Non-Nursing Theories PDF

NON-NURSING THEORIES 1. SULLIVAN’S TRANSACTIONAL ANALYSIS 2. LEWIN’S CHANGE THEORY How Can Lewin’s Change Model Be Implemented? 1. Changing the behavior and skills of a workforce 2. Changing the processes, structures, and systems in an organization 3. Changing the culture of an o...

NON-NURSING THEORIES 1. SULLIVAN’S TRANSACTIONAL ANALYSIS 2. LEWIN’S CHANGE THEORY How Can Lewin’s Change Model Be Implemented? 1. Changing the behavior and skills of a workforce 2. Changing the processes, structures, and systems in an organization 3. Changing the culture of an organization 4. Changing the technology used 5. Changing the product or service 5 Challenges of Lewin’s 3-Stage Model in Action 1. Resistance to change 2. Lack of leadership support 3. Inadequate resources 4. Poor communication 5. Inadequate training 3. MASLOW’S HUMAN NEEDS THEORY 4. VON BERTALANFFY’S GENERAL SYSTEMS THEORY 5. ERIKSON’S PSYCHOSOCIAL DEVELOPMENT According to the theory, successful completion of each stage results in a healthy personality and the acquisition of basic virtues. Basic virtues are characteristic strengths that the ego can use to resolve subsequent crises. Failure to complete a stage can result in a reduced ability to complete further stages and, therefore, a more unhealthy personality and sense of self. These stages, however, can be resolved successfully at a later time. ***The bottom line Erikson believed that his theory was a “tool to think with rather than a factual analysis.” Instead of taking these eight stages as fact, use them as a starting point you use to help your child develop the psychosocial skills they need to become a successful person. Each stage builds on the previous one, so supporting them through each stage is an important part of healthy psychological development. 6. KOHLBERG’S MORAL DEVELOPMENT Moral development and behavior involve putting ourselves in the place of others and typically require a combination of mutual respect, empathy, and caring (Gibbs, 2019). Moral judgment begins to form in the early years, taking place in a social context, driven by interactions with peers and adults involving “taking turns, sharing, harming, and responding to harm” (Haidt, 2001, p. 817). Key Takeaways  Lawrence Kohlberg formulated a theory asserting that individuals progress through six distinct stages of moral reasoning from infancy to adulthood.  He grouped these stages into three broad categories of moral reasoning, pre-conventional, conventional, and post-conventional. Each level is associated with increasingly complex stages of moral development.  Kohlberg suggested that people move through these stages in a fixed order and that moral understanding is linked to cognitive development.  NCM 100 - THEORETICAL FOUNDATIONS ON NURSING FINAL TERM MODULE 5 IDA JEAN ORLANDO DELIBERATIVE NURSING PROCESS DELIBERATIVE NURSING PROCESS THEORY  It allows nurses to formulate an effective nursing care plan that can also be easily adapted when and if any complexity comes up with the patient.  It stresses the reciprocal relationship between patient and nurse.  It emphasizes the critical importance of the patient’s participation in the nursing process.  Orlando also considered nursing as a distinct profession and separated it from medicine where nurses as determining nursing action rather than being prompted by physician’s orders, organizational needs and past personal experiences.  She believed that the physician’s orders are for patients and not for nurses.  She proposed that “patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions.” METAPARADIGM PERSON  Orlando uses the concept of human as she emphasizes individuality and the dynamic nature of the nurse-patient relationship.  For her, humans in need are the focus of nursing practice. METAPARADIGM HEALTH  In Orlando’s theory, health is replaced by a sense of helplessness as the initiator of a necessity for nursing.  She stated that nursing deals with individuals who need help. METAPARADIGM ENVIRONMENT  Orlando completely disregarded environment in her theory, only focusing on the immediate need of the patient, chiefly the relationship and actions between the nurse and the patient (only an individual in her theory; no families or groups were mentioned).  The effect that the environment could have on the patient was never mentioned in Orlando’s theory. METAPARADIGM NURSING  Orlando speaks of nursing as unique and independent in its concerns for an individual’s need for help in an immediate situation.  The efforts to meet the individual’s need for help are carried out in an interactive situation and in a disciplined manner that requires proper training. Sub-concepts of the Deliberative Nursing Process Theory  Orlando described her model as revolving around the following five major interrelated concepts: 1. the function of professional nursing, 2. presenting behavior, 3. immediate reaction, 4. nursing process discipline, 5. and improvement. FUNCTION OF PROFESSIONAL NURSING - organizing principle  This means finding out and meeting the patient’s immediate needs for help.  According to Orlando, nursing is responsive to individuals who suffer, or who anticipate a sense of helplessness.  It is focused on the process of care in an immediate experience and is concerned with providing direct assistance to a patient in whatever setting they are found in for the purpose of avoiding, relieving, diminishing, or curing the sense of helplessness in the patient. PRESENTING BEHAVIOR - problematic situation  The nurse finds the patient’s immediate need for help.  To do this, the nurse must first recognize the situation as problematic.  Regardless of how the presenting behavior appears, it may represent a cry for help from the patient.  The presenting behavior of the patient, which is considered the stimulus, causes an automatic internal response in the nurse, which in turn causes a response in the patient. IMMEDIATE REACTION - internal response  The patient perceives objects with his or her five senses.  