Nursing Theories PDF

Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences THEORETICAL FOUNDATIO...

Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences THEORETICAL FOUNDATION IN NURSING Nursing Theories FINAL PERIOD 1. HILDEGARD PEPLAU’S INTERPERSONAL RELATIONSHIP THEORY The need for a partnership between nurse and client is § The nurse responds, explains roles to the client, very substantial in nursing practice. This helps nurses and identifies problems, and uses available resources and healthcare providers develop more therapeutic interventions in services. the clinical setting. According to Peplau (1952/1988), nursing is therapeutic because it is a healing art, assisting an individual 2. Identification Phase: The identification phase begins when who is sick or in need of health care. Nursing can be viewed as the client works interdependently with the nurse, expresses an interpersonal process because it involves interaction feelings, and begins to feel stronger. between two or more individuals with a common goal. In nursing, § Selection of appropriate professional assistance this common goal provides the incentive for the therapeutic § The patient begins to have a feeling of belonging and process in which the nurse and patient respect each other as the capability of dealing with the problem, which individuals, both of them learning and growing due to the decreases the feeling of helplessness interaction. An individual learns when she or he selects stimuli and hopelessness. in the environment and then reacts to these stimuli. 3. Exploitation Phase: In the exploitation phase, the client Hildegard Peplau’s Interpersonal Relations Theory makes full use of the services offered. emphasized the nurse-client relationship as the foundation of § Use of professional assistance for problem-solving nursing practice. It emphasized the give-and-take of nurse-client alternatives relationships that was seen by many as revolutionary. Peplau § The advantages of services are used based on the went on to form an interpersonal model emphasizing the need needs and interests of the patients. for a partnership between nurse and client as opposed to the § The individual feels like an integral part of the helping client passively receiving treatment and the nurse acting out environment. doctor’s orders. § They may make minor requests or attention-getting techniques. The four components of the theory are person, which § The principles of interview techniques must be used to is a developing organism that tries to reduce anxiety caused by explore, understand and adequately deal with the needs; environment, which consists of existing forces outside underlying problem. of the person and put in the context of culture; health, which is § The patient may fluctuate in independence. a word symbol that implies a forward movement of personality § Nurses must be aware of the various phases of and nursing, which is a significant therapeutic interpersonal communication. process that functions cooperatively with another human § The nurse aids the patient in exploiting all avenues of process that makes health possible for individuals in help, and progress is made towards the final step. communities. 4. Resolution Phase: In the resolution phase, the client no Hildegard E. Peplau’s theory defined Nursing as “An longer needs professional services and gives up dependent interpersonal process of therapeutic interactions between an behavior. The relationship ends. individual who is sick or in need of health services and a nurse § In the resolution phase, the client no longer needs especially educated to recognize, and respond to the need for professional services and gives up dependent help.” It is a “maturing force and an educative behavior. The relationship ends. instrument” involving an interaction between two or more § Termination of professional relationship individuals with a common goal. § The collaborative effect of patient and nurse has In nursing, this common goal provides the incentive for already met the patient’s needs. the therapeutic process in which the nurse and patient respect § Now they need to terminate their therapeutic each other as individuals, both of them learning and growing due relationship and dissolve the links between them. to the interaction. An individual learns when she or he selects § Sometimes, it may be difficult for both as psychological stimuli in the environment and then reacts to these stimuli. dependence persists. § The patient drifts away and breaks the nurse’s bond, Therapeutic nurse-client relationship and a healthier emotional balance is demonstrated, A professional and planned relationship between client and both become mature individuals. and nurse focuses on the client’s needs, feelings, problems, and ideas. It involves interaction between two or more individuals Subconcepts of the Interpersonal Relations Theory with a common goal. The attainment of this goal, or any goal, is achieved through a series of steps following a sequential Peplau’s model has proved greatly used by later nurse pattern. theorists and clinicians in developing more sophisticated and therapeutic nursing interventions. Four Phases of the therapeutic nurse-patient relationship: The following are the roles of the Nurse in the 1. Orientation Phase: The nurse’s orientation phase involves Therapeutic relationship identified by Peplau: engaging the client in treatment, providing explanations and § Stranger: offering the client the same acceptance and information, and answering questions. courtesy that the nurse would respond to any stranger § Problem defining phase § Resource person: providing specific answers to § It starts when the client meets the nurse as a stranger. questions within a larger context § Defining the problem and deciding the type of service § Teacher: helping the client to learn formally or needed informally § The client seeks assistance, conveys needs, asks § Leader: offering direction to the client or group questions, and shares preconceptions and § Surrogate: serving as a substitute for another such as expectations of past experiences. a parent or a sibling NCM 100 l NURSING THEORIES Page 1 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences § Counselor: promoting experiences leading to health for the client such as the expression of feelings Four Levels of Anxiety § Technical Expert: Provides physical care for the § Mild anxiety is a positive state of heightened patient and operating equipment awareness and sharpened senses, allowing the person to learn new behaviors and solve problems. The Peplau also believed that the nurse could take on many other person can take in all available stimuli (perceptual roles, but these were not detailed. However, they were “left to field). the intelligence and imagination of the readers.” (Peplau, 1952) § Moderate anxiety involves a decreased perceptual Additional roles include: field (focus on the immediate task only); the person can § Technical expert learn a new behavior or solve problems only with § Consultant assistance. Another person can redirect the person to § Health teacher the task. § Tutor § Severe anxiety involves feelings of dread and terror. § Socializing agent The person cannot be redirected to a task; he or she § Safety agent focuses only on scattered details and has physiologic § Manager of the environment symptoms of tachycardia, diaphoresis, and chest pain. § Mediator § Panic anxiety can involve loss of rational thought, § Administrator delusions, hallucinations, and complete § Recorder observer physical immobility and muteness. The person may § Researcher bolt and run aimlessly, often exposing himself or herself to injury. Anxiety was defined as the initial response to a psychic threat. There are four levels of anxiety described below. 