TFN REVIEWER

Topic I: Relevant Terminologies

What is concept?

- Symbolic statement describing a

phenomena or a group of phenomena

- Formulated in words to be able to

communicate meanings about realities

in the world or give meaning to

phenomena that can be directly seen or

indirectly seen, heard, tasted, smelled

or touched.

Types of concept:

a. Abstract (hope, love, desire)

b. Concrete (Airplane, temperature,

weight)

Formulation:

1. Word – grief, empathy

2. Two words – patient’s satisfaction,

caring nurse, excellent performance

3. Phrases – maternal-child bonding,

health promoting practices, care

competency standards, advance nursing

practices

Categories:

1. Variable (continuous)

o Has concepts that describe

phenomena according to same

dimensions permits,

classification or graduation of

phenomena

o Ex. Blood pressure (has

calibration), pain (intensity)

o Includes sex-role orientation,

level of well-being and degree

of cultural identity. Hope,

quality of life, need of

fulfillment and grief are defined

operationally and measured by

tools or scales to show where

the respondents’ level or

variable fell.

2. Non-Variable (Discrete)

o Concept that identifies

categories of phenomena

o Ex. Gender, Ethnic Background

Can be answered by a

yes or no

o Occupation – job or career

o Profession – learned vocation

or an occupation with a

knowledge base, has superiority

within a division of work.

o “All professions are

occupations, but not all

occupations are considered

professions” (Shurlan, 1988)

History - considered professions before are

medicine, lawyer and priesthood.

Characteristics of profession:

1. Power – with authority over teaching

and occupation

o Core Competency

Knowledge (HEAD)

Skills (HAND)

Attitude (HEART)

2. Registration (PRC)

3. Autonomy – has its own discipline in

healing; collaborates with physicians

4. Code of Ethics

5. Lengthy Socialization

Sources of Concepts:

1. Naturalistic - Seen in nature or in

nursing practice such as body, weight,

thermoregulation, hermatologic

complications, pain and spirituality

2. Research based – result of conceptual

development that is grounded in

research processes through *qualitative

phenomelogical or grounded theory

approaches

*qualitative (lived out)

5 Areas of Well-being

1. Physical

2. Emotional

3. Mental

4. Social

5. Spiritual

History Perspective of Theory Development

- Nursing Theory

- Florence Nightingale envisioned nurses

to be educated nurses

- Her vision established home of nursing

at St. Thomas hospital in London

- 20th century nursing (start of modern

nursing began with strong emphasis on

practice

Historical Sketch

Research Era

- Nurses started to participate in

scientific works

- This course started to be introduced

and integrated in the nursing

curriculum

Graduate Education Era

- From Bachelor of Science to Master’s

Program

- Nursing models and nursing theory

course

Theory Era

- Contemporary phase where the

emphasis is on theory based nursing

practice and theory developments

- Awareness that nursing is a profession

- Nursing knowledge is distinct from

medical knowledge

What is Theory?

- System of interrelated propositions

used to predict, explain, understand

and control a part of the empirical

world (Adam, 1985)

- Ex. Of theories

1. Nursing

2. Non – Nursing

Non – Nursing Theories

1. System – abstract organization of

phenomena

2. Learning – behavior; controlled

environment

3. Social – frameworks of empirical

evidence

Theories from Sociologic Science

1. General Systems Theory – grandest of

grand theory because universal theory

elegancy and applicability; capability to

interact

o Elements of the System

1. Input – received from environment

2. Throughput – modified or

transformed in the system

3. Output – released

4. Feedback – responses

2. Role Theory – attracted to positions,

status and social organizations.

