A.

PHILOSOPHIES

I. FLORENCE NIGHTINGALE

FLORENCE NIGHTINGALE

Ø Was born in Florence Italy

Ø May 12, 1820

Ø was provided with very broad education

Ø fought the bureaucracy for bandages, food, fresh bedding, & cleaning supplies for the soldiers during
the Crimean War

Ø great concern for the well-being of the English soldiers

Ø she provided comfort for the critically ill & dying

Ø after the war, she established schools of nursing

Ø She died on August 13, 1910

Ø MOTHER OF MODERN NURSING ---She used the information gathered through life experiences
in the development of nursing

Ø GERMANY

- was the first site of organized nursing school in1836

- Pastor Theodor Fliedner; opened a hospital in Kaiserswerth Germany

- one patient, one nurse & one cook

- lack of work force led to the development of a school in nursing

- the physician spent time to teach nursing students

Ø GERTRUDE REICHARDT

- 1ST Matron of the Deaconess School of Nursing

- no textbooks available until 1837

- Nightingale visited Kaiserswerth for 14 days

- she entered the nursing program July 6, 1851, the 134th nursing student

- she developed both nursing care & management skills

Approach to Nursing:
Ø Used her knowledge, understanding & prevalence of disease & her observation to develop an
approach to nursing

Ø CONTROL OF ENVIRONMENT---Individuals & family both healthy & ill

1. Ventilation & light

2. Proper disposal of sewage

3. Appropriate nutrition

Ø NOTES ON NURSING:

- thought to women who have personal charge of health of others

- everyday sanitary knowledge

- she wanted women to teach themselves to nurse

- In her writings, she provided much information on the influence of the environment

Environmental Model

Ø Manipulation of the physical environment as a component of nursing care

Major Areas Of Environment

1. Health Of Houses

- Badly constructed houses do for the healthy what badly constructed hospitals do for the sick. Once
insure that air is stagnant & sickness is certain to follow”

- Cleanliness outside the house affects the inside

2. Ventilation & Warming

- “keep the air he breathes as pure as the external air w/o chilling him”

3. Light

- patient’s need direct sunlight

- sick people rarely lie with their face toward the wall but are much more likely to face the window

4. Noise

- patient’s should never be waked intentionally or accidentally

- noise affects the healing

5. Variety

- Variety of environment was a critical aspect affecting the patient’s recovery

- effect of the body & the mind

- reading, needlework, writing, cleaning activities to relieve boredom.

6. Bed And Bedding

- Keep bedding clean, neat, & dry & position the patient for maximum comfort

7. Cleanliness Of Rooms And Walls

- “the greater part of nursing consists in preserving cleanliness”

- she urges removal of dust instead of relocating

- a clean room is a healthy room

8. Personal Cleanliness

- Skin is important

- excretion must be washed

- unwashed skin can poison, drying & bathing can provide great relief

- ”it is necessary to keep the pores of the skin free from all obstructing excretions”

- “every nurse ought to wash her hands very frequently during the day

9. Nutrition And Taking Food

10. Chattering Hopes And Pieces Of Advice

11. Observation Of The Sick

12. Social Considerations

Metaparadigm In Nursing

Ø Nursing

- “what nursing has to do...is to put the patient in the best condition for nature to act upon him”

- signifies the proper use of the major areas in environment

Ø Person

- Not defined by Nightingale specifically, but are defined in relationship to their environment
& the impact on them

Ø Environment

- She focused on ventilation, warmth, noise, light, & cleanliness

- All that surrounds human beings is considered in relation to his state of health

Ø Health

- No definition of health specifically

- pathology teaches the harm disease has done

- “nature alone cures”

- Nursing should provide care to the healthy & ill & discussed health promotion as an activity
in which nurses should engage

II: VIRGINIA HENDERSON

Ø She was the “First Lady of Nursing” and “First Truly International Nurse”.

Ø She began her career in Public health nursing in the Henry Street Settlement and visiting nurse service
in Washington, D.C.

Ø She was First Full-time Instructor in nursing in Virginia when she was at Norfolk Protestant Hospital.

Ø During her years at Teacher College, Columbia University, she was an outstanding teacher and
student.

Ø She was Selected to the American Nurse Association Hall of Fame and had the sigma Theta Tau
international Library named in her honored.

Ø She introduced Textbook of the Principles and practice.

Ø She also directed twelve-years project entitled Nursing Study Index.

Ø In Nature of Nursing – she expressed her belief about the essence of nursing and influenced the hearts
and mind of those who read it.

Ø In 1921 – Virginia Henderson was an early advocate for introduction of psychiatric nursing in
curriculum and serve on committee to develop such a course at Eastern State Hospital in Williamsbrug.

Ø Age of 75 – Henderson directed her career to international teaching and speaking.

Ø 1988 – she was honored by the Virginia Nurse association and when the Virginia Historical Nurse
Leadership Award was presented to her.

Ø In 2000 – the Virginia nurse association recognize Henderson as one of fifty-one Pioneer Nurse in
Virginia

"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 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”.

14 Basic Needs

Ø Physiological

1. Breath 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. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the
available health facilities.

Ø Sociological

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

13. Play or participate in various forms of recreation

Ø Spiritual

14.Worship according to one’s faith

Metaparadigm In Nursing

Ø Nursing

- Henderson asserted that nurse function independently from the physician, but they must promote the
treatment plan prescribe by the physician.

- Although part of the health team, the nurse must act independently but in coordination with with the
therapeutic plan developed by the team

Ø Person
- Is an individual who requires assistance to achieve health and independence or in some case, a
peaceful death.

Ø Environment

- Individuals in relation to families

- Supports tasks of private and public agencies

- Society expects nurses to act for individuals who are unable to function independently

- Basic nursing care involves providing conditions under which the patient can perform the 14
activities unaided

Ø Health

- Definition based on individual’s ability to function independently as outlined in the 14 components.

- Nurses need to stress promotion of health and prevention and cure of disease.

- Good health is a challenge.

- Affected by age, cultural background, physical, and intellectual capacities, and emotional balance

- Impact on health by working of various social issues.

The Three Level Compromising The Nurse-Patient Relationship:

1. “The nurse as a substitute for the patient”

- In times of illness, when the patient cannot function fully, the nurse serve as then substitute as to
what the patient lack such, as knowledge, will and strength in order to make him completed, whole
independence once again.

2. “The nurse as a helper to the patient”

- In situation where the patient cannot meet his basic needs, the nurse serve as a helper to
accomplish them.

3. “The nurse as a partner with the patient”

- As a partners, the nurse and the patient formulate the plan together. Both as an advocate and as a
resource-person , the nurse can empower the patient to make effective decisions regarding his care plan.

III. FAYE GLENN ABDELLAH

FAYE GLENN ABDELLAH

Ø Identified 21 nursing problems.

Ø Defined nursing as a service to individuals and families therefore to society.

Ø Conceptualized nursing as an Art and science.

21 Nursing Problems

1. To maintain good hygiene

2. To promote optimal activity; exercise rest and sleep

3. To promote safety

4. To maintain good body mechanics

5. To facilitate the maintenance of a supply of oxygen

6. To facilitate maintenance of nutrition

7. To facilitate maintenance of elimination

8. To facilitate the maintenance of F&E balance

9. To recognize the physiologic responses of the body to disease condition

10. To facilitate the maintenance of regulatory mechanisms and functions

11. To facilitate the maintenance of sensory function

12. To identify and accept the positive and negative expressions, feelings and reactions

13. To identify and accept the interrelatedness of emotions and illness

14. To facilitate the maintenance of effective verbal and non-verbal communication

15. To promote the development of productive interpersonal relationship

16. To facilitate the progress towards achievement of personal spiritual goals

17. To create and maintain a therapeutic environment18. To facilitate awareness of self as an individual
with varying needs

19. To accept the optimum possible goals

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

IV. JEAN WATSON PhD, RN, FAAN, HNC

Ø Theorist was born in West Virginia, US

Ø Educated: BSN, University of Colorado, 1964,

Ø MS, University of Colorado, 1966,

Ø PhD, University of Colorado, 1973

Ø Distinguished Professor of Nursing

Ø Endowed Chair in Caring Science at the University of Colorado Health Sciences Center.

Ø Fellow of the American Academy of Nursing.

Ø Previously, Dean of Nursing at the University Health Sciences Center and President of the National
League for Nursing

Ø Undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and PhD in
educational psychology and counseling. She has six (6) Honorary Doctoral Degrees.

Ø Her research has been in the area of human caring and loss.

Ø In 1988, her theory was published in “nursing: human science and human care”.

Ø Jean Watson’s Theory of Transpersonal Caring also called Theory of Human

Ø Caring or The Caring Model was developed in 1979.

Theory of Human Caring or The Caring Model

Ø It emphasizes the humanistic aspects of nursing in combination with scientific knowledge

Ø Watson designed this theory to bring meaning and focus to nursing as a distinct health profession

Ø Watson believes that: “Caring” is an endorsement of professional nurses identity

Ø According to Watson, the nurse’s role is to:

- Establish a caring relationship with patients

- Treat patients as holistic beings (body, mind and spirit)

- Display unconditional acceptance

- Treat patients with a positive regard

- Promote health through knowledge and intervention

- Spend uninterrupted time with patients: “caring moments”

10 CARATIVE FACTORS

1. The formation of a humanistic- altruistic system of values. (concern for the welfare of other,
selflessness)

– Begins developmentally at an early age with values shared with the parents.

– Mediated through one’s own life experiences, the learning one gains and exposure to the humanities.
– Is perceived as necessary to the nurse’s own maturation which then promotes altruistic behavior
towards others

2. The installation of faith-hope.

– Is essential to both the carative and the curative processes.

– When modern science has nothing further to offer the person, the nurse can continue to use faith-
hope to provide a sense of well-being through beliefs which are meaningful to the individual.

3. The cultivation of sensitivity to one’s self and to others.

– Explores the need of the nurse to begin to feel an emotion as it presents itself.

– Development of one’s own feeling is needed to interact genuinely and sensitively with others.

– Striving to become sensitive, makes the nurse more authentic, which encourages self-growth and
self-actualization, in both the nurse and those with whom the nurse interacts.

– The nurses promote health and higher level functioning only when they form person to person
relationship

4. The development of a helping-trust relationship

– Strongest tool is the mode of communication, which establishes rapport and caring.

– Characteristics needed to in the helping-trust relationship are:

– Congruence

– Empathy

– Warmth

– Communication includes verbal, nonverbal and listening in a manner which connotes empathetic
understanding

5. The promotion and acceptance of the expression of positive and negative feelings.

– “Feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring
relationship”.

– Awareness of the feelings helps to understand the behavior it engenders.

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

– The scientific problem- solving method is the only method that allows for control and prediction, and
that permits self-correction.

– The science of caring should not be always neutral and objective

7. The promotion of interpersonal teaching-learning.

– The caring nurse must focus on the learning process as much as the teaching process.

– Understanding the person’s perception of the situation assist the nurse to prepare a cognitive plan.

8. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and
spiritual environment.

