EVOLUTION OF NURISNG

HISTORY OF NURSING THEORY AND ITS DISCIPLINE VS PROFESSION

SIGNIFICANCE Discipline
 Significant highlights of events in the history of  Branch of education, a department of learning
nursing theory: or a domain of knowledge.
1) Florence Nightingale Profession
2) The Columbia School (the 1950’s)  A specialized field of practice founded on
3) The Yale School (the 1960’s) theoretical structure of the science or
4) The 1970’s knowledge of the discipline and accompanying
5) The 1980’s practice abilities.
6) The 1990’s
SIGNIFICANCE OF NURSING THEORY
Florence Nightingale (1859/1992) 1. It recognized nursing as an academic discipline
• “Notes on Nursing” presents the first nursing and a profession.
theory that focus on the manipulation of the 2. It led to the development of a body of
environment for the patient’s benefit. substantive knowledge to guide nursing practice.
The Columbia School (The 1950’s) 3. It guides critical thinking in nursing practice.
• The need to prepare the nurses at the graduate 4. It recognizes that theory informs practice and
level for administrative & faculty positions was practice informs theory.
recognized. 5. It is the backbone of clinical care.
The Yale School (The 1960’s) 6. It is a tool for reasoning and decisionmaking for
• The focus of theoretical thinking in moved from quality nursing practice.
problem/need & functional role focus to the 7. It has taken nursing to higher levels of education
relationship between the nurse & the patient. and practice.
The 1970’s
• Many nursing theories were first presented. Most RATIONALISM VS. EMPIRICISM
of these theories have been revised since their Reason is the source of The senses are the
original presentation. all knowledge. source of all
The 1980’s knowledge.
• Many nursing theories were revised based on the Knowledge is gained Knowledge is gained
research findings that expanded them. through deductive through inductive
The 1990’s method of reasoning. method of reasoning.
• Research studies that tested & expanded nursing Knowledge is certain Knowledge can ever be
theories were numerous probable.
Uses Uses
ERAS OF NURSING KNOWLEDGE theory-then-research research-then-theory
Curriculum Era (1900-1904s) strategy strategy
• It emphasized on courses included in nursing
programs. NURSING SCIENCE & THEORY IN THE
• Goal is to develop specialized knowledge & LATE 20TH CENTURY
higher education. 1) Development of knowledge was mainly
Research Era (1950s-1970s) affected by the different nursing leaders and
• This era emphasizes role of nurses and what to theorist of the early 20th century.
research. 2) Evolution of Nursing Science throughout the
Graduate Education Era (1950s-1970s) time was further studied and tested that led to
• Emphasis is caving out in an advanced role & the contemporary practices of nursing.
basis for nursing practice. 3) Role of nurse became more defined.
Theory Era (1980-1990s) 4) As nursing is evolving it brings into being the
• The emphasis is that there are many ways to think different theories that guides clinical practice.
about nursing. Emergent goal is that theories guide It uses evidencebased science to support the
nursing research & practice. intervention performed in the care of patients
Theory Untilization Era (21st Centry)
• Nursing theory guides research, practice,
education & administration
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 STRUCTURE & ANALYSIS OF NURSING KNOWLEDGE
Structure Level of Nursing Knowledge direct manner. Have a stronger relationship
1. Philosophies of Nursing with research and practice.
2.Conceptual Models of Nursing  Are specific to nursing practice and specify the
3. Nursing Theories area of practice, age range of the patient,
nursing action or intervention, and proposed
PHILOSOPHIES OF NURSING outcome.
(METATHEORY)  It focus on concepts of interest to nurses: pain,
 It set forth the general meaning of nursing and empathy, grief, self-esteem, hope, comfort,
nursing phenomena through reasoning and the dignity and quality of life.
logical presentation of ideas.
 They are broad and address general ideas about ANALYSIS EVALUATION
nursing. Because of their breadth, nursing  Historical evolution  Explicitness of
philosophies contribute to the discipline by of the theory assumption
providing direction, clarifying values and Approach to model  Degree of
forming a foundation for theory development development comprehensiveness
(Alligood, 2006).  Content  Logical congruence
 They are theoretical works that address one or  Source of concern Ability of the model
more metaparadigm concepts and are to test and generate
philosophical in nature. They address questions hypothesis
such as the following (Alligood, 2005):  Contribute of the
 What is nursing? model to nursing
 What is the nature of human caring? knowledge
 What is the nature of nursing practice?
 What is the social purpose of nursing practice? CRITERIA IN EVALUATING A
THEORETICAL WORK ACCORDING TO
CONCEPTUAL MODELS OF NURSING CHINN & KRAMER (1991)
(GRAND THEORIES)  Clarity
 Also called paradigms or frameworks.  Simplicity
 It is composed of abstract and general concepts  Generality
and propositions that provide a frame of  Empirical Precision
reference for members of the discipline. This  Derivable Consequences
frame of reference determines how the world is
viewed by the members of a discipline and CLARITY
guide the members as they propose questions  Semantics (study of the meaning of language,
and make observations relevant to the symbols and logic) and structure are considered
discipline (Fawcett, 1944). important.
 It is a set of concepts and statements that Questions to be asked:
integrate the concepts into a meaningful  “Is the theory clearly stated?”
configuration.  “How clear is the theory?”
 “Is it easily understood?”
NURSING THEORIES
 It is a conceptualization of some aspect of SIMPLICITY
reality (invented or discovered) that pertains to  Adequately comprehensive at a level of
nursing. The conceptualization is articulated for abstraction to offer direction however, it must
the purpose of describing, explaining, have as few concepts as possible having simple
predicting or prescribing nursing care (Meleis, relations to assist clarity.
2007, p.41). Questions to be asked:
 They vary in scope and level of abstraction:  “How simple is the theory?”
 Middle-range theory
 Moderately abstract, comprehensive, organized
within a limited scope and have a limited
number of variables, which are testable in a 

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 STRUCTURE & ANALYSIS OF NURSING KNOWLEDGE
GENERALITY
 The scope of concepts and goals within the
theory. Situation in which the theory is
applicable should be boundless. The broader
the scope, the greater its significance.
Questions to be asked:
 “How general is the theory?”
 “How broad is the scope of the theory

EMPIRICAL PRECISION
 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.
Questions to be asked:
 “Is the theory testable?”
 “How accessible is the theory

DERIVABLE CONSEQUENCES
 It should lead itself to research testing which
would result to additional knowledge that
would guide practice.
 It should give direction to research and practice,
create new ideas, and ought to distinguish the
focus of nursing to other professions. It must
develop and guide practice.
Questions to be asked:
 “How important is the theory?”
 “Does the theory have a significant
contribution to nursing knowledge?

