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TFN REVIEWER
Topic I: Relevant Terminologies
What is concept?
- Symbolic statement describing a
phenomena or a group of phenomena
- Formulated in words to be able to
communicate meanings about realities
in the world or give meaning to
phenomena that can be directly seen or
indirectly seen, heard, tasted, smelled
or touched.
Types of concept:
a. Abstract (hope, love, desire)
b. Concrete (Airplane, temperature,
weight)
Formulation:
1. Word – grief, empathy
2. Two words – patient’s satisfaction,
caring nurse, excellent performance
3. Phrases – maternal-child bonding,
health promoting practices, care
competency standards, advance nursing
practices
Categories:
1. Variable (continuous)
o Has concepts that describe
phenomena according to same
dimensions permits,
classification or graduation of
phenomena
o Ex. Blood pressure (has
calibration), pain (intensity)
o Includes sex-role orientation,
level of well-being and degree
of cultural identity. Hope,
quality of life, need of
fulfillment and grief are defined
operationally and measured by
tools or scales to show where
the respondents’ level or
variable fell.
2. Non-Variable (Discrete)
o Concept that identifies
categories of phenomena
o Ex. Gender, Ethnic Background
Can be answered by a
yes or no
o Occupation – job or career
o Profession – learned vocation
or an occupation with a
knowledge base, has superiority
within a division of work.
o “All professions are
occupations, but not all
occupations are considered
professions” (Shurlan, 1988)
History - considered professions before are
medicine, lawyer and priesthood.
Characteristics of profession:
1. Power – with authority over teaching
and occupation
o Core Competency
Knowledge (HEAD)
Skills (HAND)
Attitude (HEART)
2. Registration (PRC)
3. Autonomy – has its own discipline in
healing; collaborates with physicians
4. Code of Ethics
5. Lengthy Socialization
Sources of Concepts:
1. Naturalistic - Seen in nature or in
nursing practice such as body, weight,
thermoregulation, hermatologic
complications, pain and spirituality
2. Research based – result of conceptual
development that is grounded in
research processes through *qualitative
phenomelogical or grounded theory
approaches
*qualitative (lived out)
5 Areas of Well-being
1. Physical
2. Emotional
3. Mental
4. Social
5. Spiritual
History Perspective of Theory Development
- Nursing Theory
- Florence Nightingale envisioned nurses
to be educated nurses
- Her vision established home of nursing
at St. Thomas hospital in London
- 20th century nursing (start of modern
nursing began with strong emphasis on
practice
Historical Sketch
Research Era
- Nurses started to participate in
scientific works
- This course started to be introduced
and integrated in the nursing
curriculum
Graduate Education Era
- From Bachelor of Science to Master’s
Program
- Nursing models and nursing theory
course
Theory Era
- Contemporary phase where the
emphasis is on theory based nursing
practice and theory developments
- Awareness that nursing is a profession
- Nursing knowledge is distinct from
medical knowledge
What is Theory?
- System of interrelated propositions
used to predict, explain, understand
and control a part of the empirical
world (Adam, 1985)
- Ex. Of theories
1. Nursing
2. Non – Nursing
Non – Nursing Theories
1. System – abstract organization of
phenomena
2. Learning – behavior; controlled
environment
3. Social – frameworks of empirical
evidence
Theories from Sociologic Science
1. General Systems Theory – grandest of
grand theory because universal theory
elegancy and applicability; capability to
interact
o Elements of the System
1. Input – received from environment
2. Throughput – modified or
transformed in the system
3. Output – released
4. Feedback – responses
2. Role Theory – attracted to positions,
status and social organizations.