3. Conflict Theory – conflict in negotiation;

social problems

4. Feminist Theory – Gender difference;

exploitation of women

5. Interpersonal theory – individuals

cannot exist alone

6. Stress theory – stress is inevitable

7. General adaptation theory – 3 stages

(Alarm, resistance and exhaustion)

Nursing Theories

1. Practice Theory (Micro)

o Prescriptive; situational

o Required to do

2. Mid – Range

o Moderately abstract

o Concepts that are measurable

o Testable hypothesis

3. Grand theory (Macro)

o Most complex and broadest in

scope

o Self-care

4. Metatheory

o Theory about theory

Theory Era

Graduate Era

Research Era

Curriculum Era

Feed

bac

k Input

Throughput

Output

Development of Nursing Theory

Major concepts (health, person, nursing

environment) + Key concepts = Nursing Theory

Importance

- Offers structure and organization in

nursing knowledge and provides

systematic means of collecting data

- Describe

- Oral

- Predicting nursing practice

TOPIC 2: Nursing Theorists

Philosophies Nightingale Watson Benner Eriksson

Grand Theories Boykin ad Shoenhofer Newman Parse Benner Fitzpatrick Hall Henderson Johnson King Levine Orem Wiedenbach Travelbee Roy Neuman

Middle Range Theories Orem Peplau Pender Leininger Orlando Swanson

Florence Nightingale – Environmental Theory

a. Person

o Referred to as “the patient”

o Recipient of nursing care

o A human being acted upon by a

nurse , or affected by the

environment

o Has reparative powers to deal

with disease

o Recovery is in the patient’s

power as long as a safe

environment exists

b. Health

o Holistic level of wellness that

the person experiences

o Maintained by using a person’s

healing powers to their fullest

extent

o Maintained by controlling the

environmental factors so as to

prevent disease

o Disease is viewed as a

reparative process instituted by

nature

o Health and disease are the

focus of the nurse

o Nurses help patients through

their healing process

c. Environment

o the foundational component of

Nightingale’s theory

o The external and internal

aspects of life that influence the

person

o Includes everything from a

person’s food to a nurse’s

verbal and non-verbal

interactions with the patient

d. Nursing

o Is essential for everybody’s

wellbeing

o Is having the responsibility for

someone’s health

o Provides women with

guidelines for caring for their

loved ones at home and gives

advice on how to “think like a

nurse”

o Trained nurses however,

applies additional scientific

principles to their work and

more skilled in observing their

patients

Ernestine Weidenbach – Helping Art of Nursing

a. Person

o May be a nurse or a patient

who is endowed with a unique

potential to develop self-

sustaining resources

b. Health (not defined)