– Watson divides these into eternal and internal variables, which the nurse manipulates in order to
provide support and protection for the person’s mental and physical well-being.

– The external and internal environments are interdependent.

– Nurse must provide comfort, privacy and safety as a part of this carative factor

9. Assistance with the gratification of human needs.

– It is based on a hierarchy of need similar to that of the Maslow’s.

– Each need is equally important for quality nursing care and the promotion of optimal health.

– All the needs deserve to be attended to and valued

10. The allowance for existential-phenomenological forces.

– Phenomenology is a way of understanding people from the way things appear to them, from their
frame of reference.

– Existential psychology is the study of human existence using phenomenological analysis.

– This factor helps the nurse to reconcile and mediate the incongruity of viewing the person holistically
while at the same time attending to the hierarchical ordering of needs.

– Thus the nurse assists the person to find the strength or courage to confront life or death.

The Seven Assumption

1. Caring can be effectively demonstrated and practiced only interpersonally.

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

3. Effective caring promotes health and individual or family growth.

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

5. 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.

6. Caring is more “ healthogenic” than is curing. A science of caring is complementary to the science of
curing.

7. The practice of caring is central to nursing

Watson’s Ordering of Needs

Lower order needs (biophysical needs)

– The need for food and fluid

– The need for elimination

– The need for ventilation

Lower order needs (psychophysical needs)

– The need for activity-inactivity

– The need for sexuality

Higher order needs (psychosocial needs)

– The need for achievement

– The need for affiliation

– Higher order need (intrapersonal-interpersonal need)

– The need for self-actualization

Metaparadigm In Nursing

Ø Person/Human being

Human being refers to “….. a valued person in and of him or herself to be cared for, respected, nurtured,
understood and assisted; in general a philosophical view of a person as a fully functional integrated self.
He, human is viewed as greater than and different from, the sum of his or her parts”.

Ø Health

Watson adds the following three elements to WHO definition of health:

– A high level of overall physical, mental and social functioning

– A general adaptive-maintenance level of daily functioning

– The absence of illness (or the presence of efforts that leads its absence)

Ø Environment/society

According to Watson, caring (and nursing) has existed in every society.

A caring attitude is not transmitted from generation to generation.

It is transmitted by the culture of the profession as a unique way of coping with its environment.

Ø Nursing

“Nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health”.

It focuses on health promotion and treatment of disease. She believes that holistic health care is central to
the practice of caring in nursing.

She defines nursing as…..

“A human science of persons and human health-illness experiences that are mediated by professional,
personal, scientific, esthetic and ethical human transactions”.

C. MIDDLE RANGE THEORIES

VII. HILDEGARD PEPLAU PhD, RN, FAAN (1909 - 1999)

Ø MOTHER OF PSYCHIATRIC NURSING ( Founder of Modern Psychiatric Nursing)

Ø FAAN - Fellow of the American Academy of Nursing

Ø Made extraordinary and sustained contributions to nursing and health care throughout their career

Ø Nursing leaders in EDUCATION, MANAGEMENT, PRACTICE and RESEARCH

Ø PhD – Doctor of Philosophy

Ø Born in Reading, Pennsylvania on September 1, 1909

Ø Graduated from the Pottstown, Pennsylvania Hospital

Ø Worked as an Operating room Supervisor at Pottstown Hospital

Ø Received a B.A. in interpersonal Psychology from Bennington College, Vermont, in 1943

Ø M.A. (Psychiatric Nursing) from Teachers College, Columbia, New York, in 1947

Ø Ed. D in curriculum Development from Columbia in 1953

Ø During World Was II, Hildegard Peplau was a member of the Army Nurse Corps and worked in a
neuropsychiatric hospital in London, England

Ø She also did work at Bellevue and Chestnut Lodge Psychiatric Facilities and was in contact with
renowned psychiatrist :

o Freida-Riechman

o Harry Stack Sullivan

Ø Holds numerous awards and position:

- The only nurse to serve the ANA as executive director and later as president

- Served two terms on the Board of the International Council of Nurses (ICN).

- In 1997, she received nursing's highest honor, the Christiane Reimann Prize, at the ICN
Quadrennial Congress.

- In 1996, the American Academy of Nursing honored Peplau as a "Living Legend,"

- In 1998, the ANA inducted her into its Hall of Fame

Ø Retired in 1974

Ø Died peacefully on March 17, 1999 at her home in Sherman Oaks California after a brief of illness

Psychodynamic Nursing

Ø Understanding of ones own behavior

Ø To apply principles of human relations to the problems that arise at all levels of experience

Ø Nursing is an interpersonal process because it involves interaction between two or more individuals
with a common goal.

Ø The nurse and patient work together so both become mature and knowledgeable in the process.

Ø The attainment of goal is achieved through the use of a series of steps following a series of pattern.

Ø According to Peplau, nursing is therapeutic in that it is a healing art, assisting an individual who is sick
or in need of health care.

Metaparadigm In Nursing

1. Nursing
- A significant therapeutic interpersonal process. It functions cooperatively with other human
process that make health possible for individuals in communities

2. Person

- A developing organism that tries to reduce anxiety caused by needs

3. Environment

- Existing forces outside the organism and in the context of culture

4. Health

- A word symbol that implies forward movement of personality and other ongoing human processes
in the direction of creative, constructive, productive, personal and community living.

Roles of nurse

Ø Stranger : receives the client in the same way one meets a stranger in other life situations provides an
accepting climate that builds trust.

Ø Teacher : who imparts knowledge in reference to a need or interest

Ø Resource Person : one who provides a specific needed information that aids in the understanding of a
problem or new situation

Ø Counselors : helps to understand and integrate the meaning of current life circumstances ,provides
guidance and encouragement to make changes

Ø Surrogate : helps to clarify domains of dependence interdependence and independence and acts on
clients behalf as an advocate.

Ø Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually
satisfying way

Theory of Interpersonal Relations

Ø Middle range descriptive classification theory

Ø Influenced by Harry Stack Sullivan's theory of inter personal relations (1953)

Ø Also influenced by Percival Symonds , Abraham Maslow's and Neal Elger Miller

Ø Identified four sequential phases in the interpersonal relationship:

1. Orientation

2. Identification

3. Exploitation

4. Resolution
Orientation Phase

Ø During this phase, the individual has a felt need and seeks professional assistance

Ø The nurse helps the individual to recognize and understand his/ her problem and determine the need
for help

Ø Problem defining phase: identifies problem

Ø Starts when client meets nurse as stranger

Ø Defining problem and deciding type of service needed

Ø Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past
experiences

Ø Nurse responds, explains roles to client, helps to identify problems and to use available resources and
services

Ø Activities:

• Nurse and patient come together as strangers;

• Meeting initiated by patient who expresses a “felt need”;

• Work together to recognize,

• Clarify and define facts related to need

Identification Phase

Ø The patient identifies with those who can help him/ her.

Ø The nurse permits exploration of feelings to aid the patient in undergoing illness as an experience that
reorients feelings and strengthens positive forces in the personality and provides needed satisfaction.

Ø Selection of appropriate professional assistance

Ø Patient begins to have a feeling of belonging and a capability of dealing with the problem which
decreases the feeling of helplessness and hopelessness

Ø Activities:

• Patient participates in goal setting;

• has feeling of belonging and selectively responds to those who can meet his or her needs.

Exploitation Phase

Ø During this phase, the patient attempts to derive full value from what he/ she are offered through the
relationship.

Ø The nurse can project new goals to be achieved through personal effort and power shifts from the
nurse to the patient as the patient delays gratification to achieve the newly formed goals.
Ø Use of professional assistance for problem solving alternatives

Ø Advantages of services are used is based on the needs and interests of the patients

Ø Individual feels as an integral part of the helping environment

Ø They may make minor requests or attention getting techniques

Ø The principles of interview techniques must be used in order to explore, understand and adequately
deal with the underlying problem

Ø Patient may fluctuates on independence

Ø Nurse must be aware about the various phases of communication

Ø Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step

Ø Activity: Patient actively seeks and draws knowledge and expertise of those who can help

Resolution Phase

Ø Termination of professional relationship

Ø The patients’ needs have already been met by the collaborative effect of patient and nurse

Ø Now they need to terminate their therapeutic relationship and dissolve the links between them.

Ø Sometimes may be difficult for both as psychological dependence persists

Ø Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and
both becomes mature individuals

Ø Activity: Occurs after other phases are completed successfully. This leads to termination of the
relationship

VIII. IDA JEAN ORLANDO

IDA JEAN ORLANDO

Ø Theorist, Ida Jean Orlando was born in 1926.

Ø Ida J. Orlando was one of the first nursing theorists to write about the nursing process.

Ø Nursing diploma - New York Medical College

Ø BS in public health nursing - St. John's University, NY,

Ø MA in mental health nursing - Columbia University, New York.

Ø Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental Health
Psychiatric Nursing.

Ø Project investigator of a National Institute of Mental Health grant entitled: Integration of Mental
Health Concepts in a Basic Nursing Curriculum.

Ø Her theory was published in her 1961 book, The Dynamic Nurse-Patient Relationship.
Ø Further development of her theory at McLean Hospital in Belmont, MA as Director of a Research
Project: Two Systems of Nursing in a Psychiatric Hospital. The results were conceptualized in her 1972
book titled: The Discipline and Teaching of Nursing Processes

Ø A board member of Harvard Community Health Plan, and served as both a national and international
consultant

Ø Theoretical Sources

- Paplau’s focus of interpersonal relationships in nursing

- Paplau acknowledged the influence of Harry Stack Sullivan on the development of her ideas

- Symbolic interactionism – Chicago school

Ø Use of field methodology

- John Dewey’s theory of inquiry

Ø Major Dimensions

- The role of the nurse is to find out and meet the patient's immediate need for help.

- The patient's presenting behavior may be a plea for help; however, the help needed may not be what it
appears to be.

- Therefore, nurses need good judgment to explore with patients the meaning of their behavior.

- This process helps nurse find out the nature of the distress and what help the patient need

Nursing Process

Assessment

Ø Systematic and continuous collection, validation and communication of client data as compared to
what is standard/norm

Purpose: to establish a data base

Types Of Assessment:

1. Initial Assessment – assessment performed within a specified time on admission

Ex: -Nursing admission assessment

-Physical assessment on admission

-Physician’s history & physical examination

2. Problem-Focused Assessment – use to determine status of a specific problem identified in an earlier

assessment

Ex: -Fluid intake & urine output (problem on urination-assess) (Diuresis/polyuria, Dysuria, Anuria,
Oliguria)
 -Snellens test (Visual Acuity)

3. Emergency Assessment – rapid assessment done during any physiologic/physiologic crisis of the
client to identify life threatening problems.

Ex: Assessment of a client’s airway, breathing status & circulation after a cardiac arrest

4. Time-Lapsed Assessment – reassessment of client’s functional health pattern

– Done several months after initial assessment to compare the clients current status to baseline data
previously obtained.

Types of Data:

1. Subjective Data – Symptom/Covert data

– Information from the client’s point of view or are described by the person experiencing it.