3. Conflict Theory – conflict in negotiation;
social problems
4. Feminist Theory – Gender difference;
exploitation of women
5. Interpersonal theory – individuals
cannot exist alone
6. Stress theory – stress is inevitable
7. General adaptation theory – 3 stages
(Alarm, resistance and exhaustion)
Nursing Theories
1. Practice Theory (Micro)
o Prescriptive; situational
o Required to do
2. Mid – Range
o Moderately abstract
o Concepts that are measurable
o Testable hypothesis
3. Grand theory (Macro)
o Most complex and broadest in
scope
o Self-care
4. Metatheory
o Theory about theory
Theory Era
Graduate Era
Research Era
Curriculum Era
Feed
bac
k Input
Throughput
Output
Development of Nursing Theory
Major concepts (health, person, nursing
environment) + Key concepts = Nursing Theory
Importance
- Offers structure and organization in
nursing knowledge and provides
systematic means of collecting data
- Describe
- Oral
- Predicting nursing practice
TOPIC 2: Nursing Theorists
Philosophies Nightingale Watson Benner Eriksson
Grand Theories Boykin ad Shoenhofer Newman Parse Benner Fitzpatrick Hall Henderson Johnson King Levine Orem Wiedenbach Travelbee Roy Neuman
Middle Range Theories Orem Peplau Pender Leininger Orlando Swanson
Florence Nightingale – Environmental Theory
a. Person
o Referred to as “the patient”
o Recipient of nursing care
o A human being acted upon by a
nurse , or affected by the
environment
o Has reparative powers to deal
with disease
o Recovery is in the patient’s
power as long as a safe
environment exists
b. Health
o Holistic level of wellness that
the person experiences
o Maintained by using a person’s
healing powers to their fullest
extent
o Maintained by controlling the
environmental factors so as to
prevent disease
o Disease is viewed as a
reparative process instituted by
nature
o Health and disease are the
focus of the nurse
o Nurses help patients through
their healing process
c. Environment
o the foundational component of
Nightingale’s theory
o The external and internal
aspects of life that influence the
person
o Includes everything from a
person’s food to a nurse’s
verbal and non-verbal
interactions with the patient
d. Nursing
o Is essential for everybody’s
wellbeing
o Is having the responsibility for
someone’s health
o Provides women with
guidelines for caring for their
loved ones at home and gives
advice on how to “think like a
nurse”
o Trained nurses however,
applies additional scientific
principles to their work and
more skilled in observing their
patients
Ernestine Weidenbach – Helping Art of Nursing
a. Person
o May be a nurse or a patient
who is endowed with a unique
potential to develop self-
sustaining resources
b. Health (not defined)
c. Environment
o Conglomerate of objects,
policies, settings, atmosphere,
time, human beings,
happenings that are dynamic,
unpredictable, exhilarating,
baffling and disruptive
Research Theory
Practice
d. Nursing
o Is the practice of identifying the
needs of a patient through
observation of symptoms,
behavior of the patient, finding
what causes those symptoms,
assessing if the patient is able
to resolve the discomfort and
determining the need for help
from the nurse or other health
care team
Virginia Henderson – Nursing Need Theory
a. Person
o have basic needs that are
component of health
o Requiring assistance to achieve
health and independence or a
peaceful death
o Mind and body are inseparable
and interrelated or a peaceful
death
o Considers the biological,
psychological, sociological and
spiritual components
o The theory presents the patient
as a sum of parts with
biopsychosocial needs
b. Health
o Definition based on individual’s
ability to function
independently as outlined in
the 14 components
o Nurses need to stress
promotion of health and
prevention and cure of disease
o Good health is a challenge –
affected by age, cultural
background, and emotional
balance and is the individual’s
ability to meet these needs
independently
c. Environment
o Settings in which an individual
learns unique pattern for living
o All external conditions and
influences that affect life and
development
o Individual’s relation to families
o Minimally discusses the impact
of the community on the
individual and family
o Basic nursing care involves
providing conditions under
which the patient can perform
the 14 activities unaided
d. Nursing
o Temporarily assisting an
individual who lacks the
necessary strength, will and
knowledge to satisfy 1 or more
of the 14 basic needs
o Assists and supports the
individual in life activities and
the attainment of
independence
o The nurse is expected to carry
out physician’s therapeutic plan
o Individualized care is the result
of nurse’s creativity in planning
for care
Faye Glenn Abdellah – 21 Nursing Problems
a. Person
o People having physical,
emotional and sociological
needs. These needs may be
overt, consisting of large
physical needs, or covert such
as emotional and social needs
o Patient is described as the only
justification for the existence of
nursing
o Individuals (and families) are
the recipients of nursing
o Health or achieving of it, is the
purpose of nursing services
b. Health
o In patient- centered approaches
to nursing, Abdellah describes
health as a state mutually
exclusive of illness
c. Environment
o Society is included in “planning
for optimum health on local,
state, national and
international levels”. However
as she further delineated her
ideas, the focus of nursing
service is clearly the individual
o The environment is the home
or community from which the
patient comes
d. Nursing
o Is a helping professional
wherein in Abdelleh’s model,
nursing care is doing something
to or for the person or
providing information to the
person with the gals of meeting
needs, increasing or restoring
self-help ability or alleviating
impairment.
