TFN-PRELIMS.pdf

’ The Rise of the Early Civilization and Ancient Cities and their Contribution to Medicine. (mesapotamia)...

’ The Rise of the Early Civilization and Ancient Cities and their Contribution to Medicine. (mesapotamia) DIAGNOSTIC introduced the methods of HANDBOOK therapy and cause. THEORY aims to describe or explain a concept PROPHYLAXIS prevention of diseases. FOUNDATION base or baseline ASIPU medical authority or exorcist healer. HISTORY OF NURSING THEORY  The history of professional nursing began with Florence Nightingale. Nightingale envisioned nurses EGYPT as a body of educated women at a time when women  egyptians are considered the healthiest of all men. were neither educated nor employed in public service.  Edwin Smith Papyrus may date to a time as early as 3000 BC. CURRICULUM ERA  experimentation era.  Addressed the question of what content nurses  the edwin smith papyrus is an ancient textbook on should study to learn how to be a nurse. surgery almost completely devoid of magical thinking.  The idea of moving nursing education from hospital-  The Kahun Gynaecological Papyrus treats women's based diploma programs into colleges and complaints including problems with conception. universities began to emerge during this era  chief of dentist and physicians is King Djoser in the (Erwin,2015; Judd & Sitzman, 2013). 27th century BCE.  Peseshet is the earliest woman physician. THEORY ERA  It was a natural outgrowth of the research and INDIA graduate education eras (Alligood,2014;Im&  The Atharvaveda is an ancient text dealing with Chang,2012). medicine.  Ayurveda; "complete knowledge for long life" medical SIGNIFICANCE FOR THE DISCIPLINE system of india with 8 branches.  The significance of theory for the discipline of nursing  Charaka and Sushruta the 2 most famous medical is that the discipline is dependent on theory for its textbooks that describes physical examinations, continued existence. diagnosis, treatement etc.  Nursing can be a vocation, or nursing can be a  Suśrutasamhita describes several surgical discipline with a professional style of theory-based procedures. practice.  Commitment to theory - based evidence for practice is CHINA beneficial to patients in that it guides systematic,  Huangdi Neijing; the foundational text of chinese knowledgeable care. medicine written 5th century to 3rd century BC, the basis of traditional chinese medicines, acupuncture THE EVOLUTION OF NURSING and moxibustion.  Intuitive Period  Apprentice Period GREECE  Education Period  wound treatement.  Contemporary Period  romans attempted to maintain vigorous health, because illness was a sign of weakness. INTUITIVE PERIOD (“kutob” or “instinct”)  care for the ill was left to the slaves or greek  as long as you are caring for the sick you're already physicians. both groups were looked upon as inferior considered as nurse. by roman society.  everything was based on instinct.  shaman or witch doctor APPRENTICE PERIOD (start of the development)  if the sick still have a disease after got treated by the  apprentice is a someone who is in training. shaman the last resort will be the trepanning.  there is already a development.  trepanning is the process of cutting a hole in the  the nuns are the early nurses. head of the afflicted to let out evil spirits.  founding of Kaiserwerth Insititute for Training of  the uses of different prehistoric medical practices Deaconesses. such as; mercury, blood letting, lobotomies,  nursing is still performed without any formal education heroin, radium water, whirling chair, arsenic and but already has an on the job training, meaning plombage. someone is teaching a person on what to do or the passing of knowledge and experience to another WATER FREEMAN nurse/nun  founding of religious order.  developed the ice pick lobotomy in 1945 and performed between 3,500 and 5,000 himself. THE BEGINNING OF RELIGIOUS WAR  religous war/holy war is caused or justified by additional info: differences in religion.   the crusades; they were holy wars waged in an 1ST TRAINING SCHOOL OF NURSING attempt to recapture holy land from the turks. BELLEVUE founded in 1873 in New HOSPITAL SCHOOL York established by MILITARY RELIGIOUS ORDERS AND THEIR WORK OF NURSING Florence Nightingale.  Knights of St. John of Jerusalem (italian) also knows as Knight Hospitalers they founded hospitals.  Teutonic Knights (german) established tent hospitals for the wounded. ILOILO MISSION established in 1906, it  Knights of St. Lazarus founded primarily nursing HOSPITAL OF is the first hospital in care of lepers in jerusalem. NURSING the Ph which trained  The Alexian Brothers they established Alexian filipino nurses. Brothers Hospital School of Nursing (the largest school of nursing under religious order that operated for only men in USA) FLORENCE NIGHTINGALE THE RISE OF SECULAR ORDER  is the mother of all nursing. she is not a nun but  rise of religious nursing orders for women. studied in institute for nursing.  the woman should be a nun first in order to become a  born on may 12, 1820 nurse because the sole purpose of women is to be a  the mother of modern nursing, the lady with the lamp wife. and professional nurse pioneer.  most famous for her work during the Crimean War. IMPORTANT NURSING PERSINAGES ST. CLARE the founder of the 2nd EDUCATION PERIOD (start of being educated) order of St. Francis of Assisi.  Florence Nightingale opened the Nightingale Training School for Nurses (1860), now part of ST. ELIZABETH OF known as king's college london. HUNGARY the Patroness of  the education of recruits involved a year of practical Nurses. instruction in the wards with courses of lecturing and she was the daughter followed by two years of work experience in the of hungarian king. hospital. CONCEPT IN THE NIGHTINGALE SYSTEM OF EDUCATION 1. Government funds should be alloted to nursing ST. CATHERINE OF the 1st lady with the education. SIENA lamp. 2. Training schools of Nursing should be in close a hospital nurse, affliation. prophetess, 3. Professional nurse should train nurses. researcher and etc. 4. Nursing students should be provided with residence near their training hospitals. > written orders of doctors were insisted. > nurses should go with doctors during their rounds. 5. All nurses must be trained, in a regular civil hospital. THE RISE OF PROTESTANTISM (1520-1562) 6. training was fundamentally on the apprenticeship  the start of the dark period of nursing. model: hands-on, in the wards, under the ward sister. 7. Classes, given by medical doctors, augmented DARK PERIOD OF NURSING 17TH TO 19TH CENTURY training in the wards.  known as the period of reformation and american civil 8. The "home sister" or "mistress of probationers" war. organized the training.  hospital were closed. 9. District nurses had to be hospital trained (or they  nursing was the works of least desirable people. would not see enough serious cases)  nurses were uneducated, filthy and overworked. 10. Midwifery nurses had to be hospital trained.  mass exodus of nurses. 11. Training was required for administrative positions  religious upheaval led by Martin Luther destroyed the 12. Probationers kept dianies and case notes of their unity of Christian faith. work, examined by the matron and home sister, and  protestanism swept away from everything connected often by Nightingale. with roman catholicism in schools, orphanages and 13. A major component of training was moral: ethical hospitals. standards for patient care  properties of hospital and school were confiscated. 14. Technical training had to be updated 15. A Probationers' Home should be provided, with a THEODORE FLIEDNER private room for each. comfortable (common) living.  