– Information supplied by family members, significant others, other health professionals are considered
subjective data.

Example: -pain, dizziness, ringing of ears/Tinnitus

(-) guarding behavior

(-) facial Grimace

2. Objective Data – Sign/Overt data

– Those that can be detected, observed or measured/tested using accepted standard or norm.

Example: -pallor, diaphoresis, BP=150/100, yellow discoloration of skin

-Patient has wobbling gait

-Petechiae

Methods of Data Collection:

1. Interview

– A planned, purposeful conversation/communication with the client to get information, identify

problems, evaluate change, to teach, or to provide support or counselling.

2. Observation

– use to gather data by using the 5 senses and instruments

Sources of Data:

1. Primary source – data directly gathered from the client using interview and physical examination.

2. Secondary source – data gathered from client’s family members, significant others, client’s medical
records/chart, other members of health team, and related care literature/journals.

Diagnosing
Ø Is the 2nd step of the nursing process

Ø The process of reasoning or the clinical act of identifying problems

Ø Identifies health care needs

Ø Analyze assessment information and derive meaning from this analysis.

Types of Nursing Diagnosis:

1. Actual Nursing Diagnosis – a client problem that is present at the time of the nursing assessment. It is
based on the presence of signs and symptoms.

– Constipation r/t long term use of laxative.

– Ineffective airway clearance r/t to viscous secretions

2. Potential Nursing Diagnosis – evidence about a health problem is incomplete or unclear. It requires
more data to support or reject it; or the causative factors are unknown. Problem is only considered
possible to occur

– Possible nutritional deficit

– Possible low self-esteem r/t loss job

3. Risk Nursing Diagnosis – is a clinical judgment that a problem does not exist, therefore no S/S are
present instead RISK FACTORS are present

*Risk factors indicates that a problem is only is likely to develop unless nurse intervene or do something
about it. No subjective or objective cues are present therefore the factors that cause the client to be more
vulnerable to the problem is the etiology of a risk nursing diagnosis.

– Risk for Constipation r/t inactivity and insufficient fluid intake

Planning

Ø To identify client goals; to determine priorities of care; to design nursing strategies to achieve expected
outcomes of care; to determine outcome criteria-

Ø SMART –Specific, Measurable, Attainable and Realistically Time-bound.

– Ex: to reduce fever within the baseline data of 37 by giving prn antipyretic medication and
performing tepid sponge bath for 4 hrs

Implementation
Ø To complete nursing actions necessary for accomplishing plan

Ø Reassess client.

Ø Review and modify existing care plan.

Ø Perform nursing actions.

*Nursing actions – directed towards providing for the patient’s immediate need

Evaluation

Ø To determine extent to which expected outcomes have been achieved.

IX. JOYCE TRAVELBEE

JOYCE TRAVELBEE

Ø Born in 1926,

Ø A psychiatric nurse, educator and writer.

Ø In 1956, she completed her Bachelor of Science degree in nursing education at Louisiana State
University and her Master of Science Degree in Nursing from Yale University in 1959.

Ø She started a doctoral program in Florida in 1973.

Ø Unfortunately, she was not able to finish the program because she died later that year. She passed
away at the prime age of 47 after a brief sickness.

Ø In 1952, Travelbee started to be an instructor focusing in Psychiatric Nursing at Depaul Hospital

Affiliate School, New Orleans, while working on her baccalaureate degree. Besides that, she also taught
Psychiatric Nursing at Charity Hospital School of Nursing in Louisiana State University, New York
University and University of Mississippi. In 1970,she was named Project Director at Hotel Dieu School
of Nursing in New Orleans. Travelbee was the director of Graduate Education at Louisiana State
University School of Nursing until her death.

Ø In 1963, Travelbee started to publish various articles in nursing journals. Her first book entitled:
Interpersonal Aspects of Nursing was published in 1966 and 1971.

Ø In 1969, she had her second book published entitled: Intervention in Psychiatric Nursing : Process in
the One-to-One Relationship.

Human to Human Relationship Model

Ø In her human-to-human relationship model, the nurse and the patient undergoes the following series of
interactional phases:

Original Encounter
Ø This is described as the first impression by the nurse of the sick person and vice-versa. The nurse and
patient see each other in stereotyped or traditional roles.

Emerging Identities

Ø This phase is described by the nurse and patient perceiving each other as unique individuals. At this
time, the link of relationship begins to form.

Empathy

Ø Travelbee proposed that two qualities that enhance the empathy process are

Ø Similarities of experience

Ø the desire to understand another person

Ø This phase is described as the ability to share in the person’s experience. The result of the empathic
process is the ability to expect the behavior of the individual with whom he or she empathized.

Sympathy

Ø Sympathy happens when the

Ø Nurse wants to lessen the cause of the patient’s suffering.

Ø “When one sympathizes, one is involved but not incapacitated by the involvement.” The nurse should
use a disciplined intellectual approach together with therapeutic use of self to make helpful nursing
actions.

Rapport

Ø Rapport is described as nursing interventions that lessens the patient’s suffering.

Ø The nurse and the sick person are relating as human being to human being.

Ø The sick person shows trust and confidence in the nurse. “A nurse is able to establish rapport because
she possesses the necessary knowledge and skills required to assist ill persons, and because she is able to
perceive, respond to, and appreciate the uniqueness of the ill human being.”

Note that the above stated interactional phases are in consecutive order and developmentally achieved
by the nurse and the patient as their relationship with one another goes deeper and more therapeutic

B. GRAND THEORIES

V. MADELEINE LEININGER

MADELEINE LEININGER

Ø Developed the Transcultural Nursing Model.

Ø Advocated that nursing is a humanistic and scientific mode of helping a client through specific cultural
caring process to improve or maintain a health condition.

Ø Leininger is the founder of the transcultural nursing movement in education research and practice.

Transcultural Nursing

Focus - cultural dynamics that influence the nurse–client relationship.

(area of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of
individuals or groups of similar or different cultures are compared)

Goal – culturally congruent holistic care.

Provide culture-specific and universal nursing care practices to promote well-being or to help people face
unfavorable human conditions in culturally meaningful ways'

VI. NOLA PENDER

NOLA PENDER

The Major Concepts and Definitions of the Health Promotion Model

Ø The health promotion model (HPM) proposed by Nola J Pender (1982; revised, 1996) was designed to
be a “complementary counterpart to models of health protection.”

Ø It defines health as a positive dynamic state not merely the absence of disease. Health promotion is
directed at increasing a client’s level of well being.

Ø The health promotion model describes the multi dimensional nature of persons as they interact within
their environment to pursue health.

A. Individual Characteristics and Experience

Ø Prior related behavior

Ø Frequency of the similar behavior in the past.

Ø Direct and indirect effects on the likelihood of engaging in health promoting behaviors.

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.

Personal biological factors

– Include variable such as age gender body mass index pubertal status, aerobic capacity, strength,
agility, or balance.
Personal psychological factors

– Include variables such as self esteem self motivation personal competence perceived health status
and definition of health.

Personal socio-cultural factors

– Include variables such as race ethnicity, acculturation, education and socioeconomic status.

B. Behavioural Specific Cognition and Affect

Perceived Benefits Of Action

– Anticipated positive outcomes that will occur from health behaviour.

Perceived Barriers To Action

– Anticipated, imagined or real blocks and personal costs of understanding a given behaviour

Perceived Self Efficacy

– Judgment of personal capability to organize and execute a health-promoting behaviour. 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 behaviour 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 behaviours, beliefs, or attitudes of the others. Interpersonal influences

include: norms (expectations of significant others), social support (instrumental and emotional
encouragement) and modelling (vicarious learning through observing others engaged in a particular
behaviour). 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
behaviour. 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 behaviour.

D. CONCEPTUAL MODEL/S

X. DOROTHEA OREM

DOROTHEA OREM
Self Care and Self Deficit Theory

Ø Self-care – is the performance or practice of activities that individuals initiate and perform on their
behalf

– The human’s ability or power to engage in self-care

Ø 3 Classifications of Nursing Systems:

 Wholly compensatory – for people who are socially dependent on others for their existence and
well being
 Partly compensatory – both nurse and patient perform care measures
 Supportive – educative – where the nurse is able to perform or can and should learn to perform
required measures of self-care but cannot do so without assistance

XI. MARTHA ROGERS

Ø Conceptualizes the science of unitary human beings.

Ø Nursing as an art and science that is humanistic and humanitarian. It is directed toward the unitary
human and is concerned with the nature and direction of human development.

Ø The goal of every nurse is to participate in the process of change.

XII. IMOGENE KING

I. IMOGENE KING

Ø Postulated the goal attainment model.

Ø Described nursing as a helping profession that assists the individuals and groups in society to attain,
maintain, and restore health.

Ø Nursing is a process of action, reaction and interaction whereby nurse and client share information
about their perception in the nursing situation.

Goal Attainment Theory

Ø Believes that there are 3 interacting systems:

· Individual (Personal System)

· Group (Interpersonal System)

· Society (Social Systems)

Xll: SISTER CALLISTA ROY

Ø Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy.
Ø At age 14 she began working at a large general hospital, first as a pantry girl, then as a maid, and
finally as a nurse's aide.

Ø She entered the Sisters of Saint Joseph of Carondelet.

Ø She earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College, Los Angeles in
1963.

Ø a master's degree program in pediatric nursing at the University of California ,Los Angeles in 1966.

Ø She also earned a master’s & PhD in Sociology in 1973 & 1977 ,respectively

Ø Sr. Callista had the significant opportunity of working with Dorothy E. Johnson

Ø Johnson's work with focusing knowledge for the discipline of nursing convinced Sr. Callista of the
importance of describing the nature of nursing as a service to society and prompted her to begin
developing her model with the goal of nursing being to promote adaptation.

ADAPTATION THEORY

Ø System-a set of parts connected to function as a whole for some purpose.

Ø Stimulus-something that provokes a response, point of interaction for the human system and the
environment

Ø Focal Stimuli-internal or external stimulus immediately affecting the system

Ø Contextual Stimulus-all other stimulus present in the situation.

Ø Residual Stimulus-environmental factor, that effects on the situation that are unclear.

Ø Regulator Subsystem-automatic response to stimulus (neural, chemical, and endocrine)

Ø Cognator Subsystem-responds through four cognitive responds through four cognitive-emotive

channels (perceptual and information processing, learning, judgment, and emotion)

Ø Behavior -internal or external actions and reactions under specific circumstances

Ø Physiologic-Physical Mode
– Behavior pertaining to the physical aspect of the human system

– Physical and chemical processes

– Nurse must be knowledgeable about normal processes

– 5 needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection)

Ø Self Concept-Group Identity Mode

– The composite of beliefs and feelings held about oneself at a given time. Focus on the
psychological and spiritual aspects of the human system.

– Need to know who one is, so that one can exist with a state of unity, meaning, and purposefulness
of 2 modes (physical self, and personal self)

Ø Role function Mode

– Set of expectations about how a person occupying one position behaves toward a occupying
another position. Basic need-social integrity, the need to know who one is in relation to others

Ø Interdependence Mode

– Behavior pertaining to interdependent relationships of individuals and groups. Focus on the close
relationships of people and their purpose.

