HISTORY OF NURSING IN THE PHILIPPINES
Historical Evolution of Nursing
Period of Intuitive Nursing/Medieval Period
Nursing was “untaught” and instinctive. It was performed of compassion for others, out of the wish
to help others.
▪ Nursing was a function that belonged to women. It was viewed as a natural nurturing job for
women. She is expected to take good care of the children, the sick and the aged.
▪ No caregiving training is evident. It was based on experience and observation.
▪ Primitive men believed that illness was caused by the invasion of the victim’s body of evil spirits.
They believed that the medicine man, Shaman or witch doctor had the power to heal by using white
magic, hypnosis, charms, dances, incantation, purgatives, massage, fire, water and herbs as a mean
of driving illness from the victim.
▪ Trephining – drilling a hole in the skull with a rock or stone without anesthesia was a last resort to
drive evil spirits from the body of the afflicted.
Period of Apprentice Nursing/Middle Ages
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Care was done by crusaders, prisoners, religious orders
Nursing care was performed without any formal education and by people who were directed by
more experienced nurses (on the job training). This kind of nursing was developed by religious
orders of the Christian Church.
▪ Nursing went down to the lowest level
▪ Wrath/anger of Protestantism confiscated properties of hospitals and schools connected
with Roman Catholicism.
▪ Nurses fled their lives; soon there was shortage of people to care for the sick
▪ Hundreds of Hospitals closed; there was no provision for the sick, no one to care for
the sick
▪ Nursing became the work of the least desirable of women – prostitutes, alcoholics,
prisoners
▪ Pastor Theodore Fliedner and his wife, Frederika established the Kaiserswerth Institute for the
training of Deaconesses (the 1st formal training school for nurses) in Germany.
▪ This was where Florence Nightingale received her 3-month course of study in nursing.
Period of Educated Nursing/Nightingale Era 19th-20th century
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The development of nursing during this period was strongly influenced by:
1. trends resulting from wars – Crimean, civil war
2. arousal of social consciousness
3. Increased educational opportunities offered to women.
▪ Florence Nightingale was asked by Sir Sidney Herbert of the British War Department to recruit
female nurses to provide care for the sick and injured in the Crimean War.
▪ In 1860, The Nightingale Training School of Nurses opened at St. Thomas Hospital in London.
▪ The school served as a model for other training schools. Its graduates traveled to other
countries to manage hospitals and institute nurse-training programs.
▪ Nightingale focus vision of nursing Nightingale system was more on developing the
profession within hospitals. Nurses should be taught in hospitals associated with
medical schools and that the curriculum should include both theory and practice.
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It was the 1st school of nursing that provided both theory-based knowledge and clinical
skill building.
▪ Nursing evolved as an art and science
▪ Formal nursing education and nursing service begun
Facts about Florence Nightingale
▪
Mother of modern nursing. Lady with the Lamp because of her achievements in improving the
standards for the care of war casualties in the Crimean war.
▪ Born may 12, 1800 in Florence, Italy
▪ Raised in England in an atmosphere of culture and affluence
▪ Not contended with the social custom imposed upon her as a Victorian Lady, she developed her
self-appointed goal: To change the profile of Nursing
▪ She compiled notes of her visits to hospitals and her observations of the sanitary facilities, social
problems of the places she visited.
▪ Noted the need for preventive medicine and god nursing
▪ Advocated for care of those afflicted with diseases caused by lack of hygienic practices
▪ At age 31, she entered the Deaconesses School at Kaiserswerth in spite of her family’s resistance to
her ambitions. She became a nurse over the objections of society and her family.
▪ Worked as a superintendent for Gentlewomen Hospital, a charity hospital for ill governesses.
▪ Disapproved the restrictions on admission of patients and considered this unchristian and
incompatible with health care
▪ Upgraded the practice of nursing and made nursing an honorable profession for women.
▪ Led nurses that took care of the wounded during the Crimean war
▪ Put down her ideas in 2 published books: Notes on Nursing, What It Is and What It Is Not and Notes
on Hospitals.
▪ She revolutionized the public’s perception of nursing (not the image of a doctor’s handmaiden) and
the method for educating nurses.
Period of Contemporary Nursing/20th Century
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Licensure of nurses started
Specialization of Hospital and diagnosis
Training of Nurses in diploma program
Development of baccalaureate and advance degree programs
Scientific and technological development as well as social changes marks this period.