Reconstituted the deaconesses and later established 16. Responsibility for probationers' health and safety, the school of nursing. including rules to prevent septicemia and ongoing monitoring of probationers' health MARIA ALYSSA JIMENEZ | BSN 1 - 22 2  17. Certificates and letters of reference had to be dated SCOPE OF NURSING and were relevant only for a short time 18. A matron should have a housekeeper under her so  Promoting Health and Wellness that she could concentrate on the nursing and the  Preventing Illness nurse training  Restoring Health 19. The superintendent herself must have the highest  Care for Dying knowledge of nursing, be herself resident in the hospital, make the training in nursing her first object, ROLES & FUNCTION OF THE NURSE TODAY and be herself at trained nurse of the highest order. 1. Caregiver CONTEMPORARY PERIOD 2. Communicator 3. Teacher NURSING AFTER WORLD WAR I 4. client advocate 5. counselor  silver lining of the great war. 6. change agent  volume of patients drastically change the role of 7. leader nurses. 8. manager  nurses performed triage (strategy of segrating which 9. case manager patients to cure first and which patients can wait for a 10. expanded career roles: specific period of time)as patients came in on nurse practitioner ambulance trains, directed corpsmen who had little clinical nurse specialist medical training. nurse specialist  Dependent (requires a doctor's order before nurse anesthetist proceeding) to Independent (these are the nursing nurse midwife intervention that they do, which do not require a nurse research doctor's order) (requires a doctor's order before nurse administrator proceeding) nursing practice. nurse educator  nurses were being respected more. nurse entrepreneur NURSING AFTER WORLD WAR II &  new opportunities for women: wartime and the american workforce.  nurses on the front lines.  the scars of war: PTSD in WW2 Nurses (Post HISTORY OF NURSING IN THE PHILIPPINES Traumatic Stress Disorder)  mysticism and superstitions.  herbolarios. RISE OF THE BSN CURRICULUM  filipinos who became sick were usually cared for by the female family members of friends in the home. The Degree of Bachelor of Science in Nursing (1945-1951); a EARLY CARE OF THE SICK nursing curriculum which was based on the thesis presented  we believed in mangkukulam or manggagaway. by Julita V. Sotejo.  good midwives.  if the birth became difficult, witches were supposed to be the cause. to disperse their influence, gunpowder UNIVERSITY OF SANTO the first college of nursing in were exploded from a bamboo cane close to the head TOMAS - COLLEGE OF the Philippines. of the sufferer. NURSING (1946) HEALTH CARE DURING THE SPANISH REGIME MANILA CENTRAL served as clinical field for  male nurses were acknowledged as Spanish Friars' UNIVERSITY -COLLEGE practice. assistants for caring sick individuals in the hospital. OF NURSING (1947)  male nurses were referred as practicante or emfermero. UNIVERSITY OF THE its first dean was Miss. Julita PHILIPPINES MANILA - Sotejo. COLLEGE OF NURSING EARLIEST HOSPITALS (1948) HOSPITAL REAL DE - established mainly to care MANILA (1577) for the spanish king's NURSING IN TODAY’S SOCIETY soldiers but also admitted Spanish civilians; founded by  Nursing is caring (from Womb to Tomb) Gov. Francisco de Sande.  Nursing is an Art SAN LAZARO - founded by Brother Juan  Nursing is wide now. HOSPITAL (1578) Clemente and was  recipient of nursing; patients, community, family, administered for many years clients, and co-workers. by the Hospitalliers of San Juan de Dios; built MARIA ALYSSA JIMENEZ | BSN 1 - 22 3  exclusively for patients with nursing services to her leprosy. troops. - now they don't cater TRINIDAD TECSON - “Ina ng Biac na Bato”, patients with leprosy stayed in the hospital at because we are leprosy-free Biac na Bato to care for already. they cater more the wounded soldiers. patients with communicable diseases like tubercolosis WHAT ARE THE THINGS THAT BROUGHT ABOUT and hiv. CHANGE? HOSPITAL DE - established by the  american began training the first Filipino nursing INDIOS (1586) Franciscan Order; service students in 1907 was in general supported by  Hospital School of Nursing's Formal Training alms and contributions from (1901-1911) charitable persons.  Persionado Act of 1903 or (Act 854); Allowing HOSPITAL DE - established in Laguna; near Filipino nursing student to study in United States. AGUAS SANTOS a medical spring, founded by Among of the wave of nurses who went to United (1590) Brother J. Bautista of the States. Fransciscan Order. 1. Iloilo Mission Hospital School of Nursing (Iloilo SAN JUAN DE DIOS - founded by the Brotherhood City, 1906); Miss Rose Nicolet, was the first HOSPITAL (1596) of Misericordia of San Juan superintendent for nurses. Wherein 1944 graduate de Dios; support was nurses took the first Nurses Board Examination delivered from alms and rents; rendered general 2. Saint Paul's Hospital School of Nursing health service to public. (Manila,1907);provided general hospital services. Opened its training school for nurses in 1908, with Mother Melanie as superintendent and Miss Cambers PROMINENT PERSONS INVOLVED IN NURSING as Principal WORKS IN THE PHILIPPINES 3. Philippine General Hospital School of Nursing JOSEPHINE BRACKEN - installed a first hospital (Manila, 1907); Mary Coleman Masters, an educator in an estate house in advocated for the idea of training Filipino girls for the Tejeros; provided nursing profession of nursing also first opened a dormitory for care to the wounded night girls enrolled at the Philippines Normal Hall and the and day. University of the Philippines. ROSA SEVILLA DE - converted their house ALVERO into quarters for the 4. St. Luke's Hospital School of Nursing (Quezon Filipino soldiers, during City, 1907); the school opened with the three girls the Philippine-American admitted. these three girls had their first year War that broke out in combined classes witht the PGH school of Nursing 1899. and St. Paul's Hospital School of Nursing. Miss Helen DONA HILARIA DE - wife of Emilio Aguinaldo; Hicks was the first principal. Mrs. Vitaliana Beltran AGUINALDO organized Filipino Red was the first Filipino superintendent of nurses and Dr. Cross under the Jose Fores was the first medical director of the inspiration of Apolinario hospital. Mabini. DONA MARIA - second wife of Emilio 5. Mary Johnston Hospital and School of Nursing AGONCILLO DE Aguinaldo; provided (Manila, 1907); Sister Rebecca Parrish together with AGUINALDO nursing care to Filipino registered nurses Rose Dudley and Gertude soldiers during revolution. Dreisbach organized this. The nurses' training course President of Filipino Red began with three Filipino young girls fresh from Cross branch in elementary as their first students. Batangas. MELCHORA AQUINO - nursed the wounded THE START OF NURSING PRACTICE (1911-1921) Filipino soldiers and gave  promulgation of Act No. 2493 which amends Medical them shelter and food Law (Act No. 310) allowing the regulation of nursing Capitan Salome – a practice transpired during this period. revolutionary leader in  in 1919, the First True Nursing Law was enacted Nueva Ecija; provided through Act 2808. During this perios Board Examiners nursing care to the for Nursing wss also created. wounded when not in  the first nursing board examination was given in 1920. combat  the first executive officer of the Board Examiners for Nurses is a physicians. AGUADA KAHABAGAN - revolutionary leader in Laguna, also provided MARIA ALYSSA JIMENEZ | BSN 1 - 22 4 A MUCH ESTABLISHED PROFESSIONAL ORGANIZATION  Rationalist Espitemology (scope of knowledge) (1931-1931) emphasizes the importance of a priori (something that  The Filipino Nurses Association was established. can be known without experience or sense data)  The Philippine Journal of Nursing reasoning as the appropriate method for advancing knowledge. PUBLIC HEALTH NURSING DEVELOPMENT  Deductive Reasoning (Cause and Effect)  in 1933, the nursing insititution have increased their  theory-then-research strategy requirement. To enter nursing education an applicant  innate, reason and deduction must be able to complete secondary education.  