INTERDEPENDENCE OF NURSING
PRACTICE, NURSING THEORY & NURSING
RESEARCH
 Observations in nursing practice, questions
raised and conceptual models are formulated –
leads to theory development and testing
through research.
 Theory interacts with and guide nursing
practice.
 Research validates and modifies theory, which
then changes nursing practice.

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 FOUR WAYS OF KNOWING
 Empirical  The manifestation of the creative and
 Aesthetic expressive styles of the nurse (Kenny, 1996)
 Ethical Knowing the distinctive characteristic of the
 Personal individual instead of the typical, stereotype
whole.
EMPIRICAL
 The scientific discipline of Nursing. EXAMPLES:
 The science of nursing, the knowledge gained 1. Nurse Moses places himself in the “patient’s
through empirical research. shoes” when communicating, giving judgment and
 It is the information source or base of knowing. providing care.
 It emphasizes scientific research is important to 2. Nurse Ace shows compassion, mercy and
nursing knowledge. understanding towards patients, co-workers and
 Clinical and conceptual knowledge are the keys supervisors.
to nursing practice. 3. Nurse Miguel uses layman terms in explaining
 Empirical knowing focuses on evidence-based the needs of the patient with right-sided heart
research for effective and accurate nursing failure.
practice.
Nurse’s Notes:
Evidence-based practice  Aesthetic knowing is using in the process of
 It involves accurate and thoughtful decision giving appropriate nursing care through
making about health care delivery for clients. understanding the uniqueness of every patient,
 This is based on the result of the most relevant thus emphasizing use of creative and practical
and supported evidence derived from research styles of care.
in response to preferences and expectations.
 It promotes quality care that has been ETHICAL
demonstrated to be effective  The code of morals or code of ethics that leads
the conduct of nurses is the main basis for
EXAMPLES: Ethical Knowing.
1. David, a nursing student answers a question  It is deeply rooted in the concept of human
posed by the clinical instructor based on what he dignity, service and respect for life.
learned from the school.  Lessening suffering, upholding and preserving
2. Elmer, a nurse researcher, uses scientific method health is one of the key elements why nursing
to produce desired study results. is a core service in society.
3. Nurse Michael practices nursing interventions
based from accepted clinical practice EXAMPLES:
1. Nurse Carl presents himself as a patient
Nurse’s Notes: advocate and defends his client’s right to choose
 Any scientific, research-based, theoretical & care.
factual information that the nurse makes use of 2. Sir Kevin, a clinical instructor, reprimands a
is under Empirical Knowing. Example is student who cheated on a quiz and explain the
knowledge obtained from textbooks, lectures, consequences.
journals & online resources. 3. Nurse Renato explains the concepts behind
organ donation to a terminally-ill patient
AESTHETIC
 Also known as Esthetics Knowing. Nurse’s Notes:
 Deals with the emphatic (primary form) aspect  Ethical Knowing involves the judgment of right
of Nursing. & wrong in relation to intentions, reasons &
 The art and act of nursing and is gained attributes of individuals & situations.
through practice and critique.
 Related to understanding what is of
significance to particular patients such as
feelings, attitudes, points of view (Carper,
1978).
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 FOUR WAYS OF KNOWING
PERSONAL
 Methods by which nurses approach their
patients.
 It encompasses knowledge of the self in
relation to others and to self. It involves the
entirety of the NursePatient Relationship.
 It is focused on realizing, meeting and defining
the real, true self (self-awareness).
 It is the most difficult to master and to 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.
 It stresses that human beings are not in a fixed
state but are constantly engaged in a dynamic
state of changes. (Kenny, 1996)
 Gained through practicing nursing and
interacting with patients and through thinking,
listening and reflecting.

EXAMPLES:
1. Ruben, a nursing student, strives to promote a
meaningful personal relationship with his elderly
patient.
2. Ruel, a nursing student, undergoes
Psychological Counseling and Self-Awareness
sessions before his Psychiatric Nursing rotation.

Nurse’s Notes:
 Personal Knowledge is focused on realizing,
meeting & defining the real, true self. One
nursing term defines this as self-awareness.

