Theoretical

Foundations of
Nursing
Module 4 Local Theories and Models of
Nursing Intervention (Philippine Setting)

Maria Corazon Lourdes C. Lucin, RN,MAN,LPT

Subject Instruction

[Pick the date]

Local Theories and Models of Nursing Intervention (Philippine Setting)

1. Technological Competency as Caring in Nursing of Rozzano Locsin

According to him. . .

“Technological competency as caring in nursing is a conceptual model that presents the link
between technology and caring in nursing as coexisting harmoniously”

 Born in 1954
 A native of Dumaguete City, Philippines who resides and practices his nursing profession
at Tokushima University
 Professor of Nursing at Tokushima University
 He is a professor emeritus of Florida Atlantic University in Boca Raton, Florida, USA
 Earned his Doctor of Philosophy in Nursing degree from the University of the Philippines
in 1988, and his Master of Arts in Nursing and Bachelor of Science in Nursing from
Siliman University in 1978 and 1976 in the Philippines
 Known for the middle-range theory, “Technological Competency as Caring in Nursing
 A multi-awarded nurse scholar and educator
“Your Technological Competence is caring, and caring is nursing”

ASSUMPTIONS:

1. Persons are caring by virtue of their humanness

2. Persons are whole or complete in the moment
3. Knowing persons is a process of nursing that allows for continuous appreciation of
persons moment to moment
4. Technology is used to know wholeness of persons moment to moment
5. Nursing is a discipline and a professional practice
THREE DYNAMIC PROCESSES OF NURSING

A. Technological Knowing
According to Locsin (2005), technological knowing involves using technology for
nursing and health care to know persons more fully in the moment.

B. Mutual Designing
Mutual designing is a multidimensional process of knowing persons in which
both the nurse and the one nursed co-create a mutually fulfilling nursing care process
derived from both the nurse’s design and those of the person being nursed, and together
conjointly practiced as nursing.

C. Participative Engaging
Participative engaging promotes the opportunity for simultaneous practice of
shared activities which are crucial to knowing persons. In this engagement, the
alternating rhythm of implementation and evaluation occurs during which the nurse
enters the world of the other and the engagement results in continuous knowing.

Dimensional of Technological Value in the Theory

- Technology as completing human being to reformulate the idea human being such as in
replacement parts, both mechanical (prostheses) or organic (transplantation of organs)
- Technology as machine technologies, e.g. computer and gadgets enhancing nursing
activities to provide quality patient care
- Technologies that mimic human beings and human activities to meet the demands of
nursing care practices, e.g. cyborgs (cybernetic organisms) or anthropomorphic machines
and robots such as nursebots
The Theory of Technological Competency as Caring in Nursing

A middle-range theory illustrated in the practice of nursing and grounded in the harmonious
coexistence between technology and caring in nursing.

a. Technological competency as caring in nursing is the harmonious coexistence between

technologies and caring in nursing
b. The harmonization of these concepts places the practice of nursing within the context of
modern healthcare and acknowledgements that these concepts can co-exist
c. Technology brings the patient closer to the nurse. Conversely, technology can also
increase the gap between the nurse and nursed.
d. When technology is used to know persons continuously in the moment, the process of
nursing is lived.
The Process of Nursing

A. Knowing
- The process of knowing the person is guided by technological knowing in which
persons are appreciated as participants in their care rather than as object of care
- The nurse enters the world of the other. In this process, technology is used to
magnify the aspect of the person that requires revealing – a representation of the
real person
- The person’s state change moment to moment – person is dynamic, living and
cannot be participated

B. Designing
- Both the nurse and the one nursed (patient) plan a mutual care process fro which
the nurse can organize a rewarding nursing practice that is responsive to the
patient’s desire for care
C. Verifying Knowledge
- The continuous, circular process demonstrate s the ever-changing, dynamic nature
of knowing in nursing
- Knowledge about the person that is derived from knowing, designing, and
implementing further informs the nurse and the one nursed
D. Participation in Appreciation
- The simultaneous practice of conjoined activities which are crucial to persons
- In this stage of the process is the alternating rhythm of implementation and
evaluation
- The evidence of continuous knowing, implementation and participation is
reflective of the cyclical process of knowing persons
 MODEL

