TFN Prelims theory" refers to the body of information

that is utilized to support nursing practice.

Definition of Nursing according to
COMPONENTS OF THEORY
A. THE INTERNATIONAL  CONCEPT in administration, for example,
COUNCIL (2002) terms like leadership, informal organization,
- Nursing encompasses autonomous and and contentment are given broad definitions
collaborative care of individuals of all ages, but are nonetheless used to describe
families, groups and communities, sick or behavior in the real world.
well and in all settings. Nursing includes the  ASSUMPTION is a statement that is
promotion of health, prevention of illness, accepted as true without proof and does not
and the care of ill, disabled and dying people. have to be self-evident.
Advocacy, promotion of a safe environment,  PHENOMENON a fact (or) situation that
research, participation in shaping health policy is observed to exist (or) happen.
and in patient and health systems management,  DEFINITIONS the definitions with in the
and education are also key nursing roles. (ICN, descriptions of a theory convey the general
2002) (ICN, 2002) meaning of the concepts in a manner that
fits the theory.
B. AMERICAN NURSES ASSOCIATION  RELATIONAL STATEMENTS
 The American Nurses Association defines relational statements define the
nursing as "protecting, promoting, and relationships between two or more concepts.
otimizing the health and abiliies of their They are the chains that link concepts to
patients." nurses also aid their patients healing one another.
processes. They also lessen their patients' pain
through human responsive diagnosis and CHARACTERISTICS OF THEORY
treatments. Finally, nurses' advocacy is  Theories can interrelate concepts in such a
concerned with individuals, families, way that they provide a new way of
communities, and the entire population. viewing a specific phenomenon. Theories
can interrelate concepts in such a way that
C. PHILIPPINE NURSING ACT OF 2002 they provide a new way of viewing a
R.A 9173 specific phenomenon.
 An act providing for a more responsive  Theories can interrelate concepts in such a
nursing profession, repealing for the way that they provide a new way of
purpose Rebulict Act No. 7164, otherwise viewing a specific phenomenon.
known as “THE PHILIPPINE a. Are logical
NURSING ACT OF 1991” AND FOR b. Can be generalized
OTHER PURPOSES. c. They serve as the foundation for testable
hypothesis
Definition of Theory d. Broaden the overall corpus of knowledge
 When specific notions are tested, a theory within profession through research to validate
varies from practice because it is a set of them
accepted beliefs or organized e. Are used to advise and improve practioners’
principles that explain and lead the practice.
investigation.

DEFINITION OF THEORY IN THE

NURSING FIELD
 Nursing Theory is a framework for
organizing information and explaining
occurrences in nursing on a more concrete
and detailed level. The phrase "nursing
 Classification of Nursing Theory  NURSING - nursing action
SIGNIFICANCE OF NURSING THEORIES  HEALTH - defined by person
 It can be basis knowledge in our profession.  ENVIRONMENT - internal & external
It is also a guide how to take care of their factors
patient with tender & love, also provide
proper knowledge and idea for nursing Examples of Grand Theory
practices. As a nurse we were expected to  Orem’s Self Care Deficit Theory - The
be prim and proper, gentle, caring and good Self-Care or Self-Care Deficit Theory of
in communications. Theories help us Nursing is made up of three interconnected
nursing students to visualize what will theories: (1) self-care theory, (2) self-care
become in near future, everything we do it deficiency theory, and (3) nursing systems
will reflect base on our actions, behaviors theory.
and discipline.  NUEMAN’S SYSTEM MODEL - Betty
THE IMPORTANCE OF NURSING THEORY Neuman describes the Neuman Systems
 Describes, anticipates and analyzes the Model as “a unique, opensystem-based
phenomena of nursing. Nursing theories perspective that provides a unifying focus
aid in distinguishing what constitutes the for approaching a wide range of concerns.
foundation of nursing. A well- defined A system acts as the boundary of a single
body of theory also leads to better patient customer, a group or even multiple groups;
care, better communication among it can also be defined as a social problem.
nurses, and higher career progress. The customer system that interacts with the
environment delineates the areas of care.
GRAND THEORY
 Grand theory is sometimes known as
macro theory, implying that it is far too Middle Range Theory
abstract to express empirical correlations  A set of related ideas that are focused on
or hypotheses, or to specify acts and a limited dimension of the reality of
processes in nursing practice (Mckenna nursing.
&Slevin, 2008).  Middle range theory is more precise
 A set of abstract ideas that together make a because it only looks at a specific situation
broad statement about human beings, the with a limited number of variables. They
environment, health, or nursing. express themselves as follows: "Middle
PURPOSE OF GRAND THEORY range theories become reference points for
 It develops overall explanations for a further developing grand nursing
discipline or body of knowledge. theories to which they may be related
 The purpose of a grand theory is to when they are tested in practice. In
organize various pieces of -information addition, direct the prescriptions of practice
around an identified broad concept, or theories toward specific goal
central point, associated with nursing accomplishments " (Walker and Avant
practice. This is done so that other 1995b).
nurses may better understand the  WHAT MAKES IT MIDDLE RANGE?
individual components that influence Middle-Range nursing theories are more
nursing perceptions and practices focused on a single topic and provide
connected to a specific concept. more explicit connections between Grand
 It provides the general framework for Nursing Theories and Nursing Practice.
nursing ideas pertaining to MiddleRange theories have less abstract
components such as people and health. concepts that can be verified through
testing. These theories are frequently used
NURSING METAPARADIGM CONCEPTS to describe, explain, or forecast specific
 PERSON - recipient(s) of care clinical events.
Middle Range Theory may be:  Do not direct specific nursing interventions.
➢ A description of a particular phenomenon,  Present and explain a phenomenon
➢ An explanation of the relationship perceived through the five senses.
between phenomena, or 2. EXPLANATORY THEORY -
➢ Predicts the effects of one phenomenon or (Factor-Relating Theories)
another (Fawcett & DeSantoMadeya, 2013).  After phenomenon has already been
established and named, it can be compared
to other phenomena.
Practice Level Nursing Theory  Relate concepts to one another, describe the
 These theories focus even more narrowly, interrelationship among
focusing on themes relating to a specific concepts/proposition.
patient population at a specific moment.  Explanatory theory is usually directed by a
These theories have a greater direct impact Correlational research.
on patients than the other two group. 3. PREDICTIVE THEORY -
 Practice-level nursing theories provide (Situation-Relating Theories)
frameworks for nursing  Identify conditions or factors that predict a
interventions and suggest outcomes phenomenon.
or the effect of nursing practice.  Describe in detail the associations between
SIGNIFICANCE OF NURSING THEORY concepts with the aid of direct or indirect
TO THE NURSING DISCIPLINE AND cause and effect relationships. They are
PRACTICE used to estimate possible outcomes of
 Nursing theory attempts to explain, predict, differents situations.
and describe the phenomenon of nursing  They’re used to predict what might happen
(Chinn and Jacobs 1978). It should lay the in different situations.
groundwork for nursing practice, aid in 4. PRESCRIPTIVE THEORY -
the generation of new information, and (Situation-Producing Theories)
determine where nursing should go in  Situation-producing theory that directs
the future (Brown 1964). actions towards an explicit goal.
 THE FIRST ONE WHO IDENTIFIED  Addresses nursing interventions, describes
NURSING THEORY. the conditions under which the prescription
Nursing theories were first identified by occurs, and predict the consequences.
Florence Nightingale, the founder of modern  provides a framework to design
nursing, and were rooted in nursing education. interventions that support and strengthen
Her Environmental Theory stated that nursing patients’ coping resources.
“ought to signify the proper use of fresh air, Three Factors of Prescriptive Theory
light, warmth, cleanliness, quiet, and the proper 1. The core objective which the practitioner
selection and administration of diet – all at the acknowledges as necessary for the discipline.
least expense of vital power to the patient.” 2. The prescription for accomplishing the
fundamental goal.
3. The current situations that have an impact on
Classification of Nursing Theories BY GOAL the main goal.
ORIENTATION
1. DESCRIPTIVE THEORY -
(Factor-Isolating Theory)
 The primary level of theory development.
 Identify and describe the major concepts of
the phenomenon, as well as their
consequences.
 Neither explain nor relate the concepts or
phenomena.
 Phenomenon  Nursing theories are normally derived from
 It can be sensed or experienced. conceptual models in which the nursing
 It describes and idea about an event or metaparadigm phenomena are clearly
group of situations. identified (Fawcett, 1983).
 It relates to Theory because it is a set of  Nursing theories vary in scope; that is, they
statements that explains the phenomena. vary in the level of abstraction. Theories
that are broader in scope are called grand
PHENOMENA CONSIST OF: range theories.
 Concepts help describe or label the
Phenomenon. 4 STRATEGIES OF THEORY
 Definitions within a theory communicate DEVELOPMENT
the general meaning of the concepts. It  There are 4 existing strategies of Theory
describes the activity necessary to Development according to Meleis. These
measure the concepts within a theory. are differentiated primarily by their origin
 Assumptions are statements that may of theory, practice, or research, and by
be accepted as true without proof. whether, in addition to their original
source, other sources were used in
NURSING PHENOMENA developing the theory. These four major
 Defined as concepts, constructs, nursing strategies are: (1) theory to practice to
diagnoses, human responses to actual or theory; (2) practice to theory; (3) research
potential illness, life processes, behaviors to theory; and (4) theory to research to
(signs), or experiences (symptoms). theory.
 The phenomenon in nursing is distinct due
to its strong links to client outcomes or THEORY TO PRACTICE TO THEORY
clientrelated goals. Complex and dynamic  This strategy begins the process of
conceptual building blocks are the basis theorizing by selecting a theory to use in
of our nursing language. practice and then uses practice to refine the
theory further.
THEORY DEVELOPMENT  This strategy attempts to explain and
 is “a process of scientific endeavors, and is describe a clinical situation through the
a goal of all scientific work.” selected theory and discovers the need for a
 Theory is defined as “an organized, modification of concepts, redevelopment of
coherent, and systematic articulation of a others, and possible reconsideration of
set of statements related to significant other definitions that better reflect the
questions in a discipline that are practice situation.
communicated in a meaningful whole; a  This strategy for theory development
symbolic depiction of aspects of reality speaks only to circumstances in which we
that are discovered or invented for see the world through an established theory
describing, explaining, predicting, or with delineated concepts. It is a particular
prescribing responses, events, situations, theory then that guides actions and dictates
conditions, or relationships” how we see nursing and how we act in the
world.
NURSING DEVELOPMENT
 It serves as a guide for education, PRACTICE TO THEORY
research, and it also strengthens the links  This strategy depends on observing new
among those areas. phenomena in a practical situation;
 It defines the body of nursing knowledge, developing sensitizing concepts; and
promotes further knowledge development, labeling, describing, and articulating the
establish nursing as a profession, and properties of these concepts.
aims to give directions to nursing
practice.
 The properties are the sub concepts SIGNIFICANCE OF NURSING THEORIES
included in them, the boundaries, the TO THE DISCIPLINE AND TO THE
definitions, the examples, the meaning, and PROFESSION
so forth.  The goal of the discipline is to expand
knowledge about human experiences
RESEARCH TO THEORY through creative conceptualization and
 The research to theory strategy is the most research.
acknowledged and accepted strategy for  The Goal of the profession is to provide
theory development, both by scientists in service to humankind through living the art
other fields as well as by many within the of science.
discipline of nursing.  Members of the nursing profession are
 This strategy is used to develop theories responsible for regulation of standards of
that are based on research. Therefore, practice and education based on
according to this perspective, the strategy disciplinary knowledge that reflects safe
par excellence is research to theory. health service to society in all settings.