2. IDA JEAN ORLANDO’S DELIBERATIVE NURSING PROCESS THEORY One important thing that nurses do is converse with the presenting behavior appears, it may represent a cry for help patients and let them know what the plan of care will be. from the patient. The patient’s presenting behavior, which is However, regardless of how well thought out a nursing care considered the stimulus, causes an automatic internal response plan is for a patient, unexpected problems to the patient’s in the nurse, which in turn causes a response in the patient. recovery may arise at any time. With these, the nurse’s job is to Distress. The patient’s behavior reflects distress when know how to deal with those problems so the patient can the patient experiences a need that he cannot resolve, a sense continue to get back and reclaim his or her well-being. Ida Jean of helplessness occurs. Orlando developed her Deliberative Nursing Process that allows nurses to formulate an effective nursing care plan that can also The immediate reaction is the internal response. The be easily adapted when and if any complexity comes up with the patient perceives objects with his or her five senses. These patient. perceptions stimulate automatic thought, and each thought stimulates an automatic feeling, causing the patient to act. Ida Jean Orlando’s nursing theory stresses the These three items are the patient’s immediate response. The reciprocal relationship between patient and nurse. It immediate response reflects how the nurse experiences his or emphasizes the critical importance of the patient’s participation her participation in the nurse-patient relationship. in the nursing process. Orlando also considered nursing as a Nurse Reaction. The patient’s behavior stimulated a distinct profession. She separated it from medicine, where nurse’s reaction, which marks the nursing process discipline’s nurses determine nursing action rather than being prompted by beginning. physician’s orders, organizational needs, and past personal Nurse’s Action. When the nurse acts, an action experiences. She believed that the physician’s orders were for process transpires. This action process by the nurse in a nurse- patients and not for nurses. patient contact is called the nursing process. The nurse’s action may be automatic or deliberative. She proposed that “patients have their meanings and Automatic Nursing Actions are nursing actions interpretations of situations and therefore nurses must validate decided upon for reasons other than the patient’s immediate their inferences and analyses with patients before concluding.” need. Subconcepts Deliberative Nursing Actions are actions decided upon after The function of professional nursing is the organizing ascertaining a need and then meeting this need. principle. This means finding out and meeting the patient’s The following list identifies the criteria for deliberative actions: immediate needs for help. According to Orlando, nursing is § Deliberative actions result from the correct responsive to individuals who suffer or who anticipate a sense identification of patient needs by validating the nurse’s of helplessness. It is focused on the process of care in an reaction to patient behavior. immediate experience. It is concerned with providing direct § The nurse explores the meaning of the action with the assistance to a patient in whatever setting they are found to patient and its relevance to meeting his needs. avoid, relieve, diminish, or cure the patient’s sense of § The nurse validates the action’s effectiveness helplessness. The Nursing Process Discipline Theory labels the immediately after completing it. purpose of nursing to supply the help a patient needs for their § The nurse is free of stimuli unrelated to the patient’s needs to be met. If the patient has an immediate need for help, need when she acts. and the nurse discovers and meets that need, the purpose of nursing has been achieved. The nursing process discipline is the investigation into the patient’s needs. Any observation shared and explored with the Presenting behavior is the patient’s problematic patient is immediately useful in ascertaining and meeting his or situation. Through the presenting behavior, the nurse finds the her need or finding out they have no needs at that time. The patient’s immediate need for help. To do this, the nurse must first nurse cannot assume that any aspect of his or her reaction to recognize the situation as problematic. Regardless of how the the patient is correct, helpful, or appropriate until he or she NCM 100 l NURSING THEORIES Page 2 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences checks its validity by exploring it with the patient. The nurse nurse uses a nursing framework to collect both subjective initiates this exploration to determine how the patient is affected and objective data about the patient. by what they say and do. Automatic reactions are ineffective because the nurse’s action is determined for reasons other than 2. The diagnosis stage uses the nurse’s clinical judgment the meaning of the patient’s behavior or the patient’s immediate about health problems. The diagnosis can then be need for help. When the nurse doesn’t explore the patient’s confirmed using links to defining characteristics, related reaction with him or her, it is reasonably certain that effective factors, and risk factors found in the patient’s assessment. communication between nurse and patient stops. The nurse decides on the appropriate action to resolve 3. The planning stage addresses each of the problems the need in cooperation with the patient. This action is evaluated identified in the diagnosis. Each problem is given a specific after it is carried out. If the patient’s behavior improves, the goal or outcome, and each goal or outcome is given action is successful, and the process is completed. If there is no nursing interventions to help achieve the goal. By the end change or the behavior gets worse, the process recycles with of this stage, the nurse will have a nursing care plan. new efforts to clarify the patient’s behavior or the appropriate nursing action. 4. In the implementation stage, the nurse begins using the nursing care plan. 5 Stages of the Deliberative Nursing Process 5. Finally, in the evaluation stage, the nurse looks at the The Deliberative Nursing Process has five stages: assessment, patient’s progress toward the goals set in the nursing care diagnosis, planning, implementation, and evaluation. plan. Changes can be made to the nursing care plan based on how well (or poorly) the patient is progressing toward 1. In the assessment stage, the nurse completes a holistic the goals. If any new problems are identified in the assessment of the patient’s needs. This is done without evaluation stage, they can be addressed, and the process taking the reason for the encounter into consideration. The starts over again for those specific problems. 3. JOYCE TRAVELBEE’S HUMAN-TO-HUMAN RELATIONSHIP Joyce Travelbee assumes that nursing is fulfilled by to building a relationship. Tasks include avoiding “using utilizing human-to-human relationships. She defined nursing as oneself as a yardstick” by which to evaluate others. Barriers “an interpersonal process whereby the professional nurse to such tasks may be due to role envy, lack of interest in practitioner assists an individual, family or community to prevent others, inability to transcend the self, or refusal to initiate or cope with the experience of illness and suffering, and if emotional investment. This phase is described by the nurse necessary, to find meaning in these experiences”. and patient perceiving each other as unique individuals. At this time, the link of the relationship begins to form. Inspired by being a psychiatric nurse, she struggles for a “Humanistic Revolution” in nursing, with devotion to caring and 3. The phase of Empathy: This phase involves sharing compassion for patients. She expressed that achieving the goal another’s psychological state but standing apart and not of nursing necessitates a genuine human-to-human sharing feelings. It is characterized “by the ability to predict relationship, which can only be established by an interaction the behavior of another”. process, this process is further divided into five phases. 4. The phase of Sympathy: Sharing, feeling, and experiencing The 5 interactional phases of Travelbee’s model are what others are feeling and experiencing is accomplished. in consecutive order and developmentally achieved by the nurse This phase demonstrates emotional involvement and and the patient as their relationship with each other goes deeper discredits objectivity as dehumanizing. The task of the nurse and more therapeutic. is to translate sympathy into helpful nursing actions. Sympathy happens when the nurse wants to lessen the 1. The phase of the Original Encounter: Emotional knowledge cause of the patient’s suffering. It goes beyond empathy. colors impressions and perceptions of both nurse and “When one sympathizes, one is involved but not patient during initial encounters. The task is “to break the incapacitated by the involvement.” The nurse should use a bond of categorization to perceive the human being in the disciplined intellectual approach together with the patient” and vice versa. Patients are the same human beings therapeutic use of self to make helpful nursing actions. as us and families; only, they need other human beings specifically nurses and doctors to maintain health. Health, 5. The phase of Rapport: Rapport is described as nursing which, Travelbee defines in two categories: subjective and interventions that lessen the patient’s suffering. The nurse objective. Subjective health is an individually defined state of and the sick person are relating as human being to human well-being in accord with self-appraisal of physical- being. The sick person shows trust and confidence in the emotional-spiritual status. Objective health is an absence of nurse. “A nurse is able to establish rapport because she discernable disease, disability or defect as measured by possesses the necessary knowledge and skills required to physical examination, laboratory tests, and assessment by assist ill persons and because she is able to perceive, the spiritual director or psychological counselor. respond to, and appreciate the uniqueness of the ill human being.” 