1. Theoretical Foundations in Nursing Revised by: Dr. Cyruz P. Tuppal RN, RM, RT, MSN, MASPED, DMS Enhancement Review 1 Dr. Cyruz P. Tuppal Professor

2. Florence Nightingale Enhancement Review 2 Dr. Cyruz P. Tuppal Professor

3. Introducing the Theory Nursing became a science when Nightingale identified the laws of nursing, also referred to as the laws of health, or nature Enhancement Review 3 Dr. Cyruz P. Tuppal Professor

4. Goal of Nursing Analysis and application of universal “laws” would promote well-being and relieve the suffering of humanity Used the presentation of statistical data to prove her case that the costs of disease, crime, and excess mortality was greater than the cost of sanitary improvements Enhancement Review 4 Dr. Cyruz P. Tuppal Professor

5. Goal of Nursing Assisting the patient in his or her retention of “vital powers” by meeting his or her needs Putting the patient in the best condition for nature to act upon (Nightingale, 1860/1969) Enhancement Review 5 Dr. Cyruz P. Tuppal Professor

6. Health Viewed as an additive process Result of environmental, physical, and psychological factors, not just the absence of disease Disease—reparative process of the body To correct a problem and could provide an opportunity for spiritual growth The laws of health, as defined by Nightingale, were those to do with keeping the person, and the population, healthy Enhancement Review 6 Dr. Cyruz P. Tuppal Professor

7. Environmental Components of Health Clean air Pure water Efficient drainage Cleanliness Light Enhancement Review 7 Dr. Cyruz P. Tuppal Professor

8. Patient At the center of the Nightingale model Model incorporates a holistic view of the person Someone with psychological, intellectual, and spiritual components Enhancement Review 8 Dr. Cyruz P. Tuppal Professor

9. Nurse Defined as any woman who had “charge of the personal health of somebody,” Whether well, as in caring for babies and children, or sick, as an “invalid” (Nightingale, 1860/1969). Enhancement Review 9 Dr. Cyruz P. Tuppal Professor

10. Nursing Nursing proper, or “sick” nursing, was both an art and a science Required organized, formal education to care for those suffering from disease Nursing was “service to God in relief of man” Nursing activities served as an “art form” through which spiritual development might occur Nightingale’s ideas about nursing health, the environment, and the person were grounded in experience She regarded one’s sense observations as the only reliable means of obtaining and verifying knowledge. Enhancement Review 10 Dr. Cyruz P. Tuppal Professor

11. 20th Century Nursing: Ernestine Wiedenbach’s, Virginia Henderson’s, and Lydia Hall’s Contributions to Nursing Theory and Their Use in Practice Enhancement Review 11 Dr. Cyruz P. Tuppal Professor

12. Impact on Nursing Three of the most important influences on nursing theory development of the 20th century. Each of these nurse scholars based theoretical work on nursing practice. Today some of this work contributes to what is referred to as practice theories. Concepts and terms they first used are heard today around the globe. Enhancement Review 12 Dr. Cyruz P. Tuppal Professor

13. Ernestine Wiedenbach Born 1900 in Germany to an American Mother and German father Migrated to the United States when she was a child Earned BA from Wellesley College in 1922 Earned MA from Columbia in1934 Faculty member at Yale University Developed her prescriptive theory Enhancement Review 13 Dr. Cyruz P. Tuppal Professor

14. Ernestine Wiedenbach (continued) Gave us new ways to think about nursing practice and nursing scholarship Introduced ideas: Nursing as a professional practice discipline Nursing practice theory Enhancement Review 14 Dr. Cyruz P. Tuppal Professor

15. Three Ingredients Essential to the Prescriptive Theory (1970) The nurse’s central purpose in nursing is the nurse’s professional commitment. The prescription indicates the broad general action that the nurse deems appropriate to the fulfillment of the central purpose. The realities are the aspects of the immediate nursing situation that influence the results the nurse achieves through what she does. Enhancement Review 15 Dr. Cyruz P. Tuppal Professor

16. Components Within Nursing Situations Agent: nurse supplying the nursing action Recipient: patient receiving the action or on whose behalf the action is taken Framework: situational factors Goal: end to be attained through nursing action Means: nursing actions and devices Enhancement Review 16 Dr. Cyruz P. Tuppal Professor

17. Nursing Situational Factors Physical Psychological Emotional Spiritual Enhancement Review 17 Dr. Cyruz P. Tuppal Professor

18. Virginia Henderson Born in Kansas City, Missouri, in 1897 5th of 8 children Entered Army School of Nursing during WWI in response to nursing shortage at Walter Reed Army Hospital Questioned regimentalization of patient care and nursing as ancillary to medicine Enhancement Review 18 Dr. Cyruz P. Tuppal Professor

19. Virginia Henderson (continued) Considered it a privilege to care for soldiers and experience influenced her ethical understanding of nursing Earned BS (1932) and MS (1934) from Columbia Teachers College Continued working on faculty for next 20 years Known as the modern-day Florence Nightingale Definition of nursing Nursing functions Enhancement Review 19 Dr. Cyruz P. Tuppal Professor

20. Virginia Henderson Caring based 14 components of basic nursing care Focused on the need to be clear about the function of nurses Posed the following question: What is nursing and what is the function of the nurse? Believed this question was fundamental to anyone choosing to pursue the study and practice of nursing Enhancement Review 20 Dr. Cyruz P. Tuppal Professor

21. Henderson’s Definition of Nursing “Nursing is primarily assisting the individual (sick or well) in the performance of those activities contributing to health or its recovery (or to a peaceful death), that he would perform unaided if he had the necessary strength, will or knowledge. It is likewise the unique contribution of nursing to help people be independent of such assistance as soon as possible” (Harmer & Henderson, 1955, p 4). Enhancement Review 21 Dr. Cyruz P. Tuppal Professor

22. 14 Components of Basic Nursing Care Breathe normally Eat and drink adequately Eliminate body wastes Move and maintain desirable postures Sleep and rest Select suitable clothes—dress and undress Maintain body temperature within normal range by adjusting clothing and modifying the environment Keep the body clean and well groomed and protect the integument Enhancement Review 22 Dr. Cyruz P. Tuppal Professor

