Ma. Criselda C. Ultado, RN,MAN.

 Organized system of accepted

knowledge that is composed of
concepts, propositions, definitions
and assumptions intended to
explain a set of fact, event or
phenomena.
Acreative and rigorous
structuring of ideas that
projects a tentative,
purposeful and systemic
view of phenomena
 Organized, coherent set of
concepts and their
relationship to each other
that offers descriptions,
explanations and predictions
about phenomena.
Setof concepts,
definitions, relationships
and assumptions that
project a systematic view
of phenomena
Areasoned proposed
explanation of occurrence,
or of something that will
occur or be produced, for
which absolute proof is
lacking.
Aset of concepts and
proposition that provide
an early way to view
phenomena.
 An abstract statement
formulated to predict,
explain or describe the
relationships among
concepts, constructs or
events. It is tested by
observation and research
using factual data.
Asupposition or system
of ideas that is proposed
to explain a given
phenomenon
Concepts
Propositions
Assumptions
Definitions
 Idea formulated by the mind or an
experience perceived and observed
such as justice, love, war and
disease.
 Mental image of phenomenon
 It is formed by generalized an
abstract idea from our experiences,
observations, events or objects.
 Building blocks of theories.
 Explains the relationships of
different concepts.
 Describes the linkages &
interaction among the
concepts of theory
◦ Ex: children who do not want to
stay in the hospital because of
their fear of injections.
 Composed of various
description which convey a
general meaning and
reduces the vagueness in
understanding a set of
concepts.
 Statement that specifies the
relationship or connection of
factual concepts or phenomena
 In theory they are the idea that
the theorist presume to be true
• Ex: All patients who are not able to take
good care of themselves need nurses.
 Concepts
Propositions Systematically
Assumptions Organized THEORY VIEW PHENOMENA
Definitions
From a latin word NUTRIX
meaning “to nourish”.
NURSING or NURSE describe
as person who nourish, fosters,
and protects and who is
prepared to take care of the
sick, injured and aged people.
 ANA) Nursing is the
(

diagnosis and treatment

of human responses to
actual or potential health
problems
 Toassist client in the
performance of activities
contributing to health, its
recovery or peaceful death
that clients will perform
unaided, if they had the
necessary will, strength or
knowledge
(ICN) Nursing encompasses
“autonomous and collaborative
care of individuals of all ages,
families, groups and
communities, sick or well and
in all settings
 alleviation of suffering and
assisting clients as he or she
responds to health-illness
situations, utilizing the nursing
process and guided by ethico-
legal moral principles
 Nursing is a dynamic discipline
 An art and science of caring
for individuals, families, groups
and communities geared
toward promotion and
restoration of health,
prevention of illness.
Group of interrelated
concepts that are
developed from various
studies of disciplines and
related experiences
 An articulated and communicated
conceptualization of invented or
discovered reality in or pertaining
to nursing for the purpose of
describing, explaining, predicting
or prescribing nursing care
 It
provides frameworks for
nurses to systematize their
nursing actions what to ask,
what to observe, what to
focus on and what to think
about.
 METAPARADIGMS comes Greek
word “META” means WITH,
“PARADIGMS” means
PATTERNS.
 Patterns or models used to show
a clear relationship among the
existing theoretical works in
nursing.
 NURSING

PERSON HEALTH

ENVIRONMENT
 PERSON
◦Recipient of nursing care like
individuals, families and
communities
 Ex: Nightingale proposed that the
physical, intellectual and spiritual being
of a person is not capable of
manipulating the environment to
promote health
 ENVIRONMENT

◦External and internal aspects

of life that influence the person
 Ex: Physical environment is
emphasized by Nightingale in her
theory.
 HEALTH

◦Holistic level of wellness that

the person experiences
 Ex: Nightingale believed that the
goal of all nursing care activity
should promote client’s health
 NURSING
◦Interventions of the nurse
rendering care in support of
or in cooperation with the
client.
 Ex. Nightingale emphasized that a
nurse is responsible in promoting
well being of clients by manipulating
the environment
 • To know the properties and
DESCRIPTIVE workings of a discipline

• To examine how properties relate

EXPLANATORY and thus affect the discipline

• To calculate relationships between

PREDICTIVE properties and how they occur

• To identify under which conditions

PRESCRIPTIVE relationships occur
 NURSING
CARE
Describes
Explains
Predicts
THEORY Prescribes
 Factor-Isolating Theory
 Primary level of theory
development
 Identify major concept of
phenomena
 They do not explain the
relationship of the concepts
 Main purpose is to present a
phenomenon based on the 5
senses together with their
corresponding meaning.
◦ Ex: Filipino nursing practices like
use of herbal medicines and other
alternative forms of treatment
 Factor-Relating Theory
 Present relationship among
concepts and propositions
 Provide information on how or
why concepts are related
 Causeand effect are well
explained by using this theory
◦ Ex: A research study about the
factors affecting newborns in
failing to thrive
 Situation-Relating Theory
 Are archive when the
relationships of concepts under a
certain condition are able to
describe future outcomes
consistently
 This
kind of theory is
generated and tested using
experimental research
◦ Ex: A theoretical model based on the
observation of the effects of
unsanitary environmental condition
on the recovery of the post-operative
patients
 Situation-Producing Theories
 Deal with nursing actions and test
the validity and certainty of a
specific nursing intervention
 Common in testing new nursing
intervention
 The next knowledge level after
metaparadigm.
 Specifies definition of metaparadigm
concepts in each of the conceptual
models of nursing
 Sets forth the meaning of phenomena
through analysis, reasoning and
logical argument
 Building blocks of theories
 Enhances one’s capacity to
understand phenomena as it helps
define the meaning of a word.
 It can come from an empirical
phenomena or abstraction of how a
person perceived an object
 • Indirectly observed or intangible
Abstract • Independent of time and place
• Ex: love, care and freedom

• Directly observed or tangible

Concrete • Ex: nurse, mother and pain
CONCEPT can be used
in making or formulating
a CONCEPTUAL or
OPERATIONAL
definition
 Meaning of word based on
how a certain theory or
relevant literature perceives it
to be.
◦ Ex: roles/concepts of nurse,
patient care and environment
 Meaningof a word based
on the method of how it was
measured or how the
person come up with the
perception.
◦ Ex: significance of pain perception
and practice nursing intervention
 Highly
established set of
concepts that are testable.
◦ Ex: Theoretical Framework of
LYDIA HALL, a nurse theorist.
 THE PERSON
Social Science
Therapeutic use of self
“THE CORE”

THE DISEASE
THE BODY Pathological and
Natural and biological Therapeutic Sciences
Sciences Intimate Seeing the patient
bodily care and family through
“THE CARE” the medical care
“THE CURE”
 Representations of an idea or
body of knowledge based on
the own understanding or
perception of a person or
researcher on a certain topic,
phenomena or theory.
 PHYSICAL LOWERED
PERSON FITNESS BLOOD
EXERCISE PRESSURE
CONCEPTUAL THEORETICAL

Structure of Structure of
concepts or concepts which
theories which exist or tested in
are pulled the literature, a
together as a ready-made map
map for the study for the study
 CONCEPTUAL THEORETICAL

Specifies exactly how

Comparable to the concept will be
definition from a determined and
literature such as a assess it also
dictionary, identifies procedures
encyclopedia and and operations
journals significant to
determine concepts
 CONCEPTUAL THEORETICAL
Hospital Stay Hospital Stay

Ex: The time Ex: The total of

during which a days as patient,
person is a beginning with
registered patient admission day
in a certain and finishing with
hospital discharge
 CONCEPTUAL THEORETICAL
Ambulation Ambulation

Ex: To walk from

Ex: Taking 6
one place to
steps without
another or to
assistance
move about
 Systematic knowledge or practice
in a discipline of study.
 Acquiring knowledge based on
scientific method
 Knowledge gained through
research
 Itis a process in which the
researcher through the use of the
senses systematically collects
observation, verifiable data to
describe, explain, or predicts
events.
 GOALS SM – are to find solutions to
problems and to develops
explanations of the world.
 • Integration of knowledge by
OBSERVATION
rational/sentient being

• Recognition and collection of

GATHERING
data

FORMING • Attempt to explain or suggest

HYPOTHESIS a nature of a phenomenon
 • Conduct survey and interview
EXPERIMENTAL
INVESTIGATION and apply statistical
treatment on the data

• Statement explaining a set of

CONCLUSION or natural phenomena or a
THEORETICAL
EXPLANATION scientific query derived from
experimental investigation
 Information, skills and expertise
acquired by a person through
various life experiences, or
through formal/informal learning
such as formal education, self-
study and vocational
 The abstract or workable
understanding of a subject or idea
 What is known in a particular field
of discipline or study
 Facts and information or
awareness or familiarity gained
by experience
 KNOWLEDGE

Perception Association Learning Reasoning Communication

 • Achieving understanding of
PERCEPTION
sensory data

• Combining 2 or more
ASSOCIATION concepts/ideas to form a new
concept or for comparison

• Acquiring process of seeking

LEARNING
conclusions through reason
 • Mental process of seeking
REASONING conclusions through reason

• Transferring data from sender to

COMMUNICATION receive using different mediums
or tools of communication
Traditional Knowledge

