Medical Colleges of Northern Philippines Instructional Learning Guide PDF

MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING INSTRUCTIONAL LEARNING GUIDE NCM 100 Theoretical Foundations In Nursing FIRST SEMESTER F.Y. 2022-2023...

MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING INSTRUCTIONAL LEARNING GUIDE NCM 100 Theoretical Foundations In Nursing FIRST SEMESTER F.Y. 2022-2023 1  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING PREPARED BY: FEVIE ANNE D. BANATAO Clinical Instructor College of Nursing and School of Midwifery Medical College of Northern Philippines 2  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING PREFACE This Instructional Learning Guide for the subject NCM 100 – Theoretical Foundations in Nursing has been prepared to address the needs of our learners in the Distance Learning Strategy. The contents of this guide has been carefully planned and reviewed to suit the learning styles of our students. This guide is a collection of lectures from different authors of the basic concepts of patient care that is deemed appropriate and useful for students to acquire knowledge and skills for the course. How to Use this Learning Guide: This shall serve as guide of the students in the completion of the course. Lectures, activities and evaluative assessment are provided in this material. The learning outcomes are specified in each chapter which shall serve as checklist of the knowledge and skills acquired by the students upon completion of the lessons and activities given. Lecture notes are also provided from the different references used for the subject to guide the students in understanding the topics supplemented by teacher’s insight and videos. Essay questions, case analysis and self-assessment exercises are provided to stir the critical thinking skills of the students and to evaluate their understanding on the concepts given. Moreover, the students are required to write a journal at the end of each term which composed of their learnings, personal reflections and realizations of the concepts given. All written outputs should be compiled in their learning portfolio to be submitted to the subject teacher as part of the requirements of the course. Features of the Instructional Learning Guide:  Learning Outcomes  Key Terms  Lectures Notes  Teachers Insight  Application  Self-reflection Questions  Other Activities (to be included in Portfolio Assessments)  Appendices  Summary of Additional References  Bibliography 3  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING TABLE OF CONTENTS I. PRELIMINARIES................................................ Chapter 1: INTRODUCTION OF NURSING THEORY............................. Definition of: 1. Theory 2. Nursing Theory 3. Nursing Paradigms a. Person b. Health c. Environment d. Nursing 4. Philosophy 5. Conceptual Models 6. Science 7. Knowledge 8. Phenomenon 9. Concepts Chapter 2: IMPORTANCE OF NURSING THEORY IN:............................ 1. Education 2. Research 3. Clinical Practice Chapter 3: FOUR WAYS OF KNOWING....................................... 1. Empirical 2. Ethical 3. Esthetics 4. Personal Chapter 4: DEVELOPMENT PROCESS OF THEORY IN NURSING................... 1. Rationalism 2. Empiricism 3. Science & Theory in the early 20th Century 4. Science & Theory in the late 20th Century 4  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Chapter 5: CATEGORIES OF THEORIES...................................... 1. Micro-range(Practice Theories) 2. Middle range theories 3. Grand theories 4. Non-Nursing Theories a. Human Need theory b. Systems Theory c. Change Theory II. MIDTERMS..................................................... Chapter 6: SELECTED NURSING THEORIES AND CONCEPTUAL MODELS............ 1. Philosophies a. Florence Nightingale b. Virginia Henderson c. Faye Abdellah d. Jean Watson 2. Grand Theories a. Madeleine Leininger b. Nola Pender 3. Middle-Range Theories a. Hildegard Peplau b. Ida Jean Orlando c. Joyce Travelbee 4. Conceptual Models a. Sr. Callista Roy b. Dorothea Orem c. Imogene King d. Martha Rogers III. SEMI FINALS................................................... Chapter 7: LOCAL MODELS OF NURSING INTERVENTION....................... 1. Sr. Carol Agravante 5  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING 2. Carmelita Divinagracia 3. Letty Kuan 4. Carmencita Abaquin 5. Cecilia Laurente Chapter 8: CORE VALUES................................................ 1. Love of God 2. Caring a. Compassion b. Conscience c. Competence d. Confidence e. Commitment 3. Love of People a. Respect for the dignity of each person regardless of race, creed, color and gender 4. Love of Country a. Patriotism IV. FINALS........................................................ Chapter 9: CORE COMPETENCIES UNDER THE 11 KEY AREAS OF RESPONSIBILITIES 1. Patient Care Competencies a. Safe Quality Care b. Communication c. Collaboration d. Health Education 2. Enhancing a. Research b. Quality Improvement 3. Empowering a. Legal Responsibilities b. Ethico-moral Responsibilities c. Personal & Professional Development 4. Enabling a. Management of Resources and Environment 6  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING b. Records Management APPENDICES  Rubrics  List of additional references  List of figures  Acknowledgement and Disclaimer 7  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING COURSE DETAILS Subject: NCM 100- Theoretical Foundations of Nursing Units: 3 No. of Class Hours: 3/wk Section: _________ Year Level: First Course: Bachelor of Science in Nursing Subject Teacher: _________________ Contact Number: ____________ Schedule/Consultation hours: ___________________________________ Course Description: This course deals with the meta concepts of a person, health, environment and nursing as viewed by the different theorists. Likewise, it includes non-nursing theories such as systems, developmental and change theories. It presents how these concepts and theories serve as guide to nursing practice. It further deals with health as a multifactorial phenomenon and the necessary core competencies that the nurse need to develop. Course Outcomes: At the end of the course and given relevant actual or simulated situations/conditions, the student will be able to: 1. Differentiate views given by various nursing theorists on person, health, environment and nursing 2. Describe the various non-nursing theories as applied to nursing 3. Utilize selected nursing theory and non-nursing theories in the care of clients 4. Demonstrate selected competencies under the eleven key area s of responsibilities pertinent to nursing Methodology of Implementation: This is a distance learning strategy wherein the students will be provided with a copy of the Instructional Learning Guide (ILG) or be enrolled in the Learning Management System (LMS) to acquire the necessary knowledge skills, and attitude offered by the course. This is in response to the new mode of delivering instruction without requiring the students to report to school. The teacher shall conduct an orientation to the students via online platforms or text message regarding the utilization of this material for them to be guided throughout the duration of the course. Topics shall be assigned based on the syllabus of the subject. Specific instructions on how complete the activities per chapter will be given to the students. Activities are given at pre- determined time to be completed by the students. At the completion of each topic, students 8  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING are required to take the evaluative examinations which shall be given by the teacher based on the intended learning outcomes. During the duration of the course, students can consult their teachers at a specified time to address their difficulties or challenges they may encounter along the way. The subjects are structured in sequential order. Course materials and references shall be provided by the teacher in advance to facilitate teaching and learning process. Delivery Mode: 1. Hard/soft copy of the Instructional Learning Guide (Offline) 2. Learning Management System (Online) 3. Audio / video materials 4. Downloaded links 9  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING MIDTERMS COVERAGE Specific Instructions in the completion of each Chapter: 1. Set your learning goals. Read and understand the Intended Learning Outcomes of each chapter. This shall serve as your checklist of acquired knowledge and skills after completing the entire chapter, likewise, the basis of the teacher in the formulation of the summative evaluation given at the end of each chapter. 2. Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read and understand before answering the activities. You can take note those concepts that are not clear to you and refer to your subject teacher during the specified consultation hours. 3. Read the teacher’s insight and watch the downloaded videos saved in the flash drive to supplement the lecture notes. 4. As you go on, you will encounter exercises that will test your knowledge and understanding as well as your critical thinking. Read the instructions carefully, and write your answers to the space provided at the end of Midterm coverage. 5. Compile you outputs in your Learning Portfolio to be submitted on the date set by your teacher. 6. Should you have any queries or clarifications with the topics, please contact your subject teacher during consultation hours (please refer to the preliminaries of this material). Chapter 6 SELECTED NURSING THEORIES AND CONCEPTUAL MODELS Duration: 3.0 hours MAJOR TOPICS SUBTOPICS Philosophies  Florence Nightingale  Virginia Henderson  Faye Abdellah  Jean Watson Grand Theories  Madeleine Leininger  Nola Pender Middle-Range Theories  Hildegard Peplau  Ida Jean Orlando  Joyce Travelbee Conceptual Models  Sr. Callista Roy  Dorothea Orem 10  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING  Martha Rogers  Imogene King Activities: 1. Self-Assessment Exercises 2. Theory Critiquing Before you proceed… Intended Learning Outcomes: 1. Identify the proponents of the different theories 2. Discuss the theory as applied to the nursing paradigms 3. Determine the assumptions made by the theorist 4. Discuss the importance of the nursing theory with emphasis on nursing practice 5. Appreciate the importance of the theory Key Terms:  Nursing Theorists  Conceptual Models  Grand Theories  Middle Range Theories Let’s Begin! A. PHILOSOPHIES I. FLORENCE NIGHTINGALE  Was born in Florence Italy  May 12, 1820  was provided with very broad education  fought the bureaucracy for bandages, food, fresh bedding, & cleaning supplies for the soldiers during the Crimean War  great concern for the well-being of the English soldiers  she provided comfort for the critically ill & dying  after the war, she established schools of nursing  She died on August 13, 1910 11  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING  MOTHER OF MODERN NURSING ---She used the information gathered through life experiences in the development of nursing  GERMANY - was the first site of organized nursing school in1836 - Pastor Theodor Fliedner; opened a hospital in Kaiserswerth Germany - one patient, one nurse & one cook - lack of work force led to the development of a school in nursing - the physician spent time to teach nursing students  GERTRUDE REICHARDT - 1ST Matron of the Deaconess School of Nursing - no textbooks available until 1837 - Nightingale visited Kaiserswerth for 14 days - she entered the nursing program July 6, 1851, the 134th nursing student - she developed both nursing care & management skills Approach to Nursing:  Used her knowledge, understanding & prevalence of disease & her observation to develop an approach to nursing  CONTROL OF ENVIRONMENT---Individuals & family both healthy & ill 1. Ventilation & light 2. Proper disposal of sewage 3. Appropriate nutrition  NOTES ON NURSING: - thought to women who have personal charge of health of others - everyday sanitary knowledge - she wanted women to teach themselves to nurse - In her writings, she provided much information on the influence of the environment Environmental Model  Manipulation of the physical environment as a component of nursing care Major Areas Of Environment 1. Health Of Houses - Badly constructed houses do for the healthy what badly constructed hospitals do for the sick. Once insure that air is stagnant & sickness is certain to follow” - Cleanliness outside the house affects the inside 2. Ventilation & Warming - “keep the air he breathes as pure as the external air w/o chilling him” 3. Light - patient’s need direct sunlight - sick people rarely lie with their face toward the wall but are much more likely to face the window 4. Noise - patient’s should never be waked intentionally or accidentally - noise affects the healing 5. Variety 12  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING - Variety of environment was a critical aspect affecting the patient’s recovery - effect of the body & the mind - reading, needlework, writing, cleaning activities to relieve boredom. 6. Bed And Bedding - Keep bedding clean, neat, & dry & position the patient for maximum comfort 7. Cleanliness Of Rooms And Walls - “the greater part of nursing consists in preserving cleanliness” - she urges removal of dust instead of relocating - a clean room is a healthy room 8. Personal Cleanliness - Skin is important - excretion must be washed - unwashed skin can poison, drying & bathing can provide great relief - ”it is necessary to keep the pores of the skin free from all obstructing excretions” - “every nurse ought to wash her hands very frequently during the day 9. Nutrition and Taking Food 10.Chattering Hopes and Pieces of Advice 11.Observation of The Sick 12.Social Considerations Metaparadigm In Nursing  Nursing - “what nursing has to do...is to put the patient in the best condition for nature to act upon him” - signifies the proper use of the major areas in environment  Person - Not defined by Nightingale specifically, but are defined in relationship to their environment & the impact on them  Environment - She focused on ventilation, warmth, noise, light, & cleanliness - All that surrounds human beings is considered in relation to his state of health  Health - No definition of health specifically - pathology teaches the harm disease has done - “nature alone cures” - Nursing should provide care to the healthy & ill & discussed health promotion as an activity in which nurses should engage 13  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Teacher’s Insight The focus of nursing in this model is to alter the patient’s environment in order to affect change in his or her health. The environmental factors that affect health as identified in the theory are: fresh air, pure water, sufficient food supplies, efficient drainage, cleanliness of he patient and environment and light (particulary direct sunlight). If any of these areas is lacking, the patient may experience diminished health. A nurse’s role in a patient’s recovery as per Environmental theory is to alter the environment in order to gradually create the optimal conditions for the patient’s healing. For instances, minimal noise for clients with seizure or sunlight therapy for clients with vitamin D deficiency. Other areas also can be manipulated to help client/patient heal and recover. II. VIRGINIA HENDERSON  She was the “First Lady of Nursing” and “First Truly International Nurse”.  She began her career in Public health nursing in the Henry Street Settlement and visiting nurse service in Washington, D.C.  She was First Full-time Instructor in nursing in Virginia when she was at Norfolk Protestant Hospital.  During her years at Teacher College, Columbia University, she was an outstanding teacher and student.  She was Selected to the American Nurse Association Hall of Fame and had the sigma Theta Tau international Library named in her honored.  She introduced Textbook of the Principles and practice.  She also directed twelve-years project entitled Nursing Study Index.  In Nature of Nursing – she expressed her belief about the essence of nursing and influenced the hearts and mind of those who read it.  In 1921 – Virginia Henderson was an early advocate for introduction of psychiatric nursing in curriculum and serve on committee to develop such a course at Eastern State Hospital in Williamsbrug.  Age of 75 – Henderson directed her career to international teaching and speaking.  1988 – she was honored by the Virginia Nurse association and when the Virginia Historical Nurse Leadership Award was presented to her.  In 2000 – the Virginia nurse association recognize Henderson as one of fifty-one Pioneer Nurse in Virginia "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 14  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING knowledge. And to do this in such a way as to help him gain independence as rapidly as possible”. 14 Basic Needs  Physiological 1. Breath 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 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. Learn, discover, or satisfy the curiosity that leads to normal developmentand health and use the available health facilities.  Sociological 12. Work in such a way that there is a sense of accomplishment. 