1. Health is perceived as a fundamental human right
2. Nursing involvement in community health
3. Technological advances – disposable supplies and equipments
4. Expanded roles of nurses was developed
5. WHO was established by the United Nations
6. Aerospace Nursing was developed
7. Use of atomic energies for medical diagnosis, treatment
8. Computers were utilized-data collection, teaching, diagnosis, inventory, payrolls, record
keeping, and billing.
9. Use of sophisticated equipment for diagnosis and therapy
Early Beliefs, Practices and Care of the sick
Early Filipinos subscribed to superstitious belief and practices in relation to health and sickness
Diseases, their causes and treatment were associated with mysticism and superstitions
Cause of disease was caused by another person (an enemy of witch) or evil spirits
Persons suffering from diseases without any identified cause were believed bewitched by
“mangkukulam”
▪ Difficult childbirth were attributed to “nonos”
▪ Evil spirits could be driven away by persons with powers to expel demons
▪ Belief in special Gods of healing: priest-physician, word doctors, herbolarios/herb doctors
Early Hospitals during the Spanish Regime
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Religious orders exerted efforts to care for the sick by building hospitals in different parts of the
Philippines:
1. Hospital Real de Manila San Juan de Dios Hospital
2. San Lazaro Hospital Hospital de Aguas Santas
3. Hospital de Indios
Prominent personages involved during the Philippine Revolution
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1. Josephine Bracken – wife of Jose Rizal installed a field hospital in an estate in Tejeros that provided
nursing care to the wounded night and day.
2. Rose Sevilla de Alvaro – converted their house into quarters for Filipino soldiers during the PhilAmerican War in 1899.
3. Hilaria de Aguinaldo –wife of Emlio Aginaldo organized the Filipino Red Cross.
4. Melchora Aquino – (Tandang Sora) nursed the wounded Filipino soldiers, gave them shelter and
food.
5. Captain Salomen – a revolutionary leader in Nueva Ecija provided nursing care to the wounded when
not in combat.
6. Agueda Kahabagan – revolutionary leader in Laguna also provided nursing services to her troops.
7. Trinidad Tecson (Ina ng Biak na Bato) – stayed in the hospital at Biac na Bato to care for the
wounded soldiers.
School Of Nursing
1. St. Paul’s Hospital School of Nursing, Intramuros Manila – 1900
2. Iloilo Mission Hospital Training School of Nursing – 1906
▪ 1909 – Distinction of graduating the 1st trained nurses in the Phils. With no standard
requirements for admission of applicants except their “willingness to work”
▪ April 1946 – a board exam was held outside of Manila. It was held in the Iloilo Mission
Hospital thru the request of Ms. Loreto Tupas, principal of the school.
3. St. Luke’s Hospital School of Nursing – 1907; opened after four years as a dispensary clinic.
4. Mary Johnston Hospital School of Nursing – 1907
5. Philippines General Hospital school of Nursing – 1910
College of Nursing
1.
2.
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5.
UST College of Nursing – 1st College of Nursing in the Phils: 1877
MCU College of Nursing – June 1947 (1st College who offered BSN – 4 year program)
UP College of Nursing – June 1948
FEU Institute of Nursing – June 1955
UE College of Nursing – Oct 1958
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3 female graduated as “qualified medical-surgical nurses”
1909
1919
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The 1st Nurses Law (Act#2808) was enacted regulating the practice of the nursing profession in the
Philippines Islands. It also provided the holding of exam for the practice of nursing on the 2nd
Monday of June and December of each year.
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1st board examination for nurses was conducted by the Board of Examiners, 93 candidates took the
exam, 68 passed with the highest rating of 93.5%-Anna Dahlgren
Theoretical exam was held at the UP Amphitheater of the College of Medicine and Surgery. Practical
exam at the PGH Library.
1920
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1921
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Filipino Nurses Association was established (now PNA) as the National Organization Of Filipino
Nurses
PNA: 1st President – Rosario Delgado
Founder – Anastacia Giron-Tupas
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Republic Act 877, known as the “Nursing Practice Law” was approved.