Case/Application PROLIFERATION OF NURSES AS A WORKFORCE (1951-  ex: Poor hand washing technique will result in 1971) spreading diseases to all patients.  The Philippine Law was approved under the Republic  Do you agree? Will you refute? Can you prove this Act No. 877 on June 19,1953. Then further theory? If yes why? If not why? amendment was created in 1966 which limits that  So when your thinking is rationalism, you're thinking practice of nurses among 21 y/o and above. (today) the whole body of knowledge which is your theory and  celebration of Nurses' Week which was proclaimed by then you will prove it through research and President Carlos P. Garcia under the Proclamation experiment. No. 539. EMPIRICISM Nursing Profession Development (1971-2001)  is based on the central idea that scientific knowledge can be derived only from sensory experience (seeing,  The Presidential Decree No. 233; establishment of the feeling, hearing facts). agency, Professional Regulation Commission  Inductive Reasoning; collection of facts perceded  The Philippine Nursing Act of 1991 was also amended attempts to formulate generalizations. under the Republic Act No. 7164.  research-then-theory strategy  Nursing Certification Council in 1999 under the Board  gathering of facts through experience and observation of Nursing through Resolution No. 14 which supervise and then formulating theories. the new programs' implementation conducted by  Case/Application Specialty Certification Boards. This improvement also prompted the start of Advanced Practice Nursing  ex: Differential Diagnosis (APN) in the Philippines. Patient‐ 31y/o productive cough for 2 weeks, low grade fever  The Philippine Nursing Act of 2002 was enacted occurring every afternoon, vital signs all in normal range. under the Republic Act No. 9173 which entails Weight, clinical observation. changes on existing policies under Republic Act No. 7164. Diagnostics— X-ray (clear)  this is the law we are following today. Sputum test (negative) History— Smoker for 15 yrs. 1 pack of cigars everyday. HISTORY OF PHILISOPHY & SCIENCE  So why do we need to study this? collect facts/data and then formulate generalizations.  because Philosophy and Science are two concepts so what will be the generalization/diagnosis that you can that actually entails to describe what is knowledge. to conclude in this patient? learn how we get information and knowledge, so we for sure the patient has no tubercolosis because of the can appreciate more on how our nursing theorist, negative sputum test. also the patienst has no pneumonia scientist and other researcher come about the body of beacuse the X-ray is clear. knowledge that they were able to further develop. the question is saan galing yung productive cough? and bakit sya may low grade fever? HISTORICAL VIEWS OF THE NATURE OF SCIENCE  What is science, knowledge, and truth? we can EARLY 20TH CENTURY VIEWS OF SCIENCE & THEORY answer this through Espitemology.  during the first half of this century, philosophers focused on the analysis of theory structure, whereas 1. Espitemology; a branch of phylosophy concerned with scientists focused on empirical research. the theory of knowledge in philosophical inquiry.  Paradigm Shift; science progresses from a pre- (inaalam nya kung paano na develop ang science, then to a normal science, then to crisis, then kaalamanan) to a revolution, and then to a new normal science.  can be derived through two things, the Truth (nag-iiba because of the better solution that has been (katotohanan or scientifically tested body of researched and testes) knowledge) and the Belief (usually came from Samples: experience).  Early mobilization of critically ill patients shows better  two competing philosophical foundations of science, patient outcomes. rationalism and epiricism, have evolved in the era of  use of betadine swab for cord care. modern science with several variations. (paano  airway breathing circulation to circulation-airway- nagdedevelop ang kaalaman/ how knowledge breathing. advances)  (good practices than the previous ones) RATIONALISM MARIA ALYSSA JIMENEZ | BSN 1 - 22 5  3. Health- defined as the degree of wellness or well- being that the client experiences. It may have different meanings for each patient, the clinical NURSING AS AN ART vs NURSING AS SCIENCE setting, and the health care provider.  Nursing as an Art; these are the abstract things that 4. Nursing- the attributes, characteristics and nurses do. the caring part, the nurses being advocate actions of the nurse. Also, providing care to the for nurses. person.  Nursing as a Science; the concrete body of knowledge we need to learn. THE FOUR RELATIONAL PROPOSITIONS:  Republic Act of 9173  The discipline of nursing is concerned with the principles and laws that govern the life-process, wellbeing, and optimal functioning of human beings, sick or well  The discipline of nursing is concerned with the patterning of human behavior in interaction with the  It is a set of complete information that are actually environment in normal life events and critical life tested and proven to be accepted as a nursing situations. knowledge for nurses and other health care  The discipline of nursing is concerned with the nursing professionals. actions or processes by which positive changes in  Is the means by which the whole purpose of caring for health status are effected. patients is achieved because it underpins what we  The discipline of nursing is concerned with the actually do. wholeness or health of human beings, or health of the  It is what defines nurses & helps to differentiate human being that they are in continuous interaction nurses from lay caregivers & support workers. with their environments.  Development of nursing knowledge reflects the interface between nursing science & research. THE FOUR NON-RELATIONAL PROPOSITIONS:  Ultimate purpose of knowledge development is to  The metaparadigm concept person refers to the improve nursing practice. individuals, families, communities, and other groups who are participants in nursing. THE FIVE COMPONENTS OF NURSING KNOWLEDGE  The metaparadigm concept environment refers to the person's significant others and physical surroundings, 1. Metaparadigm as well as to the setting in which nursing occurs,  First component of the structural hierarchy of which ranges from the person's home to clinical knowledge. agencies to society as a whole.  Is a set of theories or ideas that provides structure for  The metaparadigm concept health refers to the how a discipline should function. person's state of well-being at the time that nursing  Meta means with and paradigm means pattern of occurs, which can range from high-level wellness to shared understanding & assumption. terminal illness.  The concepts and propositions of a metaparadigm are  The metaparadigm concept nursing refers to the admittedly extremely global and provide no definitive definition of nursing, the actions taken by nurses on direction for such activities research and clinical behalf of or in conjunction with the person, and the practice. goals or outcomes of nursing actions.  