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 THEORETICAL FOUNDATION OF NURSING
THEORY human body. the tongue.
 a vision or beholding scene. ABSTRACT CONCRETE
 Comes from the Greek word “theoria”  Indirectly observed  Directly observed or
 Is an explanation of a set of related or intangible. tangible.
observations or events based upon proven  It is independent of  Relate more to a
hypotheses and verified multiple times by time and place. specific time or
detached groups of researches. (Bautista J.)  Example: love, care place.
 A set of ceoncepts, definitions, relationships, and freedom  Example: nurse,
and assumptions that projects a systematic mother or pain
view of phenomenon. (Potter - Perry)
 An organized system of accepted knowledge PROPOSITION
that is composed of concepts, propositions  Explains the relationships of different concepts.
and assumptions intended to explain a set of  Example: Children who do not want to stay in
fact, event or phenomena. the hospital because of their fear of injections
 A creative and rigorous structuring of ideas that
projects a tentative, purposeful and systemic DEFINITION
view of phenomena. (Chinn and Kramer, 1991)  Composed of various descriptions which
 An organized, coherent & systematic convey a general meaning and reduces the
articulation of a set of statements related to vagueness in understanding a set of concepts.
significant questions in a discipline that are  Example: Definition of Nursing formulated by
communicated in a meaningful whole , Peplau
discovered or invented for describing,
predicting or prescribing events or relationships ASSUMPTION
(Meleis, 2007, p37)  A statement that specifies the relationship or
connection of factual concepts or phenomena.
COMPONENTS OF THEORY  Statements that the theorists hold as factual.
CONCEPT  Example: All patients who are not able to take
 Building blocks of theories which can either be good care of themselves need nurses
an empirical or abstract data.
 An idea formulated by the mind or an HYPOTHESIS
experience perceived and observed such as  Educated guesses.
justice, love, war, and disease.  A tentative explanation for an observation,
 Are words or phrases that are used to represent phenomenon or scientific problem that can be
the phenomenon observed or experienced. It is tested by further investigation.
a mental construct.  A testable relationship statement
 Describes a phenomenon or a group of
phenomenon (Meleis, 2007) THEORETICAL MODEL OR FRAMEWORK
 A highly established set of concepts that are
THEORETICAL OPERATIONAL testable.
 Described  Based on how these  Represents an equation that describes the path
according to how concepts are used or or explains the phenomenon being observed or
these concepts are will be used within experienced.
defined in the the context of the  It is typically accompanied by a pictorial
dictionary. phenomenon being representation of these variables and their
 Example: observed or interrelationships
Temperature – It is experienced.
the homeothermic  Example: PHENOMENON
range of a person’s Temperature – It is  Occurrence or circumstance that is observed,
internal the degree of something that impresses the observer as an
environment temperature extraordinary or a thing that appears to and is
maintained by the measured by the oral constructed by the mind.
thermoregulatory thermometer taken  Observable fact that can be perceived through
system of the for one minute under the senses and explained.
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 THEORETICAL FOUNDATION OF NURSING
 An empirical data that can be observed.  The recipient of nursing care like individuals,
 It is concerned with how an individual person families and communities. Refers to direct
reacts using the human senses concerning their receivers of care.
surrounding and assessing the different ENVIRONMENT
behaviors and factors that affect such  The external and internal aspects of life that
behaviors. influence the person. Pertains to the sum of
In nursing, phenomena can be: everything outside the person.
a) Clinical or environmental setting of nursing
b) Disease process HEALTH
c) Client’s behavior  The holistic level of wellness that the person
d) Interventions experiences.
e) Practices that are utilized in nursing theories and  State of complete physical, mental, emotional,
metaparadigm social and spiritual well being and not
necessarily the absence of disease or infirmity.”
NURSING THEORY (World Health Organization)
 Refers to the body of knowledge that is used to
support and maintain the practice of nursing. NURSING
(Bautista, J.)  The interventions of the nurse rendering care in
 Conceptualization of some aspects of nursing support of or in cooperation with the client.
communicated for the purpose of describing,  As an ART, it involves the use of
explaining, predicting or prescribing nursing compassionate caring, conscientious
care. (Potter – Perry) competence and confidence. It also involves
 A group of interrelated concepts that are the art of serving, nurturing, and caring for
developed from various studies of discipline everyone who needs it.
and related experiences. This aims to view the  As a SCIENCE, it is governed by laws and
essence of nursing care theories that have been scientifically proven to
 An articulated and communicated be relevant to the performance of nursing roles.
conceptualization of invented or discovered
reality in or pertaining to nursing for the OTHER TERMINOLOGIES
purpose of describing, explaining, predicting or PHILOSOPHY
prescribing nursing care. (Meleis, p41)  Comes from the greek word “philisopia”
 A complete nursing theory is one that has which means love of knowledge or love of
context, content and process. (Barnum, 1994) wisdom.
a) Context – resembles environment to which  The study of the most general and abstract
nursing act takes place. features of the world and categories with which
b) Content – subject of the theory. we think: mind, matter, reason, proof, truth,
c) Process – method by which nurses act in using etc.
nursing theory
CONCEPTUAL MODELS
NURSING PARADIGM  Are representations of an idea or body of
 Are patterns or models used to show a clear knowledge based on the own understanding or
relationship among the existing theoretical perception of a person or researcher on a
works in nursing. certain topic, phenomena or theory.
 Metaparadigm, came from the word “meta”, a  Also called paradigms or frameworks. It is a set
Greek word which means “with” and of concepts and statements that integrate the
“paradigm” which means “pattern”. concepts into a meaningful configuration.
 Nursing metaparadigm, embodies the  They can be represented thru a diagram or in
knowledge base, theory, philosophy, research, narrative form which shows how concepts are
practice and educational experience and interrelated.
literature identified with the profession
SCIENCE
PERSON  Comes from the Latin word “scientia”
meaning “knowledge”.
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 THEORETICAL FOUNDATION OF NURSING
 Knowledge attained through study or practice.
 A system of acquiring knowledge based on RESEARCH
scientific method or research.  Offer a framework for generating knowledge
and new ideas.
 Assist in discovering knowledge gaps in
RESEARCH specific field of study.
 Use of systematic methods to study a  Offer a systematic approach to identify
phenomenon and create a general knowledge. questions for study, select variables, interpret
(Powers and Knapp) findings and validate nursing interventions.