Knowing Persons: Framework for Nursing

Calls for Nursing

(Supporting, Affirming,
Celebrating)

Multiple Pattern of Knowing

in Nursing Nursing as Caring

Empirics, Aesthetics, Ethics, (Boykin and Schoenhofer, 2001)

Personal (Chapter, 1978)
Metaparadigm of Nursing

Nursing

 “Nurses value technological competency as an expression of caring in nursing”

(Locsin, 2013).
Health

 Humanity is preserved by technology

 “An experience that is often expressed in terms of wellness and illness, and may
occur in the presence or absence of disease” (Nursing Scope and Standards of
Practice, 2010, p. 65)
Environment

 Environment as the technological world in which we live.

Person

 Patients seen as “participants in their care rather than object of nurse care”
(Locsin, 2013).

Analysis and Evaluation of the Theory

Accuracy

Technology continues to evolve and encompasses the majority of functional activities

that nurses are expected to perform, especially in a clinical setting.

Simplicity

The relationships noted in Locsin’s theory include three main components of “caring in
nursing, human beings as persons, and technological competence”

Scope

The scope of Locsin’s theory is narrow using technology, caring, and knowing persons

Acceptance

The broad concepts of caring and technology have been applied to nursing and critical
care practice by a number of authors, including Locsin. These authors have taken the use
of caring and technology in the direction of an optimistic, holistic view.
Socio-cultural Utility

Nursing occurs in critical care settings when technologies are used competently with the
genuine purpose to know patients wholly, who are in the course of living and growing in
caring.

Application of the Theory

In the midst of pandemic, Nurse Fe was asked to be assigned in the ICU (Intensive Care
Unit). Knowing that she had the job only 6 months ago, she hesitated for the new assignment.
ICU means manipulating gadgets and equipment certainly new to her. But her passion for caring
prevails more than her fear. Help Nurse Fe in her quest for care using the theory of
Technological Competency.

Start your answer here:

 2. PREPARE ME THEORY of Carmencita M. Abaquin

“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.”

Getting to know the Theorist:

 Carmencita M. Abaquin is a nurse with Master’s Degree in Nursing obtained from the
University of the Philippines College of Nursing.
 An expert in Medical Surgical Nursing with subspecialty on Oncologic Nursing which
made her known both here and abroad.
 She had served the University of the Philippines College of Nursing, as faculty and held
the position as Secretary of the College of Nursing.
 Her latest appointment as Chairman of the Board of Nursing speaks of her competence
and integrity in the field she has chosen.

Background:
During the past decade, the incidence of cancer has significantly increased not only in the
Philippines but also worldwide. Cancer has been associated with multifaceted issues and
concerns regardless of stages of development. For patients with advanced progressive cancer,
these problems are compounded, thus the need to develop interventions that can address the
needs especially those concerning the ability to be in control and maintaining their dignity.

HOLISTIC NURSING INTERVENTIONS – nursing interventions provided to address the

multi-dimensional problems of cancer patients that can be given in many setting where patients
choose to be confined.
 “PREPARE ME” INTERVENTIONS AND THE QUALITY OF LIFE ADVANCE
PROGRESSIVE CANCER PATIENTS

6 COMPONENTS

1. PRESENCE – being with another person during the times of need:

 Therapeutic communication
 Active listening
 Touch
2. REMINISCE THERAPY – recall of past experiences, feelings and thoughts to facilitate
adaptation to present circumstances.
3. PRAYER –
4. RELAXATION-BREATHING – techniques to encourage and elicit relaxation for the
purpose of decreasing undesirable signs and symptoms such as pain, muscle tension, and
anxiety.
5. MEDITATION – encourages an elicit form of relaxation altering patient’s level of
awareness focusing on image or thought to facilitate an inner sight which helps establish
connection with God use of music and other relaxation techniques.
6. VALUES CLARIFICATION - assisting another individual to clarify his own values about
health and illness in order to facilitate effective decision making skills. Through this, the
patient develops an open mind that will facilitate acceptance of disease state or may help
deepen or enhance values. The process of values clarification helps one become internally
consistent by achieving closer between what we do and what we feel.