Authoritative Knowledge

Scientific Knowledge
 Should rely on expert to do what has
to be done.
 Advantages:
◦ Practical to implement
 Disadvantages:
◦ Subjective
◦ Limited use
◦ Based practice and research as the
main focus
 Advantages:
◦ Systematic and accurate
◦ Less subjective than knowledge
gained by other methods
 Disadvantages:
◦ Requires time and effort to
produce credible results
 Trial
and Error plus COMMON
SENSE
 INTUITION
 LOGICAL REASONING
 • A type of reasoning
INDUCTION
that uses specific
details to form a
general conclusion
Patient Nurse

• Elevated • Therefore the

WBC noted nurse
• + fever T- 39 conclude the
patient may
• Wound red & have infection
oozing with
pus
 • A type of reasoning
wherein general
DEDUCTION conclusions are
made based from
specific concepts
Nurse Patient Nurse
• He has a • Therefore
the nurse
• Know that diagnosis
will monitor
infection of kidney his/her
causes infection. patient
elevated Temp. and
WBC & WBC
fever count.
 Sets of empirical data or
experiences that can be
physically observed or tangible
such as crying or grimacing when
in pain.
 Concerned with how the person
reacts using the human senses
 Clinical or environmental setting of
nursing
◦ Health Center
 Disease Process
◦ Stomach ulcer
 Client’s Behaviour
◦ Guarding behaviour at the pain site
 Interventions
◦ Care of the client in pain
 Practices that are utilized in
nursing theories and
metaparadigms
◦ (person, nursing, health and
environment)
Atheory is composed of
interrelated concepts. Cut
10-15 pictures in a
magazine and paste them in
a short bond paper. Try to
arrange them in a manner
that will exhibit relatedness.
Explain the relationship of
each picture
 Nursing Theories are developed
TO IMPROVE THE QUALITY OF
CARE rendered by NURSE to
their CLIENT/ PATIENT.
 Theory development is inhereted
in the different Nursing field :
Nursing Education, Nursing
Research & Nursing Practice.
 Learning about and applying
nursing theories are now
important parts of any nursing
curriculum. The triad of nursing
theories, medical knowledge and
nursing practice forms the basis
of nursing education.
 Nursing Theories were primarily used
to develop & guide nursing education
in universities & institutions.
 A number of nursing program
recognized the major concepts of
some of nursing models , structured
these concepts into a conceptual
frameworks and was able to built the
complete curriculum around that
frameworks.
 With those models they were able to come
up with unique term such as program
objectives, course objective, course
description and clinical performance
criteria. These new terms assist and direct
the entire education system to create
more comprehensive curriculum.
 Nursing Theory is very important to any
Nursing program. It is the foundation on
how nursing students learn and it's the
material that they care into their nursing
profession.
 Nursing theory encompasses a wide
variety of beliefs and practices
relating to nursing.
 It is used to guide nursing research,
and to predict and assess patient
responses to nursing practices.
Because there are various types of
nursing theory, the importance of
nursing theories to science in general
can be a complicated question.
 Nursing theories are systematic
descriptions and explanations of
aspects of professional nursing.
 Sets of theories range from
general constructions, called
"grand theories," to guides for
everyday practice, called "nursing
practice theories." All theories are
designed to be applied to
situations in patient care.
 Theories thoroughly guide CRITICAL
THINKING & DECISION- MAKING in
clinical nursing practice.
 Nursing theory is a key to understanding
patients' needs.
 Nursing theory is a general term, according
to Marilyn Parker in "Nursing Theories and
Nursing Practice," which describes and
explains the "phenomena of interest,"
meaning patient symptoms and care, to
nursing.
 Nursing theory provides understanding
for the nurse practitioner (NP) to use in
actual practice and clinical research.
 Nursing theory has many applications,
which reflect the various areas of
specialty in professional nursing, in the
pursuit of delivering quality patient care.
 Primary Application
◦ The primary application of nursing
theory is in the interaction and
communication with the patient.
Nursing theory aids the nurse in
identifying the needs and problems of
the patient. This identification aids the
most vital, but immeasurable, aspect of
nursing: caring.
 Practical
Application
◦Nursing theory provides a
foundation for assessing, or
explaining, patient conditions.
Once this assessment or
evaluation is made, nurses can
contribute in diagnosing a
condition and planning medical
interventions.
A good Filipino nurse is
shown by her appropriate
actions

 Propernursing actions are

the result of a good
foundation in knowledge
 …because without it. One
cannot fully know the patient

 Which hinders provision of total

care
 “Knowing thyself” or “Kilalanin
muna ang sarili bago and iba”
A good nurse consciously or
subconsciously practices what
is called the FOUR WAYS OF
KNOWING
 This is achieved and realized
by harnessing the nurse’s
collective stores of knowledge,
character, profound
experience…..
 Empirics – the scientific
discipline of Nursing
 Ethics – the moral directions of
Nursing
 Personal – method by which
nurses approach their patients
 Aesthetics or Esthetics – deals
with the emphatic aspect of
nursing
 Isthe principal form relating
factual and descriptive
information aimed at the
expansion of abstract and
theoretical explanations
 It’s the first primary model of
knowing (Kenney,1996)
 It is information source or base
of knowing
 Itemphasizes scientific research
is important to nursing
knowledge
 As a part of empirics, clinical
and conceptual knowledge are
the keys to nursing practice
 Empirical knowing focuses on
evidenced – based research for
effective accurate nursing
practice
Examples:
 David, a nursing student
answers a question posed by
the clinical instructor based on
what he learned from the
school
 Elmer, a nurse researcher, uses
scientific method to produce
desired study results

 Nurse Micheal practices nursing

interventions based from
accepted clinical practices
 Related to understanding what
is of significance to particular
patients such as feelings,
attitudes, points of view

 It
is also the manifestations of
the creative and expressive
styles of the nurse
 Aestheticknowing focuses
on empathy – the ability for
sharing or understanding
another’s feeling. Primary
form of aesthetic knowing
 It includes the nurse’s ability in
changing ways and manner of
rendering nursing care based
on the client’s individual needs
and perceptions
 It is done knowing the
distinctive individual instead as
a typical, stereotype whole
 Isused in the process of giving
appropriate nursing care
through understanding the
uniqueness of every patient,
thus emphasizing use of
creative and practical styles of
care
 Nurse Moses places himself in
the “patient’s shoes” when
communicating, giving judgment
and providing care

 Nurse Ace shows compassion,

mercy and understanding towards
patients, co workers and
supervisors
 Ethical knowing requires knowledge
of different philosophical positions
regarding what is good and right in
making moral actions and decisions.
 The code of morals or code of ethics
that leads the conduct of nurses is
the main basis for Ethical Knowing
 Itis deeply rooted in the
concepts of human activity,
service and respect for life
 Lessening suffering, upholding
and preserving health is one of
the key elements why nursing is
a core service in society

 It
includes all deliberate nursing
actions involving and under the
jurisdiction of ethics and
professionalism
Examples:
 Nurse Carl presents himself as a
patient advocate and defends his
client’s right to choose care

 Sir
Kevin a clinical instructor,
reprimands a student who cheated
on a quiz and explains the
consequences
 It
encompasses knowledge of
the self in relation to others
and self

 It
involves the entirety of the
Nurse – Patient Relationship
 It
most difficult to master and
teach

 It
is the key to comprehending
health in terms of personal well –
being

 It involves therapeutic use of self

 It takes a lot of time to fully know
the nature of oneself in relation to
the world around
Example
Ruben, a nursing student, strives to promote
a meaningful personal relationship with his
elderly patient

