalized idea of some group of objects; or an abstract idea generalized from several
specific instances
 It is an image or mental picture of some phenomenon
 Major components of a theory

ABSTRACT
- Indirectly observable and are independent of time or place
- Not easily understood

CONCRETE
- are specific to time, place and are observable.
- real, perceptible by the senses, experience

Theory –
 A group of related concepts that propose actions that guide practice
 A set of concepts, definitions, relationships, assumptions that project a systematic view of a
phenomena
 An organized system of accepted knowledge that is composed of concepts, proposition,
assumption and definition intended to explain a set of fact, event or phenomena

Phenomenon – is an aspect of reality that can be consciously sensed or influenced

- Observable event
- An empirical data that can be observed

Proposition – a statement that proposes a relationship between concepts

Definition - is composed of various descriptions which convey a general meaning and reduces the
vagueness in understanding a set of concepts

Assumption –
- is a proposition that is taken for granted, as if it were true based upon presupposition without
preponderance of the facts
- A statement that specifies the relationship or connection of factual concepts or phenomena
- Statement that the theorist hold as factual

Principle - A basic law, truth or assumption

- a fundamental, primary, or general law or truth from which others are derived

Conceptual Framework
- Group of related ideas, statements, or concepts
- Often used interchangeably with the terms “conceptual model” and “grand theories”

Examples: Freud’s structure of the mind (id, ego, and superego)

Paradigm

A paradigm is an organizing framework that contains concepts, theories, assumptions, beliefs, values,
and principles that form the way a discipline interprets the subject matter with which it is concerned.

Metaparadigm

- specifies the main concepts that encompass the subject matter and the scope of a discipline.
- the metaparadigm concepts provide the boundaries and limitations of a discipline

Four major concepts in nursing

Person Environment Health Nursing

PERSON – refers to the individual, family, or group who are the interest of nursing
- the recipient of care central to the care being provided
 individual clients
 families
 communities

HEALTH - the goal of nursing care; state of well-being; defined in different ways by the client, the
clinical setting and health care profession; it is a state that is dynamic and continuously changing.

ENVIRONMENT - the internal and external surrounding that affect the client; includes all possible
conditions affecting the client and the setting in which health care needs occur (community, home, school
or workplace).
- Is the place or community where care is provided
- It also describes the world a person lives in and interacts with

NURSING - the discipline from which client care interventions are provided; the diagnosis and treatment
of human responses to actual or potential health problems; attributes, characteristics and actions of the
nurse providing care on behalf of, or in conjunction with the client.
- Is the actions and interactions of the nurse with the person.

Components of a theory

1. Purpose
2. Concepts
3. Models
4. Theoretical statements
5. Structure
6. Assumptions

PURPOSE

- the purpose of a theory explains why the theory was formulated and specifies the context and
situation in which it should be applied
 Describe
 Explain
 Predict
 Prescribe

Purposes of nursing theory

Education

- Prepare students for practice as members of the professional community.

- Helps nursing students understand how roles and actions of nurses fit together in nursing
- Theories provide general focus for curriculum design
- Theories also guide curricular decision making

Research

- Offer a framework for generating knowledge and new ideas

- Assist in discovering knowledge gaps in the specific field of study
- Systematic approach to identify questions

Clinical Practice

- Guide critical thinking of nurses

- Represent status of nursing as a discipline
- Used as a framework for structuring nursing practice
- Development of nursing knowledge/ nursing science
- Assist nurses to describe, explain and predict everyday experiences
- Serve to guide assessment, intervention and evaluation of nursing care
- Provide a rationale for collecting reliable and valid data
- Help to establish criteria to measure the quality of nursing care
- Help build a common nursing terminology
- Enhance autonomy of nursing

CONCEPTS AND CONCEPTUAL DEFINITIONS

- concepts are linguistic labels that are assigned to objects or events and are considered to be the
building blocks of theories
- the theoretical definition defines the concept in relation to other concepts and permits description
and classification of phenomena

- Operationally defined concepts link concept to the real world and identify empirical referents
(indicators) of the concept that will permit observation and measurement.

THEORETICAL STATEMENTS

theoretical statements, or propositions, are statements about the relationship between two or more
concepts and are used to connect concepts to devise the theory

STRUCTURE AND LINKAGES

- theoretical linkages offer a reasoned explanation of why the variables in the theory maybe
connected in some manner, which brings plausibility to the theory.
- theory structuring includes determination of the order of appearance of relationships, identification
of central relationships and delineation of direction, strength, and quality of relationships

ASSUMPTIONS - are notations that are taken to be true without proof

MODEL
 - are schematic representation of some aspect of reality.
- help illustrates the processes through which outcomes occur by specifying the relationships
among the variables in graphic form where they can be examined for inconsistency,
incompleteness or errors.

WHAT IS A NURSING THEORY?

- a group of related concepts that derive from the nursing models/other discipline
- a conceptualization of some aspect of nursing communicated for the purpose of describing,
explaining, predicting and or prescribing nursing care.

- is an organized framework of concepts and purposes designed to guide the practice of nursing

Systematic set of interrelated concepts, definitions and deductions that describe, explore, explain or
predict interrelationships. – accdg to Pinnel and Menesis

Internally consistent group of relational statements (concepts, definitions and propositions) that presents a
systematic view about phenomenon and which is useful for description, explanation, exploration and
prediction. – accdg. To Walker and Avant

Creative and vigorous structuring of ideas that project a tentative, purposeful and systematic view of
phenomena. – accdg. To Chinn and Krammer

Characteristics of a Theory
 Creative in structure
 Articulate, systematic and logical
 Tentative in nature

Uses of a Theory
 Guides research
 Improves nursing practice
 Facilitates communication
 To develop body of knowledge
Categories of Nursing Theory

 Grand Theories
 Middle Range Nursing Theories

 Practice Theories

CHARACTERISTICS GRAND MIDDLE RANGE PRACTICE

Complexity/ abstractness, Comprehensive, global Less comprehensive than Focused on a narrow
scope viewpoint (all aspect of grand theories, middle view view of reality, simple and
human experience) of reality straightforward

Generalizability/specificity Nonspecific, general Some generalizability Linked to special

application to the discipline across settings and population or an identified
irrespective of setting or specialties, but more field of practice
specialty area specific than grand theories
Characteristics of Concepts are abstract and Limited number of concepts Single, concrete concepts
concepts not operationally defined that are fairly concrete and that is operationalized
may be operationnally
defined

Characteristics of Proposositions not Propositions are clearly Propositions defined

propositions alwayys explicit stated
Testability Not generally testable May generate testable Goals or outcome defined
hypothesis and testable

Source of Development Developed through Evolve from grand Derived from practice or
thoughtful appraisal and theories,clinical practice, deduced from middle
careful considerations over literature review, practice range or grand range
many years guidelines

Different views of person, health, environment and nursing by various nursing theorists
Florence Nightingale

Environmental Theory, Modern Nursing

Who is Florence Nightingale?

