Nursing Theorists PDF

NURSING THEORISTS THEORETICAL FOUNDATION OF NURSING ________________________________________________________ NURSING THEORIES 2. Person The beginning of nursing theory development can be Predominantly...

NURSING THEORISTS THEORETICAL FOUNDATION OF NURSING ________________________________________________________ NURSING THEORIES 2. Person The beginning of nursing theory development can be Predominantly described a passive patient but traced to Florence Nightingale whenever self-care is possible, the nurse should ask It is a significant development to a body of about the patient’s preference. substantive knowledge to guide nursing practice to 3. Health establish nursing as a profession and an academic Envisioned the maintenance of health through discipline prevention of disease by environmental control and Plays an important role in critical thinking and nursing social responsibility. actions towards clinical practice 4. Environment Backbone of clinical care She believed that sick and poor people would benefit Provides the nurse with focus and framework to sort from environmental improvements that address their patients data’s in practice physical and mental aspects. “theory without practice is empty and practice without Nursing was to assist nature in healing the patient. theory is blind” ASPECTS: ✓ Health of houses SIGNIFICANCE OF NURSING THEORIES ✓ Ventilation and warming At the onset of the 20th century, nursing was not ✓ Light recognized as an academic discipline or a ✓ Noise profession, but the accomplishments of the past ✓ Variety century led to recognition of nursing both areas. ✓ Bed and bedding Led to the recognition of nursing as an academic ✓ Cleanliness of rooms and walls discipline and a profession ✓ Personal cleanliness ✓ Nutrition and taking food FLORENCE NIGHTINGALE ✓ Chattering hopes and advices “ENVIRONMENTAL THEORY” ✓ Observation of the sick She was given the title ✓ Petty management “Founder of Modern Nursing. She established a school of NIGHTINGALE AND THE NIURSING PROCESS: nursing at St. Thomas Hospital 1. Assessment: ask the client what is needed or in England. wanted thru using precise and specific observation She is the most recognized concerning all aspects of the client’s physical health name in the field of nursing. and environment. Her work was instrumental for developing modern 2. Nursing Diagnosis: the client’s response to the nursing practice, and from her first shift, she worked environment and not the environmental problem thru to ensure patients in her care had what they needed reflecting about the importance of the environment to to get healthy. health and well-being of the client. She believed that the person is a holistic individual OUTCOMES AND PLANNING: and thus has a spiritual dimension. ✓ Planning is focused on modifying the environment to o “Matriarch of Modern Nursing” enhance the client’s ability to respond to the disease o “First Nursing Theorist” process o “The Lady with the Lamp” ✓ Desired outcomes are derived from the o ‘Nurse Statistician” Awards: environmental model ✓ Order of Merit (OM) ✓ Royal Red Cross (RRC) by Queen Victoria HILDEGARD PEPLAU of Great Britain “INTERPERSONAL RELATIONSHIPS” Peplau emphasizes that both the THEORETICAL SOURCES OF NIGHTINGALE’S THEORY patient and the nurse mature as the 1. Education result of therapeutic interaction 2. Literature This theory contributed to nursing in 3. Intellectuals the areas of clinical practice, theory, 4. Religious Beliefs and research, adding to the present base of nursing knowledge METAPARADIGM IN NURSING: 1. Nursing METAPARADIGM IN NURSING The act of utilizing the environment of a patient to 1) Person: An organism that lives in an unstable assist him in his recovery balance of a given system. Very essential for everybody’s well-being 2) Health: Symbolizes movement of the personality Wrote “Notes on Nursing” to provide women with and other ongoing processes guidelines for caring for their loved ones at home and 3) Environment: Forces outside the organism in to give advice on how to “think like a nurse.” context of socially approved way of living She expected nurses to use their powers of 4) Nursing: significant, therapeutic, interpersonal observation in caring for patients. process 1 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING NURSE-PATIENT RELATIONSHIP: o Partner – formulate care plan together, Orientation: the person and the nurse mutually advocate and resource person identify the person's problem Identification: the person identifies with the nurse, THE NJURSE-PHYSICIAL RELATIONSHIP thereby accepting help The nurse functions independently from doctors Exploitation: the person makes use of the nurse's Implements care plan that promotes the physician’s help prescribed therapeutic plan Resolution: the person accepts new goals and frees herself or himself from the relationship. The nurse as a member of health team: Must work independently. NURSING ROLES: Stranger Role: Receives the client the same way NOLA PENDER one meets a stranger in other life situations “HEALTH PROMOTION MODEL” Resource Person Role: Answers questions, Not really a nursing theory per se, interprets clinical treatment data, gives information. but a psychological look at how Teaching Role: Gives instructions and provides human beings perceive themselves, training their health and their ability to Counselling Role: Helps client understand and change their lifestyles to promote integrate the meaning of current life circumstances health Surrogate Role: Helps client clarify domains of dependence, interdependence, and independence BREAKDOWN: Active Leadership Role: Helps client assume 1. Features: this model is based on the idea that maximum responsibility for meeting treatment human beings are rational, and will seek their advantage in health VIRGINIA HENDERSON 2. Function: to show the individual as self-determining, “14 BASIC HUMAN NEEDS” but as also determined by personal history and general characteristics “First Lady of Nursing” 3. Effects: it puts the onus of healthcare reform on the “First Truly International Nurse” person, not on the professions This theory emphasizes the 4. Significance: the medical profession is not the main importance of increasing the ingredient in living a healthy lifestyle patient’s independence so that 5. Considerations: as healthcare costs continue to a the progress after climb, Pender advocates preventive medicines, hospitalization would not be which is another word for rational, healthy thinking delayed and therefore, healthy, and rational living METAPARADIGM OF NURSING: ASSUMPTIONS: 1. Person: The patient needs assistance to achieve 1. Individuals seeks to actively regulate their own health and independence behavior 2. Health: Requires independence and 2. Individuals in all their biopsychosocial complexity interdependence because health is more important interact with the environment than care of sick 3. Health professionals constitute a part of the 3. Environment: Nurses should minimize the chances interpersonal environment of injury through recommendations regarding 4. Self-initiated reconfiguration of person-environment building constructions, purchase of equipment and interactive patterns is essential to behavior change. maintenance. 