Nursing Theorists PDF

PAMANTASAN NG LUNGSOD NG MAYNILA (University of the City of Manila) Intramuros, Manila Nursing Theorists A Written Report Submitted in the Fulfillment of the Requirement for the Course Theoretical Foundations in Nursing Submitted by: Bachelor of Science in Nursing 1-4 Submitted to: Prof. Ronie M. Tiamson, RN, RM, MAN, MSN PAMANTASAN NG LUNGSOD NG MAYNILA (University of the City of Manila) Intramuros, Manila Lydia Hall & Dorothea Orem A Written Report Submitted in the Fulfillment of the Requirement for the Course Theoretical Foundations in Nursing Submitted by: Laniog, Kimberly Nicole R. Madamba, Yasmine Naomi Anne DJ. Ostan, Murrielle Kate S. Zita, Sofia Ysabel T. Bachelor of Science in Nursing 1-4 Submitted to: Prof. Ronie M. Tiamson, RN, RM, MAN, MSN Lydia Hall’s Care, Cure, and Core Theory I. Background Lydia Hall, born on September 21, 1906, was a pioneering nurse whose innovative approaches significantly shaped the field of nursing. She graduated from the York Hospital School of Nursing in Pennsylvania in 1927, laying the groundwork for a distinguished career dedicated to patient care. In the mid-1930s, seeking to deepen her expertise, Hall enrolled at Teachers College, Columbia University. She earned her Bachelor of Science degree in 1937 and a Master of Arts degree in 1942, equipping herself with advanced knowledge that would enhance her nursing practice. Hall's professional journey included impactful roles, notably with the Visiting Nurse Service of New York from 1941 to 1947. This experience provided her with valuable insights into community health and patient needs. She later joined the faculty at Fordham Hospital School of Nursing from 1947 to 1950, where she shared her knowledge with the next generation of nurses. At Teachers College, she developed a nursing consultation program and engaged in research, furthering the discipline of nursing. One of her most significant achievements was the establishment of a patient-centered practice model at the Loeb Center for Nursing and Rehabilitation at Es Montefiore Medical Center, which opened in 1963. This innovative model focused on active patient participation in care and led to a notable decrease in readmission rates, demonstrating its effectiveness. Lydia Hall passed away on February 27, 1969, but her legacy endures. In 1984, she was posthumously inducted into the American Nurses' Association Hall of Fame, honoring her contributions to nursing and her lasting impact on patient care. II. Major Concepts and Definitions Lydia Hall (1962) stated, “Individuals could be conceptualized ni three separate domains: the body (care), the illness (cure), and the person (core).” She defined nursing through her Care, Cure, and Core Model, emphasizing that nursing is a professional interpersonal process aimed at addressing the unique needs of patients. Her model highlights the interconnectedness of three key concepts: Care, Core, and Cure. * exclusive to nurses * involves intimate bodily care Care the body like feeding bathing and , , toileting The first key concept, care, emphasizes the intimate and personal bodily care that nurses provide to patients. This includes essential activities such as bathing, feeding, and maintaining a comfortable environment. Hall highlighted that the purpose of this care is to offer comfort to patients, stating that the intent behind bodily care is to create a comforting experience. By doing so, nurses establish a close relationship with patients, allowing them to respond positively to physical care. Hall believed this interpersonal connection is crucial for effective healing, as it encourages patients to engage and express their concerns, contributing to their overall well-being. Cure the illness * shared wr doctors The second concept, cure, refers to the medical and therapeutic functions that nursing encompasses, which often overlap with the roles of physicians. Hall recognized the [importance of nurses in assisting with medical tasks and treatments, but she warned against nurses losing sight of their distinct nurturing role.J She noted that many nurses tend to adopt roles akin to physicians, resulting in “second-class doctoring” instead of focusing on their primary strengths. This statement underscores her belief that nurses should maintain their identity as caregivers, emphasizing the importance of the nurturing relationship while supporting medical interventions. Core the person * addressed by the therapeutic use of self * shared w/ psychiatry/psychology religious ministry , ,. etc The third concept, core, addresses the↓ therapeutic relationships that nurses develop with their patients, which are vital for holistic care. Hall believed that by creating a supportive and trusting environment, nurses could significantly enhance a patient's recovery process. She pointed out that when patients feel comfortable and understood, they are more likely to engage in their healing journey. This supportive dynamic allows patients to explore their thoughts and emotions, leading to more rapid progress in their rehabilitation. III. Relationships of Theory, Practice, Academe/Education, and Research A. Theory to Practice < nursing leadership Lydia Hall’s nursing theory intricately connects theoretical principles to practical application, emphasizing the vital role of interpersonal relationships between nurses and patients. Hall actualized her vision through the establishment of the Loeb Center for Nursing and Rehabilitation at Montefiore Medical Center in 1963. This center focused on rehabilitation and facilitating smooth transitions for patients back to their homes or to long-term care if necessary. Under Hall's guidance, the nursing model implemented at the Loeb Center positioned professional nurses as the primary agents of care during the rehabilitation phase. By prioritizing nursing leadership in patient admissions and care decisions, Hall demonstrated how nurses, through close interpersonal interactions, could effectively foster learning, growth, and healing, ultimately decreasing complications and promoting overall health. B. Theory to Academe/Education -equip nursing graduates wh a curriculum focused on patient-centered care 3 interpersonal skills The implementation of Hall's theory at the Loeb Center necessitated a re-evaluation of nursing education, reinforcing the need for curricula that emphasize patient-centered care and the development of strong interpersonal skills. Future nursing programs must prepare students to engage actively with patients, facilitating their participation in care processes. Hall’s model illustrates the critical importance of equipping nursing graduates with the tools to foster rehabilitation and manage complex patient needs effectively. The outcomes observed at the Loeb Center serve as a vital case study for nursing education, highlighting the need for an educational framework that prepares nurses to implement Hall’s principles in various healthcare settings. C. Theory to Research I nurse-led rehabilitation model used in research Research plays an essential role in validating and evolving Hall’s nursing theory. The successes witnessed at the Loeb Center provide valuable evidence supporting the effectiveness of a nurse-led rehabilitation model. Studies, such as the 2007 publication by McCoy, Davidhizar, and Gillum, which applied Hall's theory to home health nurse management of patients with heart failure, underscore the ongoing relevance of her principles. This research demonstrates how effective nursing management can lead to improved patient outcomes, including reduced hospital readmissions. By examining the impact of Hall's model in diverse contexts, researchers can further validate her framework, fostering a continuous cycle of improvement in nursing practice. IV. Major Assumptions of the Theory 1. The motivation and energy necessary for healing exist within the patient rather than in the healthcare team. A patient will completely heal only if they want to heal because the motivation is driven solely by them. When faced with unmotivated patients, the nurse’s job is to bring out the motivation from the patient because the mental state of the patient is very important to hasten the healing process. If the client is unwilling to receive help, then it will be hard for them to heal. However, if they are motivated to receive help, then they are able to make conscious decisions for themselves like choosing to take the medications prescribed to them. 2. The three aspects of nursing should not be viewed as functioning independently but as17 interrelated. Nurses work collaboratively, and just because they are the care does not mean that they should only be giving care for the patient. The same goes for when doctors play the main role under the cure aspect, that does not mean that the nurses will not have anything to do with that aspect. Basically, the three aspects are interlocking with each other because if one aspect is absent, the patient will not heal completely. It also means that nurses need help from others. 