– Each relationship exists for some reason. Involves the willingness and ability to give to others and
accept from others.

– Balance results in feelings of being valued and supported by others. Basic need - feeling of security
in relationships

Ø Adaptive Responses-promote the integrity of the human system.

Ø Ineffective Responses-neither promote not contribute to the integrity of the human system

Ø Coping Process-innate or acquired ways innate or of interacting with the changing of environment

SEMIFINALS

FILIPINO LOCAL THEORIES

DR. CARMELITA DIVINAGRACIA: Advance Nurse practitioners’ Composure Behavior and Patient’s
Wellness Outcome

DR. CARMELITA DIVINAGRACIA: Advance Nurse practitioners’ Composure Behavior and

Patient’s Wellness Outcome

Biography
Ø Filipino Nurse Theorist
Ø Association of the Deans Philippine Colleges of Nursing (ADPCN) Former President
Ø Dean of University of the East Ramon Magsaysay Memorial Medical Center, Inc. (UERMMMC)
College of Nursing
Ø Member of CHED ‘s Technical committee on Nursing Education. Has been lauded for developing the
art and competency of teaching nursing.
Ø Has been a clinic nurse, staff nurse, head nurse, instructor, assistant dean and dean
Ø Expert in Research and Education
Ø Has lectured and written about her work as a nurse and has use her hands-on experience to develop
better ways to teach nursing.
Ø Her love for nursing and her dedication to carve out learning tools for nursing students has been a
commendable and rare field of discipline.
 
Education
Ø Bachelor’s degree in Nursing at the University of the East Ramon Magsaysay Memorial Medical
Center in 1962
Ø Master’s degree in Nursing at the University of the Philippines in 1975
Ø Doctorate’s degree in Nursing at the University of the Philippines in 2001

Award
Ø Recipient of the Anastacia Giron Tupas Award given by the Philippine Nursing Association (PNA) in
2008.

Theory

Objective of the study

Ø Determine the effects of composure behavior of the advance nurse practitioner on the wellness outcome
of the selected cardiac patients
 

Significance of the Study

Ø Nursing as a healthcare profession would prove its worth of being at par in quality performance with
other healthcare professionals

Study Population
Ø Adult Cardiac Patients admitted and confined at the Philippines Heart center, Coronary Care Unit.
 

Definition of Terms

Advance Nurse Practitioners

· BSN graduate
· Licensed and has a clinical experience of at least 2 years in the clinical area
· Has undergone special training in critical area
· Set of behaviors or nursing measures that the nurse demonstrates to selected cardiac patients

Composure Behaviors
· A condition of being in a state of well-being, a coordinated and integrated living pattern that involves
the dimension of wellness.

Theory COMPOSURE Behaviours

Dr. Carmelita C. Divinagracia conducted a study to determine the effects of COMPOSURE behaviours of

the advanced practitioner on the recovery of selected patients at the Philippine Heart Center. Behaviours
include: competence, presence and prayer, open-mindedness, stimulation, understanding, respect and
relaxation, and empathy.

Composure Behaviours

COMpetence
· An in-depth knowledge and clinical expertise demonstrated in caring for patients.
· This also stands for consistency and congruency of words and deeds of the nurse. 

Presence and Prayer
· A form of nursing measure which means being with another person during times of need.
· This includes therapeutic communication, active listening, and touch.
· It is also a form of nursing measure which is demonstrated through reciting a prayer with the patient and
concretized through the nurse’s personal relationship and faith in God.

Open-mindedness
· A form of nursing measure which means being receptive to new ideas or to reason.
· It conveys a manner of considering patient’s preferences and opinions related to his current health
condition and practices and demonstrate the flexibility of the nurse to accommodate patient’s views.

Stimulation
· a form of nursing measure demonstrated by means of providing encouragement that conveys hope and
strength, guidance in the form of giving explanation and supervision when doing certain procedures to
patient, use of complimentary words or praise and smile whenever appropriate.
· Appreciation of what patient can do is reinforced through positive encouraging remarks and this is done
with kind and approving behavioural approach.

Understanding
· According to her, it conveys interest and acceptance not only of patient’s condition but also his entire
being.
· This is manifested through concerned and affable facial approach; this is a way of making the patient
feel important and unique.

Respect
· Acknowledging the 31 patient’s presence.
· Use of preferred naming in addressing the patient, po and opo, is a sign of positive regard.
· It is also shown through respectful nods and recognition of the patient as someone important.

Relaxation
· Entails a form of exercise that involves alternate tension and relaxation of selected group of muscles.

Empathy
· Senses accurately other person’s inner experience.
· The empathic nurse perceives the current positive thought and feelings and communicates by putting
himself in the patient’s place.

Ø Through the COMPOSURE behaviors of the nurse, holism is guaranteed to the patient.

Ø Divinagracia (2001) stated that nursing is a profession that surpasses time and aspects of the individual
as one of its clients. From the time the nurse admits a patient to the time of his discharge, the nurse’s
presence becomes a meaningful occasion for the two parties to develop mutual trust, acceptance, and
eventually satisfying relationships.

Ø This framework represents the orthopedic patients, COMPOSURE behaviors of novice nurses, and the
patient wellness outcome such as physiologic and biobehavioral. The innermost part of the oval is the
orthopedic patients. Being the recipient of care, they are being influenced by many factors and one of
those are the behaviors of nurses in implementing quality nursing care. As the COMPOSURE behaviors
of novice nurses envelope, the orthopedic patients as shown above, the researcher believe that there will
be an essential improvement in the patient wellness outcome, may it be on physiologic and/or
biobehavioral wellness outcome.

Patient Wellness Outcome

· This refers to the perceived wellness of selected orthopedic patients after receiving nursing care in terms
of physiologic and biobehavioral.
· Many illnesses are curable and may have only a temporary effect on health. Others, such as diabetes, are
not curable but can be managed with proper eating, physical activity, and sound medical supervision. It
should be noted that those possessing manageable conditions may be more at risk for other health
problems, so proper management is essential. For example, unmanaged diabetes is associated with high
risk for heart disease and other health problems.

Two patient wellness outcomes which have been categorized as:

· Biobehavioral

· Physiologic

These patient wellness outcomes reflect their needs as their illness turn to recovery and
rehabilitation. These needs must be met through high quality nursing care, none other than through
COMPOSURE behaviors. COMPOSURE behaviors have been inspired to the principle of holistic care
wherein a patient wellness outcome can be achieved through series of quality attributes of nurses, which
caters to every aspect of patient wellness, may it be biobehavioral or physiologic wellness outcome.

Physiologic Wellness Outcome

· This refers to the perceived wellness of selected orthopaedic patients after receiving nursing care in
terms of vital signs, bone pain sensation, and complete blood count.

Biobehavioral Wellness Outcome

· This refers to the perceived wellness of selected orthopaedic patients after receiving nursing care in
terms physical, intellectual, emotional, and spiritual.

Divinagracia (2001) as cited by Leocadio (2009), conceptualized forty statements that represented the
dimensions of wellness which include the physical, emotional, intellectual, and spiritual domain. Physical
domain involves muscle strength, mobility, posture, gait exercise, and activity tolerance and cardio-
respiratory endurance. Emotional domain includes awareness, orientation, understanding of own and
other personal feelings and ability to control and cope with emotions. Intellectual domain refers
knowledge and perception of a healthy self and ability to recognize the presence of risk factors and
preventive measures and spiritual domain is defined as development of inner self or one’s soul through a
relationship with God and others.

The most basic form of holistic communication is "Active listening". Active listening is a specific way of
hearing what a person says and feels, and reflecting that information back to the speaker. Its goal is to
listen to the whole person and provide her with empathic understanding. It is the skill of paying gentle,
compassionate attention to what has been said or implied. When you listen in this way to patients, you
just try to reflect the other person's feelings and deeper meanings, which helps them feel heard and
understood. You don't analyze, interpret, judge, or give advice. When patients are listened to in this way,
they are less anxious, complain less about their caregivers, and are more likely to comply with their
treatment plan.

A cardiac patient might be angry and complaining. As the nurse, you may try to avoid his room, and,
when you have to be there, move in and out as quickly as possible. Avoidance is one solution, but there
might be a different approach.

Active listening helps patients clarify and articulate their inner process. For a patient, being carefully
listened to can be a moving and profound experience, one that transforms the relationship between patient
and nurse. Active listening is particularly relevant in a hospital setting, where patients often report 132
that they feel isolated and invisible. It can make a difference in rebuilding a patient's sense of self. It can
also be rewarding for the nurse.

A positive total outlook on life is essential to wellness and each of the wellness dimensions. A “well”
person is satisfied in his/her work, is spiritually fulfilled, enjoys leisure time, is physically fit, is socially
involved, and has a positive emotional-mental outlook. This person is happy and fulfilled. Many experts
believe that a positive total outlook is a key to wellness

The way one perceives each of the dimensions of wellness affects total outlook. Researchers use the term
self-perceptions to describe these feelings. Many researchers believe that self-perceptions about wellness
are more important than actual ability. For example, a person who has an important job may find less
meaning and job satisfaction than another person with a much less important job. Apparently, one of the
important factors for a person who has achieved high level wellness and a positive life’s outlook is the
ability to reward himself/herself. Some people, however, seem unable to give themselves credit for their
life’s experiences. The development of a system that allows a person to positively perceive the self is
important. Of course, the adoption of positive perceive lifestyles that encourage improved self-perception
is also important.

· Emotional wellness is a person’s ability to cope with daily circumstances and to deal with personal
feelings in a positive, optimistic, and constructive manner. A person with emotional wellness is generally
characterized as happy, as opposed to depressed.

Ø A person with intellectual health is free from illnesses that invade the brain and other systems that
allow learning. A person with intellectual health also possesses intellectual wellness.

· Intellectual wellness is a person’s ability to learn and to use information to enhance the quality of daily
living and optimal functioning. A person with intellectual wellness is generally characterized as informed,
as opposed to ignorant.

Ø A person with intellectual health is free from illnesses that invade the brain and other systems that
allow learning. A person with intellectual health also possesses intellectual wellness.

· Physical wellness is a person’s ability to function effectively in meeting the demands of the day’s work
and to use free time effectively. Physical wellness includes good physical fitness and the possession of
useful motor skills. A person with physical wellness is generally characterized as fit versus unfit.
Ø A person with physical health is free from illnesses that affect the physiological systems of the body
such as the heart, the nervous system, and the like. A person with physical health possesses an adequate
level of physical fitness and physical wellness

· Spiritual wellness is a person’s ability to establish a values system and act on the system of beliefs, as
well as to establish and carry out meaningful and constructive lifetime goals. It is often based on a belief
in a force greater than the individual that helps one contribute to an improved quality of life for all
people. A 138 person with spiritual wellness is generally characterized as fulfilled as opposed to
unfulfilled

Ø Spiritual health is the one component of health that is totally comprised of the wellness dimension; for
this reason, spiritual health is considered to be synonymous with spiritual wellness.