2. The phase of Emerging Identities: Tasks in the second phase (visibility of personal or emerging identities) include Comparison of the theories separating oneself and one’s experiences from others AND recognizing the different qualities that each possesses, Joyce Travelbee’s Human-to-human Relationship transcending roles by separating self and experiences from Theory was influenced by Hildegard Peplau’s Work, one another – not using oneself to judge others. Neither the Interpersonal Relations Theory. Both theories show how a nurse nor the patient is not to stereotype the other as having nurse-to-patient relationship is established. Travelbee’s theory a particular vexatious characteristic as this is not facilitative focused on having the presence of hope (emotional part) in the NCM 100 l NURSING THEORIES Page 3 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences patient’s recovery while Peplau’s theory focused on the totality of how a nurse should act upon meeting the patient until he/she is discharged. 4. LYDIA HALL’S CARE, CURE, CORE NURSING THEORY Nursing theory, in line with Lydia Hall, is nothing short closeness develops, the patient can share and explore of revolutionary. In the 1960s, she put down, in her own simple feelings with the nurse. words, her thoughts about nursing. She did not consider herself a nurse theorist but instead talked about her transparent 2. The Core Circle. thoughts and remarkable nursing care ideas as she learned § The core, according to Hall’s theory, is the patient them over the years. These led to the development of her “Care, receiving nursing care. The core has goals set by him Cure, Core Theory,” also known as the “Three Cs of Lydia Hall.” or herself rather than by any other person and behaves according to their feelings and values. This involves the Lydia Hall’s theory defines Nursing as the “participation therapeutic use of self and is shared with other in care, core and cures aspects of patient care, where CARE is members of the health team. the sole function of nurses, whereas the CORE and CURE are § This area emphasizes the patient’s social, emotional, shared with other members of the health team.” The major spiritual, and intellectual needs concerning family, purpose of care is to achieve an interpersonal relationship with institution, community, and the world. This can help the the individual to facilitate the development of the core. patient verbally express feelings regarding the disease process and its effects by using the reflective As Hall says, “To look at and listen to self is often too technique. Through such expression, the patient can difficult without the help of a significant figure (nurturer) who has gain self-identity and further develop maturity. learned how to hold up a mirror and sounding board to invite the § The professional nurse uses the reflective technique to behaver to look and listen to himself. If he accepts the invitation, act as a mirror to the patient to help the latter explore he will explore the concerns in his acts. As he listens to his his or her feelings regarding his or her current health exploration through the reflection of the nurse, he may uncover status and related potential changes in lifestyle. in sequence his difficulties, the problem area, his problem, and § Motivations are discovered through the process of eventually the threat which is dictating his out-of-control bringing into awareness the feelings being behavior.” experienced. With this awareness, the patient can now make conscious decisions based on understood and Lydia Hall’s theory has three components which are accepted feelings and motivation. represented by three independent but interconnected circles. The three circles are the core, the care, and the cure. The size 3. The Cure Circle of each circle constantly varies and depends on the state of the § As explained in this theory, the cure is nursing, which patient. involves the administration of medications and treatments. Hall explains in the model that the nurse 1. The Care Circle. shares the cure circle with other health professionals, § According to the theory, nurses are focused on such as physicians or physical therapists. performing the noble task of nurturing patients. This § In short, these are the interventions or actions geared circle solely represents the role of nurses and is toward treating the patient for whatever illness or focused on performing the task of nurturing patients. disease he or she is suffering from. During this aspect Nurturing involves using the factors that make up the of nursing care, the nurse is an active advocate of the concept of mothering (care and comfort of the person) patient. and providing teaching-learning activities. § The care circle defines a professional nurse’s primary The three interlocking circles may change in size and role, such as providing bodily care for the patient and overlap concerning the patient’s phase in the disease process. helping the patient complete such basic daily biological A nurse functions in all three circles but to different degrees. functions as eating, bathing, elimination, and dressing. When providing this care, the nurse’s goal is the For example, in the care phase, the nurse gives hands- comfort of the patient. on bodily care to the patient about daily living activities such § Moreover, the nurse’s role also includes educating as toileting and bathing. In the curing phase, the nurse applies patients and helping a patient meet any needs he or medical knowledge to the treatment of the person. In the core she is unable to meet alone. This presents the nurse phase, the nurse addresses the patient’s social and emotional and patient with an opportunity for closeness. As needs for effective communication and a comfortable environment. 5. FAYE GLENN ABDELLAH’S 21 NURSING PROBLEMS THEORY According to Faye Glenn Abdellah’s theory, “Nursing is The patient-centered approach to nursing was based on an art and science that molds the attitudes, intellectual developed from Abdellah’s practice, and the theory is competencies, and technical skills of the individual nurse into the considered a human needs theory. It was formulated to be an desire and ability to help people, sick or well, cope with their instrument for nursing education, so it is most suitable and health needs.” useful in that field. The nursing model is intended to guide care NCM 100 l NURSING THEORIES Page 4 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences in hospital institutions but can also be applied to community - Patients eat together in a pantry where they are health nursing, as well. supplied with the same tray of food. For patients who eat very fast, they are prone to choking so you have Major Concepts of 21 Nursing Problems Theory to supervise their feeding and divide large pieces of food into small pieces. With patients who don’t want The model has interrelated concepts of health and to eat, we feed them. You don’t want patients to be nursing problems and problem-solving, which is inherently malnourished due to poor food intake. logical. 7. To facilitate the maintenance of elimination. Nursing Problems. The client’s health needs can be - For patients who have difficulty in elimination, we viewed as problems, overt as an apparent condition, or covert provide dietary supplements like fiber-rich foods for as a hidden or concealed one. those with constipation. Most disturbed patients are Because covert problems can be emotional, sociological, and under restraints so they just urinate on the floor, you interpersonal, they are often missed or misunderstood. Yet, in have to change their clothes to prevent infection. many instances, solving the covert problems may solve the overt problems as well. 8. To facilitate the maintenance of fluid and electrolyte balance. Abdellah’s Typology of 21 Nursing Problems - Some patients have electrolyte imbalance so we hook intravenous fluids like PNSS or D5LR to maintain their electrolytes in balance The 21 nursing problems fall into three categories: physical, sociological, and emotional needs of patients; 9. To recognize the physiologic responses of the body to types of interpersonal relationships between the patient and disease conditions—pathologic, physiologic, and nurse; and common elements of patient care. She used compensatory. Henderson’s 14 basic human needs and nursing research to establish the classification of nursing problems. Abdellah’s 21 - If a patient has a disease like a heart problem, in a Nursing Problems are the following: psychiatric ward, he is referred to the Infirmary to pave the way to his medical condition. There, he is I. Basic Needs given medications and proper treatment. 1. To maintain good hygiene and physical comfort. 10. To facilitate the maintenance of regulatory mechanisms - Patients are bathed every morning after waking up and functions. and in the government hospital, or charity ward, they are altogether taking a bath assisted by the nurses. - For a patient with hallucinations like auditory and After that, they are provided with hospital gowns to visual, it is therapeutic to present reality. keep them clean. 