These perceptions stimulate automatic thought, and each thought stimulates an automatic feeling, causing the patient to act.  These three items are the patient’s immediate response.  The immediate response reflects how the nurse experiences his or her participation in the nurse-patient relationship. NURSING PROCESS DISCIPLINE – investigation  Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time  The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or appropriate until she checks the validity of it in exploration with the patient  The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does.  When the nurse does not explore with the patient her reaction it seems reasonably certain that clear communication between them stops IMPROVEMENT - resolution  It is not the nurse’s activity that is evaluated but rather its result : whether the activity serves to help the patient communicate her or his need for help and how it is met.  In each contact the nurse repeats a process of learning how to help the individual patient \ LYDIA HALL CARE, CORE, CURE THEORY CORE, CARE, CURE MODEL  Hall postulated that individuals could be conceptualized in three separate domains: CARE (hands on bodily care), CORE (using the self in relationship to the patient), and CURE (applying medical knowledge)  HALL believed that patients should receive care only from professional nurses.  Nursing involves interacting with a patient in a complex process of teaching & learning.  Hall believed that professional nursing hastened the recovery of patients and that more professional nursing care & health teaching was needed in the light of decreasing medical care rendered to the patient. CORE, CARE, CURE MODEL  Hall emphasized the autonomy inherent in professional nursing.  Her model encompasses adult patients who have passed the acute stage of disease and who are now in the rehabilitation phase of healthcare.  The goal is to make sure that the patient achieves success in self-actualization and self-love after the disease. CONCEPTS AND DEFINITIONS CORE – refers to the person or the recipient of care and includes the use of therapeutic self to relate with the patient. CURE – refers to medical interventions that are performed on the patient. It includes nursing activities that are dependent upon the orders of the physician. CARE – the exclusive domain of nursing METAPARADIGM PERSON  Hall emphasizes the importance of the individual as unique, capable of growth and learning, & requiring a total person approach.  The source of energy & motivation for healing is the individual care recipient NOT the health care provider. METAPARADIGM HEALTH  Health can be inferred to be a state of self-awareness with a conscious selection of behaviors that are optimal for that individual.  Hall stresses the need to help the person explore the meaning of his or her behavior to identify and overcome problems through developing self-identity & maturity. METAPARADIGM ENVIRONMENT  The concept of environment is dealt with in relation to the individual.  the hospital environment during treatment of acute illness creates a difficult psychological experience for the ill individual.  In such a setting, the focus of the action of the nurses is the individual, so that any actions taken in relation to society or environment are for the purpose of assisting the individual in attaining a personal goal. METAPARADIGM NURSING  Nursing is identified as consisting of participation in the care, core, and cure aspects of patient care MYRA ESTRIN LEVINE THE CONSERVATION MODEL CONCEPTS AND DEFINITIONS  Levine’s Conservation model is based on three (3) major concepts and assumptions namely: Conservation Adaptation Wholeness  That is promoting adaptation and maintaining wholeness using the principles of conservation.  She further advocated that individuals continuously defend their wholeness through ongoing process of change or adaptation. And the outcome or product of adaptation is conservation. A. CONVERSATION  Keeping together of the life system. It is to maintain a proper balance between active nursing interventions coupled with patient participation and on the other hand, the safe limits of the patient’s ability to participate.  The goal of conservation is health and the strength to confront disability.  The nurse accomplishes the goals of the model through the FOUR CONSERVATION PRINCIPLES.  Individuals choose the most economical, frugal, energy-sparing options available to safeguard their integrity. B. ADAPTATION  Is achieved through the “frugal, economic, contained & controlled use of environmental resources by the individual in his or her best interest”.  It is the bridge that allows ready movement from one environmental reality to another.  It is the process by which individuals ‘fit’ the environments in which they live. (Levine, 1996)  The goal of adaptive change is the conservation of wholeness (health) and integrity.  It has three (3) characteristics: 1. Historicity – patterned responses passes on through genetics. 2. Specificity – unique adaptive responses to specific environmental challenges. 3. Redundancy – availability of multiple adaptive responses. C. WHOLENESS  It exists when the interactions or constant adaptations to the environment permit the assurance of integrity. (Levine, 1991) METAPARADIGM PERSON  Is a holistic being who constantly strives to preserve wholeness and integrity and one who is sentient, thinking, future-oriented, and past-aware.  The wholeness (integrity) of the individual demands that the “individual life has meaning only in the context of social life”.  The person is also described as a unique individual in unity and integrity, feeling, believing, thinking and whole system of system. METAPARADIGM ENVIRONMENT  Completes the wholeness of the individual. It is both internal & external.  Internal Environment – combines the physiological & pathophysiological aspects of the individual & is constantly challenged by the external environment.  