Optimal health includes many areas, thus the term holistic (total) is appropriate. In fact, the word health
originates from a root word meaning “wholeness”

The holistic nurse is an embodiment of the care she renders. The nurse creates the calm environment in
any setting that facilitates treatment, healing and recovery from any pain or discomfort.

In terms of the COMPOSURE behaviors of advanced beginner nurses.

a. Competence • They always manifest good interpersonal and communication skills in dealing with
patients and able to extract significant information to aid in planning and delivery of effective nursing
care. However, they rarely develop health education plan based on the assessed and anticipated needs of
the patients.

b. Prayer • The advanced beginner nurses always allows some moment of silence. But they rarely pray
with the patients.

c. Presence • Indeed, the advanced beginner nurses often establish the purpose of the interaction and often
display interest to the 279 patients. Moreover, they sometimes spend time with patient even in silence

d. Open-mindedness • The advanced beginner nurses often create an environment of trust and rapport. On
the other hand, they sometimes listen attentively to patient. 

e. Stimulation • Likewise, the advanced beginner nurses always tell patient what he can do, what he is
supposed to do, and how to do it. More so, they often encourage patient to evaluate his action. 

f. Understanding • The advanced beginner nurses to often encourage the patient to feel comfortable in the
nurse-patient relationship. More so, they often clarify the message through the use of question and
feedback.

g. Respect • The advanced beginner nurses always call the patient by his/her preferred name and utilize
“po” and “opo” when being asked and they also provide options before making decisions.
h. Relaxation • They always evaluate and document the patient’s response to the intervention, observe
his/her breathing, and ask if he/she is feeling relaxed yet they sometimes take note of facial expression
and unnecessary body movements.

i. Empathy • Shows that they always encourage expression of feelings; focus on verbal and nonverbal
behavior and they often provide continuous feedback

DR. CARMELITA DIVINAGRACIA: Advance Nurse practitioners’ Composure Behavior and Patient’s
Wellness Outcome
SR. CAROL AGRAVANTE: CARAGSA Transformative Leadership Model

SR. CAROL AGRAVANTE: CARAGSA Transformative Leadership Model

Biography:

Ø She is famous for being the first Filipina theorist for writing the CASAGRA Transformative
Leadership Model. The title of the theory was derived from her name, CArolina S. AGRAvante. 

Ø She finished her secondary education at St. Paul University - Manila (formerly St. Paul College
Manila) as class salutatorian. 

Ø In 1964, she earned her BS Nursing degree in the same school as magna cum laude. In the same year,
she passed the nurse licensure examinations as the board topnotcher. 

Ø From 1967 to 1969, she studied Master’s Degree in Nursing Education at Catholic University of
America as a full-pledged scholar.

Ø In 2002, she earned her Doctoral Degree in Philosophy at University of the Philippines Manila and in 

Ø the same year her theory was published.

Ø She served as the president of St. Paul University - Iloilo, where she taught research subjects among
senior students.

Ø She was a former president of the Association of Deans of the Philippines Colleges of Nursing
(ADPCN) as she became the representative in the International Nursing Congress that was held in Brunei
in 1996. A year after, she was a part of a delegation that participated in the International Council of
Nursing in Vancouver, Canada.

Ø Received a Service Award from the Philippine Accreditation Association of Schools, Colleges and
Universities (PAASCU) for being one of the accreditors.

Ø One of the founding members of the Integrated Registered Nurses of the Philippines (IRNP). 

Ø Currently, she is the President of St. Paul College - Ilocos Sur while performing the duties of the Vice-
President for Academics. Moreover, she also functions as the program chair of the school's Department of
Nursing

 Theory: The CASAGRA Transformative Leadership Model

The complete title of the model is: 

The CASAGRA Transformative Leadership Model: Servant – Leader Formula & the Nursing
Faculty’s Transformative Leadership Behavior.

The theory “CASAGRA Transformative Leadership” is a psycho spiritual model. It is coined after the
name of the investigator: Sr. CArolina S. AGRAvante

The model is a Three-Fold Transformation Leadership Concept rolled into one, comprising of the
following elements:

1. Servant-Leader Spirituality;

2. Self-Mastery expressed in a vibrant care complex;

3. Special Expertise level in the nursing field one is engaged in.

These elements rolled into one make-up the personality of the modern professional nurse who will
challenge the demands of these crucial times in society today. 

The CASAGRA Transformative Leadership Theory is classified as a Practice Theory basing on the
characteristics of a Practice Theory stated by McEwen (2007), which are the following:

a. Complexity / Abstractness, Scope - Focuses on a narrow view of reality, simple and straightforward;

b. Generalizibility /Specificity - Linked to a special population or an identified field of practice;

c. Characteristic of Scope – Single, concrete concept that is operationalized;

d. Characteristic of Proposition – Propositions defined;

e. Testability – Goals or outcomes defined and testable; and

f. Source of Development – Derived from practice or deduced from middle range theory or grand theory.

Purpose

Ø The present day demands in the nursing profession challenge nursing educators to revisit their basic
responsibility of educating professional nurses who are responsive to technological, educational and
social changes happening in the Philippines society today. The reopening of the doors of foreign market
to Filipino nurses, migration made easy, attractive salaries and benefits way beyond what hospitals can
afford to give.

Ø Nursing education is faced with a new concern that is globalization of nursing services for the
international market. Therefore, a need to develop globalization of care with focus on developing caring
nurses.

Ø The formation of new nursing leaders is urgently needed; leaders with new vision who will venture
new traits and who have gone through new formation in order to serve the society as professional nurse.
Ø Nurses need competent leaders with a dream of what nursing can be, whose basic stand is caring and
service who are competent in nursing, assertive of their own rights with the help profession. 

Main Propositions

Ø CASAGRA Transformative Leadership is a psycho-spiritual model, was an effective means for faculty

to become better teachers and servant-leaders.

Ø Care complex is a structure in the personality of the caregiver that is significantly related to the
leadership behavior.

Ø The CASAGRA servant-leadership formula is an effective modality in enhancing the nursing faculty’s

servant-leadership behavior.

Ø Vitality of Care Complex of the nursing faculty is directly related to leadership behavior. 

CONCEPTS

1. Key Concepts

Ø The CASAGRA Transformative Leadership Model have concepts of leadership from a psycho-spiritual

point of view, designed to lead to radical change from apathy or indifference to a spiritual person. 

Ø Servant-leader formula is the enrichment package prepared as intervention for the study which has
three parts that parallel the three concepts of the CASAGRA transformative leadership model, namely:
the care complex primer, a retreat-workshop on Servant-leadership, and a seminar-workshop on
Transformative Teaching for nursing faculty. 

Ø Special expertise is the level of competence in the particular nursing area that the professional nurse is
engaged in workshop is the spiritual exercise organized in an ambience of prayer where the main theme is
the contemplation of Jesus Christ as a Servant-leader. 

Ø Servant-leadership behavior refers to the perceived behavior of nursing faculty manifested through the
ability to model the servant leadership qualities to students, ability to bring out the best in students,
competence in nursing skills, commitment to the nursing profession, and sense of collegiality with the
school, other health professionals, and local community.

Ø Nursing leadership is the force within the nursing profession that sets the vision for its practitioners,
lays down the roles and functions, and influences the direction toward which the profession should go. 

Ø Transformative teaching may also be termed Reflective teaching, an umbrella term covering ideas,
such as thoughtful instruction, teacher research, teacher narrative, and teacher empowerment. 
 

Ø Care complex is the nucleus of care experiences in the personality of a nurse formed by a combination
of maternal care experiences, culture based-care practices indigenous to a race and people, and the
professional training on care acquired in a formal course of nursing. 

Three-Fold Transformative Leader Concept

I. The Servant-Leadership Spirituality here is prescribed to run parallel to the generic elements of the

transformative leadership model.

This formula consists of a spiritual exercise, the determination of the vitality of the care complex in the
personality of an individual and finally a seminar workshop on transformative teaching.

The servant-leader formula prescription includes a spiritual retreat that goes through the process of
awareness, contemplation, storytelling, reflection, and finally commitment to become servant-leaders in
the footsteps of Jesus. 

II. The Self-Mastery consists of a vibrant care complex possessed to a certain degree by all who have
been through formal studies in a care giving profession such as nursing. 

III. The Special-Expertise level is shown in a creative, caring, critical, contemplative and collegial

teaching of the nurse faculty who is directly involved with the formation of the nursing.

MEANING AND PARADIGM

Meaning of the Theory 

Based on the study, the effect of the CASAGRA Leadership model using the servant leader model on the
leadership behavior of the nursing faculty, the care complex in the personality of the nursing faculty is
highly correlated to their leadership behavior. The care complex is necessary given as a stimulant in the
performance of the leadership activities. The leadership behavior of the faculty after going to the servant
leadership formula was significantly higher in the two-posttest periods than during the pre-test. It
improved the leadership behavior of the nursing faculty in both groups. 

The Paradigm of the Theory

Ø The conceptual framework is logical because the variables are very well explained on how
transformative-leadership model be applicable through care complex, transformative teaching servant-
leader spirituality, and servant-leader behavior.

Ø A person with dynamic care complex is the cornerstone of nursing leadership. According to care
complex of Agravante, caring personality rests on the possession of a care complex with in a person as an
energy source of caring.

Ø The framework explains and predicts the continuous formation of nursing leadership behavior in
nursing faculty that will eventually affect their teaching function.
Ø Servant-leadership formula runs parallel to the generic elements of the transformative-leadership
model.

Ø Transformative teaching is the guide that desired for the modern educative process designed to form
the millennium professional nurse.

Ø Expertise is the practice of caring and proactive in face of challenges for the profession go hand-in-
hand. Education and practice bring this about.

LETTY KUAN: Retirement and Role Discontinuities

LETTY KUAN: Retirement and Role Discontinuities

RETIREMENT AND ROLE DISCONTINUITIES CONCEPTUAL MODEL (as studied and researched

by the author) Determinants of Fruitful Aging

• Prepared retirement
• Health Status
• Income
• Family Constellation
• Self- Preparation Retirement Role Discontinuities (Aging Process)

BACKGROUND

· Retirement – is an inevitable change in one’s life. It is evident in the increasing statistics of aging
population accompanied by related disabilities and increased dependence. - this developmental stage,
even at the later part of life, must be considered desirable and satisfying through the determination of
factors that will help the person enjoy his remaining years of life.

It is of primary importance to prepare early in life by cultivating other role of options at age 50-60 in
order to have a rewarding retirement period even amidst the presence of role discontinuities experienced
by this age group.

BASIC ASSUMPTIONS AND CONCEPTS

· Physiological Age- is the endurance of cells and tissues to withstand the wear-and-tear phenomenon of
the human body. -some individuals are gifted with the strong genetic affinity to stay young for a long time
period. 

Role – Refers to the set of shared expectations focused upon a particular position. These may include
beliefs about what goals or values the position incumbent is to pursue and the norms that will govern his
behavior.