METAPARADIGMS

Person/patient – holistic beings with physical, psychological, social, religious, level of

independence, and environmental aspects.

Environment – not defined accurately. Nevertheless we can assume that environment is an

aspect or dimension integrated to the cancer patient.

Health – her concept of health revolves around illness, particularly cancer and the provision of
holistic care to improve the quality of life despite their terminal cases.
Quality of life
Multifaceted construct that encompasses the individual’s capabilities and abilities
of enriching life when it can no longer be prolonged.
Nursing

Goal of nursing care – improvement of quality of life for advance stage of cancer
patients.
APPROACHES

Carmencita Abaquin’s Prepare Me Theory implies a type of nursing care or holistic nursing
approach that deals on:

 How to care for cancer patients.

 Improve the quality of life of patients with cancer and other chronic diseases or terminal
illnesses.

ANALYSIS

Usefulness (practicability) – this theory is useful in addressing the needs of terminally-ill cancer
patients. This encompassed different aspects including family relationship and self-actualization.

Simplicity – Abaquin’s theory doesn’t possess simplicity because there are many variables. The
theory is designed to facilitate nursing care holistically.

Empirical precision – Abaquin’s theory appears to have a low degree of empirical validity
primarily become variables are hardly measurable to the person extent even with the use of
instruments.

Generalizability and parsimony – it can only be applicable to terminally-ill patients and hospice
facilities. But it is not limited to use in the settings. It is applicable whenever a nurse encounters
terminally-ill patients.

APPLICATION OF THE THEORY

Mrs. Ty is a very active and jolly person. She’s optimistic and a very approachable woman in
her early 40s. She loves water sports like scuba diving and wake boarding. She still has youthful
glow and energy, as she always believes that life starts at 40. But one thing struck her, and that
is, she’s diagnosed with Lung Cancer Stage 3. And she started to ask questions, “Why me?”
followed by “What did I do to have this?” and “What will I do after this?”

Start your answer here:

 3. Advance nurse practitioner`s COMPOSURE behavior and patients wellness
outcome theory by Carmelita C. Divinagracia

Facts on Theorist:
 A former president of the Association of Deans Philippines College of Nursing and the
Dean of UERMMMC College of Nursing.
 Member of CHED’s Technical Committee on Nursing Education.
 Master at Nursing in 1975.
 Degree Holder in 2001.
 She has been a clinic nurse, staff nurse, head nurse, instructor, assistant dean and dean.
 An advance Nurse Practitioner.

Theory: COMPOSURE Behavior

COMPOSURE is an acronym for the following.

COM – petence
P – resence and prayer
O – penmindedness
S – timulation
U – nderstanding
R – espect and relaxation
E - mpathy

Competence – in depth knowledge and clinical expertise demonstrated in caring for patients.

Presence and prayer – being with another person during times of need and reciting prayers that
are made through the nurse`s personal relationship and faith in god.

Open mindedness- considering the patients preferences and opinions related to his or her current
health conditions.

Stimulation – giving explanation and supervision when doing certain procedures to patient.
Understanding – covey`s interest and acceptance of patients condition and his or her entire
being.

Respect and relaxation-acknowledging the patient`s presence.

Empathy – perceives the current positive thought or feeling and communicates by putting
themselves in the patient`s place.

Wellness outcome

Physiological Outcome:
Vital sign- clinical measurements pulse rate
Chest pain- pain in the chest of the patients
Hemoglobin – blood count of the patient

Bio behavioral outcome:

Physical - A person with physical health is free from illness that affects the
physiological systems of the body such as heart and nervous system.
Emotional – Ability to cope with daily circumstances and to deal with a personal
feeling in a positive, optimistic and constructive manner.
Intellectual – Relating to the ability to think and understand things especially the
complicated ideas.
Spiritual – Relating to religion or religious belief.

Concept

 Advance nurse practitioner is a BSN graduate, licensed and has clinical experience of at
least 2 years in the clinical area and has undergone special training in critical area.
 Composure is a set of behavior or nursing measures that the nurse demonstrates to select
cardiac patients.
 Wellness status refers to a condition of being in a state of well-being, a coordinated and
integral living pattern that involves the dimensions of wellness.