23. 14 Components of Basic Nursing Care (continued) Avoid dangers in the environment and avoid injuring others Communicate with others in expressing emotions, needs, fears, or opinions Worship according to one’s faith Work in such a way that there is a sense of accomplishment Play or participate in various forms of recreation Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities Enhancement Review 23 Dr. Cyruz P. Tuppal Professor

24. Lydia Hall Born in 1906 1927 graduate of York Hospital Nursing School in Pennsylvania Earned BS (1937) and MS (1942) from Columbia Teachers College Worked as visiting nurse, faculty at Fordham Hospital School of Nursing and research activities with the U.S. Health Services and joined the faculty of Columbia Teachers College Enhancement Review 24 Dr. Cyruz P. Tuppal Professor

25. Lydia Hall (continued) Lydia Hall challenged us to think in new ways about the key role of professional nursing in the care and rehabilitation of patients. She founded the Loeb Center for Nursing and Rehabilitation. Enhancement Review 25 Dr. Cyruz P. Tuppal Professor

26. Hall’s Care, Cure, and Core Model Person as Patient: Person Body Disease The focus of nursing is the provision of intimate bodily care Nursing care is modified based on pathology and treatment in consideration of the unique needs and personality of the patient Nursing as a professional interpersonal process Enhancement Review 26 Dr. Cyruz P. Tuppal Professor

27. Overlapping Circles of the Nursing Process Care Intimate bodily care Cure Shared with medicine Nurse in role of nurturer and comforter Core Using relationships for therapeutic effect Enhancement Review 27 Dr. Cyruz P. Tuppal Professor

28. Summary Wiedenbach, Henderson, and Hall introduced nursing theory to us in the mid-20th Century. Each of these nurses looked at their nursing, and explored nurse-patient interactions, using nursing practice as the basis for their thought and for their published scholarship. These nurse theorists defined the ways nursing is thought about, practiced, and researched, both in the United States and around the world. Enhancement Review 28 Dr. Cyruz P. Tuppal Professor

29. Nurse-Patient Relationship Theories: Hildegard Peplau, Joyce Travelbee, and Ida Jean Orlando Enhancement Review 29 Dr. Cyruz P. Tuppal Professor

30. Introducing the Theorist: Peplau Leader and pioneer in psychiatric nursing Publication of Interpersonal Relations in Nursing in 1952 Provided framework for practice; a paradigm shift from viewing patients as objects to subjects; nurses must participate with patients and engage in a nurse-patient relationship Enhancement Review 30 Dr. Cyruz P. Tuppal Professor

31. Peplau’s Professional Goals for Nursing To prepare nurse psychotherapists, referring to this training as “talking to patients” (Peplau, 1960, 1962) Required of her students “unflinching self-scrutiny,” examining their own verbal and nonverbal communication and its effects on the nurse-patient relationship Encouraged self-review, such as “What message am I sending?” Enhancement Review 31 Dr. Cyruz P. Tuppal Professor

32. Overview of Nurse-Patient Relationship Defined nursing as a “significant, therapeutic, interpersonal process” Central to all nursing care Four components The nurse The patient Professional expertise Client needs (Peplau, 1992) Enhancement Review 32 Dr. Cyruz P. Tuppal Professor

33. Overview of the Nurse-Patient Relationship Goal is to further the personal development of the patient (Peplau, 1960) The nurse accepts the patients as they are Therapeutic communication a key component Growth promoting with forward movement Essential component is nurse becoming more self- aware Supervision of nurse with goal to develop nurse’s skill as an expert in interpersonal relations Enhancement Review 33 Dr. Cyruz P. Tuppal Professor

34. Phases of the Nurse-Patient Relationship Time-limited relationship Initially had four phases: orientation, identification, exploitation, and resolution (Peplau, 1952) Forchuk, a Canadian researcher who tested Peplau’s work, proposed three phases: orientation, working, and resolution (Peplau, 1992) Enhancement Review 34 Dr. Cyruz P. Tuppal Professor

35. Orientation Phase Sets the stage for the development of the relationship Patient needs are evaluated during this phase Nurse and patient work together as a team Trust develops Based on assessment information, nursing diagnosis, goals and outcomes are created. Nursing interventions are implemented and the evaluations of the patient’s goals are also incorporated (Peplau, 1992) Enhancement Review 35 Dr. Cyruz P. Tuppal Professor

36. Working Phase Incorporates identification and exploitation Focus of work is two-fold: Patient who “exploits” resources to improve health Nurse who enacts the roles of “resource person, counselor, surrogate, and teaching in facilitation. Development toward well-being” (Fitzpatrick, 2005) Active phase, patient begins to develop responsibility and independence Enhancement Review 36 Dr. Cyruz P. Tuppal Professor

37. Resolution Phase Last phase Involves patient’s continual movement from dependence to independence Resolution can take place only when patient has gained ability to be free from nursing assistance and act independently (Lloyd, 2007) Results in mutual termination of the nurse-patient relationship and involves planning for future sources of support (Peplau, 1952) Enhancement Review 37 Dr. Cyruz P. Tuppal Professor

38. Introducing the Theorist: Travelbee Joyce Travelbee (1926–1973) Nurse educator and psychiatric nurse practitioner Best known for her Human-to-Human Relationship model, a mid-range theory based on the nursing process Enhancement Review 38 Dr. Cyruz P. Tuppal Professor

39. Overview of Travelbee’s Human-to-Human Relationship Model Caring involves the dynamic, reciprocal, interpersonal connection Therapeutic use of self Meaning of the illness experience becomes self- actualizing The term patient is NOT used; this refers to a label or category of people rather than a unique individual in need of nursing care Enhancement Review 39 Dr. Cyruz P. Tuppal Professor