Nightingale became a heroine in Great Britain as a result of her work in the Crimean War. Her depiction of
the very poor sanitary conditions in the hospital wards at Scutari is overwhelming. She fought the
bureaucracy for food, bandages, fresh bedding, and cleaning supplies for the soldiers. At times she
bought supplies with her finances.

She showed concern for the comfort of the English soldier - well, injured, or sick, including supporting the
establishment of a laundry, library, assistance with letter writing, a banking system so the soldiers could
save their pay, and a hospital for the families who go with the soldiers to war. Also, she provided comfort
and security to the seriously sick and dying. Her skills in decision-making were often better than those of
many officers in the army. She spent the years after the Crimea establishing schools of nursing and
influencing public policy by lobbying her acquaintances about several of her concerns.

 Lady with the Lamp

 Mother of Modern Nursing

 First Nurse Researcher

 First Nurse Theorist

Nightingale’s Environmental Theory

Nightingale’s Canons

Ventilation and warmth

- Check the patient’s body temperature, room temperature, ventilation and foul odors.
- Create a plan to keep the room well-ventilated and free of odor while maintaining the patient’s
body temperature.

Light

- Check room for adequate light. Sunlight is beneficial to the patient.

- Create and implement adequate light in the room without placing the patient in direct light

Cleanliness

- Check room for dust, dampness and dirt

- Keep room free from dust, dirt and dampness

Health of houses

- Check surrounding environment for fresh air, pure water, drainage, cleanliness and light.
- Remove garbage, stagnant water and ensure clean water and fresh air.

Noise
 - Check noise level in the room and surroundings
- Attempt to keep noise level in minimum

Bed and Bedding

- Check bed and bedding for dampness, wrinkles and soiling.

- Keep the bed dry, wrinkle-free and lowest height to ensure comfort

Personal cleanliness

- Attempt to keep the patient dry and clean at all times

- Frequent assessment of the patient’s skin is essential to maintain good skin integrity

Variety

- Attempt to accomplish variety in the room and with the client.

- This is done with cards, flowers, pictures and books. Also encourage friends or relatives to
engage in stimulating activities

Chattering hopes and advices

- Avoid talking without giving advice that is without a fact.

- Respect the patient as a person and avoid personal talk.

Taking food

- Check the diet of the patient. Note the amount of food and fluid ingested by the patient at every
meal.

Petty management

- This ensures continuity of care

- Document the plan of care and evaluate the outcomes to ensure continuity

Observation of the Sick

- Observe and record anything about the patient.

- Continue observation in the patient’s environment and make changes in the plan of care if
needed.

 Emphasis on surroundings

 Disease was a reparative process

 Manipulation of the patient’s surroundings

 Essential Components of Environment

 Two of her Major contributions were Notes in Nursing and Notes on Hospitals
Metaparadigm

Person - referred to the person as a patient; a person with vital reparative powers to dealk with the
disease and is responsive to the environment

Health - being well and using every power that the person has to the fullest extent; focus is on the
reparative process of getting well

Environment - those elements external to and which affect the health of the sick and healthy person; all
external conditions that affect the life and development of the individual

Nursing - every woman, at one time in her life, would be a nurse ; goal is to place the individual in the best
condition for nature to act by basically affecting the environment; nurse performs the task to and for the
patient

Virginia Henderson

Definition of Nursing & 14 Fundamental Human Needs

The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he
had the necessary strength, will or knowledge and to do this in such a way as to help him gain
independence as rapidly as possible.

 American Florence Nightingale

 First Lady of Nursing

 First Truly International Nurse

14 Basic Needs

Physiologic

1. Breathe normally
2. Eat & drink adequately

3. Eliminate body waste

4. Move and maintain desirable posture

5. Sleep & rest

6. Select suitable clothing, dress and undress

7. Maintain body temperature

 8. Keep the body clean & well groomed & protect the integument

9. Avoid dangers in the environment & avoid injuring others

10. Communicate with others in expressing emotions, needs, fears, or opinions

Spiritual

11. Worship according to one’s faith

Sociological

12. Work in such a way that there is a sense of accomplishment

13. Play, or participate in various forms recreation

14. Learn, discover or satisfy the curiosity that leads to “normal” development and health, and use
available health facilities.

Metaparadigm

Person - The individual who requires assistance to achieve health and independence or peaceful death

Health - The patient’s ability to perform the 14 components of nursing care unaided or independently

Environment - The aggregate of all the external conditions and influences affecting the life and
development of an organism.

Nursing - “The unique function of the nurse is to assist the individual, sick or well, in the performance of
those activities contributing to health or its recovery (or to a peaceful death) that he would perform
unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him
gain independence as rapidly as possible.”

Major Assumptions

Person

- The person must maintain physiological and emotional balance.

- The mind and body of the person are inseparable.

- The Patient requires help toward independence.

- The patient and his or her family is a unit.

- The Patient’s needs are encompassed by the 14 components of nursing.

Health

- Health is a quality of life

- Health is basic to human functioning

- Health requires independence and interdependence.

 - Promotion of health is more important than care of the sick.

- Individuals will achieve or maintain health if they have the necessary strength, will or knowledge.

Environment

- Healthy individuals may be able to control their environment, but illness may interfere with that
ability.
- Nurses should have safety education.

- Nurses should protect patients from mechanical injury.

- Nurses should minimize chances of injury through recommendation regarding construction of

buildings, purchase of equipment, and maintenance.

- Doctors use nurse’s observations and judgments as the base of their prescriptions for protection
devices.

- Nurses must know about social customs and religious practices to assess dangers.

Nursing

- The nurse has a unique function to help sick or well individuals.

- The nurse functions as a member of a medical team.

- The nurse functions independently of the physician in attendance.

- The nurse is knowledgeable in both biological and social sciences.

- The nurse can assess basic human needs.

- The 14 components of nursing care encompass all possible functions of nursing.

GOAL OF NURSING: Assisting individuals to achieve health and independence or peaceful death
Nurse assumes the ff role:
 As a substitute for the patient (substitutive)
 As a helper for the patient (supplementary)
 As a partner with the patient (complimentary)

Faye Glenn Abdellah

Twenty One Nursing Problems

The nurse formulates an individualized view of the client’s needs, which may occur in the following four
areas:
 Comfort, hygiene and safety.
 Physiological balance
 Psychological & social factors.
 Sociological and community factors

Abdellah’s 21 Nursing 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 the
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 physiological responses of the body to disease conditions -pathological,

physiological, 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 arising from illness.