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1953
Intuitive Nursing
From Prehistoric times up to the early Christian Era
Untaught and Instinctive
Nursing performed out of compassion
Nursing belonged to women
Apprentice Nursing
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From the founding of the Religious orders in the 11th century up to 1836 with the establishment of
the Kaiserwerth Institute for training of Deaconesses
▪ Period of “on-the-job training”
▪ Nursing performed without any formal education and by people who were directed by more
experienced nurses
▪ Important personalities in this period:
▪ St. Clare-gave nursing care to the sick and the afflicted
▪ St. Elizabeth of Hungary- Patrones of nurses
▪ St. Catherine of Siena- First lady with a lamp
▪ Dark period of Nursing
▪ From the 17th century up to 19th century
▪ Nursing became the work of the least desirable of women
Educated Nursing
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Began on June 15, 1860 when Florence Nightingale School of nursing opened St. Thomas Hospital
in London
▪ Development of nursing was strongly influenced by trends resulting from wars, from an arousal of
social consciousness, from the increased educational opportunities offered to women
Contemporary Nursing
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Covers the period after the world war II to the present
Marked by scientific and technological developments as well as social changes
Nursing
As defined by the INTERNATIONAL COUNCIL OF NURSES as written by Virginia Henderson.
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The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health, it’s recovery, or to a peaceful death the client would perform
unaided if he had the necessary strength, will or knowledge.
Help the client gain independence as rapidly as possible.
Nursing Theory
Over the years, nursing has incorporated theories from non-nursing sources, including theories of systems,
human needs, change, problem solving, and decision making. Barnum defines theory as “a construct that
accounts for or organizes some phenomenon. A nursing theory, then, describes or explains nursing.” With the
formulation of different theories, concepts, and ideas in nursing it:
It guides nurses in their practice knowing what is nursing and what is not nursing.
It helps in the formulations of standards, policies and laws.
It will help the people to understand the competencies and professional accountability of nurses.
It will help define the role of the nurse in the multidisciplinary health care team.
Four Major Concepts
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Nurses have developed various theories that provide different explanations of the nursing discipline. All theories,
however, share four central concepts: Person refers to all human beings. People are the recipients of nursing
care; they include individuals, families, communities, and groups. Environment includes factors that affect
individuals internally and externally. It means not only in the everyday surroundings but all setting where nursing
care is provided. Health generally addresses the person’s state of well-being. The concept of Nursing is central
to all nursing theories. Definitions of nursing describe what nursing is, what nurses do, and how nurses interact
with clients. Most nursing theories address each of the four central concepts implicitly or explicitly.
NURSING THEORIES
Betty Neuman
(1972, 1982, 1989, 1992)
Health Care System Model
The Neuman System Model or Health Care System Model
Stress reduction is a goal of system model of nursing practice. Nursing actions are in primary,
secondary or tertiary level of prevention.
▪ To address the effects of stress and reactions to it on the development and maintenance of health.
The concern of nursing is to prevent stress invasion, to protect the client’s basic structure and to
obtain or maintain a maximum level of wellness. The nurse helps the client, through primary,
secondary, and tertiary prevention modes, to adjust to environmental stressors and maintain client
stability.
Metaparadigm
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Person
A client system that is composed of physiologic, psychological, sociocultural, and environmental
variables.
Environment
▪ Internal and external forces surrounding humans at any time.
Health
▪ Health or wellness exists if all parts and subparts are in harmony with the whole person.
Nursing
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Nursing is a unique profession in that it is concerned with all the variables affecting an individual’s
response to stressors.
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Dorothea Orem
(1970, 1985)
Self-Care Deficit Theory
Self-Care Deficit Theory
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Defined Nursing: “The act of assisting others in the provision and management of self-care to
maintain/improve human functioning at home level of effectiveness.”
Focuses on activities that adult individuals perform on their own behalf to maintain life, health and
well-being.
Has a strong health promotion and maintenance focus.
Identified 3 related concepts:
1.
1. Self-care – activities an Individual performs independently throughout life to promote
and maintain personal well-being.
2. Health – results when self-care agency (Individual’s ability) is not adequate to meet the
known self-care needs.
3. Nursing System – nursing interventions needed when Individual is unable to perform
the necessary self-care activities:
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Wholly compensatory – nurse provides entire self-care for the client.
Example: care of a new born, care of client recovering from
surgery in a post-anesthesia care unit
Partial compensatory – nurse and client perform care; client can perform
selected self-care activities, but also accepts care done by the nurse for
needs the client cannot meet independently.
