AY 2024 FIRST SEMESTER REVIEWER FOR T.F.N

Tfn

1. Manaal Vargas Tamayo BSN October 9, 2022

TOPIC 1
OVERVIEW OF TFN
• By giving nurses a sense of identity, nursing theory can
help patients, managers and other healthcare
professionals to recognize the unique contribution that
nurses make to the healthcare service (Draper 1990).
THEORY
ORIGIN: “THOERIA” – speculate THEORY
THEORIES are set of interrelated concepts that give a systematic
view of a phenomenon (an observable fact or event) that is
explanatory & predictive in nature.







CONCEPT
o A mental idea of a phenomenon.
o A comprehensive idea or generalization.
o An idea that brings diverse elements into a basic
o relationship.
o A unit of knowledge abstracted from a set of
o characteristics attributed to a class of objects,
o relations or entities.
o A unit of thought.
o A general idea formed in the mind.
o Something understood or retained in the mind, from
experience, reasoning, and/or imagination, a
generalization or abstraction of a particular set of
instances or occurrences.
• Examples: person, health, environment, nursing
DEFINITION
o The definition within the description of a theory conveys
the general meaning of the concepts in a manner that fits
the theory. These definitions also describe the activity
necessary to measure
the constructs, relationships, or variables within a theory. (Chinn
and Kramer 2004).

ASSUMPTIONS

o Are statements that describe concepts or connect two
concepts that are factual. Assumptions are the “taken for
granted” statements that determine the nature of the
concepts, definitions, purpose, relationships, and
structure of the theory.

PRINCIPLE
o A basic generalization that is accepted as true and that
can be used as a basis for reasoning or conduct.
NURSING THEORY
o A body of knowledge that describes or explains nursing
and is used to support nursing practice.
o An organized and systematic articulation of a set of
statements related to questions in the discipline of
nursing.





PHILOSOPHY
o The most basic beliefs, concepts, and attitudes of an
individual or group
o An analysis of the grounds of and concepts expressing
fundamental beliefs
o Is the next knowledge level after metaparadigm. It
specifies the definition of metaparadigm concepts.

CONCEPTUAL FRAMEWORKS/MODELS
o Are representations of an idea or body of knowledge
based on the own understanding or perception of a
person or researcher on a certain topic, phenomena or
theory











THEORETICAL MODELS/FRAMEWORK

o Are highly established set of concepts that are testable.










SCIENCE
o The organized body of knowledge gained through
research.
SCIENTIFIC METHOD:
1. Observation
2. Data Gathering
3. Forming Hypothsis
4. Expirementation
5. Conclusion

2. Manaal Vargas Tamayo BSN October 9, 2022

KNOWLEDGE
o Information, skills and expertise acquired by a person
through formal/informal learning.
PHENOMENON

o A set of empirical data or experiences that can be
physically observed or tangible such as crying or
grimacing when in pain.

NURSING

o Nursing encompasses autonomous and collaborative
care of individuals of all ages, families, groups and
communities, sick or well and in all settings. It includes the
promotion of health, the prevention of illness, and the care
of ill, disabled and dying people. (WHO)

PARADIGM

o In science and philosophy, a paradigm is a distinct set of
concepts or thought patterns, including theories, research
methods, postulates, and standards for what constitutes
legitimate contributions to a field.

HYPOTHESIS

o Translates a research question into a prediction of
expected outcomes.
- research question identifies the variables/
concepts under investigation and asks how the concepts
might be related
- hypothesis is the predicted answer.

RESEARCH

o Research comprises "creative and systematic work
undertaken to increase the stock of knowledge, including
knowledge of humans, culture and society, and the use of
this stock of knowledge to devise new applications.

PURPOSES OF NURSING THEORY IN RELATION TO:
(AREAS OF NURSING)

1. Education
• nursing theory was used primarily to establish the profession’s
place in the university.
• provide a general focus for curriculum
design.
• guide curricular decision making

2. Research
• nursing research identifies the philosophical assumptions or
theoretical frameworks from which it proceeds.
• offer a framework for generating knowledge and new ideas.
• assist in discovering knowledge gaps in specific field of study.
• offer a systematic approach to identify questions for study, select
variables, interpret findings and validate nursing interventions.

3. PRACTICE
• the primary contribution of nursing theory when employed in a
clinical setting is the facilitation of reflection, questioning, and
thinking about what nurses do.
• assist nurses to describe, explain, and predict everyday
experiences.
• serve to guide assessment, intervention, and evaluation of
nursing care.
• provide a rationale for collecting reliable and valid data about the
health status of clients, which are essential for effective decision
making and implementation.

TYPES OF NURSING THEORY

Meta-theory - the theory of theory. Identifies specific phenomena
through abstract concepts.
Grand theories – broad and complex
Middle-range theories- address specific phenomena and reflect
practice
Practice theory - explores one particular situation found in
nursing. It identifies explicit goals and details how these goals will
be achieved.
Descriptive theories – first level of theory development
Prescriptive Theories – address nursing interventions and
predict their consequences.

TOPIC 2
HISTORY OF NURSING THEORY
o The history of professional nursing began with 1.
Florence Nightingale. She envisioned nurses as a body
of educated women at a time when women were neither
2. educated nor 3. employed in public service.
Following her service of organizing and caring for the
wounded in Scutari, during the 4. Crimean War, her
vision and establishment of a 5. School of Nursing at St.
Thomas’ Hospital in London marked the birth of modern
nursing.

o Nightingale’s pioneering activities in nursing practice and
subsequent writings describing nursing education
became a guide for establishing nursing schools in the
United States at the beginning of the twentieth century
(Kalisch & Kalisch, 2003; Nightingale, 1859/1969).
HISTORICAL DEVELOPMENT
o In the early part of nursing’s history, knowledge was
extremely limited and almost entirely task oriented.
o Role of nurses where questioned; what they do, for
whom where and when were determined.
o The professionalization of nursing has been and is being
brought about through the development and use of
nursing theory.

HISTORY OF NURSING

o The word nurse is derived from the Anglo-French nurice
and the Latin word nutrica, both of which mean
NOURISH.
» Florence Nightingale pioneer activities in nursing practice & her
subsequent writings about nursing served as a guide for
establishing nursing schools in the US at the beginning of 20th
century.
» In the last century, nursing began with a strong emphasis on
practice.
» Throughout that century, nurses work toward the development
of the profession in what has been viewed as successive
HISTORICAL ERAS.



o Nightingale’s vision of nursing has been practiced for
more than a century, and theory development in nursing
has evolved rapidly over the past 5 decades, leading to
the recognition of nursing as an academic discipline with
a substantive body of knowledge.

3. Manaal Vargas Tamayo BSN October 9, 2022

HISTORICAL ERAS

CURRICULUM ERA
•Moving nursing education from hospital-based diploma
programs into college and universities
RESEARCH ERA
• Research is the path to new knowledge
• Part of the curricula of developing graduate programs.
GRAD EDU ERA
• Masters program in nursing emerged to meet the need for nurses
with specialized education in nursing
THEORY ERA
• Outgrowth of research era
• Research without theory produced isolated information; however
research and theory produced nursing science

MID 1800’S & 1960’S

MID 1800’S
o Nursing Knowledge is distinct from medical knowledge
(Nightingale)
o Nursing as a Vocational heritage more than professional
vision
MID 1970’S
o Evaluation of 25 years of nursing research revealed that
nursing lacked conceptual connections and theoretical
frameworks.
o MILESTONES:
14. The standardization of curricula for nursing master’s education
15. Doctoral education for nurses should be in nursing
o Transition from vocation to profession
o Nursing practice is based on Nursing Science.

MID 1980’S
o Preparadigm period to Paradigm period
o Introduced an organizational structure for nursing
knowledge development to the nursing literature
o Utilization phase of the Theory Era – emphasis shifts
from the development to the use and application of what
is known






STORICAL
ERAS
MAJOR
QUESTION
EMPHASIS OUTCOMES
EMERGING
GOAL
6.
What
7.

Develop
specialized
knowledge
and higher
education
curriculum
content Courses
should included in
student nursing
nurses’ programs
study to be
nurses?

Research
Era: 1950 –
1970s
8.
Role of
nurses and
what to
research
Problem
studies and
studies of
nurses
9.
10.
What Carving out
Graduate knowledge an advanced Nurses have
Education is needed role and an important
Era: 1950 – for the basis for role in health
1970s practice of nursing care
nursing? practice
11. How do 12.
these There are Theories
frameworks many ways guide
guide to think nursing
research about research and
and nursing practice
practice?