40. Overview of Travelbee’s Human-to-Human Relationship Model The human-to-human relationship “refers to an experience or series of experiences between the human being who is nurse and an ill person,” culminating in the nurse meeting the ill person’s unique needs (Travelbee, 1971, p 16–17) Hope and motivation are important nursing tasks Hope helps the suffering person to cope Enhancement Review 40 Dr. Cyruz P. Tuppal Professor

41. Overview of Travelbee’s Human-to-Human Relationship Model (continued) “Nurse “cannot” give hope to another person but strives to provide some ways and means for an ill person to experience hope” (Travelbee, 1971, p 83) Five phases of nursing care Observation Interpretation Decision making Action (or nursing intervention) Appraisal (or evaluation) Enhancement Review 41 Dr. Cyruz P. Tuppal Professor

42. Overview of Travelbee’s Human-to-Human Relationship Model (continued) Meeting spiritual and emotional needs are developed in the progression through five phases Original encounter Emerging identities Empathy Sympathy Rapport Enhancement Review 42 Dr. Cyruz P. Tuppal Professor

43. Introducing the Theorist: Orlando First book was The Dynamic Nurse-Patient Relationship: Function, Process, and Principles (1961) Second book was The Discipline and Teaching of Nursing Process (1972) National Institute of Mental Health funded study to improve education of nurses about concepts and interpersonal relationships Method of study was qualitative and inductive, using the naturalistic inquiry method First theory of nursing practice Enhancement Review 43 Dr. Cyruz P. Tuppal Professor

44. Orlando’s Theory of Dynamic Nurse-Patient Relationship Nursing is concerned with 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 (Orlando, 1972). Practice should be based on the needs of the patient. Communication is essential to understanding needs and providing effective nursing care. Enhancement Review 44 Dr. Cyruz P. Tuppal Professor

45. Orlando’s Theory of Dynamic Nurse-Patient Relationship Major components Nursing process Understanding the meaning Nurse-patient interactions Professional nurses The human transaction between the nurse and the patient in any setting holds the greatest value Enhancement Review 45 Dr. Cyruz P. Tuppal Professor

46. Myra Levine’s Conservation Model Enhancement Review 46 Dr. Cyruz P. Tuppal Professor

47. Introducing the Theorist Myra Levine Called a “renaissance woman” Born in Chicago Father often ill and frequently hospitalized Strong mother Enhancement Review 47 Dr. Cyruz P. Tuppal Professor

48. Levine: Components of the Model Adaptation Adaptation is the process of change, and conservation is the outcome of adaptation. Adaptation is the process whereby the patient maintains integrity within the realities of the environment. Adaptation is achieved through the “frugal, economic, contained, and controlled use of environmental resources by the individual in his or her best interest.” Enhancement Review 48 Dr. Cyruz P. Tuppal Professor

49. Levine: Components of the Model Conservation Conservation is the product of adaptation and is a common principle underlying many of the basic sciences. Conservation is critical to understanding an essential element of human life. Enhancement Review 49 Dr. Cyruz P. Tuppal Professor

50. Levine: Components of the Model Wholeness The unceasing interaction of the individual organism with its environment does represent an ‘open and fluid’ system, and a condition of health, wholeness, exists when the interaction or constant adaptations to the environment, permit ease—the assurance of integrity ... in all the dimensions of life. This continuous dynamic, open interaction between the internal and external environment provides the basis for holistic thought, the view of the individual as whole. Enhancement Review 50 Dr. Cyruz P. Tuppal Professor

51. Levine: Levels of Organismic Responses Response to fear (flight/fight response) Inflammatory response Response to stress Perceptual response Enhancement Review 51 Dr. Cyruz P. Tuppal Professor

52. Levine: Applications The universality of the model is supported by the use of the model in a variety of situations and patients’ conditions across the life span. A growing body of research provides the support for the development of scientific knowledge related to the model. Enhancement Review 52 Dr. Cyruz P. Tuppal Professor

53. Levine: In the 21st Century Interventions are based on the assumption that if the intervention attends to the conservation of energy, structural, personal and social integrities, the patient will return to wholeness (health). Health is a goal for individuals, families, communities, and populations at large. From a global perspective, “health for all” is an appropriate metaphor. Wholeness is universally understood. Enhancement Review 53 Dr. Cyruz P. Tuppal Professor

54. Application to Community Model provides foundation for community practice Community defined as “a group of people living together within a larger society, sharing common characteristics, interests and location” (NLN Self Study Report, 1992) Enhancement Review 54 Dr. Cyruz P. Tuppal Professor

55. Community Assessment: Provocative facts Internal environment Patterns of health and disease External environment Perceptual, operational, and conceptual levels of the environment Enhancement Review 55 Dr. Cyruz P. Tuppal Professor

56. Perceptual Level Factors processed by the senses How media effects health Influence of air quality Availability of nutritious food Noise pollution Relationships among subcultures Enhancement Review 56 Dr. Cyruz P. Tuppal Professor

57. Operational Environment Factors that affect the individual’s health but are not perceived Surveillance of communicable diseases Assessment of the use of environmental toxins Waste disposal Exposure to electromagnetic fields Environmental presence of radon, asbestos and lead Enhancement Review 57 Dr. Cyruz P. Tuppal Professor

58. Conceptual Environment Ethnic and cultural patterns Types of houses of worship Health-care settings Enhancement Review 58 Dr. Cyruz P. Tuppal Professor

59. Community Assessment: Energy Conservation Hours of employment Water supply Community budget Food sources City planning Availability of resources Transportation Traffic patterns Public services Availability of resources Enhancement Review 59 Dr. Cyruz P. Tuppal Professor

60. Community Assessment: Personal Integrity Social integrity Recreation Social services Opportunities for employment Personal integrity Community identity Mission of the government Political environment Enhancement Review 60 Dr. Cyruz P. Tuppal Professor

61. Dorothy Johnson’s Behavioral System Model and Its Applications Enhancement Review 61 Dr. Cyruz P. Tuppal Professor

62. Johnson Behavioral System Model (JBSM) Overview Evolved from philosophical ideas, theory, and research; her clinical background; and many years of thought, discussions, and writing Influences: Florence Nightingale Systems theory Developmental theory Enhancement Review 62 Dr. Cyruz P. Tuppal Professor