4. Nursing: Nurse functions as a member of the health MAJOR CONCEPTS: care team as they have a unique function to help sick 1. Personal Factors: categorized as biological, and well individuals psychological, and socio-cultural. These factors are predictive of a given behavior and shaped by the 14 COMPONENTS OF BASIC NURSING CARE – NEEDS: nature of the behavior being considered. 1. Breathe normally 2. Perceived Benefits of Action: anticipated positive 2. Eat and drink adequately outcomes that will occur from health behavior. 3. Eliminate body wastes 3. Activity-related Affect: defined as the subjective 4. Move and maintain desirable postures positive or negative feeling that occurs based on the 5. Sleep and rest stimulus properties of the behavior itself 6. Select suitable clothes 4. Interpersonal Influences: cognition-concerning 7. Maintain body temperature behavior, beliefs, or attitudes of the other 8. Keep body clean and well groomed 9. Avoid dangers in environment and avoid injuring others FAY ABDELLA 10. Communicate with others “21 NURSING PROBLEMS” 11. Worship according to one’s faith Based on the problem-solving 12. Work in such a way there is a sense of method accomplishment Viewed nursing as both an art and 13. Play or participate in recreation a science that molds the attitude, 14. Learn, discover or satisfy curiosity that leads to intellectual, competencies, and normal development and health technical skills of an individual nurse THE NURSE-PATIENT RELATIONSHIP Used Henderson’s 14 basic 3 Levels: human needs to establish classification of the o Substitute – perform tasks for patient nursing problems o Helper – assists patient perform tasks 2 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING METAPARADIGM IN NURSING: IDA JEAN ORLANDO 1. Person: All persons have self-help abilities and the “NURSING PROCESS THEORY” capacity to learn, both of which vary from one This model explains that the role of individual to another the nurse is to find out and meet the 2. Health: A state when the individual has no unmet patient’s immediate needs for help. needs and no anticipated or actual impairments 3. Environment: Included in “planning of optimum METAPARADIGM OF NURSING: health on local, state, national, and international 1. Nursing: is responsive to levels” individuals who suffer or anticipate a sense of 4. Nursing: An all-inclusive service that is based on the helplessness discipline of art and science that serves individuals, 2. Health: sense of adequacy or well being sick or well, cope with their health needs 3. Environment: not defined directly but implicitly in the immediate context for a patient KEY CONCEPTS OF 21 NURSING PROBLEMS: 4. Person: developmental beings with needs where 1. To maintain good hygiene and physical comfort. individuals have their own subjective perceptions 2. To promote optimal activity: exercise, rests, and and feelings that may not be observable sleep 3. To promote safety through prevention of accident, NURSING PRPCESS THEORY: injury or trauma and the spread of microorganisms. 1. Professional Nursing Function: Organizing 4. To maintain good body mechanics and prevent and Principle correct deformity. ✓ Finding out and meeting the patient’s 5. To facilitate the maintenance of a supply of oxygen immediate needs to all body cells. ✓ Central core of the nurse is to understand 6. To facilitate maintenance of nutrition. what is happening between the patient and 7. To facilitate maintenance of elimination. the nurse that provides framework to help 8. To facilitate the maintenance of fluid and electrolyte the client balance 2. The Patient’s Presenting Behavior – Problematic 9. To recognize the physiologic response of the body to Situation disease conditions ✓ To find out the immediate need for help, 10. To facilitate the maintenance of regulatory nurse must first recognize the situation as mechanisms and functions problematic 11. To facilitate the maintenance of sensory function ✓ Patient’s behavior stimulates the nurse’s 12. To identify and accept positive and negative immediate reaction and becomes the expressions, feelings, and reactions starting point of the investigation 13. To identify and accept and interrelatedness of 3. Immediate Reaction – Internal Response emotions and illness ✓ The reaction comprises of the nurse’s 14. To facilitate the maintenance of effective verbal and perceptions, thoughts about the non-verbal communication. perceptions, and the feelings evoked from 15. To promote the development of productive the thoughts which are uncontrollable interpersonal relationship. 4. Deliberative Nursing Process – Reflective Inquiry 16. To facilitate progress toward achievement of ✓ Views the nurse-patient relationship as a personal spiritual goals. dynamic whole 17. To create and maintain a therapeutic environment ✓ Nurse’s behavior affects the patient, and 18. To facilitate awareness of self as an individual with the nurse is affected by the patient’s varying needs behavior 19. To accept the optimum possible goals ✓ Nurse’s focus must be on the patient rather 20. To use community resources as an aid in resolving than on as assumption that he/she knows problems arising illness what the patient’s problems are 21. To understand the role of social problems as 5. Improvement – Resolution influencing factors ✓ When a situation becomes clear, it loses its problematic character and a new NURSING PROBLEMS = Health Needs equilibrium is established Overt – obvious (can be seen) ✓ If the patient’s behavior has not changed, Cover – unseen (masked) the function of nursing has not been met so the nurse continues with the inquiry process PROBLEM-SOLVING PROCESS until there is improvement ✓ Identify the problem ✓ Select relevant data OTHER CONCEPTS: ✓ Devise hypothesis 1. Nursing clients: patients who are under medical ✓ Test hypothesis care and who cannot deal with their needs or who ✓ Revise hypothesis when necessary based on cannot carry out medical treatment alone conclusions obtained from data 2. Nursing problem: distress due to unmet needs due RESEMBLES OF THE NURSING PROCESS: to physical limitations, adverse reactions to the ❖ A = assessment setting or experiences which prevent the patient from ❖ D = diagnosis communicating his needs ❖ P = planning 3. Nursing process: the of 1.the behavior of the ❖ I = implementation patient, 2.the reaction of the nurse, and 3.the nursing ❖ E = evaluation actions which are assigned for the patient’s benefit 4. Nurse-patient relations: central in theory and not differentiated from nursing therapeutics or nursing process 3 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING 5. Nursing therapeutics: composed of disciplines and 2. Environment: The environment is an “irreducible, professional activities and automatic activities with pan-dimensional energy field identified by pattern verbal and non-verbal responses and integral with the human field” a. Direct functions: initiates a process of 3. Health: Rogers defined health as an expression of helping the patient express the specific the life process; they are the characteristics and meaning of his behavior behavior emerging out of the mutual, simultaneous b. Indirect functions: calling for help of interaction of the human and environmental fields” others 4. Nursing: The concept Nursing encompasses two 6. Automatic activities: perception by five senses, dimensions automatic thoughts, automatic feeling, and action ✓ Independent science of nursing ✓ Art of nursing practice DOROTHY JOHNSON “BEHAVIORAL SYSTEM MODEL” OTHER CONCEPTS: Proposed that the client is a living a. Energy Field: provides a way to perceive people and open system; a collection of their environment as irreducible wholes behavioral subsystems that b. Openness: human being openly participate in interrelate to form a behavioral energy transformation with the environment creating system mutual change c. Pattern: a distinguishing characteristics of an energy METAPARADIGM OF NURSING: field perceived as a single wave. She calls it as an 1. Person: with pattered, repetitive, “abstraction” that gives identity to the field and purposeful ways of behaving that link the person d. Pan dimensionality: The parameters in language to the environment that human use to describe events are arbitrary 2 Major Systems: e. Homodynamic principles: apostolate the way of ✓ Biological System – focus of perceiving unitary human beings medicine 3 principles: ✓ Behavioral System – focus of a. Resonancy nursing b. Helicy 2. Health: elusive state affected by social, c. Integrality psychological, biological, and physiological factors 3. Environment: consists of all the factors that are BETTY NEUMAN NOT a part of the individual’s behavioral system but “SYSTEM MODEL” influence the system This was developed to help teach 4. Nursing: primary goal is to promote “equilibrium” graduate students an integrated within the individual. approach to client care. This model is based in General 7 SUBSYSTEMS WITHIN THE BEHAVIORAL SYSTEM System Theory and views the client 1. Attachment/Affiliative – ability to establish as an open system that responds to relationships/trust where it provides security and stressors in the environment survival Neuman provides a comprehensive 2. Dependency – promotes helping behavior that calls holistic and system-based approach for a nurturing response to nursing that contains an element of flexibility 3. Ingestive – has to do with when, how, what, how much, and under what conditions we eat METAPARADIGM OF NURSING: 4. Eliminative – excretion of waste products whereas Nursing: requires a holistic approach where it there are no socially adequate behaviors for the time considers all factors affecting one’s health and place for human to excrete Person: individual, family, community, or service 5. Sexual – has the dual function of procreation and Health: depends upon which state of health gratification but this still vary according to culture and continuum the person is in gender Environment: internal, external and created forces 6. Aggressive – behaviors concerned with self- that interact with a person’s state of health defense and self-preservation 7. Achievement – behaviors that attempts to control SYSTEMS MODEL IN NURSING PRACTICE: the environment Client/Person Variables: physiochemical structure and function of the body MARTHA ROGERS Psychological Variables: mental processes and SCIENCE OF UNITARY HUMAN BEINGS” emotions Describes life processes in Developmental Variables: process related to human beings as: wholeness, development over life openness, unidirectionality, Sociocultural Variables: relationships; social and pattern and organization, cultural expectations and activities sentience, and thought Spiritual Variables: influence of spiritual beliefs Proposed that human beings are dynamic energy fields (activities 3 LEVELS OF PREVENTION: or operations) integral with Primary Prevention – aims to strengthen the environmental fields capacity of person to maintain an optimum level Secondary Prevention – alleviate actual effects of METAPARADIGM OF NURSING: an action that caused alteration 1. Person: The people have the capacity to participate Tertiary Prevention – aims to prevent regression or knowingly and probabilistically in the process of recurrence of the illness change. 4 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING SISTER CALISTA ROY without but which are not the center of the person’s “ADAPTATION MODEL” attention and/or energy. According to this model, a person 6. Residual Stimuli: are environmental factors within is a biopsychosocial being constant or without the human systems with effects in the interaction with a changing current situation that are unclear environment. 7. Coping process: are innate or acquired ways of interacting with the changing environment METAPRADIGM IN NURSING: 8. Innate Coping Mechanisms: are genetically determined or common to the species and are Person: A biopsychosocial being generally viewed as automatic processes; humans in constant interaction with a changing environment. do not have to think about them Environment: Conditions, circumstances, and 9. Acquired Coping Mechanisms: are developed influences that affect the development and behavior through strategies such as learning of a person or group. 10. Regulator Subsystem: a major coping process Health: Process of being and becoming an involving the neural, chemical, and endocrine system integrated and whole person. 11. Cognator Subsystem: a major coping process Nursing: Science and practice that expand adaptive involving 4 cognitive-emotive channels abilities 12. Adaptive Responses: promotive integrity in terms of the goals of human systems KEY CONCEPTS: 13. Ineffective Responses: do not contribute to adapting in a stable interaction with the internal and integrity in terms of the goals of the human system external environment. 14. Integrated Life Process: adaptation level at which a source of stimuli that either threaten or promote the the structure and functions of a life process are person's unique wholeness. working as a whole to meet human needs Person's major task is to maintain INTEGRITY 15. Physiological-Physical Mode: associated with the Integrity is the degree of wholeness physical and chemical processes involved in the function and activities of living organisms TYPES OF STIMULI: 16. Self-concept-Group Identity Mode: it focuses Focal - most immediately confronting the person specifically on the psychological and spiritual Contextual - strengthens the effect of the focal aspects of the human system stimulus. 17. Role Function Mode: set of expectations about how Residual - affects the focal stimulus but the effects a person occupying one position behaves toward a are unclear. person occupying another position 18. Interdependence Mode: focuses on close 4 ADAPTIVE MODES: relationships of people and their purpose, structure, Physiological - the way a person responds as a and development physical being to stimuli from the environment Self-concept - Psychological and spiritual JEAN WATSON characteristics of the person “PHILOSOPHY AND SCIENCE OF CARING” Role function - primary, secondary and tertiary roles She is the founder of the original that a person performs in the society. Center for Human Caring in Interdependence - coping mechanism from close Colorado relationship which results to giving and receiving of She views nursing as “both as love, respect and value. human science and an art, and as such cannot be considered METAPARADIGM IN NURSING qualitatively 1. Nursing – health care profession that focuses on Addresses how nurses care for human life processes and patters and emphasizes their patients and how that caring translates into promotion of health for individuals, families, groups, better health plans to and society as a whole help patients get healthy 2. Person – described as a while with parts that function as unity for some purposes METAPARADIGM IN NURSING: 3. Health – a state and a process of being and 1. Person - Viewed holistically wherein the body, mind