A nursing student undergoes Psychological

Counseling and Self – Awareness before his
Psychiatric – Nursing Rotation
 March 1853, the Crimean war broke
out between Russia and Turkey
 Florence was among the 38 nurses that
were sent to Turkey to aid the British
soldiers
 The British soldiers were down with
cholera and malaria
 Conditions in the army hospital
were awful
 Wounded and ill soldiers lay in filth
on straw pallets in crowded
hallways
 Rats and insects crawled the floors
and walls
 The hospital lacked basic
supplies
 Such as cots, mattresses,
bandages, washbasins, soaps
and towels
 Water was rationed
 The men were placed in rooms
without blankets or decent food
 They were still wearing their
army uniform that were “stiff
with dirt and gore”
 War wounds accounted for one
death in every six patients
 Diseases such as typhus,
cholera, and dysentery were the
primary reasons for a high
death rate among the wounded
soldiers
 Florence Nightingale recognized
that overcrowding, filth, and poor
ventilation contributed to the
illness
 FN requisitioned 200 scrub brushes
and set a team to work cleaning the
filthy building
 She worked tirelessly caring for
the soldiers, day and night
 By night, she carried a lamp
through the corridors, stopping
to help the suffering
 Military officers and doctors
objected to FN’s views on
reforming or improving military
hospitals
 She received little help from the
military until she used her contacts
at the newspaper, The Times
 After a great deal of publicity,
FN was given the task to
improve in the quality of the
sanitation
 She was able to reduce the death
rate of her patients
 During this time the use of
RATIONALISM & EMPIRICISM
 RATIONALISM – make use of reason
gained thru expert study tested theory
and established facts to evidently
prove something.
- emphasis on the USE OF
REASONING for the main purpose of
knowing harm or benefit of an act to
an individual.
 EMPIRICISM – use of objective
and tangible data or those that
are perceived by the senses to
observe and collect data
 The history of Theory
Development in Nursing began
with the writings of FN, it is
considered as the beginning of
scientific practice in Nursing.
 Note on Nursing of FN was written in
mid 19th century, she stressed the
importance of observation and
recording
 She paved the way to modern
nursing
 She was the first one to insist that
FORMAL EDUCATION is needed in
the preparation on a NURSE.
 Then from FN’s time until 1950 other
milestones in Nursing Theory
Development was the publication of
Journal Nursing Research in 1952.
JOURNALS encouraged the nurses
to pursue Research thus developing
questioning the attitudes and
inquiries that set the stage for
CONCEPTUALIZATION of Nursing
Practice.
The emergence of the
SCIENTIFIC ERA in 1960 the
nature of practice was debated as
nursing leader recognized the
need to define nursing practice ,
develop nursing theory and create
a substantive body of knowledge
 Literature on the Philosophy of
Nursing as well as Conceptual
Models and frameworks
proliferated during this time.
 PEPLAU’s INTERPERSONAL
RELATIONS in NURSING
( describe the interpersonal
process occurring between the
NURSE and PATIENT.
 ABDELLAH TYPOLOGY OF
NURSING PRACTICES (her 21
Nursing Problems develop the
patients –centered approach
 HALL’s Theory CARE, CORE and
CURE. Her Theory described
Nursing Practice at the Loeb
Center for Nursing @ Montefoire
Hospital.
 In
this time were characterized by
ACCEPTANCE OF THE
SIGNIFICANCE OF THEORY IN
NURSING
 Publication of numerous books and
articles on ANALYSIS,
APPLICATION AND EVALUATION
and further DEVELOPMENT of
Nursing Theories.
 Graduate school of Nursing
Developed courses on how to
analyzed and Apply Nursing
Theories.
 CARE PROVIDER – provision of care
in meeting the needs of the patient
physically, emotionally, intellectually
and spiritually.
 COMMUNICATOR – thru the use of
interpersonal and therapeutic
communication skill to establish and
maintain helping relationship with
patient in all ages and in any setting.
 TEACHER / EDUCATOR – use
communication skills to assess,
implement, and evaluate individualized
teaching plan to meet learning needs of
patient and their families.
 COUNSELOR- the use of intrapersonal
communication skills to provide
information, make appropriate referrals,
and facilitates the patient’s problem
solving and decision making skills.
 LEADER – the assertive, self – confident
practice of nursing when providing care.
 RESEARCHER – the participation in or
conduct a research to increase
knowledge in nursing and improve
nursing care.
 ADVOCATE - the protection of human
or legal rights and securing of care for all
patients based on the belief that patient
have the right to make informed
decisions about their own health and
lives.
 MANAGER – management involves
in planning. Giving direction,
developing staff, monitoring
operations, giving rewards fairly.

 CHANGE AGENT – the nurse as

change agent identifies the problem,
assesses patient’s motivation to
change determine alternatives ,
assesses resources.
 NURSE GENERALIST – has mastery in
certain practice of nursing. Ex ER nurse MS
nurse NICU, CHN, PSYCHE ….etc.
 NURSE CLINICIAN – perform direct nursing
action in specialty areas. Shld be RN.
 NURSE PRACTITIONERS – requires advance
educational or nursing practices. Post grad
course RN.
 NURSE SPECIALIST – nurse with Master
degree / RN.
Scope
 Can correlate concepts in such a
way as to generate a different
way of looking at a certain fact or
phenomenon
 Logical in nature
 Simple but generally broad in
nature
 Can be a source of hypotheses
that can be tested for it to be
elaborated
 Can contribute in enriching the
general body of knowledge
though the studies implemented
to validate them
 Can be used by practitioners to
direct and enhance their practice
 Must be consistent with other
validated theories, laws and
principles but will open
unanswered issues that need to
be tested
 THEORY - IDEAS THAT INTENDED TO
EXPLAIN A GIVEN PHENOMENA
 NURSING THEORIES- VIEWS OF
PERSON, HEALTH, ENVIRONMENT,
NURSING, AND OTHER CONCEPT
THAT CONTRIBUTE TO THE
DEVELOPMENT OF A BODY OF
KNOWLEDGE SPECIFIC TO NURSING
CONCERNS.
 SCOPE - QUALIFIED LEVEL OF
PRECISION OF A CERTAIN THEORY
AND THE ACCURACY OF ITS
CONCEPTS AND PREPOSITIONS.
 GRAND THEORY
 MIDDLE RANGE THEORY
 MICRO RANGE THEORY
 SPEAK BROAD SCOPE OF IMPORTANCE
RELATIONSHIP AMONG CONCEPTS OF
DISCIPLINE.
 REPRESENTING COMMON AND EXTREMELY
COMPLEX PHENOMENA.
 ARISE AT A TIME WHEN NURSING WAS
ADDRESSING ITS NATURE, MISSION AND
GOALS.
 NOT EXPECTED TO PROVIDE A
PERFECT GUIDANCE FOR THE
FORMATION OF SPECIFIC
KNOWLEDGE BUT,
 PROVIDE A GENERAL FRAMEWORK
 EXAMPLE:
◦ OREM’S SELF CARE THEORY OF
NURSING
◦ NEUMAN SYSTEM MODEL THEORY
 Conceptual structures that are nearly as
abstract as the nursing models from which
they are derived, but propose outcomes based
on use and application of the model in nursing
practice.
 All inclusive conceptual structures, abstract,
including different perspective views of person,
health and environment
 Provide different ways of thinking about
nursing and address the metaparadigm
concepts that are central to its meaning
 KNOWNTO HAVE NARROWED
AND DETAILED FOCUS
COMPARED TO GRAND THEORY

 DESCRIPTIONS,
EXPLANATIONS,
AND PREDICTIONS ARE MADE
WITH THE PURPOSE OF
ANSWERING QUESTIONS ABOUT
DIFFERENT NURSING
PHENOMENA.
 DEVELOPED FROM THE SUBJECT
DATA OF QUALITATIVE
RESEARCH.
 PRODUCE A MIRROR OF WIDE
VARIETY OF NURSING CARE
STITUATIONS LIKE UNCERTAINTY,
INCONTINENCE, SOCIAL
SUPPORT, QUALITY OF LIFE AND
CARING
 PSYCHODYNAMICS NURSING
◦ Hildegard Paplau
 HUMAN TO HUMAN RELATION
MODEL
◦ Joyce Travelbee
 TRANSCULTURAL THEORY IN
NURSING
◦ Madeleine Leininger
 MODEL OF HEALTH
◦ Margaret Newman
 Lower in level of abstraction than
grand theories, they offer s more
direct application to research and
practice.
 Specific to nursing practice and
specific area of practice, age, range
of patients, nursing action or
interventions , and purposed
outlcome
 Lie between grand and micro:
synthesis of practice and research
 Emerge at the intersection of
research and practice, when theory
guides practice, practice generates
research and practice
 Known to be most concrete and
narrow in scope
 Situation specific and limited to
particular populations or field of
practice
 MOST CONCRETE AND NARROW
IN SCOPE
 SITUATION-SPECIFIC AND LIMITED
TO PARTICULAR POPULATIONS
OR FLIEDS OF PRACTISE AND
ALSO A LINKING OF CONCRETE
CONCEPTS INTO A STATEMENT
THAT CAN BE OBSERVED IN
PRACTICE AND RESEARCH
 HIGHER ABSTRACTIONS
◦ suggest strongly related to middle range
theory and consist of limited number of
concepts and is applicable to a narrow
issue or event.
 LOWER ABSTRACTIONS
◦ Hypothesis
◦ Tentative statements of relationship
between two or more variable that can
be empirically tested.
A linking of concrete concepts into a
statements that can be observed in
practice and research
 Two levels
◦ High abstraction micro-range
◦ Low abstraction micro-range
 HISTORICAL  EXPLICITNESS OF
EVOLUTION OF THE ASSUMPTION
THEORY  DEGREE OF
 APPROACH TO MODEL COMPREHESIVENESS
DEVELOPMENT  LOGICAL
 CONTENT CONGRUENCE
 SOURCE OF CONCERN  ABILITY OF THE MODEL
TO TEST AND
GENERATE
HYPOTHESIS
 CONTRIBUTION OF
THE MODEL TO
NURSING KNOWLEDGE
 CLARITY
 SIMPLICITY
 GENERALITY
 EMPIRICAL PRECISION
 DERIVABLE CONCEQUENCES
In evaluating the CLARITY of certain theory
consistency, semantics ( meaning of
language /symbols), structure are
considered important. ( operational
definition )

 Is the theory clearly stated?

 How clear is the theory?
 Is it easily understood?
 Theory must be adequately
comprehensive at the level of abstraction
to offer direction.

 How simple is the theory?

 The more limited the concepts and goals
is the less general the theory becomes.
 Accdg. To Chinn situation in which the
theory is appicable shld be boundless the
broader the scope of the theory the
greater the significance.

 How general is the theory?

 How broad is the scope of the theory?
 It defines as the degree in which the
defined concepts are observable in
actual setting.
 It is in line with the testability and
ultimate use of the theory.

 Isthe theory testable?

