THEORETICAL FOUNDATION OF NURSING SHORT HISTORY AND EVOLUTION OF NURSING

PRACTICE
What is Nursing?

- Person who cares for the sick or infirm

1. Period of Intuitive Nursing/Ancient History
Wet Nurse a woman who suckle on infant not her - No formal training. Nursing is untaught. Done by
own women who cared for the sick as it is
internalized women’s characteristics.
Dry Nurse a woman who take care of a young child  Wet Nurse
 Dry Nurse
 Nursing to attempt to cure by care - Caring is biologically programmed in human
which leads treatment. nature.
 Care entails commitments to respond
to human lives which we seek to sustain  Ancient Civilizations
enhance and nurture. - Use of magical thinking
- Superstitious and religious belief-believed that
Nursing as Defined illness was caused by black magic or voodoo
 Association of Deans of Philippine Colleges of  Shaman
Nursing - Medicine man or witch doctor had the power to
heal using white magic.
- According to Association of Deans of Philippine  Saint Fabiola
Colleges of Nursing (ADPCN) Nursing is “a - 400 AD said to have build hospital
dynamic discipline”
- It is an art and a science of caring for 2. Period of Apprentice Nursing Middle Ages
individuals, families, groups and communities (From 6th to 18th)
geared toward promotion and restoration of - care of the sick was more on beneficence
health, prevention of illness, alleviation of - The kind of nursing rendered by religious orders
suffering and assisting clients to face death with of the Christian church. (Nuns including monks)
dignity. Knights of St John of Jerusalem

 American Nursing Association (ANA) - nursing care that included asepsis and
quarantine (1095-1271 AD)
- According to American Nursing Association
(ANA), is the “diagnosis and treatment of APPRENTICE NURSING
human responses to actual or potential health  Teutonic Knights
problems” - Catholic military orders to protect Christians
and tasked to build hospital 1190 AD
 International Council of Nurses (ICN)  Augustinian Sisters
- First Nursing order
- As defined by International Council of Nurse - The growth of Christian orders marked the
(ICN), Nursing encompasses autonomous and development of early specialized institution
collaborative care of individuals of all ages, - Monasteries have hospitals, each church has
families, groups and communities, sick or well hospital
and in all settings. - 17th – 18th = stagnation of nursing care
- Nursing includes the promotion of health,
prevention of illness, and the care of ill, disabled
and dying people. IMPORTANT NURSING PERSONAGES DURING
APPRENTICE NURSING
Virginia Hendenson’s definition of Nursing

“To assist clients in the performance of activities

contributing to health, its recovery or peaceful death 1) Rufiada Al-Aslamia
that client will perform unaided. If they had necessary - First Muslim nurse (7th Century)
will, strength or knowledge. ”
2) Camillus de Lellis (1550-1614)  Dorothea Dix (USA)
- Patron saint of nurses, physicians, and the sick - 1861 the nursing leader during the American
- Italian Monk Civil War.
3) St. Claire (1994-1253) - Teacher and social reformer for treatment of
- Founder of the order of poor ladies mentally ill patients
4) St. Elizabeth of Hungary (13th Century) - Describe as the most effective advocate of
- She used her wealth to build church for the sick humanitarian reform in American Mental
- Daughter of Hungarian Institute (19th Century)
5) St. Roch
- Protector against plague  Linda Richards
6) St. Catherine of Siena (Patron Saint of Rome) - First formally trained graduate nurse in Boston,
(1347-1380) US in 1873
- 1st lady with a lamp - She created a system for charting and
- 24th child of Italian parents maintaining individual medical records for each
- She pledged her life to service and referred to patient
as little saint
- She was a hosp, nurse, prophetess, researcher  Lilian Wald (1893 US)
- First community nurse

3. Period of Educated Nursing/Nightingale Era  Bedford Fenwick

(19-early 20th Century) - 1899 established the International Council of
- Importance nursing education was given Nurses in Great Britain
emphasis by Nightingale - Introduce law to control nursing and limit it to
- June 15, 1860 Florence Nightingale opened registered nurses only.
school of nursing opened at St. Thomas hospital New Zealand first country to regulate nursing
in London. with their nursing registration act in 1901
- First school which provided theory and clinical
skill training  Ellen Dougherty
- Formal nursing education and nursing service - First registered nurse in New Zealand and in the
begun world
- Mother of Modern Nursing
4. Period of Contemporary Nursing
- This covers after World War II to present.
EARLY NURSING LEADERS UNDER THE EDUCATED - Scientific and technological developments as
NURSING PERIOD well as social changes mark this period
- Licensure of nurses started expanded
- Expanded roles of nurses was developed
- Use of atomic/nuclear energy for medical
 Theodore Fleidner
diagnosis and treatment
- 1836 revived the church order Deaconess to
- Computers for collecting data
care for those in the hospital
- Pastor Theodore Fleidner and his wife, Frederika NURSING IN THE PHILIPPINES
established the Kaiserswerth Institute for the
training of Deaconesses (the 1st formal training Prominent persons involved in Nursing Works
school for nurses) during the Philippine Revolution