Is made up four concepts, four non-relational propositions and four relational propositions. 2. Philosophy  Nursing Metaparadigm  Second component of the structural hierarchy of  Embodies the knowledge base, theory, philosophy, knowledge. research, practice, educational experience and the  Comes from Greek words Philo means love and literature identified with the profession Sophos means wisdom.  These given concepts vary in accordance to the  Specifies the definition of metaparadigm concepts in experiences and views of the different nursing each of the conceptual models of nursing. It sets forth theorist. the meaning of phenomena through analysis, reasoning & logical argument. THE FOUR CONCEPTS: 1. Person- (also referred to as Client or Human FUNCTION OF PHILOSOPHY Beings) is the recipient of nursing care and may  The function of a philosophy is to communicate what include individuals, patients, groups, families, and the members of a discipline believe to be true in communities. relation to the phenomena of interest to that discipline, 2. Environment- is defined as the internal and what they believe about the development of external surrounds that affect the client. It knowledge about those phenomena, and what they includes all positive or negative conditions that value with regard to their actions and practices. affect the patient, the physical environment, such  In other words, the function of each philosophy is to as families, friends, and significant others, and inform the members of disciplines and the general the setting for where they go for their healthcare. public about the beliefs and values of a particular i. External- the surroundings of the patient. discipline. ii. Internal- the current relationship of the patient within himself and his current mental state. MARIA ALYSSA JIMENEZ | BSN 1 - 22 6 PHILOSOPHY OF NURSING: Middle Range Theory  Kung ano ang gusto patunayan ng knowledge na  Middle-range theories are narrower in scope than gusto mo’ng i-provide. grand theories. They are made up of a limited number  Philosophies have contributed to the to the knowledge of concepts and propositions that are written at a development in nursing by forming a basis for relatively concrete and specific level. subsequent developments especially in the area of  Each middle-range theory addresses a more or less human science. relatively concrete and specific phenomenon by E.g. Nightingale`s Theory (Environmental Theory/philosophy) describing what the phenomenon is, explaining why it “Nursing ought to signify the proper use of fresh air, light, occurs, or predicting how it occurs. warmth, cleanliness, quiet and the proper selection & administration of diet– all at the least expense of vital power to Function of a Theory the patient”.  One function of a theory is to narrow and more fully specify the phenomena contained in a conceptual 3. Conceptual Models model.  third component of the structural hierarchy of  Another function is to provide a relatively concrete knowledge. and specific structure for the interpretation of initially  A set of relatively abstract and general concepts that puzzling behaviors, situations, and events. address the phenomena of central interest to a discipline, the propositions that broadly describe those 5. Empirical Indicators concepts, and the propositions that state relatively  The fifth and final component of the structural abstract and general relations between two or more of hierarchy of knowledge. the concepts.  Nurses have developed a plethora of empirical  the term conceptual model is synonymous with the indicators in the form of research instruments and terms: conceptual framework, conceptual system, distinct clinical tools. paradigm, and disciplinary matrix.  The function of empirical indicators is to provide the means by which middle-range theories are generated Functions of a Conceptual Model or tested. Empirical indicators that are instruments  Provides distinctive frame of reference yield data that can be sorted into qualitative  Tells how to observe and interpret the phenomena of categories or calculated as quantitative interest to the discipline  a very concrete and specific real world proxy for a  Simplification of reality that includes only those middle-range theory concept; an actual instrument, concepts that the model author considers relevant experimental condition, or procedure that is used to and as aids to understanding observe or measure a middle-range theory concept.  provides a structure and a rationale for the scholarly The information obtained from empirical indicators is and practical activities of its adherents, who comprise typically called data. a subculture or community of scholars within a discipline.  Conceptual model gives direction to the search for Methods of Theory Development relevant questions about the phenomena of central 1. Theory-Practice-Theory - Directs that theory interest to a discipline and suggests solutions to development in nursing is based on and parallel to practical problems. other theories used in other discipline.  Provides general criteria for knowing when a problem Example: Nurse Rodney wants to develop a new theory that is has been solved. inspired from Abraham Maslow's Hierarchy of need. 4. Theory 2. Practice Theory - Directs that the theory  fourth component of the structural hierarchy of development is based on the life/work experience and knowledge. professional practice of the theorist.  One or more relatively concrete and specific concepts Example: Nurse Harry is assigned in the ICU for 20 years, he that are derived from a conceptual model, the developed a theory about nurse's coping mechanism in caring propositions that narrowly describe those concepts, for terminally ill patients called the "Theory of attachment". and the propositions that state relatively concrete and specific relations between two or more of the 3. Research Theory- Directs that the theory concepts. development is based on the extensive research done by the theorist TWO TYPES OF THEORY Example: Prof. Rem did research on the reasons why nurses Grand Theory stay in the hospital to work and their reason for leaving she  Grand theories are broad in scope. They are made up called it "Theory of Tenure". of concepts and propositions that are less abstract and general than the concepts and propositions of a additional information: conceptual model but are not as concrete and specific as the concepts and propositions of a middle range STRUCTURE LEVEL theory.  analysis of the theory presents the structure and analysis of specialized nursing knowledge. MARIA ALYSSA JIMENEZ | BSN 1 - 22 7  Structure of knowledge that was used to organize the  does this theory create an understanding in the units of the text and the definitions of the analysis nursing discipline what is the importance of theory in criteria used for the review process of the theoretical the nursing profession. works.  Because research, theory, and practice are closely related, nursing theory lends itself to research testing a) ANALYSIS OF THEORY and research testing leads itself to knowledge of  Analysis, critique and evaluation are methods used to practice. study nursing theoretical works critically.  Analysis of theory is carried out to acquire knowledge of theoretical adequacy.  It is a important process and the first step in applying nursing theoretical works to education research, administration or practice. Purposes of Nursing Theory  Analysis process is useful for learning about the  Education works and is essential for nurse scientist who intend to test, expand, or extend the works.  