ROLE

It is also the set shared expectations from the retirees socialization experiences and the values internalized
while preparing for the position as well as the adaptations to the expectations socially defined for the
position itself. For every social role there is complementary set of roles in the social structure among
which interaction constantly occurs.

· Change of Life - is the period between near retirement and post-retirement years. In medico-
physiological terms, this equates with the climacteric period of adjustment and readjustment to another
tempo of life.

· Retiree – is an individual who has left the position occupied for the past years of productive life because
he/she has reached the prescribed retirement age or has completed the required years of service.

· Role Discontinuity - is the interruption in the line of status enjoyed or performed. The interruption may
be brought about by an accident, emergency, and change of position or retirement.

· Coping Approaches- Refer to the interventions or measures applied to solve a problematic situation or
state in order to restore or maintain equilibrium and normal functioning.

DETERMINANTS OF POSITIVE PERCEPTIONS IN RETIREMENT AND POSITIVE

REACTIONS TOWARD ROLE DISCONTINUITIES:

1. Health Status - refer to physiological and mental state of the respondents, classified as either sickly or
healthy.

2. Income – (economic level) refers to the financial affluence of the respondent which can be classified as
poor, moderate, or rich.

3. Work Status (according to Webster’s dictionary) status of an individual according to his/her work.

4. Family Constellation – Means the type of family composition described either close knit or extended
family where three or more generations of family members live under one roof; or distanced family,
whose members live in separate dwelling units; or nuclear type of family where only husband, wife and
children live together.

5. Self-Preparation (according to Webster’s dictionary) - it is preparing of self to the possible outcomes in

life.

FINDINGS AND RECOMMENDATIONS

1. Health status dictates the capacities and the type of role one takes both for the present and for the
future. - It fits for the everyone to maintain and promote health at all ages because only proper care of the
mind and body is needed to maintain health in old age.

2. Family constellation is a positive index regarding retirement positively and also in reacting to role
discontinuities. In the Philippines, the family undoubtedly stands as the security or trusting bank where all
members, young and old can always run and get help. When one retires, the shock of the role
discontinuities is softened because the family not only cushions the impact, but also offers gainful
substitutes, as in providing monetary support, absorbing emotional strains that often times with
discontinuities and other forms of surrogating.

3. Income has a high correlation with both the perception of retirement and reactions towards role
discontinuities. Since income is one of the factors that secure the outlook of individual, efforts must be
exerted to save and spend money wisely while still actively earning in order to have some reserved when
one grows old. It also implies that retirement pensions should be adjusted to meet the demands of the
elderly. This should be done in order to have a more relevant and realistic pension and benefits
adjustment.

4. Work status goes hand and hand with economic security that generates decent compensation. For the
retired, it implies that retirement should not be conceptualized as a period of no work because capabilities
to function get sharpened and refined as they practice it on a regular basis. Work enhances the aspects of
self-esteem and contributes to the feeling of wellness even and old age.

5. Self-preparation which are said to be both therapeutic and recreational in essence pays its worth in old
age. This does not only account professionalism or expertise but also benevolent work as in charitable
actions with the colleagues.  Self-preparation is investing not in monetary benefits but in something that
gives them and dignity; enhance their feelings of self-worth and happiness.

6. To cope with the changes brought by retirement, one must cultivate interest in recreational activities to
channel feelings of depression or isolation and facing realities through confrontation with some issues.

7. To perceive retirement positively, it requires early socialization of the various roles we take in life. The
best place to start is at home extending to schools, neighbourhoods, The community and society in
general. In retirement, their fellow retirees are their own best advocates. To facilitate this, barriers to full
participation in the areas where important decisions are rich should be eliminated in order to give
recognition and appreciation of the knowledge, wisdom, experience and values which are the social assets
that make the retired age and the custodians’ folk wisdom.

8. Government agency to construct holistic preretirement preparation program which will take care of the
retiree’s finances, psychological, emotional, and social needs.

9. Retirement should be recognized as the fulfillment of every individual’ s birthright and must be lived
meaningfully.

 “I have grown and sown and now I can reap the reward and blessing of a life lived in joy and love, for
I too have made others grow. ” Prof. Letty Gurdiel Kuan, RN, RGC, EdD

LETTY KUAN: Retirement and Role Discontinuities

CARMENCITA ABAQUIN: “Prepare Me” Theory

Biography

· Carmencita M. Abaquin is a nurse with Master’s Degree in Nursing obtained from the University of
the Philippines College of Nursing.

· An expert in Medical Surgical Nursing with subspecialty in Oncologic Nursing, which made her known
both here and abroad.
· She had served the University of the Philippines College of Nursing, as faculty and held the position as
Secretary of the College of Nursing.

· Her latest appointment as Chairman of the Board of Nursing speaks of her competence and integrity in
the field she has chosen.

About her Theory:

“PREPARE ME” Interventions and the Quality of Life Advance Progressive Cancer Patients.

Basic Assumptions and Concepts:

PREPARE ME (Holistic Nursing Interventions) are the nursing interventions provided to address the
multi-dimensional problems of cancer patients that can be given in any setting where patients choose to
be confined. This program emphasizes a holistic approach to nursing care. PREPARE ME has the
following components:

· Presence – being with another person during the times of need. This includes therapeutic
communication, active listening, and touch.

· Reminisce Therapy – recall of past experiences, feelings and thoughts to facilitate adaptation to present
circumstances.

· Prayer

· Relaxation-Breathing – techniques to encourage and elicit relaxation for the purpose of decreasing
undesirable signs and symptoms such as pain, muscle tension, and anxiety.

· Meditation – encourages an elicit form of relaxation for the purpose of altering patient’s level of
awareness by focusing on an image or thought to facilitate inner sight which helps establish connection
and relationship with God. It may be done through the use of music and other relaxation techniques.

· Values Clarification – assisting another individual to clarify his own values about health and illness in
order to facilitate effective decision-making skills. Through this, the patient develops an open mind that
will facilitate acceptance of disease state or may help deepen or enhance values. The process of values
clarification helps one become internally consistent by achieving closer between what we do and what we
feel.

“To Nursing… may be able to provide the care that our clients need in maintaining their quality of life
and being instrumental in “Birthing” them to External life”

Identify Origins of the theory (what prompted)

the incidence of cancer has significantly increased not only in the Philippines but also worldwide

Examine the meaning of theory

1. Terminally-ill patients especially cancer patients require holistic approach of nursing in different
aspects of man namely the emotional, psychological, social and spiritual. In this premise, patients with
incurable disease require multidimensional nursing care to improve quality of life.
2. PREPARE ME nursing interventions are effective in improving quality of life in terminally-ill patients.

3. Utilization of intervention as a basic part of care given to cancer patients, likewise, incorporation in the
basic nursing curriculum in the care of these patients. PREPARE ME must be introduced and focus
during training of nurse both in academe and practice.

4. Development of training programs for care provider as well as health care profession where
intervention is a part of treatment modalities.

5. The nurse must be honest about the feedback on his/her condition. Nurses must do this so that they
would know what the expectations of the patient and the family so that they may render a holistic caring
style for the patient together with his family in his dying days. This would help the patient and family
address the needs of the patient in any manner possible. (physical, emotional and spiritual)

6. The nurse must help make a supportive environment for the patient and his family in his dying
days. An environment like this would promote dignity in his days left thus helping the patient accept his
fate and help him/her be ready for the afterlife. The family is also guided in this rough time addressing
their grieving process by instilling in them that death is part of life.

CARMENCITA ABAQUIN: “Prepare Me” Theory

CECILIA LAURENTE: Theory of Nursing Practice and Career

Biography

Ø Cecilia Laurente is a Filipino nursing theorist, who focused her works primarily on helping a patient
through support systems, specifically the family.

Ø She published a paper entitled, “Categorization of Nursing Activities as Observed in Medical-Surgical

Ward Units in selected Government and Private Hospitals in Metro Manila.”

Ø Cecilia Laurente is known for her work in the field of nursing. In her theory of nursing practice, she
emphasized effective communication and championed using the family as an entry point to help a patient.

Cecilia Laurente’s Career

· Graduated BSN at University of the Philippines in 1967 and

· a Master of Nursing in 1973.

· She worked as a Staff Nurse in 1968-1969

· She became a Head Nurse in 1970-1972

· And as a Nursing Supervisor IN 1973-1976 at Philippine General Hospital

· She also worked at Metropolitan Hospital in Michigan US in 1977-1979

· She came and become an Instructor at University of the Philippines College of Nursing in 1979

· And later on, she became a Dean of College of Nursing in UP Manila from 1966 - 2002

NURSING THEORY: Theory of Nursing Practice and Career

"Categorization of Nursing Activities as Observed in Medical-Surgical Ward Units in Selected

Government and Private Hospitals in Metro Manila"

Theory of Nursing Practice and Career

Ø The theory was from her study, the Categorization of Nursing Activities as Observed in Medical-
Surgical Ward Units in selected Government and Private Hospitals in Metro Manila, which was
conducted from January to June year 1987

Ø In the recent study of Laurente she states that the other entry point of helping the patient is through the
family, when nurses can be of great assistance to prevent at the very beginning serious complications. The
nurse can help strengthen the family’s term of knowledge, skills, and attitude through effective
communication, employed informative, psychotherapeutic, modeling, behavioral, cognitive-behavioral,
and/or hypnotic techniques are summarized and evaluated

Concepts of the Theory

Ø What is “Anxiety”?

- A mental state of fear or nervousness about what might happen

Nursing Caring Behavior that affect patient’s Anxiety:

Ø Presence

- Person to person contact between the client and the nurses.

Ø Concern

- Development in the time though mutual trust between the nurse and the patient
Ø Stimulation

- Nurse stimulation through words tops the powerful resources of energy of person for healing

Enhancing and Predisposing Factor

Ø What is a predisposing Factor?

- Predisposing factors are defined in these models as factors that exert their effects prior to a behavior
occurring, by increasing or decreasing a person or population’s motivation to undertake that particular
behavior.

Ø Predisposing Factors

- Age

- Sex

- Civil Status

- Educational Status

- Length of Work

- Experience

Ø Enhancing Factors

- One’s caring experience, beliefs and attitude

- Feeling good about

- Learning at school

- What patients tell about the nurse coping mechanism to problems encountered

- Communication

BACKGROUND
Ø Communication is key when getting nurses to engage patients and families in their care.

Ø Research to develop the guide found that communication gaps between patients and caregivers can
occur when hospitals do not address the issues that patients' thoughts are most important. Another factor
is the available tools are to give health providers insights into patients' needs and concerns. As a result,
efforts by patients, families and health providers to communicate more effectively with each other can fall
short of their goal.

Ø Each strategy includes educational tools and resources for patients and families, training materials for
healthcare professionals and real-world examples that show how strategies are being implemented in
hospital settings. The strategies describe how patients and families, working with hospital staff, can: be
advisors; promote better communication at the bedside to improve quality; participate in bedside shift
reports; and prepare to leave the hospital.