11. To facilitate the maintenance of sensory function. 2. To promote optimal activity: exercise, rest, sleep - When a patient is admitted who is already deaf and - Every morning, they are encouraged to exercise mute, we communicate to them by body language to together and one patient leads the rest to perform maintain their basic need despite the inadequacy of daily workouts like stretching or dance class. After their sensory function. taking their night medications, they are allowed to rest and sleep. As a nurse, I keep a calm and quiet III. Remedial Care Needs environment for them to have a good sleep. 12. To identify and accept positive and negative expressions, feelings, and reactions. 3. To promote safety by preventing accidents, injuries, or - Most patients are already confined for long periods of other trauma and preventing the spread of infection. time from months to years and talking with them - As many patients stay together in one single room in therapeutically makes them ventilate their feelings a ward, we prevent the spread of infection by isolating both positive and negative. patients with communicable diseases like scabies. We always maintain safety precautions because 13. To identify and accept the interrelatedness of emotions patients with mental illness are likely to have suicidal, and organic illness. homicidal, and escape precautions therefore as a - Most patients complain of somatic complaints but as nurse you should be aware of their happenings all the a psychiatric nurse, you should distinguish one from time. malingering. With proper assessment and keen observation, you can relate whether it is true or not. 4. To maintain good body mechanics and prevent and correct deformity. 14. To facilitate the maintenance of effective verbal and - With patients with bed sores, good body mechanics nonverbal communication. is very important so we turn the patient from side to - Different patients converse in the way they are side or change position to prevent immobility and diagnosed. With Bipolar patients, one time they are pressure. talkative (manic stage), and then at one moment they are very quiet (depressed stage). We intervene II. Sustenal Care Needs through both verbal and nonverbal ways so that 5. To facilitate the maintenance of a supply of oxygen to patients would still comply. all body cells. - If a patient verbalizes difficulty of breathing and upon 15. To promote the development of productive assessment he is grasping for air, after proper referral interpersonal relationships. we attach a supply of oxygen via nasal cannula or - Families and relatives are very effective support face mask. systems for patients who are confined in a psychiatric institution, allowing for their private time together 6. To facilitate the maintenance of nutrition for all body when family visits. cells. 16. To facilitate progress toward achievement and personal spiritual goals. NCM 100 l NURSING THEORIES Page 5 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences - With Catholic patients, we assist them every Sunday 20. To use community resources as an aid in resolving to attend Holy Mass at the Chapel located inside the problems that arise from an illness. hospital. Respect also other patient’s different ways - One problem of confinement for long periods is the of worship and faith. distance of the family from the patients. We extend the community resources to social workers to find the 17. To create or maintain a therapeutic environment. families of vagrant patients who just came from the - Maintaining a therapeutic environment is very crucial streets and no family to accept them. for a mental institution. By communicating with them from time to time, you practice an area for ventilation 21. To understand the role of social problems as of feelings and emotions. influencing factors in the cause of illness. - Many psychiatric illness accounts for the social IV. Restorative Care Needs problems that predispose most patients to have 18. To facilitate awareness of self as an individual with mental problems, therefore, we as nurses, have to varying physical, emotional, and developmental needs. understand and accept the role of society as having - Different wards and pavilions in the hospital cater to a huge effect on the patients. Conducting health different patients. With a ward that caters to all male education and health teachings to the family as well patients, we nurses respect their human needs like as to the community. giving them privacy when they need to. Moreover, patients’ needs are further divided into four 19. To accept the optimum possible goals in the light of categories: basic to all patients, sustenance care needs, limitations, physical and emotional. remedial care needs, and restorative care needs. - Different patients have individualized needs therefore optimum goals ought to be achieved in all of them. Abdellah’s work, based on the problem-solving method, For example, for a patient who is withdrawn, the goal serves as a vehicle for delineating nursing (patient) problems as is for him to be participative to divert attention. the patient moves toward a healthy outcome. The theory Remotivation therapy is provided. identifies ten steps to identify the patient’s problem and 11 nursing skills to develop a treatment typology. 6. VIRGINIA HENDERSON’S NURSING NEED THEORY Virginia Henderson developed the Nursing Need 14 Components of the Need Theory Theory to define the unique focus of nursing practice. The theory focuses on the importance of increasing the patient’s The 14 components of Virginia Henderson’s Need Theory show independence to hasten their progress in the hospital. a holistic nursing approach covering physiological, Henderson’s theory emphasizes the basic human needs and psychological, spiritual, and social needs. how nurses can meet those needs. Physiological Components “I believe that the function the nurse performs is 1. Breathe normally - The gaseous exchange of the body primarily an independent one – that of acting for the patient is essential for patient health and for life itself. when he lacks knowledge, physical strength, or the will to act for 2. Eat and drink adequately - Every organism requires himself as he would ordinarily act in health or in carrying out fluids and nutrients for survival. The nurse should be prescribed therapy. This function is seen as complex and aware of the type of diet and hydration, according to the creative, as offering unlimited opportunity to apply the physical, nutritional requirements of the patient and the treatment biological, and social sciences and the development of skills ordered by the doctor. based on them.” (Henderson, 1960). Additionally, she stated that 3. Eliminate body wastes - Part of the proper functioning “…the nurse does for others what they would do for themselves of the body is the normal elimination of feces, urine, if they had the strength, the will, and the knowledge. But I go on sweat, phlegm and menstruation to say that the nurse makes the patient independent of them as 4. Move and maintain desirable postures - A patient will soon as possible.” feel more or less independent to the extent that he can move on his own to carry out his day-to-day activities. Her definition of nursing distinguished a nurse’s role in 5. Sleep and rest - Rest is very important for the quick health care: The nurse is expected to carry out a physician’s recovery of the person. Every organism recovers therapeutic plan, but individualized care results from the nurse’s physical and mental forces while it sleeps. creativity in planning for care. The nurse should be an 6. Select suitable clothes – dress and undress - Being independent practitioner able to make an independent able to select and wear the clothing that is desired also judgment. In her work Nature of Nursing, she states the nurse’s influences a patient's sense of independence. role is “to get inside the patient’s skin and supplement his 7. Maintain body temperature within normal range by strength, will or knowledge according to his needs.” The nurse adjusting clothing and modifying environment - The is responsible for assessing the patient’s needs, helping them normal body temperature is between 36.5 and 37 ° C. meet health needs, and providing an environment in which the The nurse should be aware of the factors that influence patient can perform activities unaided. the patient's cold or heat 8. Keep the body clean and well-groomed and protect SUBSTITUTIVE: acting for a person the integument - The way the patient's body is seen, felt SUPPLEMENTARY: assisting a person and smelled are external signs of his hygiene. This factor COMPLEMENTARY: working with the person is not only a physiological manifestation; in nursing, it is also considered a factor with a lot of psychological value. “… to help the person become as independent as possible.” 