3. The three aspects interact, and the circles representing them change the size, depending on the patient’s total course of progress. Every patient has unique needs, therefore, to cater to that specific need, the three C’s change in size. For Catholics, if the patient is on his deathbed, they may want to call for a clergy because spiritual health is also health and it is important to not focus only on the physical health, but on the overall health of the patient. The scenario stated could mean that the core aspect is larger than the other aspects because it required collaborative work on the healing process of the patient. V. Three C's of Lydia Halls’s Nursing Theory (Care, Cure, and Core Model) *changes in size depending on the patient's needs The care, cure, and core are essential to work together to hasten the healing process of the patient. This theory also provides significance in the nurse-patient relationship which is pivotal in effective nursing care. The patient will not heal properly if only one of the C’s is used. All three are applied to the patient but they can be unbalanced or change in size as every patient requires different needs. In the acute phase, the cure is often the primary focus, with less emphasis on acute phase CURE core and care. However, as patients transition to the recuperation stage, the need for a systemic reaction · against infection or direct medical intervention may decrease, allowing the core and care aspects to take tissue injury precedence. This shift illustrates how the emphasis on cure is intertwined with the effectiveness of core and care. recuperation stage CARE During the recuperation phase, care becomes especially prominent. As patients · recovery begin to heal, the nurturing environment created by caring interactions supports their emotional and psychological recovery, facilitating engagement with core educational practices and allowing for more effective medical interventions. Core functions enhance the effectiveness of both care and cure. For instance, when patients receive education about their conditions, they are better equipped to engage in their care, leading to improved health outcomes. This empowerment fosters a sense of ownership over their health journey, making them more receptive to both caring interactions and medical interventions. VI. Nursing Metaparadigm Person Lydia Hall described it as an individual who is 16 years of age or older and has passed the acute stage of long-term disease. The person is also the center of the nurses’ attention, and within the individual is the source of energy or motivation for healing, which do not come from the healthcare provider. The healthcare provider will just help the person to find that motivation, but it is still relying on the person’s energy. Hall also described the person as distinctive, capable of growth and learning, and needs P a total person approach. So, according to Hall’s theory, a person has different needs and in order to provide those needs, the healthcare provider should consider the mental, and physical health of the person, and also the internal and external factors that affect it. Health Hall described health as the state of self-awareness that comes with a conscious selection of optimal behaviors for the individual. She also stressed that the person needs help in exploring the meaning of his or her behavior so that they can develop and gain maturity and self-identity. Through learning and maturing, they can overcome problems and gain independence easily. Environment Hall was credited with developing the Loeb Center Concept wherein the environment is designed to assist the person in attaining their goal because she assumed that the hospital environment negatively impacts the health of the person as it may cause stress or bring the ill individual to a difficult psychological experience during treatment. The Loeb Center Concept encourages a setting that is open for personal growth so that the individual can heal. Nursing Nursing is defined as participating in all the three C’s, or the core, care, and cure aspects of patient care. Nursing is different from a nurse because nursing is the act while the nurse is the one who acts. Dorothea Orem’s Self-Care Deficit Nursing Theory I. Background Dorothea Orem, a key figure in the nursing discipline, was born in 1914 in Baltimore, Maryland. She began her career in the 1930s at Providence Hospital School of Nursing in Washington, DC, and later earned a Bachelor’s degree in 1939 and a Master’s degree in 1946 in Nursing Education from the Catholic University of America. Due to her significant contributions in the nursing discipline, several universities awarded her honorary Doctor of Science degrees, and Georgetown University was the first to grant it in 1976. During her time, she served as the operating room nurse, private duty nurse (home and hospital), hospital staff nurse on pediatric and adult medical and surgical units, evening supervisor in the emergency room, and biological science teaching. Apart from that, she also held various leadership positions and served as a consultant in nursing education and practice. Orem focused on upgrading the quality of nursing in general hospitals throughout the state. Her first book, Nursing: Concepts of Practice was published in 1971, and was followed by several subsequent editions. Throughout her career, she received numerous awards and honors for her contributions to nursing, including the Linda Richards Award from the National League for Nursing in 1991. She passed away at 92 in 2007 at her residence in Georgia. II. Major Concepts and Definitions Orem (2001) stated, “Nursing belongs to the family of health services that are organized to provide direct care to persons who have legitimate needs for different forms of direct care because of their health states or the nature of their health care requirements.” In Nursing Theorist and Their Work (2001), Orem’s concept is rooted in the idea that people require assistance when they cannot meet their own self-care needs. Nursing steps in to fill this gap by addressing the care that individuals need ↳ based on their unique health circumstances. The ↓“legitimate needs” Orem mentions refer to the justified and medically appropriate reasons why someone may need nursing care, which could vary from physical, mental, or emotional health conditions requiring professional support. The question Orem posed, “What condition exists in a person when judgments are made that a nurse(s) should be brought into the situation?” directs her thinking ↳ towards understanding when nursing care is necessary. This question led her to develop the Self-Care Deficit Nursing Theory. Orem indicates that the condition where the need for nursing assistance is necessary is when there is an inability of the person to provide continuously for themselves the amount and quality of required self-care because of situations of personal health. FOUR RELATED THEORIES The Self-Care Deficit Theory of Orem is a general theory composed of the following: 1. The Theory of Self-Care * individuals can main- tain their health and According to Orem (2001), “self-care comprises the practice of activities well-being by perform- that maturing and mature persons initiate and perform, within time frames, on ingelf-care activities their own behalf in the interest of maintaining life, healthful functioning, continuing ↳ deliberate actions personal development, and well-being by meeting known requisites for functional taken to meet their and developmental regulations” (p. 522). own needs In that definition, self-care refers to the things that maturing individuals or adults do to take care of themself, and she emphasizes that these activities are started or initiated and done by the same person, not by someone else. The goal of this is to keep an individual alive and healthy by preventing illnesses and ensuring that they meet the necessary needs for their physical, emotional, and personal growth. Since self-care activities are done within a certain time, this means that people plan and set aside time to take care of their needs regularly. By this, Orem is saying that self-care is not a passive activity; rather it involves active engagement and personal responsibility. Self-Care Requisites Self-care requisites are essential actions that individuals need to perform to maintain their health and development. These actions are based on established knowledge or hypotheses about human functioning and growth. It has two main components: and and icocontrol or may something na dapat i control to reach a goal 1. The factor to be controlled or managed - This involves identifying aspects that need attention or control. It refers to the factors that need to be controlled or managed to keep an aspect(s) of human functioning and development within the norms compatible with life, health, and personal well-being. 2. The nature of the required action - This involves defining what specific actions should be done to address the identified factors. dapat an ang win - specific actionis identified factors The purpose of the self-care requisites is to constitute the formalized purposes of self-care. They are the reasons for which self-care is undertaken; they express the intended or desired result—the goal of self-care (Orem, 2001, p. 522). Self-Care Requisites has three (3) categories: Universal Self-Care Requisites Universal self-care requisites are basic needs that apply to all people, regardless of age or gender. These are universally required goals which can be met through self-care or dependent care. There are eight (8) universal self-care requisites: 1. Maintenance of a sufficient intake of air 2. Maintenance of a sufficient intake of food 3. Maintenance of a sufficient intake of water 4. Provision of care associated with elimination processes and excrements 5. Maintenance of balance between activity and rest 6. Maintenance of balance between solitude and social interaction 7. Prevention of hazards to human life, human functioning, and human well-being 8. Promotion of human functioning and development within social groups in accordance with human potential, known human limitations, and the human desire to be normal. Normalcy is used in the sense of that which is essentially human and that which is in accordance with the genetic and constitutional characteristics and talents of individuals (Orem, 2001, p. 225). Developmental Self-Care Requisites The developmental self-care requisites or DSCR supports growth and development throughout an individual’s life. Three sets of DSCRs have been identified, as follows: 1. Provision of conditions that promote development 2. Engagement in self-development 