 How accessible is the theory?
 Theory should result to additional
knowledge that would guide practice and
should give direction to research and
practice, create new ideas.
 Accdg to Ellis in order for the theory to be
considered useful it must develop and
guide practice.
 How important is the theory?
 Does the theory have a significant
contribution to nursing knowledge?
1.Utilizes in each practice a well
– defined body of knowledge
2. Constantly enlarges the body
of knowledge to improve
education and practice.
3. Function autonomously in the
control of professional activity.
4. Provides for continuous
growth of the profession.
 The benefits of having a defined
body of knowledge include
improved patient care, enhanced
professional status, improved
communication between nurse
professional and guide for
research and education.
 EVIDENCED BASED PRACTICE
 A profession applies its body of knowledge
in practical services that are vital to
human welfare, and especially suited to
the tradition of seasoned practitioners
shaping the skills of newcomers to the
role.
 It constantly enlarges the body of
knowledge it uses and subsequently
imposes on its members a lifelong
obligation to remain current in order to “do
no harm.”
A profession functions autonomously
(with authority) in the formulation of
professional policy and monitoring its
practice and practitioners.
 It utilizes in its practice a well defines
and well organize body of knowledge
that is intellectual in nature and
describes its phenomenon and
practitioners.
A professional has a clear standard
of educational preparation for entry
into practice.
 A profession is distinguished by the
presences of specific culture, norms
and other values that are common
among its members.
 As a nurse grows and matures in
their professional status, the use of
ample knowledge as a basis for
theory-based nursing is a
characteristics of their practice!
 Organize, examine and analyze
patient’s data.
 Make decisions about effective and
efficient nursing interventions
 Make a SMART (specific,
measurable, attainable, realistic and
time bounded) plan of care)
 Predict and evaluate outcomes of
care
 Nursing theory (theory based practice) –
provides the principles that support nursing
practice
 Profession – specialized field of practice, line of
work.
 Nurse practitioner – practices the profession of
nursing with the application of acquired nursing
knowledge and concepts
 Criteria – sets of rules and principles against
which something may be evaluated.
 Nursing Theory
Ma. Criselda C. Ultado, RN, MAN
FLORENCE NIGHTINGALE
 Known as the Mother of Modern
Nursing
 The lady with the lamp
 Born in Florence, Italy
 On May 12, 1820

 Shehad a reputable education which

was uncommon during her time
 Florence Nightingales’s
Environmental Theory
 Defined Nursing: “The act of utilizing
the environment of the patient to
assist him in his recovery.”
 Focuses on changing and manipulating
the environment in order to put the
patient in the best possible conditions
for nature to act.
 Identified 5 environmental factors:
fresh air, pure water, efficient drainage,
cleanliness/sanitation and light/direct
sunlight.
 Considered a clean, well-ventilated,
quiet environment essential for
recovery.
 Deficiencies in these 5 factors produce
illness or lack of health, but with a
nurturing environment, the body could
repair itself.
PERSON
. are multidimensional, composed of
•People
biological, psychological, social and
spiritual components.

HEALTH
•Health is “not only to be well, but to be able to
use well every power we have”.
•Disease is considered as dys-ease or the
absence of comfort.
ENVIRONMENT
Poor or difficult environments led to poor health and
•"

disease".
•"Environment could be altered to improve conditions
so that the natural laws would allow healing to occur."
NURSING
•Nursing is different from medicine and the goal of
nursing is to place the patient in the best possible
condition for nature to act.
•Nursing is the "activities that promote health which
occur in any caregiving situation. They can be done by
anyone."
Nightingale’s Canons: Major Concepts
•Ventilation and warming
•Light, Noise
•Cleanliness of rooms/walls
•Health of houses
•Bed and bedding
•Personal cleanliness
•Variety
•Chattering hopes and advices
•Taking food. What food?
•Petty management/observation
Nightingale's Theory and Nursing Practice
Application of Nightingale's theory in practice:
•"Patients are to be put in the best condition for
nature to act on them, it is the responsibility of
nurses to reduce noise, to relieve patients’
anxieties, and to help them sleep."
•As per most of the nursing theories,
environmental adaptation remains the basis of
holistic nursing care.
Criticisms
•She emphasized subservience to doctors.
•She focused more on physical factors than on
psychological needs of patient.
Hildegard E. Peplau’s
Interpersonal Relations Theory /
Model
•Born in Reading, Pennsylvania [1909]
•Graduated from a diploma program in Pottstown,
Pennsylvania in 1931.
•Done BA in interpersonal psychology from Bennington
College in 1943.
MA in psychiatric nursing from Colombia University New
York in 1947.
•Started first post baccalaureate program in nursing
Published Interpersonal Relations in Nursing in 1952
1968 :interpersonal techniques-the crux of psychiatric
nursing
Factors influencing orientation phase
 NURSE
PATIENT • Values
values • Culture
culture • Belief
belief past • Past
experience experiences
expectation • expectation
NURSE – PATIENT
RELATIONSHIP 4 PHASES
Initial interaction, the client seek help the nurse
ORIENTATION assist the client .

IDENTIFICATION The client and the nurse explore the experience

phase develop the feeling of relatedness.

This phase the clients derives the full value from

EXPLOITATION the nurse .Power shift from the nurse to the
client

RESOLUTION This phase the clients earns independence over

his care
Interpersonal theory and nursing
process
•Both are sequential and focus on
therapeutic relationship
•Both use problem solving techniques
for the nurse and patient to collaborate
on, with the end purpose of meeting the
patients needs
•Both use observation communication
and recording as basic tools utilized by
nursing
Assessment Orientation
 Data collection and  Non continuous data
analysis [continuous] collection
 May not be a felt  Felt need
need  Define needs

Nursing diagnosis Identification

Planning  Interdependent goal
 Mutually set goals setting
Implementation
 Plans initiated towards
achievement of mutually
set goals
 May be accomplished by
patient , nurse or family
Evaluation
 Based on mutually
expected behaviors
 May led to termination and
initiation of new plans
Exploitation
 Patient actively seeking and
drawing help
 Patient initiated
Resolution
 Occurs after other phases are
completed successfully
 Leads to termination a
Person
.
•A developing organism that tries to
reduce anxiety caused by needs
Environment
• Existing forces outside the organism
and in the context of culture
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.
Nursing
•A significant therapeutic interpersonal
process. It functions cooperatively with
other human process that make health
possible for individuals in communities
Roles of nurse
•Stranger: receives the client in the same
way one meets a stranger in other life
situations provides an accepting climate
that builds trust.
•Teacher: who imparts knowledge in
reference to a need or interest
•Resource Person : one who provides a
specific needed information that aids in the
understanding of a problem or new situation
•Counselors : helps to understand and
integrate the meaning of current life
circumstances ,provides guidance and
encouragement to make changes
•Surrogate: helps to clarify domains of
dependence interdependence and
independence and acts on clients behalf as an
advocate.
•Leader : helps client assume maximum
responsibility for meeting treatment goals in a
mutually satisfying way
Additional Roles include:
1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Mediator
9. Administrator
10. Recorder observer
11. Researcher
‘’The nurse is temporarily the
consciousness of the unconscious, the
love of life for the suicidal, the leg of the
amputee, the eyes of the newly blind, a
means of locomotion for the infant,
knowledge and confidence for the
mother, the mouthpiece for those too
weak or withdrawn to speak and so on.’’

- Virginia Henderson
 Born in Kansas City, Missouri, in 1897 and
is the 5th child of a family of 8th children but
spent her formative years in Virginia .
 She died in 1996 at the Connecticut
Hospice, aged 98, and was interred in her
family's plot of the churchyard of St.
Stephen's Church, Forest, Bedford County,
Virginia
Received a Diploma in Nursing from the
Army School of Nursing at Walter Reed
Hospital, Washington, D.C. in 1921.
 She has been called the
‘’ First lady of Nursing’’ &
‘’First Truly International Nurse’’.
“Nightingale of Modern Nursing”
“Modern- day Mother of Nursing”
 Defined Nursing: “Assisting the
individual, sick or well, in the
performance of those activities
contributing to health or it’s
recovery (or to peaceful death)
that an individual would
perform unaided if he had the
necessary strength, will or
knowledge”.
Began her career in public
health nursing in the Henry
Street Settlement.

 First full time instructor in

nursing in Virginia when she
was at Norfolk Protestant
Hospital.
 Breathing normally
 Eating & drinking adequately
 Eliminating body wastes
 Moving & maintaining a desirable
position
 Sleeping & resting
 Selecting suitable clothes
Maintaining normal body temperature by
adjusting clothing & modifying the
environment.
 Keeping the body clean & well groomed to
promote integument (skin)
 Avoiding dangers in the environment &
avoiding injuring others.
Communicating with others in expressing
emotions, needs, fears or opinions.
Worshipping according to one’s faith.
 Working in such a way that one feels a
sense of accomplishment.
 Playing or participating in various forms of
recreation.
 Learning, discovering or satisfying the
curiosity that leads to normal development &
health, & using available health facilities.
•The first 9 components are
physiological.
•The tenth and fourteenth are
psychological aspects of
communicating and learning The
eleventh component is spiritual and
moral
•The twelfth and thirteenth
components are sociologically oriented
to occupation and recreation
 The nurse as a substitute for the
patient.
 The nurse as a helper to the
patient.
 The nurse as a partner with the
patient.
 Nurses function independently from
physicians rather they follow in a
philosophy which allows physicians to
give orders to patients or other
healthcare team members.
For a team to work together in
harmony, every member must work
interdependently.
Henderson’s approach focuses on decision –
making and is deliberate in such a way that in
every step of the Nursing Process, it plays
very important roles.
Nursing Process – Steps:
 Assessment Phase
 Planning Phase
Implementation Phase
 Evaluation Phase
 4 STEPS /PHASES IN NURSING
PROCESS

ASSESSMENT Nurse assess the 14 needs of the clients are met

PLANNING Giving the plan of care to meet the need of the

client.