9. Avoid dangers in the environment and avoid injuring others - It is important to know and evaluate very well if NCM 100 l NURSING THEORIES Page 6 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences the patient can be left alone for a long time, with enough Sociologically Oriented to Occupation and Recreation confidence that he will not hurt himself when moving or 12. Work in such a way that there is a sense of trying to carry out activities, nor compromise the safety accomplishment - of others. 13. Play or participate in various forms of recreation Psychological Aspects of Communicating and Learning Since there is much similarity, Henderson’s 14 components 10. Communicate with others in expressing emotions, can be applied or compared to Abraham Maslow‘s Hierarchy of needs, fears, or opinions - The nurse must be able to Needs. Components 1 to 9 are under Maslow’s Physiological promote and motivate healthy and proper communication Needs, whereas the 9th component is under the Safety Needs. of the patient, to help their emotional balance. The 10th and 11th components are under the Love and 14. Learn, discover, or satisfy the curiosity that leads to Belongingness category, and the 12th, 13th, and 14th normal development and health and use the available components are under the Self-Esteem Needs. health facilities. Henderson’s Needs Theory can be applied to nursing Spiritual and Moral practice as a way for nurses to set goals based on Henderson’s 11. Worship according to one’s faith - Respect the values 14 components. Meeting the goal of achieving the 14 needs of and particular beliefs of the patient. Based on these he the client can be a great basis to further improve one’s makes his decisions and exercises certain actions or performance towards nursing care. In nursing research, each of thoughts. her 14 fundamental concepts can serve as a basis for research, although the statements were not written in testable terms. 7. NOLA PENDER’S HEALTH PROMOTION MODEL Have you ever noticed advertisements in malls, as behavior motivated desire to actively avoid illness, detect it grocery stores, or schools that advocate healthy eating or early, or maintain functioning within illness constraints. regular exercise? Have you gone to your local centers or hospitals promoting physical activities and smoking cessation Individual characteristics and experiences (prior programs such as “quit” activities and “brief interventions?” related behavior and personal factors). These are all examples of health promotion. The Health Promotion Model, developed by nursing theorist Nola Pender, Behavior-specific cognitions and affect (perceived has provided healthcare a new path. According to Nola J. benefits of action, perceived barriers to action, perceived self- Pender, Health Promotion and Disease Prevention should focus efficacy, activity-related affect, interpersonal influences, and on health care. When health promotion and prevention fail to situational influences). anticipate predicaments and problems, care for illness becomes the subsequent priority. Behavioral outcomes (commitment to a plan of action, immediate competing demands and preferences, and The Health Promotion Model notes that each person health-promoting behavior). has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavioral-specific Subconcepts of the Health Promotion Model knowledge and effect have important motivational significance. These variables can be modified through nursing actions. 1. PERSONAL FACTORS are categorized as biological, Health-promoting behavior is the desired behavioral outcome psychological, and socio-cultural. These factors are and is the endpoint in the Health Promotion Model. Health- predictive of a given behavior and shaped by the target promoting behaviors should result in improved health, enhanced behavior’s nature being considered. functional ability, and better quality of life at all development stages. The final behavioral demand is also influenced by the a. Personal biological factors. Include variables such as immediate competing demands and preferences, which can age, gender, body mass index, pubertal status, aerobic derail intended health-promoting actions. capacity, strength, agility, or balance. b. Personal psychological factors. Include variables The Health Promotion Model was designed to be a such as self-esteem, self-motivation, personal “complementary counterpart to models of health protection.” It competence, perceived health status, and definition of develops to incorporate behaviors for improving health and health. applies across the lifespan. Its purpose is to help nurses know c. Personal socio-cultural factors. Include variables and understand the major determinants of health behaviors as such as race, ethnicity, acculturation, education, and a foundation for behavioral counseling to promote well-being socioeconomic status. and healthy lifestyles. 2. BEHAVIOR-SPECIFIC COGNITION AFFECT Pender’s health promotion model defines health as “a positive dynamic state not merely the absence of disease.” a. Perceived Benefits of Action. Anticipated positive Health promotion is directed at increasing a client’s level of well- outcomes that will occur from health behavior. being. It describes the multi-dimensional nature of persons as § Example: exercise makes the body physically and they interact within the environment to pursue health. mentally healthy. Exercise helps to reduce stress, provide good sleep at night, and give a better Major Concepts of the Health Promotion Model look. Health promotion is defined as behavior motivated by b. Perceived Barriers to Action. Anticipated, imagined, the desire to increase well-being and actualize human health or real blocks and personal costs of understanding a potential. It is an approach to wellness. given behavior. Health Protection or Illness Prevention is described NCM 100 l NURSING THEORIES Page 7 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences § Example: A 22-year-old male client wants to start § Example: motivated by the caregivers to perform an exercise program, but he says he doesn’t have an exercise, influenced and encouraged by the the time or money to attend a fitness club. Body friends. pain, and has no long-term benefits, lack of information regarding exercise, difficulty f. Situational Influences. Personal perceptions and performing in old age due to loss of strength and cognitions of any given situation or context can considered exercise as a tough task. The other facilitate or impede behavior. Include perceptions of barriers were lack of interest, and self-conscious options available, demand characteristics, and about the body while performing exercise aesthetic features of the environment in which given health-promoting is proposed to take place. Situational c. Perceived Self-Efficacy. The judgment of personal influences may have direct or indirect influences on capability to organize and execute a health-promoting health behavior. behavior. Perceived self-efficacy influences perceived § Example: lack of facilities, lack of supervisor or barriers to action, so higher efficacy results in lowered trainer, and feelings that somebody or something perceptions of barriers to the behavior’s performance. stops when they start doing exercise § Example: confident, self-worthy and fit to perform exercise. g. Commitment to Plan of Action. The concept of intention and identification of a planned strategy leads d. Activity-Related Affect. Subjective positive or to the implementation of health behavior. negative feeling occurs before, during, and following behavior based on the stimulus properties of the h. Immediate Competing Demands and Preferences. behavior itself. Activity-related effect influences Competing demands are those alternative behaviors perceived self-efficacy, which means the more positive over which individuals have low control because of the subjective feeling, the greater its efficacy. In turn, environmental contingencies such as work or family increased feelings of efficacy can generate a further care responsibilities. Competing preferences are positive affect. alternative behaviors over which individuals exert § Example: performing exercise will make them relatively high control, such as the choice of ice cream happy, energetic and daily life enjoyable or apple for a snack. e. Interpersonal Influences. Cognition concerning 3. BEHAVIORAL OUTCOME-HEALTH PROMOTING behaviors, beliefs, or attitudes of others. Interpersonal BEHAVIOR influences include norms (expectations of significant a. Health-Promoting Behavior. A health-promoting others), social support (instrumental and emotional behavior is an endpoint or action-outcome directed encouragement), and modeling. Primary sources of toward attaining positive health outcomes such as interpersonal influences are families, peers, and optimal well-being, personal fulfillment, and productive healthcare providers. living. 