THEORY TO RESEARCH TO THEORY

 In this strategy, theory drives the research Definition of Science
questions and the results that answer these  Science is the Intellectual and Practical
research questions inform and modify the activity encompassing the system the
theory. systematic study of the structure and
 Theorists who begin the research by behavior of the physical and natural
defining a theory and determining world through observation and
propositions for testing, and then go further experiment.
to modify and develop the original SCIENTIFICC METHOD
theories, are considered users of this  Is an Organized way of performing a
strategy. scientific inquiry.
 Examples of this strategy are offered by 6 STEPS
Berg and Sarvimaki (2003) 1. Question
2. Research
GENERAL USES OF NURSING 3. Hypothesis
THEORIES 4. Experiment
 Nursing theory aims to describe, predict, 5. Analysis
and explain phenomenon of nursing (Chinn 6. Conclusion
and Jacobs, 1987)
 Provide a basis for clinical decision making
(Wayne, 2021) DEFINITION OF PHILOSOPHY
 Provide foundations in nursing practice  Philosophy comes from two Greek words
(Brown, 1964) (Philosophia)
 Helps us to decide what we know, and Philo-Loving
what we need to know (Parsons, 2002) Sophia-Wisdom It means “love of wisdom”
 Nursing theory can help healthcare  Philosophy serves as a framework or
professionals to acknowledge and bases for interpreting or making
understand the unique contribution that judgements about the world.
nurses make to the healthcare service  Philosophy is the study of general and
(Draper, 1990). fundamental problems , such as those
 In many cases, nursing theories guide connected with reality , existence,
knowledge development and direct knowledge, values, reason, mind and
education, research, and practice, although language.
each influences the others. (Fitzpatrick and RATIONALISM
Whall, 2005)
 Knowledge is based on the use of reason approaches that would produce scientific
or logic. knowledge
 Mathematics is the paradigm of  This perspective is rooted in the idea that
knowledge. empirical facts exist independently of
 Genuine knowledge is certain. theories and offer the only basis for
 Relation to experience objectivity in science (Brown, 1977).
 Experience does not produce certainty  In this view, objective truth exists
and does not comfort to reason. independently of the researcher, and the
 Thus, experience is at best second-class task of science is to discover it, which is
knowledge. an inductive method (Gale, 1979).
EMPIRICISM OVERVIEW OF EARLY 20TH CENTRURY
 Knowledge is based on experience and VIEWS
experimentation.  Philosophers focused on the analysis of
 Experimental science is the paradigm of theory structure, whereas scientists
knowledge. focused on empirical research.
 Experience and experiment rarely, if  The logical positivist believed that
ever, produce certainly. empirical research and logical analysis
 Some empiricists believe that mathematics would produce scientific knowledge.
can be certain.  Logical empiricists argued that theoretical
propositions must be tested through
observation and experimentation.
Early Twentieth Century View  Empiricists argue that for science to
 The history and philosophy of science is maintain its objectivity, data collection
important as a foundation for exploring and analysis must be independent of a
whether scientific results are actually theory.
true.
 Modern science was established over 400 EMERGENT VIEWS OF SCIENCE AND
years ago as an intellectual activity to THEORY IN THE LATE 20TH CENTURTY
formalize given phenomena of interest in  In the latter years of the twentieth century,
an attempt to describe, explain, predict, several authors presented analyses
or control states of affairs in nature. challenging the positivist position, thus
 Scientific activity has persisted because it offering the basis for a new perspective
has improved quality of life and has of science (Brown, 1977; Foucault, 1973;
satisfied human needs for creative work, Hanson, 1958; Kuhn, 1962; Toulmin,
a sense of order, and the desire to 1961).
understand the unknown (Bronowski,  One of the major perspectives in the new
1979; Gale, 1979; Piaget, 1970). philosophy emphasized science as a
 The development of nursing science has process of continuing research rather
evolved since the 1960s as a pursuit to be than a product focused on findings.
understood as a scientific discipline,  In this emergent epistemology, emphasis
which means, identifying nursing’s shifted to understanding scientific
unique contribution to the care of discovery and process as theories change
patients, families, and communities. over time.
POSITIVISM  Empiricists view phenomena objectively,
 Positivism, a term first used by Comte, collect data, and analyze it to inductively
emerged as the dominant view of propose theory (Brown,1977).
modern science.  Brown (1977) maintained that a
 Modern logical positivists believed that presupposed theoretical framework
empirical research and logical analysis influences perception; however, theories
(deductive and inductive) were two
 are not the single determining factor INTERDEPENDENCE BETWEEN
of the scientist’s perception. THEORY AND RESERCH
 He identified the following three different  Purpose of Nursing Theory
views of the relationship between - Improve practice by positively influencing the
theories and observation: health and quality of life of the patients.
1. Scientists are merely passive observers of -Accomplishments of nursing led to the
occurrences in the empirical world. Observable recognition of nursing in an academic discipline,
data are objective truth waiting to be research and profession.
discovered.  Purpose of Nursing Theory
2. Theories structure what the scientist - Study the effectiveness of a nursing
perceives in the empirical world. interventions.
3. Presupposed theories and observable data -Effect positive outcomes for their patients and
interact in the process of scientific investigation. for others within the healthcare system.
(Brown, 1977, p. 298) RELATIONSHIP OF THEORY AND
PHENOMENOLOGY RESEARCH
 Phenomenology, set forth by Edmund  RESEARCH – process of inquiry
Husserl (1859 to 1938) proposed that  THEORY – product of knowledge
the objectivism of science could not  Theories can be used to guide the research
provide an adequate apprehension of process by creating and testing phenomena
the world. of interest.
 Phenomenological approach reduces  It is necessary to use theory as a
observations or text to the meanings of framework to provide perspective and
phenomena independent of their guidance to the research study.
particular context. This approach focuses  Theory guides the research process, forms
on the lived meaning of experiences. the research questions, aids in design,
EMERGENT VIEWS OF SCIENCE AND analysis and interpretation.
THEORY IN THE LATE 20TH CENTURY  Research without theory results in discrete
 In the new epistemology, science is viewed information or data which does not add to
as an ongoing process. Much importance the accumulated knowledge of the
is given to the idea of consensus among discipline.
scientists. As Brown (1977) concluded, it is  The choice of a research design depends on
a myth that science can establish final the question asked and the current state of
truths. theory development. (Kaiser Permanente,
2009).
WAYS TO PROMOTE THE
3 different views of the relationship and theories INTERDEPENDENCE BETWEEN
and observation by Brown THEORY AND RESEARCH
1. Scientist are merely passive observers of 1. Continued interaction between nursing
occurrences in the empirical world. Observable researchers/scholars and practicing nurses.
data are objective truth waiting to be 2. Increase undergraduate and graduate student
discovered. nurses’ exposure to theoretical principles.
2. Theories structure what the scientist 3. Stress theoretical concepts, constructs, and
perceives in the empirical world. principles following the completion of formal
3. Presupposed theories and observable data education.
interact in the process of scientific investigation
(Brown, 1977, p.298)
 theory and concept related to nursing into
Scientific Consensus nursing practices.
 It is achieved through scholarly
communication at conferences, the ONTOLOGICAL ISSUE
publication process, replication of  Discuss whether notions like caring,
reproducible results by others, scholarly healing, and transcendence are real and
debate, and peer review. important to nursing ontology and
 How does Scientific Consensus Develop? epistemology.
 It is achieved through scholarly  Ontological issues reveal whether there are
communication at conferences, the any gaps between theory and practice.
publication process, replication of EPISTEMOLOGICAL ISSUES
reproducible results by others,  Nursing knowledge growth is aided by the
scholarly debate, and peer review. use of a diversity of nursing paradigms and
 How is Scientific Consensus differ from epistemological worldviews.
Scientific Theory?  The use of a variety of knowledge
 Consensus usually revolves around one development methods allows deeper
hypothesis. Whereas a theory can insights into the discipline's nature and
incorporate multiple hypotheses as it epistemological issues in modern times
generally encompasses a larger focuses on understanding how knowledge
framework describing an aspect of the is known.
natural world. All in all, a scientific CONTEXTUAL ISSUE
consensus is not a scientific theory, but  Nursing's ontology and epistemology
a scientific theory is supported by the interact to produce new knowledge and
scientific consensus. enhance the discipline's existing concepts
 When is Scientific Consensus necessary? in the context of interdisciplinary
 Scientific Consensus is necessary when significance.
scientists need to put an end to  The creation of new ideas has been
something from further research. This is hampered by the second contextual issue:
when they need to judge something when access to nursing journals and policies
their scientific expertise is lacking and the that promote original works focusing on
best choice is a consensus (GreenFacts, existing nursing theories.
2021).
 Scientific Consensus important? NURSING SCIENCE
 Any process to obtain consensus from a  Development of theories and practical
group of experts would benefit from concepts for improving how clinicians
understanding awareness of items on which and patients administer care and manage
a later consensus is to be formed. conditions.
 It merges the worlds of natural, applied,
and human science into a
Issues In Nursing Philosophy and Science multidimensional lens that explores new
PHILOSOPHY OF NURSING and better ways to deliver health services.
 A statement that outlines a nurse ’ s values,  Contributes to the research and discovery
ethics, and beliefs, as well as their of innovative approaches that improve
motivation for being part of the profession. health outcomes.
 It covers a nurse ’ s perspective  Helps to establish the meaning of science
regarding their education, practice, and through an understanding and examination
patient care ethics. of nursing concepts, theories, laws, and
 About discussing law in nursing while aims as they relate to nursing practice.
knowing those , you can also apply its
 FOUR FUNDAMENTAL PATTERNS OF
KNOWING IN NURSING (CARPER, 1978) effective and caring clinicians, and build
on these as well as other skills that could
1. EMPIRICS - The science of nursing enhance knowledge development.
 Evidence-Based-Practice (EBP) - A unique aspect of nursing as a practice
 Concerned with the objectives, abstract discipline that further defines its perspective is
and general knowledge that is quantifiable the around-the-clock care provided by nurses
and verified through repeated testing over working in institutions.
time (Carper, 1978)  NURSING : A CARING DISCIPLINE -
2. ETHICS - The moral component The term "nursing art" has often been used
 The ethical pattern of knowing in nursing as a synonym for "caring." Johnson (1994)
requires an understanding of different established five distinct senses of art in
philo- sophical positions regarding what is nursing in an epistemological investigation
good, what ought to be desired, what is of the meaning of art in nursing. When
right; of different ethical frameworks nurses can do the following, they are
devised for dealing with the complexities of exemplifying nursing art.
moral judgments.  NURSING : A CARING DISCIPLINE -
3. AESTHETIC - "The art of nursing” Skillfully perform nursing activities.
 EMPATHY - Morally conduct nursing practice.
 This involves the nurse/patient relationship. - Grasp the meaning that is inherent in their
4. PERSONAL encounter with the patient.
 Personal knowledge involves an awareness - Choose between alternatives.
of self and others in a relationship that is - Establish connections.
subjective, concrete, and existential and  NURSING : A HEALTH-ORIENTED
does not require mediation through DISCIPLINE
language (Carper, 1978, 1992. Liaschenko - Nursing has been defined as work that focuses
& Fisher, 1999). on “the human health experience” (Newman,
Sime, and Corcoran-Perry, 1991).
PROGRESS IN THE DISCIPLINE OF - In charge of providing care, support to the
NURSING (MELEIS) individuals who are in need, sick or injured, and
 NURSING PERSPECTIVE - A individuals.
perspective is based on a set of values that  NURSING : A HEALTH-ORIENTED
help members of a group characterize the DISCIPLINE
nature of the world. It contains preferences - Health is a perspective that defines what we
for certain points of view as well as ways of consider in our assessments, in making plans for
observing and reacting to situations. interventions, in evaluating our interventions, or
 Nursing: A Human Science - The in considering changes in our interventions
science underlying the discipline of (Meleis, 1990).
nursing has shifted away from an - Nurses uncover health strengths and
emphasis on natural sciences, and nursing weaknesses to evaluate more for better care so
tends now to be described as a human that patients can face their battle with their
science. illness.
- A human science has many unique properties  DOMAIN OF NURSING
that define the ontology and epistemology of the KNOWLEDGE
nursing discipline and that shape its perspective. - The domain of nursing deals with clients who
- A human science focuses on human beings as have unmet needs related to their health or
wholes and advocates understanding the illness status, who are not able to care for
particulars in terms of the whole. themselves or are not adapting to their
 NURSING : PRACTICE-ORIENTED environments due to interruptions or potential
DISCIPLINE - To empower the discipline interruptions in health.
and its members, nurses look for and  A NURSING DOMAIN
identify the same skills that made them
- The nursing domain includes units of analysis, factors , concepts or variables and the
congruent methodology, nursing processes, presumed relationship among them.
holistic approaches to assessment, and other  Conceptual framework represents way of
practice and methodological procedures thinking about a problem or a study or
required for knowledge development. way of representing how complex things
 DEFINITION OF NURSING are.
- All these definitions evolved from previous  Conceptual framework is defined as a
definitions of nursing, from identification of network, or “plane,” of linked concepts
central concepts, from established research that together provide a comprehensive
traditions, and from previous theoretical understanding of a phenomenon. Each
work by nurse scholars. concept of a conceptual framework plays an
ontological or epistemological role in the
framework.
The Metaparadigm  TYPES OF CONCEPRTUAL
 set of concepts and propositions that sets FRAMEWORK
forth the phenomena with which a 1. Taxonomy
discipline is concerned. 2. Visual presentation
 metaparadigm is the most general 3. Mathematical description
statement of a discipline and functions as  How to make conceptual framework?
a framework in which the more restricted 1. Identify the important variables of your
structures of conceptual models develop. study.
PERSON 2. Think how the variables are related.
 focuses on the patient who is the recipient 3. Create a visual diagram or a model.
of care. 4. Explain your conceptual framework in
 Person is an individual who is unique, with narrative pattern.
their own personal set of values, beliefs, PURPOSE OF CONCEPTUAL
and ideologies. FRAMEWORK
 A patient who trusts their nurse will be  Identify relevant variables
more open and better outcomes will be  Define variables
achieved.  Have an idea of analysis
ENVIRONMENT
 Environment or situation is defined as the THEORETICAL FRAMEWORK
internal and external surroundings that  The theoretical framework is the structure
affect the client. that can hold or support a theory of a
HEALTH research study. The theoretical framework
 refers to the quality and wellness of the introduces and describes the theory that
patient. It also includes the access of the explains why the research problem under
patient has to health care. study exists.
NURSING  A theoretical framework serves as the basis
 This refers to the nurse and how he or she of the research. It points out, through its
will apply their knowledge and skills cited theories, which specific variables
when caring for patients. will be the focus of the study.
 ORIENTATION -establishing relationship
IDENTIFICATION -Clarifying the problem
Conceptual Models EXPOILATION -selecting appropriate
 CONCEPTUAL FRAMEWORK - A approach to problem and meeting needs
written or visual presentation that: explains RESOLUTION -terminating the relationship
either graphically , or in narrative form ,
the main things to be studied the key
Middle-Range Theory  Different types of nursing
 A description of a particular phenomenon A.) Nursing Proper - Nursing the sick
 An explanation of the relationship between B.) General Nursing-Health promotion
phenomena C.) Midwifery Nursing
 Predicts the effects of one phenomenon or  HUMAN BEINGS - Defined in relation to
another (Fawcett & DeSanto-Madeya, their environment and the impact of the
2013). environment upon them.
 A set of related ideas that are focused on a  ENVIRONMENT - In her theory it reflect
limited dimension of the reality of a community health model in which all that
nursing. surrounds human beings is considered in
 Substantively specific and encompass a relation to their state of health.
limited number of concepts and a limited  HEALTH - Health is the primary factor in
aspect of the real world patient care. Nightingale's theory shows
that through caring, cleanliness,
THE THEORY OF GOAL ATTAINMENT preparedness, and other medical needs,
DEFINES NURSING AS: nurses can improve individual's health
 “ a process of action, reaction and substantially.
interaction by which nurse and client
share information about their perception 13 CANONS
in a nursing situation”
 “ a process of human interactions between
nurse and client whereby each perceives
the other and the situation, and through
communication, they set goals, explore
means, and agree on means to achieve
goals.”
THREE INTERACTING SYSTEMS
 PERSONAL SYSTEM - perception, self,
growth and development, body image,
space, and time.
 INTERPERSONAL SYSTEM -
interaction, communication, transaction,
role, and stress.
 SOCIAL SYSTEM - organization,
authority, power, status, and
decision-making.