 Josephine Bracken
Germany – gave Florence Nightingale  Dona Maria Agoncillo de Aguinaldo
her nurses training of only 3 months - First chairperson of the Philippine Red Cross
 Melchora Aquino (Tandang Sora)
 Clara Barton
- Founder of American Red Cross
- Civil war nurse “angel of the battlefield”

Prominent Nursing Leaders (Philippines)

  Loreto Tupaz 3. Research Emphasis Era (1950-1970)
- Known as the Dean of the Philippine Nursing - Simultaneous with Graduated Education Era
Education and the Florence Nightingale in Iloilo - Occurred in mid 20th century where there was a
 Anastacia Giron Tupaz need for higher understanding of advances in
- Founder of Philippine Nurses Association (PNA) science in which research was recognized as
 Dr. Julita Sotejo way of knowledge
- Florence Nightingale of the Philippines. Founder
of University of the Philippine CN The Yale School 1960

- Nursing theoretical thinking began to focus on

Central Philippine University College of Nursing
the relationship between the nurse and the
 June 1906 patient
- Union Mission Hospital Training School for - Theorists of this school include Ida Jean
Nurses Orlando and Ernestine Weidenbach.
 March 5, 1932 - Myrna Levine presented her four conservation
- Iloilo Mission Hospital Training School of Nurses principles of nursing.
 Loreto D. Tupaz - the works of Johnson and Leminger were added
- Hall of the College of Nursing to the body of theoretical thought in Nursing
4. Graduate Education Era (1950-1970)
First Filipino Hospitals with School of Nursing - Simultaneous with research era
- Iloilo Mission Hospital School of Nursing (1906) - Emphasis was the advance role of nurses and
the 1944 nurse graduates took the first Nurse’s basis of nursing practice
Board Examination - 1960 debates on direction of nursing knowledge
- St. Paul’s Hospital School of Nursing (1907) as discipline (from a vocation to profession)
- Philippine General Hospital School of Nursing - 1970 continous of nursing from vocation to
(1907) profession with debates if nursing should be
- St. Luke’s Hospital School of Nursing (1907) other discipline based or nursing based.
- Mary Johnston Hospital and School of Nursing - This Era saw the nursing practice to be based on
(1907) nursing knowledge
- Acceptance of Nursing as a profession and an
First Colleges of Nursing in the Philippines academic discipline
5. Theory Utilization Era (1980-1990)
- University of Santo Tomas College of Nursing
- With emphasis on theory development and use
(1946)
of nursing theory to produce evidence for
- Manila Central University (1948)
professional practice
- University of the Philippines (1948)
- There was understanding that theory should go
History of Theory Development in Nursing hand with research to produce nursing science
- Introduction of the four nursing models as
1. Historical Era (Nightingale Era) paradigm concepts of person, nursing,
- Envisioned Nursing knowledge as distinct and environment and health
separate from medical practice 6. Theory Utilization Era (21ST Century)
- Nursing practice was at that time based on - Emphasis on development and application
traditions handed down through apprenticeship nursing theory to produce evidence based
model of education and hospital individual nursing practice
manuals - Middle range theory emerged and realized
- Nursing should focus on the manipulation of the
environment for the patients’s benefit Characteristics of Nursing -> Theory Development in
- 1854 “Notes of Nursing” presents the first the 21st Century:
nursing theory
1. The discipline of nursing is predicted on
- Strong emphasis on Nursing Practice
understanding the meanings of daily lived
2. Curriculum Era (1900-1940)
experiences as they are observed by the
- Emphasis on what courses should be included in
members or participants of the science
the nursing program
2. There is increased emphasis on practice-
- An era which produced a standard curriculum
orientation
for the nursing course
 3. Nursing’s mission is to develop theories to 1.) Improved Patient Care
develop theories to empower nurses, the a) Helps organize, examine and analyze
discipline and patients. patient’s data
4. It is accepted that woman may have different b) Helps make decisions about effective and
strategies and approaches to knowledge efficient nursing interventions
development than men do. c) Helps make a S.M.A.R.T. (Specific,
5. Nursing attempts to understand consumer Measurable, Attainable, Realistic and Time-
experiences for the purpose of empowering bounded) plan of care for patients
them to receive optimum care and to maintain
optimum health 2.) Improved Communication Between Nurse
6. The effort to broaden nursing’s perspectives Professionals
includes efforts to understand the practice of
nursing in 3rd world countries - Nursing Theory differentiates the focus of
nursing from other professions.