o Nursing is broadly grouped into
the 21 nursing problem areas to
guide care and promote use of
nursing judgment
o She considers nursing to be
comprehensive service that is
based on art and science and
aims to help people, sick or
well, cope with their health
needs
Myra Estin Levine – Conservation Model
a. Person
o Whole not only in physical
aspect but also with regards to
psychosociocultural and
spiritual aspects
o Person is a unique individual in
unity and integrity, feeling,
believing , thinking and whole
system of system
b. Health
o Implied to mean unity and
integrity and “is a wholeness
and successful adaptation”
o State of being “whole” not just
the absence of illness or disease
o Determined by the ability to
function in a reasonably normal
manner
o The return to self ; individuals
are free and able to pursue
their own interest within the
context of their own resources
c. Environment
o Composed of all experiences of
the individuals.
o Pertains to the internal
(physiologic) and external
(perceptual, operational and
conceptual) environment
d. Nursing
o Human interaction designed to
promote wholeness through
adaptation
o Nursing care is both supportive
and therapeutic (to achieve
maximum level of adaptation)
o Promote wellness through the
use of four conservation
principles
Jean Watson – Theory of Human Caring
a. Person
o A complex, holistic being; an
evolving soul
o People have value, meaning
o Not an object and cannot be
separated from self, other
nature or the larger universe
b. Health
o Can be defined as the absence
of illness but health can be
obtained even when physical
wholeness cannot be obtained
c. Environment
o Driven by curative/ carative
factors (8 and 9)
o Should be conducive to holistic
healing
o Designed to be comfortable ,
not the typical hospital
environment
o Open system containing both
internal and external variables
that we as caregivers can
manipulate
o Comprised of noise, privacy,
light, access to nature, color,
space and smells that can have
an impact on the caring-healing
process
d. Nursing
o Driven by most of caritas
o “a human science of persons
and human health-illness
experiences that are mediated
by professional, personal,
scientific, esthetic and ethical
human transactions”
o The transpersonal care/
transpersonal relationship is
central to Watson’s theory and
what she calls nurses
Dorothea Orem – Theory of Self Care, Self-
Care Deficit and Theory of Nursing Systems
Theory of Self Care – How and why people care
for themselves
Theory of Self – Care Deficit – Describes and
explains why people can be helped though
nursing
Theory of Nursing Systems – Describes and
explains relationships that must be brought
about and maintained for nursing to be
produced
a. Person
o Man is an integrated WHOLE –
a unity functioning biologically,
symbolically and socially
o Self-reliant and responsible for
self-care and well-being of his
or her dependents and self-care
is a requisite for all
o Man is a logical organism with
rational powers
o A patient is an individual who is
in need of assistance in meeting
specific health-care demands
because of lack of knowledge,
skills, motivation or orientation
b. Health
o State of wholeness or integrity
of the individual human beings,
his part and his modes of
functioning
o This concept is inherent in her
nursing systems since the goal
in each system is optimal
wellness relative to that system
o Responsibility of a total society
and all its members
o A healthy person is likely to
have sufficient self-care abilities
to meet his/her self-care needs
c. Environment
o Encompasses the elements
external to man but she
considered man and
environment as an integrated
system related to self-care
o Environment conditions
conducive to development
d. Nursing
o Service
o Art
o Technology
Nola Pender – Health Promotion Model
a. Person
o Man has the ability to express
human health potential and has
the capacity for reflective self-
awareness, including
assessment of his own
competencies
o The importance of an
individual’s unique personal
factors or characteristics and
experiences will depend on the
target behavior for health
promotion
b. Health
o This model promotes pursuit of
health throughout the lifespan
o Health promotion is defined as
client behavior toward