Research  Understanding theoretical framework is vital to  Clinical Practice applying it in practice. Nursing Education b) CLARITY  The scope of this are the university, and colleges that  major concepts, phrases or words clearly defined offers the Bachelor of Science in Nursing course. within theory  It speaks to the meaning of term used, and definitional Nursing Research consistency and structure speak to the consistent  They are responsibilities in making sure that the structural form of terms in the theory. development of nursing will continue  Words have multiple meanings within and across  Nurses that think of new theories, develop trainings, disciplines; therefore a word should be defined create or develop new tools to make nurses’ job specifically according to the framework ( Philosophy, easier conceptual model, theory, or middle range theory). Clinical Practice c) SIMPLICITY  These are the registered nurses who are actually  talks about complexity of the theory working in the hospital as staff nurses  It is highly valued in nursing theory development.  Nurses who have an administrative position  It discuss the degrees of simplicity and call for simple forms of theory, such as middle range, to guide What will be the purpose of nursing theory? practice.  The goal and aim of nursing theories is to make sure  Complex practice situation may call for more complex that the nursing profession will move forward theory.  A theory should be sufficient, comprehensive, HOW WILL IT HELP THE NURSING PROFESSION, presented at a level of abstraction to provide NURSING RESEARCH AND CLINICAL PRACTICE? guidance, and have as few concepts possible with a simplistic relation as possible to aid clarity. NURSING EDUCATION: SUNRISE MODEL (TRANSCULTURAL THEORY) d) GENERALITY  Every nurse should be well-versed with the beliefs  It speaks to the scope of application and the purpose and culture of their patients so that they can further within the theory ( Chinn & Krammer, 2015). help the patient to recover.  Understanding the levels of abstraction by doctors  Because of this theory, the nursing education added students and nurse scientist has facilitated the use of in each nursing subjects how a nurse can take care of abstract frameworks and the development of middle- a culturally diverse community. range theories. e) ACCESSIBILITY NURSING RESEARCH:  is the ability of your theory to be tested. Vital in THEORY OF THE TECHNOLOGICAL COMPETENCY AS developing a nursing theory/knowledge. CARING IN NURSING  “Accessible addresses the extent to which empiric By Dr. Rozzano Locsin indicators for the concepts can be identified and to o Nurse researcher what extent the purposes of the theory can be o Nurse Educator attained”.  It is vital to developing nursing research to test theory.  it means that for a nurse of the 20th century, for them It facilitate testing, because the empirical indicators to be able to take better car of the parents, they provide linkage too practice for test ability and should be technologically competent then ultimate use of theory to describe and test aspects of  there are new equipment’s, gadgets in the hospital practice (Chinn&Krammer,2015). (Modern world)  All nurses should be able to adjust with technology f) IMPORTANCE CLINICAL PRACTICE: HUMAN CARING THEORY MARIA ALYSSA JIMENEZ | BSN 1 - 22 8   Every nurses should follow 13 guidelines and factors  according to Florence Nightingale, every patient on now to take care of a patient inside the hospital, inside the room should breathe in  They use these 10 carative Factors as guidelines for fresh and clean air nurses  room should be properly ventilated so that the  Based on the survey of the hospital who's using the exchange of air will flow inside the room efficiently 10 carative factors:  patient should maintain proper temperature  The patient's satisfactory rate are high compared to other hospitals who are not following the 10 carative ex: hands is use to check the temperature factors. 2. Light ENVIRONMENTAL THEORY  it is important aspect By Florence Nightingale  according to Florence Nightingale, light can destroy  she was the founder of modern nursing microorganisms which destroys the infection  she was considered the first nurse theorist  she beliefs that light can purify the area, light can  she was born on May 12, 1820 in Florence Italy purify the skin, so she ordered to her nurses to make  the nightingale family is well-educated, affluent and that the patients will be moved to expose them to aristocratic. sunlight every morning. o meaning, they are in the higher or upper  she believed in the benefit of sunlight society during the Victorian period.  her father wanted her to be educated so he hired a 3. Cleanliness/Sanitation tutor who taught her subjects such as mathematics,  back in the day, cleanliness and sanitation is not languages, religion, and philosophy. widely practiced  she went to Germany to study at Kaiserswerth  she believed that cleanliness and sanitation are Training School for deaconesses in 1851 at the age of critical components of her environmental theory 31 years old.  she believes that dirty environment or surrounding  she studied for 3 months and she had her clinical can harbor germs, bacteria, that can lead to infections experience for 2 years then after that, she became the  she ordered that every patients should take a bath superintendent of the invalid gentle woman in London. everyday, for nurses to change linens from time-to-  she went to Crimean war in Turkey time  once she got back, she received cash prize from the  nurses should also take a bath and change clothes queen herself and used that money to build a nurse everyday training school at St. Thomas Hospital or the King  wash their hands every time they will touch a patient, College Hospital in London. after touching the patient and after touching the patient’s surrounding ENVIRONMENTAL THEORY  defined nursing more than 100 years ago as the “Act 4. Efficient Drainage of utilizing the environment of the patient to assist him  even if the area is clean or sanitized, if there is no in his recovery.” efficient drainage in the hospital or water drainage in  Linked health in 5 environmental factors (pure/fresh the area or ward, microorganism will still harbor air, pure water, efficient drainage, cleanliness, light)  microorganism or bacteria that can cause infection will o components that Florence Nightingale used still linger in reference to her theory  according to Nightingale, proper handling of waste o she also believed that healthy surroundings and proper disposal of body waste is essential were necessary to proper nursing care and  without proper disposal system, everything will be the aspiration and maintenance of health nonsense  the term of the word she used to describe environment is surrounding 5. Pure Water  stress the importance of keeping the client warm,  according to Nightingale, it is important for patients to maintaining a noise-free environment, and attending drink pure and clean water to the client’s diet in terms of assessing intake,  it is important that patients have an access to pure timelines of the food, and its effect on the person. clean running water to clean the wound of the  aside from the patient’s surrounding, Florence soldiers/patients. Nightingale also mentioned that it is important to maintain a relaxed, noise-free environment for the  These (5) environmental theory is very much useful patient and it also important to keep the patient even to the poor areas in the community of Florence nourished by providing healthy small frequent meals Nightingale  quiet area so that patients can relax or recover (5) ENVIRONMENTAL FACTORS/COMPONENT OF  she wants minimal activities or movements in the ENVIRONMENTAL THEORY patient’s room/ward  the need for nutritious/clean food; served with small 1. Pure air but frequent meals  ventilation for the patient, seemed to be the greatest concern  Nursing leadership and management – a good support from the leadership and management of the MARIA ALYSSA JIMENEZ | BSN 1 - 22 9  hospital, will come a long way if they will support the  is viewed as the combined result of environmental, nursing department. psychological and physical factors, not just the absence of diseases  Nightingale states that “Health is not only to be well, (10) ASPECTS OF THE ENVIRONMENTAL THEORY but to be able to use well every power we have.”  still being practiced up until today  This is consistent with our perception of health today, where one does not have to be disease free to be 1. Patients should have clean air and a temperature – healthy, but to maximize their potential to be in a controlled environment healthy state. 