21. To understand the role of social problems as influencing factors in the cause of illness.

Metaparadigm

Person - The recipient of care having physical, emotional, and sociologic needs that may be overt and
covert.

Health - A state that is mutually exclusive of illness.

Environment - Suggests that patients interact with and respond to their environment and the nurse is part
of that environment; also refers to the home or community where the patient come from

Nursing - Nursing is a helping profession.

GOAL OF NURSING

To provide service to individuals, families, and society. To be kind and caring but also intelligent,
competent, and technically well prepared to provide its service.

FRAMEWORK

Typology of 21 nursing problems

Jean Watson

Philosophy and Science of Caring, Theory of Transpersonal Caring

Ten Carative Factors

1. Formation of a humanistic-altruistic system of values.

2. Installation of faith-hope.

3. Cultivation of sensitivity to self and to others.

4. Development of a helping-trust relationship.

5. Promotion and acceptance of the expression of positive and negative feelings.

6. Systematic use of the scientific problem-solving method for decision making.

7. Promotion of transpersonal teaching-learning.

8. Provision for supportive, protective, and corrective mental, physical, sociocultural, and spiritual
environment.

9. Assistance with gratification of basic human needs.

10. Allowance for existential-phenomenological forces.

Assumptions

- Caring can be effectively demonstrated and practiced only interpersonally.

- Caring consists of carative factors that result in the satisfaction of certain human needs.

- Effective caring promotes health and individual or family growth.

 - Caring responses accept a person not only as he or she is now but as what he or she may
become.

- A caring environment is one that offers the development of potential while allowing the person to
choose the best action for himself or herself at a given point in time.

- Caring is more “healthogenic” than is curing. The practice of caring integrates biophysical
knowledge with knowledge of human behavior to generate or promote health and to provide
ministrations to those who are ill. A science of caring is therefore complementary to the science of
curing.

- The practice of caring is central to nursing. (Watson, 1979)

Metaparadigm

Person - Possesses three spears; mind, body and soul

Health - Unity and harmony within the mind, body and soul

Environment - Internal and External Environment

Nursing - To assist persons to attain a higher degree of harmony by offering caring relationships that
clients can use for personal growth and development

Dorothea Orem

Self-Care Deficit Theory of Nursing

THEORY OF SELF CARE

To understand this theory one must first understand the concepts of:

Self-Care Is the performance or practice of activities that individual initiate and perform on their own
behalf to maintain life, health and well being

Self-Care Agency - Is the human’s acquired ability or power to engage in self-care. This ability to engage
self care is affected by: basic conditioning factors

Therapeutic Self-Care Demand - Is the TOTALITY of “care measures necessary at specific times or over
a duration of time meeting an individual’s self-care requisites by appropriate methods and related sets of
operations and actions”.

Basic Conditioning Factors

 - Age
- Gender

- Developmental state

- Health state

- Sociocultural factors

- Health care system factors

- Diagnostic & Treatment modalities

- Family system factors

- Patterns of living

- Activities regularly engaged in

- Environmental factors

- Resource adequacy and availability

Self-Care Requisites - The reason for which self-care is undertaken; they express the intended or desired
results.

Three Categories of Self-Care Requisites:

1. Universal
2. Developmental

3. Health Deviation

Self-Care Requisites: UNIVERSAL

- Associated with life processes

- The maintenance of the integrity of Human structure and Functioning, and with General well-
being

- Common to all human beings during all stages of the life cycle.

- Should viewed as interrelated factors, each affecting the others.

- Common term for these requisites is the: Activities of Daily Living

Eight elements:

- Maintenance of a sufficient intake of air

- Intake of food

- Intake of water

- Provision of care associated with elimination

 - Balance between activity & rest

- Balance between solitude and social interaction

- Prevention of hazards to human life, human functioning and human well being

- Promotion of human functioning and development

Self-Care Requisites: DEVELOPMENTAL

Associated with human growth and developmental process and with condition and events occurring
during various stages of the life cycle.

Examples:

- Adjusting to a new job

- Adjusting to body changes such as hair loss or facial lines

Self-Care Requisites: HEALTH DEVIATION

Result from illness, injury, or disease or its treatment. Includes actions such as:seeking health care
assistance’ Carrying out prescribed therapies, Learning to live with effects of illness or treatment

In the theory of self-care: Orem explains WHAT it means by self-care and list the various factors that
affect its provision.

THEORY OF SELF CARE DEFICIT

Theory of Self-Care Deficit - Results when self-care agency is not adequate to meet the known self-care
demand. Delineates WHEN nursing is needed.

Five methods of helping that nurses may use:

- Acting or doing for

- Guiding and directing

- Providing physical or psychological support

- Providing and maintaining an environment that supports personal development

- Teaching

Nursing Agency -Is a complex property or attribute of people educated and trained as nurses that enables
them: to act, to know, and to help others meet their therapeutic self-care demands by exercising or
developing their own self-care agency.

Three Classifications of Nursing System

Wholly Compensatory
-When the nurse is expected to accomplish all the patient’s therapeutic self-care or to
compensate for the patient’s inability to engage self-care or when the patient needs continuous
guidance in self-care

Partly Compensatory
- When both the nurse and patient engage in meeting self-care needs.

Supportive-Educative
- Requires assistance in decision making, behavior control and acquisition of knowledge and skills.
The patient is doing all of the self-care

Metaparadigm

Person - Biopsychosocial being capable of self-care.

Health - “A state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity”.

Environment - Requisites for self-care have their origins in human beings and the environment.

Nursing - A creative effort of one human being to help another human being.
Consists of three nursing systems:
- Wholly compensatory,
- Partially compensatory, and
- Supportive/educative.

Martha Rogers

Unitary Human Being

4 Building Blocks of Conceptual Model

Energy Field - Constitute the fundamental unit of both the living and the non-living.

Universe of Open System - Holds that energy fields are infinite, open, and integral with one another.

Pattern - The nature of the pattern changes continuously, innovatively, and these changes give identity to
the energy field.

Pandimensionality - A nonlinear domain without spatial or temporal attributes.

Principles of Homeodynamics

Principle of Resonancy: - Patterning changes with development from lower to higher frequency, that is,
with varying degrees of intensity.

Principle of Helicy: - Spiral development in continuous, nonrepeating, and innovative patterning.

Principle of Integrality: - The continuous mutual process of person and environment.

Metaparadigm

Person - An open system in continuous process with the open system that is the environment.

Health - She uses the term passive health to symbolize wellness and the absence of disease and major
illness.

Environment - Irreducible, pandimensional energy field identified by pattern and manifesting

characteristics different from those of the parts.

Nursing - Nursing is a learned profession, both a science and an art.