FINALS COVERAGE

NURSING CORE VALUES

1. Love of God

2. Caring

Ø We are caring people. Despite our frustration, we keep getting up and caring for people every
day. Even though documentation, regulation, financial constraints, and a dozen other challenges impede
our abilities to provide our patients with the kind of care that we wish to provide, we keep giving our
best. We may not always feel like it, but we are optimists. We have to be in order to continue on in our
mission of improving health and wellness for all people.

· Compassion

Ø Compassion in nursing takes a nurse from competent care that includes the required skills and
knowledge to treat their patients to outwardly caring through actions and deeds that involve the emotional
aspects of the relationship. A nurse’s compassionate care can affect a patient’s outcome “The nurse's
compassion is an invaluable aspect of care,” states Koplowitz, “because it provides patients with
emotional support, which can lessen depression and strengthen the patient's will to survive.”

Ø Compassionate nursing is broadly associated with caring actions. Examples of compassion in

nursing include:  

 
o Being empathetic to better understand what your patients are going through

o Getting to know your patients to better understand their needs

o Giving patients someone to talk to, which is especially important for patients who don’t have family or
friends to lean on

o Being an active listener when patients discuss their health issues or complaints, which also helps you
pick up on unspoken concerns

o Solidifying your bond with patients by following up with their health concerns or complaints

o Providing emotional support during critical times of your patient’s treatment and recovery

o Using a positive voice and body language to imbue confidence in your patients about their eventual
recovery

o Knocking on the door before entering to show patients respect, dignity and a modicum of privacy where
privacy is often limited

o Taking time to explain tests and procedures and answering your patients’ questions, so they feel
important

o Helping relieve your patients’ concerns, so they can concentrate on getting well

Benefits of compassionate nursing

o Being a compassionate nurse not only benefits the patient, it also benefits the nurse. Nurses more
concerned about their patients’ well-being and the pain and fear they feel typically enjoy their jobs more
and feel more connected to their careers. 

o Providing emotional support to your patients can also offer tremendous self-gratification, but take care
to not fall victim to compassion fatigue. When caring for your patients becomes too much of an
emotional drain, you could experience a mix of emotional, physical and behavioral symptoms; mental and
physical exhaustion; and emotional withdrawal.

· Conscience

Ø The influence of conscience on nurses in terms of guilt has frequently been described. It primarily
affects the ethical values of a nurse. For example, nurses are consistently encountering ethical issues
related but not limited to: restrictions in providing quality patient care, or in providing care they do not
perceive to be beneficial or ethical to carry out for their patients, and/or encountering care practices they
are ethically at odds with, which creates ethical dilemmas and can result in issues of conscience for
nurses. At times, nurses may encounter an issue in practice that so strongly conflicts with their personal,
ethical beliefs that they may declare a conscientious objection to refrain from participating in or carrying
out an aspect of clinical practice. Living through an experience of making a conscientious objection, as a
nurse, sheds light on how to weave through the contentious fabric of what it means to be an ethical nurse
in today's world.

· Competence

Ø As professional nurses, we are competent to practice nursing by virtue of our education and licensure

as registered nurses. The concept of competence is regarded as a basic aspect in practice, particularly
when assessing the ability of a  nurse to offer nursing care. It is an essential professional issue in nursing
practice as far as professional standards, the quality of care and patient safety is
concerned. Reorganization within the healthcare delivery systems has pressurized the nursing profession
to guarantee the continued competence of its nurses. It is also important because it affects many other
realms of nursing profession like education and management. It is also an issue of concern for regulators,
hospitals, the public and insurance companies.

· Confidence

Ø Confidence is one of those words that we understand at face value, but have a hard time quantifying. It
is a factor of mental well-being that is determined by your level of achievement, sense of belonging, and
your self-esteem. It has a lot to do with how you see yourself, but even more to do with how you perceive
others to see you. Some of the common attributes of a nurse with confidence include:

· Optimism

· Independence

· Assertiveness

· Trust

· Enthusiasm

· Emotional Maturity

Ø Humans look to people who possess confidence and admire their calm and cool demeanors in the eye
of the storm. You can build your own confidence and become a more effective nurse by:

· Counting Your Achievements – Make your own log of your most recent achievements, and refer to it
whenever you feel self-doubt. This list can include exam scores from nursing school, recommendations
from your professors, or something you did to help someone else.

· Adding to Your List – Catch yourself doing something right and add it to your own nursing
achievement list. This will be even more impactful when it is something that you previously felt unsure
of, such as starting an IV or taking a patient history. This forces your mind to focus on the positive
contributions you are making in nursing and encourages you to strive for even more.
· Reaching Out to a Mentor – This may sound backward, but the truth is, confident people are those
who are not afraid to ask for help when they need it. Ask your nurse mentor to watch over your shoulder
as you perform a procedure for the first time or for advice on how to talk to a patient’s family members.

· Setting Realistic Goals for Yourself – Give yourself some time to acclimate in your new role as a
practicing nurse by setting goals for what you need to accomplish. Your confidence will build every time
you are able to cross another one off of the list.

· Rewarding Your Accomplishments – Self-praise helps to restore your confidence by acknowledging

that you have reached an important milestone. Treat yourself to a special lunch, buy a new lab coat, or go
for a massage when you feel good about the work you have accomplished as a nurse.

· Sharing Your Glories – Pick a friend or family as your confidence building buddy, and share your
accomplishments with them. Preferably this will be someone who will be overjoyed at your successes and
gush over every little thing – like your mom. Confident nurses don’t need to point out every achievement
to their co-workers and peers, but when you are working on building yours, it helps to have someone in
your corner.

· Allowing Room for Mistakes – To err is human, and as a new nurse, you might do this a lot. But rather
than beat yourself up over every little one, make a commitment to learn from them. Once you have
mastered the art of bouncing back over accepting defeat, you will have reached a new level of self-
confidence.

· Confidence is a learned trait, and a lack of it is not a permanent condition. Once you have regained
yours in nursing, you will begin to develop faith in the future of your career and see all obstacles as
surmountable challenges.

· Commitment

Ø When you look up the definition of commitment, you’ll see it concerns a pledge or a promise, an
obligation to something. The definition that describes commitment is dedication.

Ø Healthcare, whatever area you are in, is not a career upon which you can or should embark unless you
are dedicated to it. There is an everyday challenge of providing a service where your actions directly
affect a person’s life. Commitment is:

o Awareness of the challenges ahead and working to overcome these for the sake of your patient and your
team

o Accepting that your social life may, at times, be secondary to the needs of your patients

o Maintaining your own health to be the very best role model

o Exhibiting a willingness to learn from your co-workers

o Always striving to provide the best possible guidance and care for your patients
Ø Nursing requires you to always put the patient first. This can mean working late when someone is sick,
putting a uniform on and working nights when your friends are dressed up and out partying, opening your
Christmas presents a day late, and being shouted at by people who are upset, scared or in pain.

Ø It also means realizing that you are an ambassador for health and, in that sense, you are never off duty.

3. Love of People

Respect for the dignity of each person regardless of race, creed, color and gender

4. Love of Country

a. Patriotism (Civic duty, social responsibility and good governance)

 b. Preservation and enrichment of the environment and culture heritage

CORE COMPETENCIES UNDER THE 11 KEY AREAS OF RESPONSIBILITIES

LEGAL BASES 

Article 3 Sec.9 I of R.A. 9173/ “Philippine Nursing Act 2002”

Board shall monitor & enforce quality standards of nursing practice necessary to ensure the maintenance
of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into
account the health needs of the nation. 

PATIENT CARE COMPETENCIES

SAFETY AND QUALITY

o The first key area of nursing responsibility focuses on providing nursing care that is safe and of high
quality. Under this key area, core competencies include demonstrating knowledge about the health status
and illness of a patient; making appropriate decisions when caring for patients and their families; and
ensuring patient safety, privacy and comfort. Competencies also include setting appropriate priorities in
patient care, working with the medical team to ensure stability of care, effectively administering
medications and other treatment modalities and performing assessments and nursing services against a
background of established nursing guidelines. The nurse also works with the medical team and patient’s
family to develop a plan of care. Identifying the goals of care and evaluating progress toward those goals
are also core competencies within this key area.

CORE COMPETENCY 1:
Demonstrate knowledge based on health/illness status of individual/ groups

Indicators :
○ Identifies health needs of patients/groups
○ Explains patient/group status
You must have an in- depth knowledge regarding the diseases; their pathology; onset, manifestation and
management. So that you can identify manifesting signs and symptoms of your patient. In this
competency, you must be equipped with the fundamentals of nursing for it serves as foundation for you to
distinguish whether what you see from your clients is normal or considered deficiency. That includes your
knowledge as regards anatomy and physiology.

CORE COMPETENCY 2:
Provides sound decision making in care of individual/groups considering their beliefs, values

Indicators :
○ Problem identification
○ Data gathering related to problem
○ Data analysis
○ Selection appropriate action
○ Monitor progress of action taken

in this area, your understanding and skill in utilizing the nursing process is appreciated, from a thorough
assessment, objective and problem- focused diagnosis, SMART planning, implementation of appropriate
intervention down to significant evaluation.

CORE COMPETENCY 3:
Promotes patient safety and comfort

Indicators :
○ Performs age-specific safety measures and comfort measure in all aspects of patient care

CORE COMPETENCY 4:
Priority setting in nursing care based on patients’ needs

Indicators :
○ Identifies priority needs of patients
○ Analysis of patients’ needs
○ Determine appropriate nursing care to be provided

CORE COMPETENCY 5:
Ensures continuity of care

Indicators :
○ Refers identified problems to appropriate individuals/ agencies
○ Establish means of providing continuous patient care

 
CORE COMPETENCY 6:
Administers medications and other health therapeutics

Indicators :
○ Conforms to the 10 golden rules in medication administration and health therapeutics

CORE COMPETENCY 7:
Utilizes nursing process as framework for nursing. Performs comprehensive, systematic nursing
assessment

Indicators :
○ Obtains consent
○ Complete appropriate assessment forms
○ Performs effective assessment techniques
○ Obtains comprehensive client information
○ Maintains privacy and confidentiality
○ Identifies health needs

CORE COMPETENCY 8:
Formulates care plan in collaboration with patients, other health team members

Indicators :
○ Includes patients, family in care planning
○ States expected outcomes in nursing interventions
○ Develops comprehensive patient care plan
○ Accomplishes patient centered discharge plan

CORE COMPETENCY 9:
Implements NCP to achieve identified outcomes

Indicators :
○ Explain interventions to patient, family before carrying them out
○ Implement safe, comfortable nursing interventions
○ Acts according to client’s health conditions, needs
○ Performs nursing interventions effectively and in timely manner

CORE COMPETENCY 10:

Implements NCP progress toward expected outcomes

Indicators :
○ Monitors effectiveness of nursing interventions
○ Revises care plan PRN
 

CORE COMPETENCY 11:

Responds to urgency of patient’s condition

Indicators :
○ Identifies sudden changes in patient’s health conditions
○ Implements immediate, appropriate interventions

COMMUNICATION

o In this key area, core competencies include establishing communication with the patient and treatment
team, learning to read verbal and nonverbal cues, using visual aids and other resources when necessary,
responding to patient and group needs and effectively using technology to facilitate communication.