SIGNIFICANCE OF NURSING THEORY  Cesaria Tan

- First Filipino nurse who had Master’s degree in
 Discipline Nursing in the US.
- Refers to a branch of education, associated to
academics, learning department. HISTORY AND PHILOSOPHY OF SCIENCE
- It is about equipping knowledge and skills to a Science
specific field of study like Nursing.
- NTs assure that work in respective specialties of - is a method for describing, explaining and
nursing remains useful and relevant predicting causes or outcomes of an
 Profession intervention.
- Specialized field of practice founded on the - Nursing being a scientific discipline means we
theoretical structure of the science or need to identify the nurse’s unique knowledge
knowledge of the discipline including practicing for the care of patients, families and
abilities communities.
- Enhances the status of the nursing profession - Nurses can conduct clinical and basis nursing
- NTs give direction and purpose to the practice research to establish the basis of nursing care.
of the nursing profession - When we talk of the science of nursing, we
- NTs are developed to improve the quality of think of what is the knowledge of nursing, and
care rendered by nursing professionals how was it derived. (beliefs which are true and
which we can give sufficient justification)
Nursing Nursing
Theory Knowledge
EPISTEMOLOGY

- Branch of philosophy dedicated to the study or

Education Research Practice theory of knowledge with regards to its
attainment, validity and scope.
- Concerned with justified belief from opinion
SIGNIFICANCE OF NURSING THEORY - Although some epistemologists believe that we
do not need to be justified to know
On the
Discipline of PHILOSOPHICAL PERSPECTIVE
theories for
Nursing is PROFESSION
its continued
dependent  Rationalism
existence as a
- Reflection on ideas faculty of reasoning
- Deductive reasoning where it starts hypothesis
of statement tested if it is true thru observation

 Rationalist Epistemology
Benefits of Nursing Theory to the Nursing Progression
 - Theories first to be tested. Theory-then- - The type of housing in which a
research strategy person lives, its location, and
- Cause lack of social support information related to safety and
- Effect result in hospital re-admission comfort within the person’s
home and neighborhood.
 Empiricism Epistemology b) Spiritual Environment
- In nursing knowledge, Research then theory - Spiritual values and belief directs
strategy a person’s behavior and
- Observation in patients – collect then research approach to health problems9
and reacts to sickness.
Early 20th Century Views of Science and Theory c) Interpersonal and Cultural
a) Focused of philosophers is on analysis of theory Environment
structure while scientist on empirical research - Cultural influences, relationship
b) Positivism believed that deductive and with family and friends and
inductive are the two best approaches in presence or absence of support
scientific knowledge system
c) Increase of computers permitted analysis of 3.) Health
large data sets which contributed to acceptance - Is the ability to function
of positivist approach to modern science independently, successful
adaptation to life’s stressor,
Emergent Views of Science and Theory in the Late 20th achievement of one’s full life
Century potential and unity of mind, body
and soul.
- Emphasis on continuous research rather than
- Is the state of complete physical,
product of findings
mental and social well-being and
- Science is viewed as an ongoing process and
not merely the absence of disease
scientific knowledge is the consensus of
or infirmity. (WHO-World Health
scientist in any given era.
Org.)
- Evidence-based science thru collaboration and
4.) Nursing
evidences
- The interventions/ACTION of the
nurse rendering care in support or
in cooperation with the client
STRUCTURE OF NURSING KNOWLEDGE – PERTAINS TO o Independent
THE FRAMEWORK OF NURSING KNOWLEDGE o Dependent
o Interdependent
 METAPARADIGM
- The broad conceptual boundaries or central
 PHILOSOPHY
issues of nursing knowledge.
- Deals with the ideals, standards, values and
beliefs that describes a thought and behaviour.
Four components of METAPARADIGM
In nursing, it includes the motivation for being
1.) Person
part of the profession
- The recipient of nursing care like
individuals, families and Nursing Philosophies
communities
- Individualized patient-centered care  Nightingale
to the different levels of needs  Watson
- Patient Latin word meaning “to  Benner
suffer” one of dependence  Eriksson
2.) Environment
- The external and internal aspects of  CONCEPTUAL MODELS
life that influence the person - A set of abstract and general concepts that
including the settings in which their addresses the phenomena of the central
health care needs occur interest of nursing profession
a) Physical Environment - Person, Health, Environment, Nursing
 - Present perspective for theory development - Explains the relationship of different concepts
 ASSUMPTIONS
Conceptual Models - Statements that researcher or theorist hold as
Levine Rogers truth and excludes from measuring and testing.
King Orem These are the “taken for granted facts”
Johnsons Neuman  DEFINITION
- Composed of various descriptions that convey
general meaning and reduce vagueness in
THEORY
understanding of concept.
- A system of ideas that is proposed to explain a - Interpersonal system define as two or more
given phenomenon individuals interacting
- An explanation of some phenomena based on - Social system as large groups with common
observation experimentation and reasoning goals