External Environment is divided into: 1. Perceptual – a portion of the external environment which individuals respond to with their sense organs. 2. Operational – that portion of the external environment which interacts with the living tissue even though the individual does not possess sensory organs that can record the presence of these factors. 3. Conceptual – that portion of the external environment that consists of language, ideas, symbols & concepts & inventions & encompasses the exchange of language, the ability to think & experience emotion, value systems, religious beliefs, ethnic & cultural traditions & individual psychological patterns that come from life experiences.  ORGANISMIC RESPONSE Is a change in the behavior of a patient during an attempt to adapt to the environment. These responses help the patient protect and maintain his or her integrity. These 4 types of responses are: 1. Fight or flight: An instantaneous response to real or imagined threat. It is the most primitive response. 2. Inflammatory: A response intended to provide for structural integrity & the promotion of healing. 3. Stress: A response developed over time and influenced by each stressful experience the patient encounters. 4. Perceptual: Involves gathering information from the environment and converting it into meaningful experiences. METAPARADIGM HEALTH  Are patterns of adaptive change.  It is implied to mean unity and integrity and is wholeness and successful adaptation.  The goal of nursing is to promote health. METAPARADIGM NURSING  Involves engaging in “human interactions”. (Levine 1973)  The nurse enters into a partnership of human experience where sharing moments in time leaves its mark forever on each patient.  The goal of nursing is to promote adaptation & maintain wholeness (health). MAJOR ASSUMPTIONS OF THE CONSERVATION MODEL Assumptions About Individuals  Each individual “is an active participant in interactions with the environment… constantly seeking information from it.” (Levine, 1969)  The individual “is a sentient being, and the ability to interact with the environment seems ineluctably tied to his sensory organs.”  “Change is the essence of life, and it is unceasing as long as life goes on. Change is characteristic of life.” (Levine, 1973) Assumptions About Nursing  “Ultimately, the decisions for nursing intervention must be based on the unique behavior of the individual patient.”  “Patient-centered nursing care means individualized nursing care. It is predicated on the reality of common experience: every man is a unique individual, and as such he requires a unique constellation of skills, techniques, and ideas designed specifically for him.” (Levine, 1973) NOLA J. PENDER HEALTH PROMOTIONAL MODEL HEALTH PROMOTIONAL MODEL  It encourages scholars to look integratively at variables that have been shown to impact health behavior.  It synthesizes research findings from nursing, psychology and public health into an explanatory model of health behavior that still must undergo further testing.  It focuses on ten categories of determinants of health-promoting behaviors.  It views person’s health-promoting behavior in the light of his individual characteristics and experiences.  The person’s level of cognitive abilities and affect also play a major role in the development of these health- promoting behaviors. METAPARADIGM PERSON  Man seeks to create conditions of living through which they can express their unique human health potential  Man also has the capacity for reflective self-awareness, including the assessment of his own competencies.  Man values growth in positive directions and attempts to achieve a personally acceptable balance between change & stability.  Man also seek to actively regulate their own behavior. METAPARADIGM HEALTH  Defines health as “a positive dynamic state not merely the absence of disease”.  Health promotion is directed at increasing a client’s level of well-being.  It describes the multi-dimensional nature of persons as they interact within the environment to pursue health. METAPARADIGM ENVIRONMENT  Persons always interact with the environment, transform the environment progressively, and become transformed themselves over time. METAPARADIGM NURSING  Nursing is a helping profession that empowers patients towards self-attribution, self-evaluation, and self-efficacy TEN DETERMINANTS OF HEALTH-PROMOTING BEHAVIORS 1. Prior related Behavior 2. Perceived benefits of action (health-promoting behaviors) 3. Perceived barriers to action (health-promoting behaviors) 4. Perceived self-efficacy 5. Activity-related affect 6. Interpersonal influences (family, friends, providers), norms, support, and models 7. Situational influences (options, demand characteristics, aesthetics) 8. Immediate competing demands (low control) and preferences (high control) 9. Commitment to a plan of action 10. Personal factors (biological, psychological, sociocultural) CONCEPTS AND DEFINITIONS 1. PERCEIVED BENEFITS OF ACTION – anticipated positive outcomes that will occur from health behavior. 2. PERCEIVED BARRIERS TO ACTION – anticipated, imagined or real blocks and personal costs of understanding a given behavior. 3. PERCEIVED SELF-EFFICACY – judgment of personal capability to organize and execute a health-promoting behavior. It influences perceived barriers to action so higher efficacy results in lowered perceptions of barriers to the performance of the behavior. CONCEPTS AND DEFINITIONS (cont.) SITUATIONAL INFLUENCES  personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior.  Include perceptions of options available, demand characteristics and aesthetic features of the environment in which given health promoting is proposed to take place  It may have direct or indirect influences on health behavior.  IMMEDIATE COMPETING DEMANDS & PREFERENCES 1. COMPETING DEMANDS – are those alternative behaviors over which individuals have low control because there are environmental contingencies such as work or family care responsibilities. 