8. MADELEINE LEININGER’S TRANSCULTURAL NURSING THEORY The Transcultural Nursing Theory or Culture Care Transcultural nursing is defined as a learned subfield Theory by Madeleine Leininger involves knowing and or branch of nursing that focuses upon the comparative study understanding different cultures concerning nursing and health- and analysis of cultures concerning nursing and health-illness illness caring practices, beliefs, and values to provide caring practices, beliefs, and values to provide meaningful and meaningful and efficacious nursing care services to people’s efficacious nursing care services to their cultural values and cultural values health-illness context. health-illness context. It focuses on the fact that different cultures have Ethnonursing. This is the study of nursing care different caring behaviors and different health and illness values, beliefs, values, and practices as cognitively perceived and beliefs, and patterns of behavior. known by a designated culture through their direct experience, beliefs, and value system (Leininger, 1979). The cultural care worldview flows into knowledge about individuals, families, groups, communities, and institutions in Nursing is defined as a learned humanistic and diverse healthcare systems. This knowledge provides culturally scientific profession and discipline which is focused on human specific meanings and expressions about care and health. The care phenomena and activities to assist, support, facilitate, or next focus is on the generic or folk system, professional care enable individuals or groups to maintain or regain their well- system(s), and nursing care. Information about these systems being (or health) in culturally meaningful and beneficial ways, or includes the characteristics and the specific care features of to help people face handicaps or death. each. This information allows for the identification of similarities and differences or cultural care universality and cultural care Professional Nursing Care (Caring). Professional diversity. nursing care (caring) is defined as formal and cognitively learned professional care knowledge and practice skills obtained Next are nursing care decisions and actions that through educational institutions that are used to provide involve cultural care preservation/maintenance, cultural care assistive, supportive, enabling, or facilitative acts to or for accommodation/negotiation, and cultural care re-patterning or another individual or group to improve a human health condition restructuring. It is here that nursing care is delivered. (or well-being), disability, lifeway, or to work with dying clients. Major Concepts of the Transcultural Nursing Theory Cultural Congruent (Nursing) Care. is defined as those cognitively based assistive, supportive, facilitative, or The following are the major concepts and their enabling acts or decisions that are tailor-made to fit with the definitions in Madeleine Leininger’s Transcultural Nursing individual, group, or institutional, cultural values, beliefs, and Theory. NCM 100 l NURSING THEORIES Page 8 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences lifeways to provide or support meaningful, beneficial, and Professional Care Systems are defined as formally satisfying health care, or well-being services. taught, learned, and transmitted professional care, health, illness, wellness, and related knowledge and practice skills that Health. It is a state of well-being that is culturally prevail in professional institutions, usually with multidisciplinary defined, valued, and practiced. It reflects individuals’ (or groups) personnel to serve consumers. ‘ ability to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways. Etic. The knowledge that describes the professional perspective. It is professional care knowledge. Human Beings. Such are believed to be caring and capable of being concerned about others’ needs, well-being, Ethnohistory includes those past facts, events, and survival. Leininger also indicates that nursing as a caring instances, experiences of individuals, groups, cultures, and science should focus beyond traditional nurse-patient instructions that are primarily people-centered (ethno) and interactions and dyads to include families, groups, communities, describe, explain, and interpret human lifeways within particular total cultures, and institutions. cultural contexts over short or long periods. Society and Environment. Leininger did not define Care as a noun is defined as those abstract and these terms; she speaks instead of worldview, social structure, concrete phenomena related to assisting, supporting, or and environmental context. enabling experiences or behaviors toward or for others with evident or anticipated needs to ameliorate or improve a human Worldview. how people look at the world, or the condition or lifeway. universe, and form a “picture or value stance” about the world and their lives. Care as a verb is defined as actions and activities directed toward assisting, supporting, or enabling another Cultural and social structure dimensions are individual or group with evident or anticipated needs to defined as involving the dynamic patterns and features of ameliorate or improve a human condition or lifeway or face interrelated structural and organizational factors of a particular death. culture (subculture or society) which includes religious, kinship (social), political (and legal), economic, educational, Culture Shock may result when an outsider attempts technological, and cultural values, ethnohistorical factors, and to comprehend or adapt effectively to a different cultural group. how these factors may be interrelated and function to influence The outsider is likely to experience feelings of discomfort human behavior in different environmental contexts. helplessness and some degree of disorientation because of the differences in cultural values, beliefs, and practices. Culture Environmental context is the totality of an event, shock may lead to anger and can be reduced by seeking situation, or particular experience that gives meaning to human knowledge of the culture before encountering that culture. expressions, interpretations, and social interactions in particular physical, ecological, sociopolitical, and/or cultural settings. Cultural imposition refers to the outsider’s efforts, both subtle and not so subtle, to impose their cultural values, Culture. Culture is learned, shared, and transmitted beliefs, and behaviors upon an individual, family, or group from values, beliefs, norms, and lifeways of a particular group that another culture. (Leininger, 1978) guides their thinking, decisions, and actions in patterned ways. Sunrise Model of Madeleine Leininger’s Theory Culture Care. is defined as the subjectively and objectively learned and transmitted values, beliefs, and The Sunrise Model is relevant because it enables patterned lifeways that assist, support, facilitate, or enable nurses to develop critical and complex thoughts about nursing another individual or group to maintain their well-being, and practice. These thoughts should consider and integrate cultural health, improve their human condition lifeway, or deal with and social structure dimensions in each specific context, illness, handicaps or death. besides nursing care’s biological and psychological aspects. Culture Care Diversity. Indicates the variabilities and/or Three modes of nursing care decisions and actions differences in meanings, patterns, values, lifeways, or symbols of care within or between collectives related to assistive, 1. Cultural care preservation or Maintenance. It includes supportive, or enabling human care expressions. those assistive, supporting, facilitative, or enabling professional actions and decisions that help people of a particular culture to Culture Care Universality. Indicates the common, similar, or retain and/or preserve relevant care values so that they can dominant uniform care meanings, patterns, values, lifeways, or maintain their well-being, recover from illness, or face handicaps symbols manifest among many cultures and reflect assistive, and/or death. supportive, facilitative, or enabling ways to help people. (Leininger, 1991) 2. Cultural care accommodation or Negotiation includes those assistive, supportive, facilitative, or enabling creative Subconcepts professional actions and decisions that help people of a The following are the subconcepts of the Transcultural designated culture to adapt to or negotiate with others for a Nursing Theory of Madeleine Leininger and their definitions: beneficial or satisfying health outcome with professional care providers. Generic (Folk or Lay) Care Systems are culturally learned and transmitted, indigenous (or traditional), folk (home- 3. Culture care repatterning or Restructuring. This based) knowledge and skills used to provide assistive, includes those assistive, supporting, facilitative, or enabling supportive, enabling, or facilitative acts toward or for another professional actions and decisions that help clients reorder, individual, group, or institution with evident or anticipated needs change, or greatly modify their lifeways for new, different, and to ameliorate or improve a human life way, health condition (or beneficial health care pattern while respecting the clients’ well-being), or to deal with handicaps and death situations. cultural values and