PHENOMENON NURSING THEORY

- An aspect of reality that can be consciously - Nursing theory is an articulated and

sensed or experienced communicated conceptualization of invented or
- Can be temporary or permanent discovered reality in or pertaining to nursing for
the purpose of describing, explaining,
What is a Theory? predicting, or prescribing nursing care.

- Theory is an organized system of accepted

 GRAND THEORIES
knowledge that is composed of concepts,
- Greater degree of abstraction
definition and assumptions or proposition
- Broad in scope and complex that needs further
intended to explain a set of fact, event or
specifications through research.
phenomenon. As defined by Chinn and Kramer
- Does not provide guidance for specific nursing
(1991)
interventions; but it provides the structural
framework for broad, abstract ideas about
nursing.
THEORY DEVELOPMENT

 MIDDLE RANGE THEORIES

Concepts Propositions Assumptions
- Are more limited in scope and less abstract
- They address a specific phenomenon and reflect
Theory Phenomena Definitions nursing practice
- Focus on specific field of nursing like
incontinence, social support, quality of life, and
What is Theory? caring
 RAMONA MERCER maternal role
- A theory is a way of seeing through a “set of
attainment-becoming a mother
relatively concrete and specific concepts and
 MERLE MISCHEL uncertainty in
the propositions that describe or link the
illness theory
concepts”
 CHERYL BECK postpartum
depression
 CONCEPT
- Concepts are the building blocks of theories Purposes of Nursing Theory (NT)
- Is defined as an idea or images formulated by
the mind or an experience perceived and 1. NT are developed to improve the quality of care
observed that labels a phenomenon rendered by nurses to their clients.
- Concept-mental formulation of objects from 2. NT development is inherent in 3 different
individual perception nursing field
- These concepts can be simple or complex - Education
- Research
 PROPOSITION - Administration
 3. To assure that work in respective specialties of - Most difficult to master and teach
nursing remains useful and relevant - Involves therapeutic use of self
- Personal knowledge difficult to express in
Nursing Knowledge language so expressed in personality
- Composed of theoretical and practical
knowledge
1 Theoretical Knowledge FLORENCE NIGHTINGALE (May 12, 1820 – August 13,
- Aims to stimulate thinking and broaden 1910)
understanding of the science and practice of the
Founder of the Modern Nursing
nursing discipline
- According to Meleis (1997) theoretical - Considered as the first nursing theorist
knowledge includes and reflects basic values,
guiding principles, elements and phases of ENVIRONMENTAL THEORY
conception of nursing
 Florence Nightingale
2 Practical Knowledge
- Born on May 12, 1820 in Florence, Italy from
- Referred to as the art of nursing
parents Edward and Frances Nightingale
- Originated and resided in Embly Park,
 Education
Hamsphire, England with parents and sister
- Nursing theory used in establishing the position
- Was tutored in mathematics, languages (Greek
of the profession in the university more firmly
Latin French German) religion and philosophy
established in academia than in practice
- In 1851, trained at Kaiserwerth Institute,
- In the 1970’s and 1980’s, many nursing
Germany for 3 months later declared as nurse
educational curricula were developed around a
- Was requested by SIr Sidney Herbert (secretary
particular conceptual framework
of war) in 1854-1856 to organize nurses to
FOUR WAYS PATTERNS OF NURSING KNOWLEDGE provide nursing care to British Soldiers during
the Crimean War in Scutari, Turkey.
1.) Empirical Knowing - The “LADY WITH A LAMP”
- Scientific discipline of nursing that is objective, - She helped Established the St. Thomas Hospital
abstract, gen. quantifiable and verifiable and later King’s College Hospital in London and
through repeated testing where the 1st formal school for nursing
- Most emphasized way of knowing (Nightingale School of Nurses) was established
- Focuses on evidence based research offering both theoretical and clinical training at
2.) Aesthetic Knowing art of nursing - The only woman to receive the Order of Merit
- Focuses on empathy, the primary form of and Royal Red Cross Award (OM and RRC)