 SCIENCE = PRACTICE
RESEARCH + THEORY  Assist nurse to describe, explain and predict
everyday experiences.
INDUCTION  Serve to guide assessment, intervention and
 A type of reasoning that evaluation of nursing care.
uses specific details to form a general conclusion.  Provide a rationale for collecting reliable and
valid data about the health status of clients,
DEDUCTION which are essential for effective decision
 A type of reasoning wherein general making and implementation.
conclusions are made based from specific concepts.  Help establish a criteria to measure the quality
of nursing care.
EPISTIMOLOGY  Help build a common terminology to use in
 Branch of inquiry that is concerned with the communicating with other health professionals.
theory of knowledge or how knowledge came to be. Ideas are developed and words defined.
 Enhance autonomy of nursing by defining its
LAW own independent functions.
 A statement of fact that aims to explain, in
brief and simple terms, an action or set of actions. SOURCES OF KNOWLEDGE
 It is generally accepted to be true and universal. KNOWLEDGE
 Information, skills and experience acquired by
CHARACTERISTICS OF THEORY a person through various life experiences or
1. Theories can correlate concepts in such a way as formal/informal learning.
to generate a different way of looking at a certain  The abstract or workable understanding of a
fact or phenomenon. subject or idea.
2. Theories must be logical in nature.  What is known in a particular field or discipline
3. Theories should be simple but generally broad in or study.
nature.  Facts and information or awareness or
4. Theories can be the source of hypothesis that can familiarity gained by experience of a fact or
be tested for it to be elaborated. situation.
5. Theories contribute in enriching the general
body of knowledge through the studies COGNITIVE PROCESS
implemented to validate them.  PERCEPTION – achieving understanding of
6. Theories can be used by practitioners to sensory idea.
direct and enhance their practice.  ASSOCIATION – combining two or more
7. Theories must be consistent with other concepts/ideas to form a new concept, or for
validated theories, laws, and principles but will comparison.
leave open unanswered issues that need to  LEARNING – acquiring experience, skills,
be tested. information and values.
 REASONING – mental process of seeking
PURPOSE OF NURSING THEORY conclusions through reason.
EDUCATION  COMMUNICATION – transferring data from
 Provides a general focus for curriculum design. sender to receiver using different mediums or
 Guide curricular decision making. tools of communication.
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 THEORETICAL FOUNDATION OF NURSING
NURSE’S NOTES
TRADITIONAL  The benefits of having a defined body of
 Nursing practice which is passed down from knowledge include: improved patient care,
generation to generation. enhanced professional status, improved
 “It has always been this way communication between nurse professionals,
AUTHORITATIVE and
 An idea by a person of authority which is guide for research and education!
perceived as true because of his or her
expertise.  As a nurse grows & matures in their
professional status, the use of ample knowledge
SCIENTIFIC as a basis for theory-based nursing is a
 Type of knowledge which came from a characteristic of their practice!
scientific method through research.
 These new ideas are tested and measured
NURSING THEORY & THE NURSE
systematically using objective criteria..
PRACTITIONER
Theory helps the nurse to:
ADVANTAGE AND DISADVANTAGES
TYPES OF ADVANTAGES DISADVANTAG
 Organize, examine & analyze patient’s data
KNOWLEDGE ES  Make decisions about effective & efficient
Traditional  Practical to  Based on nursing interventions.
and implement subjective  Make a S.M.A.R.T. (Specific, Measurable,
Authoritative data Attainable, Realistic & Time-bounded) plan of
 Limited use care.
in a variety  Predict & evaluate outcomes of care.
of practice
setting
 In nursing
practice,
scientific
knowledge
through
evidence
based
practice and
research
serves as
the main
focus

Scientific  Systematic  Requires

and time and
accurate effort to
 Theories it produce
creates are credible
less results
subjective
than
knowledge
gained by
other
methods

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 FLORENCE NIGHTINGALE
ENVIRONMENTAL THEORY OR ENVIRONMENTAL
PHILOSOPHY
METAPARADIGM IN NURSING NIGHTINGALE’S 13 CANONS
Person 1) Ventilation and warmth
 The one who is receiving care; a dynamic and 2) Light
complex being. 3) Cleanliness of rooms and walls
 Refers to it as the patient. 4) Health of houses
 It comprises physical, intellectual, emotional, 5) Noise
social and spiritual components. 6) Bed and bedding
 Nurses should perform tasks to and for the 7) Personal cleanliness
patient as well as control the patient’s 8) Variety
environment (passive); but if can perform 9) Chattering hopes and advices
self-care asks preference. 10) Taking food
Health 11) What food
 Being well and using every power that the 12) Petty management
person has to the fullest extent.” 13) Observation of the sick
 DISEASE – a reparative process that nature
instituted from a want of attention. CONCEPTS & DEFINITIONS
 Prevention and health promotion through  It is believed that when one or more aspects of
environmental control is added to nursing the environment are out of balance, the client
patients from illness to health. must use increased energy to counter the
Environment environment stress.
 Anything that can be manipulated to place a  These stresses drain the client of energy needed
patient in the best possible condition for nature for healing.
to act.  HEALTHY ENVIRONMENT or HEALTH
 Both physical and psychological. OF HOUSES
 Physical components: ventilation, warmth, ✓Pure air, pure water, efficient drainage,
light, nutrition, medicine, stimulation, room cleanliness and light.
temperature and activity.  PROPER VENTILATION or VENTILATION
 Psychological components: avoiding & WARMING
chattering hopes and advices and providing ✓Keeping the air that patient breathes pure as
variety. external air without necessarily chilling him.
Nursing Normal body warmth through positioning, opening
 It is a spiritual calling. Nurses were to assist the windows and regulate room temperature.
nature to repair the patient.  ADEQUATE LIGHT
 Types: “nursing proper” (nursing the sick), ✓Direct sunlight has “quite a real and tangible
“general nursing” (health promotion) and effects on the human body who has not observed
“midwifery nursing” the purifying effect of light, and especially direct
 Viewed nursing the “Science of Environmental sunlight, upon the air of a room?”
Management”  CLEANLINESS of ROOMS & WALLS
 Nurses are to use common sense, observation, ✓Specifically focused on the patient, the nurse
and ingenuity to allow nature to effectively and the environment. A well-ventilated
repair the patient. environment is nothing if the environment itself is
 “Observation may always be improved with dirty. Recognized the presence of organic matter in
training --- will seldom be present without a dirty environment which can contribute to the
training; for otherwise the nurse does not know development of diseases. Taking a bath daily is
what to look for. emphasized.

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 FLORENCE NIGHTINGALE
ENVIRONMENTAL THEORY OR ENVIRONMENTAL
PHILOSOPHY
 NOISE (Quiet)
✓Unnecessary noise can be harmful to the patient
who is ill. Patients should never be waked
intentionally or accidentally during the first part of
sleep.
 PERSONAL CLEANLINESS
✓Function of the skin is important. Taking a
bath daily is emphasized. Keep patient dry & clean.
Advocated that personal cleanliness extended to the
nurse & that every nurse ought to wash her hand
very frequently during the day
 VARIETY
✓The mind greatly affects the body. Change of
color & form, advocates reading, writing &
cleaning, needlework & other activities that could
relieve sick of boredom.
 BED & BEDDINGS
✓Keep beddings clean, neat & dry & position
the patient for maximum comfort.
 DIET or NUTRITION & TAKING FOOD
✓Assess the meal schedule and its effects on
the patient, as well as dietary intake. Variety of
food served & on time. No distraction while eating
 CHATTERING HOPES & ADVICES
✓Should not give false hopes, it worries
patients & become fatigue, Avoid personal talk.
Talk to the client as a person & stimulate their
minds.
 OBSERVATION OF THE SICK
✓Obtaining accurate information about the
patient – it should be precise, specific &
individualized. Assure that appropriate actions are
taken.
 PETTY MANAGEMENT
✓Ways to assure that “what you do when you
are there, shall be done when you are not

