T heoretical Foundation in

• Theory
Nursing
— A set of propositions (statements/opinions), suppositions (assumptions/hypotheses) or
-

constructs (ideas) that purport to explain, describe and predict a reality.

— it aims - to describe the purpose of a reality or a concept
— it is an abstraction of reality

• Foundation -
I

— it is the baseline/basement, everything starts with foundation

— the basic knowledge and skill set that all nurses are required to have

Lesson 1: T he Evolution of Nursing

1
a. Intuitive Period
b. Apprentice Period
c. Education/ Educational Period
d. Contemporary Period
-

O
A. Intuitive Period (Primitive Era - 6th Century)

What is Intuitive? note : you're considered nurse in this period as long as

-

— Intuition (Kutob) you're caring for the sick .

• Nursing was "untaught" and instinctive. It was performed of compassion for others, out of
the wish to help others.
• Nurse's role was instinctive and directed toward comforting, practicing midwifery and being
wet nurse to a child.
>
• Nursing was a function
-
that belonged to women.
• No caregiving training is evident
-

•-Primitive men believed that illness was caused by the invasion of the victim's body of evil
- -

-
spirits.
• Believed that medicine man was called- shaman or witch doctor having the power to heal using

I
white magic.
• Trephining — Cutting a hole in the head of the afflicted to let out the evil spirit

music or
singing was often used to
chase away spirits
 Pre-historical Medical Practice not all are in Intuitive Period)

• Use of mercury • Radium Water

• Blood Letting with the use of leeches • Ecraseur
• Lobotomies (Walter Freeman) scraping frontal lobes • Plombage insert pebbles in lungs (Tuberculosis)
-

• Heroin for headaches • Peg Legs artificial legs

-

• Electroconvulsive Therapy (ECT) • Morphine for teething

• Trephining • Starvation for Aneurysms
• Cannibalistic Medical Practices • Hydroelectric Baths for Migraines

Rise of the Early Civilization and Ancient Cities and their

contribution to Medicine
Mesopotamia
• No distinction bet ween rational science and magic
• Diagnostic Handbook - introduced the methods of therapy and cause. The text contains a list of
- -

-
medical symptoms and often detailed empirical observations along with logical rules used in
combining observed symptoms on the body of a patient with its diagnosis and prognosis
• Asipu - Medical Authority/ Exorcist- Healer
• Prophylaxis - prevention of diseases
-
• Mental illness is associated with Deities

Egypt
• Egyptians are considered "The Healthiest of all men"
• Public Health System
• Medical information in the Edwin Smith
Papyrus — may date to a time as early as
-3000 BC. It details cures ailment and anatomical obser vation
• Edwin Smith Papyrus — is an ancient
-
textbook on surgery almost completely devoid of magical
thinking and describes in exquisite detail the examination, diagnosis, treatment, and prognosis of
-

numerous ailments.
• The Kahun Gynaecological Papyrus — treats women's complaints, including problems with
-

conception.
-

for King Djoser in the-

27th century BCE)
-
• The earliest known physician is also credited to ancient Egypt ("Chief of Dentists and Physicians"

• Peseshet - Earliest known woman physician.

China
• Huangdi neijing - The foundational text of Chinese medicine written 5th

-
- -

century to 3rd century BC

— Basis of traditional Chinese medicines, acupuncture and moxibustion
— They gave the world knowledge of material medica (pharmacology)
-
— Believed that in using girl’s clothes for male babies keep evils away from
them
- Prohibited the dissection of dead human body as a worship to ancestors
-
 India
• Atharvaveda - Ancient text dealing with Medicine
-

• Ayur veda - "Complete knowledge for long life"

-
Medical system of India with 8 branches of medicine
-

• Charaka and Sushruta -= 2 most famous medical

-
texbooks that describes
-
physical examinations,
diagnosis, treatment and prognosis and several surgical
procedures.
• Susrutasamhita - Describes several surgical
-
procedures
-

Greece and Roman Empire

• Wound treatment * only pouring not water on the wound
-
~

• The Romans attempted to maintain vigorous health, because illness was a sign of weakness.
-
• Care of the ill was left to the=
slaves of Greek physicians. Both groups were looked upon as inferior
-
-

by Roman society
-

G
B. Apprentice Period 6th Century - 18th Century. (longest period)

learner in training/NEWBLE note : this period at some

What is Apprentice?
point already has a structure
• Period of "on the job" training. * -
-
NUn = Nurse of knowledge for Nursing

• From the founding of the Religious orders in the 11th century up to 1836 with the establishment of
-
the Kaiser werth Institute for training of Deaconesses
• Nursing performed without any formal education and by people who were directed by more
-

experienced nurses
• Founding
-
of religious order

The Beginning of Religious War

• A religious war or holy war is a was primarily caused or * When there's
-

justified by differences in religion.

- a war , there
• The Crusades - They were- Holy Wars waged in an attempt to
-

recapture Holy Land from the Turks who denied Christ's

will be casualty
- -

pilgrims permission to visit Holy Sepulcher

-

Military Religious Orders and their Work

• Knights of St. John of Jerusalem (Italian) - Also • The Alexian Brothers were members of a
known as "Knight Hospitalers" They founded
-
monastic order founded~ 1348.
Hospitals
-
— They established the Alexian Brothers Hospital
• Teutonic Knights (German)-Established tent School of Nursing — the largest School of Nursing
-

hospitals for the wounded under religious order. It operated

exclusively forG
- -

• Knights of St. Lazarus- Founded primarily for men in United States

-
nursing care of lepers in Jerusalem
-
 The Rise of Secular Order
• There was the rise of Religious Nursing Orders for women. Although note: education is not
-
Christianity promoted equality to all men, -women were still . In
famous for women
concentrated in their roles as wives and mothers. order to have a career
,
-
a woman should enter
• Religious taboos and social restrictions influenced nursing at the the convent
time of the religious Nursing Orders.
Important Nursing Patronages
• St. Clare - founder of the second order of St. Francis of Assisi.
-

• St. Elizabeth of Hungary - known as the "Patroness of Nurses", she was the daughter of the
-

Hungarian King. She lived her life frugally despite her wealth.
• St. Catherine of Siena - The first lady with the lamp. She was a hospital nurse, prophetess,
-

researcher and a reformer of society and the church

-

The Rise of the Protestantism (1520 — 1562)

•- From 1520 onwards, Martin Luther's ideas and works could be found in France - they even
influenced the court of Francis I. The king's sister, Marguerite of Angoulême asked the Bishop of
Meaux to reform his diocese so he asked James Lefèvre d'Etaples to come and join him.
• He was the author
-
of a French version of the New Testament which had been considered
heretical by the Sorbonne and was the founder of the Circle of Reformers in Meaux which had
been forbidden by the Church. Luther's works were translated into French, mostly printed in
Switzerland and passed from one person to another in secret.
• The
-
Protestants, who were called"Lutherans' at
the time, belonged to the higher, literate class of
-

society
-
and were condemned as heretics by the
Church. Persecution began in 1521: they had to
pay fines, were sent to prison and even burnt at
the stake.

The Start of Dark Period of Nursing

— The world of nursing, despite wars and plagues made considerable

progress under the influence of Christianity. It maybe said that nursing
owes its foundation to the work of benevolent men and women, the
crusades and the guilds. But this progress in nursing was brought to a
halt by industrial and political revolution and the Reformation in the
16th century.
 Dark Period of Nursing 17th to 19th Century
• Also known as the period of reformation and • The religious upheaval led by=
-
Martin Luther
American civil war destroyed the unity of the Christian faith. The
-
• Hospitals were closed
-
wrath of Protestantism swept away from
• Nursing was the works of least desirable people
-
everything connected with Roman Catholicism in
• Nurses were uneducated, filthy and over worked
-
schools, orphanages and hospitals. Properties of
-
-

• Mass exodus of nurses hospitals and schools were confiscated.