aesthetic knowing – related to understanding - Died August 13, 1910 at age 90
what is of significance to particular patients
such as feelings, attitudes, point of view. Focus of Nightingale Theory
3.) Ethical Knowing
- Emphasized the great role of environment in the
- Moral direction of nursing
care of the patient. Central to Nightingale’s
- Used when moral dilemmas arise and when
theory is the role of environmental sanitation
consequences are difficult to predict
- Requires knowledge of different philosophical Nightingale’s Concepts and Definition
positions, right and wrong in making moral
actions and decisions 1. Proper Ventilation
- Code of ethics or code of morals that leads the - Pure air (possibility that inadequate ventilation
conduct of nurses. may cause disease).
- Concept of human dignity, service and respect - Warmth-balance between ventilation and
for life normal body warmth by manipulating the
4.) Personal Knowing environment thru:
- Refers to the way nurses view themselves and o Positioning the patient
the client o Opening the windows
- Personal maturity and freedom are components o Regulate room temperature
- Self awareness
 2. Adequate Light 3 The window and one window is
- Direct sunlight real effects on human body and considered enough to air a room
purifying effects of light upon air of room 3.) Petty management
3. Cleanliness - Continuity of the care, when the nurse is absent
- (Patient, nurse and environment dirty - Documentation of the plan of care and all
environment) source of infection evaluation will ensure others give the same care
4. Efficient Drainage to the client in absence
- Efficient handling and disposal of bodily 4.) Noise
excretions and sewage to prevent - Loud noise, unnecessary noise
contamination of environment. 5.) Variety
5. Pure water - A means of recovery
- Advocated bathing of patients on frequent - Brilliant color and form means recovery
basis, even daily, when this was not a norm - Flowers – lilies the smell of which is said to
during their time. Same with nurses depress the CNS
- Variety of thoughts
 “Notes on Nursing” (what is and what is not) 6.) Taking food
- Presents the first nursing theory - Patient starved to death in chronic disease
- Food never to be left at the patients bed side
CANONS OF NURSING NOTES ON NURSING
(What it is and what it is not) Guide the practice of There may be four different causes, any one of
professional nursing: which will produce the same result, viz., the
patient slowly starving to death from want of
1.) Ventilation and Warming nutrition:
- The very first canon of nursing, the first and last
thing upon which a nurse’s attention must be 1 Defect in cooking
fixed, the first essential to a patient. 2 Defect in choice of diet
- “to keep the air he breathes as pure as the 3 Defect in choice of hours for taking diet
external air, without chilling him” 4 Defect of appetite in patient
 open windows 7.) What food
 desirable warmth - Milk – essential to ill clients
2.) Health of the house - Jelly – great flavor with nurses and clients
Five (5) essential points in securing the health of 8.) Bed and bedding
the house - Iron bed sheets
1 Pure air - Height of the bed
- Architectural design of the house - Placed on the lightest point of the room
2 Pure water 9.) Light
3 Efficient drainage - Second to the need of fresh air
- All drains should begin and ends - Essential to health and recovery
outside the walls - Without sunlight we degenerate body and
4 Cleanliness system
5 Light 10.)Cleanliness of rooms and walls
- A dark house is always an unhealthy - Assess the room for dampness, darkness and
house dust or mildew.
- Keeping the environment clean (free from dust,
Three (3) common errors in managing the dirt, mildew and dampness)
health of the houses 11.)Personal cleanliness
1 The female head in charge does not - If the patient is allowed to remain unwashed or
think to visit every hole and corner of it their clothing to remain on them after being
each day saturated with perspiration or other excretion
2 That it is not considered essential to air, 12.)Chattering hopes and advices
sun, and to clean rooms while - Are attempts to cheer the patient
uninhabited making it ready for all kinds
of diseases
NIGHTINGALE’S THEORY ASSERTIONS TO THE FOUR JEAN WATSON, PhD, R.N (Philosophy and Theory of
METAPARADIGM Transpersonal Caring)