2. COMPETING PREFERENCES – are alternative behaviors over which individuals exert relatively high control, such as choice of ice cream or apple for a snack. CONCEPTS AND DEFINITIONS (cont.)  COMMITMENT TO PLAN OF ACTION - The concept of intention and identification of a planned strategy leads to the implementation of health behavior.  HEALTH – PROMOTING BEHAVIOR – an endpoint or action outcome that is directed toward attaining positive health outcomes such as optimal wellbeing, personal fulfillment, and productive living.  LOCAL CONCEPTUAL MODELS A. SR. LETTY G. KUAN, RN, RGC, EdD ▪ RETIREMENT AND ROLES DISCONTINUITIES ▪ Born on November 19, 1936 in Katipunan-Dipolog, Zamboanga del Norte ▪ Sister Letty G. Kuan is a nurse with two (2) Master‟s Degrees, MA in Nursing and MS in Education major in Guidance Counselling. ▪ Holds a Doctoral Degree in Education major in Guidance Counselling. All these postgraduate studies were obtained from the University of the Philippines - Diliman, Quezon City. ▪ For her vast contributions to the University of the Philippines - College of Nursing faculty and academic achievements, she was awarded the distinctive post of Professor Emeritus, a title awarded only to a few who met the strict criteria set by the University of the Philippines in September 2004. ▪ As a Professor Emeritus, aside from University of the Philippines - Manila she is affiliated in several schools namely Siliman University in Dumaguete, Cebu Normal University, Father Urios University in Butuan, St. Joseph's College in Quezon City, San Pedro College in Davao. ▪ She has clinical fellowship and specialization in Neuropsychology obtained from University of Paris, France in (Salpetriere Hospital). Neurogerontology in Watertown, New York (Good Samaritan Hospital) and Syracuse University, New York. She further added this field of specialization in Geneva in the Centre des Soins Intensifs pour les troisieme age group. ▪ She also had Bioethics formal training at Institute of Religion, Ethics and Law at Baylor College of Medicine in Houston, Texas from 1991 - 1997. ▪ She authored several books giving her insights in the areas of Gerontology, Care of Older Persons and Bioethics and Essence of Caring. These are as follows: 1) Concepts of illness and health care intervention in an urban community. 2) Understanding the Filipino elderly: a textbook for nurses and related health professional 3) Essence of Caring 4) Pag-aaruga sa mga taong may edad na. 5) Bioethics in Nursing ▪ She is a recipient of the Metrobank Foundation Outstanding Teachers Award in 1995, the first faculty to win such an award representing the UP Manila, and an Award for Continuing Integrity and Excellence in Service (ACIES) in 2004. ▪ Her religious community is the Notre Dame de Vie founded in France in 1932. ▪ As a former member of the Board of Nursing, her legacy to the Nursing Community is undeniable and indisputable. ▪ Metaparadigm in Nusing 1) PERSON (Elderly) - is a classification of age group to any person reaching the mid 70‟s up to the 80‟s. (Gerone) - given to people who are old but gracefully able to function as useful citizens at home and in the community and an exemplar in fidelity to prayer life. 2) HEALTH  It is defined as aging. It is a slow process of growth towards maturity of mind, body and spirit. Growing old is reaching a “happy plateau” but one must understand and accept what is aging. It brings a decreasing amount of energy over long periods of activities; hence slowing down and moderation in our activity involvement is one reality of aging we all must realize and accept it is a fact to reckon with that what is desirable is to feel comfortable with one’s age and never should one aspire to become caricatures of either age or youth. Aging is a reality and must be accepted as a process towards fulfilment of a total self. Developing positive attitudes towards aging while still young contributes a great deal to feeling comfortable while growing old. 3) ENVIRONMENT Kuan did not mention any metaparadigm on the topic of environment 4) NURSING It is preparing the person to have fulfillment in their retirement years, and assisting them in their elderly years in leaving a legacy. ▪ Basic Assumptions & Concepts: Physiological Age – is the endurance of cells & tissues to withstand the wear-and-tear phenomenon of the body. Some individuals are gifted with strong genetic affinity to stay young for a long time. Change of life – the period between near retirement & post retirement years. In medico-physiologic term, this equates with the climacteric period adjustment to another tempo of life. Role – refers to the set of share expectations focused upon a particular position. Retiree – an individual who has left the position occupied for the past years of productive life because she / he has reached the prescribed retirement age or has completed the require age or has completed the required years of service. Role Discontinuity – the interruption in the line of status enjoyed or role performed. The interruption may be brought about by an accident, emergency & change position or retirement. Coping Approaches – refers to the interventions or measures applied to solve a problematic situation or state in order to restore or maintain equilibrium and normal functioning. ▪ Determinants of Positive Perceptions in Retirement & Positive Reaction Discontinuities: 1) Health status – the physiological & mental state of the respondents either sickly or healthy. 