13. Play or participate in various forms of recreation  Spiritual 14.Worship according to one’s faith Metaparadigm In Nursing  Nursing - Henderson asserted that nurse function independently from the physician, but they must promote the treatment plan prescribe by the physician. - Although part of the health team, the nurse must act independently but in coordination with with the therapeutic plan developed by the team  Person - Is an individual who requires assistance to achieve health and independence or in some case, a peaceful death.  Environment - Individuals in relation to families - Supports tasks of private and public agencies - Society expects nurses to act for individuals who are unable to function independently - Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided  Health - Definition based on individual’s ability to function independently as outlined in the 14 components. - Nurses need to stress promotion of health and prevention and cure of disease. 15  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING - Good health is a challenge. - Affected by age, cultural background, physical, and intellectual capacities, and emotional balance - Impact on health by working of various social issues. The Three Level Compromising The Nurse-Patient Relationship: 1. “The nurse as a substitute for the patient” - In times of illness, when the patient cannot function fully, the nurse serve as then substitute as to what the patient lack such, as knowledge, will and strength in order to make him completed, whole independence once again. 2. “The nurse as a helper to the patient” - In situation where the patient cannot meet his basic needs, the nurse serve as a helper to accomplish them. 3. “The nurse as a partner with the patient” - As a partners, the nurse and the patient formulate the plan together. Both as an advocate and as a resource-person , the nurse can empower the patient to make effective decisions regarding his care plan. III. FAYE GLENN ABDELLAH  Identified 21 nursing problems.  Defined nursing as a service to individuals and families therefore to society.  Conceptualized nursing as an Art and science. 21 Nursing Problems 1. To maintain good hygiene 2. To promote optimal activity; exercise rest and sleep 3. To promote safety 4. To maintain good body mechanics 5. To facilitate the maintenance of a supply of oxygen 6. To facilitate maintenance of nutrition 7. To facilitate maintenance of elimination 8. To facilitate the maintenance of F&E balance 9. To recognize the physiologic responses of the body to disease condition 10.To facilitate the maintenance of regulatory mechanisms and functions 11.To facilitate the maintenance of sensory function 12.To identify and accept the positive and negative expressions, feelings and reactions 13.To identify and accept the interrelatedness of emotions and illness 14.To facilitate the maintenance of effective verbal and non-verbal communication 15.To promote the development of productive interpersonal relationship 16.To facilitate the progress towards achievement of personal spiritual goals 17.To create and maintain a therapeutic environment 16  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING 18.To facilitate awareness of self as an individual with varying needs 19.To accept the optimum possible goals 20.To use community resources as an aid in resolving problems arising from illness 21.To understand the role of social problems as influencing factors IV. JEAN WATSON PhD, RN, FAAN, HNC  Theorist was born in West Virginia, US  Educated: BSN, University of Colorado, 1964,  MS, University of Colorado, 1966,  PhD, University of Colorado, 1973  Distinguished Professor of Nursing  Endowed Chair in Caring Science at the University of Colorado Health Sciences Center.  Fellow of the American Academy of Nursing.  Previously, Dean of Nursing at the University Health Sciences Center and President of the National League for Nursing  Undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and PhD in educational psychology and counseling. She has six (6) Honorary Doctoral Degrees.  Her research has been in the area of human caring and loss.  In 1988, her theory was published in “nursing: human science and human care”.  Jean Watson’s Theory of Transpersonal Caring also called Theory of Human  Caring or The Caring Model was developed in 1979. Theory of Human Caring or The Caring Model  It emphasizes the humanistic aspects of nursing in combination with scientific knowledge  Watson designed this theory to bring meaning and focus to nursing as a distinct health profession  Watson believes that: “Caring” is an endorsement of professional nurses identity  According to Watson, the nurse’s role is to: - Establish a caring relationship with patients - Treat patients as holistic beings (body, mind and spirit) - Display unconditional acceptance - Treat patients with a positive regard - Promote health through knowledge and intervention 17  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING - Spend uninterrupted time with patients: “caring moments” 1. The formation of a humanistic- altruistic system of values. 2. The installation of faith-hope. 3. The cultivation of sensitivity to one’s self and to others. 4. The development of a helping-trust relationship 5. The promotion and acceptance of the expression of positive and negative feelings. 6. The systematic use of the scientific problem-solving method for decision making 7. The promotion of interpersonal teaching-learning. 8. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment. 9. Assistance with the gratification of human needs. 10.The allowance for existential-phenomenological forces The Seven Assumption 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 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 Ten Primary Carative Factors 1. The formation of a humanistic- altruistic system of values. (concern for the welfare of other, selflessness) – Begins developmentally at an early age with values shared with the parents. – Mediated through one’s own life experiences, the learning one gains and exposure to the humanities. – Is perceived as necessary to the nurse’s own maturation which then promotes altruistic behavior towards others 2. The installation of faith-hope. – Is essential to both the carative and the curative processes. 18  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING – When modern science has nothing further to offer the person, the nurse can continue to use faith-hope to provide a sense of well-being through beliefs which are meaningful to the individual. 3. The cultivation of sensitivity to one’s self and to others. – Explores the need of the nurse to begin to feel an emotion as it presents itself. – Development of one’s own feeling is needed to interact genuinely and sensitively with others. – Striving to become sensitive, makes the nurse more authentic, which encourages self-growth and self-actualization, in both the nurse and those with whom the nurse interacts. – The nurses promote health and higher level functioning only when they form person to person relationship 4. The development of a helping-trust relationship – Strongest tool is the mode of communication, which establishes rapport and caring. – Characteristics needed to in the helping-trust relationship are: – Congruence – Empathy – Warmth – Communication includes verbal, nonverbal and listening in a manner which connotes empathetic understanding 5. The promotion and acceptance of the expression of positive and negative feelings. – “Feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring relationship”. – Awareness of the feelings helps to understand the behavior it engenders. 6. The systematic use of the scientific problem-solving method for decision making – The scientific problem- solving method is the only method that allows for control and prediction, and that permits self-correction. – The science of caring should not be always neutral and objective 7. The promotion of interpersonal teaching-learning. – The caring nurse must focus on the learning process as much as the teaching process. – Understanding the person’s perception of the situation assist the nurse to prepare a cognitive plan. 8. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment. – Watson divides these into eternal and internal variables, which the nurse manipulates in order to provide support and protection for the person’s mental and physical well-being. 