3. Prevention of or overcoming effects of human conditions and life situations that can adversely affect human development (Orem, 1980, p. 231) Health Deviation Self-Care Requisites Health deviation self-care requisites exist for individuals who are ill or injured, who have specific forms of pathological conditions or disorders, including defects and disabilities, and who are under medical diagnosis. The demands for care come from both the illness and the treatment needed for it. So, care measures must become part of the individual’s self care or dependent care in order to address it. The more health needs a person has, the more complicated their self-care needs become, especially as these needs often have to be met within a specific time frame. Therapeutic Self-Care Demand Therapeutic self-care demand refers to the range of care activities that a person needs to perform in order to maintain their health and well-being, especially when diagnosed with specific health conditions. In other words, this consists of the summation of care measures necessary at specific times or over a duration of time to meet all of an individual’s known self-care requisites. Therapeutic Self-Care Demand is performed by the self-care agent or the individual. The therapeutic self-care demands involves: 1. Controlling or managing factors identified in the requisites, the values of which are regulatory of human functioning (sufficiency of air, water, and food) 2. Fulfilling the activity element of the requisites (maintenance, promotion, prevention, and provision) (Orem, 2001, p. 523) At any given time, therapeutic self-care demand involves: 1. The factors in the patient or the environment that must be held steady within a range of values or brought within and held within such a range for the sake of the patient’s life, health, or well-being 2. The known degree of instrumental effectiveness derived from the choice of technologies and specific techniques for using, changing, or in some way controlling patient or environmental factors. Self-Care Agency The self-care agency is a complex acquired ability of mature and maturing persons to know and meet their continuing requirements for deliberate, purposive action to regulate their own human functioning and development (Orem, 2001, p. 522). Self-care agency is what we call a person’s ability to take care of g themselves by meeting their requirements or needs. This capacity is “acquired,” because it develops over time as individuals grow or mature, and it is “complex” because it involves multiple skills and knowledge to maintain their health and well-being. In other words, these are the ability of an individual to understand their needs and to purposely take actions in order to address these needs to maintain their overall functioning. 2. The Theory of Dependent Care As per Orem, dependent care refers to the care that is provided to a person who, because of age or related factors, is unable to perform the self-care needed to maintain life, healthful functioning, continuing personal development, * when individuals are and well-being. unable to perform self- care due to limitations Based on her definition, dependent care involves helping individuals who ↳ caregivers take on cannot care for themselves. This dependency may be due to age, illnesses, the responsibility to disability, or other related factors that makes them incapable of self-reliance. The meet their health goal of dependent care is to help and support these individuals to maintain their needsthroughde life, growth, and health as well as ensure that they function well in their daily lives. Dependent-Care Demand The summation of care measures at a specific point in time or over a duration of time for meeting the dependent’s therapeutic self-care demand when his or her self-care agency is not adequate or operational. (Taylor, Renpenning, Geden, et al, 2001, p. 40). This refers to the holistic care provided to a person when they are unable to care for themself or fully meet their own self-care requisites due to limitations in their self-care agency. This involves the actions done by the dependent-care agent (nurses or caregivers) to fulfill their therapeutic self-care demands when the person cannot do so independently. Dependent-Care Agency Dependent-care agency refers to the acquired ability of a person to know and meet the therapeutic self-care demand of the dependent person and/or regulate the development and exercise of the dependent’s self-care agency. Dependent-care agency refers to the ability of a nurse or caregiver to understand and meet the healthcare needs of a person who cannot meet those requisites independently. 3. The Theory of Self-Care Deficit Self-care deficit, as defined by Orem, is the relation between an individual’s therapeutic self-care demands and his or her powers of self-care agency in which constituent-developed self-care capabilities within self-care agency are in-operable or inadequate for knowing and meeting some or all components of the existence or projected therapeutic self care demands. It expresses the relationship between action capabilities of individuals and their demand for self care. Based on that definition, a self-care deficit refers to the gap between an individual's ability to perform necessary self-care activities and the demands of their health condition. It occurs when a person lacks the capability to carry out essential self-care activities needed to maintain their health and well-being. These deficits can be physical, cognitive, or emotional, hindering individuals from meeting their own needs. It describes and explains why people can be helped through nursing Dependent Care Deficits Dependent-care deficit is a relationship that exists when the dependent care provider’s agency is not adequate to meet the therapeutic self-care demand of the person receiving dependent care. Dependent-care deficit happens when the caregiver cannot adequately meet the self-care needs of a dependent person and requires assistance, training, or resources to provide proper care. Nursing Agency Nursing agency comprises developed capabilities of persons educated as nurses that empower them to represent themselves as nurses and within the frame of a legitimate interpersonal relationship to act, to know, and to help persons in such relationships to meet their therapeutic self-care demands and to regulate the development or exercise of their self-care agency (Orem, 2001, p. 518). Nursing Design Nursing design, a professional function performed both before and after nursing diagnosis and prescription, allows nurses, on the basis of reflective practical judgments about existing conditions, to synthesize concrete situational elements into orderly relations to structure operational units. Nursing design involves creating a plan or framework that nurses use to support patients with self-care deficits. Its purpose is to establish guidelines for achieving desired outcomes in nursing care, ultimately helping to meet nursing goals. Together, these components form a cohesive pattern that directs nursing practice of nursing goals; these units taken together constitute the pattern that guides the production of nursing. 4. Theory of Nursing Systems * nurses provide care based The theory of nursing systems, describes and explains relationships that on the patient's self-care must be brought about and maintained for nursing to be produced. It proposes needs ranging from "complete , support "partial assistance to , that nursing is human action; nursing systems are action systems formed (designed and produced) by nurses through the exercise of their nursing agency , educating and "supporting self-care. for persons with health-derived or health-associated limitations in self-care or dependent care. nursing nursing system Chuman (action systems action) formed by Nursing Systems nurses in nursing) Nursing systems are series and sequences of deliberate practical actions of nurses performed at times in coordination with the actions of their patients to know and meet components of patients’ therapeutic self-care demands and to protect and regulate the exercise or development of patients’ self-care agency (Orem, 2001, p. 519). The theory of nursing systems is a comprehensive framework that integrates key concepts, including the theory of self-care deficit, the theory of self-care, and the theory of dependent care. It highlights the relationships and interactions essential for effective nursing, emphasizing that nursing extends beyond mere tasks to become a meaningful human action that helps individuals attain improved health outcomes Types of Nursing Systems I Wholly Compensatory Nursing System do for the - This system is used when patients are unable to perform any aspect of patient self-care on their own. In this case, nurses take full responsibility for meeting the patient’s needs and performing tasks such as bathing, feeding, and medication administration. 2 Partly Compensatory Nursing System help the patient do - This system is used when patients are capable of performing some for himself self-care activities but need help with others. In this case, nurses provide partial assistance to ensure all patient’s needs are met, balancing autonomy with support. 