63. Five Core Principals Wholeness and Order Stabilization Reorganization Hierarchic Interaction Dialectical Contradiction Enhancement Review 63 Dr. Cyruz P. Tuppal Professor

64. Wholeness and Order Developmental analogy of wholeness and order is continuity and identity. Continuity and change can exist across the life span. Continuity is in the relationship of the parts rather than in their individuality. Enhancement Review 64 Dr. Cyruz P. Tuppal Professor

65. Stabilization Dynamic systems respond to contextual changes by either a homeostatic or homeorhetic process. Set point maintained by altering internal conditions to compensate for changes in external conditions. Nurses act as external regulators. Monitor patient response, looking for successful adaptation to occur. Nurses intervene to help patient restore behavioral system balance. Intervention is not needed if behavioral system balance returns. Enhancement Review 65 Dr. Cyruz P. Tuppal Professor

66. Reorganization Occurs when the behavioral system encounters new experiences in the environment that cannot be balanced by existing system mechanisms Nurse acts to provide conditions or resources essential to help the accommodation process: May impose regulatory or control mechanisms to stimulate or reinforce certain behaviors May attempt to repair structural components Enhancement Review 66 Dr. Cyruz P. Tuppal Professor

67. Hierarchic Interaction Hierarchies, or a pattern of relying on particular subsystems, lead to a degree of stability. Enhancement Review 67 Dr. Cyruz P. Tuppal Professor

68. Dialectical Contradiction Motivational force for behavioral change Drives/responses developed and modified over time through maturation, experience, and learning Environmental domains that the person is responding to include the biological, psychological, cultural, familial, social, and physical setting Enhancement Review 68 Dr. Cyruz P. Tuppal Professor

69. Major Concepts of the Model Person Subsystems Health Nursing and nursing therapeutics Enhancement Review 69 Dr. Cyruz P. Tuppal Professor

70. Person Viewed as an open system with organized, interrelated, and interdependent subsystems. The whole of the human organism (system) is greater than the sum of its parts (subsystems). Wholes and parts create a system with dual constraints: Neither has continuity and identity without the other. Nursing client viewed as a behavioral system Behavioral systems are orderly, repetitive, and organized Enhancement Review 70 Dr. Cyruz P. Tuppal Professor

71. Human Behavior Is Orderly, purposeful, and predictable Functionally efficient and effective most of the time Sufficiently stable and recurrent to be amenable to description and exploration Enhancement Review 71 Dr. Cyruz P. Tuppal Professor

72. Subsystems Are parts of the behavioral system Carry out specialized tasks/functions needed to maintain the integrity of the whole system Manage system relationship to the environment Have a set of behavioral responses that are developed and modified through motivation, experience, and learning Enhancement Review 72 Dr. Cyruz P. Tuppal Professor

73. Each Subsystem Composed of at least four structural components that interact in a specific pattern Goal Set Choice Action Enhancement Review 73 Dr. Cyruz P. Tuppal Professor

74. Goal This is defined as the desired result or consequence of the behavior. The basis for the goal is a universal drive whose existence can be supported by scientific research. Enhancement Review 74 Dr. Cyruz P. Tuppal Professor

75. Behavioral Set Is a predisposition to act in a certain way in a given situation Represents a relatively stable and habitual behavioral pattern of responses to particular drives or stimuli Represents learned behavior and is influenced by knowledge, attitudes, and beliefs Enhancement Review 75 Dr. Cyruz P. Tuppal Professor

76. Behavioral Set Components Perseveration Consistent tendency to react to certain stimuli with the same pattern of behavior Preparation Functions to establish priorities for attending or not attending to various stimuli Enhancement Review 76 Dr. Cyruz P. Tuppal Professor

77. Choice Refers to the individual’s repertoire of alternative behaviors in a situation that will best meet the goal and attain the desired outcome. The greater the behavioral repertoire of alternative behaviors in a situation, the more adaptable the individual. Enhancement Review 77 Dr. Cyruz P. Tuppal Professor

78. Action Observable action of the individual Concern is with the efficiency and effectiveness of the behavior in goal attainment. Actions are observable responses to stimuli. Enhancement Review 78 Dr. Cyruz P. Tuppal Professor

79. The Johnson Model Proposes For behavior to be maintained, it must be protected, nurtured, and stimulated. Protection from noxious stimuli that threaten the survival of the behavioral system Nurturance, which provides adequate input to sustain behavior Stimulation to continue growth of the behavior and counteracts stagnation Enhancement Review 79 Dr. Cyruz P. Tuppal Professor

80. The Johnson Model (continued) Deficiency in any or all of these functional requirements Threatens the behavioral system as a whole or the effective functioning of the particular subsystem with which it is directly involved. Enhancement Review 80 Dr. Cyruz P. Tuppal Professor

81. Health Behavioral system balance or stability Demonstrated by observed behavior that is purposeful, orderly, and predictable. Behavior maintained when it is efficient and effective in managing the person’s relationship to the environment Enhancement Review 81 Dr. Cyruz P. Tuppal Professor

82. Environment Consists of all elements that are not a part of the individual’s behavioral system but influence the system and can serve as a source of sustenal imperatives Manipulated by the nurse to achieve health Enhancement Review 82 Dr. Cyruz P. Tuppal Professor

83. Nursing and Nursing Therapeutics Nursing is “a service that is complementary to that of medicine and other health professions, but which makes its own distinctive contribution to the health and well-being of people.” Nursing views patients as behavioral systems, and medicine views patients as biological systems. Enhancement Review 83 Dr. Cyruz P. Tuppal Professor

84. Specific Goal of Nursing Action Is “to restore, maintain, or attain behavioral system balance and stability at the highest possible level for the individual” (Johnson, 1980, p 214) Enhancement Review 84 Dr. Cyruz P. Tuppal Professor