-

• Theodore Fliedner - Reconstituted the

deaconesses and later- established-the school of

-
nursing
- in Kaiser werth, Germany where Florence
Nightingale had her first formal training for 3
-

months as a nurse. Ishe was 31 yes old ;

-

1st Training School of Nursing

United States of America Bellevue Hospital School of
Nursing
-
— Founded in 1873 in New York.
— It was the first school of nursing in the United States
-

to be founded on the principles of nursing established by

-
Florence Nightingale
-

Philippines Iloilo Mission Hospital School of Nursing

&
— Established in 1906
— it is the-
first hospital in the Philippines which trained Filipino nurse.
— It was run by the Baptist Foreign Mission Society of America. In March, 1944, 22 nurses graduated; in April 1944 graduate
-

nurses took the first Nurses Board Examination at the Iloilo Mission Hospital.
St Paul’s Hospital School of Nursing (Manila, 1907)
--
— Established by the Archbishop of Manila, the Most Reverend Jeremiah Harty under the supervision of the Sisters of St. Paul de
Chartes. It was located in Intramuros and it provided general hospital ser vices with free dispensary and dental clinic
-

— Philippine General Hospital School of Nursing (1907)

-
— Anastacia Giron-Tupas, the first Filipino nurse to occupy the position of chief nurse and superintendent in the Philippines ü St. Luke’s
Hospital School of Nursing (Quezon City, 1907)
-
 Nightingale Era
-

• Florence Nightingale (Born in Italy , Florence

• Born on May 12, 1820
• Born to a wealthy English parents
• Known as- "The mother of modern nursing"
•-"The Lady with the Lamp" and " Professional Nurse Pioneer
• Most famous for her work during the Crimean War
(1854-1856) soldiers dying in infections than the battle field
-
,

Under Florence's leadership, the nurses brought cleanness, sanitation, nutritious food and comfort to
- -
- -

the patients. Nightingale was known for providing the kind of personal care, like writing letters
-
home for soldiers, that comforted them and improved their psychological health
Her group of nurses transformed the hospital into a- healthy environment within six months, and as
-
a result, the death rate of patients fell from 40 to 2 percent (5). In 1857, Florence returned home a
heroine. It was the soldiers in Crimea that initially named her the "Lady with the Lamp" because of
the reassuring sight of her carrying around a lamp to check on the sick and wounded during the
night, and the title remained with her

• Published in 1859 Notes on Nursing provides a simple

-

·
but practical discussion of good patient care, along
-

atta
with helpful hints. According to Florence Nightingale,
hygiene, sanitation, fresh air, proper lighting, a good

over
-
diet, warmth, quietness and attentiveness were
necessary conditions for hospitals and were to be
ensured by trained nurses.
-

• Environmental Theory and Statistical Data

— Nightingale implemented handwashing and other hygiene

practices in the war hospital in which she worked.
— More - soldiers die because from infection than from
bullets
-

— she advocated sanitary living conditions as of great

- -

importance.
-

note :
Nightingale introduced
that if you will
wash your hands , keep the
wound clean , sanitize the area , good mu
drainage , thus
you will1 patients to heal

help Nightingale was

lamp"
called "ady
with the
because night she's
at

visiting every patient

using a lamp
 O
C. Education Period ↓
18th - 20th Century

&
Florence Nightingale was one of the pioneers in
establishing
-
the idea of nursing schools from her base at
St Thomas' Hospital, London in 1860 when she opened
-

the 'Nightingale Training School for Nurses', now part of

-
King's College London

Nightingale School of Nursing

During the war a public subscription fund The education of recruits involved a was set up for Florence
-
Nightingale to year of practical instruction in the continue her education of nurses in wards,
emer -
supplemented with courses of England, and the Nightingale Training lecturing, and followed by t wo
-
-

years of School at St. Thomas' Hospital opened in work experience in the hospital. After 1860.
-

The education of recruits involved a year of practical instruction in the wards, supplemented with
courses of lecturing, and followed by t wo years of work experience in the hospital. After graduation,
many of the students staffed British hospitals, and others spread the Nightingale education system
to other countries.

Concept in the Nightingale System of Education

1. Government funds should be allotted to nursing education
~
• First nurse political activist
2. Training schools of Nursing should be in close affiliation ~

3. Professional nurses should train nurses

4. Nursing students should be provided with residence near their training hospitals
• Written orders of doctors were insisted
• Nurses should go with doctors during their rounds
5. All nurses must be trained, in a regular civil hospital
6. Training was fundamentally on the apprenticeship model: hands-on, in the wards, under the
ward sister
7. Classes, given by medical doctors, augmented training in the wards

--
8. The "home sister" or "mistress of probationers" organized the training
9. District nurses had to be hospital trained (or they would not see enough serious cases)
10. Midwifery nurses had to be hospital trained
11. Training was required for administrative positions
12.- -
Probationers kept diaries and case notes of their work, examined by the matron and home
sister, and often by Nightingale.
13. A major component of training was moral: ethical standards for patient care
-
 14. Technical training had to be updated
15. A Probationers' Home should be provided, with a private room for each, comfortable
(common) living
16. Responsibility for probationers' health and safety, including rules to prevent
septicemia and ongoing monitoring of probationers' health
17. Certificates and letters of reference had to be dated and were relevant only for a short
time
18. A matron should have a housekeeper under her so that she could concentrate on the
nursing and the nurse training
19. The superintendent herself must have the highest knowledge of nursing, be herself
resident in the hospital, make the training in nursing her first object, and be herself a
trained nurse of the highest order.

g
D. Contemporary Period 21st Century - Present

What is Contemporary?

How will you describe nurses and nursing today?

Nursing After World War 1

• World War I - World War I (often abbreviated as WWI or
-

WW1), also known as the First World War or the Great War,
- -
was a global wai originating in Europe that lasted from 28
July 1914 to 11 November 1918
• Conflict bet ween the great powers of Europe were divided
into t wo coalitions: the Triple Entente consisting of France,
Russia and Britain-and the Triple Alliance of Germany,
Austria-Hungary and Italy

• The silver lining of the great war

• Volume of patients drastically change the role
of nurses
• The nurses performed triage as patients came
in on ambulance trains, directed corpsmen who
had little medical training, managed entire
wards of patients and performed a variety of
procedures, including irrigating wounds and
managing infection.
-o
• Dependent to Independent nursing practice
* -
requires a prescriv
nursing intervention doctors
ption or
that do not require doctor's order
order
 •-Good Infection control and wound care even with the absence of antibiotics and electricity
• American nurses worked on base hospitals, hospital trains, hospital ships, field hospitals,
camp hospitals and even evacuation hospitals and mobile units.
• Mobilizing women and women empowerment
-

•-Nurses earned the respect of those they served with, and they were decision-makers. That
was very different for them, not just as nurses but as women

Rise of BSN CURRICULUM

The Degree of Bachelor of Science in Nursing: 1941 -
1951
—- A nursing curriculum which was based on the thesis
presented by -
-
-
Julita V. Sotejo – graduate of the Philippine
-

General Hospital School of Nursing, tackles on the

-
development of a nursing education within a University-based
College of Nursing.