2. Patients should have access to direct sunlight and not  Disease is portrayed as dys-ease, or the absent of be subjected to unnecessary noise, especially when comfort. sleeping. 3. Rooms should be kept clean o Nightingale isolate (5) factors essential in securing an 4. Hospital facilities should be well constructed individual’s health; these include pure air, pure water, 5. Bedding should be kept clean and nurses should efficient drainage, cleanliness and light. wash hands frequently 6. Patients should be offered a variety of scenery, such NIGHTINGALE’S (6) D’S OF “DYS-EASE” as new books or flowers, to prevent boredom 7. Nurses should be positive but not offer false hope to ELEMENTS COMMENTS patients or make light of their illness DIRT general hygiene, 8. Patients should be kept clean and nurses wash their cleanliness in the hands frequently home, interpersonal 9. Offer a variety of small meals instead of large ones, contact and do not do patient care while patient is eating as it is distracting 10. Consider not only the individual patient but the context DRINK the cleanliness of of where he or she lives drinking water  consider the surrounding in which the patient lives, DIET the need for a proper whore the people living with this patient and balanced diet DAMP the need for a dry and (4) METAPARADIGMS OF ENVIRONMENTAL THEORY warm environment DROUGHTS the belief that droughts 1. Person can precipitate a  for Florence Nightingale, the Person, one of the disease episode elements in the (4) metaparadigms, is the individual DRAINS the need for proper receiving care drainage and sewer  she emphasized that the nurse was in control and systems responsible of the patients environment and surrounding 3. Environment  Nightingale’s perception of the Person, is that the  she emphasized that nursing was to assess or Person is a multidimensional being, that includes manipulate the nature in healing the patient biological, psychological, social, and spiritual  Nightingale believed that we nurses create and components maintain a therapeutic environment for the patient  it means that we provide a surrounding that is BIOLOGICAL comfortable so that the patient can recover  addressed by the uses of medicine and nursing to  there exist (5) environmental components which are addresses various diseases all essential to an individual’s health.  these are known collectively as the “health of houses”, PSYCHOLOGICAL AND SOCIAL COMPONENTS and outline factors of the physical environment which  consists of self-concept, feelings, thought processes must receive attention and social interactions  the underlying principle of maintaining health of houses is to put the patient in a condition which is SPIRITUALITY best for nature to act upon him or her.  intertwined with Nightingale’s own spiritual beliefs;  the environment that promotes health allows the that the person is valued patient to retain their energy or “vital powers” for use towards self-healing o Nightingale theory of the Person is based on Holism 4. Nursing HOLISM  Nightingale believes that every woman during her  is the concern of integrating the biological, social, time, would be a nurse in the sense that nursing is the psychological, and spiritual with its environment being responsible for someone else’s tasks  she believes that every woman should be responsible 2. Health for the health of her family member  she believed that nursing is for women MARIA ALYSSA JIMENEZ | BSN 1 - 22 10   Nightingale’s view on nursing is one of that is largely individuals involved in the relationship as intertwined by factors pertaining to the environment. encompassed by nursing  Nightingale believed that many of the symptoms and suffering of patients were not directly related to their What is the importance? disease or ailment, but rather consequences of poor  According to the theory of transpersonal caring, environmental conditions human caring is the center of nursing.  the duties of nursing include providing essentials such as fresh air, warmth, light cleanliness, quiet and a o How can we quantify caring? proper diet. By helping to control environmental o How can one person tell that if this nurse is actually influences, nurses can aid in the maintenance of the caring for his/her patient properly? health of their patients. o What are the things that a nurse shall possess, what are the things that nurses should show in order for CASE STUDY other people to tell that this nurse is a caring nurse? o You are caring for an 82 year old woman who has been hospitalized for several weeks for burns that she  Watson initially wrote the (10) Carative Factors. But sustained on her lower legs during a cooking her theory, just like other theory is dynamic and accident. Before the time of her admission, she lived evolves over time. alone in a small apartment. The patient reported on  So now, she is able to develop her own theory and try admission that she has no surviving family. Her to explain it further using the (10) Carative Processes support system appears to be the elders who live in her neighborhood. Because of transportation THE (10) CARATIVE PROCESSES difficulties, most of them are unable to visit frequently. 1. Cultivating the practice of loving – One of her neighbors has reported that she is caring kindness and equanimity toward self and for the patient's dog. As you care for this woman, she other as foundation to caritas says that none of the other nurses have listened to consciousness her about such a visit. As she asks you about this, she begins to cry and tells you that they have been EQUANIMITY – being calm and composed amidst separated. You call that the staff discussed their difficult situation concern about this woman's well-being during the report that morning. They said she has been eating What do you mean by this? very little and seems to be depressed.  According to Watson, this process can be defined as satisfaction through giving an TRANSPERSONAL CARING THEORY extension of the sense of self and an By: Jean Watson increased understanding of the impact of love and caring on self and others.  “We are the light in institutional darkness, and in in  In order for a nurse to give or care, the this model we get to return to the light of our nurse should first, care and love humanity” – Dr. Jean Watson him/herself  “You cannot give what you don’t have” JEAN WATSON  As a registered nurse, in order for you to  Margaret Jean Harmon Watson provide loving, care to your patients, you  Born on June 10, 1940 and raised in a small town of have to cultivate first that love and care Welch, West Virginia in the Appalachian Mountains. for yourself so you can provide it to other  She was the youngest of eight children and was people. surrounded by an extended family community. 2. Being authentically present – enabling,  Attended high school in West Virginia and then the sustaining and honoring the faith, hope, Lewis Gale School of Nursing in Roanoke, Virginia, and deep belief system and the inner where she graduated in 1961. subjective world of self/other.  After she graduated, in high school they moved to Colorado and continued her nursing education in the What do you mean by this? University of Colorado where in, she earned a  It describes the nurses’ role in developing Baccalaureate degree in Nursing in 1964 effective nurse/patient interrelationship  Then, she continued her post-graduate studies and wellness by helping the patient adapt attend her master’s degree in 1966. Then she earned health-seeking behavior. a doctorate in Educational Psychological and Council in 1973. First, you have to be authentically present  Distinguished Professor of Nursing and Chair in o Patient should feel that you are really Caring Science at the University of Colorado Health there Sciences Center o When you talk to them, you focus on them o If you are not authentically present at that THE THEORY OF TRANSPERSONAL CARING moment with your patient, you won’t be  Watson bases her theory for nursing practice on the able to connect with your patient following (10) Carative Factors. Each has dynamic o If you won’t be able to connect with your phenomenological Component that is relative to the patient, you won’t be able to help them adapt to health-seeking behaviors. MARIA ALYSSA JIMENEZ | BSN 1 - 22 11   There will come a time when patients will 6. Creative use of self and always knowing be discharged from the hospital as part of the caring process; engage in  The patient, to continue recovering at the artistry of caritas nursing home, should adapt health-seeking behavior so the patient will not go back to What do you mean by this? being ill or not go back to an ill-state  Calls upon the nurse to use knowledge 3. Cultivation of one’s own spiritual practices creatively in practicing caritas nursing and transpersonal self, going beyond ego-  Where we can use the difference between self. nursing as an art and nursing as a science What do you mean by this? 7. Engage in genuine teaching-learning  It means that the recognition of feelings experience that attends to unity and being need to self-actualization through self- and subjective meaning – attempting to acceptance for both the nurse and the stay within other’s frame of reference patient  Nurses should acknowledge their What do you mean by this? sensitivity and feelings, nurses should be  This is factor is an important concept for more genuine and sensitive to others nursing in that it separates caring from  To properly care for someone, he/she curing should have self-actualization first  It allows the patient to be informed and shift the responsibility for wellness and SELF-ACTUALIZATION health to the patient  It means that you have deeper  The nurse facilitates this process with understanding of who you are as a person teaching-learning techniques that are  As a nurse, you should know what the designed to enable patients to provide boundaries that you can accept. (Because self-care, determine personal needs and if you know that, you’ll know your provide opportunity for their personal limitations) growth 4. Development and sustaining a helping trust caring relationship (between a CURING nurse/patient)  Giving medication, you assist with the operation, etc. What do you mean by this? CARING  According to Watson, this is one of the  Caring (according to Watson) involves most crucial point of transpersonal genuine teaching-learning experience caring  You should be able to teach your patient health and wellness How do we develop and sustain a helping trust  Patient should be able to understand relationship? what you are trying to say o It involves congruence – honest/real to your patient o It involves empathy – ability to How will you know if patient understand you? understand patient feelings  They should be able to practice this o Non possessive warmth – body health and wellness that you are trying to language/ way you speak to patient teach them o Effective Communication – being able 8. Creating a healing environment at all to convey message to patient and patient levels understanding your message 5. Being present to, and supportive of, What do you mean by this? expression of positive and negative  Nurses must recognize the influence feelings that internal and external environment have on the health and illness of the What do you mean by this? individual  It means that, sharing of feelings is 9. Administering sacred nursing acts of important for nurse/patient relationship caring healing by tending to basic human needs It’s risky for nurses to share & accept these feelings from the patient. Why?  It’s not all the time that you’ll accept What do you mean by this? positive feelings, so as a nurse, you have  According to Watson, in order for you to to be ready to accept negative feelings properly care for your patient, you need from your patient and understand that this to know what are the needs that can be is not a negative feelings towards you as set aside and put in the background a person, this is a negative feeling towards what is happening MARIA ALYSSA JIMENEZ | BSN 1 - 22 12 According to Watson, the highest priority, should congruence between the self as perceived and the be the basic ones: self as experienced.” o food, elimination of waste and proper  A person can be considered healthy based on how ventilation he/she perceived her/himself  Does he/she him/herself as healthy? LOWER PRIORITY  Watson’s definition of health has evolved. The  psychological needs: sexual activity, positive state of physical, mental, and social well- socialization, etc. being with the inclusion of (3) elements; a. A high level of overall physical, mental, and spiritual  A caring nurse should know which one functioning tend be first b. A general adaptive maintenance level of functioning 10. Opening and attending to c. Absence of illness spiritual/mysterious and existential unknowns of life-death 3. Environment  Watson speaks to the nurse’s role in environment as What do you mean by this? “attending to supportive, protective, and or corrective  According to Watson, a caring nurse mental, societal, and spiritual environments”. should be open and should understand  She emphasizes the person and the environment has that not everything can be explained by a connection, nurses are part of the patient’s science environment and once a nurse enters the patient’s o Believing in miracles – there are things room an expectation is already present. that you or science cannot explain o Nurses should be open to this idea 4. Nursing THE (7) ASSUMPTIONS  “Nursing is concerned with promoting health, 1. Caring can be effectively demonstrated preventing illness, caring for the sick and restoring and practiced only interpersonally health.” 