▪ Example: Nurse can assist post operative client to ambulate,
Nurse can bring a meal tray for client who can feed himself
Supportive-educative – nurse’s actions are to help the client develop/learn
their own self-care abilities through knowledge, support and
encouragement.
▪ Example: Nurse guides a mother how to breastfeed her baby,
Counseling a psychiatric client on more adaptive coping
strategies.
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Dorothy E. Johnson
(1980)
Behavioral System Model
Behavioral System Model
Focuses on how the client adapts to illness; the goal of nursing is to reduce stress so that the client
can move more easily through recovery.
▪ Viewed the patient’s behavior as a system, which is a whole with interacting parts.
▪ The nursing process is viewed as a major tool.
▪ To reduce stress so the client can recover as quickly as possible. According to Johnson, each
person as a behavioral system is composed of seven subsystems namely:
1. Ingestive. Taking in nourishment in socially and culturally acceptable ways.
2. Eliminated. Riddling the body of waste in socially and culturally acceptable ways.
3. Affiliative. Security seeking behavior.
4. Aggressive. Self – protective behavior.
5. Dependence. Nurturance – seeking behavior.
6. Achievement. Master of oneself and one’s environment according to internalized
standards of excellence.
7. Sexual role identity behavior
▪ In addition, she viewed that each person strives to achieve balance and stability both internally and
externally and to function effectively by adjusting and adapting to environmental forces through
learned pattern of response. Furthermore, She believed that the patient strives to become a person
whose behavior is commensurate with social demands; who is able to modify his behavior in ways
that support biologic imperatives; who is able to benefit to the fullest extent during illness from the
health care professional’s knowledge and skills; and whose behavior does not give evidence of
unnecessary trauma as a consequence of illness.
Metaparadigm
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Person
▪ A system of interdependent parts with patterned, repetitive, and purposeful ways of behaving.
Environment
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All forces that affect the person and that influence the behavioral system
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Focus on person, not illness. Health is a dynamic state influenced by biologic, psychological, and
social factors
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Promotion of behavioral system, balance and stability. An art and a science providing external
assistance before and during balance disturbances
Health
Nursing
Ernestine Wiedenbach
(1964)
The Helping Art of Clinical Nursing
The Helping Art of Clinical Nursing
Developed the Clinical Nursing – A Helping Art Model.
She advocated that the nurse’s individual philosophy or central purpose lends credence to nursing
care.
▪ She believed that nurses meet the individual’s need for help through the identification of the needs,
administration of help, and validation that actions were helpful. Components of clinical practice:
Philosophy, purpose, practice and an art.
Metaparadigm
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Person
Any individual who is receiving help from a member of the health profession or from a worker in the
field of health.
Environment
▪ Not specifically addressed
Health
▪ Concepts of nursing, client, and need for help and their relationships imply health-related concerns
in the nurse—client relationship.
Nursing
▪ The nurse is a functional human being who acts, thinks, and feels. All actions, thoughts, and
feelings underlie what the nurse does.
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Faye Glenn Abdellah
(1960)
Twenty One Nursing Problems
Nursing is broadly grouped into 21 problem areas to guide care and promote the use of nursing
judgement.
▪ Introduced Patient – Centered Approaches to Nursing Model She defined nursing as service to
individual and families; therefore the society. Furthermore, she conceptualized nursing as an art and
a science that molds the attitudes, intellectual competencies and technical skills of the individual
nurse into the desire and ability to help people, sick or well, and cope with their health needs.
21 Nursing Problems
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1. To maintain good hygiene.
2. To promote optimal activity; exercise, rest and sleep.
3. To promote safety.
4. To maintain good body mechanics
5. To facilitate the maintenance of a supply of oxygen
6. To facilitate maintenance of nutrition
7. To facilitate maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic response of the body to disease conditions
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory functions
12. To identify and accept positive and negative expressions, feelings and reactions
13. To identify and accept the interrelatedness of emotions and illness.
14. To facilitate the maintenance of effective verbal and non-verbal communication
15. To promote the development of productive interpersonal relationship
16. To facilitate progress toward achievement of personal spiritual goals
17. To create and maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying needs.
19. To accept the optimum possible goals
20. To use community resources as an aid in resolving problems arising from illness.
21. To understand the role of social problems as influencing factors
Metaparadigm
Person
The recipients of nursing care having physical, emotional, and sociologic needs that may be overt or
covert.