-
• When the Japanese occupied the Philippines in 1942, training and practice at
the
-
hospital schools of nursing in Manila was "violently disrupted."
• However, U.S. colonial patterns in Philippine nursing education soon returned
-
after the U.S. reclaimed the country in 1945 and even after the Philippines gained
independence from the U.S. July 4, 1946.

The First Colleges of Nursing in the Philippines

University of Santo Tomas-College of Nursing (1946)

— In 1947, the Bureau of Private Schools permitted UST
to grant the title Graduate Nurse to the 21 students
who were of advanced standing from 1948 up to the
present

Manila Central University- College of Nursing

(1947)
— The MCU Hospital first offered BSN and Doctor of
Medicine degrees in 1947 and served as the clinical field
for practice.
University of the Philippines Manila-College of Nursing (1948)
— The idea of opening the college began in a conference bet ween
Miss Julita Sotejo and UP President.
— In April 1948, the University Council approved the curriculum,
and the Board of Regents recognized the profession as having an
equal standing as Medicine, Engineering etc. Miss Julita Sotejo
was its first dean.
 Nursing in Today’s Society

•-Change is the only constant thing in the world

• "Nursing is caring" (Womb to Tomb)
• "Nursing is an Art"
• Recipient of Nursing - Patients, community, family,
clients and coworkers =F c c C
p = -
-

SCOPE OF NURSING
— Promoting Health and Wellness P
— Preventing Illness P
— Restoring Health
— Care for the Dying R
ROLES AND FUNCTIONS OF THE NURSE TODAY
— Caregiver C
C c c C
-

c
-
- -
-

— Communicator
— Teacher
— Client Advocate T- 1- &
— Counselor
— Change Agent
— Leader
— Manager
— Case Manager

Expanded Career Roles for Nurses

1. Nurse Practitioner
2. Clinical Nurse Specialist
3. Nurse Anesthetist
4. Nurse Midwife
5. Nurse Research
6. Nurse Administrator
7. Nurse Educator
8. Nurse Entrepreneur
Additional Info:

#
• Hippocrates was given the title of “Father of Scientific Medicine”. He made major advances in
medicine by rejecting the belief that diseases had supernatural causes. He also developed assessment
m e m
standards for clients, established overall medical standards, recognized a need for nurses.

Spanish Period
— The religious orders exerted their efforts to care for the sick by building hospitals in the
-
-

-
different parts of the Philippines
—Nursing during Philippine Revolution
-

Prominent persons involved in nursing works

a. Josephine Bracken
— installed a -
first hospital in an estate house in Tejeros; provided nursing care to the wounded
-
night and day
-

b. Rosa Sevilla de Alvero

— converted their house into quarters for the Filipino soldiers, during the Philippine-American

-
War that broke out in 1899.
c. Dona Hilaria de Aguinaldo
— wife of Emilio Aguinaldo; organized-
1st Filipino Red Cross under the inspiration of
Apolinario Mabini
-

d. Dona Maria Agoncillo de Aguinaldo

-
— second wife of Emilio Aguinaldo; provided nursing care to Filipino soldiers during revolution.
-

— President of Filipino Red Cross branch in Batangas

-
e. Melchora Aquino

=
— Nursed the wounded Filipino soldiers and gave them shelter and food

e. Capitan Salome
-
— a revolutionary leader in Nueva Ecija; provided nursing care to the wounded when not in
combat
f . Agueda Kahabagan

-
— revolutionary leader in Laguna, also provided nursing services to her troops
g. Trinidad Tecson

-
— “Ina ng Biac na Bato”, stayed in the hospital at Biac na Bato to care for the wounded
soldiers.
Significance of Nursing Theory. Discipline vs. Profession

— Discipline is specific to academia and refers to a branch of education, a department of

-

learning, or a domain of knowledge.

-

— Profession refers to a specialized

-
field of practice founded on the theoretical structure
of the science or knowledge of that discipline and accompanying practice abilities.
 Lesson 2: History of Philosophy and
Science
↑

• Rationalism
• Empiricism
• Early 20th Century Views
• Emergent Views

Historical Views of the Nature of Science

• What is science, knowledge, and truth?

• Epistemology - is a branch of philosophy
-

concerned with the theory of knowledge in

- -

philosophical inquiry
-

• Two competing philosophical foundations of science,

-
rationalism and empiricism, have evolved in the era of
modern science with several variations.

Rationalism

• Rationalist epistemology (scope of knowledge) • Case/ Application

emphasizes the importance of a priori reasoning as the — Poor hand washing technique
-

appropriate method for-advancing knowledge. will result in spreading diseases

• Deductive Reasoning (Cause and effect) to all patients
• Theory-then-research strategy — Do you agree? Will you refuse?
• Innate, reason and deduction — Can you prove this theory? If
·
ask-research
yes why? If not why?

Empiricism
• The empiricist view is based on the central idea • Case/ Application
-

that scientific knowledge can be derived only from — Differential Diagnosis

e

sensory-
-

experience (.e., seeing, feeling, hearing — Patient - 31 Y/O productive cough for 2
facts). weeks, low grade fever occurring every
• Inductive Reasoning- collection of facts precedes afternoon, vital signs all in normal range.
attempts to formulate generalizations Weight, clinical observation
• Research-then-theory strategy — Diagnostics - X-ray (Clear)
• Gathering of facts through experience and — Sputum test (Negative)
obser vation and then formulating theories ' —History - Smoker for 15 years, 1 packs of
· research -
ask cigars everyday.
 Early Twentieth Century Views of Science and Theory
— During the first half of this century, philosophers focused on the analysis of theory structure,
whereas scientists focused on empirical research

Structure of Nursing Knowledge

5 components M
1. Metaparadigm

E
2. Philosophies
3. Conceptual Models
4. Theories
5. . Empirical Indicators

• The components of the structural hierarchy are made up of concepts and propositions
• Concept — is a word or phrase that summarizes the essential characteristics or
-

properties of a phenomenon.
• Proposition — is a statement about a concept or a statement of the relation
-

bet ween t wo or more or different concepts.

1. Metaparadigm
A
— The first component of the structural hierarchy of knowledge
— It is the most abstract component of the structural hierarchy
— The concepts and propositions of a metaparadigm are admittedly extremely global and
-
-
provide no definitive direction for such activities s research and clinical practice.
with and "Paradigm" means-
-

— "Meta" means & pattern of shared understanding and assumption

— The METAPARADIGM OF NURSING is made up of four concepts, four non relational
propositions, and four relational propositions

• 4 Concepts of Metaparadigm of Nursing

1. Person
2. Environment
3. Health
4. Nursing
 • 4 Non-relational Propositions
1. The metaparadigm concept person, refers to the individuals, families, communities, and
- -

other groups who are participants in nursing

-

2. The metaparadigm concept environment refers to the person's significant others and
-

physical surroundings, as well as to the-setting in which nursing occurs, which ranges

-

from the person's -

home to clinical agencies
-
to society as a whole.
3. The metaparadigm concept health refers to the person's state of wellbeing at
-

the time that nursing occurs, which can range from high-level wellness to
-

terminal illness.
-

4. The metaparadigm concept nursing refers to the- definition of nursing, the

actions taken by nurses on behalf of or in conjunction with the person, and
-
the goals or outcomes of nursing actions.