What new
13.
Middle-range
Nursing
frameworks
produce
knowledge
(evidence) for
quality
care
Theory theories are theory may
Utilization needed to be from
Era: 21
st
produce quantitative
Century evidence of or qualitative
quality care? approaches

Curriculum
Era:
1900 - 1940s
Standardized
curricula
for diploma
programs

What is the
focus for nursing
research?
Isolated
studies do
not
yield unified
knowledge
Focus
graduate
education on
knowledge
development


Theory Era:
1980 - 1990s
Nursing
theoretical
works shift
the focus
to the patient
Nursing theory
guides
research,
practice,
education, and
administration

4. Manaal Vargas Tamayo BSN October 9, 2022


FIRST CONFERENCE NURSING THEORY

o Brought leading scholars and theorists to discuss
and debate on issues regarding nursing science and
theory development. (1969)

CHANGES OF EDUCATION IN NURSING

1874 – the St. Catherine Training School was the first hospital
diploma school in Canada where the nursing program went
from an apprenticeship to an educational model.
1881 – the school for Nurses at the Toronto General Hospital
was established.
1896 – Mary Agnes Snively developed 3-year course with 84
hours of practical nursing and 119 hours of instruction by the
medical staff. 1918 - following World War 1, the widespread
influenza pandemic led to support for public health programs
and new patterns of health care delivery.
1919 – was the year the first undergraduate nursing degree
program was established at the University of British Columbia.
1932 – demanded for transfer of responsibility for nursing
education to general educational system.
1950’s and 1960’s – experiments with two-year programs for
nursing began and the movement to separate nursing
education from the authority of hospitals began.
1967 – Laurentian University started student intake.
2000 – all professional nurses are required to have a bachelor
at degree

THE NURSING THEORY

o Provides a basis of nursing practice.
o It is important to nurses because it helps to interpret data,
make decisions based on relevant information, plan for
care, and predict and evaluate outcomes.
o It helps to differentiate nursing from other disciplines.

TOPIC 3
SIGNIFICANCE OF THEORY FOR NURSING AS A
DISCIPLINE & A PROFESSION
o Discipline is specific to academia and a branch of
education, a department of learning or field of
knowledge.
o Profession refers to specialized field of practice, which
is founded upon the theoretical structure of the science
or knowledge of that discipline and the accompanying
practice abilities.
o The theoretical works have taken nursing to higher
levels of education and practice as a nurses
SIGNIFICANCE OF THEORY FOR NURSING AS A DISCIPLINE

o University baccalaureate programs proliferated, master’s
programs in nursing were developed, and a standardized
curriculum was realized through accreditation.
o Attention to the importance of nursing conceptualizations
for the research process and the role of a conceptual
framework in the purpose and design of research
production of science and nursing theoretical works also
began to publish.
o Works began to be recognize for their theoretical nature,
such as Henderson, Nightingale and Orlando, Peplau,
and Wiedenbach were recognized for the theoretical
nature of their earlier wings.

SIGNIFICANCE OF THEORY FOR NURSING AS A
PROFESSION

o Clearly nursing is recognized as a profession today
having used the criteria for a profession to guide
development\
o Nursing development was the subject of numerous
studies of numerous studies by sociologists

NURSING THEORY AND THE PRACTICING NURSE
Theory assists the practicing nurse to:
o Organize patient data
o Understand patient data
o Analyze patient data
o Make decisions about nursing interventions
o Plan patient care
o Evaluate patient outcomes

WHAT IS A PROFESSION?

o A profession is an occupation with ethical components,
i.e, devoted to the promotion of human and social welfare.
o The services and knowledge by a profession are based
on specialized skills.
o Professions are those occupations possessing a
particular combination of characteristics.
o Nursing profession is an Occupation based on the
specialized intellectual study and training, the purpose of
which is to supply skilled services with ethical
components.


CRITERIA OF PROFESSION

o Bixler and Bixler Criteria of Profession
o Abraham Flexner’s criteria for a profession
o Kelley’s Criteria

BIXLER AND BIXLER CRITERIA FOR PROFESSION

o Genevieve and Roy Bixler who were against the status of
Nursing as a profession 1945, appraised nursing
according to their original seven criteria as follows:

1. Utilizes in its practice a well defined and well organized
body of knowledge, which is on the intellectual level of the
higher training.
2. Constantly enlarges the body of knowledge its uses and
improves and improves its techniques of education and
service by the use of the scientific method.
3. Entrusts the education of its practitioners to institutions of
higher education.
4. Applies its body of knowledge in practical service, which
is vital to human beings and social welfare.
5. Functions autonomously in the formulation of professional
policy and in control of professional activities thereby.
6. Attracts individuals of intellectual and personal qualities
who exalt service above personal gain and who can
recognize their chosen profession as lifelong.
7. Strives to compensate its practitioners by providing
freedom of action, opportunity for continuous professional
growth and economic security.

ABRAHAM FLEXNER'S CRITERIA FOR A PROFESSION

Flexner believed that professional work:
1. Is basically intellectual (as opposed to physical) and is
accompanied by a high degree of individual responsibility.
2. Is based on a body of knowledge that can be learned and
is refreshed and refined through research.

5. Manaal Vargas Tamayo BSN October 9, 2022

3. Is practical in addition to being theoretical.
4. Can be taught through a highly specialized education.
professional
5. Has a strong internal organization of members and a well-
developed group consciousness.
6. Has practitioners who are motivated by altruism( the
desire to help others) and who are responsive to human
interests.

KELLEY'S CRITERIA

Kelley(1981) reiterated and expanded Flexner's criteria in her
1981 listing of characteristics of a profession.
1. The services provided are vital to humanity and the
welfare of the society
2. There is a special body of knowledge that is continually
enlarged through research.
3. The services involve intellectual activities; individual
responsibility (accountability) is a strong feature.
4. Practitioners are educated in institutions of higher
learning
5. Practitioners are relatively independent and control their
own policies and activities (autonomy).
6. Practitioners are motivated by service (altruism) and
consider their work as an important component of their
lives.
7. There is a code of ethics to guide the decisions and
conduct of practitioners.
8. There is an organization (association) that encourages
and support high standards of practice

CHARACTERISTICS OF PROFESSIONS

1. GREAT RESPONSIBILITY
o Professionals deal in matters of vital importance to their
clients and are therefore with grave responsibilities. And
entrusted obligations.
o Given these inherent obligations, professional work
typically involves circumstances where carelessness,
inadequate skill, or breach of ethics would be significantly
damaging to the client and/or his fortunes.
2. ACCOUNTABILITY
o Professionals hold themselves ultimately accountable for
the quality of their work with the client.
o The profession may or may not have mechanisms in
place to reinforce and ensure adherence to this principle
among its members. If not, the individual professionals
will (e.g. guarantees and/or contractual provisions).
3. BASED KNOWLEDGE ON SPECIALIZED,
THEORETICAL
o Professionals render specialized services based on
theory, knowledge, and skills that are most often peculiar
to their profession and generally beyond the
understanding and/or capability of those outside of the
profession. Sometimes, this specialization will extend to
access to the tools and technologies used in the
profession (e g. medical equipment)
4. INSTITUTIONAL PREPARATION
o Professions typically require a period of hands-on,
practical experience in the protected company of senior
members before aspirants are recognized as
professionals. After this provisional period, ongoing
education toward professional development is
compulsory. A profession may or may not require formal
credentials and/or other standards for admission.
5. AUTONOMY
o Professionals have control over and, correspondingly,
ultimate responsibility for their own work. Professionals
tend to define the terms, processes, and conditions of
work to be performed for clients (either directly or as
preconditions for their ongoing agency employment).

6. CLIENTS RATHER THAN CUSTOMERS.
o Members of a profession exercise discrimination in
choosing clients rather than simply accepting any
interested party as a customer (as merchants do).
7. DIRECT WORKING RELATIONSHIPS
o Professionals habitually work directly with their clients
rather than through intermediaries or proxies.
8. ETHICAL CONSTRAINTS.
o Due to the other characteristics on this list, there is a clear
requirement for ethical constraints in the professions.
Professionals are bound to a code of conduct or ethics
specific to the distinct profession (and sometimes the
individual). Professionals also aspire toward a general
body of core values, which are centered upon an
uncompromising and unconflicted regard for the client's
benefit and best interests.
9. MERIT-BASED
o In a profession, members achieve employment and
success based on merit and corresponding voluntary
relationships rather than on corrupted ideals such as
social principle, mandated support, or extortion (e.g.
union members are not professionals). Therefore, a
professional is one who must attract clients and profits
due to the merits of his work. In the absence of this
characteristic, issues of responsibility, accountability, and
ethical constraints become irrelevant, negating any
otherwise-professional characteristics.
10. CAPITALIST MORALITY
o The responsibilities inherent to the practice of a
profession are impossible to rationally maintain without a
moral foundation that flows from a recognition of the
singular right of the individual to his own life, along with all
of its inherent and potential sovereign value; a concept
that only capitalism recognizes, upholds and protects.