2) Income ( economic level) – refers to the financial affluence of the respondent , which can be classified as poor, moderate or rich. 3) Work status 4) Family constellation – type of family composition 5) Self-preparation B. CARMENCITA M. ABAQUIN ▪ PREPARE ME (Holistic Nursing Interventions) ▪ Carmencita M. Abaquin is a nurse with Master’s Degree in Nursing obtained from the University of the Philippines College of Nursing. ▪ An expert in Medical Surgical Nursing with subspecialty in Oncologic Nursing, which made her known both here and abroad. ▪ She had served the University of the Philippines College of Nursing, as faculty and held the position as Secretary of the College of Nursing. ▪ Her latest appointment as Chairman of the Board of Nursing speaks of her competence and integrity in the field she has chosen. ▪ Metaparadigm in Nursing ▪ PERSON Her theory is specific to patients in advanced stages of cancer. They are holistic being with physical, psychological, social, religious, level of independence, and environmental aspects. Patients who are terminally-ill or those with incurable diseases as with cancer must be approached in multifaceted care to improve their quality of life. ▪ HEALTH The concept of her theory revolves around illness, particularly cancer and the provision of holistic care to improve quality of life despite their terminal cases. Quality of life is defined as a multifaceted construct that encompasses the individuals capabilities and abilities of enriching life when it can no longer be prolonged. This includes proper care and maintaining integrity of the body, mind and spirit despite the limitations brought about by the present condition. The quality of life is seen through the patient's many dimensions. ▪ ENVIRONMENT Just like all the other paradigms, environment was not defined accurately. Nevertheless we can assume that environment is an aspect or dimension integrated to the cancer patient. Her quality of life can also be assessed in this aspect thus it must be given consideration in the provision of care. ▪ NURSING The goal of nursing care is the improvement of quality of life for advance stage cancer patients despite their current situation. Her concept of providing holistic nursing care in addressing the multidimensional problems that cancer patients face is summarized in the acronym PREPARE ME. ▪ Basic Assumptions & Concepts: CANCER has been associated with multifaceted issues & concerns regardless of stages of development. For patients with advanced progressive cancer, these problems are compounded, thus the need to develop interventions that can address the needs especially those concerning the ability to be in control and maintaining their integrity. ▪ “PREPARE ME”: Interventions & the Quality of Life of Advance Progressive Cancer Patients 1) PRESENCE – being with another person during the times of need. This includes therapeutic communication, active listening, and touch. 2) REMINISCE THERAPY – recall of past experiences, feelings and thoughts to facilitate adaptation to present circumstances. 3) PRAYER 4) RELAXATION-BREATHING – techniques to encourage and elicit relaxation for the purpose of decreasing undesirable signs and symptoms such as pain, muscle tension, and anxiety. 5) MEDITATION – encourages an elicit form of relaxation for the purpose of altering patient’s level of awareness by focusing on an image or thought to facilitate inner sight which helps establish connection and relationship with God. It may be done through use of music and other relaxation techniques. 6) Values Clarification – assisting another individual to clarify his own values about health and illness in order to facilitate effective decision-making skills. Through this, the patient develops an open mind that will facilitate acceptance of disease state or may help deepen or enhance values. The process of values clarification helps one become internally consistent by achieving closer between what we do and what we feel. PREPARE ME theory provides a framework on non-pharmacologic, non-surgical approach of care to advanced cases of cancer patients. The focus is not on cure but on assisting the patient to explore her humanity and internal serenity as one is faced with the challenge of life and death. Nurses must be seen not as mere caregivers but facilitators of peaceful acceptance of condition. The following are some techniques according to PREPARE ME theory that nurses can use in their care. C. SR. CAROLINA S. AGRAVANTE, SPC, RN, PhD ▪ CASAGRA TRANSFORMATIVE LEADERSHIP MODEL ▪ She is famous for being the first Filipina theorist for writing the CASAGRA Transformative Leadership Model. The title of the theory was derived from her name, CArolina S. AGRAvante. ▪ She finished her secondary education at St. Paul Univeristy - Manila (formerly St. Paul College - Manila) as class salutatorian. ▪ In 1964, she earned her BS Nursing degree in the same school as magna cum laude. In the same year, she passed the nurse licensure examinations as the board topnotcher. ▪ From 1967 to 1969, she studied Master’s Degree in Nursing Education at Catholic University of America as a full- fledged ▪ In 2002, she earned her Doctoral Degree in Philosophy at University of the Philippines Manila - the same year her theory was published. ▪ She served as the president of St. Paul University - Iloilo, where she taught research subjects among senior students. ▪ She was a former president of the Association of Deans of the Philippines Colleges of Nursing (ADPCN) as she became the representative in the International Nursing Congress that was held in Brunei in 1996. ▪ A year after, she was a part of a delegation that participated in the International Council of Nursing in Vancouver, Canada. ▪ CASAGRA MODEL ✓ A psycho-spiritual model. ✓ A multivariate paradigm for explaining & predicting the continuous formation of nursing leadership behavior in nursing faculty that will eventually affect their teaching function. ✓ Three Basic Concepts: 1) Servant Leader Spirituality 2) Self Mastery 3) Special Nursing PracticE 1. Servant Leader Spirituality ✓ SPIRITUAL EXERCISE – retreat where the spiritual depths of the nursing teacher is survived & strengthened to heed the call to serve modeled by Jesus Christ. ✓ SPIRITUAL RETREAT – process of awareness, contemplation. 