Florence Nightingale
 The foundations of nursing practiced across
the world were pioneered by the greatest
figure in nursing history, Florence
Nightingale. She helped to define nursing
practice by suggesting that nurses did not
need to know all about the disease process
like the medical field.
PHILOSOPHY IN NURSING PRACTICE
CONCEPTS
 NURSING - A spiritual calling; Nurses
were to assist nature to repair the patient
responsible to provide physicians with
accurate information about patients.
1. Ventilation and Keeping the air that
warmth the patients breathe as
pure as the external
air, without chilling
them.
2. Health of Houses Attention to pure air,
pure water, efficient
drainage, cleanliness,
and light.
3. Petty All the results of good
Management nursing may be
negated by one defect.
4. Noise Unnecessary noise, or
noise that creates as
expectation in the
mind, is that which
hurts patients.
5. Variety The nerves of the sick
suffer from seeing the
same walls, the same
ceiling, the same
surroundings during a
long confinement to
one or two rooms.
6. Taking Food The nurse should be
conscious of patients’
diets and remember
how much food each
patient has had and
ought to have each
day.
7. What food Watch for the opinions the sick how to observe •
the patients’ stomach which symptoms
gives, rather than to indicate improvement
read “analyses of • which indicate the
foods” reverse • which are
8. Bed and Bedding The patient’s bed important / which are
should have a clean not • which are
bed every 12 hours. evidence of neglect
The bed should be and what kind of
narrow, so that the neglect
patient does not feel
out of humanity’s
reach Jean Watson
9. Light Essentially direct  Theory of Transpersonal Nursing
sunlight, has a -The Theory of Transpersonal Nursing
purifying effect upon primarily concerned with how nurses care for
the air of a room. their patients and how much care leads to
10. Cleanliness of Preserving the improved plans to promote health and wellbeing,
room and walls cleanliness; the inside prevent sickness, and restore health.
air can be kept clean  JEAN WATSON’S PHILOSOPHY
only by excessive care Watson’s Philosophy and Science of Caring
to aid rooms and their is concerned with how nurses express care
furnishings of the to their patients. Her theory stresses the
organic matter and humanistic aspects of nursing as they
dust with which they intertwine with scientific knowledge and
become saturated. nursing practice
11. Personal Nurses should always  THE NURSING MODEL "Nursing is
cleanliness remember that if they concerned with promoting health,
allow patients to preventing illness, caring for the sick, and
remain unwashed or to restoring health."
remain in clothing  THE FOCUS OF NURSING MODEL
saturated with - HEALTH PROMOTION & TREATMENT
perspiration or other OF DISEASE
excretion, they are
interfering injuriously CONCEPTS THEORY OF
with the natural TRANSPERSONAL NURSING
processes of health  HUMAN - Human being is a valued person
just as much as if they to be cared for, respected, nurtured,
were to give. understood, and assisted.
12. Chattering hopes All friends, visitors, - In general, a philosophical view of a person as
and advices and attendants of the a fully functional integrated self. A human is
sick should avoid the viewed as greater than and different from the
practice of attempting sum of his or her parts.
to cheer the sick by  ENVIRONMENT - The
making light of their environment/society provides the values
danger and by that determine how one should behave and
exaggerating their what goals one should strive toward.
probabilities of - “Caring (and nursing) has existed in every
recovery. society. Every society has had some people who
13. Observation of • what to observe • have cared for others. A caring attitude is not
transmitted from generation to generation by 3 MAJOR ELEMENTS THEORY OF
genes. The culture of the profession transmits it TRANSPERSONAL NURSING
as a unique way of coping with its environment.  The Transpersonal Caring Relationship
 HEALTH - Health is the unity and -This describes the nurse’s caring consciousness and
harmony within the mind, body, and soul. - moral commitment to make an intentional
Health is associated with the degree of connection with the patient.
congruence between the self and the self as Characterizes a special kind of human care
relationship that depends on:
experienced. - It is defined as a high level
- The nurse’s moral commitment in protecting and
of overall physical, mental, and social enhancing human dignity as well as the
functioning; a general deeper/higher self.
adaptive-maintenance level of daily - The nurse’s caring consciousness communicated to
functioning; and the absence of illness, or preserve and honor the embodied spirit, therefore,
the presence of efforts leading to the not reducing the person to the moral status of an
absence of illness. object.
 NURSING - Nursing is a human science of - The nurse’s caring consciousness and connection
persons and human health-illness having the potential to heal since experience,
experiences mediated by professional, perception, and intentional connection are taking
personal, scientific, esthetic, and ethical place.
 The Carative Factors
human care transactions.
-“honor the human dimensions of nursing’s work
and the inner life world and subjective experiences
ACTUAL CARING OCCASION of the people we serve” (Watson, 1997, p. 50)
 The actual caring occasion involves Watson’s caring model requires the nurse to look at
actions and choices by the nurse and the uniqueness of the individual and go to all extents
the individual. The moment of coming possible to preserve the patient’s dignity.
together on a caring occasion presents the  Caring Occasion/Caring Moment
two persons with the opportunity to -This is the space and time where the patient and
decide how to be in the relationship – nurse come together in a manner for caring to occur
what to do with the moment -“The measures nurses take to care for the patient
enables the patient to live with as much
physical ,emotional, social, and spiritual well-being
TRANSPERSONAL
as possible”
 It is an intersubjective human-to-human
relationship in which the nurse affects 10 CARATIVE FACTORS
and is affected by the other person. Both
are fully present in the moment and feel a 01. Formation of a Nurses shall treat
union with the other; they share a humanistic-altruistic their patients as
phenomenal field that becomes part of value. who he/she is and
both’s a life story. respect their values
SUBCONCEPTS and beliefs. Treat
 PHENOMENAL FIELD - The totality of the patient with
human experience of one’s in the world. loving-kindness
and equanimity.
 SELF - The perceptions of the relationship
This gives
of the “I” and “ME” to others and various satisfaction and
aspects of life. extends the sense
 TIME - The present is more subjectively of self.
real, and the past is more objectively 02. Instillation of faith-hope. Incorporating the
real. The Past, present, and future individual,
incidents merge and fuse cultural, faith, and
traditions in taking
care of the patient
with acceptance of
current health
 status is part of
providing holistic
care, it will
promote a positive
connection
between the nurse
and the patient.
03. Cultivation of sensitivity Nurses are capable
to one’s self and to other of identifying the
personal needs and
differentiate them
from patient to
patient. It
recognizes
differences and
promotes
self-actualization
through acceptance
of others.
04. Development of helping- This is essential for
trusting human care transpersonal
relationship caring and the
expression of both
positive and
negative feelings
in the nurse-patient
relationship.
05. Promotion and Nurses and
acceptance of expression of patients must be
positive and negative prepared for either
feelings positive and
negative feedback.
Nurses should be
supportive and
listen to their
patients how they
really feel without
judging.
06. The systemic use of the The scientific
Scientific Problem-Solving problem-solving
Method for decision making method is the only
method that allows
for control and
prediction, and that
permits
self-correction.
The science of
caring should not
always be neutral
and objective.
This type of
decision-making
uses the nursing
process to bring a
 scientific
problem-solving
approach to
nursing care.
07. Promotion of The caring nurse
Interpersonal must focus on the
Teaching-Learning learning process as
much as the
teaching process.
Understanding the
person’s
perception of the
situation assists the
nurse to prepare a
cognitive plan.
Nursing engages a
teaching and
learning
environment where
continuous
education of staff
and patients is
always happening.
Nurses must also
remember that we
can all learn from
each other, every
day.
08. Provision of a Divided into
supportive, protective eternal and internal
and/or corrective Mental, variables, which
Physical, Socio-Cultural and the nurse
Spiritual Environment manipulates in
order to provide
support and
protection for the
patient’s
well-being.
External and
Internal
environments are
interdependent.
Nurses provide
comfort, privacy,
and safety as a part
of their carative
factor.
09. Assistance with the It is based on a
gratification of human needs hierarchy of need
similar to that of
the Maslow’s.
Each need is
equally important
for quality nursing
Good luck! -celestine care and the
promotion of
optimal health. All
the needs deserve
to be attended to
and valued.
The nurse
recognizes the
order of needs such
as food,
elimination, and
ventilation before
they can advance
to higher
psychophysical
and psychosocial
needs, allowing for
gratification of
human needs both
emotional and
physical.
10. Allowance for This factor helps
existential-phenomenological the nurse to
forces. reconcile and
mediate the
incongruity of
viewing the person
holistically while
at the same time
attending to the
hierarchical
ordering of needs.
Thus the nurse
assists the person
to find the strength
or courage to
confront life or
death.
Nurses have an
acceptance of
spiritual beliefs,
which may be
different from their
own. Allowing for
beliefs in things we
can’t explain helps
nurses have a
better
understanding of
one's spiritual self.
 THEORY knowledge of that discipline and accompanying practice
- Set of logically interrelated concepts that provide a abilities.
systematic explanatory and predictive view of Significance:
phenomena. - Nursing theory is a useful tool for reasoning,
Nursing Theory - a framework designed to organize critical thinking, and decision-making in
knowledge and explain phenomena in nursing. nursing practice.
- Nursing theoretical works provide a
HISTORY OF NURSING perspective of the patient.
- began with Florence Nightingale. - Nursing theory provides more direction for
- During the Crimean War, establishment of a school of nursing practice.
nursing at St. Thomas’ Hospital in London marked the - The conceptual models of nursing are
birth of Modern Nursing. comprehensive and reader to the specifics of
- It was during the mid-1800's that Nightingale practice.
recognized the nique focus of nursing and declared - Middle range theories contain the specifics of
nursing knowledge distinct from medical knowledge. nursing practice.
- Nightingale set forth of the following: that the care of
the sick is based on knowledge of persons and their HISTORY OF PHILOSOPHY AND SCIENCE
surroundings - a different knowledge than that used by - Two competing philosophical foundations of science,
the physicians in their practice. rationalism (power of reason) and empiricism (power of
- Until the emergence of nursing as science in the 1950’s sensory experience), have evolved in the era of modern
nursing practice was based on principles and traditions science with several variations.
handed down through an apprenticeship model of
education and in individual hospital procedure manuals. Rationalism (power of reason)
- Some nursing leaders aspired for nursing to be - Rationalist epistemology (scope of knowledge)
recognized as a profession and become an academic emphasizes the importance of a priori reasoning as the
discipline. appropriate method for advancing knowledge.
- Nurses began to develop a body of specialized Empiricism (power of sensory experience)
knowledge on which to base nursing practice. - based on the central idea that scientific knowledge can
Curriculum Era - addressed the question of what be derived only from sensory experience.
content nurses should study to learn how to be a nurse.
- As nurses increasingly sought degrees in higher THE STRUCTURE OF SPECIALIZED NURSING
education, the research emphasis era began to emerge. KNOWLEDGE
- In the mid-1970’s, an evaluation of the first 25 years of Metaparadigm
the journal Nursing Research revealed that nursing
studies lacked conceptual connections and theoretical
frameworks, accentuating development of specialized
nursing knowledge.

SIGNIFICANCE OF NURSING THEORY

Theory, research, and practice are bound together in a
continuous interactive relationship.

Discipline - specific to the academia

- refers to a branch of education, a department
of learning, or a domain of knowledge.
Significance:
- Theoretical works have taken nursing to a
higher level.
- The emphasis has shifted from a focus on
knowledge about how nurses function which Philosophy
concentrated on the nursing process, to focus - Most abstract type
on what nurses know and how they use - Sets forth the meaning of nursing phenomena
knowledge to guide their thinking and decision through analysis, reasoning, and logical
making while concentrating on the patient. presentation.
Conceptual Model
- Provides a distinct frame of reference for its
adherents that tells them how to observe and
interpret the phenomena of interest for the
discipline.
Profession - refers to a specialized field of practice, Nursing Theory
founded upon the theoretical structure of the science or

1 | Theoretical Foundations in
 - Comprises works derived from nursing
philosophies, conceptual models, abstract
nursing theories, or works in other disciplines.
Middle-Range Theory
- Most specific focus is concrete in its level of
abstraction.
- Precise and answer specific nursing practice
questions.