TOPIC 1 REVIEW
THEORY - A well-substantiated explanation of some aspect of
the natural world; an organized system of accepted knowledge
that applies in a variety of situations/hypotheses
CONCEPT- An idea that brings diverse elements into a basic
relationship or Something understood or retained in the mind,
from experience, reasoning, and/or imagination; a generalization
or abstraction of a particular set of instances or occurrences.
PRINCIPLE- A basic generalization that is accepted as true and
that can be used as a basis for reasoning or conduct
PHILOSOPHY- The most basic beliefs, concepts, and attitudes
of an individual or group
CONCEPTUAL FRAMEWORK/MODEL - identify concepts and
describe their relationships to the phenomena of central concern
to the discipline: person, environment, health and nursing
THEORETICAL FRAMEWORKS/MODELS - Are highly
established set of concepts that are testable.
KNOWLEDGDE - Information, skills and expertise acquired by a
person through formal/informal learning.
PHENOMENON - Experiences that can be physically observed or
tangible such as crying or grimacing when in pain. Or A set of
empirical data or experiences that can be physically observed or
tangible such as crying or grimacing when in pain.
HYPOTHESIS- Predicted answer
PHENOMENON - Help to describe or label phenomena
EDUCATION- Nursing theory was used primarily to establish the
profession’s place in the university.
CHARACTERISTICS OF A THEORY:

6. Manaal Vargas Tamayo BSN October 9, 2022

a. Interrelating concepts in such a way as to create a
different way of looking at a particular phenomenon
b. Logical in nature
c. Generalizable
d. Basis for hypothesis that can be tested
e. Increasing the general body of knowledge within the
discipline through the research implemented to validate
them
f. Used by practitioners to guide and improve their practice
g. Consistent with other validated theories, laws, and
principles but will leave open unanswered questions that
need to be investigated
TYPES OF NURSING THEORY
a. Meta-Theory
b. Grand Nursing Theory
c. Mid-Range Nursing Theories
d. Nursing Practice Theories
COMPONENTS OF NURSING THEORY
a. Concept
b. Assumption
c. Definition
d. Proposition
NURSING METAPARADIGM CONCEPTS
a. Person
b. Nursing
c. Environment
d. Health

NURSING- The attributes, characteristics, and actions provide
care on behalf of or in conjunction with the client
PERSON- the recipient of nursing care and may include
individuals, patients, groups, families, and communities
HEALTH- defined as the degree of wellness or well- being that
the client experiences
ENVIRONMENT- defined as the internal and external
surroundings that affect the client. It includes all positive or
negative conditions that affect the patient, the physical
environment, such as families, friends, and significant others,
and the setting for where they go for their healthcare

TOPIC 2 REVIEW
CURRICULUM ERA - Moving nursing education from hospital-
based diploma programs into college and universities. transpired
during this era.
THEORY ERA- Outgrowth of research era & During this era,
research without theory produced isolated information; however,
research and theory produced nursing science.
RESEARC ERA- Part of the curricula of developing graduate
programs occurred
GRADUATE EDUCATION ERA - Master’s program in nursing
emerged during this era to meet the need for nurses with
specialized education in nursing. & Nursing Theory and Nursing
Conceptual models were included as courses in the study of
nursing in which of the following era
MID 1800’s- year was nursing practices based on principles and
traditions passed on through apprenticeship education and
common-sense wisdom
1969- The First Conference in Nursing Theory which brought
leading scholars and theorists to discuss and debate on issues
regarding nursing science and theory development

TOPIC 3 REVIEW

GREAT RESPONSIBILTY - Professionals deal in matters of
vital importance to their clients and are therefore entrusted
with grave responsibilities and obligations
ACCOUNTABILTY - Professionals hold themselves
ultimately accountable for the quality of their work with the
client .
BASED ON SPECIALIZED THEORETICAL
KNOWLEDGE - Professionals render specialized
services based on theory, knowledge, and skills that are
most often peculiar to their profession and generally beyond
the understanding and/or capability of those outside of the
profession
INSTITUTIONAL PREPARATION - Professions typically
require a significant period of hands-on, practical
experience in the protected company of senior members
before aspirants are recognized as professionals.
AUTONOMY- Professionals have control over and,
correspondingly, ultimate responsibility for their own work.
CLIENTS RATHER THAN CUSTOMERS - Members of a
profession exercise discrimination in choosing clients rather
than simply accepting any interested party as a customer
(as merchants do).
DIRECT WORKING RELATIONSHIPS - Professionals
habitually work directly with their clients rather than
through intermediaries or proxies.
ETHICAL CONSTRAINTS - Due to the other characteristics
on this list, there is a clear requirement for ethical
constraints in the professions.
MERIT-BASED- In a profession, members achieve
employment and success based on merit and
corresponding voluntary relationships rather than on
corrupted ideals such as social principle, mandated support,
or extortion (e.g. union members are not professionals).
CAPITALIST MORALITY - The responsibilities inherent to
the practice of a profession are impossible to rationally
maintain without a moral foundation that flows from a
recognition of the singular right of the individual to his own
life, along with all of its inherent and potential sovereign
value; a concept that only capitalism recognizes, upholds
and protects

TOPIC 4
HISTORY AND PHILOSOPHY OF SCIENCE
“Philosophy in its broadest sense is wondering and being curious
about the “big” or fundamental questions that humans have
grappled with throughout the history. Questions about “what is
real?” (ontology), “what is knowable? (epistemology), “is this
just?” (ethics), and “is there an art to caring?” (aesthetics) are
considered indispensable reflections in nursing Practice.”
-BRUCE, RIETZE KIM 2014

NURSING AS A SCIENCE

1. Science is logical, systematic, & coherent way to solve
problems and answer questions.
2. It is a collection of facts known in area and the process
used to obtain that knowledge.

NURSING AND PHILOSOPHY

o Philosophy studies concepts that structure thought
processes, foundations, and presumptions.
o It is an approach for thinking about the nature of people,
the methods that should be used to create a scientific
knowledge and the ethics involved. It denotes a
perspective, implying a certain broad, “taken for granted”
assumptions

7. Manaal Vargas Tamayo BSN October 9, 2022

EPISTEMOLOGY

o a branch of philosophy that is concerned with the nature
and scope of knowledge. It is referred to as the “theory
of knowledge”

HISTORICAL VIEWS OF THE NATURE OF SCIENCE

01 RATIONALISM
It is the use of the rational senses in ensuring the truthfulness of
a phenomenon
02 EMPIRICISM
It is the way of looking at reality using the five general senses of
sight, touch, hearing, taste, and smell.
















EARLY 12
TH
CENTURY VIEWS OF SCIENCE & THEORY

Philosophers focused on the analysis of theory structure whereas,
o Scientists focused on empirical research
o Positivism (imposed on the mind by experience) is the
philosophy of science that information is derived from
logical and mathematical treatments and reports of
sensory experience is the exclusive source of all
authoritative knowledge

EMERGENT VIEWS IN THE LATE 20
TH
CENTURY OF
SCIENCE & THEORY

• Empiricists argue that for science to maintain its
objectivity, data collection and analysis must be
independent of a theory.
• Brown argues that the new epistemology challenged the
empiricist view of perception by acknowledging that theories play
a significant role in determining what the scientist will observe and
how it will be interpreted.