2. Self Mastery ✓ VIBRANT CARE COMPLEX possessed to a certain degree by all who have been through formal & informal care giving. ✓ CARE COMPLEX – emanates caring behaviors, pulls to itself & interprets caring needs of others, looks for a response from a client that contributes to the latter well-being. 2 sets of care experiences: ✓ CORE CARE – conglomeration of personal maternal care activities during infancy & childhood together with an illusive collective cultural care content peculiar to the Filipino people. ✓ LEARNED CARE – acquired professional manner of caring learned, witnesses & felt in a formal course & practiced in one’s daily professional life. 3. Special Nursing Practice ✓ A nursing faculty must demonstrate expertise in transformative teaching that puts premium on teaching of  values as the rock bottom line of teaching that will begin to transform all who come within the radius of its influence. ✓ Five scaffoldings that a Teacher must develop: 1) Creative thinking centered 2) Caring 3) Critical 4) Contemplative 5) Collegial Five Scaffoldings: 1) Creative thinking centered – teaching using multi-intelligence of students. 2) Caring – personal trait in the affective domain ending towards the good of another characterized by a tender nurturing manner and carried with a culturally sensitive way. 3) Critical – focuses on becoming aware of overt & covert, personal & interpersonal, institutional & societal, historical & cultural. 4) Contemplative – moves one to examine why one attempts to grow as a transformative teacher, to go beyond the here & now, focuses on becoming a visionary educator with a developed & carefully articulated ethical values. 5) Collegial – takes one beyond the confines of the individual classroom & to think of oneself as a responsible professional in the community. ▪ ROZZANO C. LOCSIN “Technological Competency as caring in nursing is a conceptual model that presents the link between technology & caring in nursing as coexisting harmoniously” Rossano C. Locsin… Born in 1954, from Dumaguete City. Siliman University – finished his BSN & masters degree in nursing (MAN) UP (1988) – Doctor of Philosophy in Nursing Tokushima University, Japan – currently residing as a Professor in Nursing. Affiliated in various institutions: Professor Emeritus in Florida Atlantic University; Visiting Professor in SPU, Silliman University; Prince of Songkla University, Thailang; Mbarara University of Science & Technology, Uganda. A nurse scholar & educator. Through the Fulbright Scholar Award, he developed the first Masters program in Uganda while researching the phenomenon “waiting-to-know” & lived experiences of persons exposed to patients who died of Ebola Hemorrhagic Fever. ▪ Technological Competency as Caring in Nursing ✓ To illustrate the harmonious co-existence between technology and caring in nursing. ✓ To place nursing in the context of modern healthcare. The importance of understanding the need for knowing “high-tech” instruments (monitors, implants, devices …) as this would give opportunities to know the patient fully as a person  LOCAL THEORISTS Carmelita Divinagracia Master in Nursing in 1975 Doctoral Degree holder in 2001 Cardiologist nurse Advance nurse practitioner Dean - College of Nursing [president] U.E.R.M Memorial medical center / ADPCN Aurora Blvd, Quezon City, Philippines. METAPARADIGM: Person. Each individual needs humane, caring, spiritually oriented interventions that can facilitate wellness regardless of creed, social class, gender, age, and nationality. Environment. The intervention that the nurses have when administering the client will have an effect to the wellness outcome of the patient. Health. Nurses needs wide knowledge of the patient’s condition, to understand how their needs can be met and complications are prevented regardless of diversity. The patient’s wellness outcome is measured through the physiologic and behavioral outcomes. Socio- demographic characteristics mainly an individual’s gender and age are connected to the wellness outcome. Nursing. The nursing profession can actively deliver quality care through caring interventions like the COMPUSURE behavior which provides care to the patient to achieve wellness. COMPOSURE BEHAVIORS ✓ A condition of being in a state of well-being, a coordinated and integrated living pattern thatinvolves the dimension of wellness. ✓ Are set of behaviors or nursing measures that the nurse demonstrates to selected patients. ✓ COMPOSURE is an acronym which stands for: COMpetence, Presence & Prayer, Open- mindedness, Stimulation, Understanding, Respect & Relaxation, Empathy. COMpetence An in-depth knowledge and clinical expertise demonstrated in caringfor patients. ❏This also stands for consistency and congruence of words and deeds of the Nurse. Presence and Prayer A form of nursing measure which means being with another personduring times of need. This includes therapeutic communication, active listening, and touch. It is also a form of nursing measure which is demonstrated throughreciting a prayer with the patient and concretized through the nurse’spersonal relationship and faith in God. Open-mindedness A form of nursing measure which means being receptive to new ideas orto reason. It conveys a manner of considering a patient's preferences and opinionsrelated to his current health condition and practices and demonstrates the flexibility of the nurse to accommodate patients' views. Stimulation A form of nursing measure demonstrated by means of providing encouragement that conveys hope and strength, guidance in the form of giving explanation and supervision when doing certain procedures to patient, use of complimentary words or praise and smile whenever appropriate Appreciation of what patient can do is reinforced through positive encouraging remarks and this is done with kind and approving a behavioral approach Understanding According to her, it conveys interest and acceptance not only of patient’s condition but also his entire being. This is manifested through concerned and affable facial approach; thisis