THEORETICAL FOUNDATIONS OF NURSING

 Dorothy Johnson
Behavioral System Model
Major Concepts and Definitions
 Behavior - Output of intraorgasmic structures and processes as they are coordinated and
articulated by and responsive to changes in sessory stimulation
 System - Is a whole that functions as a whole by virtue of interdependence of its parts.
 Behavioral System - Encompasses the patterned, repetitive and purposeful ways of behaving.
 Equilibrium - Stabilized but more or less transitory resting state in which the individual is in
harmony with himself and his environment.
 Tension - State of being stretched or strained and can be viewed as an end product of a
disturbance in equilibrium
 Stressor - Internal or external stimuli that produce tension and result in a degree of instability

7 Subsystems
 Attachment/affiliative - It forms the basis for social organization. In general provides survival
and security.
 Dependency - Promotes helping behavior that calls for a nurturing response.
  Ingestive- Has to do with when, how, what, how much, and under what conditions we eat.
 Eliminative - Addresses when, how and under what conditions we eliminate.
 Sexual - Has a dual function of procreation and gratification. Including but not limited to courting
and mating.
 Achievement - Attempts to manipulate the environment. Its function is control or mastery of an
aspect of self or environment to some standard of excellence.
 Aggressive/protective - Function is protection and preservation
Four Structural Elements
 Drive -what goal is being sought
 Set - predisposition to act
 Choice - alternatives for action
 Behavior - observable outcomes

Metaparadigm
Person - A behavior system with patterned, repetitive, and purposeful ways of behaving that link the
person to the environment.
Health - An elusive dynamic state influenced by biological, psychological and social factors.
Environment - Consists of all factors that are not part of the individual’s behavioral system, but influence
the system.
Nursing - An external force acting to preserve the organization of the patient’s behavior.

 Sister Callista Roy

Adaptation Model
Roy based her work on Helson’s Adaptation Theory
Is an excellent example of how borrowed knowledge becomes unique to nursing.
Roy synthesizes different (borrowed) theories, such as systems, stress, and adaptation, into a collective
view for explication of a person interacting with the environment.

Major Concepts
System - This is a set of parts connected to function as a whole for some purpose and that does so by
virtue of the interdependence of its parts.
Systems also have inputs, outputs and control and feedback processes
Adaptation Level - This represents the condition of the life processes described on the three levels as in
integrated, compensatory and compromised.
This is a constantly changing point, made up of focal, contextual and residual stimuli which represent the
person’s own standard of the range of stimuli to which one can respond with the ordinary adaptive
responses.
This is made up of the pooled effect of three classes of stimuli.
Stimulus - is any factor that provokes a response. Stimuli may arise from either the internal or external
environment.
 Focal Stimuli - The internal and external stimulus which confront the individual
 Contextual Stimuli - Other stimuli present that contribute to the effect of the focal stimulus
 Residual Stimuli - Environmental factors whose effects are unclear in a given situation.
Adaptation Problems - These are broad areas of concern related to adaptation. These describe the
difficulties related to the indicators of positive adaptation. These are seen not as nursing diagnoses, but
as areas of concern for the nurse related to adapting person or group.
Coping Processes - These are innate or acquired ways of interacting with the changing environment
Regulator Subsystem - Involves the neural, chemical, and endocrine system.
Cognator Subsystem - Involves 4 cognitive-emotive channels; perceptual, and information processing,
learning, judgment , and emotion.
Innate Coping Mechanism - These are genetically determined to the species and are generally viewed
as automatic processes; human do not have to think about them.
Acquired Coping Mechanism - These are developed through strategies such as learning.
Adaptive Responses - These promote integrity in terms of the goals of the human system.
Ineffective Responses - These do not contribute to integrity in terms of the goals of the human system.
Integrated Life Processes - This refers to the adaptation level at which the structures and functions of a
life process are working as a whole to meet human needs.
Perception - The interpretation of a stimulus and the conscious appreciation of it. Links the regulator with
the cognator and connects the adaptive modes.
Four Adaptive Modes
 Physiological-Physical Mode
 Self-Concept-Group Identity Mode
 Role Function Mode
 Interdependence Mode

Metaparadigm
Person - adaptive system
Health - outcome of adaptation
Environment - stimuli
Nursing - promoting adaptation and health

 Betty Neuman
SYSTEM MODEL
Major Concepts
 Lines of Resistance - Series of broken rings surrounding the basic core structure. Represent the
resource factors that help the client defend against a stressor such as the body’s immune system
 Normal Line of Defense - The model’s outer solid circle. Represents a stability state for the
individual or system
 Flexible Line of Defense - Model’s outer broken ring; Dynamic and can be rapidly altered over a
short time
 Wellness - Exists when the parts of the client system interact in harmony with the whole system.
System needs are met.
 Illness - Occurs when needs are not satisfied, resulting in a state of instability and energy
depletion.

Stressors - Tension-producing stimuli that have the potential to disrupt system stability.
  Intrapersonal forces occurring within the individual, such as conditional responses
 Interpersonal forces occurring between one or more individuals, such as role expectations.
 Extrapersonal forces occurring outside the individual, such as financial circumstances.

Prevention As Intervention
Interventions are purposeful actions to help the client retain, attain, and maintain system stability
 Primary Prevention
 Secondary Prevention
 Tertiary Prevention

Reconstitution - Occurs following treatment of stressor reactions. Represent return of system to stability,
which may be at a higher or lower level of wellness than prior to stressor invasion.
Metaparadigm
Person - A client as a system that may be an individual, family, group, community, or social issue
Health - A continuum of wellness to illness that is dynamic in nature and constantly subject to change
Environment - Internal and external factors that surround or interact with the person/client
Nursing- Concerned with the whole person

 Imogene King
- Considers watching her nursing students become successful practitioners, teachers and
researchers her greatest accomplishment.
- named as the “Living Legend” by American Academy of Nursing; inducted in the Hall of Fame of
Florida Nursing Association
Interacting Systems Framework and Theory of Goal Attainment
Dynamic Interacting System Framework - Represents personal, interpersonal and social system as the
domain of nursing. The unit of analysis in the framework is human behavior in a variety of social
environments.
King’s model of transactions
Goal Attainment Theory
ACTION - activities that are towards the accomplishment of certain act.
REACTION - is a from of reacting or a response to a certain stimuli
INTERACTION - is any situation wherein the nurse relates and deals with a patient or clientele
OPEN SYSTEM - is the absence of boundary existence

Proposition of King’s Theory

If perceptual accuracy (PA) is present in nurse-patient interactions (I), transaction (T) will occur.
PA (I) T
If nurse and client make transactions (T), goals will be attained (GA).
T GA
If goals are attained (GA), satisfaction (S) will occur.
GA S
If goals are attained (GA), effective nursing care (NCe) will occur
GA NCe
If transactions (T) are made in nurse-client interactions (I), growth and development (GD) will be
enhanced.
(I)T GD
If role expectations and role performance as perceived by nurse and client are congruent (RCN),
transaction will occur.
 RCN T
If role conflict (RC) is experienced by nurse and client or both, stress (ST) in nurse-client interactions (I)
will occur.
RC (I) ST
If nurses with special knowledge and skills communicate (CM) appropriate information to clients, mutual
goal setting (T) and goal attainment (GA) will occur. [mutual goal setting is a step in transaction and thus
has been diagrammed as transaction]
CM T GA
Metaparadigm
Person - Individuals are open systems in transaction with the environment.
Health - Health implies continuous adjustment to stress in the internal and external environment through
optimum use of one’s resource to achieve maximum potential for daily living.
Environment - Understanding of the ways that human beings interact with their environment to maintain
health is essential for nurses.
Nursing - Nursing is an interpersonal process of action, reaction, interaction, and transaction.