He identified 3 different views of the relationship
between theories and observation:
o Scientists are merely passive observers of occurrences
in the empirical world. Observable data are objective
truth waiting to be discovered.
o Theories structure what the scientists perceived in the
empirical world.
o Presupposed theories and observable data interact in
the process of scientific investigation

INTERPENDENCE BETWWEN THEORY & RESEARCH

o A theory should be judged based on the basis of scientific
o consensus.
o The acceptance of scientific hypothesis through research
depends on the appraisal of the coherence of theory
o Dubin identified when scientific consensus is necessary:
1. on the boundaries of the theory; the phenomenon it
addresses and what it excludes
2. on the logic used in constructing the theory to further
understanding from a similar perspective
3. that the theory fits the data collected and analyzed though
research

ISSUES IN NURSING PHILIOSOPHY & SCIENCE
DEVELOPMENT

Four fundamental patterns of knowledge in Nursing (Carper,
1978)
o Empirical knowledge
o Esthetic knowledge
o Moral knowledge
o Personal knowledge

▪ 1980s - Further acceptance of nursing theory and its
incorporation in the nursing curricula; publication of
several nursing journals
▪ 1990s - Nursing as a basic science, an applied science,
or a practical science
▪ Progress in the Discipline of Nursing (Meleis)
o Practice
o Education and Administration
o Research
o Development of Nursing Theory
o
▪ Peplau developed the first theory of nursing practice in
her book, Interpersonal Relations in Nursing (1952)
▪ Journal of Nursing Research (1952)
▪ 1960s and 1970s – analysis and debate on the
metatheoretical issues related to theory development

➢ Postpositivism focuses on discovering the patterns that
may describe a phenomena.
➢ Interpretive paradigm tends to promote understanding
by addressing the meanings the participants social
interaction that emphasize situation, context and multiple
cognitive constructions that individuals create on
everyday events.
➢ Critical paradigm for knowledge development in nursing ,
provides framework for inquiring about the interaction
between the social, political, economic, gender and
cultural factors and experiences of health and illness.

“Philosophy of science without history of science is empty;
history of science without philosophy of science is blind -
Imre Lakatos


TOPIC 4 REVIEW
EMPIRICISM- It is the way of looking reality using the five general
senses of sight, touch, hearing, taste and smell.
RATIONALISM- It is the use of the rational senses id ensuring the
truthfulness of a phenomenon
AESTHETICS- Questions about is there an art to caring
ETHICS- Questions about ‘it is just?”
EPISTEMOLOGY - Questions about what us knowable?
POSTPOSIVITISM- Focuses on discovering the patterns that may
describe a phenomena
ANTOLOGY- Questions about ‘what is real?”

RATIONALISM- To reason that a lack of social support (cause)
results in hospital readmission (effect). This causal reasoning is a
theoretical assertion until tested and disproven. The traditional
approach proceeds by explaining hospitalization with a systematic
explanation (theory) of a given phenomeno.

8. Manaal Vargas Tamayo BSN October 9, 2022

- Formulating differential diagnoses. Requires collecting
the facts and then devising a list of possible theories to
explain the facts
THEORY- Inductive Method
ETHICAL KNOWING - The science of nursing
- Guides and directs how nurses conduct their practice
AESTHETIC KNOWING - A pattern of knowing that draws on
traditional ideas of science
PERSONAL KNOWINNG - Used when nurses engage in the
therapeutic use of self in practice
- . Concerned with becoming self-aware
ETHICAL KNOWING - Brings together all the elements of a
nursing care situation to create a meaningful whole
1980- Acceptance of nursing theory and its incorporation in the
nursing curricula
1990- Nursing as a basic science, an applied science, or a
practical science
INTERPRETATIVE PARADIGM - Promote understanding by
addressing the meanings the participants social interaction that
emphasize situation, context and multiple cognitive constructions
that individuals create on everyday events.
CRITICAL PARADIGM - Provides framework for inquiring about
the interaction between the social, political, economic, gender and
cultural factors and experiences of health and illness
POSTPOSITIVISM- Focuses on discovering the patterns that may
describe a phenomenon.
1952- Journal of Nursing Research

TOPIC 5
STRUCTURE OF NURSING KNOWLEDGE

OVERVIEW
1. Development of the body of specialized knowledge
required for nursing to be recognized as a profession was
a driving force in the 20th century.
2. Because of the importance of nurses to the nation’s
health, studies of nursing were legislated early in the
century and conducted by sociologists who
recommended that nursing be developed as a profession

STRUCTURE LEVEL

1. METAPARADIGM a set of concepts and propositions that
sets forth the phenomena with which a discipline is
concerned.
o The concepts and propositions of a metaparadigm
are admittedly extremely abstract and provide no
definitive direction for such activities as research and
practice. Rather, the function of a metaparadigm is to
identify the basic subject matter of the discipline















2. PHILOSOPHY an abstract type that sets forth the meaning
of nursing phenomena through analysis, reasoning, and
logical presentation.

o Contribute to nursing knowledge with direction for the
discipline, forming a basis for professional
scholarship that leads to new theoretical
understanding.
o Represents early works predating the theory era and
contemporary works of a philosophical nature.
o Are works that provide broad understandings that
advance the discipline of nursing and its professional
applications.
o Example: Nightingale’s philosophy

3. CONCEPTUAL MODELS Are a set of concepts that
address phenomena central to nursing in propositions that
explain relationships among them

4. GRAND THEORY - These theories have the capacity to
threaten the solvency of the conceptual model from which
they are derived, because they test the major premise of the
conceptual model

5. THEORY- A work classified as nursing theory is developed
from some conceptual framework or grand theory and is
generally not as specific as a middle-range theory.
- Maybe specific to a particular aspect or setting of nursing
practice
6. MIDDLE RANGE THEORY - Has the most specific focus and
is concrete in its level of abstraction.
- They address the specifics of nursing situations within the
perspective of the model, grand theory, or theory from
which they originate

o The specifics in this theories are:
➢ Age group of the patient
➢ Family situation
➢ Patient’s health condition
➢ Location of the patient
➢ Action of the nurse

“The art of nursing is the creative use of the science of
nursing for human betterment.” —Rogers, 1990, p.5

TOPIC 5 REVIEW
CONCEPTUAL MODELS - Are a set of concepts that
address phenomena central to nursing in propositions that
explain relationships among them
THEORY- Maybe specific to a particular aspect or setting of
nursing practice.
GRAND-THEORY- Has the most specific focuses id
concrete in its level of abstraction
METAPARADIGM - The global concepts that identify the
phenomena of central interest to a discipline
PHILOSOPHY- Have the capacity to threaten the solvency
of the conceptual model from which they are derived
MIDDLE-RANGE- Has the most specific focus and is
concrete in its level of abstraction

9. Manaal Vargas Tamayo BSN October 9, 2022

TOPIC 5 NURSING PHILOSOPHIES
NURSING THEORISTS AND THEIR WORKS
➢ Nursing philosophy sets forth the meaning of nursing
phenomena through analysis, reasoning, and logical
argument.
➢ Philosophies contributed to nursing knowledge by
providing direction for the discipline, forming a basis
for professional scholarship and leading to new
theoretical understandings.
➢ Nursing philosophies represent early works
predating the theory era, as well as contemporary
works of a philosophical nature.
➢ Philosophies are works that provide broad
understanding that advances the discipline and its
professional application.

NURSING PHILOSOPHIES

1. ENVIRONMENTAL THEORY Florence Nightingale
2. THEORY OF HUMAN CARING Jean Watson
3. STAGES OF NURSING EXPERTISE Patricia
Benner
4. CARITATIVE CARING THEORY Katie Erickson

NIGHTINGALE’S ENVIRONMENTAL THEORY

o Nursing “is an act of utilizing the environment of the
patient to assist him in his recovery”

BIOGRAPHY

o First Nursing theorists and the Mother of Modern Nursing
o Born in May 12, 1820 in Florence, Italy to a wealthy British
Family.
o In 1853, she accepted the position of superintendent at
the institute of the Care of Sick Gentlewomen in Upper
Harley Street, London

➢ She tended to wounded soldiers during the Crimean
War. She became known as the “Lady with the Lamp”
because of her night rounds. Immortalized in the poem
“Santa Filomena” by Henry Wadsworth Longfellow. After
the Crimean war, she established a nursing school at St.
Thomas’ Hospital and King’s College in London in 1860.

INFLUENCES

o Education provided by her Father.
o Family’s aristocratic social status
o Exposure to political process of the Victorian England
o The Industrial Age
o Charles Dickens’ social commentaries and novels
o Dialogues with many political leaders
o Unitarian religious affiliation

ENVIRONMENTAL THEORY BY FLORENCE
NIGHTINGALE

➢ Stated that nursing “ought to signify the proper use of
fresh air, light, warmth, cleanliness, quiet, and the
proper selection and administration of diet – all at the
least expense of vital power to the patient.”








TYPES OF ENVIRONMENT

PHYSICAL Where the patient is being treated.
PSYCHOLOGICAL Affected by a negative physical environment
which then causes
STRESS. SOCIAL Person’s home or hospital room







VARIETY (13 CANONS)




VENTILATION & WARMTH

➢ Keep the air he breathes as pure as the external air, without
chilling him”.
o Keeping patient’s room well ventilated and free of odors.
o Keep the air within as pure as the air external air/without
noxious smells.
o Keeping patient, patient’s room warm
o Provided description for measuring the patient's body
temperature through palpation of extremities.
o Nurses were instructed to manipulate the environment to
maintain both ventilation and patient warm by good fire,
opening windows and properly positioning the patient in
the room.