a way of making the patient feel important and unique. Respect Acknowledging the 31 patient’s presence. Use of preferred naming in addressing the patient, po and opo, is a sign of positive regard. It is also shown through respectful nods and recognition of the patient as someone important. Relaxation Entails a form of exercise that involves alternate tension and relaxation of selected groups of muscles. Empathy Senses another person’s inner experience. The empathic nurse perceives the current positive thought and feelings and communicates by putting himself in the patient’s place. Through the COMPOSURE behaviors of the nurse, holism is guaranteed to the patient. Patient Wellness Outcome This refers to the perceived wellness of selected orthopedic patients after receiving nursing care in terms of physiologic and biobehavioral. Many illnesses are curable and may have only a temporary effect on health These patient wellness outcomes reflect their needs as their illness turns to recovery and rehabilitation These needs must be met through high quality nursing care, none other than through COMPOSURE behaviors. Two patient wellness outcomes which have been categorized as: (a)Physiologic; (b) Biobehavioral Physiologic Wellness Outcome This refers to the perceived wellness of selected orthopedic patients after receiving nursing care in terms of vital signs, bone pain sensation, and complete blood count. Biobehavioral Wellness Outcome This refers to the perceived wellness of selected orthopedic patients after receiving nursing care in terms physical, intellectual, emotional, and spiritual. Dimensions of Wellness Physical domain- involves muscle strength, mobility, posture, gait exercise, and activity tolerance and cardio-respiratory endurance Emotional domain includes awareness, orientation, understanding of one's own and other personal feelings and ability to control and cope with emotions. Intellectual domain refers knowledge and perception of a healthy self and ability to recognize the presence of risk factors and preventive measures Spiritual domain is defined as development of inner self or one’s soul through a relationship with God and others. Emotional wellness - is a person’s ability to cope with daily circumstances and to deal with personal feelings in a positive, optimistic, and constructive manner. ➔A person with emotional wellness is generally characterized as happy, as opposed to depressed. Intellectual wellness -is a person’s ability to learn and to use information to enhance the quality of daily living and optimal functioning ❖A person with intellectual wellness is generally characterized as informed, as opposed to ignorant. ➔A person with intellectual health is free from illnesses that invade the brain and other systems that allow learning. A person with intellectual health also possesses intellectual wellness. Physical wellness - is a person’s ability to function effectively in meeting the demands of the day’s work and to use free time effectively. ❖includes good physical fitness and the possession of useful motor skills. ❖is generally characterized as fit versus unfit. ➔A person with physical health is free from illnesses that affect the physiological systems of the body such as the heart, the nervous system, and the like. A person with physical health possesses an adequate level of physical fitness and physical wellness. Spiritual wellness - is a person’s ability to establish a values system and act on the system of beliefs, as well as to establish and carry out meaningful and constructive lifetime goals. It is often based on a belief in a force greater than the individual that helps one contribute to an improved quality of life for all people. ➔Spiritual health is the one component of health that is totally composed of the wellness dimension; for this reason, spiritual health is considered to be synonymous with spiritual wellness. "Active listening The most basic form of holistic communication. A specific way of hearing what a person says and feels, and reflecting that information back to the speaker. Its goal is to listen to the whole person and provide her with empathic understanding. It is the skill of paying gentle, compassionate attention to what has been said or implied. When you listen in this way to patients, you just try to reflect the other person's feelings and deeper meanings, which helps them feel heard and understood. You don't analyze, interpret, judge, or give advice. When patients are listened to in this way, they are less anxious, complain less about their caregivers, a are more likely to comply with their treatment plan. A positive total outlook on life is essential to wellness and each of the wellness dimensions. A “well” person is satisfied in his/her work, is spiritually fulfilled, enjoys leisure time, is physically fit, is socially involved, and has a positive emotional-mental outlook. This person is happy and fulfilled. Many experts believe that a positive total outlook is a key to wellness Self-perceptions about wellness are more important than actual ability. For example, a person who has an important job may find less meaning and job satisfaction than another person with a much less important job. Apparently, one of the important factors for a person who has achieved high level wellness and a positive life’s outlook is the ability to reward himself/herself. Optimal Health includes many areas, thus the term holistic (total) is appropriate. In fact, the word health originates from a root word meaning “wholeness” The Holistic Nurse is an embodiment of the care she renders. The nurse creates a calm environment in any setting that facilitates treatment, healing and recovery from any pain or discomfort. “Nursing as a healthcare profession would prove its point in being at par in quality performance with other healthcare professional.” Cecilia Laurente ❖ 1967- Graduate BSN at University of the Philippines ❖ 1973- Masters of Nursing ❖ 1968-1969-Staff nurse ❖ 1970-1972-Head Nurse ❖ 1973-1976-Nursing Supervisor at Philippine General Hospital ❖ 1977-1979-Metropolitan Hospital in Michigan USA ❖ 1979-Instructor at University of the Phillipines College of Nursing ❖ 1966-2002-Dean of College of Nursing in UP Manila ★ Theory of Nursing Practice and Career The theory was from her study, the Categorization of Nursing Activities as Observed in Medical-Surgical Ward Units in Selected Government and Private Hospitals in Metro Manila, which was conducted from January to June year 1987. The theory talks about the effects of a nurse’s caring behavior on the anxiety of patients in the emergency room. In the recent study of Laurente she states that the other entry point of helping the patient is through the family, when nurses can be of great assistance to prevent at the very beginning serious complications. The nurse can help strengthen the family’s knowledge, skills, and attitude through effective communication, employing informative, psychotherapeutic, modeling, behavioral, cognitive behavioral, and/or hypnotic techniques. Background of the Theory Communication is key when getting nurses to engage patients and families in their care. Research developed the guide and found that communication gaps between patients and nurses can occur when hospitals do not address the issues that patients think are most important. Another factor is the lack of available tools that can give health providers insights into patients ' needs and concerns. As a result, efforts by patients, families, and health providers to communicate more effectively with each other can fall short of their goals. Each strategy includes educational tools and resources for patients and families, training materials for healthcare professionals, and real-world examples that show how strategies are being implemented in hospital settings. The strategies describe how patients and families, working with hospital staff, can be advisors; promote better communication at the bedside to improve quality; participate in bedside shift reports; and prepare to leave the hospital. Concepts of the Theory Anxiety - a mental state of fear or nervousness about what might happen. Nurse’s Caring behavior that affect patient anxiety: 1) PRESENCE- person to person contact between the client and the nurses. Sometimes we see this in our pediatric patients wherein they see a nurse coming into their room and the nurse is in white uniform, they get anxious. That is why most nurses in the pediatric ward usually do not wear white uniform, instead they wear a scrub suit.  2) CONCERN- development in time through mutual trust nurse and the patient. In the long run, we get to give our care to our patients whenever they stay in the ward for how many days. So, this concern now develops in time through mutual trust between the patients and the nurses. 3) STIMULATION- nurse stimulation through words tops the powerful resources of energy of person for healing. This stimulation usually gives strength to our clients. Most especially if we tell or encourage them to be strong for them to look forward to so that they can improve and reach their goal to be discharged in the hospital. ✓ Enhancing factors 1) One’s caring experience, beliefs and attitude This exemplified the enhancing factors of how the nurse takes care of the client. 2) Feeling good about work When you feel good and love your work, everything follows. 3) Learning caring at school When you were still a student nurse, you were taught to care for other people and different nursing procedures. 4) What patients tell about the nurse coping mechanism to problems encountered. It is very important that we learn to appreciate what our patients tell us regardless of their status in life. 5) Coping mechanism to problems encountered In every duty, there will always be something or problem that comes out. Regardless of what nurses do, they get to cope up with it positively. 6) Communication Communication is important especially if you try to communicate the information to the patient. This is how we get to describe to the patient and family the information. We also talk about the working relationship with the hospital staff ✓ Predisposing Factors 1) Age 2) Sex 3) Civil Status 4) Educational Background 5) Length of work 6) Experience  ✓ Technology brings the patient closer to the nurse. Conversely, technology can also increase the gap between the NURSE and the NURSED. ✓ Technology – anything that makes things efficient – from basic diagnostic technologies to therapeutic practices familiar to all nurses. ▪ Metaparadigm in Nursing ▪ PERSON ✓ Patients seen as “participants in their care rather than object of nurse care” (Locsin, 2013). ▪ ENVIRONMENT ✓ Environment as the technological world in which we live. ▪ HEALTH ✓ Humanity is preserved by technology ✓ “An experience that is often expressed in terms of wellness and illness, and may occur in the presence or absence of disease” (Nursing Scope and Standards of Practice, 2010, p. 65) ▪ NURSING ✓ “Nurses value technological competency as an expression of caring in nursing” (Locsin, 2013). ▪ The Process of Nursing 1) KNOWING – the process of knowing person is guided by technological knowing in which are the persons are appreciated as participants in their care rather than objects of care. Technology is used to magnify the aspect of the person that requires revealing – a representation of the real person. 2) DESIGNING – both nurse and the patient plan a mutual care process from which the nurse can organize a rewarding nursing practice that is responsive to the patient’s desire for care. 3) PARTICIPATION IN APPRECIATION – the simultaneous practice of conjoined activities which are crucial to knowing persons. The alternating rhythm of the implementation & evaluation. 4) VERIFYING THE KNOWLEDGE – the continuous, circular process demonstrate the ever – changing, dynamic nature of knowing in nursing, knowledge about the person that is derived from knowing. 3