19  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING – The external and internal environments are interdependent. – Nurse must provide comfort, privacy and safety as a part of this carative factor 9. Assistance with the gratification of human needs. – It is based on a hierarchy of need similar to that of the Maslow’s. – Each need is equally important for quality nursing care and the promotion of optimal health. – All the needs deserve to be attended to and valued 10.The allowance for existential-phenomenological forces. – Phenomenology is a way of understanding people from the way things appear to them, from their frame of reference. – Existential psychology is the study of human existence using phenomenological analysis. – This factor helps the nurse to reconcile and mediate the incongruity of viewing the person holistically while at the same time attending to the hierarchical ordering of needs. – Thus the nurse assists the person to find the strength or courage to confront life or death. Teacher’s Insight In Caring Science, we as nurses need as much knowledge in caring as we do in curing. When we put caring into science, we provide the best care for our patients. Watson believes it is essential that we “Pause to Care!” Before any patient interaction, center yourself on the compassion you need to provide not only to your patients, but to yourself as well. In the busy day and age we live in, this is so very important! Remember that every human being needs to be heard, seen, know that they matter, and needs to have touch. Look at your patients beyond their physical disease process and truly apply the principle of caring for that patient. Being present with your patients is important too. Watson’s Ordering of Needs Lower order needs (biophysical needs) – The need for food and fluid – The need for elimination – The need for ventilation Lower order needs (psychophysical needs) – The need for activity-inactivity 20  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING – The need for sexuality Higher order needs (psychosocial needs) – The need for achievement – The need for affiliation – Higher order need (intrapersonal-interpersonal need) – The need for self-actualization Metaparadigm In Nursing  Person/Human being Human being refers to “….. a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. He, human is viewed as greater than and different from, the sum of his or her parts”.  Health Watson adds the following three elements to WHO definition of health: – A high level of overall physical, mental and social functioning – A general adaptive-maintenance level of daily functioning – The absence of illness (or the presence of efforts that leads its absence)  Environment/society According to Watson, caring (and nursing) has existed in every society. A caring attitude is not transmitted from generation to generation. It is transmitted by the culture of the profession as a unique way of coping with its environment.  Nursing “Nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health”. It focuses on health promotion and treatment of disease. She believes that holistic health care is central to the practice of caring in nursing. She defines nursing as….. “A human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions”. B. GRAND THEORIES V. MADELEINE LEININGER  Developed the Transcultural Nursing Model.  Advocated that nursing is a humanistic and scientific mode of helping a client through specific cultural caring process to improve or maintain a health condition. 21  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING  Leininger is the founder of the transcultural nursing movement in education research and practice. Transcultural Nursing Focus - cultural dynamics that influence the nurse–client relationship. (area of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups of similar or different cultures are compared) Goal – culturally congruent holistic care. Provide culture-specific and universal nursing care practices to promote well-being or to help people face unfavorable human conditions in culturally meaningful ways' Teacher’s Insight Navigating the unique cultural needs of your patients is very vital before rendering care to them. Without doing so, you might accidentally offend your patients or their families by not knowing about a crucial cultural practice and you could also witness something that goes against your personal beliefs and convictions and different from the nursing philosophies and principles that can at the same time affect the delivery of health care. Thus, it is very important to gather the cultural beliefs of your clients during the collection of data and health history taking. Second, respect their cultural practices as long as it does not threaten or contribute to risking their health status. VI. NOLA PENDER The Major Concepts and Definitions of the Health Promotion Model  The health promotion model (HPM) proposed by Nola J Pender (1982; revised, 1996) was designed to be a “complementary counterpart to models of health protection.”  It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a client’s level of well being.  The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health. A. Individual Characteristics and Experience  Prior related behaviour 22  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING  Frequency of the similar behaviour in the past.  Direct and indirect effects on the likelihood of engaging in health promoting behaviors. Personal Factors – Personal factors categorized as biological, psychological and socio-cultural. These factors are predictive of a given behavior and shaped by the nature of the target behaviour being considered. Personal biological factors – Include variable such as age gender body mass index pubertal status, aerobic capacity, strength, agility, or balance. Personal psychological factors – Include variables such as self esteem self motivation personal competence perceived health status and definition of health. Personal socio-cultural factors – Include variables such as race ethnicity, acculturation, education and socioeconomic status. A. Behavioural Specific Cognition and Affect Perceived Benefits Of Action – Anticipated positive outcomes that will occur from health behaviour. Perceived Barriers To Action – Anticipated, imagined or real blocks and personal costs of understanding a given behaviour Perceived Self Efficacy – Judgment of personal capability to organise and execute a health-promoting behaviour. Perceived self efficacy influences perceived barriers to action so higher efficacy result in lowered perceptions of barriers to the performance of the behavior. Activity Related Affect – Subjective positive or negative feeling that occur before, during and following behavior based on the stimulus properties of the behaviour itself. Activity-related affect influences perceived self-efficacy, which means the more positive the subjective feeling, the greater the feeling of efficacy. In turn, increased feelings of efficacy can generate further positive affect. Interpersonal Influences – Cognition concerning behaviours, beliefs, or attitudes of the others. Interpersonal influences include: norms (expectations of significant others), social support (instrumental and emotional encouragement) and modelling (vicarious learning through observing others engaged in a particular behaviour). Primary sources of interpersonal influences are families, peers, and healthcare providers. Situational Influences 23  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING – Personal perceptions and cognitions of any given situation or context that can facilitate or impede behaviour. Include perceptions of options available, demand characteristics and aesthetic features of the environment in which given health promoting is proposed to take place. Situational influences may have direct or indirect influences on health behaviour. C. MIDDLE RANGE THEORIES VII. HILDEGARD PEPLAU PhD, RN, FAAN (1909 - 1999)  MOTHER OF PSYCHIATRIC NURSING ( Founder of Mordern Psychiatric Nursing)  FAAN - Fellow of the American Academy of Nursing  Made extraordinary and sustained contributions to nursing and health care throughout their career  Nursing leaders in EDUCATION, MANAGEMENT, PRACTICE and RESEARCH  PhD – Doctor of Philosophy  Born in Reading, Pennsylvania on September 1, 1909  Graduated from the Pottstown, Pennsylvania Hospital  Worked as an Operating room Supervisor at Pottstown Hospital  Received a B.A. in interpersonal Psychology from Bennington College, Vermont, in 1943  M.A. (Psychiatric Nursing) from Teachers College, Columbia, New York, in 1947  Ed. D in curriculum Development from Columbia in 1953  During World Was II, Hildegard Peplau was a member of the Army Nurse Corps and worked in a neuropsychiatric hospital in london, England  She also did work at Bellevue and Chestnut Lodge Psychiatric Facilities and was in contact with renowned psychiatrist : o Freida-Riechman o Harry Stack Sullivan  Holds numerous awards and position: - The only nurse to serve the ANA as executive director and later as president - Served two terms on the Board of the International Council of Nurses (ICN). - In 1997, she received nursing's highest honor, the Christiane Reimann Prize, at the ICN Quadrennial Congress. - In 1996, the American Academy of Nursing honored Peplau as a "Living Legend," - In 1998, the ANA inducted her into its Hall of Fame  Retired in 1974 24  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING  Died peacefully on March 17, 1999 at her home in Sherman Oaks Californina after a brief of illness Psychodynamic nursing  Understanding of ones own behavior  To apply principles of human relations to the problems that arise at all levels of experience  Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal.  