 Hildegard Peplau
Psychodynamic Nursing, Interpersonal Relations in Nursing
Interpersonal Relations in Nursing
The nurse-patient relationship is a four-phase phenomenon. One can view them as separate entities, but
they could overlap with each other over the course of the nurse-patient interaction.
Nurse-Patient Relationship
 Orientation - The individual has a felt need and seeks professional assistance.
 Identification - The patient identifies with those who can help him (relatedness).
 Exploitation - The patient attempts to derive full value from what he is offered through the
relationship.
 Resolution - The patient gradually puts aside old goals and adopts new goals.

Nursing Roles
 Role of the Stranger
 Role of a Resource Person
 Teaching Role
 Leadership Role
 Surrogate Role
 Counseling Role

Metaparadigm
Person - Man is an organism that lives in an unstable equilibrium.
Health - A word symbol that implies forward movement of personality
Environment - Existing forces outside the organism
Nursing - A significant, therapeutic, interpersonal process.

 Ida Jean Orlando

Nursing Process Theory
Nursing Process Theory - Orlando describes her model as revolving around five major interrelated
concepts:
 The function of professional nursing
 The presenting behavior of the patient
 The immediate or internal response of the nurse
 The nursing process discipline
 Improvement

Nursing Process Theory

Nurse's Responsibility - Consists of "whatever help the patient may require for his needs to be met.
Need - Situationally defined as a requirement of the patient which, if supplied, relieves or diminishes his
immediate distressor and improves his immediate sense of adequacy or well-being"
Presenting Behavior of Patient - Any observable verbal or nonverbal behavior.
Immediate Reactions - Includes the nurse and patient's individual perceptions, thoughts, and feelings.
Nursing Process Discipline - Includes the nurse communicating to the patient his or her own immediate
reaction, clearly identifying that the item expressed belongs to the nurse, and then asking for validation or
correction.
Improvement - Means to grow better, to turn to profit, to use to advantage.
Purpose of nursing - To supply the help a patient requires in order for his needs to be met.
Automatic nursing action - Those nursing actions decided upon for reasons other than the patient’s
immediate need.
Deliberative nursing action - Those actions decided upon after ascertaining a need and then meeting
this need.
Metaparadigm
Person - Assumes that people are sometimes able to meet their own needs for help is some situation;
however, they become distressed when they are unable to do so.
Health - Assumes that freedom from mental and physical discomfort and feelings of adequacy and well
being contribute to health
Environment - Assumes that a nursing situation occurs when there is a nurse-patient contact and that
both nurse and patient perceive, think, feel, and act in the immediate situation
Nursing - She states that the function of professional nursing is conceptualized as finding out and meeting
the patient’s immediate need for help.

 Joyce Travelbee
Human-to-Human Relationship Model

Human-to-Human Relationship
Her theory was greatly influenced by her experiences in nursing education and practice in Catholic charity
institutions. Concluded that nursing care rendered to patients lacked COMPASSION. Thought that
nursing care needed a “humanistic revolution”

Human-to-Human Relationship
Interactional Phases
 ORIGINAL ENCOUNTER - This is described as the first impression by the nurse of the ill person
and by the ill person of the nurse.
  EMERGING IDENTITIES - This phase is characterized by the nurse and patient perceiving each
other as unique individuals.
 EMPATHY - This phase is characterized by the ability to share in the other person’s experience.
 SYMPATHY - Goes beyond empathy; Occurs when the nurse desires to alleviate the cause of the
patient’s illness or suffering.
 RAPPORT - The nurse and the ill person are relating as human being to human being.

Metaparadigm
Person - A human being is a unique, irreplaceable individual who is in continuous process of becoming,
evolving and changing
Health - It is measured by subjective and objective health
Environment (not defined)
She defined human conditions and life experiences encountered by all men as sufferings, hope, pain and
illness.
Nursing - An interpersonal process whereby the professional nurse practitioner assists an individual,
family, or community to prevent or cope with the experience of illness and suffering and, if necessary to
find meaning in these experiences.
GOAL OF NURSING - To assist an individual or family to prevent or cope with illness, regain health, find
meaning in illness or to maintain the highest maximal degree of health.
FRAMEWORK - Interpersonal process is viewed as a human-to-human relationship formed during illness
and the “experience of suffering”.