Metaparadigm of Nursing:

Each individual needs humane, caring, spirituality- oriented intervention that can
facilitate wellness regardless of creed, social class, gender, age and nationality.

Health – defined as the degree wellness or well-being that the patient experiences.

Environment – defined as the internal and external factors that surround the affect of clients or
patients.
Nursing care – characteristics and action of the nurse providing are on behalf of or in
conjunction with the client.

Analysis

 The socio-demographic characteristics, specifically gender, age, are related to the

wellness outcome of adult cardiac patients.
 A significant difference exists in the pretest and posttest scores of the wellness outcome
after the COMPOSURE behavior interventions.
 The nursing professions can actively deliver quality care through bio behavioral caring
interventions like COMPOSURE behavior because regardless of creed, social class,
gender, age and nationality, each one needs humane caring, spirituality- oriented
interventions that can facilitate wellness.

Application of the Theory

Jen is a nurse assigned at Philippine Heart Center. She is in charge of adult cardiac
patients that are confined in the coronary care unit. Jen verbalizes often that she is afraid
that her care for her patients are insufficient. Help Jen overcome her fears by using the
COMPOSURE Behavior Model of Divinagracia.

Start your answer here:

 4. Retirement and Role Discontinuities by Dr. Letty G. Kuan

“I have grown and sown now I can reap the reward and blessing of life lived in joy and love, for
I too have made others grow.”

Facts about Dr. Letty G. Kuan

• She is nurse.
• She had two master’s degrees, MA in Nursing and MA in Education, Major in Guidance
and Counselling, culminating in Doctor of Education.
• She is now a Professor Emeritus, for her vast contributions to the UP College of Nursing
Faculty and her academic achievements.
• A recipient of Metrobank Foundation Outstanding Teachers Award in 1995 and an award
for Continuing Integrity and Excellence in Service / ACIES in 2004.
• She had clinical fellowship and specialization in Neuropsychology in University of Paris,
France. Neurogentology in Watertown, New York and Syracuse University, New York.
• She also had formal training at Institute of Religion, Ethics and Law at Baylor College of
Medicine in Houston Texas.
• She is also a former member of the board of Nursing and her legacy to the Nursing
community is indisputable.
• She authored several books giving her insights in the area of Gerontology, Care of Older
Person and Bioethics.
• Her religious community is the Notre Dame De Vie founded in France in 1932.
Background of the Theory:

Retirement is an inevitable change in one’s life. It is evident in the increasing statistics of

aging population accompanied by related disabilities and increased dependence. This
developmental stage, even at the later part of life, must be considered desirable and satisfying
through the determination 0f factors that will help the person enjoy the remaining years of life. It
is of primary importance to prepare early in life by cultivating other role option at age 50 to 60 in
order to have a rewarding retirement period even amidst the presence of role discontinuities
experienced by this age of group.
 Basic Assumptions and Concepts

• 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 the strong genetic
affinity to stay young for a long time.
• Role refers to set of shared expectations focused upon a particular position. These may
include beliefs about what goals or values the position incumbent is to pursue and the
norms that will govern his behavior. It is also the set of shared expectations from the
retiree’s socialization experiences and the values internalized socially defined for the
position itself. For every social role, there is complementary set of roles in the social
structure among which interaction constantly occurs.
• Change of Life is the period between near retirement and postretirement years. In
medico-physiologic terms, this equates with the climacteric period of adjustment and
readjustment to another tempo of life.
• 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 or has completed
the required years of service.
• 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.
• 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.
Determinants of positive perceptions in retirement and positive reactions toward role
discontinuities:

1. Health Status –refer to physiological and mental state of the respondents, classified as
either sickly or healthy.
2. Income – (economic level) refers to the financial affluence of the respondent which can
be classified as poor, moderate or rich.
3. Work status- status of an individual according to his/ her work.
4. Family constellation- means the type of family composition described either close knit
or extended family where three or more generations of family members live in separate
dwelling units; or nuclear type of family where only husband, wife and children live
together.
5. Self-Preparation- Is preparing self to the possible outcomes in life.