Environment
▪ Not clearly defined. Some discussion indicates that clients interact with their environment, of which
nurse is a part.
Health
▪ A state when the individual has no unmet needs and no anticipated or actual impairment.
Nursing
▪ Broadly grouped in “21 nursing problems,” which center around needs for hygiene, comfort,
activity, rest, safety, oxygen, nutrition, elimination, hydration, physical and emotional health
promotion, interpersonal relationships, and development of self-awareness. Nursing care is doing
something for an individual
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Florence Nightingale
(1860)
Environmental Theory
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Defined Nursing: “The act of utilizing the environment of the patient to assist him in his recovery.”
Focuses on changing and manipulating the environment in order to put the patient in the best
possible conditions for nature to act.
Identified 5 environmental factors: fresh air, pure water, efficient drainage, cleanliness/sanitation and
light/direct sunlight.
Considered a clean, well-ventilated, quiet environment essential for recovery.
Deficiencies in these 5 factors produce illness or lack of health, but with a nurturing environment,
the body could repair itself.
Developed the described the first theory of nursing. Notes on Nursing: What It Is What It Is Not. She
focused on changing and manipulating the environment in order to put the patient in the best
possible conditions for nature to act.
Metaparadigm
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Person
▪ An individual with vital reparative processes to deal with disease.
Environment
▪ External conditions that affect life and individuals development.
Health
▪ Focus is on the reparative process of getting well
Nursing
▪ Goal is to place the individual in the best condition for good healthcare
Evelyn Tomlin, Helen Erickson, and Mary Ann Swain
(1983)
Modeling and Role Modeling Theory
Developed Modeling and Role Modeling Theory. The focus of this theory is on the person. The
nurse models (assesses), role models (plans), and intervenes in this interpersonal and interactive
theory.
▪ They asserted that each individual unique, has some self-care knowledge, needs simultaneously to
be attached to the separate from others, and has adaptive potential. Nurses in this theory, facilitate,
nurture and accept the person unconditionally.
Metaparadigm
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Person
A differentiation is made between patients and clients in this theory. A patient is given treatment and
instruction; a client participates in his or her own care. “Our goal is for nurses to work with clients.”
“A client is one who is considered to be a legitimate member of the decision-making team, who
always has some control over the planned regimen, and who is incorporated into the planning and
implementation of his or her own care as much as possible.”
Environment
▪ “Environment is not identified in the theory as an entity of its own. The theorist see environment in
the social subsystems as the interaction between self and others both cultural and individual.
Biophysical stressors are seen as part of the environment.”
Health
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“Health is a state of physical, mental and social well-being, not merely the absence of disease or
infirmity. It connotates a state of dynamic equilibrium among the various subsystems [of a holistic
person]”.
Nursing
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“The nurse is a facilitator, not an effector. Our nurse-client relationship is an interactive,
interpersonal process that aids the individual to identify, mobilize, and develop his or her own
strengths.”
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Hildegard Peplau
(1951)
Interpersonal Relations Theory
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Defined Nursing: “An interpersonal process of therapeutic interactions between an Individual who is
sick or in need of health services and a nurse especially educated to recognize, respond to the need
for help.
Nursing is a “maturing force and an educative instrument”
Identified 4 phases of the Nurse – Patient relationship:
1. Orientation – individual/family has a “felt need” and seeks professional assistance from a nurse (who
is a stranger). This is the problem identification phase.
2. Identification – where the patient begins to have feelings of belongingness and a capacity for dealing
with the problem, creating an optimistic attitude from which inner strength ensues. Here happens
the selection of appropriate professional assistance.
3. Exploitation – the nurse uses communication tools to offer services to the patient, who is expected
to take advantage of all services.
4. Resolution – where patient’s needs have already been met by the collaborative efforts between the
patient and the nurse. Therapeutic relationship is terminated and the links are dissolved, as patient
drifts away from identifying with the nurse as the helping person.
Metaparadigm
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Person
An organism striving to reduce tension generated by needs
Environment
▪ The interpersonal process is always included, and psychodynamic milieu receives attention, with
emphasis on the client’s culture and mores.
Health
▪ Ongoing human process that implies forward movement of personality and other ongoing human
processes in the direction of creative, constructive, productive, personal, and community living.