 Madelline Leininger
Culture Care: Diversity and Universality Theory
-Focuses on describing, explaining and predicting nursing similarities and differences focused primarily on
human care and caring in human cultures.
- Human beings are believed to be caring and to be capable of being concerned about the needs, well-
being, and survival of others
-The theory does not focus on medical symptoms, disease entities or treatments.
-It is instead focused on those methods of approach to care that means something to the people to whom
the care is given.
1. Care (Noun) -Abstract and concrete phenomena related to assisting, or enabling experiences or
behaviors toward or for others with evident or anticipated needs to ameliorate a human condition or
lifeway.
2. Caring (Gerund) -Actions and activities directed towards assisting, supporting, or enabling other
individuals or group with evident or anticipated needs to ameliorate a human condition or lifeway, or to
face death.
3. Culture-The learned, shared, and transmitted values, beliefs, norms, and lifeways of a particular group
that guides their thinking, decisions, and actions in patterned ways.
4. Culture Care -The subjectivity and objectivity learned and transmitted values , beliefs, norms, and
lifeways that assist, support, facilitate, or enable other individual or group to maintain their well being and
health, to maintain their human condition and lifeway, or to deal with illness, handicaps or death.
5. Cultural Care Diversity -The variabilities and/or differences in meanings, patterns, values, lifeways, or
symbols of care within or between collectivities that are related to assistive, supportive, or enabling
human care expressions.
6. Cultural Care Universality -The common, similar or dominant uniform care meanings, patterns,
values, lifeways, or symbols that are manifest among many cultures and reflect assistive, supportive,
facilitative, or enabling ways to help people.
7. Nursing -The learned humanistic and scientific profession and discipline that is focused on human
care phenomena and activities to assist, support, facilitate, or enable other individual or group to maintain
their well being in culturally meaningful and beneficial ways, or to help people face handicaps or death.
8. Worldview -The way people tend to look out on the world or their universe to form a picture or value
stance about their life or world around them
9. Cultural and Social Structure Dimensions --The dynamic patterns and features of interrelated
structural organizational factors of particular culture, which includes religious, kinship, political, economic,
educational, technological, and cultural values and ethnohistorical factors, and how these factors may be
interrelated and function to influence human behavior in different environmental contexts.
10. Environmental Contexts --The totality of an event, situation, or particular experience that gives
meaning to human expressions, interpretations, and social interactions, particularly physical, ecological,
sociopolitical, and/or cultural settings.
11. Ethnohistory -Those past facts, events, instances, and experiences of individuals, groups, cultures,
and institutions that are primarily people centered and that describe, explain, and interpret human
lifeways within particular cultural contexts and over short or long periods.
12. Generic (Folk or Lay) Care System -Culturally learned and transmitted, indigenous, folk knowledge
and skills used to provide assistive, supportive, enabling, or facilitative toward or for another individual,
group, or institution with evident or anticipated needs to ameliorate a human lifeway or health condition, or
to deal with handicaps and death situations.
13. Professional Care System -Formally taught, learned, and transmitted professional care, health,
illness, wellness, and related knowledge and practice skills that prevail in professional institutions usually
with multidisciplinary personnel to serve consumers.
14. Health -The state of well being that is culturally defined, valued, and practiced, and reflects the ability
of the individuals to perform their daily role activities in culturally expressed, beneficial, and patterned
lifeways.
15. Cultural Care Preservation or Maintenance -Those assistive, facilitative, or enabling professional
actions and decisions that help people of a particular culture to retain and/or preserve relevant care
values so that they can maintain their well being, recover from illness, or face handicaps, and/or death.
16. Cultural Care Accommodation or Negotiation -Those assistive, facilitative, or enabling professional
actions and decisions that help people of a designated culture to adapt to, or negotiate with, others for
beneficial or satisfying health outcome with professional health care providers.
17. Cultural Care Repatterning or Restructuring -Those assistive, facilitative, or enabling professional
actions and decisions that help clients reorder, change, or greatly modify their lifeways for new, different,
and beneficial healthcare patterns while respecting the clients cultural values and beliefs still providing a
beneficial or healthier lifeway than before the changes were coestablished with the clients.
18. Cultural Congruent (Nursing) Care -Those cognitively assistive, supportive, facilitative, or enabling
acts or decisions that are tailor made to fit with individual, group, or institutional cultural values, beliefs,
and lifeways to provide or support meaningful, beneficial, and satisfying healthcare or well-being services.
Sunrise Model
The Sunrise Model symbolizes the rising of the sun. The upper half of the circle depicts components of
the cultural & social structure and worldview factors that influence care and health through language,
ethnohistory, and environmental context.
Metaparadigm
Person - Refers to families, groups, and communities.
Health - Refers to the state of well being that is culturally defined, valued, and practiced.
Environment - Included events with meanings and interpretations given to them in particular physical,
ecological, sociopolitical or cultural setting.
Nursing - Refers to the learned humanistic and scientific profession and discipline that is focused on
human care phenomena and activities to assist, support, facilitate, or enable other individual or group.

 Nola Pender
Health Promotions Model
The Health Promotion Model
The health promotion model notes that each person has unique personal characteristics and experiences
that affect subsequent actions. The set of variables for behavioral specific knowledge and affect have
important motivational significance. These variables can be modified through nursing actions. Health
promoting behavior is the desired behavioral outcome and is the end point in the HPM. Health promoting
behaviors should result in improved health, enhanced functional ability and better quality of life at all
stages of development. The final behavioral demand is also influenced by the immediate competing
demand and preferences, which can derail an intended health promoting actions.
Major Concepts
Health promotion is defined as behavior motivated by the desire to increase well-being and actualize
human health potential. It is an approach to wellness.
On the other hand, health protection or illness prevention is described as behavior motivated desire to
actively avoid illness, detect it early, or maintain functioning within the constraints of illness.
Individual characteristics and experiences (prior related behavior and personal factors).
Behavior-specific cognitions and affect (perceived benefits of action, perceived barriers to action,
perceived self-efficacy, activity-related affect, interpersonal influences, and situational influences).
Behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences,
and health-promoting behavior).

Subconcepts
Personal Factors
Personal factors categorized as biological, psychological and socio-cultural. These factors are predictive
of a given behavior and shaped by the nature of the target behavior being considered.
a. Personal biological factors -Include variable such as age gender body mass index pubertal status,
aerobic capacity, strength, agility, or balance.
b. Personal psychological factors -Include variables such as self esteem self motivation personal
competence perceived health status and definition of health.
c. Personal socio-cultural factors -Include variables such as race ethnicity, acculturation, education and
socioeconomic status.
Perceived Benefits of Action -Anticipated positive outcomes that will occur from health behavior.
Perceived Barriers to Action -Anticipated, imagined or real blocks and personal costs of understanding
a given behavior.
Perceived Self Efficacy -Judgment of personal capability to organize and execute a health-promoting
behavior. Perceived self efficacy influences perceived barriers to action so higher efficacy result in
lowered perceptions of barriers to the performance of the behavior.
Activity Related Affect -Subjective positive or negative feeling that occur before, during and following
behavior based on the stimulus properties of the behavior itself.
Activity-related affect influences perceived self-efficacy, which means the more positive the subjective
feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further
positive affect.
Interpersonal Influences -Cognition concerning behaviors, beliefs, or attitudes of the others.
Interpersonal influences include: norms (expectations of significant others), social support (instrumental
and emotional encouragement) and modeling (vicarious learning through observing others engaged in a
particular behavior).
Primary sources of interpersonal influences are families, peers, and healthcare providers.
Situational Influences - Personal perceptions and cognitions of any given situation or context that can
facilitate or impede behavior. Include perceptions of options available, demand characteristics and
aesthetic features of the environment in which given health promoting is proposed to take place.
Situational influences may have direct or indirect influences on health behavior.
Commitment to Plan Of Action - The concept of intention and identification of a planned strategy leads
to implementation of health behavior
Immediate Competing Demands and Preferences - Competing demands are those alternative
behaviors over which individuals have low control because there are environmental contingencies such
as work or family care responsibilities.
Competing preferences are alternative behaviors over which individuals exert relatively high control, such
as choice of ice cream or apple for a snack
Assumptions
Individuals seek to actively regulate their own behavior.
Individuals in all their biopsychosocial complexity interact with the environment, progressively
transforming the environment and being transformed over time.
Health professionals constitute a part of the interpersonal environment, which exerts influence on persons
throughout their life span.
Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change.