beliefs and still providing a beneficial or healthier lifeway than before the changes were established with Emic. Knowledge gained from direct experience or the clients. (Leininger, 1991). directly from those who have experienced it. It is generic or folk knowledge. NCM 100 l NURSING THEORIES Page 9 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences 9. MARGARET NEWMAN’S THEORY OF HEALTH AS EXPANDING CONSCIOUSNESS “The theory of health as expanding consciousness was relational and is “patterned, emergent, unpredictable, unitary, stimulated by concern for those for whom health as the absence intuitive, and innovative,” rather than a traditional linear view that of disease or disability is not possible. Nurses often relate to is “causal, predictive, dichotomous, rational, and controlling” such people: people facing the uncertainty, debilitation, loss, and (Newman, 1994, p. 13). Health and the evolving pattern of eventual death associated with chronic illness. The theory has consciousness are the same. The essence of the emerging progressed to include the health of all persons regardless of the paradigm of health is the recognition of patterns. Newman sees presence or absence of disease. The theory asserts that every the life process as a progression toward higher levels of person in every situation, no matter how disordered and consciousness. hopeless it may seem, is part of the universal process of expanding consciousness – a process of becoming more of Pattern is information that depicts the whole and oneself, of finding greater meaning in life, and of reaching new understanding of the meaning of all of the relationships at once dimensions of connectedness with other people and the world.” (M. Newman, personal communication, 2004). It is conceptualized as a fundamental attribute of all there is, and it The theory explains that health and illness are gives unity in diversity (Newman, 1986). The pattern is what synthesized as health. That is the fusion of one state of being identifies an individual as a particular person. Examples of (disease) with its opposite (non-disease) results in what can be explicit manifestations of the pattern of a person are the genetic considered health. In this model, the human is unitary. He or she pattern that contains information that directs becoming, the cannot be divided into parts and is inseparable from the larger voice pattern, and the movement pattern. Characteristics of unitary field. People are individuals, and human beings are, as patterns include movement, diversity, and rhythm. Pattern is a species, identified by their patterns of consciousness. The conceptualized as being somehow intimately involved in energy person does not possess consciousness. Instead, the person is exchange and transformation (Newman, 1994). According to conscious. People are centers of consciousness with an overall Newman (1987b), “Whatever manifests itself in a person’s life is pattern of expanding consciousness. The environment is the explication of the underlying implicate pattern …. the described as a “universe of open systems.” phenomenon we call health is the manifestation of that evolving “Nursing is the process of recognizing the patient about pattern” (p. 37). the environment, and it is the process of the understanding of consciousness.” In Health as Expanding Consciousness, Newman “The theory of health as expanding consciousness was (1986, 1994) developed a pattern as a major concept that is stimulated by concern for those for whom health as the absence used to understand the individual as a whole being. Newman of disease or disability is not possible... “ described a paradigm shift in the field of health care: the shift Nursing is regarded as a connection between the nurse from the treatment of disease symptoms to a search for patterns and patient, and both grow in the sense of higher levels of and the meaning of those patterns. Newman (1994) stated that consciousness. the patterns of interaction with the environment constitute In this model, nursing is “caring in the human health health. Individual life patterns according to Newman (2008) experience.” It is seen as a partnership between the nurse and move “through peaks and troughs, variations in order-disorder patient, with both growing in the “sense of higher levels of that are meaningful for the person” (p. 6). An event such as a consciousness.” disease occurrence is part of a larger process. By interacting Newman’s theory is considered a grand nursing theory. with the event, no matter how destructive the force might be, its She states that people cannot be divided into parts. Health is energy augments the person’s energy and enhances his or her central to the theory and is seen as a process of developing power. One must grasp the pattern of the whole to see this. awareness of the individual self and the person’s environment. She also states that “consciousness is a manifestation of an Consciousness is both the informational capacity of evolving pattern of person-environment interaction.” the system and the ability of the system to interact with its environment. Newman asserts that understanding of her Newman’s Health as Expanding Consciousness definition of consciousness is essential to understanding the Theory is beneficial because it can be applied in any setting and theory. Consciousness includes not only cognitive and affective “generates caring interventions.” However, its drawbacks are awareness, but also the “interconnectedness of the entire living that it is abstract, multidimensional, and qualitative, and there is system which includes physicochemical maintenance and little discussion on the environment within the model. growth processes as well as the immune system”. In 1978, Newman identified three correlates of Health is the “pattern of the whole” of a person and consciousness (time, movement, and space) as manifestations includes disease as a manifestation of the pattern of the whole, of the pattern of the whole. The life process is seen as a based on the premise that life is an ongoing process of progression toward higher levels of consciousness. Newman expanding consciousness (Newman, 1986). It is regarded as the (1979) views the expansion of consciousness as what life and evolving pattern of the person and environment and is viewed health are all about, and the sense of time is an indicator of the as an increasing ability to perceive alternatives and respond in changing level of consciousness. a variety of ways (Newman, 1986). Health is “a transformative process to more inclusive consciousness” (Newman, 2008, p. Movement-space-time. Newman emphasizes the importance 16). of examining movement-space-time together as dimensions of Using Hegel’s dialectical fusion of opposites, Newman explained emerging patterns of consciousness rather than as separate conceptually how disease fuses with its opposite, nondisease or concepts of the theory (M. Newman, personal communication, absence of disease, to create a new concept of health that is 2004). NCM 100 l NURSING THEORIES Page 10 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences 10. ROSEMARIE PARSE’S THEORY OF HUMAN BECOMING Rosemarie Rizzo Parse created the Human Becoming § coexistence Theory of Nursing, which guides nurses to focus on the quality § situated freedom of life from each person’s perspective as the goal of nursing. It presents an alternative to most of the other theories of nursing, ASSUMPTIONS which take a bio-medical or bio-psycho-social-spiritual 1. The human is co-existing while co-constituting approach. rhythmical patterns with the universe. Basis: Pattern and organization; Co-constitution; It was first published in 1981 as the “Man-living-health” Coexistence theory, and in 1992 the name was changed to “the Human 2. The human is open, freely choosing meaning in a Becoming Theory.” It was developed as a human science situation, and bearing responsibility for decisions. nursing theory, and the assumptions underpinning the theory Basis: Energy field; Openness; Situated freedom come from the works of Heidegger, Sartre, and Merleau-Ponty, 3. The human is unitary and continuously co-constituting as well as Martha Rogers, who was a pioneer American nursing patterns of relating. theorist. Basis: Energy field; Pattern and organization; Co- constitution The Human Becoming Theory is a combination of 4. The human is transcending multidimensionality with biological, psychological, sociological, and spiritual factors, and the possible. states that a person is a unitary being in continuous interaction Basis: Openness; Four dimensionality; Situated with his or her environment. It is centered around three themes: freedom meaning, rhythmicity, and transcendence. 