3 Supportive-educative Nursing System help the patient - This system focuses on empowering patients to become self-reliant in learn to do for meeting their self-care needs. Here, nurses provide education, guidance, himself ↳ nurse has an and emotional support to help patients build the skills necessary for important role effective self-care management. in designing nursing care Helping Methods A helping method from a nursing perspective is a sequential series of actions that, if performed, will overcome or compensate for the health-associated limitations of individuals to engage in actions to regulate their own functioning and development or that of their dependents. - Acting for or doing for another - Guiding and directing - Providing physical or psychological support - Providing and maintaining an environment that supports personal development - Teaching III. Relationships of Theory, Practice, Education, and Research A. Theory to Practice Orem’s theory is highly applicable to the nursing profession as it guides nurses on assessing a patient’s ability to perform self-care and helps them determine what are the patient’s limitations or deficits. Apart from that, Orem’s model also assists nurses in developing a tailored care plan to properly address those deficits. From their assessment, they could determine whether they should provide all the care for the patient (wholly compensatory), assist them (partially compensatory), or guide the patients (supportive-educative). B. Theory to Academe In nursing academia or education, Orem's Self-Care Deficit Theory provides a structured framework that deeply influences curriculum design, clinical training, and the development of critical thinking skills. The theory is integrated into nursing programs to help students understand and assess patients' self-care needs, teaching them to identify self-care deficits and apply appropriate interventions based on patients' ability to care for themselves. By understanding this framework, nursing students learn to assess patients' abilities to perform self-care and identify areas where assistance is needed. C. Theory to Research Orem's theory serves as a significant framework in nursing research, providing a structured approach to studying patient self-care behaviors, interventions, and outcomes. It is instrumental in investigating self-care deficits and the roles of family members and caregivers in supporting patient self-care. Research grounded in Orem's framework often evaluates the outcomes of self-care interventions, focusing on improvements in health status and quality of life. Measurement tools based on Orem's theory can quantify self-care practices and knowledge, and systematic reviews can inform healthcare policies and practice guidelines. IV. Major Assumptions of the Theory 1. Human beings require continuous, deliberate inputs to themselves and their environments to remain alive and function in accordance with natural human endowments. 2. Human agency, the power to act deliberately, is exercised in the form of care for self and others in identifying needs and making needed inputs. 3. Mature human beings experience privations in the form of limitations for action in care for self and others involving making of life-sustaining and function-regulating inputs. 4. Human agency is exercised in discovering, developing, and transmitting ways and means to identify needs and make inputs to self and others. 5. Groups of human beings with structured relationships cluster tasks and allocate responsibilities for providing care to group members who experience privations for making required, deliberate input to self and others (p. 140). Orem stated pre-suppositions and propositions for the theory of nursing systems, the theory of self-care deficit, and the theory of self care. V. Dorothea Orem’s Model of Self-Care Deficit Nursing Theory > - nursing is req- wired when individuals cannotmeettheir selfa tations ↳ the nurse's role is to assess and address these deficits to restore or enhance the person's self-care abilities The conceptual framework of Orem’s Self-Care Deficit Theory presents the relationships among self-care, self-care demands, self-care agency, and nursing agency, all of which are crucial in addressing patient care deficits. Self-care has a direct relationship with self-care agency, defined as the capacity of an individual to perform self-care, as well as with self-care demands, which encompass the specific requirements self-care agency · a person's capability to identify their needs, assess their resources, andperformea necessary for individuals to effectively manage their health. As individuals encounter various health challenges, their self-care demands may increase, while their self-care agency might fluctuate due to limitations, such as illnesses or diseases, as well as factors including health status, knowledge, motivation, and available resources. This imbalance, where an individual’s self-care demands exceed their self-care agency, constitutes a self-care deficit. In such cases, nursing agency becomes essential, as nurses assist patients in meeting their self-care demands and enhancing their self-care agency. VI. Nursing Metaparadigm Person Orem sees a person as having physical, social, and psychological aspects, with varying abilities to care for themselves. Each person is a recipient of care who can learn and grow, and has the potential to develop skills to meet their own self-care needs. Environment Environment, in Orem’s definition, refers to the environment as the context in which a person exists. In her theory, Orem classified the environmental concept into 4 features or classifications: physical, chemical, biological, and socio-economic features. Additionally, she viewed these broad features as something that affects an individual’s capacity for self-care. Health In the context of Orem’s Self-Care Deficit Theory, health refers to an individual's overall state of well-being (physical, mental and social), defined by their ability to meet personal needs through self-care. Nursing Orem defined nursing as the care for individuals who are unable to perform self-care independently, offering necessary interventions, support, and education to help them meet their needs for self-care and medical assistance. References Alligood, M. R. (2013). Nursing Theorists and Their Work - E-Book (M. R. Alligood, Ed.; 8th ed.). Elsevier Health Sciences. Gonzalo, A. (2024, April 30). Lydia Hall: Care, Cure, Core Nursing Theory. Nurseslabs. Retrieved October 26, 2024, from https://nurseslabs.com/lydia-e-halls-care-cure-core-theory/ Quiambo-Udan, J. (2020). Theoretical foundation in nursing (2nd ed.). APD Educational Publishing House. Real, A. (2024). Overview of Dorothea Orem’s Self-Care Theory. IntelyCare. https://www.intelycare.com/career-advice/overview-of-dorothea-orems-self-care-t heory-for-nurses/ Self Care Theory. (2018, December 30). https://pmhealthnp.com/dorothea-orems-self-care-theory/ Shah, M., Abdullah, A., & Khan, H. (2013). Compare and contrast of grand theories: Orem’s self-care deficit theory and Roy’s adaptation model. In International Journal of Science and Research. https://www.ijsr.net/archive/v4i1/SUB15564.pdf Smith, M. C. (Ed.). (2019). Nursing Theories and Nursing Practice (5th ed.). F.A. Davis Company. PAMANTASAN NG LUNGSOD NG MAYNILA (University of the City of Manila) Intramuros, Manila Evelyn Adam and Madeleine Leininger A Written Report Submitted in the Fulfillment of the Requirement for the Course Theoretical Foundations in Nursing Submitted by: Aguiran, Norelle Y. Guiriba, Gerriel P. Quiambao, Al-John S. Sarmiento, Sian Alexa G. Group 2 Bachelor of Science in Nursing 1-4 Submitted to: Prof. Ronie M. Tiamson, RN, RM, MAN, MSN I. Evelyn Adam Themes, U. (2017, February 9). Nursing theorists of historical significance. Nurse Key. https://nursekey.com/nursing-theorists-of-historical-significance/ Evelyn Adam is a Canadian nurse who started publishing in the mid-1970s. Much of her work focuses on developing models and theories on the concept of nursing. She uses a model she learned from Dorothy Johnson in her book, “To be a Nurse." She applies Virginia Henderson's definition of nursing to the theories and identifies the assumptions, beliefs and values, and major units. In the latter category, she includes the goal of the profession, the source of the beneficiary of the professional service, The role of the professional. the source of the beneficiary’s difficulty, the intervention of the professional, and the consequences. She expands her work in the second edition. Adams' work is a good example of using the unique basis of nursing for further expansion. She has contributed to the theory development by clarification and explication of earlier work. A. Concept The development of Evelyn Adam’s conceptual model for nursing is based on her learnings from Dorothy Johnson and the definition of nursing of Virginia Henderson. Nursing Need Theory of Virginia Henderson Virginia Henderson viewed the patients as individuals requiring help toward achieving independence. She also emphasizes the art of mercy and identifies the 14 basic human needs on which nursing care is based. Henderson stated that 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 the peaceful death that he would perform unaided if he had the necessary strength, will, or knowledge and to do in such a way as to help him gain independence as rapidly as possible. 