IMPLEMENTATION The nurse uses the 14 basic needs in answering

the factors that contributing to the illness.

EVALUATION The nurse assess if the goals are met if health is

achieved.
 Nurse would assess the 14 basic
fundamental needs of patient which one is
lacking or fully met.
 Gathers data by observing, smelling,
feeling & hearing.
 To complete this phase the nurse use
critical thinking and analyze the gathered
data to come up with the complete
condition of the patient
 Involves the giving the plan of care to
meet the needs. Planning phase.
 Serves as a record and at the same
time must fit in the prescribed plan by
the physician.
 nurse uses 14 basic needs to
answer the factors that
contributing to the illness state of
the patient.
 It focuses on maintaining health,
to recover from illness or aid in
peaceful death.
 The nurse evaluate whether
goals are met or not.
 The nurse also assess if the
patient attained independence
and if health is achieved.
PERSON
An individual requires assistance to
achieve health & independence or in some
cases, a peaceful death.
HEALTH
She viewed health as a quality of life &
is very basic for a person to function fully.
ENVIRONMENT
It is the responsibility of the nurse to help the
patient manage his surroundings to protect
him from harm or any mechanical injury.
NURSING
Henderson asserted that nurses function
independently from the physician, but they
must promote the treatment plan prescribed
by the physician. Help both the sick and well
individual.
Joyce Travelbee “s Theory
Human-to-Human Relationship
Model
‘’ A nurse does not only seek to alleviate
physical pain or render physical care – she
ministers to the whole person. The existence
of suffering, whether physical, mental or
spiritual is the proper concern of the nurse. ‘’

“The nurse is responsible for helping

the patient avoid and alleviate the
distress of unmet needs.”
- Joyce Travelbee
 Born in 1926, was a psychiatric nurse.
Educator and writer.
 1952 – started to be an instructor focusing
Psychiatric Nursing at DePaul Hospital
Affiliate School, New Orleans.
 She also taught Psychiatric Nursing at
Charity Hospital School of Nursing in
Louisiana State University,
HUMAN-TO-HUMAN RELATIONSHIP MODEL
In her human-to-human relationship model, the
nurse & the patient undergoes the ff. series of
interactional phases:
 Original Encounter
 Emerging Identities
 Empathy
 Sympathy
 Rapport
 NURSE /PATIENT
RAPPORT

NURSE PATIENT
Sympathy

NURSE Empathy PATIENT

NURSE Emerging Identities PATIENT

NURSE/ Original Encounter PATIENT/

HUMAN HUMAN
METAPARADIGM IN NURSING
PERSON
Is defined as human being, is a unique,
irreplaceable individual who is in the
continuous process of becoming, evolving, &
changing.
‘’
ENVIRONMENT
Associated to human conditions and life
experiences encountered by all men as
sufferings, hope, pain & illness
HEALTH
A person’s subjective health status is an
individually defined state of well being in
accord with self-appraisal of physical-
emotional-spiritual status.’’ Objective health
. is ‘’an absence of discernible dse.,disability,
or defect as measured by physical
examination, laboratory tests, assessment
by a spiritual director , or psychological
counselor
NURSING
‘’ is an interpersonal process whereby the
professional nurse practitioner assists an
individual, family, or community to
prevent or cope with the experience of
illness & suffering &, if necessary, to find
meaning in these experiences.’’
 SYSTEM MODEL- BETTY NEUMAN
 The Neuman’s system model has two major
components:stress and reaction to stress.
 The client in the Neuman’s system model is viewed
as an open system in which repeated cycles of
input, process, out put and feed back constitute a
dynamic organizational pattern.
 The client may be an individual, a group, a family, a
community or an aggregate.
 In the development towards growth and
development open system continuously become
more differentiated and elaborate or complex.
 As they become more complex, the internal
conditions of regulation become more complex.
 Exchange with the environment are reciprocal,
both the client and the environment may be
affected either positively or negatively by the
other.
 The system may adjust to the environment to
itself.
 The ideal is to achieve optimal stability.
 As an open system the client, the client system
has propensity to seek or maintain a balance
among the various factors, both with in and out
side the system, that seek to disrupt it. Neuman
seeks these forces as stressors and views them
as capable of having either positive or negative
effects.
 Reaction to the stressors may be possible or
actual with identifiable responses and symptom.
I. PERSON VARIABLES
 Each layer, or concentric circle, of the
Neuman model is made up of the five
person variables. Ideally, each of the
person variables should be considered
simultaneously and comprehensively.
 Physiological - refers of the
physicochemical structure and function of
the body.
 Psychological - refers to mental processes
and emotions.
 Sociocultural - refers to
relationships; and social/cultural
expectations and activities.
 Spiritual - refers to the influence
of spiritual beliefs.
 Developmental - refers to those
processes related to development
over the life span.
 The basic structure, or central core, is made
up of the basic survival factors that are
common to the species (Neuman, 1995, in
George, 1996).
 These factors include: system variables,
genetic features, and the strengths and
weaknesses of the system parts. Examples
of these may include: hair color, body
temperature regulation ability, functioning of
body systems homeostatically, cognitive
ability, physical strength, and value systems.
 The person's system is an open system
and therefore is dynamic and constantly
changing and evolving.
 Stability, or homeostasis, occurs when the
amount of energy that is available
exceeds that being used by the system.
 A homeostatic body system is constantly
in a dynamic process of input, output,
feedback, and compensation, which leads
to a state of balance.
 The flexible line of defense is the outer
barrier or cushion to the normal line of
defense, the line of resistance, and the core
structure.
 If the flexible line of defense fails to provide
adequate protection to the normal line of
defense, the lines of resistance become
activated.
 The flexible line of defense acts as a cushion
and is described as accordion-like as it
expands away from or contracts closer to the
normal line of defense.
 The flexible line of defense is dynamic and
can be changed/altered in a relatively short
period of time.
 The normal line of defense represents
system stability over time.
 It is considered to be the usual level of
stability in the system.
 The normal line of defense can change
over time in response to coping or
responding to the environment. An
example is skin, which is stable and fairly
constant, but can thicken into a callus
over time.
 The lines of resistance protect the
basic structure and become activated
when environmental stressors invade
the normal line of defense.
 Example: activation of the immune
response after invasion of
microorganisms. If the lines of resistance
are effective, the system can reconstitute
and if the lines of resistance are not
effective, the resulting energy loss can
result in death
 Reconstitution is the increase in energy
that occurs in relation to the degree of
reaction to the stressor.
 Reconstitution begins at any point
following initiation of treatment for invasion
of stressors.
 Reconstitution may expand the normal line
of defense beyond its previous level,
stabilize the system at a lower level, or
return it to the level that existed before the
illness.
 The Neuman Systems Model looks at the
impact of stressors on health and
addresses stress and the reduction of
stress (in the form of stressors).
 Stressors are capable of having either a
positive or negative effect on the client
system.
 A stressor is any environmental force
which can potentially affect the stability of
the system: they may be:
Intrapersonal - occur within
person, e.g. emotions and
feelings
Interpersonal - occur between
individuals, e.g. role expectations
Extra personal - occur outside the
individual, e.g. job or finance
pressures
 The person has a certain degree of
reaction to any given stressor at any given
time. The nature of the reaction depends
in part on the strength of the lines of
resistance and defense. By means of
primary, secondary and tertiary
interventions, the person (or the nurse)
attempts to restore or maintain the stability
of the system.
 .
 As defined by Neuman's model, prevention is
the primary nursing intervention. Prevention
focuses on keeping stressors and the stress
response from having a detrimental effect on the
body.
 Primary -Primary prevention occurs before the
system reacts to a stressor. On the one hand, it
strengthens the person (primarily the flexible line
of defense) to enable him to better deal with
stressors, and on the other hand manipulates
the environment to reduce or weaken stressors.
Primary prevention includes health promotion
and maintenance of wellness.
 Secondary-Secondary prevention occurs after
the system reacts to a stressor and is provided
in terms of existing systems. Secondary
prevention focuses on preventing damage to the
central core by strengthening the internal lines
of resistance and/or removing the stressor.
 Tertiary -Tertiary prevention occurs after the
system has been treated through secondary
prevention strategies. Tertiary prevention offers
support to the client and attempts to add energy
to the system or reduce energy needed in order
to facilitate reconstitution.
 an open system that works together with
other parts of its body as it interact with the
environment

 a dynamic composite of the interrelationship

of five variables: (1.) physiological, (2.)
psychological, (3.) sociocultural, (4.)
developmental, and (5.) spiritual

 has protective mechanisms for the basic

structure, and maintains client’s system
stability: (1.) flexible line of defense, (2.)
normal line of defense, and (3.) lines of
resistance
 dynamic condition

 equated with stability of normal line of

defense

 Wellnessexists when all the part or

system of person works harmoniously
Health

Flexible Line of Defense

Normal Line of Defense

CORE
CORE Lines of Resistance

Health
can be internal, external, and
created force (stressors) that
interacts with a person’s state of
health

has the potential to alter or

improve stability of systems
 Interperson S
S al
Intraperson T
T al
Extraperson R
R al
E
E Flexible Line of Defense
S
S Normal Line of
Defense S
CORE
CORE
Lines of Resistance
S
O
Interpersonal
Interperson
O al
R
R Intraperson
al S
S Extraperson
al
 a unique profession hat requires holistic
approach – considers all factors affecting a
client’s health

 aims to promote optimal wellness to its

client through retention, attainment, or
maintenance of the stability of client’s
system
 nurse helps the different levels of clientele:
individual, family, and groups in achieving and
maintaining an optimal wellness through
intervention with the goal of reducing stress
factors and its adverse effects to the optimal
functioning of an individual in any given situation

 nursing consists of intervention modalities of

prevention which can be: (1.) primary, (2.)
secondary, (3.) tertiary
 Aim to strenghten the capacity of a person
to maintain an optimum level of functioning,
Primary HEALTH PROMOTION &DISEASE
PREVENTION