TYPES OF NURSING THEORETICAL WORKS

Philosophies: Nightingale, Watson, Ray, Benner,
Martinsen, Eriksson 5 Essential Components of Environmental Health
- Pure air
Conceptual Models: Levine, Rogers, Orem, King, - Pure water
Neuman, Roy, Johnson - Efficient drainage
- Cleanliness
Nursing Theories: Boykin and Shoenhofer, Melesis, - Light
Pender, Leininger, Newman, Parson, Erickson,
Tomlin and Swain, Husted and Husted ASSUMPTIONS
- Nursing should support the environment to
Middle-Range Theories: Mercer, Mishel, Reed,
assist the patient in healing.
Wiener and Dodd, Eakes, Burke and Hainsworth,
- Research should be utilized through
Barker, Kolcaba, Beck, Swanson, Roland and Moore
observation and empirics to define the nursing
discipline.
- The person is interacting with the
environment,

ENVIRONMENT THEORY: Florence METAPARADIGM

Nightingale Nursing
- Different from medicine and the goal of nursing is
The Theorist
to place the patient in the best possible condition
- born May 12, 1820 in Florence, Italy.
for nature to act.
- At the age of 17, she felt the ‘calling; to fulfill a useful
- “Activities that promote health which occur in any
role in the society
caregiving situation. They can be done by
- At the age of 31, she decided to be a nurse.
anyone.”
- In 1851, for 3 months, she trained as a nurse in a
- Being responsible for someone else’s health.
hospital in Kaiserworth, Germany.
Person
- In November 1854, she led a group of trained nurses to
- In most of her writings, Nightingale referred to the
the Crimean War.
person as a patient.
- In 1859, she wrote Notes on Nursing: What it is and
- People are multidimensional, composed of
What is Not.
biological, psychological, social and spiritual
- Died August 13, 1920 in London, while asleep.
components.
- She was known as the ‘Lady with the Lamp’ and the
- Nightingale saw each patient as an individual.
‘Mother of Modern Nursing’.
Health
- “Not only to be well, but to be able to use well
The Theory
every power we have.”
- Nightingale’s environmental model focuses on the
- Health is being well and using every power
manipulation of physical and social factors that affects
(resource) to the fullest extent in living life.
the health and illness.
Environment
- Her book was written for women who were responsible
- “Poor or difficult environments led to poor health
for the health of their family members, not necessarily
and disease.”
just for nurses.
- “Environment could be altered to improve
- Nightingale viewed the physical environment as a
conditions so that the natural laws would allow
critical component in both health and illness.
healing to occur.”
- She enumerated 12 concepts - The Canons consistent
- Nightingale’s concept of environment emphasized
with the mid-19th century healthcare when surgery was
that nursing was to assist nature in healing the
performed in kitchen tables in many instances and
patient.
hospitals primarily housed the dying and the homeless.
12 CANONS
MAJOR CONCEPTS

2 | Theoretical Foundations in
 - Nightingale’s emphasis on proper ventilation
THEORY OF HUMAN CARING: Margaret
indicates that she recognized the surroundings as a
source of disease and recovery. Jean Harman Watson
- Manipulation of the surroundings to maintain The Theory
ventilation and patient warmth by using a good - The theory of Human caring was developed
fire, opening windows, and properly positioning between 1975 and 1979.
the patient in the room. - Initial attempt to bring meaning and focus to
- Direct sunlight as a particular need of patients. nursing as an emerging discipline and distinct
- Dirty environment (floors, carpets, walls, and bed health profession that has its own unique values,
linens) was a source of infection through the knowledge, and practices, and its own ethic and
organic matter it contained. mission to society.
- Appropriate handling and disposal of bodily
excretions and sewage were required to prevent METAPARADIGM
contamination of the environment. Nursing
- Bathing patients on a frequent, even daily basis at - Centered around helping the patient achieve a
a time when this practice was not the norm. higher degree of harmony in a holistic manner
- Nurses are also to bathe daily, that their clothing (mind, body and soul).
be clean, and that they wash their hands Person
frequently. - (Human) Viewed as greater than and different
- Noise created by physical activities in the areas from the sum of his/her parts.
around a patient’s room was to be avoided Health
because it could harm the patient. - High level of overall physical, mental and social
- Nurse to assess not only dietary intake, but also functioning and the absence of illness.
the meal schedule and its effect on the patient. Environment
- Petty management (nursing administration) - the - Caring and nursing has existed in every society.
nurse is in control of the environment both - The nurse is part of the environment.
physically and administratively. - Nurses should ensure a caring-healing
- The nurse was to protect the patient from environment capable of transformative measures.
receiving upsetting news, seeing visitors who
could negatively affect recovery, and experiencing ASSUMPTIONS
sudden disruptions of sleep. - Caring can be effectively demonstrated and
- Nightingale recognized that pet visits (small practiced only interpersonally.
animals) might be of comfort to the patient. - Caring consists of carative factors that result in the
satisfaction of certain human needs.
PURPOSE - Effective caring promotes health and individual or
- Describe, explain, explore and predict the role of the family growth.
environment on the health of the client. - Caring responses accept a person not only as he or
she is now but as what he or she may become.
- A caring environment is one that offers the
development of potential while allowing the
person to choose the best action for himself at a
given point in time.
- Caring is more ‘healthogenic’ than is curing.
- A science of caring is complementary to the
science of curing.
- The practice of caring is central to nursing.

MAJOR CONCEPTUAL ELEMENTS

Caring Occasion/Caring Moment
- A caring occasion is the moment when the nurse
and another person come together for human
caring.
- Both people come together in human-human
transactions.
- The one caring for and the one being cared for are
influenced by the choices and actions decided
within the relationships.
Transpersonal Caring Relationship
- Transpersonal describes an intersubjective, human
to human relationship that encompasses two
individuals in a given moment (patient and nurse)

3 | Theoretical Foundations in
 - A special kind of human care relationship - a
NURSING NEED THEORY: Viirginia
union with another person with high regard for the
whole person and their being in the world. Henderson
- Watson (2013) describes a transpersonal nurse as METAPARADIGM
one who ‘has the ability to center consciousness Nursing
and intentionality on caring, healing, and - The unique function of the nurse is to assist the
wholeness, rather than on disease, illness and individual, sick or well, in the performance of
pathology’. activities contributing to health or its recovery.
Caring Healing Modalities Person
10 Carative Factors - A complete and independent being with
biological, sociological, and spiritual components.
Health
- The ability to perform independently the 14 basic
needs.
- Health is basic to human functioning and that
promotion of health is more important than the
care of the sick.
Environment
- The aggregate of the external conditions and
influences affecting the life and development of
an organism.
- The effects of 7 components (light, temperature,
air movement, atmospheric pressure, proper waste
disposal, absence of injurious chemicals, and
cleanliness of surroundings) on the life and
development of a person.

14 BASIC HUMAN NEEDS

APPLICATION TO NURSING PRACTICE

- Establishing a caring relationship with patients.
- Treat patients as holistic beings,
- Display unconditional acceptance.
- Treat patients with positive regard.
- Promote health through knowledge and THEORY APPLICATION
intervention. Nursing Practice
- Spend uninterrupted time with the patient. - Assists nurses to describe, explain, and predict
everyday experiences.
- Serve to guide assessment, interventions, and
evaluations 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.
- Helps build a common nursing terminology to use
in communicating with other health professionals.
- Ideas are developed and words are identified.

4 | Theoretical Foundations in
 - Enhance autonomy (independence and self- - A person also has an effortless and noneffective
governance) of nursing through defining its own
understanding of the self in the world.
independent functions.
Nursing Education - The person is viewed as a participant in common
- Provides a general focus for curriculum design. meanings.
- Guide a curricular decision-making. Health
Nursing Research - Defined as what can be assessed, whereas well-
- Offer a framework for generating knowledge and
new ideas. being is the human experience of health or
- Assist in discovering knowledge gaps in the wholeness.
specific field of study. Environment
- Offer a systematic approach to identify questions - Also referred to as a situation.
for study, select variables, interpret findings, and
- A situation rather than an environment, because a
validate nursing interventions.
- Approaches to developing nursing theory. situation conveys a social environment with a
- Borrowing conceptual frameworks from other social definition and meaningfulness.
disciplines.
- Inductively looking at nursing practice to discover STAGES OF NURSING EXPERTISE (Novice to
theories/concepts to explain phenomena,
Expert Model)
- Deductively looking for the compatibility of a
general nursing theory with nursing practice. - The model is situation-based and is not trait-
- Questions from practicing nurses about using based.
nursing theory. - The level of performance is not an individual
characteristic of an individual performer, but
instead is a function of a given nurse;s familiarity
CARING, CLINICAL WISDOM, AND with a particular situation in combination with
ETHICS IN NURSING PRACTICE: Patricia their educational background.
Benner
OVERVIEW
- Benner studies clinical nursing practice in an
attempt to discover and describe the knowledge
embedded in nursing practice.
- Knowledge accrues over time in a particular
discipline and is developed through experiential
learning and situated thinking and reflection on
practice in particular practice situations.
- Benner acknowledges that her thinking in nursing Novice
has been influenced greatly by Virginia - The person has no background experience of the
Henderson. situation in which he is involved.
- Context-free rules and objective attributes must be
METAPARADIGM given to guide performance.
Nursing - This level applies to students of nursing.
- A caring relationship, an ‘enabling condition of Advanced Beginner
connection and concern’. - Person can demonstrate marginally acceptable
- “Caring is primarily because caring sets up the performance, having coped with enough real
possibility of giving help and receiving help.” situations to note.
- “Nursing is viewed as a caring practice whose - Has enough experience to grasp aspects of the
science is guided by the moral art and ethics of situation.
responsibility.” - They require experience based on recognition in
Person the context of the situation.
- A person is a self-interpreting being, that is, the - Nurses functioning at this level are guided by
person does not come into the world predefined rules and are oriented by task completion.
but gets defined in the course of living a life.

5 | Theoretical Foundations in
 - They have difficulty grasping the current patient
CONSERVATION THEORY: Myra Estrine
situation in terms of larger perspectives.
Levin
- Feel highly responsible for managing patient care,
yet they still rely on the help of those who are THE CONSERVATION MODEL
most experienced. - Focused in promoting adaptation and maintaining
Competent wholeness using the principles of conservation.
- Considerable conscious and deliberate planning - Guides the nurse to focus on the influences and
that determines which aspects of current and responses at the organismic level.
future situations are important and which can be - The nurse accomplishes the goals of the model
ignored. through the conservation of energy, structure, and
personal and social integrity.
- Consistency, predictability, and time management.
ADAPTATION
- Sense of mastery is acquired through planning and
predictability. - Process of change whereby the individual retains
- Level of efficiency is increased. his integrity within the realities of his
environments.
- Devises new rules and reasoning procedures for a
- Critical conserving wholeness.
plab, while applying learned rules for action on
the basis of relevant facts of that situation. - Basic to survival.
Proficient - Expression of the integration of the entire
organism.
- Performers perceive the situation as a whole (the
total picture) rather than in terms of aspects, and WHOLENESS (HOLISM)
the performance is guided by maxims. - ‘Health’ = ‘hal’ (anglosaxon word) - ‘whole’
- Demonstrate a new ability to see changing - Wholeness emphasizes a sound, organic,
relevance in a situation, including recognition and progressive mutuality between diversified
implementation of skilled responses to the functions and parts within an entirety, the
situation as it evolves. boundaries of which are open and fluent.
- Increased confidence in their knowledge and - Exploring the parts of the whole to understand the
abilities. whole.
Expert - Conserving the integrity of the individual is the
- The expert performer no longer relies on hallmark of nursing intervention.
analytical principal (i.e., rule, guideline, maxim) CONSERVATION
to connect an understanding of the situation to an - Product of adaptation.
appropriate action. - Describes the way complexes are able to continue
- Demonstrating a clinical grasp and resource-based to function even when severely challenged.
practice. - Through conservation, individuals are able to
- Possessing embodied know-how. confront obstacles, adapt accordingly and
- Sees the big picture maintain their uniqueness.
- Thinks and sees the unexpected. - The goal of conservation is health and the strength
to confront disability.
- Primary focus of conservation is keeping together
SIGNIFICANCE OF THE THEORY
the wholeness of the individual.
- The theory changed the profession’s
- Although nursing interventions may deal with one
understanding of what it means to be an expert,
particular conservation principle, nurses must also
placing this designation not on the nurse with the
recognize the influence of the other conservation
most highly paid or most prestigious position, but
principles.
on the nurse who provided the most exquisite
ORGANISMIC RESPONSE
nursing care.
- Change in the behavior of an individual during an
attempt to the environment.
- Help individuals to protect and maintain their
integrity.