HEALTH OF HOUSES

"Badly constructed houses do for the healthy what badly
constructed hospitals do for the sick."
o This canon includes five essentials of: Pure air, Pure
water, Efficient drainage, Cleanliness, Light
o Examples include removing garbage or standing water;
ensuring clean air and water and free from odor and that
there is plenty of light.

PETTY MANAGEMENT
o Continuity of the care, when the nurse is absent

10. Manaal Vargas Tamayo BSN October 9, 2022

o Documentation of the plan of care and all evaluation will
ensure others give the same care to the client in your
absence.

NOISE

o Avoidance of sudden/startling noises.
o Keeping noise in general to a minimum.
o Refrain from whispering outside the door.

VARIETY

o Provide variety in the patient’s room to help him/her avoid
boredom and depression.
o This is accomplished by cards, flowers, pictures, books or
puzzles (presently known as diversional therapy)
o Encourage significant others to engage with the client.

FOOD INTAKE

o Assess the diet of the client.
o Documentation of amount of foods and liquids ingested at
every meal

FOOD & NUTRITION

o Nightingale addressed the variety of food presented to the
patients and discussed the importance of variety in the
food presented.
o Instructions include trying to include patient’s food
preferences.
o Attempt to ensure that the client always has some food or
drink available that he/she enjoys.

BED & BEDDINGS

o Comfort measures related to keeping the bed dry,
wrinklefree and at the lowest height to ensure the client’s
comfort.
o Noted that a dirty environment (floors, carpets, walls and
bed linens) was a source of infection through the organic
matter it contained.
o The appropriate handling and disposal of bodily
excretions and sewage was required to prevent
contamination of the environment.

LIGHT

"Light has quite as real and tangible effects upon the human
body...who has not observed the purifying effect of light, and
especially of direct sunlight, upon the air of the room ?"
o Assess the room for adequate light.
o Sunlight works best.
o Develop and implement adequate light without placing the
client in direct light.

PERSONAL CLEANLINESS

o Bathing of patients on a frequent, even daily, basis.
o Nurses should wash their hands regularly.
o Keeping the patient clean and dry at all times
o Frequent assessment of client’s skin is needed to
maintain adequate moisture.

CLEANLINESS OF ROOMS

o Assess the room for dampness, darkness and dust or
mildew.
o Keeping the environment clean (free from dust, dirt,
mildew and dampness)

CHATTERING HOPE & ADVICES

o Avoidance of talking without reason or giving advice that
is without fact.
o Continue to talk to the client as a person and to stimulate
the client’s mind
o She believed that sick persons should hear good news
that would assist them in becoming healthier

OBSERVATION OF THE SICK

o Making and documenting observations.
o Continue to observe the client’s surrounding environment.



CONCEPTUAL FRAMEWORK















FOUR MAJOR CONCEPTS ENVIRONMENTAL THEORY

PERSON
o Patient who is acted on by nurse
o Emphasized that the Nurse has in control of the patient’s
environment.
o Affected by environment
o Passive yet has reparative powers

NURSING
o Nursing "ought to signify the proper use of fresh air, light,
warmth, cleanliness, quiet, and the proper selection and
administration of diet — all at the least expense of vital
power to the patient."
o She wrote her Notes on Nursing to provide women how
to "Think like a Nurse."

ENVIRONMENT
o Foundation of theory
o Included everything, physical, psychological and social
o Nurses are instruments to change the social status of the
poor by improving their living conditions

HEALTH
o balance between human and his/her environment
o being well and using every power (resource) to the fullest
extent in living life Ø

11. Manaal Vargas Tamayo BSN October 9, 2022

o disease and illness – reparative process that nature
instituted when a person did not attend to health
concerns
o health maintenance through prevention of disease via
environmental control and social responsibility

IMPORTANCR OF ENVIRONMENTAL THEORY

NURSING PRACTICE
1. Disease control
2. Sanitation and water treatment
3. Utilized modern architecture in
1. the prevention of "sick building
2. syndrome" applying the
3. principles of ventilation and
4. good lighting.
5. Waste disposal
6. Control of room temperature.
7. Noise management

NURSING EDUCATION
1. Principles of nursing training. Better practice result from
better education.
2. Skills measurement through licensing by the use of
testing methods, the case studies

NURSING RESEARCH
1. Use of graphical representations like the bar, diagrams.
2. Notes on nursing

JEAN WATSON’S HUMAN CARING THEORY
o Born in West Virginia, currently living in Colorado.
o She earned a B.Sc. in 1964, MS in Psychiatric Nursing in
1966 and PhD in Educational Psychology and Counseling
in 1973.
o Founder of the Center for Human Caring in Colorado.

➢ Watson’s defined human caring in nursing as “an act and
a science in which caring is a human to human process
demonstrated through a therapeutic interpersonal
interactions.
Human Caring Science: A Theory of Nursing is the title of
Jean Watson's latest work, it was renamed to convey a deeper
human to human involvement and connection.

EXPLICIT ASSUMPTIONS

o An ontologic assumption of oneness, wholeness, unity,
relatedness and connectedness
o An epistemologic assumption that there are multiple ways
of knowing
o Diversity of knowing assumes all, and various forms of
evidence can be included
o A caring science model makes these diverse perspectives
explicitly and directly.
o Moral-metaphysical integration with science evokes spirit;
this orientation is not only possible but also necessary for
our science, humanity, society-civilization, and world-
planet.
o A caring science emergence, founded on new
assumptions, makes explicit an expanding unitary,
energetic worldview with a relational human caring ethic
and ontology as its starting point.



CARATIVE FACTORS

1. Formation of a humanistic- altruistic system of
values.
2. The installation of faith-hope.
3. The cultivation of sensitivity to one’s self and to
others.
4. The development of helping- trust relationship.
5. The promotion and acceptance of the expression of
positive and negative feelings.
6. The systematic use of the scientific problem-solution
method for decision making.
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and/or
corrective mental, physical, socio-cultural and
spiritual environment.
9. Assistance with the gratification of human need.
10. The allowance for existential- phenomenological
forces



THE INSTILLATION OF FAITH-HOPE

o “Being authentically present and enabling and sustaining
the deep belief system and subjective lifeworld of self
and one being cared for.”

CULTIVATION OF SENSTIVITYTO ONE’S SELF AND OTHERS

o Striving to become sensitive, makes the nurse more
authentic, which encourages self-growth and self
actualization, in both the nurse and those with whom the
nurse interacts.

ESTABLISHING A HELPING -TRUST RELATIONSHIP

12. Manaal Vargas Tamayo BSN October 9, 2022

She has defined the characteristics needed to develop the helping
trust relationship. They are congruence, empathy and warmth.

THE EXPRESSION OF FEELINGS, BOTH POSITIVE &
NEGATIVE

o “Being present to, and supportive of, the expression of
positive and negative feelings as a connection with
deeper spirit and self and the one-beingcared for

THE SYSTEMATIC USE OF SCIENTIFIC PROBLEM -
SOLVING METHOD FOR DECISION MAKING

o “Creative use of self and all ways of knowing as part of
the caring process; to engage in the artistry of caring-
healing practices.

PROMOTION OF INTERPERSONAL TEACHING -LEARNING

o “Engaging in genuine teaching-learning experience that
attends to the unity of being and meaning, attempting to
stay within others’ frame of reference.”

PROVISION FOR A SUPPORTIVE, PROTE CTIVE AND/OR
CORRECTIVE MENTAL, PHYSICAL, SOCIO -CULTURAL &
SPIRITUAL ENVIRONMENT

o “Creating healing environment at all levels (physical as
well as the nonphysical, subtle environment of energy
and consciousness, whereby wholeness, beauty,
comfort, dignity, and peace are potentiated)”

















ALLOWANCE FOR EXISTENTIAL PHENOMENOLOGICAL
FORCES

o “Opening and attending to spiritual-mysterious and
existential dimensions of one’s own life-death; soul care
for self and the one-being-cared for”

TRANSPERSONAL CARING RELATIONSHIP

o Transpersonal describes an intersubjective, human to
human relationship that encompasses two individuals,
both the nurse and the patient in a given moment.
o Describes how the nurse goes beyond the objective
assessment to show concern toward the person’s
subjective/deeper meaning of their healthcare situation.
o Involves mutuality between the two individuals involved

CARING OCCASION/MOMENT

o A caring occasion is the moment when the nurse and
another person come together in such a way that an
occasion for human caring is created.
o Both persons come together in a human -human
transaction.
o The one caring for and the one being cared for are
influenced by the choices and actions decided within the
relationship

FOUR MAJOR CONCEPTS (HUMAN CARING THEORY)

PERSON
o She adopts a view of the human being as “a valued
person in and of him or herself to be cared for, respected,
nurtured, understood and assisted; in general a
philosophical view of a person as a fully functional
integrated self.