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 DOROTHY JOHNSON (1969, 1980)
 Born on August 21, 1919, in Savannah Georgia. BEHAVIORAL SYSTEM MODEL
1942, received her BSN degree from  Proposed that nursing care facilitated the
Vanderbilt University, Nashville, Tennessee. client’s maintenance of a state of
 1948, finished her MPH from Harvard equilibrium.
University, Boston.  Proposed that clients were “stressed” by a
 1949 until her retirement in 1978, she was n stimulus of either an internal or external nature.
assistant professor of Pediatric Nursing, an These stressful stimuli created such
associate professor of Nursing and a Professor disturbances or “tensions”, in a patient that a
of Nursing at the University of California in state of disequilibrium occurred.
Los Angeles.  To return to a state of equilibrium, 2 areas were
 She had an influence on nursing through her identified:
publications since the 1950s. And she stressed a) reduce stressful stimuli
the importance of research-based knowledge b) support natural & adaptive processes
about the effects of nursing care on clients.  Her theory springs from Nightingale’s belief
 Contributions to the Nursing Profession: that nursing’s goal is to help the individuals
1968, first proposed her model of nursing care prevent or recover from disease or injury.
as fostering of “the efficient and effective  That the science and art of nursing should focus
behavioral functioning in the patient to prevent on the patient as an individual and not on the
illness.” specific disease entity.
 Also stated that Nursing was “concerned with
man as an integrated whole and this is the ASSUMPTIONS OF BAHAVIORAL SYSTEM
specific knowledge of order we require. MODEL
 1980, she published her conceptualization of 1. “From the form the behavior takes and the
“behavioral system model for nursing”, her consequences it achieves can be inferred what
first work which explicates her definitions of “drive” has been stimulated or what “goal” is being
the behavioral system model. sought.
2. Each individual has a “predisposition to act with
METAPARADIGM OF DOROTHY JOHNSON reference to the goal, in certain ways rather that the
Person other ways.” This predisposition is called as “set”.
 It has two major systems: the biological and the 3. Each subsystem has a repertoire of choices or
behavioral system. “scope of action”.
 It is a behavioral system with patterned 4. It produces “observable outcome” that is the
repetitive, and purposeful ways of behaving individual’s behavior.
that link the person to his environment.
Health 7 SUBSYSTEMS
 Is an elusive state that is affected by social, 1. Attachment or affliative subsytem
psychological, biological and physiological 2. Dependency subsystem
factors. 3. Ingestive subsytem
 Balance stability of the subsystems. 4. Elimanative subsystem
 Lack of balance = poor health Balance = health 5. Sexual subsystem
Environment 6. Aggressive subsystem
 Consists of all factors that are not part of the 7. Achievement subsytem
individual’s behavioral system but influence 8 th Subsystem:
the system. • Restorative – concerned with rest, sleep,
 Factors vary from culture to culture however comfort/freedom from pain.
outcomes are the same.
Nursing EXAMPLE:
 An external force that acts to preserve the  A 32 year old woman wanted to have a child
organization of the patient’s behavior by means (goal) she got married and conceived after a
of imposing regulatory mechanisms or by month (choice). during the entire period of
providing resources while the patient is under pregnancy, she comply all the need to preserve
stress. her pregnancy and to avoid any complications
(aggressive protective behavior -act) after 9
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 DOROTHY JOHNSON (1969, 1980)
months, she delivered a healthy child and was
very contented and satisfied (observable
behavior-outcome-achievement subsystem)

3 FUNCTIONAL REQUIREMENTS OF EACH

SUBSYTEM
1. It must be “protected” from noxious influences
with which system cannot cope.
2. It must be “nurtured” through the input of
appropriate supplies from the environment.
3. It must be “stimulated” for use to enhance
growth and prevent stagnation.

CONCEPTS AND DEFINITIONS

 Behavior – is the output of intraorganismic
structures and processes as they coordinated
and articulated by responsive to changes in
sensory stimulation.
 Systems – is a whole that functions as a whole
by virtue of the interdependence of its parts
characterized by organization, interaction,
interdependency and integration.
 Behavioral system – encompasses the
patterned, repetitive and purposeful ways of
behaving. The system is flexible enough to
allow influences that affect it.
 Subsystems – are minisystems with its own
particular goal and function that can be
maintained as long as its relationship to the
other subsystems or the environment is not
changed or disturbed
 Equilibrium – is a stabilized but more or less
transitory, resting state where the person is in
harmony with himself and with his
environment.
 Tension – is the state of being stretched or
strained and can be viewed as an end product
of a disturbance in equilibrium.
 Stressor – is a stimuli, either internal or
external, that produce tension and result in a
degree of instability.