Aim to alleviate the actual existing effect of

Secondary an action that altered that balance of
Health. EARLY DETECTION

Aim on actual treatment to facilitate the

Tertiary strengthening of person being exposed to
certain illness. REHABILITATION
Health

Flexible Line of Defense

(Primary Prevention)
Normal Line of Defense
(Secondary Prevention)

CORE
CORE Lines of
Resistance
(Tertiary
Prevention)

Health
Primary Prevention:
•Stress management Tertiary Prevention
activities •Re-assessing patient’s ability
•Relaxation techniques to independently perform and
•Anger-management maintain variables of health.
techniques •Regular consult to
•Smoking cessation psychologist.
•Maintaining client’s support
Effects on Flexible Line of system
Defense:
•sleeps very late at night
•misses breakfast and lunch
•responds with pressure and
intimidating remarks for works not Effects on Lines of
perfectly done CORE
CORE Resistance:
•smokes and drinks alcohol
•weakened immune
whenever he is stressed
response
•developed
Work-related stressors pneumonia

Effects on Normal Line of Secondary

Defense: Prevention
•exhibiting weird
•Medication (to treat
mannerisms and behaviors
•periods of mania and symptoms)
depression •Opportunities to
verbalize feelings and
concerns
•Born August 21, 1919, in Savannah, Georgia.
•B. S. N. from Vanderbilt University in Nashville,
Tennessee, in 1942; and her M.P.H. from Harvard
University in Boston in 1948.
•From 1949 till retirement in 1978 she was an
assistant professor of pediatric nursing, an
associate professor of nursing, and a professor of
nursing at the University of California in Los
Angeles.
•Johnson stressed the importance of research-
based knowledge about the effect of nursing care
on clients.
 ATTACHMENT/
ATTACHMENT

CLOSENESS
AFFILIATION
 DEPENDENCY ACHIEVEMENT DEPENDENCY

 INGESTIVE

SUBSYSTEM

AGGRESSIVE INGESTIVE
 ELIMINATIVE
 SEXUAL
 AGGRESSIVE
 ACHIEVEMENT
SEXUAL ELIMINATIVE
 Attachment or affiliative subsystem: “social
inclusion intimacy and the formation and attachment
of a strong social bond.”
 Dependency subsystem: “approval, attention or
recognition and physical assistance”
 Ingestive subsystem: “the emphasis is on the
meaning and structures of the social
events surrounding the occasion when the food is
eaten”
 Eliminative subsystem: “human cultures have
defined different socially acceptable behaviors for
excretion of waste ,but the existence of such a
pattern remains different from culture to Culture.”
 Sexual subsystem:" both biological and social
factor affect the behavior in the sexual
subsystem”
 Aggressive subsystem: " it relates to the
behaviors concerned with protection and self
preservation Johnson views aggressive
subsystem as one that generates defensive
response from the individual when life or territory
is being threatened”
 Achievement subsystem: " provokes behavior
that attempt to control the environment
intellectual, physical, creative, mechanical and
social skills achievement are some of the areas
that Johnson recognizes".
METAPARADIGM IN NURSING
PERSON
“Human being” as having two major systems, the
biological system and the behavioral system. It is role of
the medicine to focus on biological system where as
Nursling's focus is the behavioral system.
ENVIRONMENT
‘’
“Society” relates to the environment on
which the individual exists. According to
Johnson an individual’s behavior is
influenced by the events in the
environment
HEALTH
“Health” is a purposeful adaptive response,
physically
“
mentally, emotionally, and socially to
internal and external stimuli in order to maintain
stability and comfort.
NURSING
“Nursing” has a primary goal that is to foster
‘
equilibrium within the individual. Nursing is
concerned with the organized and integrated
whole, but that the major focus is on
maintaining a balance in the Behavior system
when illness occurs in an individual.
 Born in 1923.
 Completed her Bachelor in science of
nursing from St. Louis University in 1948
 Completed her Master of science in
nursing from St. Louis University in 1957
 Completed her Doctorate from Teacher’s
college, Columbia University
 …elements are seen in the interpersonal
systems in which two people, who are usually
strangers, come together in a health care
organization to help and be helped to
maintain a state of health that permits
functioning of roles.
 …reflects King’s belief that the practice of
nursing is differentiated from other
healthcare professions by what nurses do
with and for individuals
 nurse and client communicate information,
set goal mutually and then act to attain those
goals
Three systems in the conceptual
framework:
Personal System (the individual)
Interpersonal Systems (individuals
interacting with one another)
Social System (groups of people in a
community/society sharing common
goals, interests, and values)
Study systems as a whole rather than as
isolated parts of a system
METAPARADIGM IN NURSING
PERSON
Human
“. being /person: is social being who are rational
and sentient. Person has ability to : Perceive, think, f
eel, choose & set goals select means to achieve goals and
to make decision
According to King, human being has three fundamental
‘’needs:
(a) The need for the health information that is unable at
the time when it is needed and can be used
(b) The need for care that seek to prevent illness, and
(c) The need for care when human beings are unable to
help themselves.
HEALTH
Health involves dynamic life experiences of a human
being, which implies continuous adjustment to
“
stressors in the internal and external environment
through optimum use of one’s resources to achieve
maximum potential for daily living
NURSING
“A process of action, reaction and interaction by which
‘ nurse and client share information about their
perception in nursing situation.” and “ a process of
human interactions between nurse and client whereby
each perceives the other and the situation, and through
communication, they set goals, explore means, and
agree on means to achieve goals.”
ENVIRONMENT
Environment is the background for human
“
interactions. It involves:
(a) Internal environment: transforms energy
to enable person to adjust to continuous
external environmental changes.
‘

(b) External environment: involves formal

and informal organizations. Nurse is a part
of the patient’s environment.
 Defined Nursing: “The act of
assisting others in the
provision and management of
self-care to maintain/improve
human functioning at home
level of effectiveness.”
 One of foremost nursing theorists.
 Born 1914 in Baltimore.
 Earned her diploma at Providence
Hospital – Washington, DC
 1939 – BSN Ed., Catholic University of
America
 1945 – MSN Ed., Catholic University of
America
 Involved in nursing practice, nursing
service, and nursing education
 During her professional career, she worked
as a staff nurse, private duty nurse, nurse
educator and administrator and nurse
consultant
 Received honorary Doctor of Science
degree in 1976
 Published first formal articulation of her
ideas in Nursing: Concepts of Practicein
197, second in 1980, and in 1995.
 Self
care
R R

Conditioning factors
Conditioning factors

Self
Care / R Therapeutic
Dep. Self care
demands
Care
Agency
Deficit

R R
Conditioning

Nursing
factors

Agency
 Wholly
Compensatory Nursing
System

 Partly Compensatory Nursing System

 Supportive-Educative Nursing System

Nursing System – nursing
interventions needed when Individual is
unable to perform the necessary self-care
activities:
1. Wholly compensatory – nurse
provides entire self-care for the client.
•Example: care of a new born, care
of client recovering from surgery in a
post-anesthesia care unit
2. Partial compensatory – nurse
and client perform care, client can
perform selected self-care activities,
but also accepts care done by the
nurse for needs the client cannot
meet independently.
•Example: Nurse can assist post
operative client to ambulate,
Nurse can bring a meal tray for
client who can feed himself
 3. Supportive-educative – nurse’s
actions are to help the client
develop/learn their own self-care
abilities through knowledge, support
and encouragement.
Example: Nurse guides a mother
how to breastfeed her baby,
Counseling a psychiatric client on
more adaptive coping strategies.
 Accomplishes
patient’s Patient action
therapeutic self- limited
care