14 Fundamental Conceptual Model for Nursing ↑ Needs > - focuses on understanding the patient's - - needs and using a problem-solving - Approach to provide care 14 Basic Human Needs & emphasizes > - the relationship where the nurse , nurse-patient 1. Breathing 7 Behavorial listens and supports the patient in subsystems making health decisions 2. Eating and drinking > goal : to help patients become - 3. Elimination as independent as possible 4. Movement by meeting their physical , emotional and social needs 5. Rest and sleep , 6. Suitable clothing 7. Body temperature 8. Clean body and protected integument 9. Safe environment 10. Communication 11. Worship 12. Work 13. Play 14. Learning Behavioral Systems Model of Dorothy Johnson Dorothy Johnson also considered attachment, or affiliative subsystem, as the cornerstone of social organizations. Her behavioral system also includes the subsystems of dependency, achievement, aggressive, ingested, eliminative, and sexual. Seven Behavioral Subsystems 1. Attachment/Affiliate Subsystem 2. Dependency Subsystem 3. Ingestive Subsystem 4. Eliminative Subsystem 5. Sexual Subsystem 6. Achievement Subsystem 7. Aggressive/Protected Subsystem B. Relationship Nursing Practice Based on this conceptual model, the nurse is seen in a complementary-supplementary role, and the goal is client independence in the satisfaction of his or her needs. The model serves as a guide for using the nursing process and the problem-solving method. Guided by the 14 fundamental needs, the practitioner in whatever setting will assess the independence of the client in need satisfaction. The nurse will identify the client's specific needs, determine the source of difficulty, and plan an intervention to complement client strength, will, or knowledge. After the care is given, it is evaluated with reference to the client's objects; for example, have the specific needs been satisfied and has the client's independence increased? A nursing problem (a client’s health problem requiring a nurse’s intervention) is a dependency problem in need of satisfaction. A nursing diagnosis is a specific need that is and is unsatisfied because there is insufficient strength, real, or knowledge. Criteria for identifying specific needs have been developed. According to Adam. The nurse carries out the social mission of contributing to the public’s improved health by working forward greater client independence. The model serves as a guide for using the nursing process and the problem-solving method. The practitioner, in whatever setting, will assess the independence of the client in need of satisfaction. Nursing Academe Adam states, "Following Henderson's concept of nursing, the nursing curriculum is planned to prepare a little worker capable of maintaining and restoring clients independence and satisfaction of their fundamental needs, wherein students learn the complementary-supplementary role. Adam divides the program into official and unofficial content, both of equal importance. Unofficial content covers everything that is learned in an educational program without being taught. Official content is further divided into nursing and non-nursing. According to Henderson's frame of reference, nursing content includes: 1. The goal of nursing, which is to preserve or reestablish the client's independence in the satisfaction of his or her basic needs. 2. The detailed description of the 14 fundamental needs, each with its biological, physiological, psychological, social, and cultural dimensions. 3. The individual variations in fundamental needs. 4. The various problems of dependence originate from a lack of strength, will, or knowledge. 5. The explanation of the complementary-supplementary role. 6. The description of the various needs of intervention. 7. The study of the desired consequences: continued or increased independence and, in certain circumstances, a peaceful death. 8. The study of the systematic process and the problem-solving method as applied to nursing. Regardless of the conceptual model for nursing, essential subject matters are "the helping relationship, the concept of health, and the history of nursing.” The theoretical courses in non-nursing content include anatomy, physiology, pathology, psychology, sociology, and anthropology. In relation to Henderson's model, the first three relate to the biophysiological dimension and the last three to the psycho-socio-cultural aspect of the fundamental needs. Subject matter derived from the conceptual model's assumptions are: (1) The concepts of independence and dependence. (2) The concepts of universal and individual human needs, hierarchy of human needs, and need satisfaction. (3) The concept of wholeness. The practical aspect of nursing content consists of technical procedures and clinical experiences. Techniques are important in the complementary-supplementary role because the nurse is assisting the client in those activities that cannot be completed because there is insufficient strength, will, or knowledge. Techniques help pursue the goal of client independence in the satisfaction of his or her needs. Adam believes that "the goal of clinical experiences is to provide the student with opportunities to help a client recover his independence in the satisfaction of his basic needs." Although the level of education may increase, the model remains the conceptual base. Baccalaureate students' formal education will help them identify complex and subtle specific needs, find new ways of complementing and supplementing, and form and continue a helping relationship. Master's level students learn to be specialists in independence nursing or in the teaching and administration of independence nursing. Doctoral students may use the concept of independence in need satisfaction as a basis of research for theory development. Nursing Research Adam states that various clinical and educational settings in Canada are at varying stages of basing nursing care and teaching on Henderson's model and that the research for a small number of master’s theses has been based on this model. Correspondence received from Canada, the United States, and abroad indicates her book has received very favorable reviews. According to Adam, the conceptual model provides 12 key questions that guide the development of research. These questions are: 1. How can client independence be measured? 2. How can his degree of dependence be quantified? 3. What dependency problems are solved by what nursing interventions? 4. At what point must the intervention be discontinued if independence is to be promoted? 5. How can certain interventions be made more easily acceptable? 6. How can the nurse determine how much intervention is enough? 7. What dependency problems are most often encountered among selected groups (cancer patients, the aged, the mentally confused)? 8. How does pain and anxiety affect independence? 9. How can linguistic barriers be overcome? 10. How can the nurse help certain ethnic or socioeconomic groups to be independent? 11. How can the nurse increase client participation in healthcare? 12. Is the conceptual model socially useful, significant, and congruent? C. Conceptual Model of Nursing The conceptual model of nursing refers to a mental representation, concept, or conception of nursing that is sufficiently complete and detailed so as to provide direction for all fields of activity of the nursing profession. The development of nursing models and theories, especially those of Dorothy Johnson and Virginia Henderson, is the main focus of Evelyn Adam's "Conceptual Model of Nursing" theory. In her book “To Be a Nurse," Evelyn Adam combines Virginia Henderson’s 14 Fundamental Needs and definition of nursing into Dorothy Johnson’s Behavioral System Model of Nursing to outline essential assumptions, beliefs, values, and major units. Adam explains that a nurse’s primary goal is to promote effective behavioral functioning in clients to help prevent illness. By supporting and enhancing clients' strengths, knowledge, and determination, nurses assist clients in maintaining their independence in fulfilling these 14 fundamental needs. The client's strength, knowledge, and will should be complemented and enhanced by the nurse. Evelyn Adam's "Conceptual Model of Nursing" consists of six elements, which are as follows: Goal of the profession "The ultimate goal that the professional seeks to achieve" is to help the patient maintain or restore independence in addressing their health needs. The nurse supports the patient in reaching their best possible physical and mental functioning, aiding in the prevention of or recovery from illness. Beneficiary “A person or a group of people who the professional directs their clients like the client.” This refers to the patient or client. Adam views the patient as an individual with unique needs, strengths, and the capacity for self-care, emphasizing the nurse's role in helping the patient maintain autonomy. Role "This is the role of the professional, fulfilling their societal function." The nurse serves as a helper, facilitator, and advocate, with the focus on enhancing the patient’s strengths, knowledge, and will. The goal of nursing care is to promote the patient's behavioral and functional well-being. Source of Difficulty “The probable origin of the client's difficulty; one with a professional, because of his education and experience, is prepared to cope." Adam identifies illness, health problems, or environmental factors as sources of difficulty that hinder the patient's ability to meet their fundamental needs. The nurse’s task is to address and mitigate these difficulties. Intervention "The central focus of the professional's attention when intervening with a client." Nursing interventions aim to restore the patient's independence by addressing their challenges and building on their strengths. The nurse offers care, education, and support to help the patient meet their health needs. Consequences "The outcomes of the professional's efforts to achieve both the ideal and specific goals." The desired result of nursing interventions is to enhance the patient's capacity to meet their own needs and sustain independence. The ultimate aim is to promote self-reliance and prevent illness by encouraging effective behavioral functioning. D. Assumptions The assumptions that underpin Henderson's vision of nursing are influenced partly by the theories of American psychologist Thorndike and partly by Henderson's experiences in rehabilitation. There are three key assumptions: 1. Every individual strives for and desires independence Adam described the goal of nursing as maintaining or restoring the client's independence in the satisfaction of the 14 fundamental needs. The nurse plays a complementary-supplementary role in complementing and supplementing the client's resources (strength, knowledge, and will). 