developing well-being and
actualizing human health
potential
o Health protection is client
behavior geared toward
preventing illness, detecting it
early or maintaining function
c. Environment
o Harmony and balance between
human beings and surroundings
o Individuals are more apt to
perform health promotion
behaviors if they are
comfortable with the
environment versus feeling
alienated
o Safe as well as interesting
d. Nursing
o Nurses make age- specific and
risk-specific recommendations
for clinical preventative services
o Promote wellness by health
promotion education
Dorothy Johnson – Behavioral System Theory
a. Person
o Viewed the person as a
behavioral system with
patterned, repetitive ways of
behaving that link the person
with the environment
o Open system with organized,
interrelated and
interdependent subsystems
b. Health
o Result of the behavioral system
stability, balance and
equilibrium
o Elusive, dynamic state
influenced by biological,
psychological and social factors
o Reflected by the organization,
interaction and integration of
the subsystems of the
behavioral system
c. Environment
o Consists of all the factors that
are not part of the individual’s
behavioral system but that
influence the system
o Attempts to maintain
equilibrium in response to
environmental factors by
adjusting and adapting to the
forces that impinge on it
d. Nursing
o An external force that acts to
preserve the organization and
integration of the patient’s
behavior to an optimal level by
means of imposing temporary
regulatory mechanisms
o A service that is complementary
to medicine but which makes
distinctive contribution to the
health of people
Betty Neuman – Betty Neuman System Model
a. Person
o A total person as a client
system and the person is a
layered multidimensional being
o Each layer consist of five person
variable
b. Health
o Equated to wellness
o Client system moves toward
illness and death when more
energy is needed than is
available
o The client system move toward
wellness hen more energy is
available than is needed
c. Environment
o Internal environment exists
within the client system
o External exists outside the
client system
o The created environment is an
environment that is created
and developed unconsciously of
system wholeness
d. Nursing
o Unique profession with all of
the variables which influence
the response a person might
have to a stressor
o Person is seen as a whole and it
is the task of nursing to address
the person
o Role of nurse is seen in terms of
degree of reaction to stressors
and the use of primary,
secondary and tertiary
interventions
Imogene King – Goal Attainment Theory
a. Person
o Person existing in an open
system as a spiritual being and
rational thinker who makes
choices, selects alternative
courses of action and has the
ability to record to record their
history through their own
language and symbols, unique,
holistic and have different
need, wants and goals
b. Health
o Ability of a person to adjust to
the stressors that the internal
and external environment
exposes to the client
o Minimal use of the potentials
that a person can perform to
achieve balance in one’s health
c. Environment
o Process of balance involving
internal and external
interactions inside the social
system
o External environment is the
factor that exists outside the
boundary of the open system
while the internal environment
is the exact opposite as adapted
by the Neuman’s system model
d. Nursing
o An act wherein the nurse
interacts and communicates
with the client
o Nurse helps the client identify
the existing health condition
o Help the client maintain health
through health promotion,
maintenance, restoration and
caring for the sick and dying
Hildegard Peplau – Theory of Interpersonal
Relations
a. Person
o Developing organism that tries
to reduce anxiety caused by
needs
b. Health
o Word symbol that implies
forward movement of
personality and other ongoing
human processes in the
direction of creative,
constructive and productive,
personal and community living.
c. Environment
o Existing forces outside the
organism
d. Nursing
o Functions cooperatively with
other human process that make
health possible for individuals
communities
Ida Jean Orlando – Deliberative Nursing
Process
a. Person
o An individual in need.