Different Views of Non-nursing Theories

Systems Theory
 It provides another approach for studying individuals in their environments and is used by many
disciplines.
 General System Theory includes purpose, content, and process, breaking down the “whole” and
analyzing the parts.
 The relationships between the parts of the whole are examined to learn how they work together.
Von Bertalanffy (1969, 1976) developed general systems theory which assumes the following:
 All systems must be goal directed
 A system is more than the sum of its parts
 A system is ever changing, and any change in one part affects the whole
 Boundaries are implicit, and human systems are open and dynamic
Change Theory
 People grow and change throughout their lives.
 This growth and change are evident in the dynamic nature of basic human needs and how they
are met.
 Change happens daily.
 Change involves a modification or alteration.
 It may be planned or unplanned.
Although a variety of change theories exist, Kurt Lewin (1962) developed the classic theory of change,
which identifies the following six components:
1. Recognition of the area where change is needed
 2. Analysis of a situation to determine what forces exist to maintain the situation and what forces are
working to change it.
3. Identification of methods by which change can occur
4. Recognition of the influence of group mores or customs on change
5. Identification of the methods that the reference group uses to bring about change
6. The actual process of change.
Unfreeze – involves finding methods of making it possible for people to let go of an old pattern that was
counterproductive
Change or Moving – or moving to a new level involves a process of change of thoughts, feelings,
behavior, or all three, that is in some ways more liberating or more productive
Refreeze – is establishing the change as a new habit, so it now becomes the “standard operating
procedure.” Without some process of refreezing, it is easy to backslide into the old ways.
Developmental Theory
 Categorize a person’s behaviours or tasks into approximate age ranges or in terms that describe
the features of an age group.
 Allow nurses to describe typical behaviours of an individual within a certain group, explain the
significance of those behaviours, predict behaviours that might occur in given situation, and provide
rationale to control behavioural manifestations.

Needs Model/Theory
 Human needs are ranked on ascending scale according to how essential the needs are for
survival.
o Maslow’s hierarchy provides a framework for recognizing and prioritizing basic needs.
o People must meet lower level needs to some degree before they can address higher level needs.
o A person is not motivated by all five categories of human needs at the same time.
o They can learn to delay meeting their needs and modify the specific behaviours that satisfy
needs, depending on each need’s motivational strength.
o If a need goes unmet, physical illness, psychological disequilibrium or death can occur.
Abraham Maslow (1970), perhaps the most renowned needs theorist, ranks human needs on five levels.
The five levels in ascending order are as follows:
1. Physiologic Needs
 Fundamental motivating forces and provide the base for Maslow’s pyramid
 Oxygen, food, water, elimination, activity, rest, temperature, maintenance, and
sexuality are essential for existence.
2. Safety and Security Needs
 The need for safety has both physical and physiologic aspects. The person needs to
feel safe, both in the physical environment and in relationships.
3. Love and Belonging Needs
 It includes giving and receiving affection, attaining a place in a group, and
maintaining the feeling of belonging.
4. Self-Esteem Needs
 The individual needs both self-esteem and esteem from others.

5. Self-Actualization
 The need for self-actualization is the innate need to realize fully all of one’s abilities
and qualities, that is, to maximize one’s potential.
Interlinking Relationships of Factors Affecting Health

1. Physical – state of well-being void of disease or illness.

2. Emotional (Psychological) – refers to our emotional and mental states, our thoughts and feelings.
It involves awareness and acceptance of a wide range of feelings in oneself and others, the ability to
express emotions, to function independently and to cope with the challenges of daily stressors.
3. Mental (Intellectual) – refers to your ability to think and learn from life experience, being open to
new ideas, and the ability of one to question and evaluate information.
4. Social – the ability to interact effectively with other people and the social environment, to develop
satisfying interpersonal relationships, and to fulfill social roles. It involves participation in the community
and making contributions to society. Additionally social implies living in harmony with fellow human
beings, developing positive independent relationships with others, and practicing healthy sexual
behaviors.
5. Spiritual – Its essential component is a belief in some meaning or order in the universe, a higher
power that gives greater significance to individual life. People with good spiritual health identify their own
basic purpose in life; learn how to experience love, joy, peace and fulfillment; and help themselves and
others achieve their full potential.

Core Values

1. Human Dignity
 The term "dignity" is defined as "the state of being worthy of honor or respect".
 When this concept is associated with the adjective "human", it is used to signify that
all human beings possess inherent worth and deserve unconditional respect,
regardless of age, sex, health status, social or ethnic origin, political ideas, religion, or
criminal history. (Wikipedia The Free Encyclopedia, 2008).
 In nursing you are taught to treat all patients with dignity, you are to treat each person
as equal and not refuse care to anyone regardless of their past or other factors. You
 treat each patient as you would treat your own loved ones if you were to care for
them.

2. Integrity
 Integrity is the basing of one's actions on an internally consistent framework of principles.
(Wikipedia The Free Encyclopedia, 2008).
 Nurses have set values of integrity they work together as a whole with others to benefit
everyone involved.
 Nurses also behave honestly, fairly, and ethically are truthful. They are truthful,
trustworthy, and fair in all efforts, while holding themselves to the highest standards of
professional and ethical conduct.
 Nurses provide an environment of openness; they are honest in their approach to one
another and those they serve.

3. Autonomy

 Autonomy (Greek: auto – self; nomos – “determination or law”:

 Self-determination or self-government.
 Autonomy in nursing gives the patients a right to informed consent. The patient is given
the facts and consequences to their health choices and has the right to choose to go
through the procedure or not, unless that person is declared incompetent and then a
medical power of attorney or health care surrogate is appointed to them to make
decisions.

4. Altruism
 Altruism is selfless concern for the welfare of others. (Wikipedia The Free Encyclopedia,
2008).
 Everyday nurses put their own lives in danger to care for patients in their time of sickness
or death.
 Nurses are ethically required to take care of patients sometime risking their own safety
and health. Whether it be a putting themselves in the way of a physically aggressive
patient to protect the other patients or staff, or entering a room to care for a patient with
HIV, TB, MRSA or other contagious diseases.
 Nurses must put the welfare of their patients first.

5. Social Justice
 Social justice refers to the concept of a society in which justice is achieved in every
aspect of society, rather than merely the administration of law.
 Nurses are required to uphold freedom of choice in their patients' care, while upholding
their dignity.