Nursing
▪ Interpersonal therapeutic process that “functions cooperatively with others human processes that
make health possible for individuals in communities. Nursing is an educative instrument, a maturing
force that aims to promote forward movement of personality.
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Ida Jean Orlando
(1961)
The Dynamic Nurse-Patient Relationship
▪ Conceptualized The Dynamic Nurse – Patient Relationship Model.
▪ She believed that the nurse helps patients meet a perceived need that the patient cannot meet for
themselves. Orlando observed that the nurse provides direct assistance to meet an immediate need
for help in order to avoid or to alleviate distress or helplessness.
▪ She emphasized the importance of validating the need and evaluating care based on observable
outcomes.
▪ To interact with clients to meet immediate needs by identifying client behaviors, nurse’s reactions,
and nursing actions to take
Metaparadigm
Person
Unique individual behaving verbally nonverbally. Assumption is that individuals are at times able to
meet their own needs and at other times unable to do so
Environment
▪ Not defined
Health
▪ Not defined. Assumption is that being without emotional or physical discomfort and having a sense
of well-being contribute to a healthy state.
Nursing
▪ Professional nursing is conceptualized as finding out and meeting the client’s immediate need for
help.
Imogene King
(1971, 1981)
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Goal Attainment Theory
Nursing process is defined as dynamic interpersonal process between nurse, client and health care
system.
▪ Postulated the Goal Attainment Theory. She described nursing as a helping profession that assists
individuals and groups in society to attain, maintain, and restore health. If is this not possible,
nurses help individuals die with dignity.
▪ In addition, King viewed nursing as an interaction process between client and nurse whereby during
perceiving, setting goals, and acting on them transactions occurred and goals are achieved.
Metaparadigm
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Person
▪ Biopsychosocial being
Environment
▪ Internal and external environment continually interacts to assist in adjustments to change.
Health
▪ A dynamic life experience with continued goal attainment and adjustment to stressors.
Nursing
▪ Perceiving, thinking, relating, judging, and acting with an individual who comes to a nursing
situations
Jean Watson
(1979)
The Philosophy and Science of Caring
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Nursing is concerned with promotion health, preventing illness, caring for the sick, and restoring
health.
Nursing is a human science of persons and human health-illness experiences that are mediated by
professional, personal, scientific, esthetic and ethical human care transactions
She defined caring as a nurturing way or responding to a valued client towards whom the nurse
feels a personal sense of commitment and responsibility. It is only demonstrated interpersonally
that results in the satisfaction of certain human needs. Caring accepts the person as what he/she
may become in a caring environment
▪ Carative Factors:
1. The formation of a humanistic-altruistic system of values
2. Instillation of faith-hope
3. The cultivation of sensitivity to one’s self and others
4. The development of a helping- trust relationship
5. The promotion and acceptance of the expression of positive and negative feelings.
6. The systemic use of the scientific problem-solving method for decision making
7. The promotion of interpersonal teaching-learning
8. The provision for supportive, protective and corrective mental, physical, socio-cultural
and spiritual environment
9. Assistance with the gratification of human needs
10. The allowance for existential phenomenological forces
Metaparadigm
Person
A valued being to be cared for, respected, nurtured, understood, and assisted, a fully functional,
integrated self
Environment
▪ Social environment, caring and the culture of caring affect health
Health
▪ Physical, mental, and social wellness
Nursing
▪ A human science of people and human health; illness experiences that are mediated by
professional, personal, scientific, aesthetic, and ethical human care transactions.
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Joyce Travelbee
(1966, 1971)
Interpersonal Aspects of Nursing
She postulated the Interpersonal Aspects of Nursing Model. She advocated that the goal of nursing
individual or family in preventing or coping with illness, regaining health finding meaning in illness,
or maintaining maximal degree of health.
▪ She further viewed that interpersonal process is a human-to-human relationship formed during
illness and “experience of suffering”
▪ She believed that a person is a unique, irreplaceable individual who is in a continuous process of
becoming, evolving and changing.
Metaparadigm
▪
Person
A unique, irreplaceable individual who is in a continuous process of becoming, evolving, and
changing.
Environment
▪ Not defined
Health
▪ Heath includes the individual’s perceptions of health and the absence of disease.
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Nursing
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An interpersonal process whereby the professional nurse practitioner assists an individual, family, or
community to prevent or cope with the experience of illness and suffering, and if necessary, to find
meaning in these experiences.
Lydia Hall
(1964)
Core, Care and Cure Model
The client is composed of the ff. overlapping parts: person (core), pathologic state and treatment
(cure) and body (care).
▪ Introduced the model of Nursing: What Is It? Focusing on the notion that centers around three
components of Care, Core and Cure.
▪ Care represents nurturance and is exclusive to nursing. Core involves the therapeutic use of self
and emphasizes the use of reflection. Cure focuses on nursing related to the physician’s orders.
Core and cure are shared with the other health care providers.
▪ The major purpose of care is to achieve an interpersonal relationship with the individual that will
facilitate the development of the core.
Metaparadigm
▪
Person
Client is composed of body, pathology, and person. People set their own goals and are capable of
learning and growing.
Environment
▪ Should facilitate achievement of the client’s personal goals.
Health
▪ Development of a mature self-identity that assists in the conscious selection of actions that facilitate
growth.
Nursing
▪ Caring is the nurse’s primary function. Professional nursing is most important during the
recuperative period.
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Madeleine Leininger
(1978, 1984)
Transcultural Care Theory and Ethnonursing
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Developed the Transcultural Nursing Model. She advocated that nursing is a humanistic and
scientific mode of helping a client through specific cultural caring processes (cultural values, beliefs
and practices) to improve or maintain a health condition.
Nursing is a learned humanistic and scientific profession and discipline which is focused on human
care phenomena and activities in order to assist, support, facilitate, or enable individuals or groups
to maintain or regain their well being (or health) in culturally meaningful and beneficial ways, or to
help people face handicaps or death.
Transcultural nursing as a learned subfield or branch of nursing which focuses upon the
comparative study and analysis of cultures with respect to nursing and health-illness caring
practices, beliefs and values with the goal to provide meaningful and efficacious nursing care
services to people according to their cultural values and health-illness context.
Focuses on the fact that different cultures have different caring behaviors and different health and
illness values, beliefs, and patterns of behaviors.
Awareness of the differences allows the nurse to design culture-specific nursing interventions.
Martha Rogers
(1970)
Science of Unitary Man
Nursing is an art and science that is humanistic and humanitarian. It is directed toward the unitary
human and is concerned with the nature and direction of human development. The goal of nurses is
to participate in the process of
▪ Nursing interventions seek to promote harmonious interaction between persons and their
environment, strengthen the wholeness of the Individual and redirect human and environmental
patterns or organization to achieve maximum health.
▪ 5 basic assumptions:
1. The human being is a unified whole, possessing individual integrity and manifesting
characteristics that are more than and different from the sum of parts.
2. The individual and the environment are continuously exchanging matter and energy with
each other
3. The life processes of human beings evolve irreversibly and unidirectionally along a
space-time continuum
4. Patterns identify human being and reflect their innovative wholeness
5. The individual is characterized by the capacity for abstraction and imagery, language
and thought, sensation and emotion
Metaparadigm
▪
Person
Unitary man, a four-dimensional energy field.
Environment
▪ Encompasses all that is outside any given human field. Person exchanging matter and energy.
Health
▪ Not specifically addressed, but emerges out of interaction between human and environment, moves
forward, and maximizes human potential.
Nursing
▪ A learned profession that is both science and art. The professional practice of nursing is creative
and imaginative and exists to serve people.
▪
Myra Estrin Levine
(1973)
Conservation Model
▪
▪
Believes nursing intervention is a conservation activity, with conservation of energy as a primary
concern, four conservation principles of nursing: conservation of client energy, conservation of
structured integrity, conservation of personal integrity, conservation of social integrity.
Described the Four Conversation Principles. She advocated that nursing is a human interaction and
proposed four conservation principles of nursing which are concerned with the unity and integrity of
the individual. The four conservation principles are as follows:
1. Conservation of energy. The human body functions by utilizing energy. The human body
needs energy producing input (food, oxygen, fluids) to allow energy utilization output.
2. Conservation of Structural Integrity. The human body has physical boundaries (skin and
mucous membrane) that must be maintained to facilitate health and prevent harmful
agents from entering the body.
3. Conservation of Personal Integrity. The nursing interventions are based on the
conservation of the individual client’s personality. Every individual has sense of identity,
self worth and self esteem, which must be preserved and enhanced by nurses.