becoming integrated and a whole person and soul are interrelated; each part a reflection of the 4. Environment – all the conditions, circumstances, whole and influences surrounding and affecting the 2. Environment - Provides the values that determine development and behavior of person or groups how one should behave and what goals one should strive toward MAJOR CONCEPTS AND DEFINITIONS: 3. Health - Refers to unity and harmony within the 1. System: a set of parts connected to function for mind, body and soul some purpose and that does so by virtue of the 4. Nursing - A human science of people and human interdependence of its parts health-illness experiences 2. Adaptation Level: represents the condition of the life processes described on three levels as PHILOSOPHY AND SCIENCE OF CARING: integrated, compensatory, and compromised 7 Assumptions and 10 Carative Factors 3. Adaptation Problems: broad areas of concern Caring can be effectively demonstrated and related to adaptation where it described as the practiced interpersonally difficulties related to the indicators of positive Effective caring promotes health and individual or adaptation family growth 4. Focal Stimulus: the internal and external stimulus Caring responses accept a person not only as he or most immediately confronting the human system she is now but as what he or she may become 5. Contextual Stimuli: are all the environmental A caring environment is one that offers the factors that present to the person from within or development of potential 5 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING Caring is more health genic than is curing 3. Health: universal across cultures, but distinct within The practice of caring is central to nursing each culture in a way that represents the beliefs, values, and practices of the particular culture 10 CARATIVE FACTORS “Clinical Caritas” 4. Nursing: leads to deliverance of appropriate nursing 1. Practice of loving kindness and equanimity toward care that fits the patient’s cultural pattern thus self and other reducing stress and conflict 2. Being authentically present, enabling, sustaining, and honoring faith, hope, and deep belief system NURSING DECISION AND ACTION MODELS TO ACHIVE 3. Cultivation of one’s own spiritual practices and CULTURALLY CONGRUENT CARE: transpersonal self 1. Cultural care preservation/maintenance 4. Developing and sustaining a helping-trusting, Retain and preserve relevant care values authentic caring relationship so that clients can maintain their well-being 5. Being present to, and supportive of, the expression from illness, or face handicaps, or death of positive and negative feelings 2. Cultural care accommodation/negotiation 6. Creative use of self and all ways of knowing as part Adapt or negotiate with the others for a of the caring process beneficial or satisfying health outcome 7. Engaging in genuine teaching-learning experience 3. Cultural care patterning/restructuring that attends to unity Change or greatly modify client’s lifeways 8. Creating healing environment at all levels for a new, different, and beneficial health 9. Assisting the basic needs, with an intentional caring care pattern consciousness, administering “human care essentials,” KEY CONCEPTS OF TRANSCULTURAL NURSING AND 10. Opening and attending to spiritual- mysterious and ETHNO-NURSING: existential dimensions of one’s own life-death A learned subfield or branch of nursing which focuses upon the comparative study and analysis of MAJOR ASSUMPTIONS: cultures with respect to nursing and health-illness Transpersonal Caring Relationship - Characterizes a caring practices and beliefs special kind of human care relationship Caring Occasion/Caring Moment - The moment TRANSCULTURAL THEORY IN NURSING: when the nurse and another person come together Culture can be seen in actions, words, rules and standards, symbols and behavior, patterns of people WATSON’S ORDERING OF NEEDS: is learned and handled down from generation to Lower order needs (biophysical needs) generation ✓ The needs for food and fluid ✓ The need for elimination CULTURE DIVERSITY: ✓ The need for ventilation Refers to the differences or variations that can be Lower order needs (psychophysical needs) found both between and among cultures ✓ the need for activity-inactivity It is important to discover similarities and differences ✓ the need for sexuality about care and its impact on the health and well- Higher order needs (psychosocial needs) being of groups ✓ the need for achievement ✓ the need for affiliation PATRICIA BENNER “THE PRIMACY OF CARING MODEL” MADELEINE LEININGER from novice to expert “TRANSCULTURAL NURSING” An internationally noted researcher Through her observations while and lecturer on health, stress and working as a nurse, she identified a coping, skill acquisition and ethics. lack of cultural and care knowledge Believes that nurses have been as the missing component to a delinquent in documenting their nurse’s understanding clinical learning and this lack of This theory attempts to provide charting of our practices and clinical culturally congruent nursing care observations through “cognitively based assistive, facilitative, or enabling acts or decisions METAPARADIGM IN NURSING: that are mostly tailor-made to fit with individual’s, 1. Nursing: enabling condition of connection and groups, or institutions cultural values and beliefs concern which shows a high level of emotional Most current titles: involvement in the nurse-client relationship o “Culture care” or “Culture Care Diversity ✓ Nursing is viewed as a caring practice and Universality” 2. Person: a self-interpreting being who does not come into the world predefined but gets defined in the METAPARADIGM OF NURSING: course of living a life 1. Person: universally caring who survive in a diversity ✓ The person must deal with: of cultures through their ability to provide the i. Role of the situation universality of care ii. Role of the body 2. Environment: world view, social structure, and iii. Role of personal concerns environmental context iv. Role of temporality a. Environmental framework – the totality of 3. Health: defined as “what can be assessed” an event, situation, or experience 4. Environment: she suggests a social environment b. Culture – particular group and the with social definition and meaning patterning of actions, thoughts, and decisions 6 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING SKILLS ACQUISITION IN NURSING: LYDIA E. HALL 1. Novice “CARE, CORE, AND CURE MODEL” Person has no background experience of Her model of nursing was the situation he is involved progressive for the time in that it Level where student nurses belong refers to a nursing diagnosis during a 2. Advance beginner time in which nurses were taught that Person has sufficient experience to easily diagnoses are not part of their role in understand aspects of the situations health care They have difficulty grasping the current Represented her theory of nursing by patient situation in terms of the larger drawing three interlocking circler; perspective each circle representing a particular aspect of Newly graduated nurses belong to this level nursing: CARE, CORE, and CURE. 3. Competent Competent performance considers 1. The Care Circle consistency, predictability and time ✓ The nurturing component of care and is management as essential component exclusive to nursing Increase level of efficiency is evident ✓ Involves the