The nurse and patient work together so both become mature and knowledgeable in the process.  The attainment of goal is achieved through the use of a series of steps following a series of pattern.  According to Peplau, nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care. Metaparadigm In Nursing 4. Nursing - A significant therapeutic interpersonal process. It functions cooperatively with other human process that make health possible for individuals in communities 5. Person a. A developing organism that tries to reduce anxiety caused by needs Environment - Existing forces outside the organism and in the context of culture 6. Health - A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal and community living. Roles of nurse  Stranger : receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust.  Teacher : who imparts knowledge in reference to a need or interest  Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation  Counselors : helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes  Surrogate : helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate. 25  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING  Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way Theory of Interpersonal Relations  Middle range descriptive classification theory  Influenced by Harry Stack Sullivan's theory of inter personal relations (1953)  Also influenced by Percival Symonds , Abraham Maslow's and Neal Elger Miller  Identified four sequential phases in the interpersonal relationship: 1. Orientation 2. Identification 3. Exploitation 4. Resolution Orientation Phase  During this phase, the individual has a felt need and seeks professional assistance  The nurse helps the individual to recognize and understand his/ her problem and determine the need for help  Problem defining phase: identifies problem  Starts when client meets nurse as stranger  Defining problem and deciding type of service needed  Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past experiences  Nurse responds, explains roles to client, helps to identify problems and to use available resources and services  Activities: Nurse and patient come together as strangers; Meeting initiated by patient who expresses a “felt need”; Work together to recognize, Clarify and define facts related to need Identification Phase  The patient identifies with those who can help him/ her.  The nurse permits exploration of feelings to aid the patient in undergoing illness as an experience that reorients feelings and strengthens positive forces in the personality and provides needed satisfaction.  Selection of appropriate professional assistance  Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness  Activities: Patient participates in goal setting; 26  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING has feeling of belonging and selectively responds to those who can meet his or her needs. Exploitation Phase  During this phase, the patient attempts to derive full value from what he/ she are offered through the relationship.  The nurse can project new goals to be achieved through personal effort and power shifts from the nurse to the patient as the patient delays gratification to achieve the newly formed goals.  Use of professional assistance for problem solving alternatives  Advantages of services are used is based on the needs and interests of the patients  Individual feels as an integral part of the helping environment  They may make minor requests or attention getting techniques  The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem  Patient may fluctuates on independence  Nurse must be aware about the various phases of communication  Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step  Activity: Patient actively seeks and draws knowledge and expertise of those who can help Resolution Phase  Termination of professional relationship  The patients’ needs have already been met by the collaborative effect of patient and nurse  Now they need to terminate their therapeutic relationship and dissolve the links between them.  Sometimes may be difficult for both as psychological dependence persists  Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals  Activity: 27  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Occurs after other phases are completed successfully. This leads to termination of the relationship. Teacher’s Insight Nursing can be a very stressful career and it takes a solid collection of interpersonal skills to handle the tasks of dealing with patients, their family and friends and other medical personnel. Nurses are often the first person an injured or ill person interacts with, no matter if it’s at a medical facility or a Doctor’s office. It is essential nurse’s arm themselves with the best arsenal of skills to deal with the stressful situations nurses encounter each and every day. Among those skill includes interpersonal skills such as active listening and effective communication. Also it is imperative to build trust between you’re your relationship with your patient. It plays an important role in gathering truthful and necessary data needed for the implementation of nursing actions. VIII. IDA JEAN ORLANDO  Theorist, Ida Jean Orlando was born in 1926.  Ida J. Orlando was one of the first nursing theorists to write about the nursing process.  Nursing diploma - New York Medical College  BS in public health nursing - St. John's University, NY,  MA in mental health nursing - Columbia University, New York.  Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental Health Psychiatric Nursing.  Project investigator of a National Institute of Mental Health grant entitled: Integration of Mental Health Concepts in a Basic Nursing Curriculum.  Her theory was published in her 1961 book, The Dynamic Nurse-Patient Relationship.  Further development of her theory at McLean Hospital in Belmont, MA as Director of a Research Project: Two Systems of Nursing in a Psychiatric Hospital. The results were conceptualized in her 1972 book titled: The Discipline and Teaching of Nursing Processes  A board member of Harvard Community Health Plan, and served as both a national and international consultant  Theorethical Sources - Paplau’s focus of interpersonal relationships in nursing 28  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Paplau acknowledged the influence of Harry Stack Sullivan on the - development of her ideas - Symbolic interactionism – Chicago school  Use of field methodology - John Dewey’s theory of inquiry  Major Dimensions - The role of the nurse is to find out and meet the patient's immediate need for help. - The patient's presenting behavior may be a plea for help; however, the help needed may not be what it appears to be. - Therefore, nurses need good judgment to explore with patients the meaning of their behavior. - This process helps nurse find out the nature of the distress and what help the patient need Nursing Process Assessment  Systematic and continuous collection, validation and communication of client data as compared to what is standard/norm Purpose: to establish a data base Types Of Assessment: 1. Initial Assessment – assessment performed within a specified time on admission Ex: Nursing admission assessment Physical assessment on admission Physician’s history & physical examination 2. Problem-Focused Assessment – use to determine status of a specific problem identified in an earlier assessment Ex: Fluid intake & urine output (problem on urination-assess) (Diuresis/polyuria, Dysuria, Anuria, Oliguria) Snellens test (Visual Acuity) 3. Emergency Assessment – rapid assessment done during any physiologic/physiologic crisis of the client to identify life threatening problems. Ex: Assessment of a client’s airway, breathing status & circulation after a cardiac arrest 4. Time-Lapsed Assessment – reassessment of client’s functional health pattern 29  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING – Done several months after initial assessment to compare the clients current status to baseline data previously obtained. Types of Data: 1. Subjective Data – Symptom/Covert data – Information from the client’s point of view or are described by the person experiencing it. – Information supplied by family members, significant others, other health professionals are considered subjective data. Example: pain, dizziness, ringing of ears/Tinnitus (-) guarding behavior (-) facial Grimace 2. Objective Data – Sign/Overt data – Those that can be detected, observed or measured/tested using accepted standard or norm. Example: pallor, diaphoresis, BP=150/100, yellow discoloration of skin Pain scale – 0/10 “Hindi na masakit ang tiyan ko” as verbalized by the patient Patient reports of dizziness Patient has wobbling gait “Masakit ang tiyan ko” as verbalized by the patient Petechiae Methods of Data Collection: 1. Interview – A planned, purposeful conversation/communication with the client to get information, identify problems, evaluate change, to teach, or to provide support or counselling. 