2. Caring consists of carative factors that  According to Watson, the word nurse, is both a noun result in through satisfaction of certain and a verb. To her, nursing consists of “knowledge, human needs thought, values, philosophy, commitment, and action 3. Effective caring promotes health and with some degree of passion.” individual or family growth 4. Caring response accept person not only CASE STUDY as he or she is now but as what he or she o A 62 year old inmate is admitted to this hospital from may become prison with a complaint of chest pain. The patient is 5. A caring environment is one that offers being worked up for possible myocardiaI infarction the development of potential while and admitted to the cardiac unit. Because the patient allowing the person to choose the best is an inmate, while he is in the hospital a prison guard action for him/herself at a given point in will be poste outside of the patient's room and the time patient will be handcuffed to the bed rail. During the initial assessment, the admission nurse finds the 6. Caring is more “health genie" than is patient to be withdrawn. The nurse discovers the curing. A science of caring is patient has a past medical history significant for abuse complementary to the science of curing. of multiple substances. The patient describes 7. The practice of caring is central to nursing behaviors led to his incarceration and estrangement from his family. The patient expresses to the nurse THE TRANSPERSONAL CARING THEORY interest in meeting with a chaplain while in the METAPARADIGM hospital. 1. Person  Watson uses interchangeably the terms human being, person, life, personhood and self. She views the person as “unity of mind/body/spirit/nature”. Patricia Benner  Watson states “I make the point to use mind, body, soul, or unity within an evolving emergent world view  She developed a concept knows as “From Novice to – connectedness of all, sometimes referred to as Expert”. This concept explains that nurses develop unitary transformative paradigm-holographic skills and an understanding of patient care over time thinking”. from a combination of a strong educational foundation  A person will not be a person if the person will only and personal experiences. have the body.  A person has (3) elements, the mind, the body and Novice to Expert the spirit.  Benner proposed that a nurse could gain knowledge 2. Health and skills without actually learning a theory. She  She defined health as “unity and harmony within the describes this as a nurse “knowing how” without mind, body and soul”; associated with the “degree of “knowing that”. She further explains that the MARIA ALYSSA JIMENEZ | BSN 1 - 22 13  development of knowledge in fields such as nursing is  They have difficulty grasping the current patient’s made up of the extension of knowledge through situation in terms of the larger perspective. research and understanding through clinical  Clinical Situations – are viewed by nurses in this level experiences. as a test of their abilities and the demands of the  For Benner, nursing could also focus on nurses situation plays on them. gaining more and more experience.  Nurses see the tasks as a test on their ability if they  It is imperative for nurses to gain more clinical can be able to really do the job. experience so that they can progress their level.  Their focus is on testing their ability if they really can  Benner believed that nurses can actually acquire a adopt to this job. skill even if they are not really familiar with the  They rely on help of those who are more experienced. theoretical part of it.  They can work on their own but they mostly rely on  According to Patricia Benner’s Novice to Expert the experience of their senior nurses. Theory, there are (5) stages of skill acquisition; 3. Competent 1. Novice  Through learning from actual practice situation and by  In the novice stage of skill acquisition, the person has following the actions of others, the advanced beginner no background experience of the situation in which moves to the concept levels. the nurse are involved.  The competent stage is an example in which the  Not much background and clinical experience. nurses is now very considerable, conscious and  You’re student nurses. deliberate in planning their day.  Novice nurses are having difficulty between relevant  They are confident. and irrelevant aspects of a situation.  They really can do their nursing interventions and  Generally, this level 1 stage applies to the student nursing actions with minimal help form their senior nurses. nurses.  But Patricia Benner also suggest, that nurses, even if  They can already plan their day ahead. they are already in the higher level of skill in one area  They can plan their nursing actions with minimal to no can go back to novice. supervision from their senior nurses or mentors.  Competent level is most pivotal in clinical learning. Ex: If a nurse has been working in the ICU for adult for 10-15 Because the learner must begin to recognize patterns years. It’s safe to say that the nurse is already in higher level or and determine which element of the situation requires stage. But this nurse can still go back to novice level if that attention and which can be set aside for the mean nurse will be rotated or assigned in an area which he/she is not time. familiar with. (Nurse form adult ICU to Pediatric ICU)  Nurses can now plan which patient needs attention, what nursing interventions needs to be done first 2. Advance beginner before other patients.  Develops when a person can now demonstrate  What are the things that can be set aside or what are marginally acceptable performance. the things that can be ignored. (competent nurses are  Having hook/cope with enough real situations to have beginning to learn this skill set) pointed out by a mentor.  In this skill level, anxiety level is very high because of  The recurring meaningful component of the situation the pressure to consistently perform well without is that the nurses who are in the advance beginner mistakes and because they are still learning and there stage can already cope and have experienced are other nurses relying to them. enough real situations and they are being trained by a mentor or a nurse trainer. 4. Proficient  Can be a graduate of nursing and passed the board  In this stage, the nurse perceives the situation as a exams and this is his or her first employment in the whole rather than in terms of aspects and hospital. performance. a. So this nurse already has some real  Nurses at this level demonstrates a new ability to see situational experiences. changing relevance in a situation including recognition b. This nurse is being trained by another nurse and implementation of skilled responses to the (a senior nurse) situation as it evolves. c. This nurse has enough experiences to grasp  They demonstrate increased confidence in their the aspect of the situation. knowledge and ability. d. This nurse already has an idea as to what’s  At this stage, nurses are comfortable to talk to the happening. patients and families.  Nurse functioning at this level, guided by rules and  They’ve already acquired good communication skills are oriented by tasks competition. with patients and their relatives.  They are very oriented with rules and guidelines to  The transition phase of going into the expert stage. follow.  Their work is mainly on task completion. 5. Expert MARIA ALYSSA JIMENEZ | BSN 1 - 22 14   This is achieved when the expert no longer rely on  Caritative caring consists of love and charity, which is analytical principles (rules and guidelines) also known as caritas, and respect and reverence for  They no longer rely to analytical principles because human holiness and dignity. According to the theory, they already memorized it, they’ve already well versed suffering that occurs as a result of a lack of caritative and familiar with those rules and guidelines. care is a violation of human dignity.  Since they are already familiar with those rules and guidelines, they can better understand the situation of THEORY OF CARATIVE CARING the patient and render the correct nursing intervention