85. Nursing Therapeutics Attempt to repair damaged structural units by altering the individual’s set and choice Impose regulatory and control measures Supply or help the client find his or her own supplies of essential functional requirements Enhancement Review 85 Dr. Cyruz P. Tuppal Professor

86. The Nurse May Provide Nurturance Stimulation Protection Enhancement Review 86 Dr. Cyruz P. Tuppal Professor

87. Dorothea Orem’s Self-Care Deficit Theory Enhancement Review 87 Dr. Cyruz P. Tuppal Professor

88. Nursing is Commonly Viewed as: Human health service Implies two categories of human beings: Those who need nursing service Those who produce nursing service Enhancement Review 88 Dr. Cyruz P. Tuppal Professor

89. Self-Care Deficit Nursing Theory (SCDNT) Began with formulations about the reasons why individuals (the patient) Need nursing and Can be helped through nursing Enhancement Review 89 Dr. Cyruz P. Tuppal Professor

90. Central Idea Mature human beings have learned and continue to learn to meet some or all components of their own TSCDs and the TSCDs of their dependents (those for whom the dependent care agent assumes or has responsibility for meeting TSCDs). Self-care and dependent care (i.e., care delivered by someone other than the individual for the individual) are time-specific entities produced by individuals. Enhancement Review 90 Dr. Cyruz P. Tuppal Professor

91. Theory of Self-Care Individuals have the human power to develop and exercise capabilities to know and meet Therapeutic Self-Care Demands using Self-Care Agency (SCA) First, investigate or identify what can or should to be done. Second,decide what can be done. Third, produce the care. Enhancement Review 91 Dr. Cyruz P. Tuppal Professor

92. Nursing Is Needed: When Therapeutic Self-Care Demands exceed an individual’s Self-Care Agency because of health state or health-care–related conditions Self-Care Deficit (SCD) TSCD > SCA = SCD = Nursing Required Enhancement Review 92 Dr. Cyruz P. Tuppal Professor

93. Nursing Triad of Interrelated Action Systems Professional-Technical Necessary for the production of nursing–dependent on the interpersonal system Interpersonal Interaction and communication necessary for design and production of nursing Societal Established by the specifying contracting parties and their legitimate relationships Societal-contractual system Enhancement Review 93 Dr. Cyruz P. Tuppal Professor

94. View of Person Human beings are: Embodied with inherent rights At once a self and a person Person-as-agent Central to understanding and integrating the other views of human beings Subsumes all other views Essential to understanding nursing as a triad of systems Enhancement Review 94 Dr. Cyruz P. Tuppal Professor

95. Conclusion Nursing-specific views of human beings are differentiated from general views of human beings. General views (human beings as energy fields, living health, or culture-oriented or as caring beings) are helpful in understanding humankind but do not and cannot support viable nursing science. Enhancement Review 95 Dr. Cyruz P. Tuppal Professor

96. Imogene King’s Theory of Goal Attainment Enhancement Review 96 Dr. Cyruz P. Tuppal Professor

97. Original Levels of Interaction Human being (or individual or person) Perception Communication Interpersonal relations Health Social institutions Enhancement Review 97 Dr. Cyruz P. Tuppal Professor

98. Theory of Goal Attainment Derived from the goal of nursing: Help individuals maintain or regain health (King, 1990) Uses the following concepts: Self, perception, communication, interaction, transaction, role, growth and development, stress, time, personal space Enhancement Review 98 Dr. Cyruz P. Tuppal Professor

99. Examples of Practice Applications Used with different nursing specialties Used at different work sites Used to create evidence-based practice Multicultural applications Enhancement Review 99 Dr. Cyruz P. Tuppal Professor

100. Model Concepts Persons and groups are viewed as holistic adaptive systems with coping processes Coping processes act to maintain adaptation Promote person and environment transformations Goal of Nursing is to promote adaptation/positive coping in four adaptive modes to contribute to health, quality of life and dying with dignity Enhancement Review 100 Dr. Cyruz P. Tuppal Professor

101. Types of Coping Subsystems Person centered internal processes Regulator-Cognator Regulator: subsystem using physiologic processes to cope with environment Cognator: subsystem using cognitive and emotional processes to interact with environment Group related processes Stabilizer-Innovator Stabilizer subsystem supports achievement of the primary purpose of the group through the use of values, structure, and daily activities Innovator subsystem responds to the environment with innovation and change (i.e., new goals, new activities, team building Enhancement Review 101 Dr. Cyruz P. Tuppal Professor

102. Human Behavior Processing of the internal and external environments by the coping subsystems results in or can modify human behavior Behaviors or adaptive modes of individuals and groups are assessed by nurses Enhancement Review 102 Dr. Cyruz P. Tuppal Professor

103. Levels of Adaptation Integrated Adaptive modes are working to meet human needs Compensatory Occurs when cognator/regulator or stabilizer/innovator are activated by challenge Compromised Occurs when compensatory processes are inadequate Enhancement Review 103 Dr. Cyruz P. Tuppal Professor

104. Adaptive Modes Are interdependent and overlapping Physiological-physical Self-concept-group identify Role function Interdependence Enhancement Review 104 Dr. Cyruz P. Tuppal Professor

105. Central Belief of the Roy Adaptation Model Adaptive responses support health Health is a reflection of adaptive processes which promote the state and a process of being and becoming integrated and whole Enhancement Review 105 Dr. Cyruz P. Tuppal Professor

106. Background on Neuman Systems Model Neuman’s Systems Model was developed to provide a focus for student learning. It was designed to provide a framework to view nursing within various concepts. The “teaching model” has become a widely used nursing conceptual model. Enhancement Review 106 Dr. Cyruz P. Tuppal Professor

107. Neuman Systems Model Basics System is a pervasive order that holds together its parts… nursing can be readily conceptualized as a complete whole, with identifiable smaller wholes or parts. In the system, there is dynamic energy exchange, moving either toward or away from stability. Enhancement Review 107 Dr. Cyruz P. Tuppal Professor