CORE COMPETENCY 1:
Establishes rapport with patients, significant others and members of the health team.

Indicators:
○ Creates trust and confidence
○ Listens attentively to client’s queries and requests
○ Spends time with the client to facilitate conversation that allows client to express concern

CORE COMPETENCY 2:
Identifies verbal and non-verbal cues

Indicator:
○ Interprets and validates client’s body language and facial expression

CORE COMPETENCY 3:
Utilizes formal and informal channels

Indicator:
○ Makes use of available visual aids

CORE COMPETENCY 4:
Responds to needs of individuals, family, group and community

Indicator:
○ Provides re- assurance through therapeutic, touch, warmth and comforting words of encouragement
○ Readily smiles
 

CORE COMPETENCY 5:
Uses appropriate information technology to facilitate communication

Indicator:
○ Utilizes telephone, mobile phone, email and internet, and informatics
○ Identifies a significant other so that follow up care can be obtained
○ Provides “holding” or emergency numbers of services

HEALTH EDUCATION

o Educational core competencies include assessing the educational needs of the patient and family,
developing and implementing health education plans and learning materials and evaluating the outcome
of education administered.

CORE COMPETENCY 1:
Assesses the learning needs of the patient and the family

Indicators:
○ Obtains learning information through interview, observation and validation
○ Defines relevant information
○ Completes assessment records appropriately
○ Identify priority needs

CORE COMPETENCY 2:
Develops Health Education plan based on assessed and anticipated needs.

Indicators:
○ Considers nature of the learner in relation to social, cultural, political, economic, educational, and
religious factor

CORE COMPETENCY 3:
Develops learning material for health education

Indicators:
○ Involves the patient, family and significant others and other resources
○ Formulates a comprehensive health educational plan with the following components , objectives,
content and time allotment
○ Teaching-learning resources and evaluation parameters
○ Provides for feedback to finalize plan

 CORE COMPETENCY 4:
Implements the health Education Plan
Indicators:
○ Provides for conducive learning situation in terms of timer and place 
○ Considers client and family preparedness○ Utilize appropriate strategies
○ Provides reassuring presence through active listening, touch and facial expression and gestures
○ Monitors client and family’s responses to health education

CORE COMPETENCY 5:
Evaluates the outcome of health Education

Indicators:
○ Utilizes evaluation parameters
○ Documents outcome of care
○ Revises health education plan when necessary

TEAMWORK

o The teamwork and collaboration key area includes core competencies of establishing beneficial working
relationships with peers and colleagues and communicating care plans with health team members.

CORE COMPETENCY 1:
Establishes collaborative relationship with colleagues and other members of the health team

Indicators:
○ Contributes to decision making regarding patients” needs and concerns
○ Participates actively in patients care management including audit
○ Recommends appropriate intervention to improve patient care
○ Respects the role of the other members of the health team
○ Maintains good interpersonal relationships with patients, colleagues and other members of the health
team

CORE COMPETENCY 2:
Collaborates plan of care with other members of the health team

Indicator: 
○ Refers patients to allied health team partners
○ Acts liaison / advocate of the patients
○ Prepares accurate documentation of efficient communication of services

ENHANCING COMPETENCIES

RESEARCH

o Core competencies in the research key area include gathering and analyzing research data, sharing
results and applying findings to work functions.
CORE COMPETENCY 1:
Gathers data using different methodologies

Indicators:

 Identifies researchable problems regarding patient care and community health

 Identifies appropriate methods of research for a particular patient/community problem
 Combines quantitative and qualitative nursing design thru simple explanation on the phenomena
observed
 Analyzes data gathered 

CORE COMPETENCY 2:
Recommends actions for implementation

Indicator:

 Based on the analysis of data gathered, recommends practical solutions appropriate for the
problem

CORE COMPETENCY 3:
Disseminates results of research findings

Indicators:

 Communicates results of findings to colleagues/patients/family and to others

 Endeavors to publish research
 Submits research findings to own agencies and others as appropriate

CORE COMPETENCY 4:
Applies research findings in nursing practice

Indicators:

 Utilizes and findings in research in the provision of nursing care to

individuals/groups/communities
 Makes use of evidence-based nursing to ameliorate nursing practice

QUALITY IMPROVEMENT

o In the quality improvement key area, core competencies include identifying areas for improvement,
participating in nursing rounds and audits, staying aware of variances in treatment and recommending
solutions to improve quality.

CORE COMPETENCY 1:
Gathers data for quality improvement

Indicators:

 Demonstrates knowledge of method appropriate for the clinical problems identified

 Detects variation in the vital signs of the patient from day to day
  Reports necessary elements at the bedside to improve patient stay at hospital
 Solicits feedback from patient and significant others regarding care rendered

CORE COMPETENCY 2:
Participates in nursing audits and rounds

Indicators:

 Contributes relevant information about patient condition as well as unit condition and patient
current reactions
 Shares with the team current information regarding particular patients condition
 Encourages the patient to speak about what is relevant to his condition
 Documents and records all nursing care and actions
 Performs daily check of patient records/condition
 Completes patients records
 Actively contributes relevant information of patients during rounds thru readings and sharing
with others

CORE COMPETENCY 3:
Identifies and reports variances

Indicators:

 Documents observed variance regarding patient care and submits to appropriate group within 24
hours
 Identifies actual and potential variance to patient care
 Reports actual and potential variance to patient care
 Submits report to appropriate groups within 24 hours

CORE COMPETENCY 4:
Recommends solutions to identified problems

Indicators:

 Gives appropriate suggestions on corrective and preventive measures

 Communicates and discusses with appropriate groups
 Gives and objective and accurate report on what was observed rather than an interpretation of the
event.

EMPOWERING
COMPETENCIES

LEGAL RESPONSIBILITIES

o Core competencies in the legal key area include following legally mandated state and federal processes
and procedures, such as obtaining informed consent from patients and adequately documenting all
procedures performed for patients.

CORE COMPETENCY 1:
Adheres to practices in accordance with the nursing law and other relevant legislation including contract
and informed consent.

Indicators:
○ Fulfill legal requirements in Nursing Practice 
○ Holds current professional license
○ Acts in accordance with the terms of contract of employment and other rules and regulation
○ Complies with the required CPE
○ Confirms information given by the doctor for informed consent 
○ Secures waiver of responsibility for refusal to undergo treatment or procedures
○ Check the completeness of informed consent and other legal forms

CORE COMPETENCY 2:
Adheres to organizational policies and procedures, local and national

Indicators:
○ Articulates the vision and mission of the institution where one belongs
○ Acts in accordance with the established norms and conduct of the institution/ organization

CORE COMPETENCY 3:
Document care rendered to patients.

Indicators:
○ Utilizes appropriate patient care records and reports
○ Accomplish accurate documentation in all matters concerning patient care in accordance with the
standard of nursing practice.

ETHICAL RESPONSIBILITIES

o In this key area that concerns morals and ethics, core competencies include respecting the rights of all
individuals and groups, accepting responsibility for individual decisions and adhering to the nurses’
national and international code of ethics.

CORE COMPETENCY 1:
Respects the rights of individual/ groups

Indicator:
○ Renders nursing care consistent with the patient’s bill of rights (ie. Confidentiality of information,
privacy, etc.)

CORE COMPETENCY 2
Accepts responsibility & accountability for own decisions and actions

Indicators:
○ Meets nursing accountability requirements as embodied in the job description
○ Justifies basis for nursing actions and judgment
○ Protects a positive image of the profession
CORE COMPETENCY 3
Adheres to the national and international code of ethics for nurses 

Indicators:
○ Adheres to the Code of Ethics for Nurses and abides by its provisions
○ Reports unethical and immoral incidents to proper authorities

PROFESSIONAL DEVELOPMENT

o The professional development key area includes core competencies of identifying personal needs for
education and pursuing those goals, participating in professional organizations and community activities,
presenting a professional image and positive attitude as well as performing work duties in a professional
manner.

CORE COMPETENCY 1
Identifies own learning needs 

Indicators:
○ Verbalizes strengths, weaknesses, limitations.
○ Determines personal and professional goals and aspirations. 

CORE COMPETENCY 2
Pursues continuing education 

Indicators:
○ Participates in formal and non-formal education.
○ Applies learned information for the improvement of care.

CORE COMPETENCY 3
Gets involved in professional organizations and civic activities 

Indicators:
○ Participates actively in professional, social, civic and religious activities
○ Maintain membership to professional organizations
○ Support activities related to nursing and health issues

 CORE COMPETENCY 4
Projects a professional image of nurse 

Indicators:
○ Demonstrate good manners and right conduct at all times.
○ Dresses appropriately.
○ Demonstrates congruence of words and actions.
○ Behaves appropriately at all times.

CORE COMPETENCY 5
Possesses positive attitude towards change and criticism 
Indicators:
○ Listens to suggestions and recommendations.
○ Tries new strategies or approaches.
○ Adapts to changes willingly.

CORE COMPETENCY 6
Performs function according to professional standards 

Indicators:
○ Assesses own performance against standards of practice.
○ Sets attainable objectives to enhance nursing knowledge and skills.
○ Explains current nursing practices, when situations call for it.

ENABLING COMPETENCIES

RESOURCES AND ENVIRONMENT

o The next key area is the management of resources and environment. Core competencies in this area
include identifying tasks that need to be completed, developing financially effective programs, ensuring
that equipment performs adequately and maintaining safety in the environment.

CORE COMPETENCY 1:
Organizes workload to facilitate patient care

Indicators:
○ Identifies task or activities that need to be accomplished
○ Plans the performance of task or activities based on priority
○ Finishes work assignment on time

CORE COMPETENCY 2:
Utilizes resources to support patient care

Indicators:
○ Determines the resources needed to deliver patient care
○ Control the use of equipment

CORE COMPETENCY 3:
Ensures the functioning of resources

Indicators:
○ Check proper functioning of the equipment
○ Refers Malfunctioning equipment to appropriate unit

 CORE COMPETENCY 4:
Check the Proper functioning of the Equipment

Indicators:
○ Determines the task and procedures that can be safely assigned to the other members of the team
○ Verifies the competence of the staff prior to delegating tasks

CORE COMPETENCY 5:
Maintains safe Environment
Indicators:
○ Observe proper disposal of waste
○ Adheres to policies, procedures and protocols on prevention and control of infection
○ Defines steps to follow in case of fire , earthquake and other emergency situation

RECORDS MANAGEMENT

o The records management key area includes core competencies of maintaining appropriate
documentation using the appropriate system and staying within legal boundaries in the area of patient
privacy.

CORE COMPETENCY 1:
Maintains accurate and updated documentation of patient care

Indicator:

 Completes updated documentation of patient care

CORE COMPETENCY 2:
Records outcome of patient care

Indicator:

 Utilizes a record system

CORE COMPETENCY 3:
Observes legal imperatives in recording keeping

Indicators:

 Observes confidentially and privacy of patient’s records

 Maintains an organized system of filing and keeping patient’s records in a designated area
 Refrains from releasing records and other information without proper authority