2. Observation – use to gather data by using the 5 senses and instruments Sources Of Data: 1. Primary source – data directly gathered from the client using interview and physical examination. 2. Secondary source – data gathered from client’s family members, significant others, client’s medical records/chart, other members of health team, and related care literature/journals. Diagnosing  Is the 2nd step of the nursing process  The process of reasoning or the clinical act of identifying problems  Identifies health care needs  Analyze assessment information and derive meaning from this analysis. 30  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Types of Nursing Diagnosis: 1. Actual Nursing Diagnosis – a client problem that is present at the time of the nursing assessment. It is based on the presence of signs and symptoms. – Constipation r/t long term use of laxative. – Ineffective airway clearance r/t to viscous secretions 2. Potential Nursing Diagnosis – evidence about a health problem is incomplete or unclear. It requires more data to support or reject it; or the causative factors are unknown. Problem is only considered possible to occur – Possible nutritional deficit – Possible low self-esteem r/t loss job 3. Risk Nursing Diagnosis – is a clinical judgment that a problem does not exist, therefore no S/S are present instead RISK FACTORS are present *Risk factors indicates that a problem is only is likely to develop unless nurse intervene or do something about it. No subjective or objective cues are present therefore the factors that cause the client to be more vulnerable to the problem is the etiology of a risk nursing diagnosis. – Risk for Constipation r/t inactivity and insufficient fluid intake Planning  To identify client goals; to determine priorities of care; to design nursing strategies to achieve expected outcomes of care; to determine outcome criteria-  SMART –Specific, Measurable, Attainable and Realistically Time-bound. – Ex: to reduce fever within the baseline data of 37 by giving prn antipyretic medication and performing tepid sponge bath for 4 hrs Implementation  To complete nursing actions necessary for accomplishing plan  Reassess client.  Review and modify existing care plan.  Perform nursing actions. *Nursing actions – directed towards providing for the patient’s immediate need Evaluation  To determine extent to which expected outcomes have been achieved. 31  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING One of the fundamental principles for developing critical thinking is the nursing process,” Vest says. “It needs to be a lived experience in the learning environment.” Nursing students often find that there are multiple correct solutions to a problem. The key to nursing is to select the “the most correct” solution—one that will be the most efficient and best fit for that particular situation. You will often find yourself in situations where there are few “correct” forms of care, but one that is most appropriate. Using the nursing process, students can narrow down their options to select the best one. IX. JOYCE TRAVELBEE  Born in 1926,  A psychiatric nurse, educator and writer.  In 1956, she completed her Bachelor of Science degree in nursing education at Louisiana State University and her Master of Science Degree in Nursing from Yale University in 1959.  She started a doctoral program in Florida in 1973.  Unfortunately, she was not able to finish the program because she died later that year. She passed away at the prime age of 47 after a brief sickness.  In 1952, Travelbee started to be an instructor focusing in Psychiatric Nursing at Depaul Hospital Affiliate School, New Orleans, while working on her baccalaureate degree. Besides that, she also taught Psychiatric Nursing at Charity Hospital School of Nursing in Louisiana State University, New York University and University of Mississippi. In 1970,she was named Project Director at Hotel Dieu School of Nursing in New Orleans. Travelbee was the director of Graduate Education at Louisiana State University School of Nursing until her death.  In 1963, Travelbee started to publish various articles in nursing journals. Her first book entitled: Interpersonal Aspects of Nursing was published in 1966 and 1971.  In 1969, she had her second book published entitled: Intervention in Psychiatric Nursing : Process in the One-to-One Relationship. Human to Human Relationship Model  In her human-to-human relationship model, the nurse and the patient undergoes the following series of interactional phases: 32  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Original Encounter  This is described as the first impression by the nurse of the sick person and vice- versa. The nurse and patient see each other in stereotyped or traditional roles. Emerging Identities  This phase is described by the nurse and patient perceiving each other as unique individuals. At this time, the link of relationship begins to form. Empathy  Travelbee proposed that two qualities that enhance the empathy process are  Similarities of experience  the desire to understand another person  This phase is described as the ability to share in the person’s experience. The result of the empathic process is the ability to expect the behavior of the individual with whom he or she empathized. Sympathy  Sympathy happens when the  Nurse wants to lessen the cause of the patient’s suffering.  “When one sympathizes, one is involved but not incapacitated by the involvement.” The nurse should use a disciplined intellectual approach together with therapeutic use of self to make helpful nursing actions.. Teacher’s Insight The terms empathy and sympathy are often confused. Although both of the words deal with the relationship a person has to the feelings and experiences of another person One is considered to be of more therapeutic than the other. Both sympathy and empathy have roots in the Greek term páthos meaning “suffering, feeling.”Sympathy is largely used to convey commiseration, pity, or feelings of sorrow for someone else who is experiencing misfortune. You feel bad for them … but you don’t know what it is like to be in their shoes. Empathy on the other hand is now most often used to refer to the capacity or ability to imagine oneself in the situation of another, experiencing the emotions, ideas, or opinions of that person. For the two, empathy is more of therapeutic use than sympathy. Meaning for nurses, we should be aware that we must understand our patient’s feelings by trying to put our self in their situation to better understand their needs but not to be sympathetic to their situation in anyway. 33  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Rapport  Rapport is described as nursing interventions that lessens the patient’s suffering.  The nurse and the sick person are relating as human being to human being.  The sick person shows trust and confidence in the nurse. “A nurse is able to establish rapport because she possesses the necessary knowledge and skills required to assist ill persons, and because she is able to perceive, respond to, and appreciate the uniqueness of the ill human being.” Note that the above stated interactional phases are in consecutive order and developmentally achieved by the nurse and the patient as their relationship with one another goes deeper and more therapeutic D. CONCEPTUAL MODEL/S X. DOROTHEA OREM Self Care and Self Deficit Theory  Self-care – is the performance or practice of activities that individuals initiate and perform on their behalf – The human’s ability or power to engage in self-care  3 Classifications of Nursing Systems: - Wholly compensatory – for people who are socially dependent on others for their existence and well being - Partly compensatory – both nurse and patient perform care measures - Supportive – educative – where the nurse is able to perform or can and should learn to perform required measures of self-care but cannot do so without assistance XI. MARTHA ROGERS  Conceptualizes the science of unitary human beings.  