2. Every individual is a complex whole, made up of fundamental needs. In this model, the person is portrayed as a complex whole, made up of 14 fundamental needs and the resources to satisfy them. This assumption asserts that each person is a unified entity composed of various interrelated needs, including biological, physiological, psychological, and sociocultural dimensions. This holistic perspective recognizes that a person’s well-being is influenced by their physical health, emotional state, social interactions, and cultural background. 3. When a need is not satisfied, it follows that the individual is not complete, whole, or independent. This assumption emphasizes that each individual has fundamental needs that must be met for them to function effectively and feel fulfilled. If any of these needs remain unmet, it impacts their overall sense of completeness and autonomy. For example, physiological needs like nutrition and hydration, as well as psychological needs such as emotional support and social interaction, are critical for maintaining health and well-being. When a person lacks fulfillment in these areas, they may experience feelings of inadequacy, dependence, or even distress. E. Metaparadigm The nursing metaparadigm encompasses four essential concepts that shape the practice of nursing, in which these concepts equip nurses to provide holistic and patient-centered care. The nursing metaparadigm of Evelyn Adams adopts a comprehensive approach to healthcare by considering multiple interconnected aspects: A. Person Based on Evelyn Adam’s “Conceptual Model of Nursing,” a person is defined as the beneficiaries, which are the people or a group of people to whom the professional directs their activities. 14 Fundamental Needs By relating this to Virginia Henderson’s 14 Fundamental Needs to Dorothy Johnson’s “Behavioral System Model,” it states that for a person or patient to satisfy their Benavorial System Models independence to the 14 Fundamental Needs asserted in Henderson’s Theory, it needs Dorothy Johnson’s “Behavioral System Model,” whose goal is to advocate the fostering of efficient and effective behavioral functioning in the patient to prevent illness through nursing care. B. Health Based on Evelyn Adam’s Theory, health is defined as intervention, the focus or the center of the professional’s attention, the moment they intervene with a client. In relation to Henderson and Johnson’s theories, health is the client’s independence to satisfy the 14 Fundamental Needs for good health to achieve, which are influenced by & different aspects such as age, health, cultural background, or emotional imbalance. 14 Fundamental Needs Benavorial System Models G Thus, one’s health should be adjusted through nursing care, demonstrating the behavioral system to such an extent that efficient and effective adaptation will occur. C. Environment In Evelyn Adam’s Theory, it states that to maintain the supportive environment conducive to health that was included in Henderson’s 14 Fundamental Needs, requires the application of Johnson’s “Behavioral System Model,” which affirms that all elements of the surroundings of the human system, including the interior stressors, should be taken into consideration. D. Nursing Evelyn Adam’s theory defined nursing as a role in which the professional plays his/her part and societal function. It is also defined as a source of difficulty where the professional plays his/her part and societal function by preparing to cope with the probable origin of the client’s difficulty. By relating Virginia Henderson and Dorothy Johnson’s theories, Evelyn Adam defined nursing as a function that is to assist the individual in making them complete, whole, or independent in satisfying the 14 Fundamental Needs, in which one specific assisting a nurse needs to execute is to promote to the client the efficient and effective behavioral functioning to preserve the organization and integration of the patient’s behavior from demeanors that constitute a threat to the physical or social health of the client. II. Madeleine Leininger Image from Dreyer-Kramshoj (2012). Madeleine Leninger: Everything stems from culture Madeleine Leininger was the first nurse to formally investigate how patients' ethnic backgrounds affect their health and well-being. She understood that a patient's ethnicity could significantly shape their experiences of health, illness, and healthcare. Leininger suggested that nurses could be more effective in their roles by understanding the connection between ethnicity and health. Identifying herself as both an anthropologist and a nurse, Leininger earned a Ph.D. in Cultural Anthropology and developed her theory while studying in this field. In 1969, Leininger established the first course in transcultural nursing in the United States, laying the foundation for integrating cultural competence into nursing practice. Later, in 1977, she launched the first master's and doctoral programs specifically focused on transcultural nursing. Throughout her distinguished career, Leininger made substantial contributions to the field, writing 27 books, publishing over 200 articles, and authoring 45 chapters in various books. Her work continues to influence nursing education and practice, emphasizing the importance of understanding cultural diversity in healthcare. A. Concepts Transcultural Theory Madeleine Leininger recognized early on that nursing needed a more holistic approach that blended scientific and humanistic knowledge to address patients' diverse cultural backgrounds. This realization led her to develop the concept of transcultural nursing, which integrated insights from anthropology and nursing. By combining these two fields, Leininger sought to address the gaps in understanding how culture influences health and healthcare delivery. She believed that both nursing and anthropology should be seen as a unified whole and that a comprehensive understanding of a patient's cultural background was essential for providing effective care. Her Culture Care Theory is based on the idea that nurses must understand their patients' cultures' unique expressions, patterns, and practices to offer culturally congruent care—care that aligns with the patient’s cultural values and beliefs. This groundbreaking idea paved the way for a more inclusive and culturally sensitive approach to nursing. Leininger introduced three core nursing decisions and actions to help nurses deliver culturally sensitive care. These are cultural preservation or maintenance, where nurses support and encourage patients in continuing cultural practices that benefit their health; cultural care accommodation or negotiation, which involves adjusting and negotiating care plans to respect cultural differences without compromising health outcomes; and cultural care repatterning or restructuring, where nurses work with patients to modify harmful cultural practices and adopt healthier behaviors. These actions enable nurses to provide care that respects the patient’s cultural heritage and enhances their overall well-being. By considering these factors, nurses can promote health in culturally relevant and acceptable ways, building a stronger nurse-patient relationship based on mutual understanding and respect. In Leininger’s Transcultural Nursing Theory, nurses are responsible for understanding how culture plays a role in a patient’s health and healthcare choices. A patient’s cultural background not only influences how they view health and illness but may also involve traditional or home remedies that could interact with modern medical treatments. Recognizing these cultural influences allows nurses to provide more effective care by identifying potential risks or benefits that cultural practices may pose. One key aspect of transcultural nursing is the cultural and logical assessment, which involves gathering detailed information about a patient's cultural background, beliefs, and practices during the initial assessment. This information is then used to develop a nursing care plan that is tailored to the patient’s cultural values, ensuring that the care provided is respectful and appropriate for their cultural context. There are several important benefits to incorporating cultural knowledge into nursing practice. First, understanding a patient’s culture helps nurses recognize how their beliefs and traditions influence their experiences with illness, suffering, and even death. It allows nurses to be more empathetic and respectful of the diversity they encounter in their patient populations. This understanding strengthens the nurse-patient relationship, fostering trust and open communication. Additionally, by considering cultural considerations, nurses are more likely to view patients as whole individuals rather than just a set of symptoms. This approach also makes nurses more open to non-traditional treatments, such as spiritual practices or alternative therapies that may be deeply rooted in a patient’s culture. By being open-minded and culturally aware, nurses can provide care that not only addresses the patient's physical health but also respects their emotional, spiritual, and cultural needs. This holistic approach ultimately improves the quality of care and promotes better health outcomes for diverse patient populations. Ethnonursing Ethnonursing is a research method pioneered by Madeleine Leininger, blending concepts from ethnography and nursing to explore how culture influences healthcare. Leininger’s background in anthropology, particularly her experience with ethnography in the 1960s, was instrumental in the development of ethnonursing. Ethnography, a fundamental approach in anthropology used to understand cultural phenomena, was adapted by Leininger to create a method that could be applied in healthcare. This approach allows researchers to study cultural factors affecting health behaviors and practices, aiming to bridge the gap between nursing and the diverse cultural