Care Enhancement Qualities including Core Values

 Love of God
 Caring
 Love of People
 Love of Country

Love of God
  The bible indicates that love is from god. In fact, the bible says "god is love.“. Love is one of the
primary characteristics of god. Likewise, god has endowed us with the capacity for love. This
capacity for love is one of the ways in which we are "created in the image of god."
 For god so loved (agape) the world, that he gave his only begotten son, that whoever believes in
him should not perish, but have eternal life. (john 3:16)
Caring
 The core of nursing practice
a. Compassion
 Deep awareness of the suffering of another coupled with the wish to relieve it.
 Compassion is when you see that someone needs help and you want to help them.

1. Promote sweetness
2. Show how to be gentle
3. Enforce rules
4. Provide structure
5. Expect her to help

b. Conscience
 The awareness of a moral or ethical aspect to one's conduct together with the urge to prefer right
over wrong: Let your conscience be your guide.
 A source of moral or ethical judgment or pronouncement: a document that serves as the nation's
conscience.
 Conformity to one's own sense of right conduct: a person of unflagging conscience

c. Competence
 The quality of being competent; adequacy; possession of required skill, knowledge, qualification,
or capacity.
Here are a few tips on becoming an expert.
1. Set your goal
2. Plan your strategy
3. Study thoroughly
4. Perform diligently
5. Strengthen it by visualizing
6. Add positive emotions
7. Ask for help and accept feedback
8. Choose your environment
9. Commitment is essential
10. Persist

d. Confidence

 Confidence is generally described as a state of being certain, either that a hypothesis or

prediction is correct, or that a chosen course of action is the best or most effective
 Self-confidence is having confidence in oneself

 Remember that no one is perfect

 Identify your successes
  Be thankful for what you have
 Look in the mirror and smile

e. Commitment

 Commitment means the duty or pledge to something or someone

How to Become a Committed Adult Learner

1. Not everyone learns from books
2. Broaden your definition of learning
3. Do things
4. Create
5. Take classes, both formal and informal
6. Teach others

Love of People
 Respect for the Dignity of Each Person Regardless of Race, Creed, Color & Gender
 The Essential Teaching Of Jesus: "Love All People As Yourself

How to Respect Other People

1. Always think before speaking.
2. Empathize with the other person.
3. Refrain from criticizing other people’s beliefs different from yours.
4. Don’t push your beliefs.
5. Understand that everyone you meet is unique.
6. Listen to what other people have to say even if you don’t agree.

Love of Country
 It's always good to love your country. After all, it's where you live. Here are some tips that can
help you discover how great your country really and truly is!

 Patriotism
1. Be an active citizen.
2. Study the history of your country.
3. Focus on current events.
4. Read stories, tall tales, and patriotic legends of your country.
5. Have a hero.
6. Wear patriotic colors.
7. Fly a flag
8. Celebrate holidays.
9. Encourage children to love their country so they will have respect someday as a citizen.
10. Don't be prejudiced or biased.
11. Abusing your country or taking advantage of any of its systems or programs is not a good
way to show your love.
12. You certainly do not have to agree with every event and decision made in your country's
history to love your country
  Preservation and Enrichment of the Environmental and Cultural Heritage
1. Cultural heritage
Physical or "tangible cultural heritage" includes buildings and historic places, monuments, artifacts, etc.,
that are considered worthy of preservation for the future. These include objects significant to the
archaeology, architecture, science or technology of a specific culture.
2. Natural Heritage
"Natural heritage" is also an important part of a culture, encompassing the countryside and natural
environment, including flora and fauna, scientifically know as biodiversity

V. Core competencies under the 11 Key Areas of Responsibility

1. Patient care competencies

 Cluster of key areas of responsibility that include safe and quality care, communication, health
education and collaboration and teamwork.
a. Safe and Quality Nursing Care
o Promotes achievement of client outcome by providing nursing care that enhances the
care delivery in any setting and across the life span in order to protect client, family,
significant others and other health care personnel.
Examples:
 Safe and quality nursing care
 Medical and surgical asepsis
 Safety use of the equipment
 Use of restraints/safety devices
 Handling hazardous and infectious materials
 10 golden rules in drug administration
 Home safety

b. Communication
o The nurse utilizes principles of communication in the care of clients/families and
communities
 Nursing informatics
 Nurse clients relationship
 Inter and intra personal communication
 Effective/functional communications
 Therapeutic relationship
 Elements of communication

c. Collaboration
o The nurse establishes collaborative relationship with colleagues and other members of
the health team
 Inter and intra-professional relationship
 The health care delivery system
 Health/hospital team
 Referral

d. Health Education
 o The nurse utilizes principles in teaching/learning in addressing the health problems of the
clients/family/significant others
 Clients education
 Principles in teaching/learning
 Discharge planning
 Learning domains
 Teaching strategies
 Barriers to learning

2. Enhancing
 Cluster of key areas of responsibility that ensures safe and quality nursing care to include
research and quality improvement

a. Research
o Nursing research advances the discipline of nursing, helps develop nursing knowledge
and improves nursing care
 Evidence-based practice
 Research methodologies
 Research process
 Sources of knowledge
 COPAR –Community Organizing Participatory Action Research

b. Quality Improvement
o The nurse participates in activities towards quality care management that will ensure
quality patient care.
 Total patient care
 Individualized nursing care

3. Empowering
 Cluster of key areas of responsibility that mandate compliance to the standards of legal, ethico-
moral responsibilities and personal and professional development

a. Legal Responsibilities
o The nurse adheres to practice in accordance with the laws, policies and guidelines
affecting nursing.
 Sanitation law (PD 856)
 Reproductive right
 Bill of rights
 Informed consent
 Provision on health, women and family
 Contracts and other legal forms
 RA 9173

b. Ethico-moral responsibilities
 o The nurse observes ethico-moral considerations in the practice of the profession.
 Accountability
 Professionalism
 Confidentiality
 Privacy
 Ethical principles
 Code of ethics
 Patient’s bill of rights
 Ethical dilemma

c. Personal and Professional development

o The nurse accepts responsibility for one’s personal and professional development in the
practice of nursing.
 Nursing theories
 Historical development in nursing
 Nursing as a science, art, professional vocation
 Professional decorum

4. Enabling
 Cluster of key areas of responsibility that provide support to effective and efficient performance of
patient care competencies including management of resources and environment and record
management

a. Management of Resources and Environment

o Includes managerial and supervisory skills that enhance nursing care delivery to protect
clients, family, significant others.
 Establishing priorities
 Case management
 Advocacy
 Continuity of care
 Resources of management
 Triage

b. Records Management
o The nurse maintains accurate and updated documentation of patient care.
 SOAPIE charting
 Legal imperatives in record keeping
 The nursing care plan
 Kardex
 Confidentiality and privacy of patients records

/cj14