Nursing as an art and science that is humanistic and humanitarian. It is directed toward the unitary human and is concerned with the nature and direction of human development.  The goal of every nurse is to participate in the process of change. XII. IMOGENE KING  Postulated the goal attainment model.  Described nursing as a helping profession that assists the individuals and groups in society to attain, maintain, and restore health.  Nursing is a process of action, reaction and interaction whereby nurse and client share information about their perception in the nursing situation. Goal Attainment Theory 34  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING  Believes that there are 3 interacting systems:  Individual (Personal System)  Group (Interpersonal System)  Society (Social Systems) XIII. SISTER CALLISTA ROY  Born at Los Angeles on October 14, 1939 as the 2nd child of Mr. and Mrs. Fabien Roy.  At age 14 she began working at a large general hospital, first as a pantry girl, then as a maid, and finally as a nurse's aid.  She entered the Sisters of Saint Joseph of Carondelet.  she earned a Bachelor of Arts with a major in nursing from Mount St. Mary's College, Los Angeles in 1963.  a master's degree program in pediatric nursing at the University of California ,Los Angeles in 1966.  She also earned a master’s & PhD in Sociology in 1973 & 1977 ,respectively  Sr. Callista had the significant opportunity of working with Dorothy E. Johnson  Johnson's work with focusing knowledge for the discipline of nursing convinced Sr. Callista of the importance of describing the nature of nursing as a service to society and prompted her to begin developing her model with the goal of nursing being to promote adaptation. ADAPTATION THEORY 35  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING  System-a set of parts connected to function as a whole for some purpose.  Stimulus-something that provokes a response, point of interaction for the human system and the environment  Focal Stimuli-internal or external stimulus immediately affecting the system  Contextual Stimulus-all other stimulus present in the situation.  Residual Stimulus-environmental factor, that effects on the situation that are unclear.  Regulator Subsystem-automatic response to stimulus (neural, chemical, and endocrine)  Cognator Subsystem-responds through four cognitive responds through four cognitive-emotive channels (perceptual and information processing, learning, judgment, and emotion)  Behavior -internal or external actions and reactions under specific circumstances  Physiologic-Physical Mode – Behavior pertaining to the physical aspect of the human system – Physical and chemical processes – Nurse must be knowledgeable about normal processes – 5 needs (Oxygenation, Nutrition, Elimination, Activity & Rest, and Protection)  Self Concept-Group Identity Mode 36  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING – The composite of beliefs and feelings held about oneself at a given time. Focus on the psychological and spiritual aspects of the human system. – Need to know who one is, so that one can exist with a state of unity, meaning, and purposefulness of 2 modes (physical self, and personal self)  Role function Mode – Set of expectations about how a person occupying one position behaves toward a occupying another position. Basic need-social integrity, the need to know who one is in relation to others  Interdependence Mode – Behavior pertaining to interdependent relationships of individuals and groups. Focus on the close relationships of people and their purpose. – Each relationship exists for some reason. Involves the willingness and ability to give to others and accept from others. – Balance results in feelings of being valued and supported by others. Basic need - feeling of security in relationships  Adaptive Responses-promote the integrity of the human system.  Ineffective Responses-neither promote not contribute to the integrity of the human system  Coping Process-innate or acquired ways innate or of interacting with the changing of environment Reminders: Before proceeding to the exercises, if you have other topics not fully clear to you, feel free to browse again on the topics and you can also do additional readings from other textbooks and references. No cheating in the self- assessment exercises. Answer it on your own without looking at your notes. Good Luck! I. SELF ASSESSMENT EXERCISES: Answer the questions by choosing the letter of your preferred answers. Use the answer sheet provided at the end of the exercise. 1. Maintenance of system equilibrium is a goal of: A. Imogene King C. Joyce Travelbee B. Betty Neuman’s D. Dorothea Orem 37  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING 2. Identified 14 basic needs and says that the unique functions of the nurse is to assist clients, sick or well in the peaceful death. A. Virginia Henderson C. Dorothea Orem B. Imogene King D. Faye Glen Abdellah 3. A patient in Intensive Care Unit (ICU) who is coma for 4 days is being bathed by a kind nurse. This reflects which level of nurse-patient relationship according to V. Henderson? A. Nurse as a substitute C. Nurse as a partner B. Nurse as a helper D. Nurse as a believer 4. Mrs. Lozada is a 25 year old, pale looking cafeteria manager who often retires very late at night. She went to the hospital complaining of dizziness, fatigue and body malaise. The diagnosis of the physician is anemia (below normal level of red blood cells and haemoglobin). The nurse instructed the patient about the food that she must take. This action is: A. Nurse as a substitute C. Nurse as a partner B. Nurse as a helper D. Nurse as a believer 5. A man who has had quadriplegia from a fall accident is being cared by the nurse thru the performance of ADL’s (Activities of Daily Living) for him. The nurse acts as a? A. Substitute C. Partner B. Helper D. Believer 6. Who is this nurse theorist that has been called the “First Truly International Nurse”? A. Faye Abdellah C. Imogene King B. Virginia Henderson D. Dorothy Johnson 7. The nurse is interviewing the newly admitted client in the geriatric ward. The nurse is including the client in making a health plan. Which of the following this action is included? A. Substitute C. Partner B. Helper D. Believer 8. She defined health as “Health is a condition in which all parts and subparts are in harmony with the whole of the client.” Who among the following theorist defined this? A. Imogene King C. Dorothy Johnson B. Betty Neuman D. Dorothea Orem 9. Virginia Henderson believed that the nurses needed to be more that caregivers, they needed to be both educators and advocates. A nurse must keep an individual fulfill which fundamental need? 38  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING A. Dependence on health care providers. B. Seeking help from health care providers. C. Refraining from expressing their emotions. 10.Which of the following nursing theorists introduced Transcultural Nursing model? A. Sister Callista Roy C. Ernestine Wiedenbach B. Jean Watson D. Madeleine Leininger 11.Who is this nurse theorist that introduced "The Nursing Process Theory"? A. Lydia Hall C. Sister Kuan B. Ida Jean Orlando D. Patricia Benner 12.This theory is about the person in adaptive system which uses coping skills to deal with stressors. A. "Humanistic Nursing" B. "Adaptation Theory" C. "Theory of Human Becoming" D. "PREPARE ME" Interventions & the Quality of Life of Advance Progressive Cancer Patients 13.It refers to assistive, supporting professional notions that help people retain relevant values so they can maintain well being. A. Cultural care repatterning B. Cultural care preservation C. Cultural care accommodation D. Cultural care restructuring 14.Typology of twenty one Nursing problems were explained by: A. Imogene King C. Faye G. Abedellah B. Virginia Henderson D. Lydia E. Hall 15.Which of the following statements is related to Florence Nightingale? A. Nursing is therapeutic interpersonal process. B. The role of nursing is to facilitate "the body’s reparative processes" by manipulating client’s environment. C. Nursing is the science and practice that expands adaptive abilities and enhances person and environment transformation D. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs. 16.Watson's carative factors include all the following, EXCEPT: A. Forming humanistic-altruistic value system B. Instilling faith-hope C. Cultivating sensitivity to self and others D. Strengthening flexible lines of defense 39  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING 17.When applying Roy's Adaptation Model in caring a patient, the type of stimuli which needs to be assessed as per are all the following, EXCEPT; A. Focal Stimulus B. Contextual Stimulus C. Perceptual Stimulus D. Residual Stimulus 18.Which is NOT a concept related to Faye Abdellah's theory? A. Susternal Care Needs B. The twenty-one Nursing Problems C. Restorative Care Needs D. Therapeutic Self-care Demands 19.According to Roy's Adaptation Model, the adaptive modes includes all the following, EXCEPT: A. Physiologic Needs C. Role Function B. Self Concept D. Achievement 20.Category of self care requisites according to Orem's theory of nursing includes all, EXCEPT: A. Universal C. Health deviation B. Developmental D. Fundamental 21.Imogene King's "goal attainment theory" is a type of: A. Need theories C. Outcome theories B. Interaction theories D. Humanistic theories 22.“Notes on Nursing: What it is – what it is not” was written by: A. Virginia Henderson C. Jean Watson B. Patricia Benner D. Florence Nightingale 23.Which of the following is NOT a concept related to Roy's Adaptation Model? A. Focal Stimuli C. Role function B. Cognator Subsystem D. Flexible line of defense 24.The definition of nursing according to Nightingale is: A. Assisting individual, sick and well, in the performance of those activities contributing to health and recovery that he would perform unaided if he had the necessary strength, will, or knowledge. B. A clinical discipline that is a practice discipline designed to produce explicit desired result. C. Put the patient in the best condition for the nature to act upon him. D. The science and practice that expands adaptive abilities and enhances person and environment transformation. 25. Cognator subsystem is a concept related to: A. Jhonson'sBehaviour System Model B. Imogene King's Goal Attainment Theory C. Roy's Adaptation Model 40  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING D. Neuman's System's Model Self Assessment Exercises: Answer Sheet 1. ______________________ 2. ______________________ 3. ______________________ 4. ______________________ 5. ______________________ 6. ______________________ 7. ______________________ 8. ______________________ 9. ______________________ 10.______________________ 11.______________________ 12.______________________ 13.______________________ 14.______________________ 15.______________________ 16.______________________ 17.______________________ 18.______________________ 19.______________________ 20.______________________ 21.______________________ 22.______________________ 23.______________________ 24.______________________ 25.______________________ II. Theory Critiquing: In each categories of nursing theory presented, choose one from each category: Philosophies, Grand Theories, Middle Range, Conceptual Models, and make a comprehensive theory critiquing. Use the tables below for your answers. *Note: You can use other books/journals as your reference. I. PHILOSOPHIES 41  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING THEORY:__________________________________________________________ Content: Clarity: Simplicity: Generality: Accessibility: Importance: Nursing Metaparadigm: Person: Health: Environment: 42  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Nursing: Assumption/s: References(APA Style): II. GRAND THEORY THEORY:__________________________________________________________ Content: Clarity: 43  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Simplicity: Generality: Accessibility: Importance: Nursing Metaparadigm: Person: Health: Environment: Nursing: Assumption/s: 44  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING References(APA Style): III. MIDDLE RANGE THEORY THEORY:__________________________________________________________ Content: Clarity: 45  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Simplicity: Generality: Accessibility: Importance: Nursing Metaparadigm: Person: Health: Environment: Nursing: Assumption/s: 46  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING References(APA Style): IV. CONCEPTUAL MODEL/S THEORY:__________________________________________________________ Content: Clarity: 47  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Simplicity: Generality: Accessibility: Importance: Nursing Metaparadigm: Person: Health: Environment: Nursing: Assumption/s: 48  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING References(APA Style): THIS IS THE END OF THE MIDTERMS COVERAGE Before proceeding to the Semi Finals Coverage….  Do not forget to write your reflective journal for this term regarding your learnings, personal reflections and realizations of the different concepts given. All written outputs should be compiled in your learning 49  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING portfolio to be submitted to the subject teacher as part of the requirements of the course. Rubric for Reflective Journal Completeness: 50% Construction of Sentence : 45% (organization of thoughts, grammar) Creativity/Neatness: 5% _____ 50  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Total: 100% RUBRICS FOR THEORY CRITIQUE 10 8 6 4 2 0 Excellent Very Good Good Fair Poor Non- 51  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING Compli ant Content in terms Comprehen Adequate Inadequ Inadequ No No of Clarity, sive critique/ ate ate critique answer Simplicity, critique/ analysis in critique/ critique/ done provided Generality, analysis in terms of the analysis analysis and Accessibilit terms of 5 concepts in terms in terms provide y and the 5 but was not of the of the d Importanc concepts explained concept concept summar e needed comprehensi s s y only. and vely needed. needed. explained Lacking Lacking broadly 1-2 3-4 concept concept s in s in critiquin critiquin g. g. Applicati Application Some Some Applicati No on of theory application applicati on of applicat No Application to the four of theory to on of theory ion of answer of theory concepts of the four theory to the theory to nursing the nursing concepts of to the four done. meta met the nursing four concept Concept paradigm paradigm met concept s of the s are (person, are all paradigm s of the nursing not nursing, correct and are correct. nursing met related health and appropriate Only three met paradig to environme concepts paradig m are theory. nt) were m are incorrect correlated correct. but properly and Only somewh correctly one to at two related concept to the s were concept 52  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING correlat s of the ed theory properly and correctly Assumpti Specific Conveys Conveys Does Topics No ons statements topic and topic not and answer supported subtopics of generall adequat subtopi with strong the theory y with ely cs are topic and only it limited convey not clearly provides discussi topics related defined general on of and at all to subtopics statements importa subtopic the of the nt s of the theory theory subtopic theory s of the theory Referenc Wide Varied Limited One Did not es and variety, references referenc type of One use/indic APA style appropriate used with es used referenc type of ate any and timely most of with e is referen referenc references them are some used ce is es used. timely and outdate with used Format has appropriate. d and many which is no errors. Format has format errors of somew few errors. has the hat not some format. related obvious to the errors. theory with many errors of the format. 53  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING REFERENCES: TEXTBOOK: Nursing Theories and their Works 9th ed, Alligood, 2018 Other References: 54  MEDICAL COLLEGES OF NORTHERN PHILIPPINES Alimannao Hills Penablanca, Cagayan COLLEGE OF NURSING 1. Theoretical basis for nursing 5th ed. (R) Mcewen 2019 2. Fundamentals of nursing 9th ed. (T) Potter 2017 3. Kozier and Erb's Fundamentals of Nursing: Concepts, Process, and Practice volume 1+ vol 2 (T) Bermam, 2016 4. Kozier & Erb’s Fundamentals of Nursing Concepts, Process and Practice 9th ed. (T) Berman, A 2014 Journals : 1. American Journal of Nursing 2. Philippine Journal of Nursing Education 3. The Journal for Nurse Practitioners Website: 1. www.nurseslabs.com 2. medicinenet.com 3. nursing-theory.org 4. www.nursingguide.html 55