1. Nursing Central Theme: “Caring is the Essence of Nursing”

- Comparable to mother’s instincts. Her “Notes
PHILOSOPHY AND SCIENCE OF CARING
on Nursing” provided guidelines to women who
wanted to become nurses and gave advice on - Watson’s definition of ‘caring’ as opposed to
how to “think like a nurse”. ‘curing’ characterizes nursing from medicine.
2. Person - She views ‘caring’ as the most valuable
- Is the patient himself. Nightingale viewed the attribute nursing has to offer to mankind
patient as passive who needed nursing care because ‘caring’ is the essence of nursing and it
regardless of patient’s social worth. connotes interactive relationship between
3. Health nurse and patient.
- Nightingale viewed health as being well and
living up to one’s potential to the fullest extent Educational Background:
4. Environment
- Graduated at Lewis Gale School of Nursing,
- She defined it as everything external which
Virginia
affects the health of the sick and healthy
- B.S in nursing (1964), M.S in psychiatric-mental
person.
health nursing and a Ph.D. in educational
psychology and counseling at the University of
Colorado
NIGHTINGALE’S THEORY APPLICATION TO NURSING - Several honorary doctoral degree
FIELDS - Founder of Center for Human Caring at the
1 Nursing Practice University of Colorado.
- The environmental aspect of her theory remains There are 3 major elements of Watson’s Theory
an important component of nursing care.
- Nursing practice as described as an A. Transpersonal Caring Relationship
environmental adaptation - Special kind of human care relationship a union
2 Nursing Education with another person high regard for the whole
- Separation of nursing training from the hospital person and their being in the world.
to a different environment like a school or B. Caring Occasion/Caring Moment
university setting. - Is the moment when the nurse and patient
- Advocated practice nursing in education come together in such a way that an occasion
- She advocated case studies to monitor student’s for human caring is created.
progress. Did not believe on licensure - A human-to-human transaction is created
examination. C. 10 Carative Factors
3 Nursing Research - Using these 10 carative factors, the nurse could
- Mother of Nursing Research provide care to various patients
- Exceptional ability in gathering and analyzing - The term ‘carative’ is a contrast with the usual
data and presenting data graphically medicine term ‘curative’
- She was the first to use the polar diagrams - Each carative factor describes the caring process
of how a patient attains/maintains health or
Nightingale dies a peaceful death.
 Research
10 CARATIVE FACTORS
 Invented the polar diagrams
1. Humanistic-Altruistic System of Values
POLAR AREA DIAGRAM
- It is the satisfaction gained through giving and it
- Nightingale rose diagram is an extension of sense of self. It is learned at
- First female member of the Royal Statistical an early age but can be influenced by nurse-
Society educators.
- Honorary member American Statistical 2. Instillation of Faith-Hope
Association - When modern science has nothing further to
offer the person, the nurse can continue to use
 faith-hope to provide a sense of well-being 2. Person (Human being)
through beliefs which are meaningful to the - Human being as a valued person in and of him
individual or herself to be cared for, respected, nurtured,
3. Sensitivity to Self and Others understood and assisted; in general a
- Acknowledgement of one’s feelings is needed philosophical view of a person as a fully
for a nurse to become more genuine, authentic, functional integrated self.
and sensitive to others. - She views a person as a unity – 3 spheres –
4. Development of Helping-Trusting, Human Care mind, body, spirit (soul) - unique and has
Relationship freewill
- This is crucial for transpersonal caring. A 3. Health
trusting relationship that involves congruency, - According to Watson, health is more than the
empathy, warmth, therapeutic communication, absence of illness. It is the unity and harmony
and honesty promotes the expression of both within the mind, body, and soul and is
positive and negative feelings. associated with the degree of congruence
5. Promotion and Acceptance of the Expression between the self as perceived and the self as
of Positive and Negative Feelings exerienced
- Sharing of feelings is a risk-taking experience for 4. Environment
the both nurse and patient. - According to Watson caring (and causing) has
6. Systematic use of the scientific problem- existed in every society. A caring attitude is not
solving method for decision making transmitted from generation to generation. It is
- Inclusion of the different ways of knowledge transmitted by the culture of the profession as a
- Emphasizes the importance of the nursing unique way of coping with its environment.
process in providing holistic care to patients.
7. Promotion of Interpersonal Teaching-Learning
- Empowering the patient thru education and CONTRIBUTIONS TO THE 3 NURSING FIELDS
shifting responsibilities of health and wellness
to patient, (self-care) 1. PRACTICE
8. Supportive, protective, &/or corrective mental, - Watson’s works are being clinically validated
physical, societal, and spiritual environment and are used by nurses in diverse settings.
- The nurse manipulates external & internal
environment in order to provide support and They have been used in:
protection for the person’s mental and physical  Critical Care Unit
well-being.  Transplant Units
9. Assistance with Gratification of Human Needs  Neonatal Intensive Care Units
- This is derived from Maslow’s hierarchy of  Pediatric and Gerontological Care Units
needs. The nurse helps in promoting wellness 2. EDUCATION
and health by recognizing and achieving need of - Her theory is being taught in numerous
patients. baccalaureate nursing curricula all over the U.S.
10. Allowance for Existential-Phenomenological- and even in the other foreign countries
Spiritual Forces 3. RESEARCH
- “rational mind and modern science do not have - A source of research material, dissertation and
all answers to life and death, we have to be DNP project
open to the unknowns which we can not contro, - Many other researchers have also analyzed the
even allowing what we consider as “miracle” to caring theory and suggested additional
enter our lives” information