• 4 Relational Propositions
1. The discipline of nursing is concerned with the principles and laws that govern
the life-process, wellbeing, and optimal, functioning of human beings, sick or
well
2. The discipline of nursing is concerned with the patterning of human behavior in
interaction with the environment in normal life events and critical life
situations.
3. The discipline of nursing is concerned wth the nursing actions or processes by
which positive changes in health status are effected
4. The discipline of nursing is concerned with the wholeness or health of human
beings, or health of the human beings that they are in continous interaction
with their environments

2. Philosophy
— The- second component of the STRUCTURAL HIERARCHY OF CONTEMPORARY NURSING
KNOWLEDGE is the PHILOSOPHY
>
— a statement encompassing ontological claims about the phenomena of central interest to a
-
discipline, epistemic claims about how those phenomena come to be known, and ethical claims about
what the members of a discipline value.
— Function of a Philosophy: The function of a philosophy is to - communicate what the members of a
discipline believe to be true in relation to the phenomena of interest to that discipline, what they
-
believe about the development of knowledge about those phenomena, and what they value with
regard to their actions and practices
— In other words, the function of each philosophy is to inform the members of disciplines and the
-
general public about the beliefs and values of a particular discipline.
-
 3. Conceptual Models
— The- third component of the STRUCTURAL HIERARCHY OF CONTEMPORARY NURSING
KNOWLEDGE is the CONCEPTUAL MODEL
— A set of relatively abstract and general concepts that address the phenomena of
-

central interest to a discipline, the propositions that broadly describe those concepts,
and the propositions that state relatively bet ween t wo or more of the concepts
— The term conceptual model is synonymous with the terms: conceptual framework,
-

conceptual system, paradigm, and disciplinary matrix.

-

Functions of Conceptual Model

1. Provides distinctive frame of reference
-

2. Tells how to observe and interpret the phenomena of interest to the discipline
-

3. Simplification of reality that includes only those concepts that the model author considers
-

relevant and as aids to understanding

4. provides a structure and a rationale for the scholarly and practical activities of its adherents,
-

who comprise a subculture or community of scholars within a discipline

5. Conceptual model gives direction to the search for relevant questions about the phenomena of
-

central interest to a discipline and suggests solutions to practical problems.

6. Provides general criteria for knowing when a problem has been solved.
-

What is your perception of the word "Model"?

— We all use models to guide our actions, be it the way we conduct our personal lives or the
-

way we nurse. These are based on the beliefs and values of family, friends, peers, and those
we respect or those who have influenced us greatly.
— Conceptual models of nursing, then, are the explicit and formal presentations of some
-

nurses' implicit, private images of nursing.

-
 4. Theory

— The- fourth component of the STRUCTURAL HIERARCHY OF CONTEMPORARY NURSING

KNOWLEDGE is the THEORY
-
— One or more relatively concrete and specific concepts that are derived from a
-

conceptual model, the propositions that narrowly describe those concepts, and the
-

propositions that state relatively concrete and specific relations bet ween t wo or more of
the concepts.

1. Grand Theory
— Grand theories are- broad in scope.
— They are made up of concepts and propositions that are less abstract and general than the
-

concepts and propositions of a conceptual model but are not as concrete and specific as the concepts
and propositions of a middle-range theory.

2. Middle-range Theory
-
— Middle-range theories are narrower in scope than grand theories.
— They are made up of a limited number of concepts and propositions that are written at a relatively
-

concrete and specific level.

— Each middle-range theory addresses a -more or less relatively concrete and specific phenomenon by
describing what the phenomenon is, explaining why it occurs, or predicting how it occurs.

Function of a Theory

• One function of a theory is to- narrow and more fully specify the phenomena contained in a
conceptual model.
-

• Another function is to provide a relatively concrete and specific structure for the
-
interpretation of initially puzzling behaviors, situations, and events.
 5. Empirical Indicators

— The- fifth and final component of the STRUCTURAL HIERARCHY OF CONTEMPORARY NURSING
KNOWLEDGE is the EMPIRICAL INDICATOR
— Nursing Empirical Indicators
— Nurses have developed a plethora of empirical indicators in the form of T
research
C
instruments and distinct clinical tools.
— The function of empirical indicators is to provide the means by which middle-range theories

-
are generated or tested.
— Empirical indicators that are instruments yield data that can be sorted into qualitative
categories or calculated as quantitative scores.

Methods of Theory Development

1. Theory-Practice-Theory
— directs that theory development in nursing is based on and parallel to
-
-

-
other theories used in other disciplines
— Example: Nurse Rodney wants to develop a new theory that is inspired
from Abraham Maslow's Hierarchy of needs .

2. Practice Theory
— directs that the theory development is based on the life/work experience
-

and professional practice of

-
the theorists
— Example: Nurse Harry is assigned in the ICU for 20 years, he developed a
theory about nurse's coping mechanism in caring for terminally ill patients called
the " Theory of attachment"

3. Research Theory
— directs that the theory development is based on the extensive research
- -
done by the theorist
— Example: Prof. Rem did research on the reasons why nurses stay in the
hospital to work and their reason for leaving she called it
"Theory of Tenure"

• Development of theory requires understanding of selected scholarly terms, definitions,

and assumptions so that scholarly review and analysis may occur. Attention is given to
terms and defined meanings to understand the theory development process that was used.
• Three categories of theory components are presented as a basis for understanding the
function of each element in the theory-building process.
 Theory Components

1. Concepts and Definition

• Concept — Concepts, the building blocks of theories, classify the phenomena of interest
-

• Definition — Conveys general meaning and reduce vagueness in understanding a set of concept
-
-

2 Types of Concept
1. Abstract
— concepts are mentally constructed independent of a specific time or place
- -

— Example: Transport, Cardiovascular Diseases, Nurse Competency

2. Concrete
— directly experienced and relate to a particular time or place
-

— Example: Stretcher, Wheelchair, hospital bed, Stroke, Myocardial Infarction,

Vital signs taking, Insertions of nasogastric tube, IV Catheter insertion

2. Relational Statements
• Propose relationships bet ween and among t wo or more concepts.
-
• Concepts are the building blocks of theory, and theoretical statements are the chains that link.
-

the blocks to build theory.

-

• Concepts must be connected with one another in a series of theoretical statements to devise a
-

nursing theory.

3. Linkages and Ordering

• Development of theoretical linkages provides an explanation of why the variables are
-

connected in a certain manner; that is, the theoretical reason for particular relationships
-

• Operational linkages contribute testability to the theory by specifying how measurement

variables are connected.
• A theory may be considered fairly complete if it presents the concepts, definitions, relational
statements, and linkages. Complete development of a theory, however, requires organizing the
concepts, definitions, relational statements, and linkages into premises and hypotheses

Characteristics of Theory Purpose of the Nursing Theory

1. A theory must be- "falsifiable." 1. Education
E
2. A theory must be simple in terms of the general 2. Research
- R
principles involved. 3. Clinical Practice
C
-

3. It must be workable
-

4. It must be elegant or beautiful (Symmetry, Simplicity,

-
Accuracy)
5. The theory should be as& general as possible.
6. It should have few or no anomalies
-

7. If possible, the theory ought not to be purely

-

statistical.
-

-
8. The theory should bring out analogies and use models
 Nursing T heorist of Historical
Significance
• Hildegard Peplau — Interpersonal Theory

• The Mother of Psychiatric Nursing

Hildegard Peplau's Interpersonal Relations Theory
emphasized the nurse-client relationship as the
foundation of nursing practice.
• It gave emphasis on the give-and-take of nurse-
m e m

client relationships that was seen by many as

-

revolutionary. Peplau went on to form an

interpersonal model emphasizing the need for a
partnership bet ween nurse and client as opposed to
the client passively receiving treatment and the
nurse passively acting out doctor's orders.