o Unique individual verbally or
non-verbally
o Assumption is that individuals
are at times able to meet their
own needs and at other times
unable to do so.
b. Health
o Being without emotional or
physical discomfort and having
a sense of well-being contribute
to a healthy state
c. Environment
o When there is nurse-patient
contact and that both nurse
and patients perceive, think,
feel and act in the immediate
situation
d. Nursing
o Providing direct assistance to
individuals in whatever setting
they are found for the purpose
of avoiding, relieving,
diminishing or curing the
individual’s sense of
helplessness
Sister Callista Roy – Roy Adaptation Model
a. Person
o Humans are holistic, adaptive
systems
o Main focus of nursing, recipient
of nursing care, a living complex
b. Health
o State and a process of being
and becoming integrated a
whole person
o Not a freedom from the
inevitability of death, disease,
unhappiness and stress but the
ability to cope with them in a
competent way.
c. Environment
o All the conditions ,
circumstances and influences
surrounding and affecting the
development and group
behavior of persons or groups
with particular consideration of
the mutuality of person and
earth resources that includes
focal, contextual and residual
stimuli
d. Nursing
o Health care profession that
focuses on human life
processes and patterns and
emphasizes promotion of
health for individuals, families,
groups and society as a whole
o Science and practice that
expands abilities and enhances
person ad environmental
transformation
Joyce Travelbee – Human to Human
Relationship
a. Person
o Human being
o Both nurse and patient are
human beings
b. Health
o Subjective and objective
c. Environment
o Human condition and life
experiences encountered by a
patient in suffering, hope, pain
and illness
d. Nursing
o Interpersonal process whereby
the professional nurse
practitioner assists an
individual, family or community
to prevent or cope with
experience or illness and
suffering and if necessary find
meaning in these
Madeline Leininger – Cultural Care Diversity
and Universality Theory
a. Person
o Humans are believed to be
caring and capable of being
concerned
o Human care is universal and is
seen in all cultures
o Universally caring beings
b. Health
o State of wellbeing that is
culturally defined, valued and
practiced and which reflects the
ability to perform daily role
activities in culturally
expressed, beneficial and
patterned life ways
c. Environment
o Not defined, but concept of
culture is closely related to
society or environment
d. Nursing
o Learned humanistic and
scientific profession and
discipline focused on human
care phenomena and caring
activities in order to assist,
support, facilitate or enable
individuals to maintain or
regain their health
Joyce Fitzpatrick - Life Perspective Rhythm
Model Theory of Fitzpatrick
a. Person
o A term that integrates the
concepts of both self and
others, and recognizes
individuals as having unique
biological, psychological,
emotional, social, cultural, and
spiritual attitudes.
b. Health
o A dynamic state of being that
results from the interaction of
person and the environment.
c. Wellness-Illness
o A promotion of wellness
practices, the attentive
treatment of those who are
acutely or chronically ill or
dying, and restorative care of
people during convalescence
and rehabilitation.
d. Nursing
o A developing discipline whose
central concern is the meaning
attached to life.
o Primary purpose of nursing is
the promotion and
maintenance of an optimal level
of wellness.
Rosemarie Rizzo Parse - Human becoming
theory (Man Leaving Health Theory)
a. Person
o Open being who is more than
different from the sum of the
parts.
o Who value the human
becoming belief system live the
theory in true presence with
others
b. Environment
o Everything in the person and his
experiences.
o Inseparable and irreducible,
complimentary to and evolving
with.
c. Health
o Open process of being and
becoming involves synthesis of
values.
d. Nursing
o A human science and art that
uses an abstract body of
knowledge to serve people.