Compensates for
Nurse Action patient’s inability to
engage in self-care

Supports and
protects patient
 Performs some self-care
measures for patient

Compensates for self-care

limitations of patient
Nurse action
Assists patient as required

Regulates self-care agency

Performs some self-care

Patient Action agency

Accepts care and

assistance from nurse
 Accomplishes self-
care

Patient action
Regulates the
exercise and
development of
self-care agency
Nurse action
 Nursing – is art, a helping service, and a
technology
 Actions deliberately selected and
performed by nurses to help individuals or
groups under their care to maintain or
change conditions in themselves or their
environments
 Encompasses the patient’s perspective of
health condition ,the physician’s
perspective , and the nursing perspective
 Goal of nursing – to render the patient
or members of his family capable of
meeting the patient’s self care needs
 To maintain a state of health
 To regain normal or near normal state
of health in the event of disease or
injury
 To stabilize ,control ,or minimize the
effects of chronic poor health or
disability
 health and healthy are terms used to
describe living things …
 It is when they are structurally and
functionally whole or sound … wholeness or
integrity. .includes that which makes a
person human,…operating in conjunction
with physiological and psychophysiological
mechanisms and a material structure and in
relation to and interacting with other human
beings
 environment components are
enthronement factors,
enthronement elements,
conditions, and developed
environment
 Human being – has the capacity to reflect, symbolize
and use symbols
 Conceptualized as a total being with universal,
developmental needs and capable of continuous self
care
 A unity that can function biologically, symbolically and
socially
 Nursing client
 A human being who has "health related /health derived
limitations that render him incapable of continuous self
care or dependent care or limitations that result in
ineffective / incomplete care.
 A human being is the focus of nursing only when a self
–care requisites exceeds self care capabilities
 Birth:1919
 Dr Abdellah worked as Deputy Surgeon General in
US and Chief Nurse Officer for the US Public
Health Service , Department of Health and human
services, Washington, D.C.
 She was a leader in nursing research and has over
one hundred publications related to nursing care,
education for advanced practice in nursing and
nursing research.
 According to her, nursing is based on an art and
science that mould the attitudes, intellectual
competencies, and technical skills of the individual
nurse into the desire and ability to help people , sick
or well, cope with their health needs.
21 NURSING PROBLEMS
Basic to all Patients
1.To promote good hygiene and physical
comfort
2.To promote optimal activity, exercise, rest,
and sleep
3.To promote safety through prevention of
accidents, injury, or other trauma and through
the prevention of the spread of infection
4.To maintain good body mechanics and
prevent and correct deformities
Sustenal care needs
5.To facilitate the maintenance of a
supply of oxygen to all body cells
6.To facilitate the maintenance of
nutrition of all body cells
7.To facilitate the maintenance of
elimination
8.To facilitate the maintenance of fluid and
electrolyte balance
9.To recognize the physiologic responses
of the body to disease conditions
10.To facilitate the maintenance of
regulatory mechanisms and functions
11.To facilitate the maintenance of sensory
function
Remedial care needs
12.To identify and accept positive and negative
expressions, feelings, and reactions
13.To identify and accept the interrelatedness of
emotions and organic illness
14.To facilitate the maintenance of effective verbal
and nonverbal communication
15.To promote the development of productive
interpersonal relationships
16.To facilitate progress toward achievement of
personal spiritual goals
17.To create and maintain a therapeutic
environment
18.To facilitate awareness of self as an
individual with varying physical, emotional,
and developmental needs
19.To accept the optimum possible goals in light
of physical and emotional limitations
Restorative care needs
20.To use community resources as an
aid in resolving problems arising
from illness
21.To understand the role of social
problems as influencing factors in the
cause of illness
 Nursing – is a helping profession.
 In Abdellah’s model, nursing care is doing
something to or for the person or providing
information to the person with the goals of
meeting needs, increasing or restoring self-help
ability, or alleviating impairment.
 Nursing is broadly grouped into the 21 problem
areas to guide care and promote use of nursing
judgment.
 She considers nursing to be comprehensive
service that is based on art and science and
aims to help people, sick or well, cope with their
health needs
 Abdellah describes people as having
physical, emotional, and sociological
needs. These needs may overt, consisting
of largely physical needs, or covert, such
as emotional and social needs.
 Patient is described as the only justification
for the existence of nursing.
 Individuals (and families) are the recipients
of nursing
 Health, or achieving of it, is the purpose of
nursing services.
 In Patient–Centered Approaches to
Nursing, Abdellah describes health as
a state mutually exclusive of illness.
 Although Abdellah does not give a
definition of health, she speaks to
“total health needs” and “a healthy
state of mind and body” in her
description of nursing as a
comprehensive service
 Society and environment is included
in “planning for optimum health on
local, state, national, and international
levels”. However, as she further
delineated her ideas, the focus of
nursing service is clearly the
individual.
 The environment is the home or
community from which patient comes
 Sr.Callista Roy, a prominent nurse
theorist, writer, lecturer, researcher and
teacher
 Professor and Nurse Theorist at the
Boston College of Nursing in Chestnut
Hill
 Born at Los Angeles on October 14,
1939 as the 2nd child of Mr. and Mrs.
Fabien Roy
 she earned a Bachelor of Arts
with a major in nursing from
Mount St. Mary's College, Los
Angeles in 1963.
 a master's degree program in
pediatric nursing at the University
of California ,Los Angeles in 1966
1. Physiologic-Physical Mode
Physical and chemical processes involved in
the function and activities of living organisms; the
underlying need is physiologic integrity as seen in
the degree of wholeness achieved through
adaptation to change in needs.
2. Self-concept- Group Identity Mode
Focuses on psychological and spiritual
integrity and sense of unity, meaning, and
purposefulness in the universe.
3. Role Function Mode
Roles that individuals occupy in
society, fulfilling the need for social
integrity. It is knowing who one is in
relation to others.
4. Interdependence Mode
The close relationships of people
and their purpose, structure and
development
individually and in groups and the
adaptation potential of these groups.
Nursing
 To promote adaptation in the four adaptive
modes
 To promote adaptation for individuals and
groups in the four adaptive modes, thus
contributing to health, quality of life, and
dying with dignity by assessing behaviors
and factors that influence adaptive abilities
and by intervening to enhance
environmental interactions
 Bio-psycho-social being in constant
interaction with a changing environment
 Uses innate and acquired mechanisms to
adapt
 An adaptive system described as a whole
comprised of parts
 Functions as a unity for some purpose
 Includes people as individuals or in
groups-families, organizations,
communities, and society as a whole.
 Inevitable dimension of person's
life
 Represented by a health-illness
continuum
 A state and a process of being
and becoming integrated and
whole
 Focal - internal or external and immediately
confronting the person
 Contextual- all stimuli present in the situation that
contribute to effect of focal stimulus
 Residual-a factor whose effects in the current
situation are unclear
 All conditions, circumstances, and influences
surrounding and affecting the development and
behavior of persons and groups with particular
consideration of mutuality of person and earth
resources, including focal, contextual and residual
stimuli
Madeleine Leininger’s
Transcultural Theory in Nursing
 a pioneering nursing theorist and
transcultural global nursing consultant.
 MSN from Catholic University in
Washington DC.
 PhD in anthropology from the University of
Washington.
 She developed the concept of
transcultural nursing and the ethnonursing
research mode
 Transcultural Nursing
 Transcultural nursing is a comparative
study of cultures to understand similarities
(culture universal) and difference (culture-
specific) across human groups (Leininger,
1991).
 Culture
 Set of values, beliefs and traditions, that
are held by a specific group of people and
handed down from generation to
generation.
 Culture is the learned, shared and
transmitted values, beliefs, norms and life
way practices of a particular group that
guide thinking, decisions, and actions in
patterned ways.
 Culture is learned by each generation
through both formal and informal life
experiences.
 Culture is also beliefs, habits, likes,
dislikes, customs and rituals learn from
one’s family.
 Language is primary through means
of transmitting culture.
 The practices of particular culture
often arise because of the group's
social and physical environment.
 Culture practice and beliefs are
adapted over time but they mainly
remain constant as long as they
satisfy needs.
 Religion
 Is a set of belief in a divine or super
human power (or powers) to be
obeyed and worshipped as the
creator and ruler of the universe.
 Ethnic
 refers to a group of people who share
a common and distinctive culture and
who are members of a specific group.
 Ethnicity
 a consciousness of belonging to a
group.
 Cultural Identify
 the sense of being part of an ethnic
group or culture
 Culture-universals
 commonalities of values, norms of
behavior, and life patterns that are
similar among different cultures.
 Culture-specifies
 values, beliefs, and patterns of
behavior that tend to be unique to a
designate culture.
 Material culture
 refers to objects (dress, art, religious
arti1acts)
 Non-material culture
 refers to beliefs customs,
languages, social institutions.
 Subculture
 composed of people who have a
distinct identity but are related to
a larger cultural group.
Bicultural
 a person who crosses two cultures,
lifestyles, and sets of values.
Diversity
 refers to the fact or state of being
different. Diversity can occur between
cultures and within a cultural group.
Acculturation
 People of a minority group tend to assume the
attitudes, values, beliefs, find practices of the
dominant society resulting in a blended cultural
pattern.
Cultural shock
 the state of being disoriented or unable to
respond to a different cultural environment
because of its sudden strangeness, unfamiliarity,
and incompatibility to the stranger's perceptions
and expectations at is differentiated from others
by symbolic markers (cultures, biology, territory,
religion).
Ethnic groups
 share a common social and cultural
heritage that is passed on to
successive generations.,
Ethnic identity
 refers to a subjective perspective of
the person's heritage and to a sense
of belonging to a group that is
distinguishable from other groups.
Race
 the classification of people according
to shared biologic characteristics,
genetic markers, or features. Not all
people of the same race have the
same culture.
Cultural awareness
 It is an in-depth self-examination of
one's own background, recognizing
biases and prejudices and
assumptions about other people
.
Culturally congruent care
 Care that fits the people's valued life
patterns and set of meanings -which is
generated from the people themselves,
rather than based on predetermined criteria.
Culturally competent care
 is the ability of the practitioner to bridge
cultural gaps in caring, work with cultural
differences and enable clients and families
to achieve meaningful and supportive
caring.
Margaret Jean Watson’s
Philosophy & Science of Caring
 Theorist was born in West Virginia, US
 Educated: BSN, University of Colorado, 1964, MS,
University of Colorado, 1966, PhD, University of
Colorado, 1973
 Distinguished Professor of Nursing and endowed
Chair in Caring Science at the University of
Colorado Health Sciences Center.
 Previously, Dean of Nursing at the University
Health Sciences Center and President of the
National League for Nursing
 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.
1. The formation of a humanistic- altruistic
system of values.
2. The installation of faith-hope.
3. The cultivation of sensitivity to one’s self
and to others.
4. The development of a helping-trust
relationship
5. The promotion and acceptance of the
expression of positive and negative
feelings.
6. The systematic use of the scientific problem-
solving method for decision making
7. The promotion of interpersonal teaching-
learning.
8. The provision for a supportive, protective
and /or corrective mental, physical, socio-
cultural and spiritual environment.
9. Assistance with the gratification of human
needs.
10. The allowance for existential-
phenomenological forces.
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”.
 She adopts a view of the human
being as: “….. 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”.
 Watson believes that there are other
factors that are needed to be included in
the WHO definition of health. She adds the
following three elements:
 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)
 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.
Patricia Benner’s
From Novice to Expert
 Patricia E. Benner, R.N., Ph.D., FAAN is a Professor
Emerita at the University of California, San
Francisco.
 BA in Nursing - Pasadena College/Point Loma
College MS in Med/Surg nursing from UCSF PhD -
1982 from UC Berkeley 1970s –
 Research at UCSF and UC Berkeley Has taught and
done research at UCSF since 1979 Published 9
books and numerous articles Published ‘Novice to
Expert Theory’ in 1982
 Received Book of the Year from AJN in
1984,1990,1996, 2000
NOVICE – Maybe a nursing student or
any nurse entering a clinical setting
where that a person has no
experience yet. Beginner with no
experience
 Taught general rules to help perform tasks
 Rules are: context-free, independent of
specific cases, and applied universally
 Rule-governed behavior is limited and
inflexible
 Ex. “Tell me what I need to do and I’ll do it.”
 advance beginner can demonstrate
marginally accepted performance. They
has had experience with real situations.
Demonstrates acceptable performance
 Has gained prior experience in actual
situations to recognize recurring
meaningful components
 Principles, based on experiences, begin
to be formulated to guide actions
 COMPETENT – is manifested by
the nurse who has been on the
job in a similar situation for 2 or 3
years
 More aware of long-term goals
 Gains perspective from planning own
actions based on conscious, abstract,
and analytical thinking and helps to
achieve greater efficiency and
organization
 the nurse perceived a situation as a whole
rather than just its individual aspect. The
nurse focuses on long term goals and is
oriented towards managing the nursing
care of a client rather than performing
specific tasks.
 More holistic understanding improves
decision-making
 Learns from experiences what to expect in
certain situations and how to modify plans
 EXPERT – the expert no longer relies
on rules, guidelines, or maxim, to
connect and understanding of the
situation to an appropriate action. No
longer relies on principles, rules, or
guidelines to connect situations and
determine actions
 Much more background of experience
 Has intuitive grasp of clinical situations
 Performance is now fluid, flexible, and
highly-proficient
Lydia Hall’s
Core, Care & Cure Model
 Lydia Hall was born in New York City on
September 21, 1906.
 She promoted involvement of the
community in health-care issues.
 She derived from her knowledge of
psychiatry and nursing experiences in the
Loeb Center the framework she used in
formulating her theory of nursing.
 THE PERSON
Therapeutic use of self
“THE CORE”