needs of patients. Ethnonursing became a core component of transcultural nursing, helping nurses provide culturally sensitive care. Ethnonursing involves immersive research techniques, including fieldwork and interviews with individuals from specific cultural groups. This approach allows researchers to gather in-depth insights into how cultural values, beliefs, and traditions shape health behaviors and care preferences. By examining these factors, researchers can identify culturally congruent care practices, which can then be incorporated into healthcare delivery to improve patient outcomes. Ethnonursing helps healthcare providers understand how culture affects a patient’s perception of illness, treatment preferences, and overall health management. This method has proven useful in nursing and other fields involving human care, such as social work, therapy, and medicine. The ethnonursing research method is a critical tool within both transcultural nursing and anthropology, focusing on the relationship between culture and healthcare. The method’s goal is to systematically analyze people's care expressions, patterns, and practices in their natural environments to identify generic (folk) and professional care practices that promote health and well-being. By combining these practices, healthcare professionals can plan and implement care that is culturally congruent, ensuring that it is meaningful and beneficial for patients. The method’s applications extend beyond nursing, offering valuable insights for other disciplines where care is central, such as education, administration, and various health professions. Leininger’s theory provides a framework for designing culturally competent care to promote well-being across diverse populations. B. Relationships Nursing Practice In nursing practice, Madeleine Leininger’s Transcultural Theory provides a framework for understanding and integrating patients' cultural backgrounds into their care. This theory emphasizes that effective nursing goes beyond medical knowledge, highlighting the importance of recognizing cultural beliefs, values, customs, and practices that influence a patient’s health behaviors and perspectives on illness and treatment. By applying Transcultural Theory, nurses are encouraged to conduct a cultural assessment to learn about patients' unique backgrounds, which can include family dynamics, spiritual beliefs, language preferences, and traditional healing practices. Nurses can develop care plans that are clinically effective, culturally respectful, and aligned with patients' beliefs and expectations. This culturally sensitive approach helps create a sense of trust and comfort, making patients feel acknowledged and valued in their cultural identities. In practice, it supports more open communication, strengthens the nurse-patient relationship, and ultimately leads to improved health outcomes by promoting patient adherence to meaningful and relevant treatments. Leininger’s Transcultural Theory guides nurses in providing holistic, inclusive care that adapts to the diverse needs of today’s multicultural patient populations. Nursing Academe In the nursing academe, Madeleine Leininger’s ethnonursing method has emerged as a foundational research approach for understanding the role of cultural factors in shaping patient care. Ethnonursing integrates the principles of nursing with ethnographic techniques commonly used in anthropology, including immersive fieldwork, in-depth interviews, participant observations, and detailed data collection. These methods allow nursing researchers to gather comprehensive insights into diverse patient groups' cultural beliefs, values, and health practices. By focusing on patients’ cultural backgrounds and lived experiences, ethnonursing reveals how these elements influence patients’ health behaviors, approaches to illness, treatment preferences, and even their expectations of healthcare providers. For nursing students and researchers, ethnonursing provides an effective framework for examining how individuals’ unique cultural backgrounds shape their health-related decisions and responses to treatment. Through this research approach, students learn to view health behaviors as individual choices and actions embedded within broader cultural, social, and environmental contexts. For example, students studying ethnonursing may investigate how family roles, religious beliefs, community norms, or traditional healing practices impact a patient’s approach to illness and recovery. Understanding these elements encourages students to move beyond viewing patients purely from a clinical perspective, instead of seeing them as individuals whose health decisions are deeply influenced by their cultural identities. This approach encourages nursing students and practitioners to become more empathetic and culturally competent caregivers who respect and value cultural diversity. The insights gained through ethnonursing contribute to a healthcare environment where comprehensive and personalized patient care enhances patient satisfaction and health outcomes. Nursing Research In nursing research, Madeleine Leininger’s ethnonursing method and the Sunrise Model serve as essential frameworks for examining the influence of culture on patient care. Ethnonursing incorporates techniques from ethnography, such as immersive fieldwork, interviews, and observations, allowing researchers to gain a detailed, firsthand understanding of patients’ cultural beliefs, health practices, values, and traditions. By capturing these cultural insights, ethnonursing helps researchers see how factors like family structure, spirituality, traditional healing practices, and community beliefs shape patients’ health behaviors, perceptions of illness, and preferences in treatment. The Sunrise Model complements this approach by providing a structured, visual guide that outlines the cultural, social, and environmental factors affecting health. This model organizes key elements such as patients' worldviews, social structures, cultural norms, language, and even economic conditions, showing how these elements intersect with health practices and influence care needs. Using the Sunrise Model, nursing researchers can systematically assess cultural contexts, helping to identify universal and culture-specific care practices that can improve patient care. Together, Leininger’s ethnonursing and the Sunrise Model enable nursing research to move beyond a one-size-fits-all approach, encouraging the development of culturally competent care practices. These tools guide researchers in understanding patients as holistic individuals influenced by their cultural environments and help develop interventions that respect and align with patients’ cultural values. By integrating these methods into nursing research, healthcare providers are better prepared to deliver effective, culturally sensitive care that builds trust, enhances patient satisfaction, and improves health outcomes across diverse populations. C. Sunrise Model Image from De Melo (2013). The sunrise model: A contribution to the teaching of Nursing Consultation in Collective Health. In 1991, Madeleine Leininger developed the Sunrise Model, a conceptual framework designed to support and guide nursing practice in the context of culturally diverse care. This model serves as a cognitive map that helps nurses systematically understand and approach patient care by integrating cultural factors. The Culture Care Diversity and Universality Theory is central to this model, providing a visual and structured way to explore and analyze the cultural or subcultural contexts of individuals or communities. It helps healthcare providers understand the cultural influences that shape patients' health behaviors, values, and care preferences. As Omeri (2003) explained, the Sunrise Model demonstrates the various domains of Leininger’s theory and guides nurses in discovering new transcultural knowledge. The model facilitates a deeper understanding of the similarities and differences across cultures by identifying and examining both culturally universal and culture-specific care practices. The model adopts a holistic approach, taking into account important elements such as an individual's worldview, cultural values, beliefs, and lifeways, as well as the broader social and structural factors that influence health. It is designed to be flexible and applicable to individuals, groups, and institutions, ensuring that nurses can use it across various healthcare settings to provide culturally competent care. The Sunrise Model also emphasizes the importance of examining both generic (folk) care practices, which are traditional methods rooted in culture, and professional care, provided by trained healthcare practitioners. By integrating both forms of care, nurses can offer more personalized and culturally aligned interventions. The implementation of this model encourages nurses, not only as caregivers but also as researchers, to reflect on their own cultural values, beliefs, and biases and consider how these factors might affect their interactions with patients and the provision of care. This self-reflection is essential for ensuring that care is delivered in a manner that respects cultural diversity and is sensitive to each patient's unique needs. Through the application of the Sunrise Model, nurses can foster greater cultural awareness and competency, ultimately improving the quality of care provided in increasingly multicultural societies. D. Assumptions According to Alligood (2017), these are the major assumptions of Leininger’s theory: 1. “Care is the essence and the central dominant, distinct, and unifying focus of nursing.” 2. “Humanistic and scientific care is essential for human growth, well-being, health, survival, and to face death and disabilities.” 3. “Care is essential to curing or healing, because there can be no curing without caring.” 