Roles of a Nurse
S — Stranger
R — Resource
C and T — Councilor and Teacher councilor and teacher
Su — Surrogate
L — Leader
en technical
TE — Teacher

Phases in the Nurse-Patient Relationship o -1 E R

-
-

1. Orientation Phase: This is the initial phase where the nurse and patient meet and start to get to
-
-

know each other. The nurse assesses the patient’s needs, establishes trust, and sets the foundation for the
- -
-

relationship. The goal is to make the patient feel comfortable and secure, helping them to openly express
their concerns and expectations.

2. Identification Phase: In this phase, the nurse and patient work together to identify the patient’s
-

problems and develop a plan of care. The nurse provides support, education, and inter ventions, while the
patient actively participates in their own care. This phase is characterized by collaboration, problem-
solving, and the building of a stronger therapeutic relationship.

3. Exploitation Phase: The nurse assists the patient in using the resources available to them, including
the nurse’s expertise, to address their health concerns. The patient
-
begins to take more responsibility for
their care, utilizing the knowledge and support provided by the nurse. This phase is marked by patient
-

growth, increased independence, and progress towards health goals.

4. Resolution Phase: This final phase occurs when the patient’s health goals have been achieved or when
the relationship is coming to an end, such as when the patient is
-
discharged or the nurse’s assignment ends.
The nurse helps the patient
 • Virginia Henderson — Nursing Need Theory
-
--
— Henderson was born on November 30 1897 in Kansas City, Missouri, USA.
— Henderson is famous for a definition of nursing: "The unique function of the nurse is to assist the
individual, sick or well, in the performance of those activities contributing to health or its
recovery ( or to peaceful death) that he would perform unaided if he had the necessary strength,
will or knowledge”
— Henderson emphasized the art of nursing and proposed 14 basic human needs on which nursing
-

care is based. Her contributions include defining nursing, delineating autonomous nursing functions,
stressing goals of interdependence for the patient, and creating self-help concepts.

Henderson identified three levels of nurse-patient relationships in which the

nurse acts as:
1. A substitute for the patient
2. A helper to the patient
3. A partner with the patient
• Through the interpersonal process, the nurse must get "inside the skin" of each of her patients
in order to know what help is needed.

The Nursing Need Theory

In 1966, Virginia Henderson's definition of the unique function of nursing was a major stepping stone
in the emergence of nursing as a discipline separate from medicine. Henderson conceptualized the
nurse's role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental
needs

1. Breathe normally.
2. Eat and drink adequately.
3. Eliminate body wastes.
4. Move and maintain desirable postures.
5. Sleep and rest.
6. Select suitable clothes; dress and undress.
7. Maintain body temperature within a normal range by adjusting clothing and
modifying the environment.
8. Keep the body clean and well groomed and protect the integument.
9. Avoid dangers in the environment and avoid injuring others.
10. Communicate with others in expressing emotions, needs, fears, or opinions.
11. Worship according to one's faith.
12. Work in such a way that there is a sense of accomplishment.
13. Play or participate in various forms of recreation.
14. Learn, discover, or satisfy the curiosity that leads to normal development
and health, and use the available health facilities
• Henderson explains in Nature of Nursing that the role of a nurse is "to get inside the patient's
skin and supplement his strength will or knowledge according to his needs." The nurse has the
responsibility to assess the needs of the patient, help him or her meet health needs, and
provide an environment in which the patient can perform activity unaided.
 • Faye Abdellah — 21 Nursing Problems Theory
— Abdellah views nursing as an art and a science that mold the attitude, intellectual
-

competencies, and technical skills of the individual nurse into the desire and ability to help
-
individuals cope with their health needs, whether they are ill or well.
— She formulated 21 nursing problems - based on a review of nursing research studies. She used
Henderson's 14 basic human needs and nursing research to establish the classification of nursing
-
problems.

Abdellah's Typology of 21 Nursing Problems

1. To maintain good hygiene and physical comfort

2. To promote optimal activity: exercise, rest, sleep
3. To promote safety through prevention of accident, injury, or other trauma and through prevention of
the spread of infection
4. To maintain good body mechanics and prevent and correct deformity
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition for all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic responses of the body to disease conditions— pathologic, physiologic, and
compensatory
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings, and reactions
13. To identify and accept interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement and personal spiritual goals
17. To create or maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and
developmental needs
19. To accept the optimum possible goals in the light of limitations, physical and emotional
20. To use community resources as an aid in resolving problems that arise from illness
21. To understand the role of social problems as influencing factors in the cause of illness
10 steps to identify the client's problems

1. Learn to know the patient

2. Sort out relevant and significant data
3. Make generalizations about available data in relation to
similar nursing problems presented by other patients
4. Identify the therapeutic plan
5. Test generalizations with the patient and make additional generalizations
6. Validate the patient's conclusions about his nursing problems
7. Continue to observe and evaluate the patient over a period of time to identify
any attitudes and clues affecting his behavior
8. Explore the patient's and family's reaction to the therapeutic plan and involve
them in the plan
9. Identify how the nurses feels about the patient's nursing problems
10. Discuss and develop a comprehensive nursing care plan

11 Nursing Skills

1. Observation of health status

2. Skills of communication
3. Application of knowledge
4. Teaching of patients and families
5. Planning and organization of work
6. Use of resource materials
7. Use of personnel resources
8. Problem solving
9. The direction of work of others
10. Therapeutic use of the self
11. Nursing procedure
 • Ida Jean Orlando — Nursing Process Theory

— Orlando's nursing theory stresses the reciprocal

-

relationship bet ween patient and nurse.

-
— What the nurse
-
and the patient say and do affects
them both. Orlando's theory focuses on how to produce
-
-
improvement in the patient's behavior. Evidence of
-

relieving the patient's distress is seen as positive changes

in the patient's observable behavior. Orlando may have
facilitated the development of nurses as logical thinkers

Nursing Process Theory

— The Deliberative Nursing Process has five stages: assessment, diagnosis, planning,
implementation, and evaluation:
— Nurses use the standard nursing process in Orlando's Nursing Process Discipline Theory to
produce positive outcomes or patient improvement. Orlando's, key focus was the definition of
the function of nursing.
— The goal of this model is for a-
nurse to act deliberately rather than automatically. The
nurse will have a meaning behind the action This nursing process is use to different patients
with different problems, and can be stopped at any time, depending on the patient's progress
or health. This makes Orlando's theory universal for the nursing field.
-
 • Lydia Hall — Core, Care, Cure

• Hall used three interlocking circles to represent

aspects of the patient and nursing functions.
• The Core — represents the inner feelings and
-

management of the person.