4. Conservation of Social integrity. The social integrity of the client reflects the family and
the community in which the client functions. Health care institutions may separate
individuals from their family. It is important for nurses to consider the individual in the
context of the family.
Metaparadigm
Person
A holistic being
Environment
▪ Broadly, includes all the individual’s experiences
Health
▪ The maintenance of the client’s unity and integrity
Nursing
▪ A discipline rooted in the organic dependency of the individual human being on his or her
relationship with others
▪
Rosemarie Rizzo Parse
(1981)
Theory of Human Becoming
Nursing is a scientific discipline, the practice of which is a performing art
Three assumption about Human Becoming
1. Human becoming is freely choosing personal meaning in situation in the intersubjective
process of relating value priorities
2. Human becoming is co-creating rhythmic patterns or relating in mutual process in the
universe
3. Human becoming is co-transcending multidimensionality with emerging possibilities.
Metaparadigm
▪
▪
Person
A major reason for nursing existence
Environment
▪ Man and environment interchange energy to create what is in the world, and man chooses the
meaning given to the situations he creates
Health
▪ A lived experience that is a process of being and becoming
Nursing
▪ Nursing Practice is directed toward illuminating and mobilizing family interrelationships in light of the
meaning assigned to health and its possibilities as language in the co created patterns of relating.
▪
Sister Callista Roy
(1979)
Adaptation Model
Viewed humans as Biopsychosocial beings constantly interacting with a changing environment and
who cope with their environment through Biopsychosocial adaptation mechanisms.
▪ Presented the Adaptation Model. She viewed each person as a unified biopsychosocial system in
constant interaction with a changing environment. She contented that the person as an adaptive
system, functions as a whole through interdependence of its part. The system consists of input,
control processes, output feedback.
▪ Focuses on the ability of Individuals, families, groups, communities, or societies to adapt to change.
▪ The degree of internal or external environmental change and the person’s ability to cope with that
change is likely to determine the person’s health status.
▪ Nursing interventions are aimed at promoting physiologic, psychologic, and social functioning or
adaptation.
▪ To identify the types and demands placed on a client and client’s adaptation to the demands.
Metaparadigm
▪
Person
Biopsychological being and the recipient of nursing care.
Environment
▪ All conditions, circumstances, and influences surrounding and affecting the development of an
organism or groups of organisms
Health
▪ The person encounters adaptation problems in changing the environment.
Nursing
▪ A theoretical system of knowledge that prescribes a process of analysis and action related to the
care of the ill or potentially ill persons
▪
Virginia Henderson
(1955)
The Nature of Nursing Model
▪
▪
▪
▪
▪
1.
2.
3.
4.
5.
6.
Introduced The Nature of Nursing Model. She identified fourteen basic needs.
She postulated that the unique function of the nurse is to assist the clients, sick or well, in the
performance of those activities contributing to health or its recovery, the clients would perform
unaided if they had the necessary strength, will or knowledge.
She further believed that nursing involves assisting the client in gaining independence as rapidly as
possible, or assisting him achieves peaceful death if recovery is no longer possible.
Defined Nursing: “Assisting the individual, sick or well, in the performance of those activities
contributing to health or its recovery (or to peaceful death) that an individual would perform unaided
if he had the necessary strength, will or knowledge”.
Identified 14 basic needs :
Breathing normally
Eating and drinking adequately
Eliminating body wastes
Moving and maintaining desirable position
Sleeping and resting
Selecting suitable clothes
7. Maintaining body temperature within normal range
8. Keeping the body clean and well-groomed
9. Avoiding dangers in the environment
10. Communicating with others
11. Worshipping according to one’s faith
12. Working in such a way that one feels a sense of accomplishment
13. Playing/participating in various forms of recreation
14. Learning, discovering or satisfying the curiosity that leads to normal development and health and
using available health facilities.
Metaparadigm
Person
Individual requiring assistance to achieve health and independence or a peaceful death. Mind and
body are inseparable.
Environment
▪ All external conditions and influences that affect life and development
Health
▪ Equated with independence, viewed in terms of the client’s ability to perform 14 components of
nursing care unaided: breathing, eating, drinking, maintaining comfort, sleeping, resting clothing,
maintaining body temperature, ensuring safety, communicating, worshiping, working, recreation,
and continuing development.
Nursing
▪ Assists and supports the individual in life activities and the attainment of independence.
▪