HEALTH

o Health is the unity and harmony within the mind, body,
and soul; health is associated with the degree of
congruence between the self and the self as experienced.
It is defined as a high level of overall physical, mental, and
social functioning; a general adaptivemaintenance level
of daily functioning; and the absence of illness, or the
presence of efforts leading to the absence of illness

ENVIRONMENT/SOCIETY

o According to Watson caring (and nursing) has existed in
every society. A caring attitude is not transmitted from
generation to generation. It is transmitted by the culture of
the profession as a unique way of coping with its
environment

NURSING

o According to Watson “nursing is concerned with
promoting health, preventing illness, caring for the sick
and restoring health”.
o It focuses on health promotion and treatment of disease.
She believes that holistic health care is central to the
practice of caring in nursing

HOW TO INTEGRATE JEAN WATSON’S THEORY OF CARING
INTO NURSING PRACTICE

o Establishing a caring relationship with patients.
o Treat patients as holistic beings.
o Display unconditional acceptance.
o Treat patients with positive regard.
o Promote health through knowledge and intervention.
o Spend uninterrupted time with patient.

13. Manaal Vargas Tamayo BSN October 9, 2022


PATRICIA BENNER’S (STAGE OF NURSING EXPERTISE)
NOVICE-EXPERT MODEL

BIOGRAPHY

o Patricia Benner was born in Hampton, Virginia and spent
her childhood in California, where she received her early
and professional education. Majoring in nursing, she
obtained a Bachelor of Arts degree from Pasadena,
College. In 1970, she earned a master's degree in
nursing, with her major emphasis in medical-surgical
nursing from the University of California, San Francisco
School of Nursing. She worked as a research assistant to
Richard Lazarus at the University of California, Berkeley,
while working on her Ph.D. in stress, coping, and health,
which was conferred in 1982


SKILL ACQUISITION

➢ “The utility of the concept of skill acquisition lies in helping
the teacher understand how to assist the learner in
advancing to the next level” (McClure, 2005)
o Dr. Benner categorized nursing into 5 levels of
capabilities: novice, advanced beginner, competent,
proficient, and expert.
o She believed experience in the clinical setting is key to
nursing because it allows a nurse to continuously expand
their knowledge base and to provide holistic, competent
care to the patient.
o Her research was aimed at discovering if there were
distinguishable, characteristic differences in the novice’s
and expert’s descriptions of the same clinical incident.

SIX AREAS OF PRACTICAL K NOWLEDGE

o Graded qualitative distinctions
o Common meanings
o Assumptions, expectations and sets
o Paradigm cases and personal knowledge
o Maxims
o Unplanned practices

SEVEN DOMAINS OF NURSING PRACTICE

o Helping role
o The teaching-coaching function
o Diagnostic client-monitoring function
o Effective management of rapidly changing situations
Administering and monitoring therapeutic interventions
and regimens
o Monitoring and ensuring quality of health care practices
Organizational and work-role competencies

5 STAGES OF ACQUIRING EXPERTISE

NOVICE
o The person has no background experience of the
situation in which he or she is involved.
o These inexperienced nurses function at the level of
instruction from nursing school. They are unable to make
the leap from the classroom lecture to individual patients.
Often, they apply rules learned in nursing school to all
patients and are unable to discern individual patient
needs. These nurses are usually new graduates, or those
nurses who return to the workplace after a long absence
and are re-educated in refresher programs.

ADVANCED BEGINNER
o Develops when the person can demonstrate marginally
acceptable performance having coped with enough real
situations to note, or to have pointed out by mentor, the
recurring meaningful components of the situation.
o Nurses functioning at this level are guided by rules and
oriented by task completion.
o Still requires mentor or experienced nurse to assist with
defining situations, to set priorities, and to integrate
practical knowledge

COMPETENT
o After two to three years in the same area of nursing the
nurse moves into the Competent Stage of skill acquisition.
o The competent stage is the most pivotal in clinical
learning because the learner must begin to recognize
patterns and determine which elements of the situation
warrant attention and which can be ignored.
o The competent nurse devises new rules and reasoning
procedures for a plan while applying learned rules for
action on the basis of the relevant facts of that situation.

PROFICIENT
o After three to five years in the same area of nursing the
nurse moves into the Proficient Stage “The nurse
possesses a deep understanding of situations as they
occur, less conscious planning is necessary, critical
thinking and decision-making skills have developed”
o The performer perceives the information as a whole (total
picture) rather than in terms of aspects and performance.
o Proficient level is a qualitative leap beyond the competent.
o Nurses at this level demonstrate a new ability to see
changing relevance in a situation including the recognition
and the implementation of skilled responses to the
situation as is it evolves.

EXPERT
o This stage occurs after five years or greater in the same
area of nursing (experienced nurses changing areas of
nursing practice may progress more quickly through the
five stages)
o The expert performer no longer relies on an analytic
principle (rule, guideline, maxim) to connect her or his
understanding of the situation to an appropriate action.
o The expert nurse, with an enormous background of
experience, now has an intuitive grasp of each situation
and zeroes in on the accurate region of the problem
without wasteful consideration of a large range of

14. Manaal Vargas Tamayo BSN October 9, 2022

unfruitful, alternative diagnoses and solutions. The expert
operates from a deep understanding of the total situation


FOUR MAJOR CONCEPTS (STAGES OF NURSING
EXPERTIESE)

PERSON

o “The person is a selfinterpreting being, that is the person
does not come into the world predefined but gets defined
in the course of living a life.” - Dr. Benner

HEALTH

o Dr. Benner focuses on the lived experience of being
healthy and being ill.
o Health is defined as what can be assessed, whereas well
being is the human experience of health or wholeness.
o Well being and being ill are understood as distinct ways
of being in the world

ENVIRONMENT

o Benner uses situation rather than environment because
situation conveys a social environment with social
definition .
o “To be situated implies that one has a past, present, and
future and that all of these aspects… influence the current
situation.” - Dr. Benner

NURSING

o Nursing is described as a caring relationship, an “enabling
condition of connection and concern.” -Dr. Benner
o “Caring is primary because caring sets up the possibility
of giving and receiving help.”
o Nursing is viewed as a caring practice whose science is
guided by the moral art and ethics of care and
responsibility.
o Dr. Benner understands that nursing practice as the care
and study of the lived experience of health, illness, and
disease and the relationships among the three elements.

KATIE ERIKSSON’S (CARITATIVE CARING THEORY)

BIOGRAPHY

o Eriksson was born on November 18, 1943, in Jakobstad,
Finland. She belongs to the Finland-Swedish minority in
Finland, and her native language is Swedish. She is a
1965 graduate of the Helsinki Swedish School of Nursing,
and in 1967, she completed her public health nursing
specialty education at the same institution. She graduated
in 1970 from the nursing teacher education program at
Helsinki Finnish School of Nursing. She continued her
academic studies at University of Helsinki, where she
received her MA degree in philosophy in 1974 and her
licentiate degree in 1976; she defended her doctoral
dissertation in pedagogy

CARITATIVE CARING THEORY

o The Theory of Caritative Caring was developed by Katie
Eriksson. This model of nursing distinguishes between
caring ethics, the practical relationship between the
patient and the nurse, and nursing ethics. Nursing ethics
are the ethical principles that guide a nurse’s decision-
making abilities. Caritative caring consists of love and
charity, which is also known as caritas, and respect and
reverence for human holiness and dignity. According to
the theory, suffering that occurs as a result of a lack of
caritative care is a violation of human dignity.

MAJOR CONCEPTS

CARITAS
o Caritas means love and charity. In caritas, eros and
agapé are united, and caritas is by nature unconditional
love. Caritas, which is the fundamental motive of caring
science, also constitutes the motive for all caring. It
means that caring is an endeavor to mediate faith, hope,
and love through tending, playing, and learning.

CARING COMMUNION
o Caring communion constitutes the context of the meaning
of caring and is the structure that determines caring
reality. Caring gets its distinctive character through caring
communion (Eriksson, 1990). It is a form of intimate
connection that characterizes caring. Caring communion
requires meeting in time and space, an absolute, lasting
presence (Eriksson, 1992c). Caring communion is
characterized by intensity and vitality, and by warmth,
closeness, rest, respect, honesty, and tolerance. It cannot
be taken for granted but pre-supposes a conscious effort
to be with the other. Caring communion is seen as the
source of strength and meaning in caring.