• The Care — represents the patient's body
-

• The Cure — represents the disease that affects

-

the patient's physical system

Core, Care, and Cure Model/Theory

• The three circles change in size and overlap in relation to the patient's phase in the
disease process.
• A nurse functions in all three circles but to different degrees.
• For example, in the care phase, the nurse gives hands on bodily care to the patient in
relation to activities of daily living such as toileting and bathing.
• In the cure phase, the nurse applies medical knowledge to treatment of the person,
• and in the core phase, the nurse addresses the social and emotional needs of the
patient for effective communication and a comfortable environment
 Florence Nightingale : Environmental T heory
The Environmental Theory
— Florence Nightingale often considered
-

-
the first nurse theorist.
— Defined nursing more than 100 years
ago as the "Act of utilizing the
environment of the patient to assist him in
his recovery"

Fourrounding
• Linked health in 5& environmental factors (pure/
-

fresh air, pure water, efficient drainage, cleanliness,

- -
light)
-

• Stress the importance of keeping the client warm,

-

maintaining a noise-free environment, and

-

attending to the client's diet in terms of assessing

#
intake, timelines of the food, and its effect on the
person

10 aspects of The Environmental Theory

1. Patients should have clean air and a temperature-controlled environment

2. Patients should have access to direct sunlight and not be subjected to unnecessary noise,
especially when sleeping
3. Rooms should be kept clean
3. Hospital facilities should be well-constructed
4. Bedding should be changed and aired frequently
5. Patients should be kept clean and nurses should wash hands frequently.
6. Patients should be offered a variety of scenery, such as new books or flowers, to prevent
boredom
7. Nurses should be positive but not offer false hope to patients or make light of their illness
8. Patients should be kept clean and nurses should wash hands frequently
9. Offer a variety of small meals instead of large ones, and do not do patient care while patient
is eating as it is distracting
10. Consider not only the individual patient but the context of where he or she lives
•5 environmental factors/components of environmental theory

1. Pure air — Maintain proper temperature; keep the room in proper temperature
-

2. Light — according to her it (light) can destroy microorganism infection, light

-
can purify the area.
3. Cleanliness and Sanitation — is a critical component of her theory, she believes
-

that dirty environment/surrounding can harbor germs that can lead to

- -

infections; she orders to take patients bathe everyday and clean and change
-

beddings to prevent infection. Wash their hands

4. Efficient drainage — proper handling of waste and proper disposal of body
-

waste is essential
5. Pure water — drink pure and clean water. And to clean the wound with clean
water. -

Emphasize the important of quiet area so that parents can relax or recover minimal
-

activities or movement in the patients room/ward.

In addition is the need of nutritious and clean food that served small but frequent
-
meals.
-
One of the major of nursing theory is Nursing Leadership and Management —
provide budget to have support
-
 What are your 2 cents?

* this states the importance of

surrounding/environment

The Hospital Window

According to Nightingale, manipulating the patients environment is the key in recovery of patients.

The Hospital Window: There are t wo patients, confined in a single room. One patient on the left is blind.
The patient on the right near the window is a patient dying from cancer. The blind patient is asking
the other patient near the window “What do you see outside the window?”. The other patient
describes that there is a beautiful garden with colorful blooming flower, and children playing outside, a
colorful bird, mountains and rivers. The blindman asked the patient to tell story everyday about what
he is seeing outside the window. Thus, that is the patient near the window did, everyday he is telling
stories to the blind patient whatever he is seeing outside. Then one day, the blind patient have his
operation to restore his eyesight. After the operation, his eyesight was restored, and he came back to
his room. When he came back, the other patient already passed away. In his mind, he wanted to
thanked the patient for what he did to him everyday. He went to the window, and then he saw a wall,
a brick black wall. The truth is the other patient cannot see, aside from a brick wall.
 The 4 Metaparadigms of Environmental Theory

• Person -
holistic patient
patient
emphasize that the nurse was in control of patients environment
— In Florence Nightingale's theory, the Person, one of the elements in the four
metaparadigms, is the individual receiving care
— Nightingale's perception of the Person is that the person is a multidimensional being, that
includes biological, psychological, social and spiritual components

• Biological — addressed by the use of medicine and nursing to address various diseases
• Psychological and social components — consists of self-concept, feelings, thought-processes
and social interactions
• Spirituality — intert wined with Nightingale's own spiritual beliefs; that the person is valued

— Nightingale theory of the person is based on holism

— Holism is the concern of concentrating the biological, social, psychological and spiritual with
its environment

• Health
— Health is viewed as the combined result of environmental, psychological and physical factors,
-
not just the absence of disease.
-

— Nightingale states that "health is not only to be well, but to be able to use well every power we
have." Leven it not 100% health
-
you y
maximize your energy then your considered
can --
healthy
— This is consistent with our perception of health today, where one does not have to be disease free
to be healthy but to maximize their potential to be in a healthy state.
—:Disease is portrayed as dys-ease, or the absent of comfort. clack energy diseases =

• Nightingale isolated 5 factors

essential in securing an individual's
health; these include pure air, pure
water, efficient drainage, cleanliness
and light

•Environment
— There exist five environmental components which are all essential to an individual's health.
-
— These are known collectively as the "health of houses", and outline factors of the physical
environment which must receive attention
-

— The underlying principle of maintaining health of houses is to put the patient in a condition
-
which is best for nature to act upon him or her. An environment that promotes health allows
-
the patient to retain their energy, or "vital powers" for use towards self healing
# believed that nurses creates a therapeutic environment for
the comfortable
patient surrounding
=
 • Nursing
— Nightingale's view on nursing is one that is largely intert wined by factors pertaining to the
environment. cmanipulating the environment)
-

— Nightingale believed that many of the symptoms and sufferings of patients were not directly
-

related to their disease or ailment, but rather consequences of poor environmental conditions
-

— The duties of nursing include providing essentials such as fresh air, warmth, cleanliness, quiet,
and a proper diet. By helping to control environmental influences, nurses can aid in the
maintenance of health of their patients.

* The believes that every woman during her time

would be a nurse in sense of that is the
a
health nursing
responsible of
patients
 Jean Watson : Transpersonal
Caring T heory
"We are the light in institutional
darkness, and in this model we get to
return to the light of our humanity."
-Dr. Jean Watson

• (June 10, 1940 - present) Watson was born Margaret

Jean Harmon and grew up in the small town of Welch, West
-

Virginia, in the Appalachian Mountains.

-

• She was the youngest of eight children and was

-

surrounded by an extended family-community environment.

• Watson attended high school in West Virginia and then
the Lewis Gale School of Nursing in Roanoke, Virginia, where
she graduated in 1961.

• Educated:
— BSN, University of Colorado, 1964
— MS, University of Colorado, 1966
— PhD, University of Colorado, 1973
• Distinguished Professor of Nursing and Chair in Caring Science at the
University of Colorado Health Sciences Center.
• Fellow of the American Academy of Nursing.
• Dean of Nursing at the University Health Sciences Center and President of the
National League for Nursing.
• Undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and PhD in
educational psychology and counseling.
• Six (6) Honorary Doctoral Degrees.
• Research has been in the area of human caring and loss.
• In 1988, her theory was published in “nursing: human science and humble and care”.
 The Theory of Transpersonal Caring

Watson bases her theory for nursing practice on

-

the following 10 carative factors. Each has a center

-
dynamic phenomenological component that is -
nursing
relative to the individuals involved in the r
&
relationship as encompassed by nursing.

The Ten Caritas Processes

being calm
1. Cultivating the practice of loving-kindness and equanimity toward self and other
--

order to provide care

as foundation to caritas consciousness. Linprovide
to patient you'll need
,
first to

it to yourself)

2. Being Authentically Present- Enabling, sustaining, and honoring faith, hope, and
Linep shouldrecoverally a
te,
-
deep belief system and the inner subjective world of self/other.
3. Cultivation of one’s own spiritual practices and transpersonal self, going beyond
ego-self. /recognition
of JELF-ACTUALIZATION through self-acceptance for both the nurseapx.
feelings lead to -
(full attainment of who you really are ; in
order to properly care
for PX
(
they
.

4. Development and sustaining a helping-trust caring relationship.

namet being
5. Being present to, and supportive of, the expression of positive and negative
important in nurse-px relationship Nurse need ready accept negative feelings
)
to be
sharing of feelings is to

I
.

feelings. it does not towards you as a person but to his/her situation

,

6. Creative use of self and all ways of knowing as part of the caring process; engage in
the artistry of caritas nursing.Jex X
CREATIVE =
: asked you
VIE
to
OF SELE
pray with her even though you have diff-religion , yetyou still
oblie)
7. Engage in genuine teaching-learning experience that attends to unity and being and
separateom curing
-
health a
subjective meaning- Attempting to stay within other’s frame of reference. I Wellness
practice health wellness
( teach your pr
understand .

8. Creating a healing environment at all levels (physical as well as nonphysical), subtle

- -

environment of energy and consciousness, whereby wholeness, beauty, comfort,

dignity, and peace are potentiated. (inspired by Nighting all theory)
9. Administering sacred nursing acts of caring-healing by tending to basic human
needs. I
you need to know what
HIGHEST PRIORITY Basic Needs
to prioritize first ; what are the needs to be set aside .
(food , elimination of waste properventilation LOWER PRIORITY
,
. Psychosocial needs (sexual , social)
10. Opening and attending to spiritual/mysterious and existential dimensions of one’s
understand
most difficult to
)
for. I
.

own life-death; soul care for self and the one-being-cared

lacaringnuropeanduantanoeverythingcanpe
and facts explained by science .
Even if you're anure , you should be open that there
ay

to
 The Seven Assumptions
1. Caring can be effectively demonstrated and practiced only interpersonally.
2. Caring consists of carative factors that result in the satisfaction of certain
human needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept a person not only as he or she is now but as what he or
she may become.
5. A caring environment is one that offers the development of potential while
allowing the person to choose the best action for himself or herself at a given
point in time.
6. Caring is more “healthogenic” than is curing. A science of caring is complementary
to the science of curing.
7. The practice of caring is central to nursing.

Transpersonal Caring Theory Metaparadigm

• Person

— Watson uses interchangeably the terms human being, person, life, personhood, and self. She
- -

views the person as “a unity of mind/body/spirit/nature.”

— Watson states, “I make the point to use mind, body, soul or unity within an evolving emergent
world view-connectedness of all, sometimes referred to as Unitary Transformative Paradigm-
Holographic thinking.” (a person will not be a person if the person will only have the body. A person has three
elements Mind , Body
:
, Spirit)

• Health

— She defined health as “unity and harmony within the mind, body, and soul”; associated with
the “degree of congruence bet ween the self as perceived and the self as experienced.”
(a person can be considered healthy based on how she is
perceived herself : Does she see herself as healthy ! even if she
sick)
— Watson’s definition of health has evolved. The positive state of physical, mental, and social
well-being with the inclusion of 3 elements:

1. A high level of overall physical, mental, and social functioning

2. A general adaptive maintenance level of functioning (v can cope , maintain =
HEALTHY
3. Absence of illness
 • Environment

— Watson speaks to the nurse’s role in the environment as “attending to supportive,

protective, and/or corrective mental, physical, societal, and spiritual environments.”

— She emphasizes the person and the environment has a connection, nurses are part of the
patient’s environment and once a nurse enters the patient’s room an expectation is already
present. Churse is part of the environment = affect the patient)

• Nursing

— “Nursing is concerned with promoting health, preventing illness, caring for the sick and
restoring health.”
— According to Watson, the word nurse is both a noun and a verb. To her, nursing consists of
-

“Knowledge, thought, values, philosophy, commitment, and action with some degree of
passion.”
 Marilyn Anne Ray :
T heory of Bureaucratic Caring
-

* discuss that in patient care

,
its not just about the nurse whom is directly related
ANTI-THESIS
in caring for the person Hence ,
.
it is an INTERRELATEDNESS/COLABORATION OF THE

or thesis

• Inspiration
— When she was a child, her father got sick
and a nurse was able to saved her father’s
live. From then on, she decided that she
wanted to saved lives and become a nurse.

• Origin
— The theory of Marilyn Anne Ray is
inspired by the theorist Georg Wilhelm
Friedrich Hegel —- Interrelationship Among
Thesis, Anti-Thesis, and Synthesis Theory.
-

Theory of -
Bureaucratic Caring
of decision making in an
it is the process
organization ; theres a
process of approval
• According to Marilyn Anne Ray this Thesis and Anti-thesis are reconciled into
unitive force to become a bureaucratic caring. This can transform the caring of a
nurse to a patient
• In addition the theory of her is, every nurse will have their own definition of
caring depending on their area of specialization.

• Thesis
— Thesis caring (Humanistic, spiritual and ethical)
— this is more on the nurses side: the implicative side
— this is what the nurse is providing

• Anti-Thesis
— Anti-thesis of bureaucracy ( Technological, economical, political and legal)
— this is the explicit/explicate (outside: other factor or concept that can be related to
caring to a patient)
 Major Concepts and Definitions
• Thesis <15 ,
E , P ,
• Caring
— it is defined as complex transcultural relational process grounded on spiritual contents. Caring is
the relationship bet ween charity and right action, bet ween love as compassion, in response to
suffering in need justice. Caring occurs within a culture or society including personal culture,
hospital organizational culture, societal and global culture
— its not just about physical caring, but you should also be able to learn the culture and beliefs of
the patient; if you cannot understand, thus you cannot be an effective and efficient nurse. In
addition about love and compassion is that you should be able to provide the correct intervention and
action beacuse you have that part and compassion to your patient. Also, in terms of ethical; you
have to be fair and provide equal care to every patient

• Spiritual-Ethical Caring
— you should not treat people as a means to an end. Therefore if you want to achieve something you
should not treat your patient in an incorrect way . Hence, you should be able to respect the patients
autonomy and that you should understand that the patient has a right to decide especially if they
have the capacity to decide

• Educational
— part of nursing intervention is to provide health teaching to patient such as pamphlets, audio
visual presentations, video, in order to provide information to them

• Physical
— this is the typical knowledge of what caring is. However, its not just about the physcial body bur
also the mental health of patient

• Social Cultural
— if you can be able to relate to the family members, to respect their ethnicity, values, and ways,
thus it is caring

· .

dia
 • Anti-Thesis

• Legal
— it means that there are different documentations such as consent that we need to
-
accomplished in order to do a procedure to a patient.
— In order to provide safe and quality nursing care, you should follow rules and procedures of
the hospital, that you’re legally obliged to do.; if not followed you’ll be called as malpractice or
negligence that has legal implications
— also, you need to be advocate of your patients right. A nurse should know what are the rights
of his/her patient. And you should know how to fight for your patients right.

• Technological
— Caring is knowing how to manipulate machines, properly dispense medication from the
machine
-

• Economic
— caring includes money, budget, insurance, limitation and guidelines
-

— without this, the hospital will collapsed of we don’t have the budget; therefore hospital will
not work and we cannot care for the patient

-
• Political
— a power structure within healthcare administration influence how nurses is view in
healthcare and include pattern of communication
— how the leaders can be able to organize a structured organization that can directly how can
nurse care for the patient
 Metaparadigm of Bureaucratic Theory

• Nursing
— nursing is holistic, relational, spiritual, and ethical caring and others in complex community,
organizational and bureaucratic cultures

• Person
— person is the patient; person as spiritual and cultural meaning
— person are created by God the mystery of being in the engage group in human organization

• Health
— health provides a pattern of cleaning for individuals, family and communities in all human
societies believes in caring practices about illness and health are central features of culture.
— health is not the consequence of physical state of being, but people construct their reality of
health in terms of biology mental patterns, mind & soul, ethnicity, family structures, society, etc.

• Environment
— environment is a complex spiritual, ethical, ecological and cultural phenomena. this
conceptualization of environment embodies knowledge and conscience about the beauty of life
forms and symbolic patterns of meaning, this factors are transmitted historically, and preserve
or change through caring values, attitudes and communication
 Patricia Benner :
Novice to Expert T heory
• Patricia Benner
— was born in Hampton, Virginia and spent her childhood in
California, where she received her early and professional
education.
— She obtained a baccalaureate of arts degree in nursing from
Pasadena College in 1964.
— In 1970 she earned a master's degree in nursing, with major
emphasis in medical surgical nursing from University of
California, San Francisco School of Nursing
— Her PhD in stress, coping and health was conferred in 1982
at the University of California, Berkeley, and her dissertation
was published in 1984.
— Benner has a rang of clinical experience, including acute
medical surgical, critical care and home health care.

Novice to Expert Theory

~ to define diff level
-

of skill acquisition
— Benner adapted Hubert Dreyfus : Model of skill acquisition.
— Benner applied it to her work " From novice to Expert" Benner's model is situational and
describes five levels of skill acquisition and development.

-4
-
>
-
-2
- I
 Major Concepts and Definitions

• Novice
— The person has no background experience of the situation in which he or she is involved.
-

— Context free rules and objectives attributes must be given to guide performance.
follow and
-
Student nurseryClst-4th) Responsibly listen the CF
maximize learning experience

• Advance Beginner
— The person can demonstrate marginally acceptable performance, having coped with enough
real situations to -
note, or to have pointed out by a mentor, the recurring meaningful
components of the situation.
— Nurses functioning at this level are guided by rules and are oriented by task completion.
-
nurses graduated working fresh grad
,
-
joined another institution

• Competent -
most critical level

— Consistency, predictability and time management are important in competent performance.

-
-
> Recognize patterns
> Prioritize
> Devise new rules and plan diskarte
-

> Less supervision

> High Anxiety

• Proficient
— Nurses at this level demonstrate a new ability to see changing relevance in a
-
situation, including recognition and implementation of skilled responses to the situation as it
evolves.
— Nurses are more confident with their knowledge and abilities
-

-
has 10-15yrs experience (same area
-charge nurse

• Expert
— Nurses have an intuitive grasp of the situation, and as being able to identify the region of the
-
problem without losing time considering a range of alternative diagnoses and solutions.
— Expert nurses -
"know the patient"
Key aspect of expert nurse
1. Demonstrating a clinical grasp and resource based practice
2. Possessing embodied know how
3. Seeing the big picture
4. Seeing the unexpected

-25-up years
 Metaparadigm

• Nursing
— Described nursing as a caring relationship, an enabling condition of connection and concern
Caring is primary because caring sets up the possibility of giving help and receiving help.
Nursing is viewed as a caring practice whose science is guided by the moral art and ethics of care
and responsibility

• Person
— The body of a person has 5 dimensions, Benner pointed out that nurses should attend to all
these dimensions o the body and seek too understand the role of embodiment in particular
situation of health illness and recovery

• Health
— is defined as what can be assessed, whereas well being is the human experience of health or
wholeness. Health is described as not just the absence of disease and illness. A person may have
the disease and not experienced illness, because illness is thee human experience of loss or
dysfunction, whereas disease is what can be assessed at the physical level

• Situation
— Benner and Wrubel use the term situation rather than environment, because situation
conveys a social environment with social with social definition and meaningfulness. The person's
past, present, and future, which include her or his own personal meanings, habits, and
perspectives, influence the current situation.
 Katie Eriksson :
T heory of Caritative Caring
L
similar to Jean Watson

• Katie Eriksson is a Finnish nursing theorist born in

1943, recognized for her influential work in developing
the "Theory of Caritative Caring." Her contributions to
nursing focus on the ethical and philosophical aspects
of care, emphasizing the importance of love, charity,
and human dignity in the nurse-patient relationship.
Eriksson's ideas have shaped nursing practice and
theory, particularly in Scandinavia.

Major Concepts and Definitions

• Caritas
— which is the fundamental motive of caring science, also constitutes the motive for all caring. It
-

means that caring is an endeavor to mediate faith, hope, and love through tending, playing, and
learning.

• Caring Communion
— Caring communion constitutes the context of the meaning of caring and is the structure that
-

determines caring reality

— Caring communion is characterized by intensity and vitality, and by warmth, closeness, rest,
respect, honesty, and tolerance

• The Act of Caring

&
-2000
— The act of caring contains the caring elements (faith, hope, love, tending, playing, and learning),
involves the categories of infinity and eternity, and invites to deep communion.
— The act of caring is the art of making something very special out of something less special.
 • Caritative Caring Ethics
— Caritative caring ethics comprises the ethics of caring, the core of which is determined
by the caritas motive.
-

— Eriksson makes a distinction bet ween caring ethics and nursing ethics

> Caring ethics

— deals with the basic relation bet ween the patient and the nurse-the way in which the
-

nurse meets the patient in an ethical sense. It is about the approach we have toward the
patient.

> Nursing ethics

— deals with the ethical principles and rules that guide my work or my decisions.
-
-
-

— Caring ethics is the core of nursing ethics

• Dignity
— Dignity constitutes one of the basic concepts of caritative caring ethics
-

• Invitation
— Invitation refers to the act that occurs when the carer welcomes the patient to the caring
communion. -

—The concept of invitation finds room for a place where the human being is allowed to rest, a
place that breathes genuine hospitality, and where the patient's appeal for charity meets with a
response

• Suffering
— Suffering is an ontological concept described as a human being's struggle bet ween good and evil
-
in a state of becoming.
— Suffering implies in some sense dying away from something, and through reconciliation, the
-

wholeness of body, soul, and spirit is re-created, when the human being's holiness and dignity
appear.
— Suffering is a unique, isolated total experience and is not synonymous with pain
-

— These are three different forms of suffering:

> Suffering related to illness is experienced in connection with illness and treatment.
> When the patient is exposed to suffering caused by care or absence of caring, the patient
experiences suftering related to care, which is always a violation of the patient's dignity.
> In the situation of being a patient, the entire life of a human being may be experienced as
suffering related to life
• Caring culture
— is the concept that Eriksson uses instead of environment.
-

— It characterizes the total caring reality and is based on cultural elements such as
-

- -

traditions, rituals, and basic valuesng Culture -

↑
 Kari Martinsen :
Philosophy of Caring
• Inspiration
-grew in nursing inequalities
• Origin
• What is it?
Kari Martinsen is a Nor wegian nursing theorist who
believes that caring is the heart of nursing and should
focus on building relationships with patients. Inspired by
philosophers, she emphasizes the ethical responsibility of
nurses to care for patients with empathy and
compassion. Martinsen criticizes modern healthcare for
being too focused on efficiency and technology, which she
feels takes away from the human connection bet ween
nurses and patients. She believes that caring should be
based on respect, dignity, and understanding each
patient's unique needs.

1
caring without care"
 Major Concepts and Definition

• Care
-
fundamental need
- trinity , relational , practical ,
and moral

• Professional Judgment and Discernment

-
it is through exercised

• Moral Practice Is Founded on Care

-
emphatya reflection work
together

• Person-Oriented Professionalism
-
to demand professional knowledge which affords the view of the patient as a
suffering person

• Sovereign Life Utterances

-

openness , mercy , trust , hope , love

• The Untouchable Zone

-
area that must not be interfered

of patient
-

privacy

• Vocation
is a demand life makes to
me completely human
in a
way
-

-
nursing is a
calling and a way
of life

I
• The Eye of the Heart
-

stems from the parable of good Samaritan compassion

-

and
love

• The Registering Eye

-
is objectifying and the perspective is that of the observer

-
 Metaparadigm

• Nursing

• Person

• Health

• Environment
 -
>
-
-
=>
-