108. Neuman Systems Model Basics (continued) Nursing defines appropriate actions in stressor-related situations or in reactions of the client-client system. Any system tries to maintain a steady state or balance among disruptive forces operating within or upon it. Enhancement Review 108 Dr. Cyruz P. Tuppal Professor

109. Neuman Systems Model Basics (continued) Neuman calls these forces stressors and suggests that possible reactions and actual reactions with identifiable signs or symptoms may be mitigated through appropriate early interventions. Enhancement Review 109 Dr. Cyruz P. Tuppal Professor

110. Neuman’s Propositions Each client system is a composite of factors or characteristics within a normal, given range of response within a basic structure. Many known, unknown, and universal environmental stressors exist. Each differs in its potential for disturbing a client’s usual stability level or normal line of defense. Enhancement Review 110 Dr. Cyruz P. Tuppal Professor

111. Neuman’s Propositions (continued) Primary prevention relates to general knowledge applied in client assessment and intervention to identify and reduce or mitigate risk factors from environmental stressors to prevent reaction. Includes health promotion. Secondary prevention relates to symptoms following a reaction to stressors, appropriate ranking of intervention priorities, and treatment to reduce their noxious effects. Enhancement Review 111 Dr. Cyruz P. Tuppal Professor

112. Neuman’s Propositions (continued) Tertiary prevention relates to the adaptive processes as reconstitution begins and maintenance factors move the client back toward primary prevention. The client as a system is in a dynamic, constant energy exchange with the environment. Enhancement Review 112 Dr. Cyruz P. Tuppal Professor

113. Five Client Variables Physiological Psychological Sociocultural Developmental Spiritual Enhancement Review 113 Dr. Cyruz P. Tuppal Professor

114. Helen Erickson, Evelyn Tomlin, and Mary Ann Swain’s Modeling and Role Modeling Enhancement Review 114 Dr. Cyruz P. Tuppal Professor

115. Overview of Modeling and Role-Modeling theory Guiding principles: Nursing interventions should have intent Nursing intervention aims and goals Aims = intent Goals = general markers to evaluate efficiency Enhancement Review 115 Dr. Cyruz P. Tuppal Professor

116. Modeling Process Involves an assessment of a client situation Starts with interaction with client Concludes with understanding of person’s perspective of situation Builds a mirror image of an individual’s worldview Enhancement Review 116 Dr. Cyruz P. Tuppal Professor

117. Person’s Worldview Tells Us What person perceives to be important What caused problems What will help How he or she wants to relate Enhancement Review 117 Dr. Cyruz P. Tuppal Professor

118. Role-Modeling Process Requires objective and artistic actions Analyze data using theoretical propositions Interpret meaning Search for linkages Implications for nursing actions Nursing actions artistically designed with intent and outcomes Enhancement Review 118 Dr. Cyruz P. Tuppal Professor

119. Martha E. Rogers’ Science of Unitary Human Beings Enhancement Review 119 Dr. Cyruz P. Tuppal Professor

120. Principles of Homeodynamics Like adaptation, homeostasis—maintaining balance or equilibrium—is an outdated concept in the worldview represented in Rogerian nursing science. Rogers chose “homeodynamics” to convey the dynamic, ever-changing nature of life and the world. Her three principles of homeodynamics-resonancy, heliacy, and integrality-describe the nature of change in the human-environmental field. Enhancement Review 120 Dr. Cyruz P. Tuppal Professor

121. Personalized Nursing LIGHT Practice Model The acronym LIGHT guides the voluntary mutual patterning process. Nurses: L—love the client, I—intend to help, G—give care gently, H—help the client improve well-being, and T—teach the healing process of the LIGHT model. Enhancement Review 121 Dr. Cyruz P. Tuppal Professor

122. Personalized Nursing LIGHT Practice Model (continued) Clients make progress toward well-being as they learn to: L—love themselves, I—identify concerns, G—give themselves goals, H—have confidence and help themselves, and T—take positive action. Enhancement Review 122 Dr. Cyruz P. Tuppal Professor

123. Personalized Nursing LIGHT Practice Model The goal of the LIGHT model is to assist clients in improving their sense of well-being. (Anderson & Smereck, 1989, 1992, 1994) Enhancement Review 123 Dr. Cyruz P. Tuppal Professor

124. Madeleine Leininger’s Theory of Culture Care Diversity and Universality . Enhancement Review 124 Dr. Cyruz P. Tuppal Professor

125. Background of the Theory Transcultural nursing care can provide meaningful and therapeutic health and healing outcomes Nurses advance new scientific and humanistic dimensions of caring for people of diverse and similar cultures Nurses require transcultural knowledge of health and illness practices to function with people of diverse cultures locally and worldwide Enhancement Review 125 Dr. Cyruz P. Tuppal Professor

126. Background of the Theory (continued) Care and caring is the essence and central domain of nursing. Before Leininger’s work, there were no theories focused on care and culture in nursing. Leininger held that caring for children/people of different cultures required an understanding of their unique behaviors, needs and responses, and care expectations. Nurses and other health professionals were not prepared to respond to cultural differences. Enhancement Review 126 Dr. Cyruz P. Tuppal Professor

127. Background of the Theory (continued) At that time, nursing and medicine focused on new and improved medical technologies and treatment regimens. Leininger saw the need to develop a new body of culturally based care knowledge to support. transcultural nursing care and shift nurses’ and other health care providers’ thinking and attitudes from symptoms, diseases, and treatments to knowing cultures and their caring values and patterns. Enhancement Review 127 Dr. Cyruz P. Tuppal Professor

128. Theory Basics Care diversities and similarities (or commonalities) are found among cultures. Worldview and social structure factors—such as religion (and spirituality), political and economic considerations, kinship, and so on—are important. influences on health care outcomes There are differences and similarities with regard to two kinds of care (professional and generic). Enhancement Review 128 Dr. Cyruz P. Tuppal Professor

129. Rationale for Transcultural Nursing Global migrations Few health-care providers from different cultures Lack of the provision of culturally congruent care Conflicts and stress between providers and consumers of health care Fear of new treatments Lack of patient satisfaction with “one size fits all” approach to care Enhancement Review 129 Dr. Cyruz P. Tuppal Professor