concept of “mothering” and Competent nurse displays more provide for teaching-learning activities responsibility for the patient ✓ The nurse’s goal is the comfort of the 4. Proficient patient Person perceives the situation as a whole ✓ Provide care for the patient at the basic rather than in terms of aspects needs level presents the nurse and the They no longer rely on preset goals for patient with an opportunity for closeness organization 2. The Core Circle There is much more evident involvement ✓ Based on social sciences with the patient and family ✓ Involves therapeutic use of self 5. Expert ✓ Patient is able to maintain who they are Person no longer relies on analytical ✓ Patient is able to make informed or principles like rules, guideline, and maxims conscious decisions to connect her understanding of a situation 3. The Cure Circle Key aspects: ✓ Based in the pathological and therapeutic i. Demonstrate a clinical grasp and sciences and is shared with other members resource-based practice. of the health team ii. Possess embodied knowledge ✓ The nurse helps the patient and family iii. See the big picture. through medical, surgical, and rehabilitative iv. See the unexpected prescriptions made by the physician DOMAINS OF NURSING PRACTICE: INTERACTIONS OF THE 3 ASPECTS OF NURSING: 1. The Helping Role Domain Hall emphasizes the importance of total person ✓ Includes competencies related to approach establishing a healing relationship Only nursing is defined as the function necessary to 2. The Teaching-Coaching Function Domain carry out care, core, and cure ✓ Includes timing, readying patients for The size of the circles represents the degree to which learning, motivating, change, assisting with the patient is progressing in each of the 3 areas lifestyle alterations, and negotiating agreement on goals 11 NURSING SKILLS IN THE THEORY: 3. The Diagnostic and Patient-Monitoring Function 1. Observation of health status Domain 2. Skills of communication ✓ Refers to the competencies in ongoing 3. Application of knowledge assessment and anticipation of outcomes 4. Teaching of patients and families 4. The Effective Management of Rapidly Changing 5. Planning and organization of work Situations Domain 6. Use of resource materials ✓ Includes the ability to contingently match 7. use of personal materials demands with resources and to assess and 8. Problem-solving manage care during crisis situations 9. Direction of work of others 5. The Administering and Monitoring Therapeutic 10. Therapeutic use of the self Interventions and Regimens Domain 11. Nursing procedure ✓ includes competencies related to preventing complications during drug METAPARADIGM IN NURSING: therapy, wound management, and 1. Person: The source of energy and motivation for hospitalization healing is the individual care of the recipient, not the 6. The Monitoring and Ensuring the Quality of healthcare provider Health Care Practices Domain 2. Health: Hall stresses the need to help the person ✓ includes competencies about maintenance explore the meaning of his/her behavior to identify of safety, continuous quality improvement and overcome problems trough developing self- 7. The Organizational and Work-Role identity and maturity Competencies Domain 3. Environment: Hall is credited with developing the ✓ includes competencies in priority setting, concept of Loeb Center because she assumed that team building, coordinating, and providing the hospital environment during treatment of acute for continuity illness creates a difficult psychological experience for the ill individual 7 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING 4. Nursing: Care is the sole function of nurses, MARGARET NEWMAN whereas core, core, and the cure aspects of patient “HEALTH AS EXPANDING CONSCIOUSNESS” care Newman asserted that the phenomena of inquiry for nursing JOYCE TRAVELBEE should be parameters of human “HUMAN-TO-HUMAN RELATIONSHIP MODEL” wholeness and that there were Humanistic revolution characteristics of people identified the Deals with interpersonal aspects of whole nursing, focusing especially on mental health CONSCIOUSNESS She explained that “human-to- The “informational capacity of the system: the ability human-relationship is the means of the system to interact with the environment” through which the purpose of Includes not only cognitive and affective awareness nursing is fulfilled” but also the interconnectedness of the entire living Travelbee based the assumptions of her model on system which includes: the concepts f existentialism by Kierkegaard and o Physiochemical maintenance logotherapy by Frankl. o Growth processes o The immune system METAPARADIGM OF NURSING: 1. Person: a human being is unique, irreplaceable ABSOLUTE CONSCIOUSNESS – where all opposites are individual who is in continuous process of becoming, reconciled = love evolving and changing ✓ Love and pain 2. Health: subjective and objective ✓ Pain and pleasure a. Subjective health: an individual defined ✓ Disease and non-disease state of well-being in accordance with self- appraisal of physical-emotional-spiritual HEALTH – a process of developing awareness of self and status environment together with an increasing ability to perceive b. Objective health: an absence of alternatives and respond in a variety of ways discernible disease, disability of defect as measured by physical examination by MOVEMENT – THE MEANS WHERE ONE PERCEIVE spiritual director or psychological counselor REALITIES 3. Environment: she defined human conditions and She believes that health and disease are part of the life experiences encountered by all men as same entity and are manifested in the pattern of the sufferings, hope, pain and illness. human being 4. Nursing: an interpersonal process whereby the Nursing is needed when a person reaches a choice professional nurse practitioner assists an individual point where the old patterns of coping and response to prevent or cope with the illness. are no longer achieving the desired results Nursing is a relationship, not a problem-solving INTERACTIONAL PHASES OF HUMAN-TO-HUMAN process RELATIONSHIP MODEL: 1. Original Encounter METAPARADIGM OF NURSING: First impression by the nurse of the sick 1. Person person and vice-versa Newman used the terms client, individual, Stereotyped or traditional roles patient, person, and human being 2. Emerging Identities interchangeably The time when relationship begins in which Clients are viewed as participants in the the nurse and the patient perceives each transformative process other’s uniqueness 3. Empathy 2. Health The ability to share in the person’s Health is the main focus for Newman’s experience theory of expanding consciousness 4. Sympathy Outcome of the person’s interaction with When the nurse wants to lessen the cause their environment of patient’s suffering Becoming ill does not diminish wholeness, “when one sympathizes, one is involved but but simply alters it not incapacitated by the involvement” 3. Environment 5. Rapport The pattern of person-environment Described as nursing interventions that interactions shapes health lesson the patient’s suffering No boundaries In unison with human beings TRAVELBEE’S ASSUMPTIONS: 4. Nursing ✓ Human beings are an open system that reacts and According to Newman, nurses help clients adjusts itself to the environment get in touch with the meaning of life by ✓ They rely on a delicate chemical and environmental identifying their health patterns balance to secure their survival She states 9 patters of interactions: ✓ Without the balance, the entire system will crash choosing, communicating, exchanging, feeling, knowing, moving, perceiving, relating, and valuing The nurse works together with the client through critical choice points, when change takes place 8 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING ROSEMARIE RIZZO PARSE COMPOSED OF 4 RELATED THEORIES: “THEORY OF HUMAN BECOMING” o Theory of self-care Developed this theory through the o Theory of dependent care combination of concepts from Martha o Theory of self-care deficit Rogers and from existential- o Theory of nursing systems phenomenological thought 1. The Theory of Self-Care: practice of activities on This theory presents an alternative to their own behalf both the conventional and bio-medical a. Self-Care: practice of activities that approach as well as the bio-psycho- individuals perform independently on their social-spiritual approach of most other theories and behalf in maintaining life, health, and well- models of nursing. being. b. Self-Care Agency: ability for engaging in 3 PRINCIPLES: self-care activities 1. Meaning c. Therapeutic Self-Care Demand: totality of a. Imaging – process of knowing and coming self-care actions to be performed for some to know as persons accept and reject ideas, duration in order to meet self-care beliefs, values, and practices requisites b. Valuing – process of choosing and embracing what is important 2. The Theory of Dependent Care c. Languaging – using spoken or written a. Dependent Care: refers to a care that is words to express meaning provided to a person who, because of age 2. Rhythmicity: a design or model or related factors a. Revealing-concealing: exposing or hiding b. Dependent Care Agency: acquired ability true intentions of a person to know and meet the b. Enabling-limiting: proving something with therapeutic self-care demand of the means to operate dependent person c. Connecting-separating: associating or c. Dependent Care Demand: summation of keeping someone apart care measures at a specific point in time or 3. Transcendence over a duration of time a. Powering – harnessing the capacity to do something 3. The Theory of Self-care Deficit: relationship b. Originating – to invent or do something from between an individual’s therapeutic self-care somewhere demand and his powers of self-care agency c. Transforming – converting something to another form 4. The Theory of Nursing Systems: series and sequences of deliberate practical actions of nurses “each of the principles has a practice dimension and performed at times in coordination with the actions of process” their patients 3 classifications: METAPARADIGM OF NURSING: i. Wholly compensatory 1. Person ii. Partially compensatory multi-faceted, decisive entity, autonomous iii. Supportive-educative system patterns in a person’s life demonstrate personal meanings and preferences, and METAPARADIGM OF NURSING: involve engagements and disengagements 1. Person 2. Health Has the capacity to reflect, symbolize, and Personal process only known by the self use symbols Subjective and related to the culture A unity that can function biologically, Affects optimal state of wellness symbolically, and socially 3. Environment Universe; perceived by the person 2. Environment Internal/external components and reality Composed of environmental factors, may not elements, conditions, and developmental Can improve or deteriorate an individual’s environment health 3. Health 4. Nursing When human beings are structurally and Service to humankind practices in functionally whole or sound relationship with individuals, groups, and 4. Nursing communities in their process An art of helping others Art and science of caring To render the patient or the members of his family, capable of meeting the patient’s self- DOROTHEA ELIZABETH OREM needs “SELF-CARE DEFICIT NURSING THEORY” One of the America’s foremost nursing theorist Received many awards during her distinguished career in nursing Recognized that if nursing was to advance as a field of knowledge and as a field of practice, a structured, organized body of nursing knowledge was needed 9 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING MYRA ESTRINE LEVINE 8. A system consists of a set of objectives and their “FOUR CONCERVATION PRINCIPLES” relationships. Proposed that this model seeks to 9. A system is a dynamic network of interconnecting elements. promote and maintain wholeness of A change in only one of the man by a proper balance of supply elements must produce change in all the others. and demand. 10. When subsystems are arranged in a series, the output of one is the input for another. Therefore, process alterations in one requires alterations in EXAMPLE OF ADAPTATION = organismic response other subsystems. 11. All systems tend toward equilibrium, which is a balance of A change in behavior of an individual during various forces within and outside an attempt to adapt to the environment. of a system. 4 types: 12. The boundary of a system can be redrawn at will by a 1. Flight or Fight system analyst. 2. Inflammatory 13. To be viable, a system must be strongly goal-directed, 3. Stress governed by feedback, and have the 4. Perceptual ability to adapt to changing circumstances. MAJOR CONCEPTS AND ASSUMPTONS: KURT LEWIN Conservation – “keeping together of the life system” = proper balance between nursing intervention and “CHANGE THEORY” patient participation through: 1. Conservation of energy: balancing 3 MAJOR CONCEPTS: energy input and output to avoid Driving forces: those that push in excessive fatigue a direction that causes change to 2. Conservation of structural occur integrity: maintaining or restoring Restraining forces: they hinder the structure of the body change because they push the preventing physical breakdown or patient in the opposite direction promoting healing Equilibrium: a state of being where driving forces 3. Conservation of personal integrity: equal restraining forces, and no change occurs recognizes the individual as one who strives for recognition, 3 STAGES IN THIS THEORY: respect, self-awareness, selfhood, Unfreezing: recognition of the need for change and and determination the dissolution of previously held patterns of behavior 4. Conservation of social integrity: Movement (Change stage): shift of behavior toward recognizes the individual’s need or a new and more healthful pattern family and friends, community, Refreezing stage: long-term solidification of the new workplace and school, religion, patter of behavior and personal choices MAJOR ASSUMPTIONS: LUDWIG VON BERTALANFFY People grow and change throughout their lives “GENERAL SYSTEMS THEORY” Change happens daily Proposed that a system is made up Restrictions to change are grounded in the basic of separate components. The parts human needs for self-esteem, safety, and security rely on one another, are interrelated, Change involves modification or alteration share a common purpose, and together form a whole. 6 COMPONENTS: Recognition of the area where change is needed ASSUMPTIONS: Analysis if a situation to determine what force exist ✓ All systems must be goal-directed to maintain the situation ✓ A system is more than the sum of its parts Identification of methods by which change occur ✓ A systems is everchanging and any change in one Recognition of the influence of group on change part affects the whole Identification of the methods that the reference group ✓ Boundaries are implicit and human systems are open uses to bring about change and dynamic The actual process of change BASIC PRINCIPLES OF A SYSTEMS APPROACH: ERIK ERIKSON 1. A system is greater than the sum of its parts. 2. The portion of the world studied must exhibit some “DEVELOPMENTAL THEORIES” predictability. 3. Though each subsystem is a self-contained unit, it is part of 8 DEVELOPMENTAL TASKS a wider and higher order. 1. Trust vs Mistrust (birth-18 4. The central objective of a system can be identified by the months) Infancy fact that other objectives will be Starting with oral satisfaction sacrificed to attain the central objective. where the infant learns to trust the 5. Every system, living or mechanical, is an information caregiver as well as his self system. Must analyze how suitable the Very crucial to this stage is symbols used are for information transmission. consistent caregiving 6. An open system consists of a set of objectives and their Important event: feeding relationships. 7. A highly complex system may have to be broken into subsystems so each can be analyzed and understood before being reassembled into a whole. 10 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING 2. Autonomy vs Sence of Shame and Doubt (18 o Children continue to accept rules of months-3 yrs) authority figures, but this is now due to The child is now becoming accomplished in some their beliefs basic self-care activities, including feeding, walking ▪ Step 3: Good Boy, Nice Girl and toileting Orientation- wants the approval The toddler develops his autonomy by making of others and act in ways to avoid choices disapproval Important event: toilet training ▪ Step 4: Law-and-Order Orientation- child blindly accepts 3. Initiative vs Guilt (3-5 yrs) Preschool rules and convention because of Children like to pretend and try out new roles their importance in maintaining a Children are developing their superego or functioning society conscience Important event: exploration Post-conventional o Person’s sense of morality is defined in 4. Industry vs Inferiority (6-11 yrs) School Age terms of more abstract principles and School age children are eager to apply themselves values to learning socially productive skills and tools o People now believe that some laws are They learn to work and play with their peers unjust and should be changed ▪ Stage 5: Social-contract Important event: school Orientation- world is viewed as holding different opinions, rights 5. Identity vs Role Confusion (12-18) Adolescence and values Dramatic physiological changes associated with ▪ Stage 6: Universal-Ethical sexual maturation highlight at this stage Principal Orientation- highest It is during this stage that the individual is able to stage of functioning seek for the answer to the question, “who am i?” Important event: social relationships ABRAHAM HAROLD MASLOW 6. Intimacy vs Isolation (19-40) Young Adulthood “HIERARCHY OF NEEDS” Young adults, after developing a sense of identity, A motivational theory in deepen their capacity to love others and care for psychology comprising of five-tier them model of human needs, often Time to become fully participative in the community, depicted as hierarchical levels enjoying adult freedom and responsibility within a pyramid Important event: relationships o Self-actualization needs o Esteem needs 7. Generativity vs Self-Absorption and Stagnation o Love and belongingness needs (40-65) Middle Age o Safety needs o Physiological needs The adult can now focus on supporting future generations States that human are motivated to fulfill their needs in a hierarchal order The individual pursues expansion of personal and social involvement This explains huma motivation based on the pursuit of different levels of needs Important event: work and parenthood BREAKDOWN: 8. Ego Integrity vs Despair (65 yrs and older) Old 1. Physiological needs: most essential things a Age person needs to survive. For example: shelter, water, The adult suffer loss of status and function, such as food, warmth, rest, and health through retirement or illness. 2. Safety needs: relate to a person’s need to feel safe Despair is experienced when the elderly view and secure in their life and surroundings. For himself a failure example: security, order, law, stability, freedom from Important event: reflection on life fear 3. Love and belongingness needs: outlines the need LAWRENCE KOHLBERG for friendship, intimacy, family, and love. “THEORY OF MORAL DEVELOPMENT” 4. Esteem needs: related to a person’s need to gain recognition, status, and feel respected. STAGES OF MORAL DEVELOPMENT: 5. Self-actualization needs: relates to the realization Preconventional of an individual’s full potential. o Child’s sense of morality is externally controlled EXPANDED HIERARCHY OF NEEDS: o Children continue to respect 1. Biological and physiological needs the rules of authority figures 2. Safety needs ▪ Stage 1: Obedience and 3. Love and belongingness needs Punishment Orientation- child’s 4. Esteem needs desire to obey rules and avoid 5. Cognitive needs being punished 6. Aesthetic needs ▪ Stage 2: Instrumental 7. Self-actualization needs Orientation- expresses “what’s in 8. Transcendence needs it for me? ” CHARACTERISTICS OF SELF-ACTUALIZERS: Conventional 1. Highly creative o Child’s sense of morality is tied to personal 2. Need for privacy societal relationships 3. Peak experiences 11 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING 4. Democratic attitudes PROPOSITIONS OF KING’S THEORY: 5. Unusual sense of humor 1. If perceptual interaction accuracy is present in nurse- 6. Able to look at life objectively client interactions, transaction will occur. 7. Strong moral/ethical standards 2. If nurse & client make transaction, goal will be 8. Spontaneous in thought and action attained. 9. Problem-centered (not self-centered) 3. If goals are attained, satisfaction will occur in nurses 10. Concerned for the welfare of humanity and patients. 11. Accept themselves and others for what they are 4. If transactions are made in nurse-client interactions, 12. Capable of deep appreciation of basic life experience growth & development will be enhanced. 13. Resistant to enculturation, but not purposely 5. If role expectations and role performance as unconventional perceived by nurse & client are congruent, 14. They perceive reality efficiently and can tolerate transaction will occur. uncertainty 6. If role conflict is experienced by nurse or client or 15. Establish deep satisfying interpersonal relationships both, stress in nurse-client interaction will occur. with a few people 7. If nurse with social knowledge and skill communicate appropriate information to client, mutual goal setting HENRY (HARRY) STACK-SULLIVAN and goal attainment will occur. “TRANSACTIONAL ANALYSIS” or called 8. If goal attainment is achieved, there is decreased INTERPERSONAL THEORY stress and anxiety in nursing situations. Explained that the purpose of all behavior is to get needs met through 3 INTERACTING SYSTEMS: interpersonal interactions and to 1. Personal System - individuals are personal decrease or avoid anxiety systems. Everyone is an open, total unique system in constant interaction with the environment. 3 MODES OF EXPERIENCES: 2. Interpersonal System - 2 or more individuals in 1. Prototaxic Experience: like the “stream of interaction form interpersonal systems consciousness, “the raw sensations, images, and 3. Social System - an organized boundary system of feelings that flow through the mind of a sensate social role, behaviors and practices developed to being. maintain values and the mechanisms to regulate the 2. Parataxic Mode: consists of seeing causal practice and rules relationship between events 3. Syntaxic: consists of consensually validated symbol KATIE ERIKSSON activity, especially of a verbal nature “THEORY OF CARITATIVE CARING” 6 SATGES IN THE DEVELOPMENT OF PERSONALITY: Pioneers of caring science in the 1. Infancy (0-18 months) - Oral zone is the primary Nordic countries zone of interaction between the baby and its This theory is a fundamental environment motive of caring science, also 2. Childhood (18 months-6 years) - learning of constitutes the motive of caring language and the organization of experience in the syntaxic mode MAJOR CONCEPTS AND DEFINITIONS: 3. Juvenile Era (6-9 years) - acquires social 1. Caritas - means love and charity, eros and agape subordination to authority figures outside the family are united, and caritas is by nature unconditional love 4. Preadolescence (9-12 years) - self-system begins 2. Caring communion - constitutes the context of the to develop the conception of gender meaning of caring and is the structure that 5. Early Adolescence (12-14 years) - development of determines caring reality a pattern of heterosexual activity 3. The act of caring - contains the caring elements 6. Late Adolescence (14-21 years) - prolonged (faith, hope, love, tending, playing, and learning) initiation into the privileges, duties, satisfactions, and 4. Caritative caring ethics - comprises the ethics of responsibilities of social living caring, the core of which is determined by the caritas motive IMOGENE KING 5. Dignity - constitutes one of the basic concepts of “CONCEPTUAL SYSTEM AND MIDDLE-RANGE caritative caring ethics THEORY OF GOAL ATTAINMENT” 6. Invitation - refers to the act that occurs when the Describes his theory as a dynamic, nurse welcomes the patient to the caring communion interpersonal relationship in which a 7. Suffering - an ontological concept described as a patient grows and develops to human being’s struggle between good and evil in a attain certain life goals state of becoming This theory explains that factors 8. The suffering from human being - used to describe which can affect the attainment of the patient, patients (Latin) which means “suffering” goals are roles, stress, space, and 9. Reconciliation - a change through which a new time wholeness is formed of the life of the human being has lost his suffering METAPARADIGM IN NURSING: 10. Caring culture - characterizes the total caring reality 1. Nursing - an observable behavior found in the health and is based on cultural elements such as traditions, care systems in society rituals and basic values 2. Person - Has the ability to perceive, think, feel, choose, set goals, select means to achieve goals & METAPARADIGM IN NURSING: to make decision 1. Human - is fundamentally holy, which means 3. Health - a dynamic state in the life cycle, whereas accepting the human obligation of serving with love illness interferes with the process and existing for the sake of others 4. Environment – the background for human 2. Nursing - care of all teaching and fostering growth in interactions all forms of human relations 12 #LabaRN NURSING THEORISTS| THEORETICAL FOUNDATION OF NURSING 3. Environment - the ethos of caring science, as well KEY CONCEPTS: as that of caring, consists of the idea of love and CASAGRA transformative leadership model has charity and respect and honor of the holiness and concepts of leadership from a psycho-spiritual point dignity of the human being of view, designed to lead to radical change from 4. Health - soundness, freshness and well-being apathy or indifference to a spiritual person. Servant-leader formula is the enrichment package FILIPINO NURSING THEORISTS: prepared as interventions for the study which has 3 parts: ROZZANO C LOCSIN ✓ Care complex primer ✓ Retreat-workshop on servant-leadership “TECHNOLOGICAL COMPETENCY AS CARING ✓ Seminar workshop on transformative IN NURSING: A MODEL FOR PRACTICE” teaching for nursing faculty Her theory is an interesting Special expertise is the level of competence in discussion of the correlation between nursing skills, commitment to the nursing hands-on patient care and the use of profession, and sense of collegiality with the school technology Nursing leadership is the force within the nursing profession ASSUMPTIONS: 1. People are caring by virtue of their humanness. Transformative teaching may also be termed Reflective Teaching, an umbrella term covering 2. People are whole or complete in the moment. ideas such as thoughtful instruction 3. Knowing persons is a process of nursing that allows for continuous appreciation of persons moment to Care complex is the nucleus of care experiences in moment. the personality of a nurse formed by a combination 4. Technology is used to know the wholeness of of maternal care experiences persons moment to moment. 5. Nursing is a discipline and a professional practice. CARMELITA DIVINAGRACIA “COMPOSURE MODEL” DIMENSION OF TECHNOLOGICAL VALUE: 1. Technology as completing human beings to re- Objective And Significance of The Study: formulate the ideal human being such as in determine the effects of the COMPOSURE replacement parts behavior of the Advance Nurse Practitioner on 2. Technology as machine technologies the wellness outcome of the selected cardiac 3. Technologies that mimic human beings and human patients activities to meet the demands of nursing care Significance of the Study: Nursing as a health care practices profession would prove its worth of being at par in quality performance with other health care professionals TECHNOLOGICAL COMPETENCY Study Population: Adult cardiac patients-admitted and 1. Technological competency as caring in nursing is confined at the Philippine Heart Center, Coronary Care Unit the harmonious coexistence 2. The harmonization of these concepts can co-exist. Definition of Terms: 3. Technology brings the patient closer to the nurse. a. Advance Nurse Practitioners 4. When technology is used to know persons ✓ BSN graduate continuously in the moment ✓ Licensed and has clinical experience of at least 2 years in the clinical area THE PROCESS OF NURSING: ✓ Has undergone special training in critical a. Knowing - guided by technological knowing in area which people are appreciated as participants in their b. COMPOSURE behaviors care rather than objects of care. ✓ set of behaviors or nursing measures that b. Designing - both the nurse and the one nursed the nurse demonstrates to selected cardiac plan a mutual care process patients c. Participation in appreciation - the simultaneous ✓ stands for: practice of conjoined activities which are crucial to COM – petence knowing persons. P – presence and prayer d. Verifying knowledge - knowledge about the O – open mindedness person that is derived from knowing S – stimulation U – understanding METAPARADIGM CONCEPTS: R – respect and relaxation 1. Nursing - “Nurses value technological competency E - empathy as an expression of caring in nursing.” c. Wellness status: a condition of being in a state of 2. Health - “Humanity is perceived by technology.” well-being 3. Environment - “Environment as the technological world in which we live.” CONCLUSIONS: 4. Person - Patie