THE DISEASE
THE BODY Seeing the patient and
Intimate bodily care family through medical
“THE CARE” care
“THE CURE”
 The core is the person or patient to
whom nursing care is directed and
needed.
 The core has goals set by himself and
not by any other person.
 The core behaved according to his
feelings, and value system. the core
is the person or patient to whom
nursing care is directed and needed.
 The cure is the attention given to
patients by the medical professionals.
The model explains that the cure
circle is shared by the nurse with
other health professionals. These are
the interventions or actions geared on
treating or “curing” the patient from
whatever illness or disease he may be
suffering from.
 The care circle explains the role of nurses, and
focused on performing that noble task of nurturing
the patients, meaning the component of this
model is the “motherly” care provided by nurses,
which may include limited to provision of comfort
measures, provision of patient teaching activities
and helping the patient meet their needs where
help is needed.
It is easy to understand from the
model that in all of the circles of the
model, the nurse is always
presents the bigger role she takes
belongs to the care circle where
she acts a professional in helping
the patient meet his needs and
attain a sense of balance.
 The development of nursing theories
from the past years made Nursing a
legally professionalized and scientifically
founded health care service. In 1948, the
University of the Philippines together with
Dean Julita Sotejo founded its own
college of Nursing, which became the
beacon light in early days of Nursing
education here in the Philippines.
 Nursing became a requirement deans,
faculty members, and Nursing service
directors as cited by Republic Act 9173 better
known as the Philippine nursing act of 2002.
Filipino nurses are exemplary models to
other nationalities through their innate caring
traits. The local conceptual models cited in
the Association of Deans of Philippine
colleges (ADPCN) resource Unites for the
new BSN curriculum are available in the
University of the Philippines college of
Nursing (UPCN).
“ 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”
 Dr. letty G. Kuan, RN, RGC, EdD

◦ Had two masters degrees, MA in

nursing and MA in education.
◦ Has a vast contributions to the
University of the Philippines College
of Nursing faculty and academic
achievements, she is now a
professor Emeritus, a title awarded
only to a few who met the strict
criteria.
 ◦ Is a recipient of the Metrobank Foundation
Outstanding Teachers Award in 1995
◦ Award for Continuing Integrity and
Exellence in Service (ACIES) In 2004.
Dissertation Retirement and
Role Discontinuities”
Conceptual model (as studied and researched by
the author)
•Sister Letty Kuan focused her work
on fruitful aging and role discontinuity.
•She discussed factors that may
affect a fruitful aging since it is
enevitable for us to undergo aging
process.
•She is also a former Board of
Nursing.
•Her specialization includes concepts
in family relationships and holistic
care for patients.
◦ Role- refers to the set of shared expectations
focused upon a particular position
◦ Change in life- is the period between near
retirement and post-retirement years.
◦ Retiree- an individual who left the position
because he/she had reached the retirement age
or has completed the required years of service.
◦ Role discontinuity- the interruption in the line of
status enjoyed or role performed.
◦ Coping approaches- measures applied to solve
a parabolic situations to restore balance
◦ Health status- refer to physiological and mental
state of the respondents.
◦ Income- refer to the financial affluence of the
respondent.
◦ Work status
◦ Family constellation- the type of family
composition described either close knit or
extended family.
◦ Self- preparation
“ 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”
◦ A nurse with master’s and Doctorial
Degrees in nursing obtained from the
university of the Philippines college of
nursing.
◦ Served the university of the Philippines
college of nursing, her alma mater, as
faculty and held the position as
secretary of the College of nursing.
◦ Chairman of the Board of nursing.
About her Theory:
“PREPARE ME” Interventions and the
Quality of Life Advance Progressive
Cancer Patients.
Prepare me – 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.
◦ Presence- being with another person
during the times of need. This includes
therapeutic communication, active
listening, and touch.
◦ 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.
◦ Values clarification- assisting another individual to
clarify his own values about health and illness in
order to facilitate effective decision making skills.

Quality of life is multifaceted construct that

encompasses the individual’s capacities and
abilities with an aim of enriching life when it
cannot longer be prolonged.
◦ Reminisce therapy- recall of past
experiences, feelings and thoughts
to facilitate adoption 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.
 Local nursing theorist in the Philippines,
who focused her works on helping a
patient through support systems
specifically the family.
 She has a publication
entitled "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 is

the nursing theory of Laurente.
 Cecilia Laurente is a local nursing theorist in the
Philippines, who focused her works on helping a
patient through support systems specifically the
family. She has a publication entitled
"Categorization of Nursing activities as Observed
in Medical Surgical Ward Units in Selected
Government and Private Hospitals in Metro Manila
 CASAGRA transformative
leadership model was
proposed by Sister
Carolina .
 She focus on the type of
leadership in nursing that
can challenge the values of
the anging world.
 it is a model in which nurses learn to lead
members of there practice.
 it is also helpful because in these recent days,
nurses are tend to wait for some instructions from
their leaders that is why this model will help them
learn something new and let the nurses lead the
patient into full recovery by leading and teaching
them how to handle the pain or any problems that
they have suffered right now.
◦ Finished her BSN and her master of arts in
Nursing, major in maternal and child health,
both at the University of Santo Tomas, with the
highest honors.
◦ Is an educator, a counselor, a writer, a
consultant and a researcher , both nationally
and internationally.
◦ A faculty of the UST Graduate School and
College of nursing.
◦ An associate professor at the Aga Khan
International University, with eight international
satellite campuses for several years.
 Master of Nursing in 1975, and a
doctoral degree holder in 2001,
has been lauded for developing
the art and competency of
teaching nursing.
 She has lectured and written
about her work as a nurse and
how she has used her hands-on
experience to develop better
ways to teach nursing.
 Her love for nursing and her dedication to carve
out learning tools for nursing students has been a
commendable and rare field of discipline.
 As a teacher, she could not be anything else but a
perfect thesis adviser.
 She has teamed up with the Commission on
Higher Education for the drafting of a higher
standard of competency in nursing schools in the
Philippines.
 She can be considered as a part of nursing
measure since it contributes to the well being of
the patients.