130. Josephine Patterson and Loretta Zderad’s Humanistic Nursing Theory Enhancement Review 130 Dr. Cyruz P. Tuppal Professor

131. Origins of the Theory Arose from collaborative work related to “existential phenomenology” by Dr. Josephine Paterson—focus on education, public health nursing, doctoral study of comfort Dr. Loretta Zderad—focus on education, mental health nursing, doctoral study of empathy Further developed and brought to nursing situations by Susan Kleiman —former student Enhancement Review 131 Dr. Cyruz P. Tuppal Professor

133. Originallyformulated to define nursing as nurses respond to the call of a human need

134. Illuminate the values and meanings central to nursing experiences. Humanistic Nursing Theory Enhancement Review 132 Dr. Cyruz P. Tuppal Professor

135. Humanistic Nursing Theory Interactive theory of nursing that provides a methodology for reflection and articulation of nursing essences. Theory that provides a methodological bridge between theory and practice by providing a broad guide for nursing “dialogue” in a myriad of settings. Enhancement Review 133 Dr. Cyruz P. Tuppal Professor

136. Jean Watson’s Theory of Human Caring Enhancement Review 134 Dr. Cyruz P. Tuppal Professor

137. Original 10 Carative Factors Formation of a humanistic-altruistic system of values Instillation of faith-hope Cultivation of sensitivity to one’s self and to others. Development of a helping-trusting, human caring relationship Promotion and acceptance of the expression of positive and negative feelings Enhancement Review 135 Dr. Cyruz P. Tuppal Professor

138. Original 10 Carative Factors Systematic use of a creative problem-solving caring process Promotion of transpersonal teaching-learning Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment Assistance with gratification of human needs Allowance for existential-phenomenological-spiritual forces. (Watson, 1979/1985) Enhancement Review 136 Dr. Cyruz P. Tuppal Professor

139. Transpersonal Caring Relationship A transpersonal caring relationship moves beyond ego self and radiates to spiritual, even cosmic, concerns and connections that tap into healing possibilities and potentials. Transpersonal caring seeks to connect with and embrace the spirit or soul of the other, through the processes of caring and healing and being in authentic relation, in the moment. Enhancement Review 137 Dr. Cyruz P. Tuppal Professor

140. Caring-Healing Environment for Patients, Families and Staff Compassion, Competence, Commitment Advocacy Respect, Research Individuality Nurturing Generosity Enhancement Review 138 Dr. Cyruz P. Tuppal Professor

141. Anne Boykin and Savina O. Schoenhofer’s Nursing as Caring Theory Enhancement Review 139 Dr. Cyruz P. Tuppal Professor

142. Assumptions of Nursing as Caring Persons are caring by virtue of their humanness. Persons are whole and complete in the moment. Persons live caring moment to moment. Personhood is a way of living grounded in caring. Personhood is enhanced through participation in nurturing relationships with caring others. Nursing is both a discipline and a profession. Enhancement Review 140 Dr. Cyruz P. Tuppal Professor

143. Rozzano Locsin’s Technological Competency as Caring and the Practice of Knowing Persons in Nursing Enhancement Review 141 Dr. Cyruz P. Tuppal Professor

144. Rozzano Locsin’s Technological Competency as Caring and the Practice of Knowing Persons in Nursing Enhancement Review 142 Dr. Cyruz P. Tuppal Professor

145. Introducing the Theorist Rozzano C. Loscin RN, PhD, FAAN Professor of Nursing Florida Atlantic University Christine E. Lynn College of Nursing Program of Research: “Life transitions n the health-illness experience” Earned BSN and MS from the Silliman University of the Philippines Earned PhD at the University from the Philippines Enhancement Review 143 Dr. Cyruz P. Tuppal Professor

146. Awards Fullbright Scholar to Uganda in 2000 Fullbright Alumni Initiative Award to Uganda 2004–2006 Fullbright Senior Specialist in Global and Public Health and International Development Edith Moore Copeland Excellence in Creativity Award: Sigma Theta International Lifetime Achievement Awards from Schools of Nursing in the Philippines Enhancement Review 144 Dr. Cyruz P. Tuppal Professor

147. Book Publications Advancing Technology, Caring and Nursing (2001) Technological Caring in Nursing: A Model for Practice (2005) A Contemporary Process of Knowing: The (Unbearable) Weight of Knowing in Nursing (2009) Enhancement Review 145 Dr. Cyruz P. Tuppal Professor

148. Chapter Purpose Explain “knowing persons as whole” as a theoretical construct of Technology Competency as Caring in Nursing Illuminate the harmonious relationship between Technology-competency Caring in nursing Enhancement Review 146 Dr. Cyruz P. Tuppal Professor

149. Technological Competency as Caring in Nursing is defined as “The practice of knowing persons as whole, frequently with the use of varying technologies” (Locsin, 2001) . Enhancement Review 147 Dr. Cyruz P. Tuppal Professor

150. Model Assumptions Persons are whole or complete in the moment (Boykin & Schoenhofer, 2001). Knowing persons is a process of nursing allowing for continuous appreciation of persons moment to moment (Locsin, 2001). Nursing is a discipline and profession practice (Boykin & Schoenhofer, 2001). Technology is used to know persons as a whole from moment to moment (Locsin, 2001). Enhancement Review 148 Dr. Cyruz P. Tuppal Professor

151. Nursing Intention To know human beings fully as a whole person By affirming, appreciating, and celebrating personhood Through expert and competent use of nursing technologies Enhancement Review 149 Dr. Cyruz P. Tuppal Professor

152. Focus of Nursing The Focus of Nursing is Person A human being whose hopes, dreams, and aspirations are to live fully as a caring person (Boykin & Schoenhofer, 2001) Enhancement Review 150 Dr. Cyruz P. Tuppal Professor

153. Purpose of Technological Competency Acknowledge wholeness of persons as a focus of nursing Technological means are used to know wholeness more fully Technology used to know “who is person” rather than “what is person” Enhancement Review 151 Dr. Cyruz P. Tuppal Professor