4. “Culture care is the synthesis of two major constructs (culture and care) that guide the researcher to discover, explain, and account for health, well-being, care expressions, and other human conditions.” 5. “Culture care expressions, meanings, patterns, processes, and structural forms are diverse, but some commonalities (universalities) exist among and between cultures.” 6. “Culture care values, beliefs, and practices are influenced by and embedded in the worldview, social structure factors (e.g., religion, philosophy of life, kinship, politics, economics, education, technology, and cultural values) and the ethnohistorical and environmental contexts.” 7. “Every culture has generic (lay, folk, naturalistic; mainly emic) and usually some professional (etic) care to be discovered and used for culturally congruent care practices.” 8. “Culturally congruent and therapeutic care occurs when culture care values, beliefs, expressions and patterns are explicitly known and used appropriately, sensitively, and meaningfully with people of diverse or similar cultures.” 9. “Leininger’s three theoretical mode of care offer new, creative, and different therapeutic ways to help people of diverse cultures.” 10. “The ethnonursing research method and other qualitative research paradigmatic methods offer important means to discover largely embedded, covert, epistemic, and ontological culture care knowledge and practices.” 11. “Transcultural nursing is a discipline with a body of knowledge and practices to attain and maintain the goal of culturally congruent care for health and well-being.” E. Metaparadigm A. Nursing Care is the “essence of nursing.” Professional nursing care refers to formal and explicit cognitively learned professional care knowledge and practices obtained generally through educational institutions that are taught to nurses and others to provide assistive, supportive, enabling, or facilitative acts for or to another individual or group in order to improve their health, prevent illnesses, or to help with dying or other human conditions. Three types of nursing action: 1. Culture Care Preservation or Maintenance refers to assistive, supportive, facilitative, or enabling professional actions and decisions that help people of a particular culture to retain, preserve or maintain meaningful care beliefs and values for their well-being, to recover from illness, or to deal with handicaps or dying. 2. Culture Care Accommodation or Negotiation refers to those assistive, accommodating, facilitative, or enabling creative professional care actions and decisions that help people of a designated culture to adapt to or negotiate with others for culturally congruent, safe, effective care for meaningful and beneficial health outcomes. 3. Culture Care Repatterning or Restructuring refers to the assistive, supportive, facilitative, or enabling professional actions and decisions that help clients reorder, change or modify their lifeways for beneficial health care patterns, practices, or outcomes. B. Health Refers to a state of well-being that is culturally defined, valued, and practiced that reflects the ability of individuals or groups to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways. C. Environment Refers to the totality of an event, situation, or particular experience that gives meaning to people’s expressions, interpretations, and social interactions within particular geophysical, ecological, spiritual, sociopolitical, and technological factors in specific cultural settings. D. Person Human care is collective, that is seen in all cultures. Humans are believed to be caring and to be capable of being concerned about the needs, well-being and survival of others. They are universally caring beings who survive in a diversity of cultures through their ability to provide the universality of care in a variety of ways according to differing cultures, needs and settings. References Alfanoud, A., Alijurbua, F., Almazroa, S., & Alenazi, S. (2023). The Effect of Prolonged Usage of Headsets on Hearing Efficiency Among Students at Qassim University, 4–10. https://doi.org/10.54905/disssi/v27i137/e286ms2979 Alligood, M. R. (2017). Nursing theorists and their work (9th ed.). 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Retrieved from: https://youtu.be/lBKPxLJDUyg?si=yucgMpaJzth99ImW SimpleNursing. (2023, December 7). What are Nursing Metaparadigms?https://simplenursing.com/nursing-metaparadigm/#:~:text=The%20nursi ng%20metaparadigm%20encompasses%20fourhttps://simplenursing.com/nursing-meta paradigm/#:~:text=The%20nursing%20metaparadigm%20encompasses%20four Studocu. (n.d.). Evelyn Adam (Conceptual Model of Nursing) - INTERPERSONAL RELATIONSHIPS CONCEPTUAL MODEL OF NURSING - StudoCu. https://www.studocu.com/ph/document/university-of-perpetual-help-system-dalta/bachel or-of-science-in-nursing/evelyn-adam-conceptual-model-of-nursing/18296003?origin=org anic-success-document-viewer-cta Tomey, A. M., PhD, RN, FAAN, & Alligood, M. R., PhD, RN (2002). Nursing Theorists and Their Work (5th ed., pp. 610-621). University of Maine at Fort Kent Online - Learn, Innovate, Find, Engage. (2020b, February 7). Transcultural care in Nursing. https://online.umfk.edu/nursing/rn-to-bsn/transcultural-care-in-healthcare/ PAMANTASAN NG LUNGSOD NG MAYNILA (University of the City of Manila) Intramuros, Manila Jean Watson & Rosemarie Rizzo Parse A Written Report Submitted in the Fulfillment of the Requirement for the Course Theoretical Foundations in Nursing Submitted by: Arce, Paulyne Club, Vernice Gabriele Molano, Russel Babe Santiago, Russel Cyrus Group 3 Bachelor of Science in Nursing 1-4 Submitted to: Prof. Ronie M. Tiamson, RN, RM, MAN, MSN I. JEAN WATSON An ordinary individual may think that nursing is only the act of caring for patients. While it may seem superficial and simple for others, they don’t know how deep the nursing practice really is and to what nursing theories they are rooted in. The foundations laid by numerous theorists helped cultivate the nursing practice that is present today and greatly influenced the way nurses care for their patients. Margareth Jean Watson is a highly influential figure in the nursing profession and is a highly regarded nursing theorist. Her Theory of Human Caring aimed to foster an environment where healing is not only done through pharmacological treatments, but also through human interactions. Watson was born on July 21st, 1940 and raised in the small town of Welch, West Virginia where she attended high school in West Virginia and the Lewis Gale School of Nursing in Roanoke, Virginia and graduated in 1961. She then continued her studies in nursing at the University of Colorado where she earned her baccalaureate degree in 1964, a master’s in 1966, and a doctorate in educational psychology and counseling in 1973. She joined the School of Nursing Faculty at the University of Colorado Health Sciences Center, serving in faculty and administrative positions. Watson assumed the position of Dean wherein she developed a post baccalaureate nursing curriculum in human caring, health, and healing that led to a nursing doctorate. She retired from the University in 2012 as a distinguished Professor Emerita and Dean Emerita. In 1981 and 1982, Watson went on to pursue sabbatical studies in New Zealand, Australia, India, Thailand, and Taiwan. Also, in 2005 she took a sabbatical for a walking pilgrimage in the Spanish El Camino. With the help of her Colleagues, Watson was able to establish the Center for Human Caring at the University of Colorado, which is the nation’s first interdisciplinary center using human caring knowledge for clinical practice, scholarship, administration, and leadership. This Center became the foundation for establishing the Watson Caring Science Institute (WCSI) which is a nonprofit organization that devotes itself to advance caring science in Global World Caring Science programs and projects. Having established herself as a significant figure and contributing largely to the nursing profession and practice with her published studies, articles and books where she authored 12, and have shared authorship of 9, she was given multiple awards from national and international universities and organizations. She received 15 honorary degrees, 12 from international universities. In 1993, she received the National League for Nursing (NLN) Martha E. Rodgers Award wherein she served on the Executive Committee and Governing Board for the NLN, and as their president in 1995-1996. In the following year of 1997, she was awarded with an honorary lifetime holistic nurse certificate by the NLN. and in addition to these, the American Academy of Nursing inducted her as a “Living Legend” which is their highest honor. And in 2016, she was honored by the United Nations via the Nightingale Global Health Initiative 60th session on Commission of Women. CONCEPTS Jean Watson's Human Caring Theory highlights the essential role of compassion in nursing, asserting that nurses should establish strong relationships with their patients by addressing not only their physical health but also their emotional and spiritual needs. This holistic approach distinguishes nurses from other healthcare professionals, fostering a caring environment where patients feel valued and safe, ultimately leading to improved health outcomes. To effectively implement her theory, Watson introduces the concept of caritas carative factors processes, which comprises ten essential elements that guide nurses in delivering compassionate care. The first element of Jean Watson's Human Caring Theory, Embrace, centers on the importance of caring for others and recognizing the significance of love and kindness in nursing practice. Nurses are encouraged to cultivate an attitude of warmth and genuine concern for t

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