c. Environment

o Conglomerate of objects,

policies, settings, atmosphere,

time, human beings,

happenings that are dynamic,

unpredictable, exhilarating,

baffling and disruptive

Research Theory

Practice

d. Nursing

o Is the practice of identifying the

needs of a patient through

observation of symptoms,

behavior of the patient, finding

what causes those symptoms,

assessing if the patient is able

to resolve the discomfort and

determining the need for help

from the nurse or other health

care team

Virginia Henderson – Nursing Need Theory

a. Person

o have basic needs that are

component of health

o Requiring assistance to achieve

health and independence or a

peaceful death

o Mind and body are inseparable

and interrelated or a peaceful

death

o Considers the biological,

psychological, sociological and

spiritual components

o The theory presents the patient

as a sum of parts with

biopsychosocial needs

b. Health

o Definition based on individual’s

ability to function

independently as outlined in

the 14 components

o Nurses need to stress

promotion of health and

prevention and cure of disease

o Good health is a challenge –

affected by age, cultural

background, and emotional

balance and is the individual’s

ability to meet these needs

independently

c. Environment

o Settings in which an individual

learns unique pattern for living

o All external conditions and

influences that affect life and

development

o Individual’s relation to families

o Minimally discusses the impact

of the community on the

individual and family

o Basic nursing care involves

providing conditions under

which the patient can perform

the 14 activities unaided

d. Nursing

o Temporarily assisting an

individual who lacks the

necessary strength, will and

knowledge to satisfy 1 or more

of the 14 basic needs

o Assists and supports the

individual in life activities and

the attainment of

independence

o The nurse is expected to carry

out physician’s therapeutic plan

o Individualized care is the result

of nurse’s creativity in planning

for care

Faye Glenn Abdellah – 21 Nursing Problems

a. Person

o People having physical,

emotional and sociological

needs. These needs may be

overt, consisting of large

physical needs, or covert such

as emotional and social needs

o Patient is described as the only

justification for the existence of

nursing

o Individuals (and families) are

the recipients of nursing

o Health or achieving of it, is the

purpose of nursing services

b. Health

o In patient- centered approaches

to nursing, Abdellah describes

health as a state mutually

exclusive of illness

c. Environment

o Society is included in “planning

for optimum health on local,

state, national and

international levels”. However

as she further delineated her

ideas, the focus of nursing

service is clearly the individual

o The environment is the home

or community from which the

patient comes

d. Nursing

o Is a helping professional

wherein in Abdelleh’s model,

nursing care is doing something

to or for the person or

providing information to the

person with the gals of meeting

needs, increasing or restoring

self-help ability or alleviating

impairment.

o Nursing is broadly grouped into

the 21 nursing problem areas to

guide care and promote use of

nursing judgment

o She considers nursing to be

comprehensive service that is

based on art and science and

aims to help people, sick or

well, cope with their health

needs

Myra Estin Levine – Conservation Model

a. Person

o Whole not only in physical

aspect but also with regards to

psychosociocultural and

spiritual aspects

o Person is a unique individual in

unity and integrity, feeling,

believing , thinking and whole

system of system

b. Health

o Implied to mean unity and

integrity and “is a wholeness

and successful adaptation”

o State of being “whole” not just

the absence of illness or disease

o Determined by the ability to

function in a reasonably normal

manner

o The return to self ; individuals

are free and able to pursue

their own interest within the

context of their own resources

c. Environment

o Composed of all experiences of

the individuals.

o Pertains to the internal

(physiologic) and external

(perceptual, operational and

conceptual) environment

d. Nursing

o Human interaction designed to

promote wholeness through

adaptation

o Nursing care is both supportive

and therapeutic (to achieve

maximum level of adaptation)

o Promote wellness through the

use of four conservation

principles

Jean Watson – Theory of Human Caring

a. Person

o A complex, holistic being; an

evolving soul

o People have value, meaning

o Not an object and cannot be

separated from self, other

nature or the larger universe

b. Health

o Can be defined as the absence

of illness but health can be

obtained even when physical

wholeness cannot be obtained

c. Environment

o Driven by curative/ carative

factors (8 and 9)

o Should be conducive to holistic

healing

o Designed to be comfortable ,

not the typical hospital

environment

o Open system containing both

internal and external variables

that we as caregivers can

manipulate

o Comprised of noise, privacy,

light, access to nature, color,

space and smells that can have

an impact on the caring-healing

process

d. Nursing

o Driven by most of caritas

o “a human science of persons

and human health-illness

experiences that are mediated

by professional, personal,

scientific, esthetic and ethical

human transactions”