5. Becoming is unitary human-living-health Basis: Openness; Co-constitution; Situated freedom The theme of meaning says that Human Becoming is 6. Becoming is a rhythmically co-constituting process of choosing personal meaning in situations and that a person’s the human-universe process. reality is given meaning through experiences he or she lives in Basis: Pattern and organization; Four dimensionality; the environment. Rhythmicity explains that Human Becoming is Co-constitution co-creating rhythmical patterns of relating with the universe and 7. Becoming is the human’s pattern of relating value that a person and the environment cocreate in rhythmical priorities. patterns. Transcendence says that Human Becoming refers to Basis: Openness; Pattern and organization; Situated reaching beyond the limits a person sets and that a person is freedom constantly transforming him or herself. 8. Becoming is an intersubjective process of transcending the possible. The Human Becoming Theory of Nursing is a model Basis: Openness; Coexistence; Situated freedom that focuses on the quality of life of the patient and sees the 9. Becoming is a unitary human’s emerging. patient not as different aspects of a whole, but as a person. This Basis: Energy field; Four dimensionality; Coexistence. is different than many other nursing theories and allows nurses to do what so many of them go into the nursing field to help Three main themes: people. § Meaning - refers to the linguistic and imagined content of something and the interpretation that one gives to “Man-Living-Health” something. – unique theory of nursing presented by Parse (1981) § Rhythmicity - refers to the fast-paced, paradoxical – synthesized principles and concepts from Rogers, and patterning of the human-universe mutual process. concepts and tenets from existential phenomenology § Transcendence - described as reaching beyond with possible the hopes and dreams seen in Roger’s three major principle multidimensional experience § helicy § complimentarity (now called integrality) PRINCIPLES § resonancy 1. Principle I - Structuring meaning multidimensionally Roger’s four major concepts: is cocreating reality through languaging valuing and § energy field imaging. § openness 2. Principle II - Cocreating rhythmical patterns of § pattern relating is living the paradoxical unity of revealing- § organization concealing, and enabling-limiting while connecting- separating. Tenets and concepts of exixtential-phenomenological 3. Principle III – Co-transcending with the possible is thought: powering unique ways of originating in the process of § intentionality transforming. § human subjectivity § coconstitution 11. ERNESTINE WEIDENBACH’S HELPING ART OF CLINICAL NURSING THEORY Wiedenbach conceptualizes nursing as the practice of discomfort or if the patient needs help from the nurse or other identifying a patient's need for help through observation of healthcare professionals. Nursing primarily consists of presenting behaviors and symptoms, exploration of the meaning identifying a patient's need for help. If the need for help requires of those symptoms with the patient, determining the cause(s) of intervention, the nurse facilitates the medical plan of care and discomfort, and determining the patient's ability to resolve the also creates and implements a nursing plan of care based on NCM 100 l NURSING THEORIES Page 11 of 14  Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences the needs and desires of the patient. In providing care, a nurse III. Validation that the help given was indeed the exercises sound judgment through deliberative, practiced, and help needed. educated recognition of symptoms. The patient's perception of the situation is an important consideration for the nurse when 3. Practice. Overt action, directed by disciplines, providing competent care. thoughts and feelings toward meeting the pa- patient’s need for help, constitutes the practice of clinical Wiedenbach asserted that there are four elements to clinical nursing… goal-directed, deliberately carried out and nursing: patient-centered. Wiedenbach considered that there are three elements necessary for effective practice, 1. Philosophy. Is an attitude toward life and reality that knowledge, judgment and skills, with three additional evolves from each nurse’s beliefs and code of conduct, components of practice directly related to patient care motivates the nurse to act, guides her thinking about - identification, ministration and validation with what to do, and influences decisions. It stems from both coordination indirectly related to it. her culture and subculture and is an integral part of her. It is personal, unique to each nurse, and expressed in her Knowledge encompasses all that has been perceived and way of nursing. Philosophy underlines purpose and her grasped by the human mind. Knowledge has infinite scope and purpose reflects philosophy. According to Wiedenbach, a range. Knowledge may be required by the nurse in the academic nursing philosophy has three essential components: arena and be useful for directing, teaching, planning and § Reverence for the gift of life coordinating the care of the patient but is not sufficient to meet § Respect for the dignity, worth, autonomy, and his need for help. This knowledge comes through interaction individuality of each human being. with patients in the real-world environment. Knowledge may be § A resolution to act on personally and factual, speculative, or practical. professionally held beliefs 2. Purpose. That which the nurse wants to accomplish § Factual - accepted knowledge that is known to be through what she does - is the overall goal toward which true she is striving and so is constant. It is her reasons for § Speculative - theories and concepts that are put being and doing; it is the why of clinical nursing and forward to explain phenomena particularly transcends the immediate intent of her assignment or relevant to the subject areas of the natural task by specifically directing her activities towards the sciences, the social sciences and the humanities ‘good’ of her patient. The fulfillment of purpose involves § Practical - knowing how to apply factual or essentially three Major units of Nursing Practice: speculative knowledge to the situation at hand. I. Identification of the individual’s need for help II. The ministration of help needed The judgment represents the nurse’s potential for § Determining if patients can resolve their making sound decisions after weighing the facts. Judgment is problems or need help derived from a cognitive process of present knowledge against the personal values achieved through ideals, principles and 2. Ministration is providing the needed help, It requires the convictions. The judgment also differentiates facts from identification of the need for help, the selection of an assumptions, relating them to cause and effect. Wiedenbach, appropriate skill and acceptance of that skill by the suggested that judgment is very personal and the nurse will patient. Validation is evidence that the patient’s need for exercise this according to the purpose to be served, the help has been met as a result of the help given. available knowledge and her reaction to the prevailing environment at the time, in terms of the time, setting and Wiedenbach identified one other element in practice that individuals involved. Decisions that are made this way may not indirectly affects the nurse’s role. This coordination, in which the be sound depending on the degree to which the nurse’s nurse coordinates all the services to the patient to prevent emotions and thoughts have been disciplined. Uncontrollable fragmentation of care by consulting and conferring with others emotions can blot out both knowledge and purpose. Unfounded to plan future care and reporting this information both orally and assumptions can distort facts. Hence, the nurse requires as in writing to ensure teamwork. broad a knowledge and experience base as possible and as great a clarity of purpose as practical, to make a sound Art - the application of knowledge and skill to bring about judgment. desired results… Art is individualized action. Nursing art, then, is carried out by the nurse in a one-to-one relationship with the Skills present the nurse’s potential for achieving the patient and constitutes the nurse’s conscious responses to required results. Skill covers various and numerous acts which specifics in the patient’s immediate situation. are characterized by ‘harmony and movement, expression and intent, by precision and by adroit use of self’. the art of clinical nursing consists of: 1. The nurse’s understanding of the patient’s condition, 1. Identification includes individualized care of patients situation, and need. taking into account their experiences and their perception 2. The nurse’s internal goals and external actions are of their condition and needs. Wiedenbach organized four meant to enhance patient capability through elements to the identification of the patient’s need for appropriate nursing care. help. 3. The nurse’s activities are directed toward the § Observing behaviors consistent or inconsistent improvement of the patient’s condition through artful with comfort utilization of the medical plan of care § Exploring the meaning of individual patients’ 4. The nurse’s interventions are aimed at the prevention behavior with them of the recurrence of the current concern or the § Determining t