ASSERTIONS TO THE 4 METAPARADIGMS

1. Nursing PATRICIA BENNER from Novice to Expert

- Viewed nurse as both noun and a verb. Nursing
- Described 5 levels of nursing experience or skill
consist of knowledge, thoughts, philosophy,
acquisition in Nursing
values, commitments and action with some
degree of passion

Levels reflect:
 - Movement from reliance on past abstract - BSN (1939) Master of Science in Nursing (1945)
principles to the use of past concrete
Career:
experience as paradigms
- BA in Nursing-Pasadena, California - Early experiences include: O.R nurse, private
- MA (Med-Surgical), PhD in UC-San Francisco duty nurse, staff nurse on pedia and MS wards,
- Author, recipient of numerous awards and supervisor at the E.R.
- Became a director of the Dept. of Nursing at the
Providence Hospital in Detroit
PATRICIA BENNER - Dean of CUA

Central theme: How nurses learn to do nursing THE SELF-CARE DEFICIT NURSING THEORY

5 levels skill Acquisition in Nursing - The focus of the theory is to enhance the
person’s ability for self-care
1.) NOVICE
- A person has no background experience pf the Orem’s General nursing theory has 4 interrelated parts:
situation on which he is involved.
2.) ADVANCED BEGINNER 1.) Theory of Self-Care
A. Self-Care
- Example are newly registered nurses. (Rely on
more experienced nurses) - Describes why and how people take care of
themselves to maintain life, health and well-
- Still guided by rules and more oriented in the
completion of the task being
B. Self-Care Agency
- Difficulty grasping totality current patient
perspective as they view clinical situations as a - Human ability to engage in self-care
C. Therapeutic Self-Care Demand
test of their abilities rather than response to
patients, needs. - Totality of self care actions to be performed to
meet self care requisites
3.) COMPETENT
- The nurse progresses into this level by learning D. Self-Care Requisites
- Actions directed towards provision of self care
from actual practice situations and by following
the actions of others. Three Categories of Self-Care
- The nurse will be able to recognize patterns and
identify which situation needs the most 1. Universal Self-Care
attention. - Common to everyone;
- Feeling of satisfaction and uneasiness with - Maintenance sufficient intake of air, water, food,
regards to performance of acts which elimination process, balance activity & rest,
sometimes results to anxiety. prevent hazards human life, promotion of
4.) PROFICIENT human functioning.
- A transition into expertise where the person has 2. Developmental
a better understanding of the situation as a - Self-care that depends on maturation/human
whole. development and life situations, e.g. toilet
- Shows increased confidence in their knowledge training, adjusting to a new job, body changes.
and skills and no longer rely on the preset goals 3. Health Deviation Self-Care
in their organization. - Self-care that may occur as a result of disability,
5.) EXPERT illness , or injury
- Possesses intuitive grasp of the problem 2.) Theory of Self-Care Deficit
without losing time considering a range of - The instance when nursing is needed as an
alternative diagnosis and solutions. individual/ a patient is unable to meet his own
self-care requisites.
DOROTHEA ELIZABETH OREM (Self-Care Deficit Nursing - Nursing is required to identify these deficits in
Theory) order to support or help.
- Born in Baltimore, Maryland