o The transpersonal care/

transpersonal relationship is

central to Watson’s theory and

what she calls nurses

Dorothea Orem – Theory of Self Care, Self-

Care Deficit and Theory of Nursing Systems

Theory of Self Care – How and why people care

for themselves

Theory of Self – Care Deficit – Describes and

explains why people can be helped though

nursing

Theory of Nursing Systems – Describes and

explains relationships that must be brought

about and maintained for nursing to be

produced

a. Person

o Man is an integrated WHOLE –

a unity functioning biologically,

symbolically and socially

o Self-reliant and responsible for

self-care and well-being of his

or her dependents and self-care

is a requisite for all

o Man is a logical organism with

rational powers

o A patient is an individual who is

in need of assistance in meeting

specific health-care demands

because of lack of knowledge,

skills, motivation or orientation

b. Health

o State of wholeness or integrity

of the individual human beings,

his part and his modes of

functioning

o This concept is inherent in her

nursing systems since the goal

in each system is optimal

wellness relative to that system

o Responsibility of a total society

and all its members

o A healthy person is likely to

have sufficient self-care abilities

to meet his/her self-care needs

c. Environment

o Encompasses the elements

external to man but she

considered man and

environment as an integrated

system related to self-care

o Environment conditions

conducive to development

d. Nursing

o Service

o Art

o Technology

Nola Pender – Health Promotion Model

a. Person

o Man has the ability to express

human health potential and has

the capacity for reflective self-

awareness, including

assessment of his own

competencies

o The importance of an

individual’s unique personal

factors or characteristics and

experiences will depend on the

target behavior for health

promotion

b. Health

o This model promotes pursuit of

health throughout the lifespan

o Health promotion is defined as

client behavior toward

developing well-being and

actualizing human health

potential

o Health protection is client

behavior geared toward

preventing illness, detecting it

early or maintaining function

c. Environment

o Harmony and balance between

human beings and surroundings

o Individuals are more apt to

perform health promotion

behaviors if they are

comfortable with the

environment versus feeling

alienated

o Safe as well as interesting

d. Nursing

o Nurses make age- specific and

risk-specific recommendations

for clinical preventative services

o Promote wellness by health

promotion education

Dorothy Johnson – Behavioral System Theory

a. Person

o Viewed the person as a

behavioral system with

patterned, repetitive ways of

behaving that link the person

with the environment

o Open system with organized,

interrelated and

interdependent subsystems

b. Health

o Result of the behavioral system

stability, balance and

equilibrium

o Elusive, dynamic state

influenced by biological,

psychological and social factors

o Reflected by the organization,

interaction and integration of

the subsystems of the

behavioral system

c. Environment

o Consists of all the factors that

are not part of the individual’s

behavioral system but that

influence the system

o Attempts to maintain

equilibrium in response to

environmental factors by

adjusting and adapting to the

forces that impinge on it

d. Nursing

o An external force that acts to

preserve the organization and

integration of the patient’s

behavior to an optimal level by

means of imposing temporary

regulatory mechanisms

o A service that is complementary

to medicine but which makes

distinctive contribution to the

health of people

Betty Neuman – Betty Neuman System Model

a. Person

o A total person as a client

system and the person is a

layered multidimensional being

o Each layer consist of five person

variable

b. Health

o Equated to wellness

o Client system moves toward

illness and death when more

energy is needed than is

available

o The client system move toward

wellness hen more energy is

available than is needed

c. Environment

o Internal environment exists

within the client system

o External exists outside the

client system

o The created environment is an

environment that is created

and developed unconsciously of

system wholeness

d. Nursing

o Unique profession with all of

the variables which influence

the response a person might

have to a stressor

o Person is seen as a whole and it

is the task of nursing to address

the person

o Role of nurse is seen in terms of

degree of reaction to stressors

and the use of primary,

secondary and tertiary

interventions

Imogene King – Goal Attainment Theory

a. Person

o Person existing in an open

system as a spiritual being and

rational thinker who makes

choices, selects alternative

courses of action and has the

ability to record to record their

history through their own

language and symbols, unique,

holistic and have different

need, wants and goals

b. Health

o Ability of a person to adjust to

the stressors that the internal

and external environment

exposes to the client

o Minimal use of the potentials

that a person can perform to

achieve balance in one’s health

c. Environment

o Process of balance involving

internal and external

interactions inside the social

system

o External environment is the

factor that exists outside the

boundary of the open system

while the internal environment

is the exact opposite as adapted

by the Neuman’s system model

d. Nursing

o An act wherein the nurse

interacts and communicates

with the client

o Nurse helps the client identify

the existing health condition

o Help the client maintain health

through health promotion,

maintenance, restoration and

caring for the sick and dying

Hildegard Peplau – Theory of Interpersonal

Relations

a. Person

o Developing organism that tries

to reduce anxiety caused by

needs

b. Health

o Word symbol that implies

forward movement of

personality and other ongoing

human processes in the

direction of creative,

constructive and productive,

personal and community living.

c. Environment

o Existing forces outside the

organism

d. Nursing

o Functions cooperatively with

other human process that make

health possible for individuals

communities

Ida Jean Orlando – Deliberative Nursing

Process

a. Person

o An individual in need.

o Unique individual verbally or

non-verbally

o Assumption is that individuals

are at times able to meet their

own needs and at other times

unable to do so.

b. Health

o Being without emotional or

physical discomfort and having

a sense of well-being contribute

to a healthy state

c. Environment

o When there is nurse-patient

contact and that both nurse

and patients perceive, think,

feel and act in the immediate

situation

d. Nursing

o Providing direct assistance to

individuals in whatever setting

they are found for the purpose

of avoiding, relieving,

diminishing or curing the

individual’s sense of

helplessness

Sister Callista Roy – Roy Adaptation Model

a. Person

o Humans are holistic, adaptive

systems

o Main focus of nursing, recipient

of nursing care, a living complex

b. Health

o State and a process of being

and becoming integrated a

whole person

o Not a freedom from the

inevitability of death, disease,

unhappiness and stress but the

ability to cope with them in a

competent way.

c. Environment

o All the conditions ,

circumstances and influences

surrounding and affecting the

development and group

behavior of persons or groups

with particular consideration of

the mutuality of person and

earth resources that includes

focal, contextual and residual

stimuli

d. Nursing

o Health care profession that

focuses on human life

processes and patterns and

emphasizes promotion of

health for individuals, families,

groups and society as a whole

o Science and practice that

expands abilities and enhances

person ad environmental

transformation

Joyce Travelbee – Human to Human

Relationship

a. Person

o Human being

o Both nurse and patient are

human beings

b. Health

o Subjective and objective

c. Environment

o Human condition and life

experiences encountered by a

patient in suffering, hope, pain

and illness

d. Nursing

o Interpersonal process whereby

the professional nurse

practitioner assists an

individual, family or community

to prevent or cope with

experience or illness and

suffering and if necessary find

meaning in these

Madeline Leininger – Cultural Care Diversity

and Universality Theory

a. Person

o Humans are believed to be

caring and capable of being

concerned

o Human care is universal and is

seen in all cultures

o Universally caring beings

b. Health

o State of wellbeing that is

culturally defined, valued and

practiced and which reflects the

ability to perform daily role

activities in culturally

expressed, beneficial and

patterned life ways

c. Environment

o Not defined, but concept of

culture is closely related to

society or environment

d. Nursing

o Learned humanistic and

scientific profession and

discipline focused on human

care phenomena and caring

activities in order to assist,

support, facilitate or enable

individuals to maintain or

regain their health

Joyce Fitzpatrick - Life Perspective Rhythm

Model Theory of Fitzpatrick

a. Person

o A term that integrates the

concepts of both self and

others, and recognizes

individuals as having unique

biological, psychological,

emotional, social, cultural, and

spiritual attitudes.

b. Health

o A dynamic state of being that

results from the interaction of

person and the environment.

c. Wellness-Illness

o A promotion of wellness

practices, the attentive

treatment of those who are

acutely or chronically ill or

dying, and restorative care of

people during convalescence

and rehabilitation.

d. Nursing

o A developing discipline whose

central concern is the meaning

attached to life.

o Primary purpose of nursing is

the promotion and

maintenance of an optimal level

of wellness.

Rosemarie Rizzo Parse - Human becoming

theory (Man Leaving Health Theory)

a. Person

o Open being who is more than

different from the sum of the

parts.

o Who value the human

becoming belief system live the

theory in true presence with

others

b. Environment

o Everything in the person and his

experiences.

o Inseparable and irreducible,

complimentary to and evolving

with.

c. Health

o Open process of being and

becoming involves synthesis of

values.

d. Nursing

o A human science and art that

uses an abstract body of

knowledge to serve people.

Anne Boykin and Savina Schoenhofer – Nursing

as Caring Theory

a. Person

o All persons are caring

o Caring is innate to an individual

in that a person lives their lives

growing the capacity of caring

b. Health

o The overall health is achieved

with the application of caring in

all matters that deals with

patients

c. Environment

o Person should have an

environment that radiates a

sense of nurturing atmosphere

which helps an individual to

grow in caring while revealing

the richness of nursing

d. Nursing

o A discipline and profession

o Grounded by caring

Margaret Newman – Theory of Expanding

Consciousness

a. Person

o Person as individuals are

identified by their individual

patterns of consciousness.

o Persons are further defined

as “centers of

consciousness” within an

overall pattern of expanding

consciousness.”

o The definition of person has

also been expanded to include

family and community

b. Health

o A fusion of disease and non-

disease creates a synthesis that

is regarded as health.

o Disease and non-disease are

each reflections of the larger

whole; therefore a new concept

“pattern of the whole” is

formed.

o Newman has stated that

pattern recognition is the

essence of the emerging health.

Manifest health, encompassing

disease and non-disease can be

regarded as the explication of

the underlying pattern of

person-environment.

c. Environment

o Environment is not explicitly

defined but is described as

being the larger whole, which is

beyond the consciousness of

the individual.

o Described as “universe of open

systems”

d. Nursing

o Nursing is “caring in the human

health experience”.

o Nursing is seen as a partnership

between the nurse and client,

with both grow in the “sense of

higher levels of consciousness”.

Josephine Patterson and Loretta Zderad –

Humanistic Nursing Theory

a. Person

o refers to a person, family, or

group of people in need of

nursing care

o Humanistic nursing is a

response to a patient call.

b. Health

o It isn’t just an absence of

disease but….

o Nurses restoring, sustaining,

and promoting health.

o Nurses provide health

education and client

supervision.

It’s the well-being targeted

under nursing care.

c. Nursing

o The individual Nurse and their

emotions, experiences, and

interactions involved in the

interaction between the

patient-nurse situation.

o The concern about the

relationship between the

individual and nurse.

o An exercising of good

judgments

o The Humanistic Nursing Theory

mainly focuses on the Nursing

concept; Humanistic Nursing is

all about the interaction

between the nurse and the

patient in a nursing situation.

Topic 4: Nursing Competency and Standards

COMPETENCY STANDARDS

WHAT IS COMPETENCY?

Competency focuses on one’s actual performance in a situation

Competency is determined by comparing current work functioning with established performance standards developed in the work environment according to specific role and setting

OBJECTIVES: THE BSN CURRICULUM

It aims to produce a fully functioning nurse who:

1. Practices legal, ethico-moral, social responsibilities and accountabilities 2. Practices S-K-A’s (skills, knowledge & attitude) for the promotion of health, prevention

of illness, restoration of health, alleviation of suffering, assisting clients to face death with dignity and in peace

3. Prepares a creative and critical thinking nurse who is abreast with local needs and the demands of global competitiveness

4. Demonstrates caring behavior 5. Assumes responsibility for personal and professional development 6. Utilizes research findings in the practice and development of the profession 7. Contributes effectively to national health development 8. Demonstrates love of God, country and profession

Patient Care Competencies - is a cluster of key areas of responsibility which serves as the core

of competencies which includes safe and quality care, communication, collaboration and team

work and health education

Empowering Competencies - is a cluster of key areas of responsibility that mandate compliance

to the standards of ethico-moral, spiritual responsibilities, legal and personal and professional

development

Enhancing Competencies - is a cluster of key areas of responsibility that ensures excellent

performance of the patient care competencies which includes research and quality

improvement

Enabling Competencies - is a cluster of key areas of responsibility that provide support to the

effective and efficient performance of the patient care competencies which includes record

management and management of resources and environment

3 RESOURCES:

1. Man (manpower, human resource) 2. Machine 3. Money

ENABLING (10%) ENHANCEMENT (10%)

EMPOWERING (15%)

*SQHC- safe quality health care

-Management of resources and

environment

-Record management

-Research

-Quality Improvement

CORE (most vital)

1.Patient Core Competencies

SQHC(50%)

2.Communication (5%)

3.Collaboration (5%)

4. Health Education (5%)

-Legal responsibilities

-Ethico Moral responsibilities

-Personal & professional development