6 | Theoretical Foundations in
TYPES OF ORGANISMIC RESPONSE - External environment is divided into 3: Perceptual
1. Fight or Flight Level, Operational Level, and Conceptual Level.
- Most primitive response Perceptual Level
- Instantaneous response to real or managed threat. - Aspects of the world that individuals are
2. Inflammatory able to intercept and interpret with their
- Response intended to provide for structural sense organs.
integrity and the promotion of healing. - E.g. Patient’s change in temperature.
- Protects the organism from environmental irritants Operational Level
and pathogens. - Things that affect individuals physically.
3. Stress - Cannot be directly perceived such as
- Response developed over time and influenced by microorganisms.
each stressful experience encountered by the - E.g. Environmental pollutants, and
person. infections.
4. Perceptual Conceptual Level
- Involves gathering information from the - Environment is constructed from cultural
environment and converting it into a meaningful patterns.
experience. - Characterized by spiritual existence and
mediated by the symbols of language,
METAPARADIGMS thought, and history.
Nursing - E.g. own belief, traditions to health,
- A human interaction. rituals, patient’s ability to decide his own
- The nurse participates actively in every patient’s treatment.
environment and much of what she does supports
his adjustments as he struggles in the predicament MAJOR ASSUMPTIONS
of illness. - The person can be understood only in the context
- The goal of nursing is to promote adaptation and of his/her environment.
maintain wholeness. - Every self-sustaining system monitors its own
Person behavior by conserving the use of resources
- Person is described as a holistic being; wholeness is required to define its unique identity.
integrity. Integrity means that the person has - Human beings respond in a singular, yet,
freedom of choice and movement. The person has a integrated fashion.
sense of identity and self-worth. - A holistic approach to care of all people, well or
Health sick.
- Health is socially determined by the ability to
function in a reasonably normal manner. KEY CONCEPTS: Conservation Principles
- Health is not just an absence of pathological - The core concept of Levine’s theory is
conditions. conservation.
- Health is the return to self; individuals are free and - When a person is in a state of conservation, it
able to pursue their own interests within the context means that individual adaptive responses conform
of their own resources. change productively, and with the least
Environment expenditure of effort, while preserving optimal
- Conceptualized as the context in which individuals function and identity.
live their lives. - Conservation is achieved through successful
- The individual actively participates in his activation of adaptive pathways and behaviors that
environment. are appropriate for the whole range of responses
- Individuals have their own environment, both required by functioning human beings.
internally and externally. - The principles focus on conserving an individual’s
- Nurses can relate to the internal environment as the wholeness.
physiological and pathophysiological aspects of the
patient.

7 | Theoretical Foundations in
Conservation of Energy - This guides nurses to focus on the influences and
- Individuals require a balance of energy and a responses of a client to promote wholeness through
constant renewal of energy to maintain life the conservation principles.
activities. - The goal of this model is to accomplish this
- E.g. Availability of adequate rest, maintenance of through the conservation of energy, structural,
adequate nutrition. personal, and social integrity. The goal of nursing is
Conservation of Structural Integrity to recognize, assist, promote, and support adaptive
- Refers to maintaining or restoring the structure of processes that benefit the patient.
the body preventing physical breakdown (integrity)
and promoting healing.
- E.g. Nurses can limit the amount of tissue involved
in a disease by early recognition of functional UNITARY HUMAN BEINGS: Martha E.
changes and by nursing interventions; Assists
Rogers
patients in range of motion exercise; Maintenance
MAJOR CONCEPTS
of patient’s personal hygiene.
- Wholeness, openness, unidirectionality, pattern,
Conservation of Personal Integrity
and organization, sentence, and thought
- Recognizes the individual as one who strives for
characterized the life process.
recognition, respect, self-awareness, selfhood and
- Human beings are dynamic energy fields that are
determination.
integral with environmental fields.
- Self-worth and a sense of identity are important.
- Both human and environmental fields are identified
- E.g. Nurses can show patients respect by calling
by pattern and characterized by a universe of open
them by name, respecting their wishes, valuing
systems.
personal possessions, providing privacy during
procedure, supporting their defenses, and teaching
ENERGY FIELD
them.
- Fundamental unit of both the living and the
Conservation of Social Integrity
non-living.
- Social integrity is reflected in dynamic
- Ability to create change.
relationships among human beings.
- Infinite and pandimensional (across all dimensions)
- Life gains meaning through social communities and
- Two fields are identified: the human field and the
health is socially determined.
environmental field.
- E.g. Nurses fulfill professional roles, provide for
Unitary Human Being (Human Field)
family members, assist with religious needs, and
- Defined as irreducible, indivisible,
use interpersonal relationships to converse social
pandimensional energy fields identified
integrity.
by pattern and manifesting characteristics
that are specific to the whole and that
NURSING PROCESS
cannot be predicted from knowledge of
- Assessment
the parts.
- Trophicognosis - scientific approach to
Environmental Field
determination of an individual patient’s nursing
- Defined as an irreducible,
care needs.
pandimensional energy field identified by
- Hypothesis
pattern and integral with the human field.
- Interventions
Each environmental field is specific to its
- Evaluation
given human field.

SYNTHESIS
UNIVERSE OF OPEN SYSTEMS
- Levine expressed the view that within the nurse-
- Energy fields are infinite, open, and integral with
patient relationship, a patient’s state of health is
one another.
dependent on the nurse-supported process of
- The human and environmental fields are in
adaptation.
continuous process and are open systems.

8 | Theoretical Foundations in
PATTERN by pattern and manifesting characteristics that are
- Identifies energy fields. specific to the whole’.
- The nature of pattern changes continuously and - Human beings ‘are not disembodied entities, nor
innovatively, and these changes give identity to the are they mechanical aggregates. Man is a unified
energy field. whole possessing his own integrity and manifesting
- Manifestations emerge as a human-environmental characteristics that are more than and different from
mutual process. the sum of his parts’.
- Pattern is changing continually and may manifest Health
disease, illness, or well-being. - A value term defined by the culture or the
individual.
PANDIMENSIONALITY - Events manifested in the life process indicates the
- Nonlinear domain without spatial or temporal extent to which a human being achieves maximum
attributes. health according to some value system.
- Essentially a spaceless and timeless reality. - Passive health - symbolizes wellness and the
- Provides an infinite domain without limit. absence of disease and major illness.
- Best express the idea of a unitary whole. Environment
- Irreducible, pandimensional energy field identified
NURSING PROCESS by pattern and manifesting characteristics different
Assessment from those of the parts.
Areas of assessment: - Each environmental field is specific to its given
- Total pattern of events at any given point in human field. Both changes continuously and
space-time. creatively.
- Simultaneous state of the patient and his/her - Environmental fields are infinite, and change is
environment. continuously innovative, unpredictable, and
- Rhythms of the life processes. characterized by increasing diversity.
- Supplementary data.
- Categorical disease entities. ASSUMPTIONS
- Subsystem pathology. - The principles of hemodynamics postulate a way of
- Pattern appraisal. perceiving unitary human beings.
The assessment should be a comprehensive Principles of Change
assessment of the human and environmental 1. Helicy - spiral development in
fields. continuous, non-repeating, and
Voluntary Mutual Patterning innovative patterning.
Evaluation 2. Resonancy - patterning changes
with the development from lower to
METAPARADIGM higher frequency.
Nursing 3. Synchrony - stresses the continuous
- Learned profession and is both a science and an art. mutual process of person and
- Focuses on concern with people and the world in environment.
which they live- a natural fit for nursing care, as it Wholeness
encompasses people and their environments. - Human beings are considered as a united whole.
- Purpose of nursing is to promote health and well- Openness
being for all people. - A person and his environment are continuously
- Nursing exists for the care of people and the life exchanging energy with each other.
process of humans.
Person Unidirectionality
- An open system in continuous process with the - The life process of human being evolves
open system that is the environment. irreversibly and unidirectional (birth to death)
- Defines unitary human-being as an ‘irreducible, Pattern and Organization
indivisible, pandimensional energy field identified

9 | Theoretical Foundations in
- Pattern identifies individuals and reflects their Environment
innovative wholeness - It is an external source of influence in the internal
Sentence and Thought interaction of the person’s different aspects.
- Humans are the only organism able to think,
imagine, have language and emotions. RELATED THEORIES
Theory of Self-Care
APPLICATION - describes why and how people care for themselves.
- Plan and implement nursing practice in a Theory of Dependent-Care
continuous process (of voluntary mutual patterning) - explains how family members and/or friends
whereby the nurse assists clients to freely choose provide dependent-care for a person who is socially
with awareness ways to participate in their well- dependent.
being. Theory of Self-Care Deficit
- Noninvasive patterning modalities used within - Describes and explains why people can be helped
Rogerian practice: Acupuncture, Aromatherapy, through nursing.
Therapeutic Touch, Massage, Guided Imagery, Theory of Nursing Systems
Meditation, Self-reflection, Humor, Sleep, Music, - Describes and explains relationships that must be
and Physical Exercise. brought about and maintained for nursing to be
produced.

KEY CONCEPTS
SELF CARE DEFICIT THEORY: Dorothea E. Self-Care
Orem - Activities that a person does to achieve health.
Self-Care Agency
- Innate ability of a person to accomplish self-care.
Self-Care Demand
- Care needed of a person at a specific time to meet
self-care requisites.
Self-Care Requisites
- Action directed towards provision of self-care.
Self-Care Deficit
- Occurs when an individual is unable to meet self-
care requisites.
- Impaired ability to perform self-care.
Nursing Agency
- Knowledge and abilities of the nurse to meet the
client’s self-care demand.
Nursing Systems
METAPARADIGM - Classification on actions of the nurse consistent to
Nursing the self-care demands of the client.
- It is helping clients to establish or identify ways to - Wholly Compensatory, Partially Compensatory,
perform self-care activities (nursing agency). Supportive Educative
Person
- Has the capacity to regulate own functioning and
development (self-care agency)

Health
- structurally/functionally whole or sound
- One must be able to perform self-care activities
(illness is having a self-care deficit).

10 | Theoretical Foundations in
 PURPOSE
- Describe, explain, explore, and predict when the
client needs therapeutic self-care.

THEORY OF GOAL ATTAINMENT: Imogene

King

THE THEORY
- Nursing cares’ goal is to help individuals maintain
or regain health.
- Describes a dynamic, interpersonal relationship in
which a person grows and develops to attain
certain life goals.
- Factors which affect the attainment of a goal are:
roles, stress, space, and time.

ASSUMPTIONS
- Nursing focus is the care of a human being.
- Nursing goals are the health care of individuals
and groups.
- Human beings are open systems interacting
constantly within their environment.
- Nurse and client communicate information, set
goals mutually and then act to attain these goals, is
also the basic assumption of the nursing process.
- “Each human being perceives the world as a total
person in making transactions with individuals
and things in the environment.”
- “Transaction represents a life situation in which
the perceiver and the object perceived are
encountered and in which person enters the
situation as an active participant and each is
PROPOSITIONS changed in the process of these experiences.”
- The individual is capable of providing self-care to - Used systems approach in constructing her
meet some health needs. conceptual system and theory of goal attainment.
- The nurse compensates for the patient’s inability
to engage in self-care by providing care.
- The patient resumes self-care actions as s/he
regains ability to do so.

ASSUMPTIONS
- Humans require continuous, deliberate self-care
for health development and well-being.
- Individuals have the power to make decisions
about their self-care.
- Nurses maintain the capacity of individuals for
self-care and assists when s/he is unable to do so.

11 | Theoretical Foundations in
 Health
- Dynamic life experiences of a human-being,
which implies continuous adjustment to stressors
in the internal and external environment through
optimum use of one’s resources to achieve
maximum potential for daily living.
Environment
- Background for human interactions

- Individuals interact to set goals that result in goal 3 FUNDAMENTAL NEEDS OF HUMAN
attainment. - The need for the health information that is unable
- A human process that can be observed in many at the time when it is needed and can be used.
situations when two or more people interact, such - The need for care that seeks to prevent illness.
as in the family and in social events. - The need for care when human-beings are unable
- Nurses bring knowledge and skills that influence to help themselves.
perceptions, communications, and interactions Internal Environment
performing the functions of the role. - Transforms energy to enable a person to adjust to
- Provides the theoretical knowledge base to continuous external environmental changes.
implement the nursing process (ADPIE) External Environment
- Evaluation determines whether or not goals were - Involves formal and informal organizations.
attained. If not, ask why, and the process begins - Nurse is part of the patient’s environment.
again.
Action - sequence of behaviors involving mental and PROPOSITIONS WITHIN KING’S THEORY OF
physical action. GOAL ATTAINMENT
Reaction - considered as included in the sequence of
behaviors described in action.
Goal of Nurse - to help the individuals maintain their
health so they can function in their roles.
Domain of Nurse - promoting, maintaining, and
restoring health, and caring for the sick, injured, and
dying.
Function of Professional Nurse - interpret information
in the nursing process to plan, implement and evaluate
nursing care.

METAPARADIGMS
Nursing
- Process of action, reaction, and interaction
whereby nurse and client share information about
their perceptions in the nursing situation (King,
1981)
- Observable behavior found in the healthcare SYSTEMS MODEL: Betty Neuman
society. OVERVIEW
Person - The conceptual model was developed to explain
- Human-being the client-client system as an individual person for
- Social-being who are rational and sentient. the discipline of nursing.
- Has ability to: perceive, think, feel, choose, set - The model can be applied to an individual, a
goals, select means to achieve goals, and to make group, a community, or a social issue and is
decisions. appropriate for nursing and other health
disciplines.

12 | Theoretical Foundations in
METAPARADIGM - Wellness is on a continuum of available
Nursing energy to support the system in an optimal
- Unique profession in that it is concerned with all state of system stability.
of the variables affecting an individual's response - Implicit within each client system are internal
to stress. resistance factors known as lines of resistance.
Person - Functions to stabilize and return the client to
- Open client system in reciprocal interaction with the usual wellness state (normal line of
the environment. defense) or possibly to a higher level of
Health stability following an environmental stressor
- Continuum of wellness to illness that is dynamic reaction.
in nature and is constantly changing. Primary Prevention
Environment - Relates to a general knowledge that is applied in
- All the internal and external factors that surround client assessment and intervention in identification
and influence the client system. and reduction or mitigation of possible or actual
risk factors associated with environmental
MAJOR CONCEPTS stressors to prevent possible reaction.
- Each individual client or group as a client system - The goal of health promotion is included in
is unique; each system is a composite of primary prevention.
commonly known factors or innate characteristics Secondary Prevention
within a normal, given range of response - Relates to symptomatology following a reaction to
contained within a basic structure. stressors, appropriate ranking of intervention
- The client as a system is in a dynamic, constant priorities and treatment to reduce their noxious
energy exchange with the environment. effects.
- Many known, unknown, and universal Tertiary Prevention
environmental stressors exist. - Relates to the adaptive processes taking place as
- Each differs in its potential for disturbing a reconstitution begins and maintenance factors
client’s usual stability level or normal line of move the client back in a circular manner toward
defense. primary prevention.
- The particular interrelationships of client Client-Client System
variables - physiological, psychological, - Five client variables occur and are considered
sociocultural, developmental, and spiritual - simultaneously in each concentric circle that
at any point in time can affect the degree to makes up the client-client system: Physiological,
which a client is protected by the flexible line Psychological, Sociocultural, Developmental and
of defense against possible reaction to a Spiritual.
single stressor or a combination of stressors. Central Core
- Each individual client-client system has evolved a - Consists of basic survival factors: normal
normal range of response to the environment that temperature range, genetic structure, response
is referred to as a normal line of defense, or usual pattern, organ strength, ego structure, knowns.
wellness/stability state.
- It represents change over time through
coping with diverse stress encounters.
- The normal line of defense can be used as a
standard from which to measure health
deviation.
- The client, whether in a state of wellness or
illness, is a dynamic composite of the
interrelationships of variables - physiological,
psychological, developmental, sociocultural, and
spiritual.

13 | Theoretical Foundations in
 Optimal System Sustainability
- Optimal wellness is the greatest possible degree of
system stability at a given point in time.
- Optimal client system stability means the highest
possible health condition achievable at a given
point in time.
Varying from Wellness
- Varying degrees of system instability.
- The difference from the normal or usual wellness
condition.
Illness
- Illness is a state of insufficiency with disrupting
needs unsatisfied.
- Illness is an excessive expenditure of energy.
- When more energy is used by the system in its
state of disorganization than is built and
stored, the outcome may be death.
Reconstitution
- Is the determined energy increase related to the
degree of reaction to a stressor, and represents the
return and maintenance of system stability
following treatment for stress reactions.
- May be viewed as feedback from the input/output
of secondary intervention.
- Complete reconstitution may occur beyond the
Flexible Line of Defense (FLD)
previously determined NLD or usual wellness
- Forms the outer boundary of the defined client
state, may stabilize the system to a lower level, or
system. (individual, family, group, community)
return to the level of wellness prior to illness.
- Acts as a protective buffer system for the client’s
Prevention as Intervention
normal line of defense or wellness state.
- Basic for health promotion
- Prevents stressor invasion of the client system.
- Nursing is prevention as intervention encompasses
Normal Line of Defense (NLD)
three dimensions: Primary, Secondary, and
- The client/client system’s normal or usual wellness
Tertiary Intervention.
level.
- Primary: Reduce responsibility of encounter
- This line represents what the client has
with stressors. Strengthen flexible line of
become/evolved over time.
defense.
- The NLD defines the stability and integrity of the
- Secondary: Early-case findings. Treatment of
client system, its ability to maintain stability and
symptoms.
integrity.
- Tertiary: Readaptation. Re-education to
- This normal defense line is the standard against
prevent future occurrences. Maintenance of
determining any variance from wellness.
stability.
Lines of Resistance (LOR)
- A protective mechanism that attempts to stabilize
the client system and foster a return to the usual
wellness.
- Contain certain known and unknown internal and
external resource factors that support the client’s
basic structure and normal line of defense (mobilize
WBC, activate immune system mechanisms)

14 | Theoretical Foundations in
 KEY CONCEPTS

ADAPTATION MODEL: Callista Roy 1. STIMULI

Focal Stimuli - most immediate response that
confronts the individual and demands the most
attention and adaptive energy.
Contextual Stimuli - all other stimuli present in
the situation that contribute to the strength of
the focal stimulus may it be positive or
negative.
Residual Stimuli - environmental factors of which
the effects are unclear in a given situation.
METAPARADIGM 2. ADAPTATION LEVEL
Nursing Integrated - the structures and functions of life
- The science and practice that expands adaptive processes that are working as a whole to meet
abilities and enhances person and environment human needs.
transformation. Compensatory - coping mechanisms that have
Person been activated by a challenge to the integrated
- Main focus in nursing. life process.
- Recipient of nursing care. Compromised - results from inadequate integrated
- A living, complex, adaptive system. and compensatory life processes, and is an
Health adaptation problem.
- State and a process of being and becoming 3. COPING MECHANISMS
integrated and a whole person. Primary - control processes subsystem that
- A reflection of adaptation, that is, the interaction of consists of regulator and cognator.
the person and the environment, a. Regulator - major coping process
Environment involving the neural, chemical, and
- “All the conditions, circumstances, and influences endocrine system.
surrounding and affecting the development and b. Cognator - major coping process involving
behavior of a person or groups, with particular four cognitive-emotive channels:
consideration of the mutuality of person and earth perceptual information processing,
resources that includes focal, contextual, and learning, judgement, and emotion.
residual stimuli” Secondary - effector subsystem that consists of
four adaptive modes.
PERSON AS AN ADAPTIVE SYSTEM a. Physiological Needs -
physiological-physical mode. Physical
response to the environment through
physiological processes to meet the basic
needs of oxygenation, nutrition,
elimination, activity and rest, and
protection.
b. Self-Concept - self-concept group identity
adaptive mode. Person’s thoughts, beliefs,
- Response may either be an adaptive or an or feelings about himself. An individual’s
ineffective response. self-concept is composed of the physical
- Adaptation occurs when a person responds self (body sensation and body image) and
positively to environmental changes. the personal self (self-consistency, self-
- Ineffective responses to stimuli lead to disruption ideal, and moral-ethical-spiritual self)
of the integrity of the person. c. Role Function - social integrity of for one
to know how to behave and what is
expected of him in the society.

15 | Theoretical Foundations in
 d. Interdependence - relationships among - Staff Nurse at the Chatham Savannah Health Council
people. Major task is for people to receive (1943-1944)
love, respect, and value. - Chairperson on the Committee of California Nurses
Association ( 1965-1967)
- Published 4 books, more than 30 articles on periodicals
- died in February 1999 at the age of 80

THEORETICAL SOURCES
- Influenced heavily by Florence Nightingale’s
book, Notes on Nursing.
- Used the work of behavioral scientist, psychology,
sociology, and ethnology to form her seven
subsystems.
- Also relied on the system theory and used
concepts and definitions from Rapport, Chin, von
Bertalanffy, and Buckley.

OVERVIEW
- First proposed in 1968
- Advocates the fostering of the efficient and
PROPOSITIONS effective behavioral functioning of the patient to
- Nursing actions promote effective adaptive prevent illness.
responses by the patient. - The patient is defined as a behavioral system
- Nursing actions decrease ineffective adaptive composed of seven behavioral subsystems.
responses. - Each subsystem consists of four structural
- Nursing actions modify the stimuli so that the characteristics.
person can adapt. - An imbalance in each result in disequilibrium.
- A nurse's role is to help the patient maintain their
NURSING PROCESS equilibrium.
1. Assessment of behavior 4. Goal setting
2. Assessment of stimuli 5. Intervention METAPARADIGM
3. Nursing diagnosis 6. Evaluation Nursing
- Goal is to maintain and restore an individual’s
ASSUMPTIONS behavioral systems balance through imposing
- The person is able to adapt. temporary regulatory or control mechanisms
- Adaptation occurs when the person is able to through resources.
respond to changes in the environment. Person
- Positive adaptation means returning to health. - A behavioral system with patterned, repetitive,
and purposeful ways of behaving that links the
BEHAVIORAL SYSTEMS MODEL: Dorothy E. person to the environment.
Johnson Health
- Elusive, dynamic state influenced by biological,
THE THEORIST psychological and social factors.
- born on August 21, 1919 in Savannah, Georgia Environment
- BSN Degree from Vanderbilt University in Nashville, - Factors that are not part of a person’s behavioral
Tennessee (1942) system but have influence on the behavioral
- Master of Public Health Degree on Harvard University system.
in Boston (1948)
- professional experience: mostly teaching

16 | Theoretical Foundations in
GOALS OF NURSING - The behavioral system attempts to achieve balance
- To assist the patient whose behavior is proportional to by adapting to internal and environmental stimuli.
social demands. - The behavioral system manages its relationship
- To assist the patient who is able to modify his behavior with its environment. The nurse is external to and
in ways that it supports biological imperatives. interactive with the behavioral system.
- To assist the patient who is able to benefit to the fullest - Incorporation of the nursing process.
extent during illness from the physician’s knowledge
and skill. THE SEVEN SUBSYSTEMS
- To assist the patient whose behavior does not give 1. Attachment or Affliative
evidence of unnecessary trauma as a consequence of - Survival and security
illness. - Consequences are social inclusion, intimacy,
and formation and maintenance of a strong
social bond.
2. Dependency
- Promotes helping behavior that calls for a
nurturing response.
- Consequences are approval, attention, or
recognition and physical assistance.
- A certain amount of interdependence is
essential for the survival of social groups.
3. Ingestive
- “Has to do with when, what, how much, and
under what conditions we eat”
- Function of appetitive satisfaction
- Associated with social, psychological, and
biological considerations.
4. Eliminative
- “When, how, and under what conditions we
eliminate”
- As with ingestive subsystem, the social and
THEORETICAL SOURCES psychological factors are viewed as
- Each of the 7 subsystems gas the same 3 functional influencing the biological aspects of this
requirements: protection, nurturance, stimulation. subsystem and may be, at times, in conflict
- These functional requirements must be met through with the eliminative subsystem.
the person’s own efforts, or with the outside 5. Sexual
assistance of the nurse. - Functions of procreation and gratification
- For the subsystems to develop and maintain - Courting and mating
stability, each must have a constant supply of - Begins with the development of gender role
functional requirements that are usually supplied by identity and includes the broad range of sex
the government. role behaviors.
- During illness or when the potential for illness
poses a threat, the nurse may become a source of 6. Aggressive-Protective
functional requirement. - Protection and preservation
- Aggressive behavior is not only learned but
THEORETICAL ASSERTIONS has primary intent to harm others.
- The response by the subsystems are developed - Society demands that limits be placed on
through motivation, experience, and learning and modes of self-protection and that people and
are influenced by biological, psychological, and their property be respected and protected.
social factors.

17 | Theoretical Foundations in
7. Achievement EFFECTIVE COMMUNICATION CAUSES
- Attempts to manipulate the environment. NURSE TO TAKE ON NUMEROUS ROLES:
- Control or mastery of an aspect of self or - Stranger - Teacher - Surrogate
environment to some standard excellence - Resource person - Leader - Counselor
- Intellectual, physical, creative, mechanical, - Technical expert
and social skills.
METAPARADIGMS
NURSING PROCESS Nursing
- Identification of the source of the problem in the - A significant therapeutic process.
system leads to appropriate nursing action that - It functions cooperatively with other human
results in the maintenance or restoration of processes that make health possible for individuals
behavioral system balance. in communities.
- Nursing interventions can be in such general forms Human
as: repairing structural units, temporarily imposing - An organism that thrives in its own way to reduce
external regulatory or control measures, supplying tension generated by needs.
environmental conditions or resources, providing - The client is an individual with felt and need.
stimulation to the extent that any problem can be Health
anticipated, and preventive nursing action is in
- Word symbol that implies forward movement of
order.
personality and other ongoing human processes in
the direction of creative, productive, personal and
community living.
Environment
THEORY OF INTERPERSONAL
- Existing forces outside the organism and in the
RELATIONSHIP: Hildegard Peplau
context of culture.

THERAPEUTIC RELATIONSHIP
- A professional and planned relationship between
the patient and nurse that focuses on the patient’s
needs, feelings, concepts, and ideas.
- Nursing involves interaction between two or more
individuals with a common goal.
- The attainment of this goal or any goal is achieved
through a series of steps following a sequential
pattern.
The first model to suggest that nurse and patient acts
as partners to initiate change rather than the patient PHASES OF NURSE-PATIENT RELATIONSHIP
passively receiving treatment and the nurse simply
acting on orders from the physician. 1. Orientation
- Problem defining phase
- Starts when the client meets the nurse as a
ASSUMPTIONS
stranger.
- The nurse and patient can interact.
- Defining problems and deciding what type of
- Both the patient and nurse mature as the result of
service needed.
the therapeutic interaction.
- Client seeks assistance, conveys needs, asks
- Communication and interviewing skills remain
questions, shares preconceptions and
fundamental nursing tools.
expectations of past experiences.
- Nurses must clearly understand themselves to
- Nurse responds, explains roles to clients, helps to
promote their client’s growth and to avoid limiting
identify problems and to use available resources
client’s choices to those that nurses value.
and services.
- Get acquainted phase
- Parameters are established and met

18 | Theoretical Foundations in
 - Early levels of trust are developed
- Roles begin to be understood.
2. Identification
- Selection of appropriate professional assistance
- Patient begins to have a feeling of belonging and
capability of dealing with the problem which
decreases the feeling of helplessness and
hopelessness.
- The client begins to identify the problems to be
worked on within the relationship.
- The goal of the nurse is to help the patient
recognize their own interdependent/participation
role and promote responsibility for self.
3. Exploitation
- Use of professional assistance for problem
solving alternatives.
- Advantages of services are used based on the
needs and interests of the patient.
- Individual feels as an integral part of the helping
environment
- They may make minor requests or attention
getting techniques. HUMAN-TO-HUMAN RELATIONSHIP THEORY:
- The principles of interview techniques must be Joyce Travelbee
used in order to explore, understand and
adequately deal with the underlying problems.
- Patient may fluctuate on independence
- Nurse must be aware about the various phases of
communication
- Nurse aids the patient in exploiting all avenues of
help and progress is made towards the final step.
- Client’s trust of the nurse reached full potential.
- Client making full use of nursing services.
- Solving immediate problems.
- Identifying and orienting self to discharge goals.
4. Resolution
- Client met needs
- Mutual termination of relationship
- Sense of security is formed
- Patient is less reliant on the nurse
- Increased self reliance to with the their own
problems
- The patient gradually puts aside old goals and
adapts new goals. This is a process in which the
patient frees himself from identification with the OVERVIEW
nurse. - Used human because it is unique and equivalent
- Caring, in the human-to-human relationship
model, involves the dynamic, reciprocal,
interpersonal connection between the nurse and
patient, developed through communication and the

19 | Theoretical Foundations in
 mutual commitment to perceive self and others as Empathy
unique and valued. - The nurse begins to see the individual ‘beyond outward
- Through the therapeutic use of self and the behavior and sense accurately another’s inner experience
integration of evidence-based knowledge, the at a given point in time’,
nurse provides quality patient care that can foster - Empathy enables the nurse to predict what the person
the patient’s trust and confidence in the nurse. is experiencing and requires acceptance, as empathy
- The human-to-human relationship ‘refers to an involves the ‘intellectual and emotional comprehension
experience or series of experiences between the of another person’.
human being who is a nurse and an ill person’, Sympathy
culminating in the nurse meeting the ill person’s - A demonstration to the person that he is not carrying
unique needs. the burden of illness alone.
- All human beings endure suffering, though the - Trust develops between the nurse and person in the
experience of suffering differs from one individual phase of sympathy, and the person’s distress is
to another. diminished.
- Hope helps the suffering person to cope and it is Rapport
an assumption of Travelbee’s (1971) that “the - A process of happening, and experience, or series of
role of the nurse is to assist the ill person to experiences, undergone simultaneously by the nurse and
experience hope in order to cope with the stress of the recipient of care.
illness and suffering”. - Composed of a: cluster of interrelated thoughts and
- Nursing care, according to Travelbee (1971), is feelings, interest in and concern for others, empathy,
delivered through five stages: observation, compassion, and sympathy, a non-judgemental attitude
interpretation, decision-making, action or nursing and respect for each individual as a unique human being.
intervention, appraisal or evaluation. - Through the establishment of rapport, the nurse is able
- The goals of communication in the nursing to foster a meaningful relationship with the ill person
process are: to know the person, to ascertain and during multiple points of contact in the care setting.
meet the nursing needs of ill person, and to fulfill
the purpose of nursing

5 PHASES OF HUMAN-TO-HUMAN
NURSING PROCESS THEORY: Ida Jean Orlando
RELATIONSHIP

Original Encounter
- The nurse and ill person form judgements about each - She was one of the first nursing leaders to identify
other that will guide and shape future nurse-person and emphasize the elements of the nursing process
interactions. and the critical importance of the patient’s
Emerging Identities participation in the nursing process.
- A bond begins to form between nurse and person as
each individual begins to ‘appreciate the uniqueness of OVERVIEW
the other’. - Finding out and meeting the patient’s immediate
needs for help.

20 | Theoretical Foundations in
- Practice should be based on needs of the patient - Human beings are able to be secretive or explicit
and that communication with the patient is essential about their needs, perceptions, thoughts and
to understanding needs and providing effective feelings.
nursing care. - The nurse-patient situation is dynamic, actions and
- Orlando’s theory stresses the reciprocal relationship reactions are influenced by both the nurse and the
between patient and nurse. What the nurse and the patient.
patient say and do affects them both. - Human beings attach meanings to situations and
- Focuses on how to produce improvement in the actions that are not apparent to others.
patient’s behavior. - Nurses are concerned with needs that patients
- Development of nurses as logical thinkers. cannot meet on their own.

NURSING PROCESS

METAPARADIGM
Nursing
THEORY OF CULTURE CARE DIVERSITY AND
- Process of care in an immediate experience for
UNIVERSALITY: Madeleine Leininger
avoiding, relieving, diminishing or curing the
individuals sense of helplessness.
- Goal of nursing is to increase sense of well-being,
increase in ability, adequacy in better care of self,
and improvement in patients’ behavior.
Human
- Developmental beings with needs.
- Individuals have their own subjective perceptions
and feelings that may not be observable directly.
Health OVERVIEW
- Sense of adequacy or well-being. - Culture care diversity and universality theory was
- Fulfilled needs. first introduced in the 1960s to provide culturally
- Sense of comfort. congruent and competent nursing care.
Environment - Developed to establish a substance knowledge
- Not defined directly. based to guide nurses in discovery and use of
transcultural nursing practices.
ASSUMPTIONS - During the post-World War II period, Dr.
- Persons become patients who require nursing care Leininger realized nurses would need transcultural
when they have needs for help that cannot be met knowledge and practices to function with people
independently. of diverse cultures worldwide.
- Patients experience distress or feelings of
helplessness as the result of unmet needs for help.
- When individuals are able to meet their own needs,
they do not feel distress and do not require care
from a professional nurse.

21 | Theoretical Foundations in
 - Culturally based care is the most comprehensive
and holistic means to know, explain, interpret, and
predict nursing care phenomena and to guide
nursing decisions and actions.
- Transcultural nursing is a humanistic and scientific
care discipline and profession.
- Culturally based caring is essential to curing and
Transcultural Nursing - comparative study of cultures healing.
to understand similarities (culture universal) and - Culture care concepts, meanings, expressions,
difference (culture-specific) across human groups. patterns, processes, and structural forms of care
Culture - the learned, shared, and transmitted values, vary transculturally with diversities (differences)
beliefs, norms, and lifeways of a particular group that and some universalities (similarities).
guides their thinking, decisions, and actions in patterned - Beneficial, healthy and satisfying culturally based
ways. care influences the health and well-being of
Care - abstract and concrete phenomena related to individuals, families, groups, and communities
assisting, supporting, or enabling experiences toward or within their environmental contexts.
for others with evident or anticipated care needs to - Culturally congruent and beneficial nursing care
ameliorate or improve a human condition or lifeway. can occur only when care values, expressions, or
- ‘Caring’ refers generally to care actions and patterns are known and used explicitly for
activities. appropriate, safe, and meaningful care.
Culture Care Diversity - variability and/or differences - Culture care differences and similarities exist
in meanings, patterns, values, lifeways, or symbols of between professional and client-generic care in
care within or between cultures that demonstrate human cultures worldwide.
assistive, supportive, or enabling human care Person
expressions. - Every human culture has generic care knowledge
Culture Care Universality - common, similar, or and practices and usually professional care
dominant uniform care meaning, patterns, values, knowledge and practices, which vary
lifeways, or symbols that manifest with cultures and transculturally and individually.
reflect assistive, supportive, facilitative, or enabling - Culture care values, beliefs, and practices are
ways to help people. influenced by and tends to be embedded in the:
Culture Shock - state of being disoriented or unable to worldview, language, philosophy, religion (and
respond to a different cultural environment because of spirituality), kinship, social, politics, legal,
its sudden strangeness, unfamiliarity, and educational, economic, technological,
incompatibility to the stranger’s perceptions and ethnohistorical, and environmental contexts of
expectations is differentiated from others by symbolic cultures.
markers (cultures, biology, territory, religion). Health
Culturally Congruent Care - care that fits the people’s - Beneficial, healthy and satisfying culturally based
valued life patterns and set of meanings. care influences the health and well-being.
Culturally Competent Care - ability of the practitioner - Culturally congruent and beneficial nursing care
to bridge the cultural gaps in caring, work with cultural can occur only when care values, expressions, or
differences and enable clients and families to achieve patterns are known and used explicitly for
meaningful and supportive caring. appropriate, safe, and meaningful care.
Environment
METAPARADIGM & ASSUMPTIONS - Cultural conflicts, cultural impositions practices,
Nursing cultural stresses, and cultural pain reflects the lack
- Care is the essence of nursing. of cultural care knowledge to provide culturally
- Culturally based care is essential for well-being, congruent, responsible, safe, and sensitive care.
growth, and survival, and to face handicaps or even - The ethnonursing qualitative research method
death. provides an important means to accurately discover
and interpret local and universal values.

22 | Theoretical Foundations in
 CORE, CARE, CURE MODEL: Lydia Hall

METAPARADIGM
Nursing
- It is helping others to move in the direction of self-
awareness.
- Nursing is identified as consisting of participation
in the care, core, and cure aspects of patient care.
Person
- It is composed of three elements: body, disease, and
person.
CONCEPTS: - The focus of nursing care.
- The health concepts held by many cultural groups Health
may result in people choosing not to seek modern - It is the state of being able to achieve self-
medical treatment procedures. awareness thereby releasing their own power to
- Healthcare providers need to be flexible in the heal.
design of programs, policies, and services to meet Environment
the needs and concerns of the culturally diverse - It is the hospital services that are organized to
population, groups that are likely to be accomplish tasks efficiently.
encountered. - The concept of society or environment is dealt with
- The use of traditional or alternate models of in relation to the individual.
healthcare delivery is widely carried and may come
into conflict with western models of healthcare
practice.
NURSING DECISION
- The decision and action modes to achieve culturally
congruent care are: cultural preservation or
maintenance, cultural care accommodation, cultural
care repatterning or restructuring.

23 | Theoretical Foundations in
MAJOR CONCEPTS 21 NURSING PROBLEMS THEORY: Faye G.
- A nurse functions in all three circles but to different Abdellah
degrees.
- Nurses also share the circles with other healthcare THE THEORIST
providers. - Dissertation focused on improving clinical teaching
CORE: THE PERSON (Therapeutic use of self; in nursing (1955).
Social Sciences) - She developed a clinical evaluation tool for
- Represents the inner feelings and management of undergraduate nursing programs.
the person. - Nursing had to develop a strong scientific base in
- The core has goals set by himself rather than by any order to gain professional status.
other person, and behaves according to his feelings - Classified medical diagnoses into 58 categories
and values. representing nursing problems.
- This involves the therapeutic use of self, and is - Typology of 21 Nursing Problems.
shared with other members of the health team.
- Example: The nurse addresses the social and METAPARADIGM
emotional needs of the patient for the effective Nursing
communication and a comfortable
- Nursing care is doing something to or for the
environment.
person or providing information to the person with
CARE: THE BODY (Innate Bodily Care; Natural and the goals of meeting needs, increasing or restoring
Biological Sciences) self-help ability, or alleviating impairment.
- Represents the patient’s body. Person
- The care circle defines the primary role of the - Abdellah describes people as having physical,
professional nurse such as providing bodily care for emotional, and sociological needs.
the patient and helping the patient complete such
- Patients are described as the only justification for
basic daily biological functions.
the existence of nursing.
- When providing this care, the nurse’s goal is the - Individuals (and families) are the recipients of
comfort of the patient. nursing.
- Example: The nurse gives hands on bodily Health
care to the patient in relation to activities of
- The dynamic pattern of functioning whereby there
daily living such as toileting and bathing.
is a continued interaction with the internal and
CURE: THE DISEASE (Seeing the patient and external forces that results in the optimal use of
family through medical care; Pathologic and necessary resources that serve to minimize
Therapeutic Sciences) vulnerabilities.
- These are the interventions or actions geared
Environment
toward treating the patient for whatever illness or
- Home or community from which the patient comes.
disease they are suffering from.
- During this aspect of nursing care, the nurse is an
MAJOR CONCEPTS
active advocate of the patient.
- Abdellah’s model or nursing was progressive for
- Example: the nurse applies medical
the time in that it refers to a nursing diagnosis
knowledge to treatment of the patient.
during a time in which nurses were taught that
diagnoses were not part of their role in health care.
ASSUMPTIONS
- The theory has combined the concepts of health,
- Human beings have the capacity to decide on their
nursing problems, and problem solving.
behalf.
- Problem-solving is an activity that is inherently
- Nursing should be done only by a professional and
logical in nature.
educated nurse.
- The framework focuses on nursing practice and
- Core followed by Care should be the most
individual patients.
dominant circle in the practice of nursing.

24 | Theoretical Foundations in
 - The needs of patients are divided into four
categories:
- Basic to all Needs
- Sustenal Care Needs
- Remedial Care Needs
- Restorative Care Needs

10 STEPS TO IDENTIFY THE PROBLEM

1. Learn to know the patient.
2. Sort out relevant and significant data.
3. Make generalizations about available data in
relation to similar nursing problems presented by
other patients.
4. Identify the therapeutic plan.
5. Test generalizations with the patient and make
additional generalizations.
6. Validate the patient’s conclusions about his nursing
problems.
7. Continue to observe and evaluate the patient over a
period of time to identify any attitudes and clues
affecting his behavior.
8. Explore the patient’s family’s reaction to the
therapeutic plan and involve them in the plan.
9. Identify how the nurses feel about the patient’s
nursing problems.
10. Discuss and develop a comprehensive nursing care
plan.

11 SKILLS IN DEVELOPING NURSING CARE

PLAN

21 NURSING PROBLEMS
- The 21 nursing problems fall into three categories:
- Physical, sociological, and emotional needs of
patients
- Types of interpersonal relationships between
the patient and nurse.
- Common elements of patient care.

25 | Theoretical Foundations in
THEORETICAL ASSERTIONS THEORY OF PLANNED CHANGE: Kurt Lewin
- The nursing problem and nursing treatment
typologies are principles of nursing practice and THE THEORIST
constitute the unique body of knowledge that is - A German psychologist
nursing. - Proposed a method of planned change which is
- Correct identification of the nursing problem controlled change or change by design.
influences the nurse’s judgement in selecting steps
in solving the patient’s problem. OVERVIEW
- The core of nursing is patient/client problems that - Lewin described a method in his field theory that
focus on the patient and their problems. provides a basis for considering the process of
planned change.
- Planned change occurs by design, as opposed to
change that is spontaneous or that occurs by
HIERARCHY OF NEEDS: Abraham Maslow
instance or by accident.
- When Lewin’s process is used correctly in its
THE THEORIST
entirety by a group or a system, effective change
is implemented.

CONCEPTS
- Lewin describes effective change as the return to
equilibrium as a result of balancing opposing
forces.
HIERARCHY OF NEEDS Field
- Maslow’s hierarchy of needs is a motivational - A field can be viewed as a system
theory in psychology comprising a five-tier model - When change occurs in one part or aspect of the
of human needs. system, the whole system must be examined to
- Maslow (1943, 1954) stated that people are determine the effect of that change.
motivated to achieve certain needs and that some Force
needs take precedence over others. - Directed entity that has the characteristics of
- Maslow noted that the order of needs might be direction, focus, and strength.
flexible based on external circumstances or - Lewin states that change is a move from the status
individual differences. quo that results in a disruption in the balance of
- For example, he notes that for some individuals, the forces or disequilibrium between opposing factors.
need for self-esteem is more important than the 2 Forces
need for love. For others, the need for creative Driving Force - encourages or facilitates
fulfillment may supersede even the most basic movement to a new direction, goal or
needs. outcome.
- Human beings are motivated by a hierarchy of - It should be identified and accentuated.
needs. Restraining Force - block or impede progress
towards the goal.
- It should also be identified and
minimized to achieve the desired
outcome or change.

26 | Theoretical Foundations in
3 PHASES OF PLANNED CHANGE - Critical difference between Erikson and Freud is
that Erikson places much less emphasis on the
sexual urges and far more emphasis on social and
cultural influences than that Freud did.
- During each of Erikson’s stages, there is a
psychological conflict that must be successfully
overcome in order for a child to develop into a
healthy, well-adjusted adult.

1. Unfreezing ERIKSON’S STAGE OF DEVELOPMENT

- Individuals involved must be informed of the
need for change and should agree that change is
needed.
- Change, particularly in the work environment,
often leads to feelings of uneasiness, uncertainty,
and loss of control.
- Change, just for the sake of change, is viewed by
most individuals as stressful and unnecessary.
2. Change/Movement
- Driving forces should exceed restraining forces.
- The initiator of the change, the change agent,
should recognize that change takes time, should
be accomplished gradually, and should be Trust vs. Mistrust
thoughtfully and comprehensively planned - Infants until 1 year
before implementation. - Infants must learn to trust others to care for their
3. Refreezing basic needs.
- Stabilization occurs. - If caregivers are rejecting inconsistent, the infant
- If stabilization is successful, the change is may view the world as a dangerous place filled
assimilated into the system. with untrustworthy and unreliable people.
- Change disrupts the comfort of the status quo; it - The primary caregiver is the key social agent.
leads to disequilibrium. Therefore, resistance to Autonomy vs. Shame & Doubt
change should always be anticipated and - Infant until 3 years of age
expected. - Children must learn to be ‘autonomous’ - to feed
and dress themselves, to look after and doubt their
own hygiene, and so on.
- Failure to achieve this independence may force
THEORY OF PSYCHOSOCIAL DEVELOPMENT: the child to doubt his or her own abilities and feel
Erik Erikson ashamed.
- Parents are the key social agents.
KEY POINTS Initiative vs. Guilt
- Erik Erikson (1902-1994) was a stage theorist - 3 to 6 years of age
who took Freud’s controversial psychosexual - Children attempt to act grown up and will try to
theory and modified it into an eight-stage accept responsibilities that are beyond their
psychosocial theory of development. capacity to handle.
- During each of Erikson’s eight development - They sometimes undertake goals or activities that
stages, two conflicting ideas must be resolved conflict with those of parents and other family
successfully in order for a person to become a members, and these conflicts may make them feel
confident, contributing member of society. guilty.
- Failure to master these tasks leads to feelings of - Successful resolution of this crisis requires a
inadequacy. balance: the child must retain a sense of initiative

27 | Theoretical Foundations in
 and yet learn not to impinge on the rights, Ego Integrity vs. Despair
privileges, or goals of others. - Old age
- The family is the key social agent. - The older adult looks back at life, viewing it as
Industry vs. Inferiority either a meaningful, productive, and happy
- 6 to 12 years of age experience or a major disappointment full of
- Children must master important social and unfulfilled promises and unrealized goals.
academic skills. - One’s life experiences, particularly social
- This period when the child compares themselves experiences, determine the outcome of this final
with peers. life crisis.
- If sufficiently industrious, children acquire the
social and academic skills to feel self-assured.
- Failure to acquire these important attributes leads
to feelings of inferiority. PSYCHOSEXUAL THEORY: Sigmund Freud
- Significant social agents are teachers and peers.
Identity vs. Role Confusion THE THEORIST
- 12 to 20 years of age - Sigmund Freud (1856-1939) was a theorist who
- This is the crossroad between childhood and had a great impact on Western thought.
maturity. - Freud’s theory states that maturation of the sex
- The adolescent grapples with the question ‘Who instinct underlies stages of personality
am I?’ development, and that the manner in which
- Adolescents must establish basic social and parents manage children’s instinctual impulses
occupational identities, or they will remain determines the traits that children display.
confused about the roles they should play as
adults. 3 COMPONENTS OF PERSONALITY
- The key social agent is the society of peers. Id
Intimacy vs. Isolation - Only the Id is present at birth
- 20 to 40 years of age - Animalistic and childish desires and no values.
- The primary task at this stage is to form strong - Operates on pleasure principle, to gain pleasure
friendships and to achieve a sense of love and and avoid pain.
companionship (or a shared identity) with another - Immediate satisfaction
person. - I want it, and I want it right now!
- Feelings of loneliness or isolation are likely to Example: When hungry or wet, young infants
result from an inability to form friendships or an fuss and cry until their needs are met.
intimate relationship. Ego
- Key social agents are lover, spouses, and close - Conscious, rational component of the personality
friends (of both sexes). that reflects the child’s emerging abilities to
Generativity vs. Stagnation perceive, learn, remember, and reason.
- 40 to 65 years of age - Reality principle
- At this stage adults face the tasks of becoming - Responsible for dealing with reality.
productive in their work and raising their families - Exists in the conscious mind.
or otherwise looking after the needs of young - As egos mature, children become better at
people. controlling their irrational Ids and finding
- These standards of ‘generativity’ are defined by appropriate ways to gratify their needs.
one’s culture. Superego
- Those who are unable or unwilling to assume - Develops from 5 to 6.
these responsibilities become stagnant and self- - Opposite of the Id.
centered. - Operates on moral principle.
- Significant social agents are the spouse, children, - Differentiate between good and bad.
and cultural norms. - If we follow it, we feel proud and if not, we feel
guilt.

28 | Theoretical Foundations in
 Latency (6-12 yrs of old)
- Sexual instincts subside, and children begin to
further develop the superego, or conscience.
- Children begin to behave in morally acceptable
ways and adopt the values of their parents and
other important adults.
Genital (12+ yrs old)
- Sexual impulses reemerge.
- If other stages have been successfully met,
adolescents engage in appropriate sexual behavior,
which may lead to marriage and childbirth.

KEY POINTS
- Each stage of psychosexual development must be
met successfully for proper development.
- If we lack proper nurturing and parenting during a
stage, we may become stuck in, or fixated on, that
stage.
- Freud’s psychosexual theory has been seriously
criticized for the past few decades and is now
considered largely outdated.

Oral (0-1yr old)

- Mouth is the pleasure center for development.
- Freud believed this is why infants are born with a MORAL DEVELOPMENT THEORY: Lawrence
sucking reflex and desire their mother’s breasts. Kohlberg
- If a child’s oral needs are not met during infancy, THE THEORIST
they may develop negative habits such as nail - Lawrence Kohlberg was, for many years, a
biting or thumb sucking to meet this basic need. professor at Harvard University.
Anal (1-3yrs old) - He started as a developmental psychologist and
- Toddlers and preschool-aged children begin to then moved to the field of moral education.
experiment with urine and feces.
- The control they learn to exert over their bodily OVERVIEW
functions is manifested in toilet-training. - One must progress through the stages in order,
- Improper resolution of this stage, such as parents and one cannot get to a higher stage without
toilet-training their children too early, can result in passing through the stage immediately preceding
a child who is uptight and overly obsessed with it.
order. - Kohlberg assumes that each succeeding stage
Phallic (3-6yrs old) evolves from and replaces its predecessor, once
- Preschoolers take pleasure in their genitals and, the individual has attained a higher stage of moral
according to Freud, begins to struggle with sexual reasoning, he or she should never regress to earlier
desires toward the opposite sex parent. (boys to stages.
their mothers and girls to their fathers
- Electra Complex is a girl's desire to replace her
mother and sees her as a rival.
- Oedipus Complex is a boy’s desire to replace their
father and sees him as a rival.
- Castration Anxiety - the fear of a child to be
punished by feeling the desire to replace their
father/mother.

29 | Theoretical Foundations in
 Level 3: Post-Conventional Morality
- A person at his highest level of moral reasoning
defines right and wrong in terms of broad
principles of justice that could conflict with
written laws or with the dictates of authority
figures.
- Morally right and legally proper are not always
one and the same.
- Most people take their moral views from those
Level 1:Preconventional Morality around them and only a minority thinks through
- Rules are truly external to the self rather than ethical principles for themselves.
internalized. Stage 5: The Social-Contract Orientation
- The child conforms to rules imposed by authority - The individual becomes aware that while rules
figures to avoid punishment or obtain personal and laws might exist for the good of the greater
rewards. number, there are times when they will work
- Morality is self-serving; what is right is what one against the interest of particular individuals.
can get away with or what is personally Stage 6: Morality of Individual Principles of Conscience
satisfying. - People at this stage have developed their own set
- The reasoning is based on the physical of moral guidelines which may or may not fit the
consequences of actions. law.
Stage 1: Punishment and Obedience Orientation
- The child/individual is good in order to avoid
being punished. If a person is punished, they
must have done something wrong. COGNITIVE DEVELOPMENT THEORY:Jean
Stage 2: Naive Hedonism Piaget
- Children recognize that there is not just one right THE THEORIST
view that is handed down by the authorities. - A swiss scholar who began to study intellectual
Different individuals have different viewpoints. development during the 1920s.
Level 2: Conventional Morality - Focused on the growth of children’s knowledge
- The individual now strives to obey rules and and reasoning skills.
social norms in order to win others’ approval or - Had three children whom he studied infancy.
to maintain social order.
- Social praise and the avoidance of blame have COGNITIVE DEVELOPMENT
now replaced tangible rewards and punishments - Refers to the manner in which people learn to
as motivation of ethical conduct. The think, and use language. It involves a person’s
perspectives of other people are clearly intelligence, perceptual skills, and the ability to
recognized and given careful consideration. process information.
- Children continue to accept the rules of authority - Piaget believed that children are naturally
figures, but this is now due to their belief that curious explorers who are constantly trying to
this is necessary to ensure positive relationships make sense of their surroundings.
and societal order. THE SCIENCE OF CHILDCARE
Stage 3: ‘Good Boy’ or ‘Good Girl’ Orientation
- The individual is good in order to be seen as
being a good person by others. Therefore,
answers relate to the approval of others.
Stage 4: Social Order Maintaining Morality
- The individual becomes aware of the wider rules
of society so judgement concerns obeying the
rules in order to uphold the law and to avoid
guilt.

30 | Theoretical Foundations in
 - Egocentric thinking wherein children have
inability to see a situation from another person’s
point of view.
Concrete Operational Stage
- Children are no longer fooled by appearances.
- They are becoming much more proficient at
inferring motives by observing others’ behavior
and the circumstances in which it occurs.
- It marks the beginning of logical or operational
thought. The child can work things out internally
in their head.
Schema - mental model of the world. The basic building Formal Operational Stage
block of intelligent behavior. A set of linked mental - Adolescent’s cognitive operations are reorganized
representations of the world, which we use both to in a way that permits them to operate on
understand and to respond to situations. operations (think about thinking).
Assimilation - using the existing schema to deal with a - Think more about moral, philosophical, ethical,
new object or situation. Adding new experiences. social and political issues that require theoretical
Accommodation - happens when the existing schema and abstract reasoning and test their hypothesis.
does not work, and needs to be changed to deal with a
new object or situation.
Equilibration - the force which moves development
along. Occurs when a child’s schemas can deal with
most new information through assimilation.

Sensorimotor Stage
- Infants use sensory and motor capabilities to
explore and gain basic understanding of the
environment.
- Infants ‘think’ by means of their senses and motor
actions.
- Infants continually touch, manipulate, look, listen
to, and even bite and chew objects.
- Object Permanence is the ability to know that an
object still exists even if it's hidden.
Preoperational Stage
- Children use symbolism (images and language) to
represent and understand various aspects of the
environment.
- Children become imaginative in their play
activities.

31 | Theoretical Foundations in