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 BETTY NEUMAN
WHO IS BETTY NEUMAN? stability: (1) flexible line of defense, (2) normal
 Born in 1924 on a farm near Lowell, Ohio. line of defense, and (3) lines of resistance.
 Growing in a rural area, she developed love for
the land and compassion for people in need. CONCEPTS AND DEFINITIONS
 1947, received her RN Diploma from Peoples  CLIENT VARIABLES – one or combination
Hospital School of Nursing, Akron, Ohio. of physiological, sociocultural, developmental
Moved to California and gained experience as a and spiritual.
hospital staff and head nurse; school nurse and  Physiological – body structure and function
industrial nurse; and as a clinical instructor in  Psychological – mental processes in interaction
medical-surgical, critical care and with environment
communicable disease nursing.  Sociocultural – effects of social condition
 1957, attended the University of California at  Developmental – age-related processes
Los Angeles (UCLA) with double major in  Spiritual – beliefs and influences related to
psychology and public health. Received her BS spirituality
in Nursing from UCLA.  CORE – basic survival factors or energy
 1966, received Masters degree in Mental resources of the client.
Health, Public Health Consultation from  LINES OF RESISTANCE – act when the
UCLA. normal line of defense is invaded by too much
 1985, received her Doctoral Degree in Clinical stressor, producing alterations in the client’s
Psychology from Pacific Western University. health.
 1970, the conceptual model was designed in  NORMAL LINE OF DEFENSE – to achieve
response to request from UCLA graduate stability of the system, this line must act in
students who wanted a course emphasizing coordination with the normal wellness state.
breadth rather than depth in understanding the  FLEXIBLE LINE OF DEFENSE – serves as
variables in nursing. boundary for the normal line of defense to
adjust to situations that threaten the imbalance
SYSTEM THEORY within the client’s stability.
 Emphasizes on the components and dynamic
interaction of the elements that comprise the METAPARADIGMS: HEALTH
nature of Nursing.  Dynamic in nature.
 Goal-centered phenomenon that relies on the  Equated with stability of normal line of defense
interplay of and continuous change of the parts  A person’s health depends upon which state of
of the system. the health continuum they are in line with,
 Parts of the System: whether in the state of wellness or illness.
 INPUT – data that go through and are  WELLNESS – stable condition when the parts
integrated in the system. of the client system interact in harmony with
 OUTPUT – end product of the input that is the whole system.
processed in the system.  ILLNESS – needs are not satisfied.
 FEEDBACK – the re-evaluated and changed
output that goes as input back into the system. METAPARADIGMS: ENVIRONMENT
 Can be internal, external and created force that
METAPARADIGMS: PERSON interacts with a person’s state of health.
 An individual, family or community or the  It can alter or improve the systems in which a
society. person exists.
 A person is an OPEN SYSTEM that works These factors are what Neuman termed as the
together with other parts of its body as it STRESSORS:
interact with the environment. Intrapersonal – occurs within the self and
 A dynamic composite of the interrelationship comprises of man as a psychospiritual being.
of five variables: (1) physiological, (2) Interpersonal – occurs between one or more
psychological, (3) sociocultural, (4) individual and consists of man as a social being.
developmental, and (5) spiritual Extrapersonal – occur outside the individual.
 has protective mechanisms for the basic
structure, and maintains client’s system
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 BETTY NEUMAN
 INTRAPERSONAL – emotions and feelings,
hypertension, low blood glucose CONCEPTS AND DEFINITIONS
 INTERPERSONAL – role expectations,  PREVENTION – used to attain balance within
perception of care given the continuum of health.
 EXTRAPERSONAL – job and financial  PRIMARY PREVENTION – focuses on
pressure foreseeing the result of an act or situation and
 NEGENTROPY - towards stability or preventing its unnecessary effects as possible.
wellness.  SECONDARY PREVENTION – helping
 EGENTROPY OR ENTROPY – set towards alleviate the actual existing effects of an action
disorganization of system > illnes that altered the balance of health of a person.
 TERTIARY PREVENTION – actual
CONCEPTS AND DEFINITIONS treatments or adjustments to facilitate the
 STRESSORS – forces that produce tensions, strengthening of a person after being exposed
alterations or potential problems causing to a certain disease or illness.
instability within the client’s system.  RECONSTITUTION – adjustment state from
 REACTION – outcomes or produced results the degree of reaction. Going back to the actual
of certain stressors and actions of the lines of state of health before illness.
resistance of a client
LEVELS OF PREVENTION
METAPARADIGMS: NURSING  PRIMARY PREVENTION – maintain
 A unique profession that requires holistic optimum level of functioning (health
approach – considers all factors affecting a promotion & disease prevention)
client’s health.  SECONDARY PREVENTION – early
 Aims to promote optimal wellness to its client detection of disease and prompt treatment; aims
through retention, attainment, or maintenance to avoid further decline of functioning.
of the stability of client’s system.  TERTIARY PREVENTION – prevent the
 Nurse helps the different levels of clientele: regression and recurrence of illness;
individual, family, and groups in achieving and rehabilitation
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.
 Once an individual is exposed to stress, the
flexible line of defense will be “alarmed” to
protect the normal (solid) line of defense to
keep the system free from stressor reactions.
 However, if this individual is continuously
exposed to stress and if the flexible line of
defense is unable anymore to cope up with the
stressors, the normal line of defense will be
altered.
 If this happens, there will be a threat to the wall
that protects the basic structure of the
individual and therefore causing instability of
the systems and illness develops.

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 INTERACTIVE THEORIES
(NURSING THEORIES AND THEIR WORKS)
INTERACTIVE THEORIES METAPARADIGM IN NURSING OR
NURSE PATIENTRELATIONSHIP OR HILDEGARD PEPLAU
THERAPEUTIC RELATIONSHIP Person
 The professional interaction of the nurse to her  A man who is an organism that lives in an
client that is aimed towards the promotion of unstable balance of a given system
wellness and health of the latter. Health
 The most essential part of nursing care  It symbolizes movement of the personality and
rendered to the health consumers other ongoing human processes that directs the
 Forming a strong relationship with the person towards creative, constructive,
healthcare team is also essential. productive and community living.
 It enhances an atmosphere of  To achieve and maintain health, needs must be
COOPERATION. met. These are physiological demands and
 Processes involved: Roles and phases nurse and interpersonal conditions
patient go through; communication techniques Environment
to achieve therapeutic results and elements  Forces outside the organism and in the context
needed in providing a lasting and a maturing of the socially-approved way of living, from
experience for the patient. which vital human social processes are derived
such as norms, customs and beliefs.
HILDEGARD PEPLAU  It also includes interpersonal process
(1952) Nursing
 Was born in Reading, Pennsylvania on Sept. 1,  A significant, therapeutic interpersonal process.
1909. It functions cooperatively with human
 Died March 7, 1999 at the age of 89, at processes that present health as a possible goal
Sherman Oaks, California. for individuals.
 The Psychiatric Nurse of the Century.  Working with health care team, they offer
 1931, graduated from Pottstown, Pennsylvania health services projecting health holistically.
Hospital School of Nursing later worked as an  Uses interpersonal model to explore and to
OR supervisor at Pottstown Hospital. identify the needs of the person seeking
 1943, Bachelor of Arts in Interpersonal professional help.
Psychology from Bennington College,
Vermont. INTERPERSONAL THEORY OF
 1947, Master of Arts in Psychiatric Nursing HILDEGARD PEPLAU
from Teacher’s College, Columbia New York.  Described the nurse-patient relationship as a
1953, Doctor of Education in Curriculum four-phase phenomenon.
Development  It can be viewed as separate entities, however it
 Career started late 1930’s, she worked overlaps with each other over the course of the
tirelessly to advance nursing education and interaction.
practice.  Each phase is unique and has distinguished
 Saved ANA from bankruptcy and moved the contributions on the outcome of the
nursing profession towards scientific nurse-patient interaction.
recognition.  Important in the practice of Psychiatric Nursing
 Member, Army Nurse Corps  She also discussed four (4) psychological
 Worked in the following: experience that compel destructive or
 Neuropsychiatric Hospital in London, UK constructive responses.
 Bellevue & Chestnut Lodge Psychiatric These includes: needs, frustrations, conflicts
Facilities and anxieties.
 With renowned psychiatrists Freida  Her work was greatly influenced by the works
Fromm-Riechman & Harry Stack Sullivan. of Sigmund Freud (Psychoanalytic Theory),
 “Interpersonal Relations in Nursing”, first book Abraham Maslow (Hierarchy of Needs Model)
in 1952 Received numerous awards. and Harry Sullivan (Interpersonal Relationship
Theory)