3.) Theory of Nursing Systems

Educational Background: - It describes how the self-care needs will be met
by the nurse, patient, or both.
 - Has physical, chemical, and biological features
It consists of 3 support modalities:
- It includes the family, culture and community.
1. Wholly Compensatory
- Patient is totally dependent on others for self-
care. They are completely unable to care for
themselves. 1.) PRACTICE
2. Partly Compensatory
- Patient can meet some but not all needs. Both 1. It is used in a variety of clinical
populations from neonates to the elderly,
the nurse and patient contributes to the
for health promotion and care of the
patient’s needs. sick.
3. Supportive-educative
- Patient is fully capable and responsible for their 2. Teaching self-care to people with DM,
own self-care, he only needs information. The ESRD, dialysis, and renal transplant.
primary role of the nurse is in
educating/teaching the patient. 3. Used in pain assessment, prevention,
control, and alleviation.
THE SELF-CARE DEFICIT NURSING THEORY
4. Used in cardiology especially for post-
Orem identifies 5 methods of helping:
stroke patient’s self-care needs.
1. Acting for and doing for others
2. Guiding others 5. Used in oncology especially with cancer
prevention and maintenance of self-care
3. Supporting another
after being diagnosed with malignancies
4. Providing an e nvironment w/c promotes
personal development in relation to meet 6. Used in assessment and intervention of
future demands psychiatric disorders
5. Teaching another
7. Also used in occupational health nursing
ASSUMPTIONS TO THE 4 METAPARADIGMS
especially in identifying health hazards
and job-related risk factors.
1. Nursing
8. The supportive-educative systems have
- Is an art through which the practitioner of been effective mostly with pregnant
nursing gives specialized assistance to persons women, patients with heart failure or
with disabilities which makes more than cancer.
ordinary assistance necessary to meet needs for
self-care.
2.) EDUCATION
- The nurse also intelligently participates in the
- Used as a framework for curriculum and
medical care the individual receives from the
teaching in at least 45 schools of nursing like
physician.
Sinclair School of Nursing, Oakland University,
University of Missouri, etc.
2. Person

- Defined as “men, women, and children cared

for either singly or as social units” and are the
KATIE ERIKSSON (Eriksson’s Caritative Caring Theory)
“material object” of those who provide direct
care.
Eriksson’s Caritative Caring Theory
3. Health
- One of the pioneers of caring science in the
Nordic Countries
- WHO definition of health “is the state of
physical, mental, and social well-being & not
merely the absence of disease or infirmity” - A graduate of Helsinki Swedish School of
Nursing
4. Environment
- With Master and Doctorate Degree
 - The first appointed docent of caring science in - Also means willingness to sacrifice something of
Nordic territory oneself

- Worked for the development of caring science 4. Dignity

as an independent discipline
- Partly Absolute Dignity human being as
- Developed Master’s and Doctoral degrees in creation, unique human being
caring Science
- Partly Relative Dignity influence and formed
- Researcher, author and recipient of multiple thru culture and outer context
professional and academic awards
5. Suffering
MAJOR ASSUMPTIONS OF ERIKSSON
- Unique isolated total experience and not always
1.) Human being is entity of body, soul, and spirit synonymous with pain

2.) Human being is religious being 6. Sufferings Related to:

3.) Caring is something human in nature a call to a. Due to disease

serve in love
b. Caused by care or absence of care –
4.) Suffering is inseparable part of life violation of human dignity

5.) Caritative ethics is the context of the meaning c. Situation of being a patient, the entire life
of caring derives meaning from ethos of love of being human being
responsibility and sacrifice-caritative ethics
7. The Suffering Human Being
MAJOR CONCEPTS CARITATIVE CARING
- Eriksson’s concept of human being (suffering
1. Caritas human being who patiently endures)

- Love and charity eros and agape are united 8. Reconciliation

- The fundamental motive of caring science - Is a pre-requisite of caritas

- Caring is an act to faith hope and love through - Achieving reconciliation is living with
tending, playing and mediating imperfection with regards to self and others but
seeing a positive light and meaning to
2. Caring Communion sufferings.

- Entails intimate connection that requires 9. Caring Culture

meeting in time and space, an absolute and
lasting presence - Eriksson’s concept of environment

- Owning up – deepest form, of communion - Total caring reality and based on cultural
elements such as traditions, rituals and basic
- Gives caring its significance values

3. Caritative Caring Ethics - When communion arises because based on

ethos caring culture becomes inviting
- Distinction between the caring ethics and
nursing ethics ASSUMPTIONS TO THE METAPARADIGM

- Caring ethics practice in care, is without  Human Being

prejudice, sees human being with respect that
confirms the human being’s absolute dignity - When entering the caring context. He becomes
a suffering human being.
- Eriksson stresses the understanding of dual
tendencies of human beings, continued struggle
and living in tension between being and non-
being. Effort to be unique at the same time
longs for belonging in larger communion.

 Nursing

- Love and charity (caritas) motive of caring

- In caritas the two basic forms of love-Eros and

Agape are combined generosity becomes
attitude towards life and joy becomes its form
of expression

- Ultimate purpose is to bring human being back

to mission

- Differentiated between nursing care and caring

nursing

 Environment

- Caring culture

 Health

- Health implies being whole in body, soul and

spirit