Anne Boykin and Savina Schoenhofer – Nursing
as Caring Theory
a. Person
o All persons are caring
o Caring is innate to an individual
in that a person lives their lives
growing the capacity of caring
b. Health
o The overall health is achieved
with the application of caring in
all matters that deals with
patients
c. Environment
o Person should have an
environment that radiates a
sense of nurturing atmosphere
which helps an individual to
grow in caring while revealing
the richness of nursing
d. Nursing
o A discipline and profession
o Grounded by caring
Margaret Newman – Theory of Expanding
Consciousness
a. Person
o Person as individuals are
identified by their individual
patterns of consciousness.
o Persons are further defined
as “centers of
consciousness” within an
overall pattern of expanding
consciousness.”
o The definition of person has
also been expanded to include
family and community
b. Health
o A fusion of disease and non-
disease creates a synthesis that
is regarded as health.
o Disease and non-disease are
each reflections of the larger
whole; therefore a new concept
“pattern of the whole” is
formed.
o Newman has stated that
pattern recognition is the
essence of the emerging health.
Manifest health, encompassing
disease and non-disease can be
regarded as the explication of
the underlying pattern of
person-environment.
c. Environment
o Environment is not explicitly
defined but is described as
being the larger whole, which is
beyond the consciousness of
the individual.
o Described as “universe of open
systems”
d. Nursing
o Nursing is “caring in the human
health experience”.
o Nursing is seen as a partnership
between the nurse and client,
with both grow in the “sense of
higher levels of consciousness”.
Josephine Patterson and Loretta Zderad –
Humanistic Nursing Theory
a. Person
o refers to a person, family, or
group of people in need of
nursing care
o Humanistic nursing is a
response to a patient call.
b. Health
o It isn’t just an absence of
disease but….
o Nurses restoring, sustaining,
and promoting health.
o Nurses provide health
education and client
supervision.
It’s the well-being targeted
under nursing care.
c. Nursing
o The individual Nurse and their
emotions, experiences, and
interactions involved in the
interaction between the
patient-nurse situation.
o The concern about the
relationship between the
individual and nurse.
o An exercising of good
judgments
o The Humanistic Nursing Theory
mainly focuses on the Nursing
concept; Humanistic Nursing is
all about the interaction
between the nurse and the
patient in a nursing situation.
Topic 4: Nursing Competency and Standards
COMPETENCY STANDARDS
WHAT IS COMPETENCY?
Competency focuses on one’s actual performance in a situation
Competency is determined by comparing current work functioning with established performance standards developed in the work environment according to specific role and setting
OBJECTIVES: THE BSN CURRICULUM
It aims to produce a fully functioning nurse who:
1. Practices legal, ethico-moral, social responsibilities and accountabilities 2. Practices S-K-A’s (skills, knowledge & attitude) for the promotion of health, prevention
of illness, restoration of health, alleviation of suffering, assisting clients to face death with dignity and in peace
3. Prepares a creative and critical thinking nurse who is abreast with local needs and the demands of global competitiveness
4. Demonstrates caring behavior 5. Assumes responsibility for personal and professional development 6. Utilizes research findings in the practice and development of the profession 7. Contributes effectively to national health development 8. Demonstrates love of God, country and profession
Patient Care Competencies - is a cluster of key areas of responsibility which serves as the core
of competencies which includes safe and quality care, communication, collaboration and team
work and health education
Empowering Competencies - is a cluster of key areas of responsibility that mandate compliance
to the standards of ethico-moral, spiritual responsibilities, legal and personal and professional
development
Enhancing Competencies - is a cluster of key areas of responsibility that ensures excellent
performance of the patient care competencies which includes research and quality
improvement
Enabling Competencies - is a cluster of key areas of responsibility that provide support to the
effective and efficient performance of the patient care competencies which includes record
management and management of resources and environment
3 RESOURCES:
1. Man (manpower, human resource) 2. Machine 3. Money
ENABLING (10%) ENHANCEMENT (10%)
EMPOWERING (15%)
*SQHC- safe quality health care
-Management of resources and
environment
-Record management
-Research
-Quality Improvement
CORE (most vital)
1.Patient Core Competencies
SQHC(50%)
2.Communication (5%)
3.Collaboration (5%)
4. Health Education (5%)
-Legal responsibilities
-Ethico Moral responsibilities
-Personal & professional development