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 INTERACTIVE THEORIES
(NURSING THEORIES AND THEIR WORKS)
CONCEPTS AND DEFINITIONS NURSING ROLES
ORIENTATION PHASE STRANGER ROLE
 Initial interaction between the nurse and the  During the initial contact, nurse and patient are
patient who has a felt need and expresses the strangers to one another.
desire for professional assistance.  As nurse attempts to know patient better, he is
 Nurse assists in recognizing and understanding treated with outmost courtesy, which includes
the “patient” experience. acceptance of the patient as a person and due
IDENTIFICATION PHASE respect to his individuality.
 The patient identifies with those who can help  This coincides with the Identification Phase.
him/ her. RESOURCE ROLE
 The nurse permits exploration of feelings to aid  Patient assumes a dependent role.
the patient in undergoing illness as an  Nurse provides specific answers to this queries
experience that reorients feelings and - health information, advices and simple
strengthens positive forces in the personality explanation regarding care.
and provides needed satisfaction.  Nurse should appropriately change her
EXPLOITATION PHASE responses to the patient’s level of
 Patient derives the full value of the relationship understanding.
as he moves from dependent to independent TEACHING ROLE
role.  As interaction progresses, nurse gives
 New goals are projected by the nurse, buy the importance for self-care and in helping patient
power is shifted to the patient as these goals understand the therapeutic plan.
would be achieved through personal or  Nurse should determine how the patient
self-effort. understands the subject at hand.
RESOLUTION PHASE  Nurse must develop her discussion around the
 Patient earns independence over his care as he interest of the patient and his ability of using
gradually puts aside old goals and formulates the information provided.
new ones. LEADERSHIP ROLE
 Even though the patient and the nurse end the  Nurse acts in behalf of the patient’s best
relationship, it is very apparent that the interest and the same time enable him to make
experience leaves a lasting impression on the decisions over his own care.
patient since illness and assuming a dependent  This is achieved through cooperation and active
role is a unique human experience. participation.
SURROGATE ROLE
INTERPERSONAL THERAPEUTIC  The patient’s dependency for his care gives the
PROCESS nurse a surrogate (temporary care giver) role.
 Based on the theory proposed by Peplau and  Helping client clarify domains of dependence,
particularly useful in helping psychiatric interdependence and independence and acts on
patients become receptive for therapy. clients’ behalf as advocate.
 Referred as “PSYCHOLOGICAL COUNSELING ROLE
MOTHERING”  It strengthens the nursepatient relationship as
 Includes the following steps: nurse becomes a listening friend, an
a) Patient is accepted unconditionally as a understanding family member and someone
participant in a relationship that satisfies who gives sound and emphatic advises.
his needs.  The core of the interpersonal technique is for
b) There is recognition of and response to the the patient to remember and to understand the
patient’s readiness for growth, as his experience and how could it be integrated into
initiative. his daily life.
c) Power in the relationships shifts to the
patient, as the patient is able to delay
gratification and to invest in goal
achievement.