THE ACT OF CARING
o The act of caring contains the caring elements (faith,
hope, love, tending, playing, and learning), involves the
categories of infinity and eternity, and invites to deep
communion. The act of caring is the art of making
something very special out of something less special.

CARITATIVE CARING ETHICS
o Caritative caring ethics comprises the ethics of caring, the
core of which is determined by the caritas motive.
Eriksson makes a distinction between caring ethics and
nursing ethics. She also defines the foundations of ethics
in care and its essential substance. Caring ethics deals
with the basic relation between the patient and the
nurse—the way in which the nurse meets the patient in an
ethical sense. It is about the approach we have toward the
patient.

DIGNITY
o Dignity constitutes one of the basic concepts of caritative
caring ethics. Human dignity is partly absolute dignity,
partly relative dignity. Absolute dignity is granted the
human being through creation, while relative dignity is
influenced and formed through culture and external
contexts. A human being’s absolute dignity involves the
right to be confirmed as a unique human being

INVITATION
o Invitation refers to the act that occurs when the career
welcomes the patient to the caring communion. The
concept of invitation finds room for a place where the
human being is allowed to rest, a place that breathes

15. Manaal Vargas Tamayo BSN October 9, 2022

genuine hospitality, and where the patient’s appeal for
charity meets with a response

SUFFERING
o Suffering is an ontological concept described as a human
being’s struggle between good and evil in a state of
becoming. Suffering implies in some sense dying away
from something, and through reconciliation, the
wholeness of body, soul, and spirit is re-created, when the
human being’s holiness and dignity appear. Suffering is a
unique, isolated total experience and is not synonymous
with pain

RECONCILIATION
o Reconciliation refers to the drama of suffering. A human
being who suffers wants to be confirmed in his or her
suffering and be given time and space to suffer and reach
reconciliation. Reconciliation implies a change through
which a new wholeness is formed of the life the human
being has lost in suffering. In reconciliation, the
importance of sacrifice emerges

CARING CULTURE
o Caring culture is the concept that Eriksson (1987a) uses
instead of environment. It characterizes the total caring
reality and is based on cultural elements such as
traditions, rituals, and basic values. Caring culture
transmits an inner order of value preferences or ethos,
and the different constructions of culture have their basis
in the changes of value that ethos undergoes

AXIOMS

o The human being is fundamentally an entity of body, soul,
and spirit.
o The human being is fundamentally a religious being.
o The human being is fundamentally holy. Human dignity
means accepting the human obligation of serving with
love, of existing for the sake of others.
o Communion is the basis for all humanity. Human beings
are fundamentally interrelated to an abstract and/or
concrete other in a communion.
o Caring is something human by nature, a call to serve in
love.
o Suffering is an inseparable part of life. Suffering and
health are each other’s prerequisites.
o Health is more than the absence of illness. Health implies
wholeness and holiness.
o The human being lives in a reality that is characterized by
mystery, infinity, and eternity.

THESES

o Ethos confers ultimate meaning on the caring context.
o The basic motive of caring is the caritas motive.
o The basic category of caring is suffering.
o Communion forms the context of meaning of caring and
derives its origin from the ethos of love, responsibility, and
sacrifice, namely, caritative ethics.
o Health means a movement in becoming, being, and doing
while striving for wholeness and holiness, which is
compatible with endurable suffering.
o Caring implies alleviation of suffering in charity, love, faith,
and hope. Natural basic caring is expressed through
tending, playing, and learning in a sustained caring
relationship, which is asymmetrical by nature


TOPIC 7 NURSING CONCEPTUAL MODELS
NURSING THEORISTS AND THEIR WORKS


MARTHA ROGERS’ SCIENCE OF UNITARY HUMAN BEING’S

SCIENCE OF UNITRY HUMAN BEINGS
Two dimensions:
o The Science of Nursing
o The Art of Nursing

ASSUMPTIONS
o WHOLENESS
o OPENNESS
o UNIDIRECTIONALITY
o PATTERN & ORGANIZATION
o SENTENCE & THOUGHT



HOMEODYNAMICS PRINCIPLES
➢ Homeodynamics refers to the balance between the
dynamic
➢ life process and environment.
➢ These principles help to view human as unitary human
➢ being.
➢ Three principle of homeodynamics:
o Resonancy
o Helicy
o Integrality

DOROTHEA OREM’S SELF -CARE DEFICIT MODEL
➢ Orem’s general theory of nursing’s three related parts:
o Theory of self care
o Theory of self care deficit
o Theory of nursing system

16. Manaal Vargas Tamayo BSN October 9, 2022

THEORY OF SELF CARE
1. SELF CARE – practice of activities that an individual
initiates and performs on his/her own behalf in
maintaining life, health and well being
2. SELF CARE AGENCY – is a human ability which is "the
ability for engaging in self care“; conditioned by age,
developmental state, life experience, sociocultural
orientation, health, and available resources
3. SELF CARE REQUISITES - action directed towards
provision of self care. 3 categories of self care requisites
are:
o Universal self care requisites - requisites/needs that are
common to all individuals
o Developmental self care requisites - needs resulting from
maturation or develop due to a condition or even
o Health deviation self care requisites - needs resulting from
illness, injury & disease or its treatment

THEORY OF SELF CARE DEFICIT
o Specifies when nursing is needed
o Nursing is required when an adult (or in the case of a
dependent, the parent) is incapable or limited in the
provision of continuous effective self care

THEORY OF NURSING SYSTEMS
o Describes how the patient’s self care needs will be met by
the nurse , the patient, or both
o Identifies 3 classifications of nursing system to meet the
self care requisites of the patient:
❖ Wholly compensatory system
❖ Partly compensatory system
❖ Supportive – educative system

INOGENE KING’S GOAL ATTAINMENT THEORY

PERSONAL SYSTEM

o The concepts for the personal system are: perception,
self, growth and development, body image, space, and
time. These are fundamentals in understanding human
being because this refers to how the nurse views and
integrates self based from personal goals and beliefs.
Among all these concepts, the most important is
perception, because it influences behavior.
o PERCEPTION— a process of organizing, interpreting,
and of reality, and influences one's behavior.
o SELF— a composite of thoughts and feelings that
constitute a person's awareness of individual existence,
of who and what he or she is transforming information
from sense data and memory that gives meaning to one's
experience, represents one's image
o GROWTH AND DEVELOPMENT — cellular, molecular,
and behavioral changes in human beings that are a
function of genetic endowment, meaningful and satisfying
experiences, and an environment conducive to helping
individuals move toward maturity.
o BODY IMAGE—a person's perceptions of his or her
body.
o TIME— the duration between the occurrence of one event
and the occurrence of another event.
o SPACE— the physical area called territory that exists in
all directions.
o LEARNING— gaining knowledge

INTERPERSONAL SYSTEM
➢ This shows how the nurse interrelates with a co-worker or
patient, particularly in a nursepatient relationship.
Communication between the nurse and the client can be
verbal or nonverbal. Collaboration between the Dyads
(nurse-patient) is very important for the attainment of the
goal.
o INTERACTIONS—the acts of two or more persons in
mutual presence; a sequence of verbal and nonverbal
behaviors that are goal directed.
o COMMUNICATION — the vehicle by which human
relations are developed and maintained; encompasses
intrapersonal, interpersonal, verbal, and nonverbal
communication.
o TRANSACTION— process of interaction in which human
beings communicate with the environment to achieve
goals that are valued; goal-directed human behaviors.
o ROLE — a set of behaviors expected of a person
occupying a position in a social system.
o STRESS — a dynamic state whereby a human being
interacts with the environment to maintain balance for
growth, development, and performance, involving an
exchange of energy and information between the person
and the environment for regulation and control of
stressors.
o COPING—a way of dealing with stress

SOCIAL STATUS
➢ The final interacting system is the social system. This
shows how the nurse interacts with co workers, superiors,
subordinates and the client environment in general.

o AUTHORITY — a transactional process characterized by
active, reciprocal relations in which members' values,
backgrounds, and perceptions play a role in defining,
validating, and accepting the authority of individuals within
an organization.
o POWER — the process whereby one or more persons
influence other persons in a situation.
o STATUS — the position of an individual in a group or a
group in relation to other groups in an organization.
o DECISION MAKING — a dynamic and systematic
process by which goal-directed choice of perceived
alternatives is made and acted upon by individuals or
groups to answer a question and attain a goal.
o CONTROL — being in charge

BETTY NEUMAN’S SYSTEMS THEORY MODEL

17. Manaal Vargas Tamayo BSN October 9, 2022



CENTRALCORE
Made up of the basic survival factors common to all
o Normal temperature range
o Genetic structure ◦ Response pattern
o Organ strength or weakness
o Ego structure
o Knowns or commonalities

FLEXIBLE LINES OF DEFENSE
➢ Model’s outer broken ring
➢ Can be altered over time; Protective buffer for preventing
stressors from breaking through usual wellness state
➢ Dependent on
o amount of sleep,
o nutritional status,
o quality and quantity of stress

NORMAL LINES OF DEFENSE
o Model’s outer solid circle
o Represents client’s usual wellness level.
o Change in response to coping or responding to the
environment



STRESSORS
o Is any environmental force which can potentially affect the
stability of the system
o Produce either a positive or negative effect on the client
system.