154. The What Is/Who Is Person What is Person? Empirical facts about the compositions of the person Persons as objects Who is Person? Understanding the unpredictable, irreducible person who is more and different than the sum of his or her empirical self Persons as unique individual Enhancement Review 152 Dr. Cyruz P. Tuppal Professor

155. Katharine Kolcaba’s Theory of Comfort Enhancement Review 153 Dr. Cyruz P. Tuppal Professor

156. “Comfort Theory provides the language and rational to once again claim and document essential nursing activities which are most beneficial to patients and family members in stressful health-care situations.” Enhancement Review 154 Dr. Cyruz P. Tuppal Professor

157. Joanne Duffy’s Quality Caring Model Enhancement Review 155 Dr. Cyruz P. Tuppal Professor

158. Quality–Caring Model Background Few nursing theories that could guide Development of caring-based nursing interventions Speak to the relationship between nurse caring and quality Initial testing with a group of patients with heart failure Enhancement Review 156 Dr. Cyruz P. Tuppal Professor

159. Caring Factors Mutual problem-solving Attentive reassurance Human respect Encouraging manner Healing environment Appreciation of unique meaning Affiliation needs Basic human needs Enhancement Review 157 Dr. Cyruz P. Tuppal Professor

160. Transformative Leadership Model Sr. Carol Agravante CASAGRA Theory Enhancement Review 158 Dr. Cyruz P. Tuppal Professor

161. Casagra Theory Transformational leadership can improve cooperative climate within the health care team which, in turn, improves task consistency. Also, education imposed mutual learning on the health care team acknowledging the possibility of learning from the other and being sensitive to the value of what the other contributes to the working relationship . Enhancement Review 159 Dr. Cyruz P. Tuppal Professor

162. Casagra Theory CASAGRA Transformational Leadership Model could help in promoting a successful collaboration as it will develop a reciprocal communication between the nurses and health care team in which thoughtful feedback will facilitate appropriate adjustments on the management of patients. Enhancement Review 160 Dr. Cyruz P. Tuppal Professor

163. Casagra Theory This is vital because it provides not only direction, but it also creates opportunities for professional development. It was concluded by Weberg (2010) that transformational leadership was significantly related to increased satisfaction, increased staff well-being, decreased burnout, and decreased overall stress in staff nurses. This is effective as it will lead to a better care management to the patients. Enhancement Review 161 Dr. Cyruz P. Tuppal Professor

164. Retirement and Role DiscontinuitiesSr. Letty Kuan Enhancement Review 162 Dr. Cyruz P. Tuppal Professor

165. Physiological Age is the endurance of cells and tissues to withstand the wear-and-tear phenomenon of the human body. Some individuals are gifted with strong genetic affinity to stay young for a long time. Enhancement Review 163 Dr. Cyruz P. Tuppal Professor

166. Role refers to the set of shared expectations focused upon a particular position. For every social role, there is complementary set of roles in the social structure among which interaction constantly occurs. Enhancement Review 164 Dr. Cyruz P. Tuppal Professor

167. Change of Life is the period between near retirement and post retirement years. In medico-physiologic terms, this equates with the climacteric period of adjustment and readjustment to another tempo of life. Enhancement Review 165 Dr. Cyruz P. Tuppal Professor

168. Retiree is an individual who has left the position occupied for the past years of productive life because he/she has reached the prescribed retirement age of has completed the required years of service. Enhancement Review 166 Dr. Cyruz P. Tuppal Professor

169. Role Discontinuity is the interruption in the line of status enjoyed or role performed. The interruption may be brought about by an accident, emergency, and change of position or retirement. Enhancement Review 167 Dr. Cyruz P. Tuppal Professor

170. Coping Approaches refer to the interventions or measures applied to solve a problematic situation or state in order to restore or maintain equilibrium and normal functioning. Health Status Income Work Status Family Constellation Self Preparation Enhancement Review 168 Dr. Cyruz P. Tuppal Professor

171. “PREPARE ME” Interventions & the Quality of Life of Advance Progressive Cancer Patients Carmencita M. Abaquin Enhancement Review 169 Dr. Cyruz P. Tuppal Professor

172. PREPARE ME (Holistic Nursing Interventions) are the nursing interventions provided to address the multi-dimensional problems of cancer patients that can be given in any setting where patients choose to be confined. This program emphasizes a holistic approach to nursing care. PREPARE ME has the following components: Enhancement Review 170 Dr. Cyruz P. Tuppal Professor

173. PREPARE ME (Holistic Nursing Interventions) This program emphasizes a holistic approach to nursing care. PREPARE ME has the following components: Presence Reminisce Therapt Relaxation Breathing Prayer Meditation Values Clarification Enhancement Review 171 Dr. Cyruz P. Tuppal Professor

174. “To Nursing… may be able to provide the care that our clients need in maintaining their quality of life and being instrumental in “Birthing” them to External life” Enhancement Review 172 Dr. Cyruz P. Tuppal Professor

175. Women Status towards the enhancement of self esteem for the Filipino of Abused WomenDr. Ma. Irma Bustamante Enhancement Review 173 Dr. Cyruz P. Tuppal Professor

176. The essence of womanhood is being a good mother and a good wife; Roles that women play can either be working mother or non-working mother, however, whether women are working or not, they should still perform their responsibilities as mother and wife. Respondents felt that it is still the male who has the higher status in the society, although they were others who felt that men and women are equal. Abused was perceived wrong, however, respondents felt they could do little about the situation. Enhancement Review 174 Dr. Cyruz P. Tuppal Professor

177. A number of respondents felt that women are to blame for the occurrence of abuse. As measured by the self-esteem scale, the respondent self-esteem was found to be moderate. There was no relationship between the roles that women play and their status in society to their levels of self esteem. Enhancement Review 175 Dr. Cyruz P. Tuppal Professor

178. Thank you very much… Dr. Cyruz P. Tuppal Professor Enhancement Review Dr. Cyruz P. Tuppal Professor 176