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 INTERACTIVE THEORIES
(NURSING THEORIES AND THEIR WORKS)
VIRGINIA HENDERSON (1955)  If they get sick, nurses help patient manage the
 “First Lady of Nursing” surroundings to protect him from harm and
 “First Truly International Nurse” Renowned mechanical injury.
researcher, teacher and scholar.  Basic nursing care involves providing
 Working Experience: conditions under which the patient can perform
 Public Health Nurse in Henry Street Settlement the 14 activities unaided.
& in the visiting nurse service in Washington, Nursing
D.C.  Nurses function independently from the
 Full-time instructor in nursing in Virginia as physician, but they promote the treatment plan
well as an outstanding teacher of Teachers prescribed by the physician.
College, Columbia University.  Coordinate with the therapeutic plan developed
 Published several books. by the health care team.
 At age 75, focused on international teaching  Helps both the sick and the well individual.
and speaking. This includes people from all walks of life,
 (Halloran) “Henderson was to the twentieth from well to sick, from newborn to dying.
century as Nightingale was to the nineteenth.  Care given by the nurse must empower the
Both wrote extensive works that have patient to gain independence, to be “complete”
influenced the world or “whole”.
 “The Nightingale of Modern Nursing”  Both knowledgeable in both biological and
 “Modern-Day Mother of Nursing” social sciences and must have the ability to
 The 20th Century Florence Nightingale assess basic human needs.
 In the Nature of Nursing “ that the nurse is and
METAPARADIGM IN NURSING OF should be legally, an independent practitioner
VIRGINIA HENDERSON and able to make independent judgments as
Person long as s/he is not diagnosing, prescribing
 Referred to a person a patient. treatment for disease, or making a prognosis,
 An individual who requires assistance to for these are the physicians function.”
achieve health and independence or a  “Nurse should have knowledge to practice
peaceful death. individualized and human care and should be a
 The mind and body of the person as scientific problem solver.”
inseparable.  In the Nature of Nursing Nurse role is,” to get
 Viewed as an holistic being which is composed inside the patient’s skin and supplement his
of physical, psychological, sociological and strength will or knowledge according to his
spiritual dimensions. needs.”
Health
 A quality of life and is very basic for a person 14 BASIC HUMAN NEEDS
to function fully, which is outlined in the 14  She conceptualized the 14 Fundamental Needs
components. of humans upon which nursing care is based.
 As a vital need it requires independence and  Her philosophy is greatly influenced by the
interdependence. psychologist Thorndike and nurse theorist Ida
 Nurses need to stress promotion of health and Jean Orlando’s conceptualization of deliberate
prevention and cure of disease. nursing action. Her prior experience in the field
 Good health is considered a challenge and is of rehabilitation nursing helped her refine her
affected by age, cultural background, physical models of nursing as a profession with
and intellectual capacities and emotional autonomous functions.
balance.  She defined nursing in terms of the function of
Environment the nurse: “the unique function of the nurse is
 Settings in which an individual learns unique to assist the individual sick or well, in the
pattern for living. All external conditions and performance of those activities contributing to
influences that affect life and development. health or its recovery ( or to peaceful death)
that he would perform unaided if he had the
necessary strength or will or knowledge and to
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 INTERACTIVE THEORIES
(NURSING THEORIES AND THEIR WORKS)
do this in such a way as to help him gain  As partners, nurses implement plan of care in
independence as rapidly as possible.” (Harmer such a way that will promote the physician’s
& Henderson, 1955) plan of care. Nurses do not follow doctor’s
 Emphasized the need to view the patient and orders; rather they follow in a philosophy
his family as a single unit ( to meet his need which allows physicians to give orders to
for support system – emotional needs). patients or other healthcare team members.
 Postulated that nurses functions in relation  Many nursing roles overlap with that those of
with the patient, physician and other members the physician’s.
of the health team and each type of
relationship gives nurses specific NURSE AS A MEMBER OF THE HEALTH
responsibilities and roles. TEAM
 To work harmoniously, every member must
1. Breathe Normally work interdependently.
2. Eliminate Body Waste  Nurses works and contributes in carrying out
3. Sleep and Rest the total program of care.
4. Eat and Drink Adequately  Working interdependently does not include
5. Maintain Desirable Positions taking other’s roles and responsibilities.
6. Suitable Clothes
7. Maintaining Body Temperature by Adjusting JOYCE TRAVELBEE
Clothes and Modifying Environment  A psychiatric nurse, educator and writer. Born
8. Avoid Dangers and Injuring Others in 1926.
9. Worship According to One’s Faith  1956, completed her Bachelor of Science
10. Keep the Body and Well-groomed Degree in Louisiana State University .
11. Communicate with others, express emotions,  1959, Master of Science Degree in Nursing,
needs, and fears. Yale University.
12. Work to have sense of Accomplishment  1973, pursued doctoral degree in Florida but
13. Play and Participate in various forms or not able to finish for she died later that year
Recreation (age 47). Working experience:
14. Learn, Discover, and Satisfy Curiosity  Instructor , Psychiatric Nursing, Depaul
Hospital Affiliate School, New Orleans and
CATEGORIZATION: Charity Hospital School of Nursing in
 Physiological – first 9 components. Louisiana State University, New York
 Psychological aspects of communicating and University and University of Mississippi.
learning – 10th and 14th components.  1970, Project Director at Hotel Dieu School of
 Spiritual and moral aspects - 11th component. Nursing, New Orleans.
 Sociologically oriented to occupation and  Director of Graduate Education, Louisiana
recreation – 12th & 13th component State University School of Nursing
 Publications:
NURSE-PATIENT RELATIONSHIP  1966 & 1971, International Aspects of Nursing
Comprising 3 Levels:  1969, Intervention in Psychiatric Nursing:
 Substitute for the patient – doing for the Process in the One-to-One Relationship.
patient (substitutive).
 Helper to the patient – helping the patient or
assisting patient meet his needs
(supplementary).
 Partner with the patient – working with the
patient (complementary).

NURSE-PHYSICIAN RELATIONSHIP
 Nurse function independently from
physicians.

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 INTERACTIVE THEORIES
(NURSING THEORIES AND THEIR WORKS)
METAPARADIGM IN NURSING OF JOYCE a. Original Encounter
TRAVELBEE b. Emerging identities
Person c. Empathy
 Defined as a human being. d. Sympathy
 Both nurse and patient are human beings. e. Rapport
 Human being is a unique, irreplaceable
individual who is in the continuous process of ORIGINAL ENCOUNTER
becoming, evolving and changing.  First impression by the nurse of the sick person
Health and vice-versa.
 Measured subjectively and objectively.  Nurse and patient see each other in stereotyped
 Subjective health status, is an individually or traditional roles.
defined state of well being in accord with EMERGING IDENTITIES
self-appraisal or physical, emotional, spiritual  Nurse and patient perceiving each other as
status. unique individuals.
 Objective health, an absence of discernable  The link of relationship begins to form.
disease, disability or defect as measured by EMPATHY
physical examinations, laboratory tests,  Similarities of experience and the desire to
assessment by spiritual director or understand another person.
psychological counselor.  The ability to share in the person’s
Environment experience.
 Human conditions and life experiences  Results with the ability to expect the behavior
encountered by all men as sufferings, hope, of the individual with whom he or she
pain and illness. These are associated to the empathized.
environment. SYMPATHY
Nursing  Nurse wants to lessen the cause of the patient’s
 An interpersonal process whereby the suffering.
professional nurse practitioner assists an  “When one sympathizes, one is involved but
individual, family or community to prevent or not incapacitated by the involvement”.
cope with the experience of illness and  It goes beyond empathy
suffering and, if necessary, to find meaning in RAPPORT
these experiences.  Nursing interventions that lessens the patient’s
 It is an interpersonal process because it is an suffering.
experience that occurs between the nurse and  Nurse and the sick person are relating as human
an individual or group of individuals. being to human being.
 There’s trust and confidence in the nurse.
HUMAN-TO-HUMAN RELATIONSHIP  Nurse is able to establish rapport because she
MODEL possesses the necessary knowledge and skills
 Also called “Interpersonal Aspects of Nursing required to assist ill persons and able to
Theory” perceive, respond to, and appreciate the
 Her theory was greatly influenced by her uniqueness of the ill human being.
experiences in nursing education and practice COMMUNICATION
in Catholic charity institutions – whereby she  The vehicle through which nurse-patient
concluded care rendered lacked compassion. relationships are established.
 Thought nursing care needed a “humanistic RELATIONSHIP
revolution” – a return to focus on the caring  A mutually significant meaningful relationship
function towards the ill person. through which the nursing needs of the
 In her model, the nurse and patient undergoes individual or family member are met.
the following series of interactional phases:

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