FINDINGS & RECOMMENDATION

1. Health status dictates the capacities and the type of role one takes both for the present and
for the future. It fits for everyone to maintain and promote health at all ages because only
proper care of the mind and body is needed to maintain health in old age.
2. Family Constellation is a positive index regarding retirement positively and also in
reacting to role discontinuities. In the Philippines, the family undoubtedly stands as the as
the security or trusting bank where all members, young and old can always run and get
help. When one retires, the shock of the role discontinuities is softened because the
family not only cushions the impact, but also offers gainful substitutes, as in providing
monetary support, absorbing emotional strains that oftentimes with discontinuities and
other forms of surrogating.
3. Income has a high correlation with both the perception of retirement and reactions
towards role discontinuities. Since income is one of the factors that secure the outlook of
individual, efforts must be exerted to save and spend money wisely while still actively
earning in order to have some reserve when one grows old. It also implies that retirement
pensions should be adjusted to meet the demands of the elderly. This should be done in
order to have a more relevant and realistic pension and benefits adjustment.
4. Work status goes hand in hand with economic security that generates decent
compensation. For retired, it implies that retirement should not be conceptualized as a
period of no work because capabilities to function get sharpened and refined as they
practice it on a regular basis. Work enhances the aspects of they practice it on a regular
basis. Work enhances the self- esteem and contributes to the feeling of wellness even in
old age.
 5. Self –preparation which are sad to be both therapeutic and recreational in essence pays
its worth in old. This does not only account professionalism or expertise but also
benevolent work as in charitable actions with the colleagues. Self- preparation is
investing not in monetary benefits but in something that give them and dignity: Enhance
their feeling of self-worth and happiness.
6. To cope with changes brought by retirement, one must cultivate interest in recreational
activities to channel feelings of depression or isolation and facing realities through
confrontation with some issues.
7. To perceive retirement positively, it requires early socialization of the various roles we
take in life. The best place to start is at home extending to retirement, their fellow retirees
are their own best advocates. To facilitate this, barriers to fall participation in the areas
where important decisions are of the knowledge, wisdom, experience and values which
are the social assets that make the retired age and custodian's folk wisdom.
8. Government agency to construct holistic pre-retirement preparation program which will
take care of the retiree’s finances, psychological, emotional, and social needs.
9. Retirement should be recognized as the fulfillment of every individual’s birthright and
must live meaningfully.

Metaparadigm:

Nursing
 is defined as preparing the person to have fulfillment in their retirement years, and
assisting them in their elderly years in leaving a legacy.
Health
 is defined as aging.
 it slow process of growth towards maturity of mind, body and spirit.

Person
 Elderly- is a classification of age group to any person reaching the mid 70‟s up to
the80's.
 Gerone- given to people who are old but gracefully able to function as useful citizens at
home and in the community and an exemplar in fidelity to prayer life.

Analysis and Evaluation

 Simplicity
The variables are clearly defined and determinants were clearly known as it relates to the
outcome of fruitful retirement and aging.
  Generality
The study can be applied not only dealing with the people undergoing retirement process,
but also with individuals who are experiencing role transition.
The theory can also be applied in creating programs that are suited for individuals
needing adjustments regarding role change.
This theory may be applied to individuals near their retirement stage, during retirement
stage and post-retirement stage and also to individuals from any developmental stage
experiencing life challenge brought by change in role.

 Empirical Precision
A study done by Reitzes and Mutran (2004) in which they proposed that there are
psychological process that may contribute to positive changes in retirement adjustments. Self
concepts, continuity of roles and bridge identities (such as friend identity) were determined
as it can lead to a more satisfying and fulfilling experience. As supported to the theory of
Letty Kuan, they only recognized positive determinants that could lead to a fruitful retirement
and aging.
 Derivable Consequences
The theory is useful in geriatric nursing where nurses can derive a plan of care to help
the patient to have ease of movement through a transitional process
If individuals have a better understanding of the retirement process and their new role,
they will prepare and adjust better. (Kelly & Swisher, 1998)
Application of the Theory
Mrs. Margaux is a 58 years old registered nurse who had been working at the San Lazaro
hospital for almost 21 years. She dedicated her life to her chosen career since she is widowed
and her children have already migrated to the States. She wants to continue serving her patients
despite her age but her body is declining. Mrs. Margaux always complains about having
backache and numbness of her fingers. Sometimes she also forgot how much dosage should be
administered to her patient.