RECONSTITUTION
o The return or maintenance of system stability following
the treatment for stressor reaction.
o Occurs after treatment for stressor reaction

OPEN SYSTEM
o FUNCTION OR PROCESS - Client as a system
exchanges energy, information and matter with the
environment as it uses available energy resources to
move toward stability and wholeness
o INPUT OR OUTPUT - Matter, energy, and information
that are exchanged between the client and the
environment
o FEEDBACK - System output in the form of matter,
energy, and information for corrective action to change,
enhance or stabilize the system Open System
o NEGENTROPY - a process of energy conservation
utilization that assists system profession toward stability
or wellness
o ENTROPY – A process of energy depletion and
disorganization moving the system toward illness or
possible death
o STABILITY - Dynamic and desired state of balance.
Copes with stressors to maintain an optimal level of health
and integrity

PREVENTION AS INTERVERTION
➢ Purposeful actions to help client maintain system stability
➢ Levels of Prevention:
o Primary: Used when stressor is suspected or identified;
Degree of risk in known
o Secondary: Involves interventions or treatment initiated
after symptoms occurred
o Tertiary: Occurs after active treatment; maintenance

Sr. Callista Roy’s ADAPTATION THEORY

ROY’S ADAPTATION MODE L (RAM)
o “Nursing is to help the person adapt to change in
physiological needs, self-concepts, role function and
interdependent relations during health and illness

SYSTEM
o A set of units so related or connected as to form a unity
or whole and characterized by inputs, outputs, and control
and feedback processes.

ADAPTATION LEVEL
o A constantly changing point, made up of focal,
contextual and residual stimuli, which represent the
person’s own standard of the range of stimuli to
which one can respond with ordinary adaptive
responses.

STIMULUS
o FOCAL STIMULUS – the degree of change or stimulus
most immediately confronting the person and the one to
which the person must make an adaptive response, that
is, the factor that precipitates behavior
o CONTEXTUAL STIMULI – all other stimuli present that
contribute to the behavior caused or precipitated by the
focal stimuli
o RESIDUAL STIMULI – factors that may be affecting
behavior but whose efforts are not validated

18. Manaal Vargas Tamayo BSN October 9, 2022

SUBSYSTEMS
o REGULATOR – subsystem coping mechanism which
responds automatically through neural -
chemical endocrine processes.
o COGNATOR - subsystem coping mechanism which
responds to complex processes of perception and
information processing, judgment, and emotion.

RESPONSES
o ADAPTIVE RESPONSES – responses that promote
integrity of the person in terms of goals of survival, growth,
reproduction, and mastery
o INEFFECTIVE RESPONSES – responses that do not
contribute to adaptive goals, that is, survival, growth,
reproduction, and mastery

ADAPTIVE MODEL
1. PHYSIOLOGICAL MODE – involve the body’s basic
needs and ways of dealing with adaptation
2. SELF-CONCEPT MODE – the composite of beliefs and
feelings that one holds about oneself at a given time. It is
formed from perceptions, particularly of other’s reactions,
and directs one’s behavior
3. ROLE PERFORMANCE MODE – role function is the
performance of duties based on given positions in society.
4. INTERDEPENDENCE MODE – involves one’s relations
with significant others and support systems. In this mode
one maintains psychic integrity by meeting needs for
nurturance and affection.

LEVELS OF ADAPTATION
o Integrated Process: The various modes and subsystems
meet the needs of the environment.
o Compensatory Process: The cognator and regulator are
challenged by the needs of the environment but are
working to meet the needs
o Compromised Process: The modes and subsystems
are inadequately meeting the environmental challenge).

DOROTHY JOHNSON ’S BEHAVIORAL SYSTEM THEORY



AFFILIATE OR ATTACHEMENT SUBSYSTEMS
o the “social inclusion intimacy and the formation and
attachment of a strong social bond.”
o It forms the basis for all social organization. On a general
level, it provides survival and security.

DEPENDENCE SUBSYSTEMS
o “approval, attention or recognition and physical
assistance.”
o It promotes helping behavior that calls for a nurturing
response.
o A certain amount of interdependence is essential for the
survival of social groups.

INGESTIVE SUBSYSTEMS
o Behaviors associated with the intake of needed resources
from the external environments, including food, fluid,
information, knowledge and objects for the propose of
establishing an effective relationship with the
environment.

ELIMINATE SUBSYSTEMS
o Behavior associated with the release of physical waste
products from the body.
o Express feelings

SEXUAL SUBSYSTEMS
o Behaviour associated with a specific gender-based
identity for the purpose of ensuring pleasure/procreation,
and knowledge and behavior being congruent with
biological sex.

AGGRESSIVE PROTECTIVE SUBSYSTEMS
o Behaviour associated with real or potential threat in the
environment for the purpose of ensuring survival. §
Protection of self through direct or indirect acts. §
Identification of potential danger

ACHIEVEMENT SUBSYSTEMS
o Behaviour associated with mastery of oneself and one’s
environment for the purpose of producing a desired effect
o Includes problem solving activity
o Knowledge of personal strengths and weaknesses

SUBCONCEPTS
o STRUCTURE. The parts of the system that make up the
whole.
o VARIABLES. Factors outside the system that influence
the system’s behavior, but which the system lacks power
to change.
o BOUNDARIES. The point that differentiates the interior of
the system from the exterior
o HOMEOSTASIS. Process of maintaining stability.
o STABILITY. Balance or steady-state in maintaining
balance of behavior within an acceptable range.
o STRESSOR. A stimulus from the internal or external
world that results in stress or instability.
o TENSION. The system’s adjustment to demands, change
or growth, or to actual disruptions.
o INSTABILITY. State in which the system output of energy
depletes the energy needed to maintain stability.

19. Manaal Vargas Tamayo BSN October 9, 2022

o SET. The predisposition to act. It implies that despite
having only a few alternatives from which to select a
behavioral response, the individual will rank those options
and choose the option considered most desirable.
o FUNCTION. Consequences or purposes of action

MYRA LEVINE’S CONSERVATIONAL THEORY

ADAPTATION • Adaptation is the process whereby the patient
maintains integrity within the realities of the environment
WHOLENESS • Exist when the interaction or constant
adaptations to the environment permits the assurance of integrity
CONSERVATION • Product of adaptation

CHARACTERISTICS OF ADAPTATION

1. HISTORICITY - Adaptation is a historical process,
responses are based on past experiences, both personal
and genetic SPECIFICITY – Individual responses and
their adaptive pattern varies on the base of specific
genetic structure
2. REDUNDANCY – Safe and fail options available to the
individual to ensure continued adaptation
3. ORGANISMIC RESPONSE – A change in behavior of an
individual during an attempt to adapt to the environment

FOUR TYPES OF ORGANISMIC RESPONSE
1. FLIGHT OR FIGHT: an instantaneous response to real or
imagined threat, most primitive response
2. INFLAMMATORY : response intended to provide for
structural integrity and the promotion of healing
3. STRESS: developed over time and influenced by each
stressful experience encountered by person
4. PERCEPTUAL: Involved gathering information from the
environment and converting it in to a meaning experience

PRINCIPLES OF ADAPTATION
1. Conservation of Energy - Refers to balancing energy
input and output to avoid excessive fatigue. It includes
adequate rest, nutrition and exercise.
2. Conservation of Structural Integrity -Refers to
maintaining or restoring the structure of body preventing
physical breakdown and promoting healing
3. Conservation of Personal Integrity - Recognizes the
individual as one who strives for recognition, respect, self
awareness, selfhood and self determination.
4. Conservation of Social Integrity - An individual is
recognized as some one who resides with in a family,: a
community, a religious group, an ethnic group, a political
system and a nation