Help Mrs. Marguax using Dr. Kuan’s Theory.

Start your answer here:

 5. Casagra Transformative Leadership Model by Sister Carolina Agravante

Facts about the theorist:

• She is famous for being the first Filipina theorist for writing the CASAGRA
Transformative Leadership Model. The title of the theory was derived from
her name
• She finished her secondary education at St. Paul University - Manila
(formerly St. Paul College - Manila) as a salutatorian.
• In 1964, she earned her BS Nursing degree in the same school as magna cum
laude. In the same year, she passed the nurse licensure examinations as the
board topnotcher.
• From 1967 to 1969, she studied Master’s Degree in Nursing Education at
Catholic University of America as a full-fledged scholar.
• In 2002, she earned her Doctoral Degree in Philosophy at University of the
Philippines Manila - the same year her theory was published.

Theory:

The CASAGRA Transformative Leadership Model: Servant – Leader Formula & the Nursing
Faculty’s Transformative Leadership Behavior.

The theory “CASAGRA Transformative Leadership” is a psycho spiritual model. It is coined after
the name of the investigator

The model is a Three-Fold Transformation Leadership Concept rolled into one, comprising of
the following elements:
1. Servant-Leader Spirituality

For nurse educators, they can apply this concept by being passionate about their craft. They can
also show willingness to impart their acquired knowledge to their students and colleagues in
selfless way. These educators contemplate first by attending a variety of workshops regarding
new trends in nursing, applying evidenced – based practices through patient simulation and
cascading it to the target learning group.

2. Self-Mastery

In spite of our worlds empirical culture where in newly accepted norms that focus on the external
rather the internal or mental thought process, people tend to have a direct reaction and an
emotional response. This concept aims to promote self – discovery by knowing their strengths
and weaknesses as well as to practice controlling internal thought processes that will eventually
influence emotions, ideas, and behaviors. Knowing one’s strength and weak points can help in
becoming a better individual and also in your profession.

3. Special Expertise

This concept states that it is the level of competence of a professional nurse in the particular
nursing area is engaged into. In other words, professionals should be aware on what area they are
expert at. A expert should experience hands on practices and evidence – based practice as well as
the demonstration of personal values and characters needed should be built also to themselves.

Concept:

The CASAGRA Transformative Leadership Model has concepts of leadership from a psycho-
spiritual point of view, designed to lead to radical change from apathy or indifference to a
spiritual person.

METAPARADIGM OF NURSING:

Nursing

 Agravante viewed nursing as professional nurses

Person

 Person component of the theory focuses on the receiver of care which is the patient or the
client
Environment

 Environment aspect of the nursing focuses on the surroundings that affect the patient
which is the hospital.
Health
  Agravante viewed health as the care that we gave to our patients, whether it is a
professional care, folk care or personal care.

Analysis and Evaluation:

Simplicity

 Agravante’s theory does not possess simplicity because the study group has to undergo
seminar and retreats which somehow give hassles to them.
 The theory is designed to transform a servant leader which Agravante possesses Jesus as
a sample
Generality

 Nursing students will be assured of similar leadership formation that will be provided to
them by the nursing educators who advocated the CASAGRA Transformative Leadership
model. It will give them the confidence they need to face the challenges in the profession.
Empirical precision

 The study was conducted to determine the effects of the CASAGRA transformative
leadership model for nursing faculty on the servant leadership behavior of the nursing
faculty.

Application of the Theory

Nurse Laura is a new RN, trying to cope the pressures and stress in the ICU in one of the largest
hospitals in the country. Like many other nurses, she too, wants to become not just a staff nurse
but to become one of the nurse-managers in the said hospital, particularly in the ICU.
Help Nurse Laura achieve her goal using the CASAGRA transformative leadership model.

Start your answer here: