PAMANTASAN NG LUNGSOD NG MARIKINA

COLLEGE OF NURSING

Compilation of Theorists and Theories in Nursing

Presented to: Prof. Ma. Lourdes Revilla

Presented by : TFN Students SY 2025-2026 (1st Sem)

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Rozzano C. Locsin: A Nursing Theorist

Rozzano C. Locsin is a distinguished Filipino-

American Professor of Nursing, currently serving at
Tokushima University in Japan. He also holds the title
of Professor Emeritus at Florida Atlantic University in
the United States. Born in 1954 in Dumaguete,
Philippines, Locsin earned his Bachelor of Science in
Nursing from Silliman University in 1976, followed by a
Master’s degree in Nursing from the same university in
1978. He completed his PhD in Nursing at the
University of the Philippines Manila in 1988.
Locsin’s academic career includes joining Florida
Atlantic University’s Christine E. Lynn College of
Nursing in 1991, where he became a tenured professor and distinguished faculty
member, ultimately being named Professor Emeritus. Currently, he serves as a
Professor of Nursing at Tokushima University, Japan, and maintains visiting and
honorary professorial roles internationally, including in Thailand, Uganda, and the
Philippines.
Major Contributions and Theory
Technological Competency as Caring in Nursing: A Model for Practice
● This theory revolutionizes the understanding of caring in modern healthcare by
asserting that technology and caring are not opposing forces but complementary.
Locsin emphasizes that medical technologies, such as machines, monitors, and
other devices, are tools that enhance the nurse's ability to know patients fully as
whole persons, rather than reducing them to mere cases or numbers.
● His model is especially vital in technology-intensive environments such as
intensive care units, operating rooms, and telehealth settings, where the human
element may be overshadowed by scientific and technical procedures. The
theory offers a framework for nursing education, guiding future nurses to merge
technological proficiency with genuine compassionate care. It also catalyzes
nursing research by raising important discussions about ethics, human dignity,
and person hood in the age of digital healthcare, ensuring nursing remains
patient-centered despite technological advances.
Global Impact and Research
● Through the prestigious Fulbright Scholar Award (2000-2001 and 2004-2006),
Locsin developed nursing education programs internationally, notably
establishing the first master’s nursing program in Uganda. He contributed to
global health by researching the lived experiences of families and patients during
critical outbreaks like Ebola, illustrating his deep commitment to culturally
responsive and community-based nursing.
● He also played a pivotal role in founding the first community-based university
nursing education program in collaboration with Mbarara University and
supported by the Fulbright Alumni Initiative Award. Locsin’s ongoing research
deepens understanding of caring in technologically complex.
Awards and Honors
● Fulbright Scholar Award, Florida Center for International Exchange of Scholars,
Washington, D.C., 2000-2001 and 2004-2006
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● Julita V. Sotejo Medallion of Honor: Lifetime Achievement Award, University of

the Philippines Nursing Alumni International Inc., Los Angeles, California, 2003
● Edith Moore Copeland Award for Excellence in Creativity (Founder’s Award),
Sigma Theta Tau International Honor Society of Nursing, Indianapolis (37th
Biennial Convention), 2003
● Excellence in Undergraduate Teaching, Florida Atlantic University, Boca Raton,
Florida, 2003
● University Research of the Year – Professor, Scholarly & Creative Works,
Florida Atlantic University, 2006
● Outstanding Alumni Award - Lifetime Achievement in Nursing Education, St.
Paul University of Dumaguete, Philippines, 2004
● Fulbright Alumni Initiative Award, 2004-2006
● Fulbright Senior Specialist in Global and Public Health, 2005 ● Academic
Excellence Award, Philippine American Society, 2010 ● Fellowship, American
Academy of Nursing (FAAN)
● Fellowship, Philippine-American Academy of Science & Engineering (PAASE)
● Balik Scientist Program, Department of Science&Technology, Philippines, 2009
Publications
• Locsin has authored the influential book Technological Competency as Caring
in Nursing: A Model for Practice and edited/co-authored several additional
nursing texts, including A Contemporary Nursing Practice: The (Un)Bearable
Weight of Knowing in Nursing. His scholarly work spans theories of caring,
integration of arts and technology in nursing, and initiatives for advancing nursing
knowledge globally.
● Technological Competency as Caring in Nursing Theory often called the
Technological Nursing as Caring Model
● It explains how nurses can give genuinely human, person-centered care while
working in today’s high-tech healthcare service.
● The grand theory Nursing As Caring (NAC), developed by Anne Boykin and
Savina Schoenhofer and first presented in 1991, served as the foundation for Dr.
Rozzano Locsin's Middle Range Theory of "Technological Competency as
Caring in Nursing," which was published in 1993 and 2001.
● The first theoretical study of Locsin's middle-range theory of technological
competency as caring in nursing was published in Image, Journal of Nursing
Scholarship, in 1991. The book that sparked a global awareness of the theory
was published by Sigma Theta Tau Press International Press in 2005. Tetsuya
Tanioka derived his 2017 Transactive Relationship hypothesis of Nursing
(TRETON) hypothesis from these theoretical foundations, identifying transactive
relationships with healthcare robots as a particular theoretical application of
technological competency as caring.
● The 2020 "Model for the Intermediary Role of Nurses in Transactive
Relationships with Healthcare Robots" (MIRTH) by Kyoko Osaka was inspired by
TRETON. Additionally, Locsin's Technological Competency as Caring in Nursing
theory and Nursing As Caring theory served as the foundation for Waraporn
Kongsuwan's 2020 theory of "Aesthetic Nursing Practice (AesNURP)".
Development of the Technological Competency as Caring in Nursing
Theory
● Dr. Rozzano Locsin, born in 1954 in Dumaguete City, Philippines, is Professor
of Nursing at Tokushima University in Japan and Professor Emeritus at Florida
Atlantic University in Boca Raton, Florida, USA. He earned his Bachelor of
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Science in Nursing in 1976 and his Master of Arts in Nursing in 1978, both from
Silliman University in the Philippines, and completed his Doctor of Philosophy in
Nursing at the University of the Philippines in 1988.
● Drawing on decades of clinical practice, Dr. Locsin observed that technological
tools in healthcare could either create distance between nurses and patients or
serve to deepen their connection. Motivated by this insight, he embarked on a
systematic study of how technology influences the nurse– patient relationship,
seeking to reposition technology not as an impediment but as an instrument of
caring.
● His resulting Theory of Technological Competency as Caring in Nursing
asserts that technology, when thoughtfully integrated, must support the holistic
treatment of patients as persons rather than merely as clinical cases. According
to the theory, technological competency enables nurses to engage more fully
with patients by enhancing assessment, communication, and intervention without
diminishing the essential human bond. In reframing technology as an asset
rather than a threat, Dr. Locsin’s work offers a paradigm for improving healthcare
quality through compassionate, technologically informed practice.

CORE IDEA
● Technology is not a barrier to caring.
● Instead, when used skillfully and intentionally, technology helps the nurse know
the patient more fully as a whole person — not just as data or a diagnosis.
Competence with machines and devices becomes part of caring itself.
EVALUATION AND CRITIQUES
● Locsin has published updated editions (early 2000s through 2016) clarifying
definitions and adding applications to telehealth and nursing education.
● Some authors note the need for stronger empirical testing and clearer
measurement tools for concepts like “ technological competency as caring.”
● Ongoing research explores how the theory supports person-centered care in
emerging fields such as robotics and remote monitoring.
STRENGTHS
It highlights that machines and technological tools are not meant to replace
human touch but to enhance the nurse’ s ability to know and understand the
patient as a whole person. The theory supports patient-centered care by
encouraging nurses to use technology as an extension of their caring presence,
allowing them to gather data that deepens their understanding of patients’ lived
experiences. This makes it highly relevant in today’ s healthcare settings where
high-tech equipment is common, and it offers valuable guidance for nursing
education and clinical practice in developing both technological skills and
compassionate care.
LIMITATIONS
Despite its relevance, the theory faces challenges in application because several
of its concepts—such as “knowing persons as caring”—are abstract and difficult
to measure or operationalize in everyday nursing tasks. Successful
implementation requires adequate training and access to technology, which may
not be feasible in underfunded or resource-limited healthcare environments.
Additionally, while there is growing qualitative support, there is still limited large-
scale empirical evidence to fully validate the theory. Cultural and contextual
differences also pose a challenge, as the model assumes a level of technological
availability that may not exist in all settings, and there is a risk that technology
might unintentionally overshadow the caring relationship if not carefully balanced.
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APPLICATIONS
- In settings like intensive care units (ICUs), emergency departments, and
operating rooms, where advanced medical technologies are frequently used,
TCCN provides a framework for nurses to integrate technological skills with
compassionate care.
- In nursing schools and continuing education programs, TCCN can guide
curricula to ensure that future nurses are equipped with both technological
competencies and a strong foundation in caring practices.
- For studies exploring the use of electronic health records, telemedicine, and
other digital health tools, TCCN offers a theoretical basis to examine how
technology affects the nurse-patient relationship and care outcomes.
- While originally developed for nursing, TCCN has been explored in other health
disciplines, such as physical therapy, to understand how technology can be used
to enhance patient care while maintaining a focus on the human aspect of
healing.
- In international health contexts, especially in regions with limited resources,
TCCN can inform the development of low-cost, technology-enabled healthcare
solutions that prioritize patient-centered care.
REAL LIFE APPLICATIONS
The central premise of Rozzano Locsin’ s theory is the coexistence of nursing
and technology. He proposes that technological competency is not separate from
nursing; rather, it is an essential expression of caring. In contemporary nursing
practice, technology is not only utilized to deliver
treatment but also to foster deeper connections between nurses and patients.
However, the use of technology in the medical field must be guided by empathy
and ethical considerations, rather than being purely functional. Nurses are
therefore expected to be technologically literate to ensure the delivery of high-
quality, patient-centered care. Importantly, this theory does not advocate for the
replacement of nurses by machines. Instead, it emphasizes that technology
should support and enhance the nurse’s ability to provide compassionate care,
affirming that technology and human touch can coexist harmoniously.
In real-life scenarios, the application of this theory is evident. For example, when
a nurse monitors a patient’s vital signs through telemetry and takes the time to
explain the patient’ s current condition while offering reassurance, technology
becomes a bridge— not a barrier— in the nurse-patient relationship.
Another example can be seen in a school setting, where a nurse administers a
nebulizer treatment to a child. Rather than simply performing the procedure and
dismissing the child, the nurse engages in friendly conversation to ensure the
child feels safe and comfortable. This transforms the clinical interaction into a
personalized experience, reinforcing the caring aspect of nursing.
Locsin’s theory encourages nurses to adopt a holistic approach to care.
Technology should not be viewed merely as a functional tool, but as a means to
connect with patients and deliver the high-quality healthcare that every individual
deserves.
Metaparadigm in Locsin’s Theory
Person
● He defines a person as a whole, in a given moment, and one who is constantly
growing, changes according to personal conditions and experiences, and is a
union of mind, body and spirit. Technologies of care support the expectations of
persons that they will be known as participants in their care rather than as
objects of care (2, 5; Locsin RC)
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Environment
● In a critical care unit, the environment is shaped by advanced technology that
supports patients. Monitors, machines, and electronic surveillance are essential
in tracking the patient’s condition and ensuring that every vital sign is monitored,
helping nurses and doctors respond quickly and accurately. The nurses should
always check the patients and know how to use technology to ensure their safety
and truly address the patient's needs as a whole person.
Health
● Understood as a constantly changing process of being and becoming. It is not
merely the absence of illness or disease, but the expression of a person’s
wholeness. Health is co-created in the nurse-person relationship, emerging from
mutual understanding and caring. It reflects the person’s ability to live fully in the
moment, despite physical limitations or illness.
Nursing
● Nurses value technological competency as an expression of caring in nursing"
the goals; nurses know the occasion of a peaceful death, and have specialized
practice that employs technology to personalize treatment and able to give the
specific need of the patient or client.
CONCLUSION
Locsin’s theory emphasizes that technology should not dehumanize care.
Instead, when applied skillfully and compassionately, it deepens the nurse’s
capacity to know patients as whole beings. This ensures that even in a
technologically advanced era, nursing remains a profession of science, ethics,
and human dignity. Locsin’ s TCCN theory is versatile and can be applied across
various healthcare settings where technology is utilized. Its core principle— that
technological competence is a form of caring— ensures that patient care remains
compassionate and holistic, even in technologically advanced environments.
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Transformative Leadership Theory CASAGRA

Dr. Carolina S. Agravante, SPC, PhD, RN

Sr. Carolina Agravantes, SPC, RN, PhD

She is famous for being the first Filipina theorist for writing the
CASAGRATransformative Leadership Model. The title of the theory was
derived from her name, Carolina S. AGRAvante.
She continues to hold various administrative positions in St. Paul College
Univeristy in the Philippines.
She is also active in National Nursing Organization committed to the
advancement of the nursing profession.
∙ 1967-1969 studied Master’s Degree in Nursing Education at Catholic University
of America as a full-flagged scholar.
∙ 1964 BS Nursning Degree (St. Paul University Top 10 in the Licensure Exam) ∙
1970 Master Degree (CUA)
∙ 2002 Doctoral Degree (UP Manila Published her theory)
CASAGRA Transformative Leadership Model
It is a model in which nurses learn to lead members of their practice
CONCEPTS
The CASAGRA Transformative Leadership Model have concepts of leadership
from a psycho-spiritual point of view, designed to lead to radical change from
apathy or indifference to a spiritual person.
Servant Leader Formula
Is the enrichment package prepared as intervention for the study which has
threepartsthat parallel the three concepts of the CASAGRA Transformative
Leadership Model, namely: The care complex primer, A retreat-workshop on
Servant-leadership, andaSeminar- workship on Transformative Teaching for
Nursing faculty.
Special Experties
Is the level of competence in the particular nursing area that the professional
nurseisengaged in workshop is the spiritual exercise organized in an ambience of
prayer wherethe main theme is the contemplation of Jesus Christ as a Servant-
Leader.
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Servant- Leader Behavior

Refers to the perceived behavior of nursing faculty manifested through the
abilitytomodel the servant leadership qualities to students, ability to bring out the
best instudents, competence in nursing skills, commitment to the nursing
profession, andsense of collegiality with school, other health proffesionals, and
local community.
Nursing Leadership
Is the force within the nursing profession that sets the vision for its practitioners,
laysdown the roles and functions, and influences the direction toward which the
professionshould go.
Transformative Teaching
May also termed reflective teaching, an umbrella term covering ideas, such as
thoughtful instruction, teacher research, teacher narrative, and teacher
empowerment.
Care Complex
Is the central of care experiences in the personality of a nurse formed by a
combination of maternal care experience, culture based-care practices
indigenous to a race and people, and the professional training on a care acquired
in a formal course of nursing.
The model is a Three- Fold Transformative Leadership Concepts rolled into one
comprising of the following elements:
a. Servant- Leadership Spiritually
b. Self Mastery
c. Special Expertise Level
THREE FOLD TRANSFORMATIVE LEADER CONCEPTS
1. The servant- Leadership Spiritually here is prescribed to run parallel to the
generic elements of the transformative leadership model.
- This formula consists of a spiritual exercise, the determination of the viability of
the care complex in the personality of an individual and finally a seminar
workshop on transformative teaching.
-The servant-leader formula prescription includes a spiritual retreat that goes
though the process of awareness, contemplation, storytelling, reflection, and
finally commitment to become servant leaders in the footsteps of Jesus.
2. The Self Mastery consist a vibrant care complex possessed to a certain
degree by all who been through formal studies in a care giving profession such
as nursing.
3. The Special Expertise Level is shown in a creative, caring, critical,
contemplative and collegial teaching of the nurse faculty who is directly involved
with the formation of the nursing.

PROFESSIONAL CARE CARING BEHAVIOR

CLIENT WELL- BEING
MEANING OF THE THEORY
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Based on the study, the effect of the CASAGRA Leadership model using the
servant leader model on the leadership behavior of the nursing faculty, the care
complex inthepersonality of the nursing faculty is highly correlated to their
leadership behavior. Thecare complex is necessary given as a stimulant in the
performance of the leadershipactivities. The leadership behavior of the faculty
after going to the servant leadershipformula was significantly higher in the two-
post test periods than during the pre-test. It improved the leadership behavior of
the nursing faculty in both groups.
IMPLICATION TO NURSING
As a practicing nurses, it’s very common for nurses to take on different roles.
Oneof the common roles taken by the nurse practitioner is the leadership role
which is oneof the topics discussed in the CASAGRA Transformative Leadership
Model by Sr. CarolinaS. Agravante. In our shifts, it is important that one of the
nurses will take on thelead, inour institution, it is the charge nurse who takes on
this role. The charge nurse wll serveas the captain of the ship, so it is vital that he
or she take on the job with outmost careand compassion.
IMPACT ON NURSING PRACTICES
- Introduces a psycho-spiritual model for nursing.
- Shapes ethical practices though the teaching of Jesus Christ. - Encourage
holistic leadership among nurses and nurse educators. - Promotes the
development of innovative, competent, and empowered nursesfor nation-
buiding.
- Criticism: May face cultural/religious limitations (e.g., Muslimor non-
Christiancontext).

NURSING PRACTICE
- Nurses take on multiple roles (Leader, Servant, Educator}
- Charge nurses act as leaders during shifts, ensuring teamwork and
compassionate care.
- Servants-leadership approach promotes selfless service, reilience, and
adaptability during unpredictable shifts.
- Nurses are encouraged to practice vibrant care complex (staying grounded,
compassionate, and inspiring others).
NURSE EDUCATION
- Nurse educators apply servnat-leadership spiritually by: ∙ Passion for teaching
∙ Willingness to share knowledge selflessly
∙ Using evidence-based practices, workshops,and simulations. - Self-Mastery
helps educators understand strengths/weaknesses improves teaching
effectiveness.
- Special Expertise emphasizes perceptorship programs hands-on learning
novice nurses.
CLINICAL PRACTICES
- Charge nurses lead shift like a captain of the ship.
- Use of servant-leader formula in handling staff and patients - Workshops and
retreats on servant leadership applied to clinical settings. - Encourage evidence-
based practice combined with values/character formation/
LEADERSHIP
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- Based on servant- leadership

- Leadership roles extend to being educators, mentors, and spiritual guides. -
Aims to transform leaders from indifferent to empathetic and spiritual grounded.
- CASAGRA model offers a formula for organizing healthcare teams toward
shared goals.
REAL-LIFE EXAMPLE
- Charge Nurses in a Hospital Shift- acts as a leader, educator, and servant
- Perceptorship program- senior nurses guide new hires with hands-on
- Retreat- wokshops & seminar workshops- used as interventions for faculty
and nurse leaders
- Educators attending workshops and stimulations- passing on update
knowledge to students
STRENGTHS
Culturally Relevant
- It was created by a Filipino nurse theorist and is related to Filipino nurses
because it embodies Filipino values (collectivism, spirituality).
Promotes Transformational Leadership
- Instead than only giving orders or exercising control, leaders are encouraged to
inspire, motivate, and empower their employees.
- It can also be use in other educational settings not just on nursing profession.
Support Professional Growth
- Promotes ongoing education, direction, and mentoring the nurses under the
leader’s care.
- Establishes a culture of professional growth, accountability, and respect.
WEAKNESSES/LIMITATIONS
Cultural Specificity
- While it works well in the Filipino context, it might be less applicable in
multicultural or secular
settings where spirituality is not emphasized. - -The CASAGRA Transformative
Leadership Model is limited to Roman Catholic and Christian nursing educators,
excluding other faiths. In the Philippines, where diverse religions exist, each with
its own traditions and practices, this aspect should also be taken into account.
Requires High Emotional Intelligence
- Leaders must be skilled in empathy, moral reasoning, and communication,
which not all nursing managers may have without proper training.
Implementation Challenges
- In high- pressure hospitals environments (understaffed or resource-limited
settings), It may be hard to balance spiritual care with urgent clinical tasks. - This
study’s design posed potential, the control and study groups were selected from
the same faculty in the two schools, it is highly possible that experience could
have been discussed casually in faculty room and in some way must
contaminated the intervention.

CONCLUSION
The CASAGRA Transformative Leadership Theory developed by Sister
CarolinaS. Agravante,SPC,PhD, RN, serves as an invaluable framework that
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redefines nursing leadership through the integration of care, spirituality, and

transformative teaching. Rooted in Filipino values and Christian principles, the
theory emphasizes that authentic leadership in nursing transcends managerial
roles and focuses on nurturing compassion, moral integrity, and professional
excellence.
Through its threefold components-Servant-Leadership Spirituality, Self-Mastery,
and Special Expertise- the CASAGRA model guides nurses toward personal and
professional transformation. It reinforces the importance of holistic
care,empowering nurses to become reflective practitioners, compassionate
caregivers, and visionary leaders who inspire others toward shared goals.
Moreover, it bridges the gap between theory and practice by promoting value-
driven leadership applicable in various nursing context, from education to clinical
settings.
In essence, the CASAGRA Transformative Leadership Theory remains a corner
stone of nursing in the Philippines. It continues to influence how nurses
lead,teach,and care-anchoring the profession in compassion and spirituality while
driving and spirituality while driving progress and innovation in healthcare. Sister
Agravante’s work stands as a lasting testament to the power of faith-based
leadership in shaping nurses who serve with both competence and conscience.
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Divinagracia’s COMPOSURE Model

CARMELITA C. DIVINAGRACIA, RN, PhD

Carmelita C. Divinagracia
● A Filipino nurse theorist and educator.
● Developed the COMPOSURE Model based on her study of advanced nurse
practitioners caring for cardiac patients.
● Advocated for holistic care by balancing physiological and bio behavioral
wellness.
Position Held:
● Clinic Staff Nurse, Staff Nurse, Head Nurse, Instructor
● Assistant Dean, College of Nursing
● Dean, College of Nursing (UERMMMC – University of the East Ramon
Magsaysay Memorial Medical Center)
Leadership & Memberships:
● Former President, Association of Deans of Philippine Colleges of Nursing
(ADPCN)
● Member, Technical Committee on Nursing Education, CHED
Awards:
● Received the Anastacia Giron Tupas Award by the Philippine Nursing
Association (2008).
Theory of COMPOSURE Behavior
● COMPOSURE behavior refers to a set of therapeutic nurse behaviors that
directly affect patient outcomes.
● The acronym COMPOSURE represents 8 key behaviors that promote both
physiological and biobehavioral wellness.
● Applied particularly in settings like cardiac care units but remains relevant in all
nursing fields.
Brief Nursing Background
● Dr. Carmelita Divinagracia earned:
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○ Bachelor’s degree in Nursing – UERMMMC (1962)

○ Master’s degree in Nursing – University of the Philippines (1975) ○ Doctorate in
Nursing – University of the Philippines (2001)
Overview of the COMPOSURE Model:
● Integrates physical, psychological, social, and spiritual aspects of care. ●
Recognizes Filipino cultural values, family involvement, and spirituality in healing.
● Guides nurses in promoting wellness, adaptation, and recovery.
Key Emphases:
● Importance of a caring nurse–patient relationship.
● Balance between professional knowledge, technical skill, empathy, faith, and
respect.
● Addresses individuality and cultural background of patients.
Philosophy
● Dr. Carmelita C. Divinagracia conducted a study to determine the effects of
COMPOSURE behaviors of the advanced practitioner on the recovery of
selected patients at the Philippine Heart Center. Through the COMPOSURE
behaviours of the nurse, holism is guaranteed to the patient. Divinagracia (2001)
stated that nursing is a profession that surpasses time and aspects of the
individual as one of its clients. The nurse's presence provides a significant
opportunity for the two parties to build mutual trust, acceptance, and ultimately
fulfilling relationships from the moment of the patient's admission until the
patient's discharge.
● According to her, WELLNESS is more than the absence of illness. It is a
balanced and integrated state of well-being that encompasses both physiological
outcomes (such as vital signs, pain relief, laboratory results) and biobehavioral
outcomes (including emotional stability, intellectual engagement, and spiritual
strength).
Major Concepts – The COMPOSURE Behaviors
● Is a set of behaviors determined by the theorist that would be demonstrated by
advanced nurse practitioners to see how it would affect the overall recovery of
the patients in the Coronary Care Unit of the Philippine Heart Center.
● A condition of being in a state of well-being, a coordinated and integrated living
pattern that involves the dimension of wellness.
The ComPOSURE Model, developed by Filipino nurse theorist Carmelita C.
Divinagracia, is a nursing framework that guides practitioners in delivering care
that is both professional and compassionate. It emphasizes integrating clinical
expertise with cultural sensitivity, ensuring patients receive holistic, patient-
centered care (Tandog, 2017).
● Com - Competence
○ Involves a nurse’s ability to apply the necessary knowledge, skills, and
judgment to provide safe and effective care. It builds patient confidence and
ensures that interventions promote health and recovery.
● P - Presence & Prayer
○ Being present with the patient during times of need to give support and a sense
of companionship.
○ Providing comfort physically and spiritually when needed to give hope and
strength to patients.
● O - Open-mindedness
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○ Respecting and accepting the patient’s beliefs, culture, and values without
judgement to give care suited to their distinct identity.
● S - Stimulation
○ Motivating patients with encouragement, praise, and positive reinforcement to
keep their spirits high and help them cope with illness through small actions like
smiling or saying kind words.
● U - Understanding
○ Able to grasp the situation the patient is in and able to show concern and
compassion.
● R - Respect & Relaxation
○ Use of "po" and "opo" as well as nods and gestures to dactility courtesy ○
Allowance of resting periods for the patient
○ Activities that allow use of certain muscles while the others relaxing ● E -
Empathy
○ Able to relate to the hardship the patient is going through
○ Can share in the joys and sorrow of the patient while not being attached
[Link] principles guide nurses to provide holistic, culturally sensitive
care that addresses the physical, emotional, intellectual, and spiritual needs of
patients (Divinagracia, 2001).
Wellness Outcome:
● Physiologic Outcome - Refers to the perceived physical stability of the patient
as shown in vital signs, symptoms, and laboratory results.
○ Vital signs : Stable and within normal range.
○ Chest pain : Absence or minimization of pain and discomfort.
○ Hemoglobin : Adequate levels indicating improved blood function and
recovery.
● Biobehavioral Outcome - Refers to the perceived wellness of patients in
terms of Physical, Emotional, and Spiritual aspects
○ Physical : The patient is able to do his/her daily activities and functions without
signs of fatigue.
○ Emotional : The patient is able to handle the stresses of life and can maintain
and regulate his/her feelings.
○ Intellectual : The patient has properly applied all the steps. The nurse has
instructed the patient to do
○ Spiritual : The patient can properly establish a value system and act upon that
system.

CONCEPTUAL FRAMEWORK
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Metaparadigm
P – Person
● The patient is viewed as a holistic being with physical, emotional, social,
cultural, and spiritual dimensions.
● Each individual is unique and requires personalized, respectful, and
compassionate care.
H – Health
● Health is defined as a state of overall wellness, not just the absence of disease.
● Achieved when both physiological stability (vital signs, healing) and
biobehavioral wellness (emotional balance, motivation, spiritual strength) are
attained.
E – Environment
● Includes both the internal environment (patient’s emotional, spiritual, and
psychological state) and the external environment (family support, cultural
background, healthcare setting).
● A supportive, respectful, and faith-oriented environment enhances recovery.
N – Nursing
● Nursing is a holistic practice that integrates competence, compassion, faith,
respect, and cultural sensitivity.
● Nurses play a central role in achieving patient wellness by applying the
COMPOSURE behaviors in practice.
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RETIREMENT AND ROLE DISCONTINUITIES (Graceful Aging Theory)

Sister Letty G. Kuan

BIOGRAPHIC SKETCH
Prof. Letty Gurdiel Kuan, RN, RGC, EdD, was born on November 19, 1936,
in Katipunan-Dipolog, Zamboanga del Norte. Sister Letty G. Kuan is a
nurse with two (2) Master’s Degrees, MA in Nursing and MS in Education major
in Guidance Counselling, and she also holds a Doctoral Degree in
Education major in Guidance Counselling. All these postgraduate studies were
obtained from the University of the Philippines - Diliman, Quezon City. For her
vast contributions to the University of the Philippines - College of Nursing
faculty and academic achievements, she was awarded the distinctive post of
Professor Emeritus, a title awarded only to a few who met the strict criteria set
by the University of the Philippines in September 2004.
As a Professor Emeritus, aside from the University of the Philippines - Manila,
she is affiliated in several schools namely Silliman University in Dumaguete,
Cebu Normal University, Father Urios University in Butuan, St.
Joseph’s College in Quezon City, and San Pedro College in Davao. She has
clinical fellowship and specialization in Neuropsychology obtained from
the University of Paris, France (Salpetriere Hospital), as well as in
Neurogerontology in Watertown, New York (Good Samaritan Hospital) and
Syracuse University, New York, and she further added this field of specialization
in Geneva in the Centre des Soins Intensifs pour les troisième age group.
Moreover, she also had Bioethics formal training at the Institute of Religion,
Ethics and Law at Baylor College of Medicine in Houston, Texas from 1991 to
1997. In addition, she authored several books giving her insights in the areas of
Gerontology, Care of Older Persons, Bioethics, and Essence of Caring,
including Concepts of Illness and Health Care Intervention in an Urban
Community (1975), Understanding the Filipino Elderly: A Textbook for Nurses
and Related Health Professionals (1993), Essence of Caring (1993), Edad na
(1998), and Bioethics in Nursing (2006).
She is also a recipient of the Metrobank Foundation Outstanding Teachers
Award in 1995, being the first faculty to win suchan award representing UP
Manila, and an Award for Continuing Integrity and Excellence in Service (ACIES)
in 2004.
Furthermore, her religious community is The Notre Dame de Vie founded in
Francein 1932, and as a former member of the Board of Nursing, her legacy to
the Nursing Community is undeniable and indisputable.
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Dissertation: RETIREMENT AND ROLE DISCONTINUITIES

BACKGROUND OF THE THEORY
Retirement is a natural and unavoidable stage of
life. It can be seen in the growing number of older
adults, many of whom face health issues and
increased dependence on others.
Even though it happens later in life, retirement
should still be viewed as a positive and fulfilling
stage. This can be achieved by identifying and
focusing on factors that allow a person to enjoy
their remaining years.
Kuan's "Retirement and Role Discontinuities or
Theory of Graceful Aging" emphasizes that it is very important to prepare early,
ideally between the ages of 50 and 60, by exploring new roles and interests.
Doing so can lead to a meaningful and satisfying retirement, even with
the presence of role discontinuities experienced by this age group.
BASIC ASSUMPTIONS AND CONCEPTS
1. Physiological Age - The physiological age of a person can be higher or
lower than their chronological age, since aging is not only limited to time, but is
in fact a complex process with multiple causes. The evolution of aging can be
modulated by internal as well as external factors: genetics, diet,
environment, mental health. Knowing your physiological age allows you
to better understand the life patterns that have an impact on aging, which in
turn allows us to act accordingly to limit its effects. Our physiological age, also
called biological or functional age, is the one that shows the real
biological state of a person (Julie, 2017)
Also, it is the endurance of cells and tissues to withstand the wear and-tear
phenomenon of the human body.
2. Role – Refers to the 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.
Roles are fundamental to the operation of social systems and the behavior of
individuals. They are organized behavioral patterns and expectations that
attend a given position or accompany a specific situation. These expectations
can be formally assigned and explicitly stated or informally assumed and tacit.
By evoking behavioral expectations, roles affect how individuals cognitively
frame, interpret, and process physical or social stimuli, and thus they further
condition emotional responses.
3. Change of Life- The Change of Life in Retirement and Role Discontinuities,
also known as the Theory of Graceful Aging, is a concept developed by Sister
Letty G. Kuan. It encompasses the period between near retirement and post-
retirement years, which is the climacteric period of adjustment and readjustment
to another tempo of life. This theory emphasizes the importance of health,
income, family relationships, and self-preparation as determinants of
successful aging. It also addresses the role discontinuity, which is
the interruption in the line of status enjoyed or performed, often brought about
by retirement or other changes in life. The theory aims to help older adults enjoy
a rewarding retirement by cultivating other roles and coping approaches.
4. Retiree- Refers to an individual who has left the position they occupied for
the past years due to reaching the prescribed retirement age or completing the
required years of service. This transition is marked by a change in the line
of status enjoyed or role performed, which may be brought about by
an accident, emergency, or change of position. The retiree's role discontinuity
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involves adapting to the new tempo of life and may require adjustments to
maintain equilibrium and normal functioning.
5. Role Discontinuity- Role discontinuity in retirement refers to the interruption
in the line of status enjoyed or performed. This interruption can lead to a shift
in the individual's social role and responsibilities, requiring adjustments and
adaptations to the expectations socially defined for the position itself.
These factors influence how people perceive retirement and react to
discontinuing work roles, and government support for holistic pre-retirement
programs addressing retirees' diverse needs is recommended.
6. 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. These approaches can include
setting meaningful goals, maintaining social connections, finding new purpose,
and caring for mental health. By implementing these strategies, retirees can
navigate the emotional landscape of retirement with a sense of purpose,
accomplishment, and connection.
Determinants of positive perceptions in retirement and positive
reactions toward role discontinuities
1. Health Status - A person’s health determines their abilities and the roles they
can take on, both in the present and in the future. It is essential to maintain and
promote health at all stages of life, since proper care of the body and
mind ensures better well-being and quality of life even in old age.
2. Income (Economic Level) - Income strongly influences how retirement is
perceived and how individuals adjust to role changes. Since financial stability
secures one’s outlook in later years, it is important to save and spend wisely
during one’s working life to prepare for the future. Retirement pensions should
also be reviewed and adjusted to meet the actual needs of the elderly, making
them more realistic and beneficial.
3. Work Status - Work is closely linked to economic security through fair
compensation. For retirees, this means that retirement should not always
be seen as a time of complete inactivity. Engaging in meaningful activities or
part-time work helps keep skills sharp, boosts self esteem, and supports overall
well being even in old age.
4. Family Constellation - Family plays a vital role in easing the challenges of
retirement. In the Philippines, the family is regarded as a strong support
system, providing financial aid, emotional care, and security. This helps soften
the impact of role changes brought by retirement and offers valuable
alternatives, such as emotional support and financial assistance.
5. Self-preparation - Preparing for old age involves not only professional
growth but also activities that are therapeutic and meaningful. Volunteer
work, hobbies, and charitable acts provide dignity and fulfillment. Unlike
material investments, self preparation enriches life by enhancing self-worth,
happiness, and the ability to leave a lasting legacy.
METAPARADIGMS
Person
The elderly are individuals who belong to the age group typically ranging from
their mid-70s to 80s. They are at a stage in life where experiences, wisdom,
and personal history shape their identity and legacy.

Environment
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Refers to the surroundings and conditions that influence the life and well being
of the elderly. This includes the physical environment (such as the
home, community, and healthcare facilities), the social environment (family,
friends, and support systems), and the cultural environment (beliefs, traditions,
and values that shape attitudes toward aging). A supportive
environment promotes safety, comfort, dignity, and active participation of the
elderly, while a negative environment can contribute to isolation, stress, or
decline in health.
Health
Health in old age is closely connected to the natural process of aging. Aging is
a gradual journey of growth and maturity in mind, body, and spirit. It is
characterized by slower energy levels and the need for moderation in daily
activities. Accepting this reality is essential to aging gracefully. Instead of
resisting the changes brought by age, it is healthier to embrace one’s stage in
life with comfort and confidence. Cultivating positive attitudes toward aging early
in life greatly contributes to well-being in old age.
Nursing
Nursing involves helping the elderly find fulfillment in their retirement years
and supporting them as they navigate the later stages of life. It also includes
guiding them toward leaving a meaningful legacy for future generations.
Graceful aging allows a person not only to live with dignity but also to leave
a legacy. This legacy is shaped by early life experiences, the challenges one
has overcome, and the values carried through the aging process.
ELEMENTS OF LIFE'S EARLY IMPRINT
1. Importance of Love
- It is the foundational experience of being loved and appreciated
during childhood creates a strong emotional base.
2. The hug factor
- This refers to the need for physical affection and comforting gestures, it leaves
a feeling of secured and being cared of.
3. Good parental and sibling modeling roles
- Being a good role model of being positive parental figures and
siblings provides essential life lessons and promotes healthy social
development.
4. The sense of humor and relaxation - The ability to find humor and to relax
are very essential for maintaining stress and enjoying life, which can lead to
positive mindset of each individual.
5. The value of work and prayer life, growing closer to God who loves
us tremendously.
- Early experiences with work teach responsibility and the value of contribution,
while developing a connection to the divine through prayer strengthens a
person's spirit and provides a sense of purpose.
AGING PROCESS IS DEPENDENT BY MANY FACTORS
- Healthy, genetic background - Happy, fulfilled, childhood foundation
- Successful middle aged life experience
- Healthy surroundings
- Relaxation
- Recreation and nutrition
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- Had been recipient of being recognized, appreciated and honored with love
- Has attained a mastery of knowing oneself and a mastery of a skill, in any
category so long as the person feels recognized and appreciated for the
contribution done to self, family, community and society.
- Grows closer to divine worship regardless of affiliation, the person is attuned
to God who is all goodness, kindness, humility and love.
- Connectedness with others, it is a big social support that makes life worth
living for.
FINDINGS AND RECOMMENDATIONS
1. Health status determines the capacities the roles they are able to take on,
both in the present and in the future.
● It is suitable for everyone to maintain and promote health at all ages since
proper care of both mind and body is essential to preserve good health in old
age.
2. Family constellation is a positive index that serves as a positive factor
in facing retirement and in reacting to role discontinuities.
● In the Philippines, the family undoubtedly stands 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 provides emotional strains but can also provide monetary
support and practical assistance, helping cushion the adjustments that come
with retirement.
3. Income has a high correlation with both the perception of retirement
and reactions towards role discontinuities.
● Since income secures a person’s stability, individuals should strive to save
and spend wisely while still earning, so they have resources when they get old.
● It also implies that retirement pensions should be updated 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 and hand with economic security that generates
decent compensation.
● For retirees, it implies that retirement should not be conceptualized as a
period of no work since continuing to engage in work-related activities helps
sharpen and refine as they practice it on a regular basis.
● Work boosts the aspects of self esteem and contributes to the feeling of
wellness even in old age.
5. Self-preparation, which is said whether through therapeutic or recreational
pursuits, proves valuable in later life.
● This does not only account for professionalism or expertise but also
benevolent work as in charitable actions with the colleagues.
● Self-preparation is about investing not just in monetary security, but in
meaningful activities that bring dignity, self-worth, and happiness.
6. To cope with the 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.
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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 schools, neighborhoods, the
community and society in general.
● In retirement, their fellow retirees are their own best advocates. To facilitate
this, barriers to full participation in the areas where important decisions are
rich should be eliminated in order to
give recognition and appreciation of the knowledge, wisdom, experience and
values which are the social assets that make the retired age and the
custodians’ folk wisdom.
8. Government agencies should design holistic pre-retirement programs
that address the financial, psychological, emotional, and social needs of
retirees.
9. Retirement must be seen as the fulfillment of every individual’s right
and should be experienced as a meaningful stage of life.

STRENGTHS AND WEAKNESSES

 STRENGTHS
Culturally Relevant
- Rooted in Filipino values, the theory emphasizes family support, spirituality,
and community— making it highly applicable to local nursing and
gerontology practices.
Holistic Approach
- It integrates physical, emotional, social, and spiritual dimensions of aging,
encouraging retirees to maintain health, purpose, and relationships.
Practical Guidance
- Offers actionable strategies like financial planning, early role socialization, and
engagement in meaningful activities to promote graceful aging
Empowering Perspective
- Frames retirement not as decline but as a transition to new roles and legacies,
fostering dignity and self-worth among the elderly.
Policy Implications
- Advocates for government supported pre-retirement programs, which can
inform public health and social welfare planning.
 WEAKNESSES
Limited Empirical Validation
- While conceptually strong, the theory lacks extensive quantitative research or
standardized tools to measure its constructs across diverse populations.
Context-Specific
- Its deep cultural grounding may limit applicability in non-Filipino or more
individualistic societies, where family and community roles differ.
Idealistic Assumptions
- Assumes access to supportive family, stable income, and good health—
conditions not universally available to all retirees.
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Overemphasis on Role Continuity - May underplay the

psychological challenges of identity loss or grief that some retirees face when
roles are discontinued abruptly.
NURSING METAPARADIGM
Nursing
- Preparing a person to have a fulfillment in their retirement years, and assisting
them in their elderly years in leaving a legacy.
Person
- “Elderly”- 70-80 y/o
- “Gerone”- old but gracefully able to function as useful citizens at home and in
the community and exemplar infidelity to prayer life.
Environment
- refers to a patient's surroundings and conditions, both internal and external,
that influence their health and well-being. This includes the physical
environment (like their home or hospital), social factors (family, culture,
economic status), and even technological and political contexts that impact
health outcomes.
Health
- “Aging”-slow process of growth towards one maturity level of their mind, body,
and spirit.
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Dr. Carmencita M. Abaquin, RN, PhD, MSN

"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"

ABAQUIN’S PREPARE ME HOLISTIC NURSING INTERVENTIONS

Relevance of Local Theories
Local theories provide a framework that is sensitive to cultural differences and
can help nurses better understand their patients, improve the quality of their care,
and resolve issues that arise between them and their patients. As local nurses,
we may also offer care that is consistent with our practices, attitudes, and beliefs.
Nurses can also be aware of the gaps they will encounter as future practitioners.
In the absence of medical supplies and equipment, local theories are also crucial
for understanding what nurses can do in the case that the area is unable to
handle these problems. Nurses can do options that are appropriate for the
location or area.
Brief intro of PREPARE ME
The prepare me theory is intended for people with advanced progressing cancer.
Before beginning treatment for a cancer patient, it is necessary to ascertain the
patient's circumstances and general health in order to determine whether the
"Prepare me" method is truly beneficial for them.
Who is Carmencita Matias-Abaquin?
Abaquin is a distinguished Filipino nurse with a Master’s degree in Nursing (1975)
and a Doctorate (2000) from the University of the Philippines College of Nursing.
She is an expert in Medical-Surgical Nursing with a sub-specialty in Oncologic
Nursing, gaining recognition both locally and internationally.
She served at the UP College of Nursing for 35 years as a faculty member and
secretary, and later became Chairman of the Board of Nursing (2006–2016). She
developed projects like the National Nursing Care Competencies. Extending her
contributions further as part of the CHED Technical Committee in Nursing, and
holds leadership roles in the UP-PGH School of Nursing Alumni Association.
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
the 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.
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Theoretical Framework
The theory of Abaquin "PREPARE ME Interventions and Quality of Life Advance
Progressive Cancer Patients" serves as a structure on a non-pharmacologic and
non-surgical approach of care to advance progressive cancer patients. Its center
of interest is not on curing the patient's disease but on aiding them to have peace
of mind and benevolence as one is faced with a life and death situation. Nurses
should not solely be perceived as caregivers but also as facilitators of a peaceful
acceptance of the condition.
Basic Assumptions and Concepts:
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.
Presence - is having the presence of another person in times of hardship. It
involves therapeutic communication, active listening, and touch.
Reminisce Therapy - is thinking back on events, feelings, or thoughts that
happened in the past to ease adaptation to the current situation.
Prayer - a solemn expression of feelings through deliberate communication
directed towards a deity.
Relaxation-Breathing - techniques that aid in stimulating relaxation, to avoid
any undesirable signs and symptoms such as pain, muscle tension, and anxiety.
Meditation - evokes relaxation to help alter a patient's level of awareness by
concentrating on a thought or image to promote insight, which in turn aids in
forming a rapport and relationship with God. This could be done through music
and other relaxation techniques. Values Clarification - facilitates another person
in clarifying his own values regarding health and illness to promote effective
decision-making skills. This helps the patient develop an open mind that will
encourage acceptance of the disease state.
METAPARADIGM
Person – The theory is developed for patients with advanced stages of cancer.
To improve their quality of life with a multifaceted or holistic care.
Environment – The patient and environment are interrelated. Since quality of life
can be evaluated here, it is crucial in providing care.
Health – Quality of life is the individual's abilities and capabilities of enhancing
life when it can no longer be prolonged, regardless of the limitations brought
upon by the state of health.
This involves physical, psychological, social, religious, independence,
environment, and spiritual aspects.
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Nursing – The goal of nursing care is to enrich the quality of life of cancer
patients in advanced stages. Abaquin’s holistic, multidimensional approach is
summarized in PREPARE ME.
AIMS AND ASSUMPTIONS
Aim: improve quality of life a multifaceted construct emphasizing capacities to
enrich life even when it can no longer be prolonged.
Assumption: non-pharmacologic, spiritually sensitive, patient-centered
interventions can be taught and integrated into routine nursing care for advanced
cancer.
The number of patients who were diagnosed with cancer has increased through
the years, as it invades hospitals, medical doctors, and nurses are taking good
care of their patients, as Carmencita Abaquin's theory stated. PREPARE ME will
help nurses to easily communicate with their patients. Most cancer patients
experience emotional distress, and nurses can empathize with what they feel. So,
the theory helps nurses to solve the problem of the connection between nurses
and patients. It applies the holistic approach of nursing for peaceful
communication with them without causing chaos to both parties. It promotes
presence, reminiscing therapy, prayer, relaxation-breathing, meditation, and
values clarification.
Application in the Philippine Setting
Abaquin's theory holds particular relevance in the Philippines for several
reasons:
Cultural Congruence: The emphasis on Prayer (P) and Reminisce (R) strongly
resonates with the Filipino cultural values of deep religiosity, strong family ties,
and respect for the elderly's life stories. The spiritual dimension of care is
naturally integrated, making the model highly adaptable.
Addressing Local Healthcare Gaps: The theory provides a structured
framework for delivering palliative and hospice care, which historically has had
limited formal integration into the mainstream Philippine healthcare system. It
guides nurses in providing quality care beyond curative treatment.
Holistic Approach to Illness: Filipino patients often view illness not just as a
physical problem but as a family and spiritual crisis. The PREPARE ME model,
by addressing the psychological, social, and spiritual needs alongside the
physical, provides care that is genuinely holistic and culturally sensitive.
Nursing Education and Research: Developed by a Filipino nurse for the
Filipino patient, the theory is a cornerstone of Filipino nursing literature and is
widely taught in nursing schools across the country. It serves as a local,
evidence-based guide for practice in hospitals and community settings.
Strengths & Limitations

Strengths Limitations

Holistic and Comprehensive: It Narrow Patient Scope: The theory

provides a structured framework that was originally developed specifically for
addresses the patient's multi- advanced progressive cancer patients.
dimensional needs (physical, While applicable to other chronic or
psychological, social, religious, and terminal illnesses, its primary evidence
spiritual), moving beyond purely base and focus remain concentrated on
biological interventions. this specific group.
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Focus on Quality of Life and Dignity: Subjectivity in Measurement: The

The primary goal is to improve the core concepts, such as "inner peace,"
patient's Quality of Life and facilitate a "spiritual well-being," and "quality of
peaceful, dignified death, making it life," can be highly subjective, making
highly relevant for terminally-ill patients. the objective measurement and
evaluation of the theory's success
challenging in purely empirical research
settings.

Culturally Congruent (Philippine Requires Specialized Training:

Setting): The inclusion of interventions Effective implementation of certain
like Prayer and Reminiscence aligns components (like therapeutic touch,
strongly with Filipino cultural values of advanced reminiscence, and
deep religiosity and close family ties, meditation guidance) requires nurses to
making the model easily applicable and have specialized knowledge and skills
highly accepted locally. that may not be covered in standard
basic nursing education.

Specific and Actionable: The Time and Resource Intensive:

PREPARE ME acronym provides Delivering all nine components of the
nurses with a clear, concrete, and PREPARE ME intervention holistically
easy-to-remember set of actions that and consistently requires sufficient
can be immediately implemented in nursing time, staffing, and a supportive
practice environment, which may be difficult to
ensure in busy, under-resourced hospital
settings.

Non-Invasive and Empowering: It

emphasizes non-pharmacological,
non-surgical interventions, which can
empower the patient by giving them a
sense of control over their emotional
and spiritual well-being.

Findings and Recommendations

Holistic Nursing for Terminally-Ill Patients: Terminally-ill patients require a
comprehensive nursing approach that addresses all aspects of their being:
physical, psychological, social, religious, independence, environment, and
spiritual. This integrated care is especially vital for individuals with incurable
illnesses like cancer, aiming to enhance their quality of life.
Effectiveness of PREPARE ME Interventions: The PREPARE ME Interventions
are effective in improving the quality of life for cancer patients. These
interventions are also beneficial for terminally-ill patients, those with acute and
chronic diseases, and individuals experiencing prolonged hospital stays.
Integrating PREPARE ME into Nursing Education and Practice: It is
recommended to utilize PREPARE ME Interventions as a fundamental part of
care for cancer patients. Furthermore, the core components of PREPARE ME
should be integrated into basic nursing curricula and emphasized during the
training of nurses in both academic and clinical settings, to effectively meet the
needs of these specific patient populations.
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Training for Care Providers: The development of training programs is

recommended for care providers and other healthcare professionals whose roles
involve interventions as part of treatment modalities.
Patient Feedback and Communication: For patients, providing honest information
and receiving their feedback on their illness and management, as well as
understanding their perceptions, can significantly improve services and
communication among patients with advanced progressive cancer, their families,
and their healthcare team.
Supportive Environments for Dignified Dying: A supportive environment is crucial
for patients with advanced progressive cancer and terminally-ill patients, allowing
them to experience a dignified and peaceful passing. Their families also need
ample support to cope. Healthcare professionals and family members play a vital
role in creating such an environment, whether at home or in a hospital setting.
This ultimately ensures holistic support for these specialized clients.
Conclusion
The study's findings have significant implications for hospice/palliative care
administrators, hospice care providers, nursing education, nurse researchers,
patients, and families. The intervention should be used as part of fundamental
cancer care, as well as incorporated into the basic nursing curriculum. Some
institutional policies that promote the care of this patient population must be
modified. It is also recommended that training programs for care providers and
health care professionals be developed in areas where the intervention is part of
the care modalities.
It is also recommended that research employing the intervention be conducted
for patients with cancer of any stage, as well as those with chronic debilitated
conditions. One of the studies that may be done as a result of this is to determine
the mediating influence of the symptom on QOL. Some of the research that can
be conducted includes module development, evaluative study on the success of
a training program with an emphasis on this, and application of the intervention to
various stages of cancer and other chronic debilitating disorders.
And for patients, providing an honest opinion and feedback about their condition
and its management, as well as gathering their perceptions, can lead to improved
service and communication between patients with advanced progressive cancer,
their families, and the health team. This study found that patients require and
value a supportive environment in which patients with advanced progressive
cancer and terminally ill patients can die with dignity while their families receive
the necessary support to cope with the problems associated with the patient's
illness and death.
As a result, the health care provider and the patient's family must create this type
of environment, whether at home or in the hospital. Support for the caregiver is
also critical in maintaining a comprehensive approach to care. The theory
"Prepare Me," which is based on this study, can be broadened to encompass
caring for old, debilitated people; once this is done, the theory can be applied to a
large population of cancer patients and the elderly.
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NOLA PENDER: HEALTH PROMOTION THEORY

Background of Nola Pender

Early Life
● Born on August 16, 1941, in Lansing, Michigan, United States.
● Only child of Frank Blunk and Eileen Blunk, who were strong advocates
for women's education.
● Pender's first encounter with professional nursing occurred at the age of
seven when she observed the care provided by nurses to her hospitalized
aunt. This experience, along with her later education, instilled in her a
commitment to caring for others and shaped her belief that the primary
goal of nursing is to empower individuals to care for themselves.
Education
● 1962: Nursing diploma from West Suburban Hospital School of Nursing
● 1964: Bachelor of Science in Nursing from Michigan State University
● 1965: Master’s degree in Human Growth and Development from Michigan
State University
● 1969: Doctor of Philosophy in Education from Northwestern University
● Pender's dissertation research focused on developmental changes in
encoding processes in short-term memory among children.
● Years later, Pender also completed master s-level coursework in
community health nursing at Rush University.
Career and Appointments
● Worked on a medical-surgical and pediatric unit in a Michigan hospital in
1962.
● Nurse educator for more than 40 years (BSN, MSN, PhD levels).
● Co-founder of the Midwest Nursing Research Society.
● Trustee, Midwest Nursing Research Society Foundation (2009-present).
● Member, U.S. Preventive Services Task Force (1998-2002).
● Board member, Research America (1993-2000).
● President, American Academy of Nursing (1991-1993).
● President, Midwest Nursing Research Society (1985-1987).
● Member, American Nurses Association (1962-present).
● Associate Dean for Research at the University of Michigan School of
Nursing (1990-2001).
● Professor Emeritus, Michigan State University.
● Professor of Nursing, Loyola University School of Nursing in Chicago,
Illinois.
● International scholar, presenter, and consultant in health promotion.
● Works with the editor of the American Journal of Health Promotion to
promote legislation supporting health promotion research.
Works
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● Authored various articles on exercise, behavior change, and relaxation

training.
● Served on editorial boards and acted as an editor for several journals and
books.
● 1975: Published "A Conceptual Model for Preventive Health Behavior,"
which serves as a foundation for understanding how individuals make
health care decisions and the factors influencing disease prevention
actions.
● 1982: Released the first edition of "Health Promotion in Nursing Practice,"
introducing the Health Promotion Model (HPM).
● 1982: Revised the HPM in the second edition of "Health Promotion in
Nursing Practice."
● 1996: Published the third edition of "Health Promotion in Nursing
Practice."
● 2002: Fourth Edition of Health Promotion in Nursing Practice (co-authored
by Pender, Murdaugh, and Parsons)
● 2006: Fifth edition of Health Promotion in Nursing Practice (co-authored
by Pender, Murdaugh, and Parsons)
● 2010: Sixth edition of Health Promotion in Nursing Practice (co-authored
by Pender, Murdaugh, and Parsons)
● 2014: Seventh edition of Health Promotion in Nursing Practice (co-
authored by Pender, Murdaugh, and Parsons)
● 2018: Eighth edition of Health Promotion in Nursing Practice (co-authored
by Pender, Murdaugh, and Parsons)
Notable Awards / Honors
● "Portraits of Excellence" series, Volume II, from FITNE.
● Lifetime Achievement Award from the Midwest Nursing Research Society
(2005).
● Distinguished Contributions to Nursing and Psychology Award from the
American Psychological Association (1997).
● Honorary Doctorate of Science from Widener University (1992).
● Recognized for Distinguished Contributions to Research by the Midwest
Nursing Research Society (1988).
● Distinguished Alumni Award from the Michigan State University School of
Nursing (1972).
● Named a Living Legend by the American Academy of Nursing (2012).

Introduction of Health Promotion Theory

Around the world, we have seen different advertisements that advocate a
healthy lifestyle or different programs to help an individual stop a certain
addiction. All of these are an example of Health Promotion. The Health
Promotion Model created by nursing theorist Nola Pender. According to her,
health promotion should also be focused on healthcare.

The Health Promotion Model theory was originally published back in 1992
and later on revised and improved in 1996 and 2002. This notes that each
person has their own traits and characteristics that may affect their own
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subsequent actions. A health promoting behavior leads to an improved health

and a more functional body. The Health Promotion Model was designed as a
complementary counterpart of other health models. It is developed with different
health promoting behaviors that improves health and may be used their whole life.
This helps nurses to determine health behaviors that a patient have or lacking
when performing behavioral counselling, this serves as their foundation.

Nola Pender's Health Promotion Model defines Health as not only

absence of disease but also positive dynamic state. It is well directed onto a
person's health and well being. It's directed on different ways a person interacts
with the environment to pursue good health.

The model focuses on the following three areas, individual characteristics

and experiences, behavior-specific cognition and affect, and behavioral
outcomes.

Major Concepts of Health Promotion Theory

Individual Characteristic and Experience
● The first category delves into the concept that every individual possesses
a set of characteristics and experiences, which consequently shape their
behaviour.
● Pender highlighted the connection between an individual’s past behaviors
and their likelihood of engaging in future health-promoting practices.
● Personal factors and habits may serve as barriers to engaging in health-
enhancing activities.

I. Prior related behavior refers to the frequency of the same or similar

behavior in the past. This has direct and indirect effects on the likelihood
of engaging in health-promoting behaviors
II. Personal Factors are categorized as biological, psychological, and
sociocultural . These factors are predictive of the target behavior being
considered.
● Personal biological factors. Include variables such as age, gender,
body mass index, pubertal status, aerobic capacity, strength, agility, or
balance.
● Personal psychological factors. Include variables such as self-
esteem, self-motivation, personal competence, perceived health status,
and definition of health.
● Personal socio-cultural factors. Include variables such as race,
ethnicity, acculturation, education, and socioeconomic status.

Behavioral-Specific Cognition's and affect

I. Perceived Benefits of Action
● Expected positive results from health behavior.
II. Perceived Barriers to Action
● Understanding a behavior involves overcoming real, imagined, or
anticipated obstacles and expenses associated with understanding that
behavior.
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III. Perceived Self-Efficacy

● Influences personal organization and execution of health-promoting
behaviors, reducing perceived barriers and enhancing the belief in one's
capabilities to act.
IV. Activity-related affect
● positive or negative emotions linked to a specific behavior, enhancing self-
efficacy and potentially generating further positive affect.
V. Interpersonal influences
● refers to the influence of others' behaviors, beliefs, or attitudes on an
individual's health-promoting behaviors. Includes norms, social support,
and modeling
VI. Situational influences
● includes personal perceptions and cognitions, can directly or indirectly
affect health behavior by influencing available options, environment
characteristics, and aesthetic features.

Behavioral Outcomes
I. Commitment to a Plan of Action
● It involves an intention and identification of setting goals and strategies to
plan a specific health behavior.
II. Immediate Competing Demands and Preferences
● Competing Demands - an alternative behavior over which individuals
have low control because of environmental contingencies.
● Competing Preferences - an alternative behavior over which individuals
exert relatively high control.
III. Health-Promoting Behavior
● An endpoint of action-outcome directed toward attaining positive health
outcomes.

Major Assumptions of Pender’s about Health Promotion Theory

The assumptions reflect the behavioral science perspective and
emphasize the active role of the patient in managing health behaviors by
modifying the environmental context. People can actively develop and control
their own health behaviors, according to Nola Pender's Health Promotion Model.
Individuals and their surroundings interact continuously, influencing one another
to produce health. Health care providers, including nurses, are crucial in
promoting and assisting these habits. Making self-initiated adjustments that
enhance well-being is ultimately how people seek balance, progress, and the
achievement of their full potential. The following are the principal assumptions.
1. Persons aim to create a living condition that lets them realize their
unique health potential. Health is pursued not only as disease
prevention but as a process of growth, balance, and achievement of the
highest possible well-being.
2. Persons have the ability to reflect on themselves and evaluate their
own capabilities. Individuals can evaluate their strengths and limitations,
which enables them to make choices regarding their health behaviors.
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3. Persons value growth in directions viewed as positive and attempt to

achieve a personally acceptable balance between change and
stability. While they seek positive growth, individuals also work toward
maintaining a personally acceptable level of stability in their lives.
4. People seek to actively regulate their own behavior. They are not just
passive in health, but capable of making choices and managing their own
behavior.
5. Individuals in all their biopsychosocial complexity interact with the
environment. This interaction is reciprocal, meaning both the person and
environment influence each other.
6. Health professionals are part of the interpersonal environment.
Within their biopsychosocial complexity, people both influence and are
influenced by their surroundings—biological, psychological, social, and
cultural contexts continuously shape health behavior.
7. Self-initiated reconfiguration of person–environment patterns is
essential. People can change their interactions with the environment to
achieve better health.
8. Individuals strive for stability and actualization of human potential.
The ultimate goal of health promotion is to enable people to reach the
highest possible level of wellness and fulfillment.

Propositions
● Past behaviors, along with inherited and acquired personal characteristics,
shape individuals’ beliefs, emotional responses, and engagement in
health-promoting behaviors.
● Individuals are more likely to commit to behaviors when they anticipate
personally valued benefits as outcomes.
● Perceived barriers may limit both commitment to action and actual
performance of health-promoting behaviors, acting as a mediator of
behavior.
● Belief in one’s competence or self-efficacy to carry out a behavior
increases the likelihood of both committing to and performing the behavior
successfully.
● Higher perceived self-efficacy is linked to fewer perceived barriers to
engaging in a specific health behavior.
● Positive affect or emotions related to a behavior can enhance perceived
self-efficacy and increase the likelihood of both commitment and action.
● A feedback loop exists where greater self-efficacy can also reinforce
positive affect, further promoting behavior.
● When positive emotions are associated with a behavior, individuals are
more likely to commit to and follow through with that behavior.
● Individuals are more likely to engage in health-promoting behaviors when
important others, such as family, friends, or peers model the behavior,
expect it to occur, and provide encouragement and support.
● Interpersonal influences from family members, peers, and healthcare
providers can either strengthen or weaken an individual’s commitment to
and participation in health-promoting behaviors.
● External environmental or situational influences can either facilitate or
obstruct one’s intention to commit to or engage in a health-promoting
behavior.
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● Strong commitment to a specific plan of action increases the likelihood

that the behavior will be maintained over time.
● Competing demands, especially those over which the individual has little
control can interfere with commitment and reduce the likelihood of the
desired behavior occurring.
● When alternative behaviors are perceived as more attractive or preferred,
they may take precedence over the intended health-promoting behavior,
even if commitment exists.
● Individuals can consciously modify their cognitions, emotions, social
interactions, and environmental conditions to generate incentives and
motivation for engaging in healthy behaviors.

Metaparadigm
Person - Pender views the person as autonomous, an active recipient of care
that has the ability to improve their own health or well being.
Health - Defines health as a positive dynamic state not merely the absence of
disease.
Environment - The model explains how Socio-cultural, economic, and religious
factors influence and affect people's health practices.
Nursing - States that the nurse’s job is to educate and empower their patient,
and promote health by helping patients to engage in behaviors that improves
their health.

madeline eininger’s Culture Care Diversity and Universality

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I. INTRODUCTION
Madeleine Leininger is one of the most influential theorists in the nursing
world. Her ideas and contributions help in strengthening nursing practices,
specifically in the way we approach patient care. She is well recognized as
the founder of Culture Care Diversity Theory, which emphasizes the
importance of understanding the patient's culture in order to give truly holistic
and effective care. It has been said that nursing involves more than just
curing patients; it is also about considering their culture in nursing practices to
provide the best possible care for them. In addition, this theory serves as a
framework that offers concepts for research, education, and nursing practices
relating to culture-nursing relationships as well as defining how the four major
concepts, including person, health, and environment, interact with one
another, making a long-term impact on the nursing profession.
II. THE THEORIST: MADELEINE LEININGER
NAME AND BIRTH

Madeleine Leininger was born on July 13, 1925, in Sutton, Nebraska. She
lived on a farm with her siblings and graduated from Sutton High School. After
graduation from Sutton High, she was in the U.S. Army Nursing Corps while
pursuing a basic nursing program. The one who led her to pursue nursing is
her aunt who had congenital heart disease.

EDUCATIONAL AND CAREER BACKGROUND OF LEININGER

● 1945 - Madeleine Leininger, together with her sister, entered the Cadet
Nurse Corps, a federally-funded program to increase the number of
nurses trained to meet anticipated needs during World War II.
● 1948 - She earned a nursing diploma from St. Anthony’s Hospital
School of Nursing.
● 1954- She received a Master of Science in Nursing from the Catholic
University of America.
● 1960s - She first coined the concept of “culturally congruent care,”
which was the goal of the Theory of Culture Care, and today the
concept is being used globally.
● 1965 - Leininger embarked upon a doctoral program in Cultural and
Social Anthropology at the University of Washington in Seattle and
became the first professional nurse to earn a Ph.D. in anthropology.
● 1969-1974 - Leininger was appointed Dean of the University of
Washington, School of Nursing.
● 1974 - 1980 - Leininger served as Dean, Professor of Nursing, Adjunct
Professor of Anthropology, and Director of the Center for Nursing
Research and the Doctoral and Transcultural Nursing Programs at the
University of Utah College Nursing.

Leininger’s professional career is recognized as an educator and academic

administrator from 1956 to 1995, a writer from 1961 to 1995, a lecturer from
1965 to 1995, a consultant from 1971 to 1992, and a leader in the field of
transcultural nursing from 1966 and retired in 1995.

MAJOR CONTRIBUTIONS TO NURSING

Foundation of Trans-cultural Nursing

● While working as a nurse, Madeleine Leininger noticed that nurses

often lacked cultural and care knowledge, which she recognized as a
crucial gap in providing effective patient care. This insight led her to
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create the Theory of Trans-cultural Nursing, also known as the Culture

Care Theory.

Promotes Holistic and Patient-Centered Care

● Leininger’s theory goes beyond the biomedical model of health by

stressing the holistic nature of care. She taught that nursing should
not only address physical needs but also consider the social, spiritual,
cultural, and emotional dimensions of the patient. This approach
ensures that care plans are more comprehensive, individualized, and
respectful of the patient’s worldview.

● Fosters Cultural Competence

The theory provides nurses with the knowledge and tools to recognize,
respect, and integrate cultural differences into their practice, leading to
more effective and sensitive care.

● Improves Patient Outcomes

By aligning care with patients' cultural beliefs and practices,

transcultural nursing increases patient satisfaction, promotes health
promotion, and improves adherence to treatment plans.

● Addresses Health Disparities

The framework helps bridge gaps in care by making healthcare more

accessible and appropriate for individuals from diverse cultural
backgrounds, thereby reducing inequities.

● Promotes an Inclusive Healthcare Environment

By incorporating patients' traditional healing practices and respecting

their spiritual needs, the theory helps build trust and create more
collaborative relationships between nurses and diverse communities.

INSPIRATION FOR DEVELOPING THE THEORY

Her main inspiration for creating the Culture Care Diversity and Universality
Theory (Transcultural Nursing Theory) are:

1. Anthropology Studies Background

Theorist Madeleine M. Leininger had a formal training and background study
in anthropology which allowed her to understand that health, illness, and care
were deeply connected to culture. She found anthropology fascinating,
suggesting that it could be possible to interrelate it with nursing in providing
more meaningful care.

2. Desire for Global Relevance in Nursing

She envisioned nursing as a global discipline. This theory of Madeleine M.
Leininger has helped nursing students to understand more the cultural
differences in terms of the healthcare system to help them to adapt to the
needs of a diverse population.
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3. Gap in Nursing Practice

While theorist Leininger was working in Psychiatric, located at Cincinnati, she
observed the differences of responses to care and psychiatric treatment. She
also realized that nurses often lacked knowledge about cultural beliefs, values,
and practices that influenced patients’ health. Madeleine Leininger became
particularly concerned about patients—especially children from different
cultural groups, who did not respond well to the standardized care, and it also
motivated her to create a theory that emphasizes the importance of culturally
congruent care.

4. Fieldwork Experiences
She carried out her most significant fieldwork while pursuing her doctoral
degree in anthropology at the University of Washington. Madeleine Leininger
lived with the Gadsup people of the Eastern Highlands of New Guinea in a
span of two year—she also conducted her ethnographic and ethnonursing
study there. Beyond this, Leininger expanded her research and studied at
least 14 different cultures worldwide and the cultural practices that are related
to health, caring, and well-being.

5. Conviction and Belief that care is a “ Nursing’s Essence”

Madeleine Leininger consistently emphasized that care is the essence of
nursing and the unifying focus of the profession. She believed that without the
care, nursing wouldn’t exist because according to her, it is the central concept
that gives meaning and purpose to the discipline. Leininger also said that
neglecting the cultural aspects in nursing can lead to poor outcomes, so she
came to a decision to develop the Cultural Care Diversity and Universality
Theory (Transcultural Theory).

6. Global and Educational Vision

Leininger had a strong vision for making nursing into a globally relevant and
educationally sound discipline. She extensively trained nurses to deliver
culturally congruent care, mentored the students in transcultural nursing and
ethnonursing research method and offered the first formal transcultural
nursing courses in the U.S. Throughout her career, she studied 14 different
cultures worldwide that provided consultation, lectures, and established
organizations such as the Transcultural Nursing Society (1974) and the
Journal of Transcultural Nursing (1989).

III. The Nursing Theory: Culture Care Theory of Diversity and

Universality

Core Concepts
The Culture Care Theory underscores that nursing must be culturally congruent,
meaning care should be consistent with the patient’s cultural values, beliefs, and
lifeways. It identifies three modes of nursing action, preservation or maintenance,
accommodation and negotiation, and repatterning/restructuring, which serve as
strategies to deliver care that is both effective and meaningful. Ultimately, its goal is to
foster health, promote well-being, and support a dignified death, while simultaneously
respecting cultural diversity and uncovering universal patterns of care.

Assumptions of the Theory

Leininger posited that care is the essence of nursing and serves as the foundation for
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healing, growth, and well-being. She asserted that culturally grounded care is
indispensable for recovery, survival, and adaptation in the face of illness, disability, or
death. The theory rests on the premise that cultural values, beliefs, and life ways
significantly influence health, and that culturally congruent care produces more favorable
health outcomes.

METAPARADIGM
Nursing
● Caring constitutes the distinct, dominant, central, and unifying focus of
nursing.
● Culturally informed care serves as the “most comprehensive and holistic”
framework guiding nursing actions and decisions.
● When nurses discern both cultural similarities and differences, their
interventions and judgments become more precise and effective.
● The theory establishes Transcultural Nursing as a humanistic and
scientific discipline, dedicated to serving individuals, groups, communities,
societies, and institutions through culturally congruent practice.
Person
● Every culture possesses its own generic care knowledge and practices
whether folk, indigenous, religious, or traditional in origin.
● Since cultural perspectives inevitably differ, nurses are called to
demonstrate respect, openness, and cultural sensitivity toward the values
and lifeways of those they serve.
Health
● Health is shaped by culturally grounded care that is beneficial, meaningful,
and satisfying for individuals, families, groups, and communities.
● Both professional care, which is derived from nursing science and generic
care, which is rooted in cultural traditions, may present differences as well
as areas of convergence.
● Providing culturally congruent care fortifies health, enhances well-being,
and facilitates peaceful transitions at the end of life.
Environment
● The environment encompasses the social, cultural, and contextual
settings that mold health beliefs and practices.
● Cultural conflicts, impositions, stresses, and cultural pain often emerge
when cultural care knowledge is insufficient or disregarded.
● Delivering care that is culturally congruent, responsible, safe, and
sensitive mitigates these challenges and fosters healing.

IV. Application in Nursing Practice

How the Theory is applied in Patient Care

The theory is Leininger’s Culture Care Theory is applied in patient care by

guiding nurses to deliver care that respects and integrates the patient’s cultural
values, beliefs, and practices Leininger’s Culture Care Theory is applied in
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patient care by guiding nurses to deliver care that respects and integrates the
patient’s cultural values, beliefs, and practices.

This begins with a cultural assessment, where nurses gather information about
the patient’s traditions, language, religion, dietary preferences, and health
practices. Based on this assessment, nurses can design care plans that are
culturally congruent and avoid practices that may conflict with the patient’s
values. It concludes that nurses must carefully assess patients and use all
available resources before finalizing diagnostic results.

Nurses apply the theory by incorporating the patient’s spiritual and traditional
healing practices into care to show respect for them. nurses may use
interpreters or translators to overcome language barriers, ensuring that patients
fully understand their diagnosis, treatment options, and care instructions. They
may also adapt dietary plans to accommodate cultural or religious restrictions,
such as avoiding pork for Muslim patients or fasting considerations for certain
faiths.

Examples in Clinical Settings

On the blog published by the Notre Dame of Maryland University titled The
Importance of Transcultural Nursing (2024) it sited that patients with limited
English proficiency experience more adverse health outcomes due to errors in
diagnostic as the results of the cultural barrier from this observation, it is
concluded that nurses should be careful on the patient assessment and must
exhaust all resources before releasing the results of patient diagnostic.

Language proficiency is also one of the factors that make rural areas encounter
more obstacles when it comes to accessing health services. There is also a
financial means, the trust to the health care providers because of the fear of
invading their privacy due to lack of trust and confidence about their language.
That is why Transcultural Care Nursing Theory explores the importance of
having knowledge on the patient's cultural background. It builds inclusion among
the community. It eliminates the barrier that can lead to efficiency when it comes
to care services.
Relevance in Modern Nursing
The theory started with the belief in the "evil eye". It talks about a superstition of
harboring negative energy that can cause harm. Its origin is the Sardinian
culture, where its people turn to healer for every discomfort that they
experienced and once the symptoms start showing that is the only time they turn
to modern medicine. This led to the theory of transcultural care in nursing
because of the two points of view from Sardinian medicine and western
medicine.
The theory highlights the importance of taking into consideration the patient
culture when it comes to nursing care and the importance of having knowledge
about a cultural background of the patient as it promotes a better overall well-
being and it harnesses trust.
Additionally, it focuses on recognizing the cultural background of the patient and
drilling cultural sensitivity for promotion of harmony as the patient will feel that
they are being taken care of by the nurses who have knowledge on their
tradition.
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V. Strengths and Limitations

Advantages and Positive Impacts
1. Promotes Cultural Competence & Sensitivity
Leininger’s theory emphasizes that nurses understand patients’ beliefs, values,
and practices in their cultural context. This helps reduce misunderstandings,
fosters respect, and improves
2. Holistic, Patient-Centered Care
Her framework (including the Sunrise Model) encourages looking beyond just the
biological or physical aspects of health to include social, environmental, religious,
kinship, economic, and educational factors.
3. Adaptability Across Cultures
Because Leininger’s theory deals with both the diversity (what varies among
cultures) and universality (what is common across cultures) of caring practices, it
can be applied in many cultural settings, including multicultural environments.
4. Improved Health Outcomes
Culturally congruent care (i.e., care that aligns with the patient’s own cultural
values and practices) has been linked to better compliance, less conflict, greater
trust, and sometimes better clinical outcomes.
5. Educational & Policy Influence
The theory has been integrated into nursing education curricula. It has influenced
nursing research, policies, and institutional priorities toward cultural competence.
6. Ethical Sensitivity
It forces awareness of ethical issues like cultural imposition (forcing one’s cultural
values onto another) and encourages negotiation/accommodation rather than
simply imposing biomedical norms.
Limitations / Criticisms
1. Complexity and Resource Intensiveness
Fully implementing Leininger’s model requires time, resources, and effort (for
example, cultural assessments, training, adapting care plans). In busy or
resource-limited settings, this can be difficult.
2. Risk of Over generalization or Stereotyping
While aiming to honor culture, there is a danger of treating all individuals in a
cultural group as the same, or oversimplifying cultural norms.
3. Insufficient Guidance for Conflict Between Cultural Practices & Medical
Evidence
When cultural practices conflict with medical best practices (e.g. refusing certain
treatments, traditional practices that may be harmful), Leininger’s theory may not
provide clear guidelines on how to balance respect for culture with ensuring
safety and efficacy.
4. Training & Competency Gaps
Nurses (especially new graduates) may not have enough education or
experience to assess cultural needs adequately. Also, some may lack awareness
of their own biases.
5. Implementation Challenges
Institutional, administrative, and systemic barriers (e.g., policy constraints, time
pressure, limited staffing, lack of interpreters) may hamper the use of the model.
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6. Measurement & Research Difficulties

Because culture is complex and multivariate, measuring outcomes, standardizing
practices, or conducting comparative research is challenging. Also obtaining
evidence for universality vs. diversity may be difficult.
7. Potential Ethical Dilemmas
When cultural norms contradict human rights or safety (for example, gender
inequity, harmful religious practices), the theory does not always specify how to
mediate those conflicts.
VI. Group Conclusion
As a group, we acknowledge Madeleine Leininger's significant influence on
modern nursing through the development of the Culture Care Diversity and
Universality Theory. Her integration of anthropology and nursing became the
foundation for trans cultural nursing, urging nurses to adopt a holistic approach
that values cultural, spiritual, and social factors. The theory outlines three care
modes—preservation, accommodation, and re patterning—that guide nurses in
delivering culturally appropriate care in various clinical settings. Nursing students
and professionals who work with patients of different races and cultural
backgrounds would benefit from this, as it guarantees appropriate therapeutic
and cultural interventions. While exploring Leininger’s Theory, we have gained a
better understanding of the role of cultural awareness in reducing health
disparities, improving communication, and building nurse-patient relationships, as
this also outweighs challenges like potential stereotyping, ethical conflicts, and
lack of institutional support. Leininger's theory reminds us that knowing our
culture is a responsibility and that caring is the core of nursing, as this whole
became a major contribution to modern nursing.
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PAMATANSAN NG LUNGSOD NG MARIKINA

Prof. Ma. Lourdes Revilla

Overview
Ida Jean Orlando’s theory mainly focuses on the reciprocal relationships
between patient and nurse. She stresses that the patients who experience
distress or feeling of helplessness because of an unmet need for help. With her
theory being easy to comprehend, understand, and be practiced by nurses that
allows them to effectively create a nursing care plan, in which they can adapt
when and if any complications arise with the patient.
BIOGRAPHY OF IDA JEAN ORLANDO
Early Life and Family Background
1.1 Ida Jean Orlando was born on August 12, 1926, in New York City, United
States, to immigrant parents (variously noted as Irish or Italian descent), who
valued education and hard work.
1.2 She was one of the six children in a working-class family; her father worked
as a mechanic and her mother was a homemaker.
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1.3 Orlando’s early years were shaped by the Great Depression, fostering a
sense of empathy and service that influenced her future career.
Education and Clinical Training
2.1 Obtained a nursing diploma in 1947 from the Flower Fifth Avenue Hospital
School of Nursing, New York Medical College.
2.2 Earned a Bachelor of Science in Public Health Nursing from St. John’s
University, Brooklyn, in 1951.
2.3 Completed a Master of Arts degree in mental health consultation (or mental
health nursing) at Teachers College. Columbia University, in 1954.
2.4 While studying, Orlando worked in various nursing positions, including staff
nurse in obstetrics (OB), medical-surgical (MS), and emergency room (ER)
setting.
2.5 Also functioned as a general hospital supervisor, assistant director, and
taught several nursing courses.
Career
3.1 Joined Yale University School of Nursing in 1954 as an associate professor
of mental health and psychiatric nursing, serving for 8 years.
3.2 Became Director of the graduate program in mental health and psychiatric
nursing at Yale (1958-1961), using her conceptual model as the foundation for
the program’s curriculum.
3.3 Served as principal investigator for a National Institute of Mental Health
(NIMH), grant, focusing on “Integration of Mental Health Concepts in a Basic
Curriculum”.
3.4 After leaving Yale, worked as clinical nurse consultant at McLean Hospital in
Belmont, Massachusetts (1962-1972), launching educational programs based on
her nursing theories.
3.5 Served on the board of Harvard Community Health Plan (1972-1984) and as
an educator at Boston University School of Nursing (1981).
3.6 Held administrative roles at Metropolitan State Hospital, Waltham,
Massachusetts, including Assistant Director of Nursing for Education and
Research (mid-1980s to 1987).
3.7 Worked as a consultant on the Mental Health Project for Associate Degree
Faculties with the New England Board of Higher Education.
3.8 Retired in 1992 after a distinguished career and received the Nursing Living
Legend award from the Massachusetts Registered Nurse Association.
Major Publications and Works
4.1 “The Dynamic Nurse-Patient Relationship: Function, Process, and Principles”:
first comprehensive presentation of her theory based on empirical studies of
nurse-patient interactions.
4.2 “The Discipline and Teaching of Nursing Process”(1972): expanded her
earlier work, integrating her findings from subsequent clinical research and
educational projects.
Orlando’s Deliberative Nursing Process Theory Origin
5.1 While observing nurses, Orlando saw that many acted without truly
understanding the patient’s needs. She created the theory to help nurses think
critically, avoid guesswork, and improve patient outcomes through intentional
interaction.
HISTORICAL BACKGROUND/DEVELOPMENT OF THE THEORY
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Ida Jean Orlando was born in the United States in 1926. She finished her
basic nursing education at New York Medical College in 1947, earned a Bachelor
of Science in Public Health Nursing in 1951, and went on to complete a master’s
degree in Mental Health Nursing in 1954. During the late 1950s and early 1960s,
Orlando worked as an associate professor and researcher at the Yale University
School of Nursing. During her time at Yale, she became interested in how nurse-
patient communication affects the quality of care.
The development of the theory happened here when Orlando led a
research project that carefully observed about 2,000 nurse-patient interactions
over three years. The study focused on understanding what made nursing care
effective or ineffective, and it brought together ideas from mental health and
clinical practice. Ida Jean Orlando developed the Deliberative Nursing Process to
help nurses design an effective care plan that can be easily adjusted whenever
new problems develop for the patient.
In 1961, she shared her findings in the first book she presented entitled
The Dynamic Nurse-Patient Relationship: Function, Process, and Principles. This
work introduced the Deliberative Nursing Process Theory, which is focused on
the nurse-patient relationship, nurse’s role in recognizing, and meeting a patient’s
immediate need for help. Her framework became the basis of the five familiar
steps of nursing practice: assessment, diagnosis, planning, implementation, and
evaluation. The second book that she wrote was entitled The Discipline and
Teaching of Nursing Process,” in 1972. These can be led to produce positive
outcomes or patient improvement.
Orlando's theory came about when nursing was starting to be independent
to stand on its own feet and not just follow doctors. Nurses were beginning to be
seen as people who could look at a patient’s condition and give care on their own,
not only carry out a doctor’s instructions. Her theory explains that nursing care
works best when the nurse and patient participate and work together. She said
that any action or sign from a patient can be seen as a call for help, and the
nurse should ask and check with the patient to understand the need and give the
appropriate care.
Key Concepts
Function of professional nursing: By identifying and meeting a patient's urgent
need for assistance, nurses can independently alleviate their sensation of
powerlessness. Orlando held that the patient's needs, not directives or
procedures, should guide effective nursing interventions.
Presenting behavior: This refers to the patient's troublesome circumstance and
may manifest as a direct or indirect appeal for assistance. When a patient is
unable to meet a need on their own, their behavior suggests discomfort.
Immediate reaction: This is the internal reaction that takes place during an
interaction between the nurse and the patient.
Patient's reaction: The patient's perceptions, thoughts, and feelings automatically
lead to an action.
Nurse's reaction: The nurse's own views, emotions, and feelings are triggered by
the patient's behavior, causing an automatic internal reaction.
Nursing process discipline: By discussing and examining the patient's views,
feelings, and thoughts, the nurse must confirm that they comprehend the
patient's conduct. This guarantees that the nursing activity is not predicated on
the nurse's presumptions but rather on the patient's actual need.
Improvement: This is when the patient's discomfort is alleviated. A shift in the
patient's conduct is considered an improvement since it shows that their urgent
need for assistance has been satisfied. This attests to the efficacy of the
thoughtful nursing interventions.
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Automatic vs. deliberative actions

Orlando distinguished between two types of nursing actions:
Automatic nursing actions: These are routine actions performed for reasons other
than the patient's immediate need. These actions are considered ineffective
because they are based on assumptions rather than on validated patient
information.
Deliberative nursing actions: These are carried out following a proper
identification of the patient's needs by patient validation of the nurse's
perceptions. When operating consciously, the nurse must be free from
distractions that are irrelevant to the patient's demands.
THE FIVE-STAGE DELIBERATIVE NURSING PROCESS
Orlando's theory is operationalized through a five-stage process that is similar to
the standard nursing process:
Assessment: The first step in determining whether a patient needs assistance is
for the nurse to watch how they behave.
Diagnosis: The nurse assesses the patient's condition using clinical judgment
and, most importantly, discusses their knowledge with the patient.
Planning: To address the identified need, the patient and nurse work together to
create a plan of action.
Implementation: The nurse does the predetermined, intentional activity.
Evaluation: The nurse watches how the patient reacts to the activity. The
demand was satisfied if there is an improvement in the patient's conduct.
Otherwise, the procedure recycles to further elucidate the patient's demand.

ASSUMPTIONS OF THE THEORY

Orlando’s theory is built on several key assumptions about nursing and
patient care:
1. Nursing is responsive to the patient’s behavior. The nurse’s role begins when
a patient presents behavior that signals distress (verbal or nonverbal).
2. Patient behavior may represent a cry for help. This cry for help may not always
be obvious or clearly expressed.
3. The nurse’s role is to find out and meet the patient’s immediate need for help.
4. Nursing actions should be deliberate rather than automatic. Deliberate actions
are based on assessment and validation with the patient, not just on routine or
assumptions.
5. Nurse-patient interaction is crucial. Through effective communication, the
nurse validates perceptions, avoids misinterpretations, and ensures that care
truly meets the patient’s need.
6. The patient should be involved in their care. The nurse verifies and validates
observations with the patient instead of acting solely based on assumptions.
What Orlando Believed
About the Patient
•The patient has an immediate need for help, which may be expressed through
behavior (direct or indirect).
•Patients may not always be able to clearly communicate their needs.
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•Patient behavior (verbal or nonverbal) is a starting point for the nurse’s

assessment.
•The patient’s distress or discomfort requires nursing intervention that is validated
through communication.
About the Nurse
•The nurse is a problem-solving agent who helps meet the patient’s immediate
needs.
•The nurse must use critical thinking and avoid acting automatically.
•Nursing actions must be based on the nurse’s perception of the patient’s
behavior, but validated with the patient before intervention.
•The nurse’s role is not just physical care but also understanding and responding
to emotional and psychological needs.
About the Interaction (Nurse–Patient Relationship)
•The interaction between nurse and patient is dynamic, reciprocal, and essential.
•Effective communication and validation are required to ensure that care aligns
with what the patient truly needs.
•The nurse’s perception, thought, and feeling about the patient’s behavior must
be shared with the patient for confirmation.
•A therapeutic relationship is formed when the nurse deliberately responds to the
patient’s expressed needs, leading to better outcomes.
Metaparadigm
Person
Orlando highlights individuality and the dynamic aspect of the nurse-
patient relationship by using the concept of human. She believes that the goal of
nursing practice is to help people in need.
Health
According to Orlando's Theory, the need for nursing is triggered by a
sense of helplessness rather than health. She stated that nursing deals with
individuals who require help.
Environment
Orlando's theory ignored the surroundings entirely, concentrating only on
the patient's urgent needs and the nurse-patient connection and behavior (the
patient was only an individual in her theory; no families or groups were
mentioned). The effect that the environment could have on the patient was never
mentioned in Orlando’s theory.
Nursing
A distinct and Independent in its concerns to a person's urgent need for
assistance. In order to address the person's need for assistance, efforts are
made in a collaborative setting and with discipline, which calls for the right
training.
Nursing Process
She proposed that “patients have their own meanings and interpretations
of situations and therefore nurses must validate their inferences and analyses
with patients before concluding.”
The nursing process is an organized, methodical, and evidence-based
approach to care giving that nurses employ. It guarantees that nursing practice is
goal-oriented, patient-centered, and flexible enough to accommodate patients'
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evolving requirements. Because each step demands critical thinking, judgment,

and deliberate action, it is sometimes referred to as the Deliberative Nursing
Process.
The five phases of the Deliberative Nursing Process include assessment,
diagnosis, planning, implementation, and evaluation. Orlando's Nursing Process
Discipline Theory's standard nursing procedure is used by nurses to improve
patient outcomes. Orlando's main concern was defining the role of nursing.
Assessment
The nurse collects objective information like vital signs, test results, and physical
exam findings in addition to subjective information like the patient's feelings or
symptoms. This establishes a baseline and aids the nurse in comprehending the
patient's general state of health.
Diagnosis
In order to determine nursing diagnoses—clinical assessments of current or
potential health issues that nurses can treat—the nurse examines the information
gathered. These focus on the patient's reactions to medical issues and are
distinct from medical diagnosis.
Planning
Choosing suitable interventions and establishing quantifiable, attainable goals for
the patient's care are part of the planning stage. The care plan is tailored to each
patient and is intended to address the issues noted in the nursing diagnoses.
Implementation
The nurse executes the proposed interventions, conducts instruction, plans care,
and records all activities during the implementation phase. The care plan is
implemented at this action step.
Evaluation
After reviewing the patient's progress, the nurse assesses if the objectives and
results were met. If not, the treatment plan is changed, and the procedure starts
over at the right stage.
Advantages / Strengths of the Theory
Orlando's Theory of Deliberative Nursing Process remains an active
practice theory by creating a dynamic nurse-patient relationship focused on
meeting the patient's immediate needs for help. Nurses improve care by
observing a patient's behavior, reflecting on their own thoughts and feelings
about the patient's behavior and then acting to resolve the patient's distress. The
theory also fosters a collaborative nurse-patient relationship through observation,
communication and validation of patient behavior to achieve positive patient
outcomes.
Patient-Centered Care: The theory puts the patient at the core of the
nursing process, emphasizing that their needs and experiences are paramount.
The patient will be treated as individuals and have an active and constant input to
their own care.
Nurse-Patient Interaction: Orlando's model requires both the nurse and
the patient’s active participation and input in the nursing care plan. It encourages
open communication to explore the meaning of behaviors, understand needs and
confirm the problem. Through this, the nurse can understand and validate the
patient's situation leading to better understanding and collaboration with the
patient. This also prevents inaccurate diagnosis and/or ineffective plans.
Proactive Problem-Solving: Nurses can proactively identify and resolve
issues before they escalate by focusing on presenting behavior and seeking
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clarification. This prevents potential harm and improves the patient's overall
situation.
Meaningful Patient Outcomes: By deliberating with the patient to meet their
identified needs, the process aims to bring about improvements in the patient's
condition and provide relief from distress and alleviate feelings of helplessness.
Enhanced Critical Thinking: The theory cultivates logical thinking and
professional judgment among nurses by requiring them to observe, interpret and
validate patient behavior and needs.
Professional Judgment and Growth: Assertion of nursing’s independence as a
profession and her belief that this independence must be based on a sound
theoretical framework.
Disadvantages / Weaknesses of the Theory
In Orlando’s Deliberative Nursing Process, it is interpreted as a valuable
part of the nursing process; however, it is believed that her theory is primarily
focused on nurse-patient interaction and immediate patient needs, while also
having notable limitations. Critics argued that while the model highlights the
importance of validating a patient's needs, the theory was too narrow in scope,
as it centers not only on the individual nurse-patient dyad but also neglects
broader influences, such as family, culture, and the healthcare system.
Furthermore, a few backlashes were also aimed at the theory from scholars who
viewed it as a less comprehensive theory than other models. Other than that,
some educators also shared notes from students who failed to apply the
deliberative process fully. Moving on, the theory also struggles in settings where
patients cannot communicate, such as critical care, pediatrics, or with cognitively
impaired patients. Gaps were also seen in Orlando’s theory, such as including
vague concepts, relying on a subjective nurse interpretation, limited guidance for
long-term or even complex concepts, and lastly, a weak empirical support
compared to broader nursing theories.
Narrow Scope
- Her theory only focuses on nurse-patient interaction, leading to the
problem of environmental, social, and systemic factors being ignored.
Limited applicability
- Though her theory covers a few great aspects, it is still undeniable that it
is not as effective for patients who are unconscious, non-verbal, or unable
to participate in communication.
Subjectivity
- Her theory relies heavily on the nurse’s perceptions and interpretations,
which may lead to bias or inconsistency.
Educational/practical challenges
- Nursing students often default to physical interventions rather than fully
applying the deliberative process.

Limited for research support

- Using her theory may help you in other areas, but it has fewer empirical
studies compared to other theories, making it less validated in diverse
clinical settings.
Not ideal for complex health issues
- Oversimplifies cases that are influenced by multiple interacting factors, like
economic, cultural, and institutional factors.
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APPLICATION IN NURSING PRACTICE

Critical thinking in nursing practice with Orlando’s Theory
Postoperative patient in pain
1. Guiding principle (Finding out and meeting the patient’s immediate need
for help)
A nurse visits a patient after its abdominal surgery. The nurse focuses fully on
his patient, observing while assessing him.
2. Problematic situation and immediate reaction(s)
The nurse recognizes that the patient has a problem based on its facial
expression and action (trying to hold its abdomen). The nurse's immediate
perception is, "The patient looks uncomfortable and may be in pain." Now the
nurse's goal is to relieve the patient's discomfort.
3. Inquiry - problem determination
The nurse asks the patient, "Are you in pain? If yes, can you rate the pain
from 0 to 10?" The patient replies, "Yes, it’s about 7 out of 10." The nurse
confirms by asking, "So your main concern right now is the pain?" After that
question, the patient nods in agreement.
4. Identifying specific plans for each problem
Now the nurse creates a plan to help relieve the pain of the patient. After that
the nurse collaborates with the patient and explains the plan, which is giving
the patient pain medication and teaching him the right position that will help to
reduce the pain. The nurse asks, “Does this plan sound okay to you? ” Then,
the patient agrees.
5. Implement
The nurse now implements its plan. The nurse gives the prescribed
medication and helps to reposition the patient carefully. After that the nurse
then asks, “Is this helping? Do you feel more comfortable now? ” The patient
agrees again.
6. Improvement
After 30 minutes of implementing the plan, the nurse checks the patient again
and asks if the plan is helping while also observing the patient's verbal and
nonverbal behavior. The patient says, “My pain is down to a 3 now. I feel
much better." The patient looks relaxed and is not holding his abdomen like
before. The nursing action was effective.
Example Scenario using the 5 Stages of the Deliberative Nursing Process
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
Patient is having a breathing problem after surgery
1. Assessment
While assessing the patient, the patient suddenly said, “It hurts to breathe
deeply.” The nurse observed that the patient was breathing shallowly, had a low
oxygen saturation of 92%, and the patient appeared anxious.
2. Diagnosis
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The nurse identified a risk for an ineffective breathing pattern related to post-
operative pain and the effects of anesthesia, as shown by shallow breathing and
decreased oxygen saturation.
3. Planning
The nurse planned that the patient would maintain oxygen saturation above 95%,
perform deep breathing and coughing exercises correctly, demonstrate an
effective coughing technique, and remain free of respiratory complications. To
achieve these goals, the nurse would monitor the patient’s respiratory status to
ensure adequate oxygenation, teach and encourage deep breathing exercises to
promote lung expansion, and reposition the patient to a comfortable position to
improve breathing.
4. Implementation
The nurse implemented the plan by checking the patient’s oxygen saturation and
monitoring the patient's breathing, positioned the patient in a right position, taught
the patient how to do slow deep breathing, and provided reassurance to lessen
anxiety.
5. Evaluation
The patient’s oxygen saturation improved to 97%. The patient was able to
demonstrate deep breathing and coughing correctly, showed less shallow
breathing, and had no signs of respiratory complications. Now, the patient is
breathing comfortably.
Relevance to Modern Nursing
The theory of the deliberative nursing process of Orlando became the
foundation for the five-step systematic framework (Assessment, Diagnosis,
Planning, Implementation, and Evaluation), or ADPIE, which is now accepted
globally as the professional standard for delivering patient-centered care. The
theory focuses on the dynamic nurse-patient relationship and the "deliberative"
nature of nursing actions is what truly gives ADPIE its patient centered care. The
core of Orlando’s theory was that nurses must first validate their perceptions,
thoughts, and feelings with the patient before acting. This is a critical and
important step of validation that prevents action care based on guesswork and
ensures interventions are created for the patient's actual and immediate needs,
rather than what the nurse assumes them to be. In relevance today’s complex
and fast-paced environment of healthcare. The principle of Orlando’s theory of
nursing process is more relevant than ever, it serves as a tool that is important to
improve therapeutic communication, avoid clinical errors based on false
assumptions, and actively involve the patient as a partner in their own care.
Orlando's model Deliberative Nursing Process provides a structure for
teaching students on how to think critically and professionally. This teaches the
student how to apply a disciplined, step-by-step process for analyzing a patient's
situation and its needs. For nursing education, the framework is a foundation in
transitioning students from a task-oriented to a professional mindset, and an
analytical one. The theory teaches them not just to observe a symptom, but to
deeply analyze it directly with the patient, by strengthening their clinical judgment
and diagnostic accuracy. The theory provides a method for students to practice
active listening, validation and critical thinking, that builds the student nurse
competence and confidence in real-time patient interactions when in the field. By
learning and applying this deliberative process, new nurses learn to deliver care
that is not only evidence-based but unique and effective for each patient.

Summary
Ida Jean Orlando’s Deliberative Nursing Process Theory focuses on the
important relationship between nurses and patients. She believed that nurses
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should carefully observe and understand a patient’s needs instead of just

guessing or following routine actions. Her theory includes five clear steps: first,
the nurse observes the patient to see what is happening; second, the nurse
works to understand the problem by talking with the patient; third, they plan care
together based on what the patient needs; fourth, the nurse carries out the plan;
and fifth, the nurse checks if the plan helped the patient get better. This process
helps nurses give care that matches what each patient really needs and
improves the patient’s comfort and health.
While Orlando’s theory works well for patients who can communicate, it
has some limits when used with patients who cannot speak or when bigger social,
family, or cultural influences affect care. Some also find it hard to always use the
theory fully in busy clinical or teaching settings. Even with these challenges,
Orlando’s theory helps nurses think critically and act with careful judgment rather
than just following orders. It encourages nurses to listen actively, work closely
with patients, and deliver care that is thoughtful and respectful. Overall, her
theory remains an important guide for nursing practice and education, helping
nurses become better problem-solvers and partners in patient care.

PEPLAU’S THEORY OF INTERPERSONAL RELATIONSHIPS

OVERVIEW

● Developed by Hildegard E. Peplau, known as the “Mother of Psychiatric

Nursing.”

● Emphasizes that nursing is a therapeutic and interpersonal process aimed

at helping patients improve their health and well-being.

● The theory highlights the importance of the nurse-patient relationship in

promoting healing, reducing anxiety, and fostering personal growth.
Peplau identified four phases of this relationship—orientation,
identification, exploitation, and resolution—each representing a stage of
interaction and collaboration that moves the patient toward independence.

● She also described six nursing roles (stranger, teacher, resource person,
leader, counselor, and surrogate) that nurses use to meet patient needs
and guide them through recovery.

● By focusing on understanding human behavior, emotions, and

communication, Peplau’s theory encourages patient-centered care and
forms the foundation of modern psychiatric and mental health nursing
practice.

DESCRIPTION

Hildegard E. Peplau's theory defined Nursing as "An interpersonal process of

therapeutic interactions between an individual who is sick or in need of health
services and a nurse especially educated to recognize, respond to the need for
help." It is a "maturing force and an educative instrument" involving an interaction
between two or more individuals with a common goal.
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PEPLAU’S BACKGROUND

Who is Hildegard E. Peplau?

Peplau was well-known for her Theory of Interpersonal Relations, which helped
to revolutionize nurses' scholarly work. Her achievements are valued by nurses
worldwide and became known to many as the "Mother of Psychiatric Nursing"
and the " Nurse of the Century."

BIOGRAPHY

Hildegard Peplau was born on September 1, 1909. She was raised in Reading,
Pennsylvania, by her parents of German descent, Gustav and Otyllie Peplau.
She was the second daughter, having two sisters and three brothers. Though
illiterate, her lather was persevering while her mother was a perfectionist and
oppressive. With her young age, Peplau's eagerness to grow beyond traditional
women's roles was precise. She considers nursing to be one of few career
choices for women during her time. In 1918, she witnessed the devastating flu
epidemic that greatly influenced her understanding of the impact of illness and
death on families.
HISTORY
Hildegard E. Peplau (September 1, 1909 - March 17, 1999) was the first
published nursing theorist since Florence Nightingale and created the middle-
range descriptive nursing theory of interpersonal relations, which helped to
revolutionize the scholarly work of nurses.
As a primary contributor to mental health law reform, she led the way towards
humane treatment of patients with behaviour and personality disorders.
EDUCATION

Peplau graduated from Pottstown, PA Hospital School of Nursing in 1931 and

pursued a BA in Psychology from Bennington College in 1943.
● During World War II, she worked in a neuropsychiatric hospital in London,
England, as part of the Army Nurse Corps.
● Peplau earned an MA in Psychiatric Nursing in 1947 and an Ed.D. in
Nursing Education in 1953, both from Teachers' College, Columbia
University.
● She also obtained certification in Psychoanalysis for Teachers from the
William Alanson White Institute, New York City in 1954.

KEY CONCEPTS:

1. Interpersonal Relationship
- Peplau emphasized the nurse-client relationship as the foundation of
nursing practice, highlighting the give-and-take of nurse-client
relationships that was seen by many as revolutionary.
- Peplau developed an interpersonal model emphasizing the need for a
partnership between nurse and client as opposed to the client passively
receiving treatment and the nurse passively merely carrying out doctor’s
orders.
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2. Roles of the Nurse

- According to Peplau (1952/1988), nursing is therapeutic because it is a

healing art, assisting an individual who is sick or in need of health care.
Nursing can be viewed as an interpersonal process because it involves
interaction between two or more individuals with a common goal. In
nursing, this common goal provides the incentive for the therapeutic
process in which the nurse and patient respect each other as individuals,
both of them learning and growing due to the interaction. An individual
learns when she or he selects stimuli in the environment and then reacts
to these stimuli.

Peplau identified six nursing roles:

a. Stranger
- The nurse needs to build rapport and trust by offering an accepting,
respectful, and nonjudgmental attitude.
- The partnership starts with empathy, decency, and respect.
- This phase establishes the groundwork for additional therapeutic
involvement and relationship.
- Initially, nurses are expected to greet patients with the “respect and
positive interest accorded a stranger” (Peplau, 1952/1991, p. 44).
- It occurs when the nurse and his/her client or patient meet and become
acquainted with prejudged expectations for the first encounter (Peplau,
1952)
- Recipient of the client in a similar way of meeting a stranger in another
situation, bringing about trust in the client and impartially accepting the
patient (Olufunke, 2016).

b. Resource Person

- In order to help the patient make informed decisions, the nurse interprets
clinical data, delivers precise answers to inquiries, and provides
information.
- Being a source of knowledge about health, treatment programs,
medications, and procedures is part of this role.
- The resource person "provides specific answers to questions usually
about health information" and "interprets the clinical plan of care" (Lego,
1998).

c. Teacher

- Both formal and informal training and teaching are given by the nurse.
This includes both experiential (analyzing the patient's experience to help
them learn from it and create new coping mechanisms) and instructional
(providing information) components.
- The nurse assists the client to "attain knowledge to improve health"
through instructional and experiential learning processes (Peplau, 1952).
- Gives clear instructions and also provides training that involves analyzing
the learner's experience. Peplau categorizes the teaching into two parts
the Instructional and Experiential
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a. Instructional - consists of information giving detailed ways to do or

operate it.
b. Experiential - which takes advantage of learners' experience as a
basis to form and use it to increase knowledge and development
(Olufunke, 2016).

d. Leader

- Assists the client to assume maximum responsibility for achieving

treatment objectives in a way that is mutually satisfactory.
- The nurse helps the client "accept increased responsibility for the plan of
care" by offering guidance, direction, and support for collaboration toward
treatment goals (Peplau, 1952).

e. Counselor
- The nurse encourages the client to explore his or her current situation or
presenting problem.
- The nurse should recognize that this kind of exploration often engenders
anxiety and, as a result, creates an atmosphere that is conducive for the
client to safely express his or her concerns (Peplau, 1952).
- To successfully carry out the counseling role, the nurse needs to practice
active listening skills, apply therapeutic communication strategies, provide
guidance and offer support in the process of self-discovery, and uphold
both professional boundaries and self-awareness (Gastmans, 1998).

f. Surrogate
- The nurse functions as an advocate or a substitute for another human
being who is well known to the client, such as a parent, sibling, other
relative, friend, or teacher (Lego, 1998).
- In this interaction, the client may unconsciously project behaviors or
emotions linked to a significant person onto the nurse. The nurse
addresses this response and assists clients to recognize the differences
as well as similarities between themselves and the other.

Peplau also believed that the nurse could take on many other roles, but these
were not defined in detail. However, they were “left to the intelligence and
imagination of the readers.” (Peplau, 1952)

FOUNDATION OF PEPLAU’S FRAMEWORK

Peplau was influenced by psychodynamic theories (particularly interpersonal

psychiatry), drawing from theorists such as Harry Stack Sullivan, Percival
Symonds, Abraham Maslow, and others.
She saw nursing not just as a set of tasks, but as a therapeutic, interpersonal
process involving interaction between nurse and patient with a common goal.

Peplau’s model emphasizes the evolving relationship, in which both nurse

and patient grow and learn.
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The nurse-patient relationship passes through phases:

FOUR PHASES

● Orientation - Patient seeks help and begins to trust the nurse.

● Identification - The patient recognizes the nurse as someone who can
help and works with them to clarify problems.
● Exploitation - Patients use nursing resources and services to address
needs.
● Resolution - Goals are achieved, and the therapeutic relationship ends as
the patient gains independence.

The nurse assumes different roles to meet the patient’s needs (e.g., stranger,
resource person, teacher, counselor, surrogate, leader) at various points in the
relationship.

Thus, the foundation is that nursing is relational, dynamic, and centered on

interpersonal processes rather than solely technical tasks or biological
phenomena.

PHASES OF THE NURSE-PATIENT RELATIONSHIP

1. Orientation Phase

The nurse-patient therapeutic relationship begins here. Nurses are

expected to greet their clients with respect and positive interest, according to a
stranger (Gonzalo, 2021). To build trust and encourage open communication,
they give the clients basic details like their names and professional roles (Arabacı,
2019). In the orientation phase, the nurse is a resource person, counsellor, and
surrogate. The ultimate goal is helping the patient become oriented to their
problem and understanding their sources of anxiety.

During the brief orientation phase, clients may realize they need assistance
as they adjust to their current status. Simultaneously, nurses introduce
themselves and begin to obtain essential information about clients as individuals
with unique needs, values, beliefs, and priorities. During this brief phase, trust is
established, and rapport begins to develop between the client and the nurse.
Nurses ensure privacy when talking with the client and providing care and
respect the client’s values, beliefs, and personal boundaries. As Peplau states in
her original work, the nurse and patient learn to work in a co-operative manner to
resolve difficulties (Peplau
1952)

A common framework used for introductions during patient care is AIDET, a

mnemonic for Acknowledge, Introduce, Duration, Explanation, and Thank You.
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Acknowledge: Greet the patient by the name documented in their medical

record. Make eye contact, smile, and acknowledge any family or friends in the
room. Ask the patient their preferred way of being addressed (for example, “Mr.
Doe,” or “Jonathon ) and their preferred pronouns (e.g., he/him, she/her, or
they/them).

Introduce: Introduce yourself by your name and role. For example, “I’m John
Doe, and I am a nursing student working with your nurse to take care of you
today.”

Duration: Estimate a timeline for how long it will take to complete the task you
are doing. For example, “I am here to perform an admission assessment. This
should take about 15 minutes.”

Explanation: Explain step by step what to expect next and answer questions.
For example, “I will be putting this blood pressure cuff on your arm and inflating it.
It will feel as if it is squeezing your arm for a few moments.”

Thank You: At the end of the encounter, thank the patient and ask if anything is
needed before you leave. In an acute or long-term care setting, ensure the call
light is within reach and the patient knows how to use it. If family members are
present, thank them for being there to support the patient as appropriate. For
example, “Thank you for taking time to talk with me today. Is there anything I can
get for you before I leave the room? Here is the call light (Place within reach).
Press the red button if you would like to call the nurse.”

For example, when a newly admitted patient to a hospital meets their

assigned nurse for the first time. The nurse introduces themself, clarifies their
role and the purpose of their interaction, and gathers information to understand
the patient's needs and concerns. This initial contact focuses on building rapport
and trust, assessing the patient's distress, and establishing a comfortable, non-
judgmental communication environment

FACTORS AFFECTING ORIENTATION PHASE

FACTORS ON THE PATIENT’S SIDE:

1. Needs and Expectations: The patient's stated needs and preconceptions

about their experience and the helping process influence their engagement

2. Trustworthiness: The patient's perception of the nurse's integrity affects their

willingness to share and rely on professional help.

3. Communication Style: A patient's unfamiliarity with the nurse's dialect or

language can hinder communication.
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4. Psychiatric Factors: For patients with chronic mental illnesses, factors like
worsening paranoia or depression can affect the orientation phase, potentially
causing a return to it.
FACTORS ON THE NURSES’ SIDE:

1. Communication & Competency: The nurse's ability to use therapeutic

communication, show interest, concern, and competence is crucial for
establishing trust.

2. Respect & Privacy: Nurses must respect the client's values, beliefs, personal
boundaries, and ensure privacy to create a safe environment.
3. Role Clarity: The nurse must clarify their own role and help the patient
understand the purpose of the interaction.
4. Attitude: The nurse's attitude, whether it's aggressive or empathetic, can
significantly impact the orientation phase and the overall relationship.
5. Experience Level: The nurse's level of experience can affect the dynamics of
the relationship and the outcomes of the phase.
2. Identification Phase
In the identification phase, trust begins to develop, the patient begins to
have a feeling of belongingness and a capacity for dealing with a problem, and
the client identifies and attaches themselves with those who accept them. At this
point, the patient begins to identify problems to be worked on within the
relationship. They start to address personal feelings about the experience and
are encouraged to participate in care to promote personal acceptance and
satisfaction. During this phase, the meaning between feelings and behavior of
the nurse and the patient are explored. Peplau (1991) states that "when a nurse
permits a patient to express what they feel and still get all the nursing that is
needed, then the patient can undergo illness as an experience that reorients
feelings and strengthens positive forces in the personality" (p. 31).
For instance, a patient that is diagnosed with diabetes, collaborates with
nurses to create treatment and diet plans. The patient expresses that he/she is
scared of the sudden changes such as injecting an insulin and changes on
his/her diet. The nurse actively listens to the patient and gives reassurance. As
the patient begins to express his/her feelings and accept help, the mutual goal
setting develops. It allows patients to be active participants in their care, works
interdependently with the nurse, and the patient begins to have a feeling of
belonging and a capability of dealing with the problem, which decreases the
feeling of helplessness and hopelessness.
The major goal of the identification phase is to develop clarity about the
patient’s preconceptions and expectations of nurses and nursing, develop
acceptance of each other, explore feelings, identify problems and respond to
people who can offer help. While, the nurse's goal in this phase is to help the
patient to recognize his/her participation role and promote responsibility for self.

FACTORS AFFECTING THE IDENTIFICATION PHASE

FACTORS ON THE PATIENT'S SIDE:
1. Level of trust built in the orientation phase: If the trust is already built in the
orientation phase, the patient is most likely to open up and cooperate easily with
the nurse.
2. Readiness of patient to share feelings: The patient should be ready and feel
comfortable to share their feelings and thoughts.
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3. Psychological state: The patient's anxiety, denial, depression or acceptance

can affect how they participate to identify their problems.
4. Past experiences with healthcare providers (doctors and nurses): The
patient's past, good or bad experiences with the healthcare providers can affect
how they will behave.
5. Support from the family or loved ones: The encouragement from their
family and loved ones can help the patients feel more motivated to collaborate
with the nurses.
6. Not feeling judged: Encourages the patient to share or express their feelings
without fear of being judged.
FACTORS ON THE NURSES’ SIDE
1. Communication Skills: When a nurse has good communication skills can
make it easier for the patient to understand, leading for the patients to express
themselves, identify their problems and needs.
2. Building Connection through empathy: By showing empathy, encourages
the patient to cooperate in the therapeutic relationship. And it will make the
patient feel accepted, leading them to be willing to open more.
3. Respectful Communication: Being respectful helps build trust and help the
patients express what they feel without fear.
4. Creating safety and trust: When the patient feels secure, they are now
comfortable working with a nurse and accepting help.
5. Encouraging the patient to share feelings: This allows the patient to
recognize and talk about their problem to identify their needs, which is the goal of
this phase.

3. EXPLOITATION (WORKING) PHASE

In Peplau’s original four-phase model (orientation, identification,
exploitation, resolution), the exploitation phase is the stage where the patient
begins to use (exploit) to the fullest extent all the services, help, and resources
offered via the therapeutic nurse–patient relationship (Peplau’s Theory of
Interpersonal Relations - Nursing Theory, 2023).
It is also sometimes referred to as the “working” phase (especially in later
or reinterpreted models), when active work toward goals is underway (Canadian
Journal of Nursing Informatics | Promoting Nurses Work in Health Informatics in
Practice, Research, Leadership, and Education, 2022). Additionally, in this phase,
the patient is more confident, begins to express needs more clearly, and relies
less on the nurse for direction and more on self-initiative with the nurse’s support
(Bsn, 2024).

During the exploitation phase, the patient starts to get the most out of the
care and services offered by questioning, seeking resources, and taking an
active role in the interventions. In this phase, the nurse takes on an essential role
as facilitator and encourager, guiding and encouraging and progressively
transferring responsibility to the patient. Together, they define goals, modify care
plans, clarify expectations, and assess progress while resolving any difficulty
which might occur. Open and therapeutic communication is also crucial since the
nurse makes use of listening, feedback, teaching, and counseling to ensure the
patient derives the maximum benefit out of the relationship. The patient
continues to test boundaries or rely on the nurse for comfort, but with increasing
partnership, becomes more independent and self-assured, taking greater
responsibility for his or her own decisions and care.

As an example, consider a patient with chronic heart failure who is being

instructed on noticing symptoms, keeping a healthy diet, and tracking their weight.
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The patient consciously utilizes the nurse's teaching at the exploitation stage.
They learn through practice, inquire about sodium restrictions, ask for examples
of sample diets, and request return feedback on their practices (e.g., how to
weigh themselves daily). Another is wound care, where a postoperative patient
may request more complete instructions on changing dressings, request to have
them done, recommend changes, and take over more self-care with the nurse
checking instead of doing it all.

FACTORS AFFECTING THE EXPLOITATION PHASE

Based on Peplau's Interpersonal Relations Theory, the willingness and

capability of the patient to use the nurse's resources, the level of established trust,
and the presence of effective therapeutic communication all influence the
Exploitation stage. In addition, the nurse needs to employ therapeutic roles in
assisting the patient to become self-sufficient and achieve their objectives. This
stage also largely depends on the patient's level of anxiety and awareness of
their needs and the nurse's skill in helping them to explore and develop.

FACTORS ON THE PATIENT'S SIDE

1. Trust and a developed relationship: The patient should have developed or

established a trust relationship with the nurse, which had been built during the
Identification stage.

2. Readiness for change: The patient must be willing and receptive to

examining his or her feelings and constructing his or her new coping strategy.

3. Understanding and communication: The patient needs to be able to

express their needs and cooperate in problem-solving, which can make use of
the information and support provided by the nurse.

4. The anxiety levels: The level of anxiety of the patient has an impact and
influence on their participation in the relationship and their constructive
processing of their experiences.

FACTORS ON THE NURSES' SIDE

1. Role performance: The nurse has to successfully integrate the different

therapeutic roles, e.g., being a source person or technical specialist, able to give
certain information and bodily care.

2. Therapeutic communication: How well the nurse can apply therapeutic

communication skills to build a non-critical and helpful relationship is vital to
achievement.

3. Encouraging exploration: The nurse helps the patient explore their feelings
and reactions, enabling them to build a better self-concept and improved coping
ability.

4. Goal-directed approach: The nurse keeps an eye on the patient's goals to

enable them to fulfill their needs and lead them towards independence.

4. RESOLUTION (TERMINATION) PHASE

The resolution phase is the final stage in Peplau’s four-phase model, in

which the therapeutic relationship is terminated. The patient’s needs have been
or are close to being met, dependence on the nurse has decreased, and the
patient moves toward independent functioning (Peplau’s Theory of Interpersonal
Relations - Nursing Theory, 2023). In addition, it is sometimes called the
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“termination” or “disengagement” phase in other interpretations of Peplau’s

theory (Canadian Journal of Nursing Informatics | Promoting Nurses Work in
Health Informatics in Practice, Research, Leadership, and Education, 2022). The
resolution phase also implies a dissolution of the professional bond or when the
client is no longer in need of care and professional services: the patient “drifts
away” from identifying with the nurse as the helper, and more fully identifies with
self as the agent and as a mature individual (Bsn, 2024). It is emotionally and
professionally significant that both nurse and patient must manage endings,
feelings, losses, and transfer of responsibility (On The Shoulders of Giants: The
History of the Psychiatric Nurse as Therapist | Springer Publishing, 2019).

During the resolution stage, the objectives that were established previously
are checked to determine which ones were accomplished, which require
modification, and what is still pending. In this process, the patient slowly releases
dependency on the nurse, assuming complete autonomy in decision-making and
self-care, or delegating that function to other support systems. Any pending tasks,
like referrals, follow-up, or discharge planning, are attended to in order to provide
continuity of care. Meanwhile, the nurse accompanies the patient in working
through the feelings of ending the relationship, including sadness, anxiety, or
uncertainty, and enhancing confidence in being able to continue on their own.
Most importantly, the nurse withdraws and minimizes contact, as the patient goes
back to self-care or other arrangements. This professional and emotional
detachment is necessary to keep the relationship therapeutic and not become
open-ended or burdensome.

For instance, the nurse reduces session frequency gradually, and this
assists the client in preparing for relapse prevention, facilitates referrals to
community resources, and ends the professional relationship with a stabilized
mental health client who has learned coping skills and may no longer need
frequent sessions. Another is in the case of chronic disease management, the
intensive nurse coaching period concludes when a patient demonstrates
competence in self-management (e.g., managing hypertension); the nurse shifts
back to occasional check-ins, and the patient goes on independently.

FACTORS AFFECTING THE RESOLUTION PHASE

The resolution phase is affected by the patient's ability to disengage from the
nurse-patient relationship and accept new goals through a successful completion
of the previous phases (orientation, identification, and exploitation). Other factors
are the patient's own achievement of a healthier state of balance in affect,
understanding of the goals reached by both parties, and the nurse's ability to
facilitate this change by fostering the patient's independence and self-reliance.

FACTORS ON THE PATIENT'S SIDE

1. Independence and Self-Determination: The main objective of the resolution

phase is to provide the patient with his/her capacity to provide for their own
needs and solve their issues independently.

2. Accomplishment of Objectives: The needs of the patient have to be

effectively fulfilled through cooperation between the nurse and patient in the
previous phases.

3. Sense of Belonging: The patient will become confident and develop a sense
of belonging in the post-treatment setting, which will give them a positive outlook.

4. Decrease helplessness: As the patient becomes confident, this will reduce

helplessness and hopelessness.

FACTORS ON THE NURSES' SIDE

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1. Development of Independence: The nurse has to lead the patient towards

independence so that they can utilize resources and make decisions.

2. Handling the Termination: The nurse should enter into the termination
process, which may be difficult for both.

3. Avoidance of Dependence: The nurse should avoid the continuation of

psychological dependence so that the relationship moves from a therapeutic one
to a mutual professional bond.

METAPARADIGM
Person (Human Being) - The person is a “developing organism” striving to
reduce anxiety generated by unmet needs; not merely a passive recipient of care
but an active participant in the interpersonal process. Peplau views the person as
including physiological, social, and spiritual dimensions (i.e. multiple parts).
Health - is viewed as a forward movement of personality and development; the
patient moves toward self-understanding, coping, and maturity as part of the
therapeutic process.
Environment - The environment includes external forces outside the person
(social, cultural, relational) that influence the individual; interpersonal
relationships are embedded in that environment.
Nursing - is a therapeutic interpersonal process that functions cooperatively
with human processes to make health possible. The nurse’s role is not just
performing tasks but facilitating growth, helping with anxiety, interpreting
meanings, and guiding the patient through phases of the relationship.
ASSUMPTIONS
Hildegard Peplau's Interpersonal Relations Theory's assumptions are:
1. The nurse and the patient can interact.
2. Peplau emphasized that both the patient and nurse mature as the result of
the therapeutic interaction.
3. Communication and interviewing skills remain fundamental nursing tools.
And lastly,
4. Peplau believed that nurses must clearly understand themselves to
promote their client's growth and avoid limiting their choices to those that
nurses values.
5. The patient’s needs are central; the relationship is patient-oriented, not
nurse-oriented.
6. Anxiety is a motivating force, when patients have unmet needs, anxiety is
generated, and that motivates them to seek help. Nursing helps in
managing that anxiety.
7. The nurse’s role is multifaceted and shifts over time depending on patient
needs and the phase of relationship.
APPLICATION IN NURSING; GOAL
● To establish a therapeutic nurse-patient relationship that promotes
patient growth, self-understanding, and health.
● To guide nursing interventions based on where the nurse–patient dyad
is in the relationship phases.
● To help manage patient anxiety, unmet needs, and to facilitate coping
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● To encourage independence and self-reliance in the patient so that the

nurse can gradually withdraw and the patient can maintain progress
How It Is Applied in Practice
● Nurses assess where the patient is in the relationship phases and adopt
appropriate roles (e.g. teacher, counselor, surrogate, leader, resource) in
that phase.
● Communication strategies (verbal, nonverbal) are intentionally used to
elicit patient concerns, validate perceptions, and encourage expression of
feelings.
● Nurses interpret and validate patients’ statements (i.e. checking with
the patient whether the nurse’s inference is correct), this helps correct
misunderstandings, refine goals, and promote insight.
● Interventions may target anxiety reduction, coping skill development,
education, counseling, adjustment to illness, and planning for discharge.
● The nurse gradually reduces direct involvement as the patient becomes
more capable, culminating in termination when goals are met.
● So effectively, the goal is relational: to aid patient growth, reduce
distress, foster autonomy, and guide care through the phases of the
relationship.

IMPORTANCE

1. Encourages Patient-Centered Care

Peplau’s theory emphasizes that the patient is not just a passive recipient of care
but an active participant in the healing process. By focusing on the patient’s
unique needs, experiences, and goals, the nurse tailors interventions to fit the
individual rather than applying a one-size-fits-all approach. This creates a
therapeutic relationship where patients feel valued, respected, and understood,
ultimately improving trust and health outcomes.

2. Promotes Collaboration Between Nurse and Patient

The theory highlights that the nurse and patient work as partners in the care
process. The nurse provides professional knowledge, while the patient
contributes their lived experience of illness or health concerns. Through
communication, goal-setting, and mutual decision-making, both sides
collaborate to achieve better results. This partnership fosters a sense of
empowerment for the patient and strengthens the effectiveness of care.

3. Helps Patients Gain Self-Awareness, Independence, and Coping Skills

One of the goals of the interpersonal relationship is to help patients grow beyond
their current limitations. By guiding patients to explore their thoughts, emotions,
and behaviors, nurses support them in gaining greater self-understanding. This
process encourages independence by helping patients take control of their health
and equips them with coping strategies to handle stress, illness, and future
challenges.

4. Shapes Modern Nursing Practice, Particularly in Mental Health Care

Peplau’s theory laid the foundation for psychiatric and mental health nursing by
placing communication and relationships at the heart of care. Today, these
principles extend beyond psychiatry into all areas of nursing practice. The focus
on empathy, trust-building, and therapeutic interaction has influenced modern
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standards of care, making interpersonal skills just as important as clinical and

technical knowledge.

SUMMARY

Hildegard Peplau’s Theory of Interpersonal Relationships focuses on the

importance of the nurse-patient relationship as the foundation of nursing practice.
She believed that nursing is a therapeutic and interpersonal process that helps
individuals understand and overcome their health problems while promoting
personal growth and self-awareness. According to Peplau, the nurse and the
patient work together through four key phases—orientation, identification,
exploitation, and resolution—which guide the progression of their relationship
from initial contact to the patient’s recovery and independence. Throughout these
phases, the nurse may assume different roles such as a teacher, counselor,
leader, or resource person, depending on the patient’s needs. Peplau
emphasized that effective communication, empathy, and understanding are
essential for reducing a patient’s anxiety and fostering trust. Her theory
encourages patient-centered care by viewing the patient as an active participant
in their healing process rather than a passive recipient of treatment. Ultimately,
Peplau’s theory transformed nursing into a humanistic, collaborative, and growth-
oriented profession, laying the foundation for modern psychiatric and mental
health nursing.

Betty M. Neuman: Neuman's System Model

Betty M. Neuman
Born: September 11, 1924
Died: May 28, 2022

•She said that "Health is a condition in which all parts and sub-parts are in
harmony with the whole of the client"

• She is a nursing theorist, educator, community health nurse, and counselor.

She is best known for developing the Neuman Systems Model (NSM) in nursing.

· 1947 – RN diploma, Peoples Hospital School of Nursing, Akron, Ohio

· 1957 – Bachelor’s in Public Health & Psychology, UCLA

· 1966 – Master’s in Mental Health & Public Health Consultation

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· 1985 – PhD in Clinical Psychology, Pacific Western University

● Early career in California

·Staff nurse & head nurse, Los Angeles County General Hospital

·School nurse & industrial (occupational health) nurse

·Clinical instructor, University of Southern California Medical Center

● Leadership & program development

· Department chair, UCLA School of Nursing graduate program

· Developed first community mental health nursing program for graduate

students in Los Angeles

● Innovations in nursing

·1985 – Among the first to establish nurse counselor roles in community

crisis centers (with Donna Aquilina)

·Maintained private practice as marriage & family therapist, specializing in

Christian counseling

● Recognitions

· Fellowship, American Association of Marriage and Family Therapy

·Fellowship, American Academy of Nursing

● Legacy

·1988 – Founded Neuman Systems Model Trustees Group, Inc. to

preserve & promote her model

·Continued as consultant after stepping down from leadership in 2009

● Contributions

Betty Neuman first created the “Neuman Systems Model” as a teaching

tool in 1972, but it grew into a widely recognized nursing model worldwide
and was later expanded and published in book form.

● Famous Quotes by Betty Neuman

“The Neuman Systems Model fits well with the wholistic concept of
optimizing a dynamic yet stable interrelationship of spirit, mind, and body
of the client in a constantly changing environment and society.”

“Neuman’s work focuses on the wellness of the client system in relation to

environmental stressors and reactions to stressors … the goal of nursing
is to facilitate optimal wellness for the client through retention, attainment,
or maintenance of client system stability.”

● Other Relevant Information

Origin / Early Life: She grew up on a farm in rural Ohio. Being raised there
influenced her understanding of human-environment interaction.

● Why did she develop the model?

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During her time teaching, she saw a need for a framework that could help
nurses see the “whole person” rather than just disease, considering
stressors, prevention, and how people stabilize (or reconstitute) after
stress.

● Model impact

The Neuman Systems Model is used in education, in clinical settings, in

research, globally. It has been translated and used in many cultural
settings.

Neuman's Theoretical sources

1. General System Theory (von Bertalanffy) -Provided the idea of an
open system with input, process, output, and feedback.
2. Stress Theory (Hans Selye) - Influenced her focus on stressors and
the body's reaction to stress.
3. Gestalt Theory - Shaped her holistic view that the whole person is
more than the sum of parts.
4. De Chardin's Philosophy - Emphasized the idea of human beings in
constant interaction with the environment.
5. Caplan's Theory on Preventive Psychiatry -Inspired her focus on
three levels of prevention (primary, secondary, tertiary).

Neuman's " Systems Model"

Major Concepts and Definitions

● Purpose of the Model

The Neuman model shows the client as a whole person made up of many
parts, focusing on stress and how the person reacts to it. The client is
seen as an open system that always interacts with the environment
through input, process, output, and feedback.
● Wholistic Approach
The model sees the client as a total person with physical, mental, social,
developmental, and spiritual parts, all working together and always
affected by the environment.
● Open System
The client is an open system, which means there is a constant exchange
of energy, matter, and information with the environment. Stress and how
the person responds to it are part of this exchange.
● Input, Output, and Feedback
Input is what the client receives from the environment, such as energy and
information. Output is how the client responds, and feedback is the
information that helps the client adjust, change, or stay balanced.
● Negentropy and Stability
Negentropy is the process of saving energy to keep or improve order.
Stability means a balanced state that shows the client is healthy and well.
● Environment
The environment includes everything inside and outside the client that
affects them. It also includes the client’s own view of their world and what
makes them feel whole.
● Client System Variables
The client system has five parts: physical (body functions), psychological
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(thoughts and feelings), developmental (growth and life changes), social

and cultural (relationships and traditions), and spiritual (beliefs and values).
● Basic Structure and Lines of Defense
The client’s basic structure includes the core things needed for survival,
like natural abilities and inherited traits. This core is protected by three
defenses: the normal line of defense (usual state of health), the flexible
line of defense (a buffer that can expand or shrink depending on stress),
and the lines of resistance (internal defenses that work when stress
breaks through the normal defense).
● Health
Health is seen as a line between wellness and illness. Wellness happens
when the client’s needs are met and the system is balanced, while illness
happens when energy is lost and balance is disturbed.
● Stressors and Degree of Reaction
Stressors are things that disturb the client system and can come from
inside the person, from others, or from outside forces. The degree of
reaction is how much the client’s balance is disturbed when stressors
break through the defenses.
● Prevention as Intervention
Prevention is the main nursing action in the model and has three levels.
Primary prevention happens before stress to keep wellness and prevent
problems. Secondary prevention happens after stress shows, to lessen
the reaction and make defenses stronger. Tertiary prevention happens
after treatment, to keep stability, prevent relapse, and support recovery.
● Reconstitution
Reconstitution is the return to balance after stress. The person may go
back to the same level of health, a higher level, or a lower level than
before the stress.

I. Person Variables
Each layer of the concentric circle of the Neuman's model is made up of
five person variables, which are as follows:
1. Physiological Variable. Refers to the "physiochemical structure and
function of the body".
Examples:
a. Individual system. Circulation as reflected by vital signs, peripheral
pulses, heart sounds, skin color, skin temperature.
b. Community system. Reflected as vital statistics, morbidity, mortality,
and general environmental health (Hassel, 1998)
2. Psychological Variable. Refers to the "mental processes and emotions."
Examples:
a. Self-esteem and its effect on relationships for the individual and
communication patterns for a family.
3. Developmental Variable. Refers to those processes related to
development over the lifespan.
Examples:
a. "Empty Nest Syndrome" adjustment for aging parents as their children
move out of the home and establish their own families. This may be
manifested by: unhappiness with life and the lifestyle that may have
provided them with happiness for many years; boredom with people and
things that may have been of interest to them before; feeling a need for
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adventure and change; questioning the choices, they have made in their
lives and the validity of decisions they made; confusion about who they
are and where they are going;anger at their spouse and blame for feeling
tied down; unable to make decisions about where they want to go with
their life; doubt that they ever loved their spouse and blame for feeling tied
down; unable to make decisions about where they want to go with their
life;doubt that they ever loved their spouse and resentment over the
marriage; a desire or new and passionate, intimate relationship.
b. "Sandwich generation" among middle adults as they are caught
between the responsibilities of caring for dependent children and those of
caring for aging and ailing parents.
4. Sociocultural Variable. Refers to the relationships; and social and
cultural expectations and activities.
Examples: Ethnic cultural practices and health belief practices on:
a. Birthing
b. Food preferences in different regions of the country
c. Care of the dying and dead
5. Spiritual variable. Refers to the influence of spiritual beliefs.
Examples:
a. Anointing the sick or dying with oil,among Roman Catholics.
b. Avoiding scavenger fishes (shrimp, squids, crabs, fishes with no scales)
among Seventh Day Adventists.
c. Prohibiting blood transfusion among Jehovah's Witnesses.
II. Central Core
- The basic structure or central core is made up'of the basic "survival
factors".
- These factors include system variables, genetic features, and the
strengths and weaknesses of the system parts. Examples are hair color,
body temperature regulation ability, functioning of body systems
homeostatically, cognitive ability, physical-strength, and value systems.
- The person's system is an open sýstem and therefore is dynamic and
constantly changing and evolving. Stability or homeostasis occurs when
the amount of energy that is available exceeds that being used by the
system. A homeostatic body system is consistently in a dynamic process
of input, output, feedback, and compensation which leads to a state of
balance.
III. Flexible Line of Defense
The flexible line of defense is the outer barrier or cushion to the normal
line of defense, the line of resistance, and the core structure. If the flexible
line of defense fails to provide adequate protection to the normal life of
defense, the lines of resistance become activated. The flexible line of
defense acts as a cushion and is described as accordion-like as it
expands away from or contracts closer to the normal line of defense. The
flexible line of defense is dynamic and can be changed/altered in a
relatively short period of time.
IV. Normal Line of Defense
The normal line of defense represents system stability over time. It is
considered to be the usual level of stability in the system. The normal line
of defense can change over time in response to coping or responding to
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the environment. An example is the skin, which is stable and fairly

constant but can thicken into a callus over time.
V. Lines of Resistance
The lines of resistance protect the basic structure and become activated
when environmental stressors invade the normal line of defense.
Example: activation of the immune response after invasion of
microorganisms.
If the lines of resistance are effective, the system can reconstitute and if
the lines of resistance are not effective, the resulting energy loss can
result in death.
VI. Reconstitution
Is the increase in energy that occurs in relation to the degree of reaction to
the stressor. Reconstitution begins at any point following initiation of
treatment for invasion of stressors. Reconstitution may expand the normal
line of defense beyond its previous level, stabilize the system at a lower
level, or return it to the level that existed before the illness.
VII. Stressors
The Neuman Systems Model focuses on the impact of stressors on health
and addresses stress and the reduction of stress (in the form of stressors).
Stressors are capable of having either a positive or negative effect on the
client system. A stressor is any environmental force which can potentially
affect the stability of the system; they may be:
● Intrapersonal - occur within the person (e.g. emotions and feelings,
hypertension, low blood glucose)
● Interpersonal - occur between individuals (e.g. role expectations,
perceptions of caregiver, friend relationships)
● Extrapersonal - occur outside the individual (e.g. job or finance pressures)
VIII. Prevention
Neuman defines prevention as the primary nursing intervention.
Prevention focuses on keeping stressors and the stress response from
having a detrimental effect on the body.
- Primary Prevention. Occurs before the system reacts to a stressor. On
one hand, it strengthens the person (primarily the flexible line of defense)
to enable him to better deal with stressors, and on the other hand
manipulates the environment to reduce or weaken stressors. Primary
prevention includes health promotion and maintenance of wellness.
-Secondary Prevention. Occurs after the system reacts to a stressor and
is provided in terms of the existing system. Secondary prevention focuses
on preventing damage to the central core by strengthening the internal
lines of resistance and/or removing the stressor.
-Tertiary Prevention. Occurs after the system has been treated through
secondary energy to the strategies. Tertiary prevention offers support to
the client and attempts to add system or reduce energy needed in order to
facilitate re-constitutions.
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Use of
Empirical
Evidence
1. Theoretical Grounding and Initial Validation
Betty Neuman conceptualized her systems model from established
theories before nursing research formally began on the model (Neuman &
Fawcett, 2002). Neuman first evaluated the model by submitting a
research tool to graduate nursing students at the University of California,
Los Angeles. The results, published in Nursing Research, provided the
earliest empirical evidence of the model’s applicability in nursing education
and practice (Neuman & Young, 1972).
2. Clinical and Educational Applications
The NSM has since guided numerous clinical and academic studies. For
example, Fulbrook (1991) demonstrated its usefulness in structuring
nursing interventions in an intensive therapy unit, improving patient
assessment and care planning. In surgical nursing, Kabusi et al. (2024)
applied the model to guide the nursing process for a patient undergoing
Whipple surgery, illustrating how the model organizes data collection,
stressor identification, and intervention.
3. Middle-Range Theory Development
Contemporary research also adapts the NSM to more specific contexts.
Almino et al. (2024) developed a middle-range theory of occupational
stress among health personnel derived from Neuman’s constructs. This
adaptation empirically supports the model’s flexibility across occupational
health settings.
Similarly, Provencher (2025) refined the concept of reconstitution within
the NSM, showing that empirical and theoretical work continue to expand
the model’s scope.
4. Broader Research Evidence
Gigliotti (1999) tested the NSM’s concept of the flexible line of defense to
examine multiple-role stress in women who were both mothers and
students, confirming that NSM concepts can be operationalized
quantitatively. Memmott, Marett, Bott, and Duke (2000) documented
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successful interdisciplinary applications of the NSM, supporting its

reliability for guiding team-based practice and research.
5. Summary
From Neuman’s original validation with UCLA students to contemporary
middle-range adaptations, a substantial body of empirical evidence
supports the NSM. Research consistently confirms the model’s
effectiveness in assessing stressors, structuring prevention-focused
interventions, and maintaining client system stability across diverse
nursing contexts.
Neuman's major assumption
1. The client is an open system constantly interacting with internal,
external, and created environments.
2. The normal line of defense represents a client's usual wellness level
and stability.
3. Stressors are ever-present
intrapersonal, interpersonal, and extrapersonal stressors can disrupt
system stability.
4. Nursing's goal is stability - interventions aim to reduce stress and
strengthen defenses.
5. Health is a continuum - ranging from wellness (optimal stability) to
illness (instability).
6. Prevention is key - nursing interventions occur at three levels:
● Primary prevention: protecting the normal line of defense before
stress occurs.
● Secondary prevention: interventions after symptoms appear to
strengthen resistance.
● Tertiary prevention: helping re-adaptation and stability after
treatment or stress resolution.
7. Each person is unique - with distinct characteristics and responses to
[Link]'s Theoretical sources

Logical Forms

Neuman built her model using both deductive and inductive logic.
Deductive logic means she applied broad theories and principles to
nursing practice, while inductive logic means she relied on the actual
experiences and observations she had in her teaching and clinical work.
By combining these two approaches, her model became both grounded in
theory and practical in real-life situations.

Her system model was also influenced by different fields of study,

including general systems theory, stress theory, and nursing concepts.
This shows that her work was shaped by existing scientific knowledge,
which she then applied and adjusted to meet the needs of nursing.

Aside from theory, the model was also a product of Neuman’s personal
beliefs and her experiences with students and patients in mental health
nursing and counseling. These guided her in seeing how stress affects
people and how nurses can help protect or restore balance in their health.

The logic of the model follows this flow:

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1. The client is an open system that interacts with the environment.

2. Stressors from the environment influence the client system.
3. These stressors may penetrate the client’s lines of defense.
4. Once the defenses are affected, the client reacts and may
experience imbalance or illness.
5. Nursing interventions focus on preventing or reducing the effects of
stressors.
6. With proper care, the client can recover and return to a stable state
of health.

Neuman’s System Model connects theories, observations, and nursing

practice. It provides a logical explanation of how stress affects people and
how nurses can step in to keep or bring back wellness

Critique: Neuman’s Systems Model

Criticism plays a central role in the growth of the work of every theorist.
Chinn and Kramer (2023) explain that critiquing theories helps find gaps,
and making the theory itself stronger and improved. In this way, it ensures
that theories are not just taught or just reading it without practicing, but
also applied in hospitals, communities, and research (Alligood, 2022;
Fawcett, 2023).

● Clarity

The Neuman Systems Model is generally clear in its main ideas—client,

environment, stressors, and prevention. These are defined in ways that
both students and practicing nurses can grasp. In a hospital ward, a nurse
can distinguish between internal stressors like fear of surgery and external
stressors like excessive noise in the ICU, which helps in tailoring holistic
care.

● Simplicity

The Neuman Systems Model is considered partly simple because it

emphasizes prevention and patient stability, which are straightforward
goals. Its step-by-step approach—identifying stressors, using lines of
defense, and applying prevention levels—offers a clear process to follow.
However, the model also has areas of complexity. The multiple layers of
stressors (intrapersonal, interpersonal, extra personal), combined with
different lines of defense, can be overwhelming for new learners. This
complexity risks limiting its usability in urgent situations.

● Generality

Neuman’s Systems Model is not just limited in one situation—it is broad

and adaptable, making it applicable in many different nursing situations. It
is comprehensive, covering the physical, psychological, sociocultural,
developmental, and spiritual aspects, and is sufficient to guide the nurses
or other healthcare professionals in caring not only for individual patients
but for larger groups. This model allows nurses to use different ways on
how to care and asses the patients.

● Accessibility (Empirical Precision)

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Neuman’s Systems Model is not only theoretical but can also be tested in
real-world nursing practice. It has already been applied in many nursing
studies—this shows that the more the model is used by the researchers,
the more evidence emerges to support Neuman’s Systems Model’s
effectiveness. However, some researchers, such as Fawcett (2005) and
Alligood (2018), point out that the model is difficult to operationalize or put
into measurable variables, which makes empirical testing challenging.

Chapter’s Summary: Neuman’s “ Systems Model”

● Definition of the Model
The Neuman Systems Model is a wholistic, open systems framework that
views the client as a complete system in constant interaction with the
environment. The client system can be an individual, family, group,
community, or even a social issue, and it functions through continuous
processes of input, process, output, and feedback.

The model emphasizes that clients are made up of five interacting

variables—physiological, psychological, sociocultural, developmental, and
spiritual—which must all be considered in understanding health. These
variables constantly interact with both the internal and external
environment, and the stability of the client system depends on how well it
adapts to stressors that threaten balance.

Neuman’s model uses the concepts of lines of defense (flexible and

normal) and lines of resistance to illustrate how clients protect themselves
against stress and maintain wellness. Stress and the client’s reaction to
stress are seen as core components, and nursing interventions are
directed at preventing or reducing their negative effects.
● Goal of the Model
The primary goal of the Neuman Systems Model is to promote and
maintain the client’s stability and wellness. This is achieved by:
1. Identifying and managing stressors that may disrupt the system’s
balance.
2. Supporting the client’s defense mechanisms (flexible line, normal
line, and lines of resistance) so they can better withstand or adapt to
stress.
3. Promoting wholeness and optimal health by addressing all five
variables simultaneously—body, mind, culture, growth, and spirit.
4. Using prevention as intervention, applied at three levels:
● Primary prevention: stopping a stressor before it causes a
reaction.
● Secondary prevention: minimizing the reaction after symptoms
appear.
● Tertiary prevention: restoring stability and preventing recurrence
after treatment.
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Ultimately, the model’s purpose is to help clients achieve a dynamic state

of balance in which energy, information, and matter are used effectively to
maintain or regain wellness. Nurses apply the model to understand the
client holistically, anticipate potential stressors, and provide interventions
that lead to stability, energy conservation, and optimal functioning.
Application of Neuman’s System Model

Case History of Mr. Renato H.

Mr. Renato H. is an 86-year-old widower of two years from San Fernando,
Pampanga. He finished high school and served in the Armed Forces of
the Philippines until he retired at 65. He receives a monthly government
pension and holds PhilHealth insurance as a senior citizen (noted as
provided under the law during Pres. Duterte’s term). He attends a nearby
Catholic parish only occasionally and lives with a married daughter. His
health history includes chronic obstructive pulmonary disease (COPD),
gout, hypertension, and congestive heart failure. He smoked one pack a
day until he quit eight years ago after being diagnosed with COPD. In the
last two months he had three hospital admissions for severe breathing
problems. He generally dislikes taking medicines but does take a
prescribed antihypertensive and a diuretic, and he receives bronchodilator
nebulization from time to time for breathing difficulty.

He was recently admitted for severe shortness of breath and vague chest
pains that had lasted about ten hours; his daughter urged him to go to the
hospital. He was diagnosed with an acute COPD exacerbation and found
to have right-sided congestive heart failure, which explains the swelling in
both legs. He told Nurse Charles he has lost his appetite and has had
extreme difficulty swallowing for several months. He has lost weight and
looks weak and pale. He used to drive himself but has not been able to for
three years. He has had visits from his children and other relatives.

Chest X-ray showed an enlarged heart and pulmonary atelectasis with

infiltrates. His cardiac status is relatively stable. The physician ordered
arterial blood gas (ABG) analysis and other blood tests; labs showed a low
potassium level. Treatment ordered included oxygen therapy, medications
for COPD, and Ensure for nutrition. He refuses having any tubes placed in
his throat. He expressed a wish to see his sisters and expects to be
discharged in a few days. Since admission his shortness of breath has
greatly decreased and his oxygen saturation is stable. He also stated that
he does not want to die in the hospital.

Nursing Care of Mr. Renato H. with Betty Neuman’s Systems Model

● Model Components and Application to the Case History of Mr.

Renato H.:
1. Nurse–client relationship / assessment.
A cooperative partnership was formed during the initial and ongoing
assessments. The nurse prioritizes the physiological stressors to prevent
depletion of the patient’s energy, while also acknowledging psychological,
developmental, sociocultural, and spiritual stressors.

2. Physiological Stressors

● Intrapersonal: COPD, congestive heart failure (right-sided), hypertension,

dyspnea, leg edema, abnormal chest X-ray findings, new medications,
and difficulty swallowing.
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● Interpersonal: Reported loss of appetite and that food tastes “tasteless.”

● Extrapersonal: Situational stress from illness, current fears, concerns

about the future, and worries about discharge affecting his physiological
state.

3. Psychological Stressors

● Intrapersonal: Fear of tubes, fear of dying in the hospital, coping with

lifestyle changes, and a strong desire to go home.

● Interpersonal: Requests to see his sisters and possible

unresolved/grieving issues after his wife’s death.

● Extrapersonal: Stress from being physically separated from his usual

support system while hospitalized.

4. Developmental Stressors

● Intrapersonal: At 86 years old and a high school graduate, he needs

simple explanations about his condition and asks if he is going to die.

● Interpersonal: Widowed two years, with five married adult children, facing
ego integrity vs. despair issues.

● Extrapersonal: Potential loss of autonomy within relationships.

5. Sociocultural Stressors

● Intrapersonal: Former AFP serviceman (retired military).

● Interpersonal: Close, frequent interaction with his daughter who cares for
him.

● Extrapersonal: Reliant on a fixed government pension, covered by

PhilHealth, living in his daughter’s home, and unable to drive for three
years.

6. Spiritual Stressors

● Intrapersonal: Finds meaning in church membership and prayer.

● Interpersonal: Not active in the parish but wishes he could attend more
regularly; feels too weak.

● Extrapersonal: Uncertainty about life and death.

7. Affected Boundaries
Mr. Hipolito’s flexible and normal lines of defense have been breached
and his lines of resistance are activated. If preventive measures fail, the
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system could become imbalanced and lead to death. Therefore,

secondary interventions will be used to strengthen his lines of resistance,
and tertiary interventions will follow to rebuild his flexible line of defense.

Summary (Neuman Systems Model)

The Neuman Systems Model teaches an integrated approach to client

care and is grounded in General Systems Theory. It views the client as an
open system that reacts to stressors from the environment across five
variables: physiological, psychological, sociocultural, developmental, and
spiritual. The system has a core structure protected by lines of resistance;
the usual health level is the normal line of defense, itself guarded by a
flexible line of defense. Stressors,classified as intra-, inter-, and
extrapersonal—come from internal, external, and created environments.
When stressors penetrate the flexible line of defense, the system is
invaded and the lines of resistance activate, moving the client toward
illness on a wellness–illness continuum. If enough energy is available or
generated, the system can be reconstituted and the normal line of defense
restored at, below, or above its prior level. Nursing uses three prevention
modalities: primary (before invasion), secondary (after reaction to a
stressor), and tertiary (during reconstitution). The model is flexible and
applicable across nursing education, research, administration, and direct
patient care.

CECILIA “ CECILE” LAURENTE: THEORY OF NURSING PRACTICE AND

CAREER

Laurente’s Theory Of Nursing Practice and Career

● Biography

- Dr. Cecilia Laurente was born in the Philippines.

- She is a Filipino Nursing Theorist who primarily focused on helping
patients to have support systems such as their families.

➔ 1967- She graduated with a Bachelor of Science in Nursing at the

University of the Philippines.

➔ 1969- She worked as a staff nurse at the Philippine General

Hospital.

➔ 1970-1972: She worked as a head nurse at the Philippine General

Hospital

➔ 1973- She finished her master’s degree in nursing at the University

of the Philippines.

➔ 1973-1976—She worked as a nursing supervisor at the Philippine

General Hospital.

➔ She returned in 1976 and became an instructor at the University of

the Philippines College of Nursing.
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➔ 1987—She conducted a study entitled “Categorization of Nursing

Activities as Observed in Medical-Surgical Ward Units in Selected
Government and Private Hospitals in Manila.”

➔ 1996-2002- She served as the Dean of the College of Nursing in

UP Manila.

➔ She is named as 2002 J.V. Sotejo Medallion of Honor Recipient.

Significance of Cecilia Laurente’s Theory

- Laurente’s Theory of Nursing Practice and Career is needed because it
highlights the significance of care in nursing by means of presence, concern, and
stimulation. Based on her standpoint, a nurse's caring demeanor helps reduce
clients' anxiousness and nurture their mental well-being. By increasing empathy
and communication, it also improves the nurse-patient interaction

-Laurente's argument provides a framework grounded in Filipino culture that

takes into account hospital environments and local values. Nurses are guided
towards offering clients comprehensive care that takes into account their physical
and emotional requirements. Finally, her concept correlates caring behaviors to
career advancement and high-quality hospital treatment, thereby contributing to
nurses' professional development.
● Nursing Theory and Theory of Nursing Practice and Career

The theory came from Laurente's study that was conducted from January
to June year 1987, "The Categorization of Nursing Activities as Observed
in Medical-Surgical Ward Units in selected Government and Private
Hospitals in Metro Manila"
The guide's research revealed that when hospitals fail to address the
issues that patients believe are most essential, communication gaps can
arise between patients and caregivers. According to her approach,
involving patients and their families in their care requires effective
communication.
Based on Laurente's recent research, nurses can play a significant role in
preventing major issues before they arise, and families can also be a
source of support for patients. Through appropriate communication and
the use of behavioral, cognitive-behavioral, psychotherapeutic,
informational, modeling, and/or hypnotic techniques, nurses can
significantly assist families in strengthening their knowledge, abilities, and
attitude.

The core idea of Cecilia Laurente's paper is to assist patients by means of

their support network, particularly their family.

● Concepts of the Theory

Laurente believed that what nurses do and how they act can really affect
how anxious or worried a patient feels.
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Cecilia Laurente is known in nursing for her Theory of Nursing Practice. In

this theory, she explained that communication is very important and that
the family can be used as a starting point to help patients.

She believed that good communication helps nurses connect better with
patients and their families so that they can work together in the care and
healing process.

Anxiety – described as a feeling of fear, nervousness, or worry about

something that might happen, which many patients feel when they are sick.

Predisposing factors are things that influence a person’s behavior before

it even happens. These factors can make someone more motivated or
less motivated to act. Examples are age, experiences, education, or
beliefs.

Laurente’s theory reminds us that nursing is not just about giving medicine
or treatment. It is also about being present, talking to patients, supporting
families, and helping reduce their worries through caring actions.

Hospital-base
This framework demonstrates the way hospital nurses tend to clients, in
particular on medical-surgical wards.
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Laurente emphasized on the ways that a nurse's compassionate actions may

influence a patient's mental state, especially when it comes to hospital
anxiousness.

Nurses Caring Behavior That Affects Patient Anxiety

Enhancing factors

Cecilia Laurente's work on nurses' caring behaviors emphasizes how specific

actions and attitudes of nurses can significantly reduce patient anxiety.

Three Nurse Caring Behavior:

1. Presence
-Person to person contact between the client and the nurse which reassures the
patients, making them feel supported

-For example, Sarah, anxious after surgery, is in her hospital bed. The nurse sits
beside her, listens to her worries, and reassures her, “You’re safe; I’m here to
help.” This presence helps Sarah relax and reduces her anxiety

2. Concern
- The development in time through mutual trust between the nurse and patient.

-Eventually, we are able to provide our patients with care regardless of how
many days they spend in the ward. Therefore, via mutual trust between the
nurses and the patients, this concern is now developing over time.

3. Stimulation
-Nurse’s stimulation through the utilization of words that helps more than the
powerful resources of energy of a person for healing.

-It usually gives strength to the patients or clients. Particularly if we tell or

encourage them to be strong and resilient for them to look forward so that they
can improve and reach their goal to be discharged in the hospital.

Enhancing Factors

-One’s caring experience, beliefs, and attitudes

-Feeling good about your work
-Learning caring at school
-What other patients tell about the nurse
-Coping mechanisms to problems encountered
-Communication

Predisposing Factors
-Age -Educational Background
-Sex -Length of Work
-Civil Status -Experience
Metaparadigm
Person
- Every person develops anxiety, and it must be reduced with the help of
healthcare providers. Therefore, a nurse's caring behavior is significant to patient
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care.

-Laurente characterized the person as an “individual who requires nursing care

and is frequently reliant on the nurse,” particularly in a hospital environment. In
order to maintain or restore health while in the hospital, the client needs help with
basic necessities (Laurente, 1983)
Environment
- Hospitals are where patients are being treated, Therefore, Hospitals must
increase their efficiency.
-As defined by Laurente, the hospital environment encompasses not only the
actual resources and facilities but also: the laws, regulations, and organizational
frameworks affecting nursing practice. Social interactions and the medical staff
are additionally important, as they have an impact on client outcomes. Effective
care is facilitated by a supportive and well-organized atmosphere, whereas a
disordered one may impair nursing performance and recovery. (Alligood, 2004;
Gonzalo, 2021; Laurente, 1983)
Health
- Anxiety is one of the factors that could affect one’s health, it must be minimized
or eliminated.
-The extent of a patient's independence or dependency on nursing care—the
amount of nursing support needed to restore or maintain an optimal level of
functioning depends on the patient's health (Alligood, 2014; Laurente, 1983)
Anxiety
-Anxiety implies a disturbance in stability and comfort in the healthcare
environment. It indicates a circumstance when the client’s well-being becomes
compromised, requiring nursing intervention to establish equilibrium and to
uphold well-being. (Laurente, 1983)
Nursing
- Practicing “nursing” will lead to more effective services of hospitals.
-Laurente defines nursing as “a professional service”—which concentrates on
fulfilling the demands of hospitalized patients and ensuring recovery. It is carried
by means of fostering, nurturing, and fulfilling duties, as governed by institutional
regulations and professional standards (Alligood & Tomey, 2006; Laurente,
1983).

The Major Concepts and Definition in Cecilia Laurente’s Theory

A. Nursing: The compassionate field of nursing is dedicated to easing patients'

discomfort and lowering their worry.

B. Nurse: Primary care provider; patient outcomes are influenced by their

demeanor, background, and communication.

C. Patient: A person receiving care who could experience worry or terror while in
the hospital.

D. Predisposing Factors: characteristics that existed prior to care (e.g., age,

sex, education, experience).

E. Enhancing factors: characteristics (such as attitude, belief, satisfaction, and

communication) that lead to better care.
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F. Caring Behaviors: Core theory of caring behaviors.

G. Presence: Being physically and emotionally accessible to the patient

H. Concern: demonstrating sincere understanding, trust, and empathy.

I. Stimulation: the process of promoting healing and happy feelings by words or

deeds.

J. Communication: Fosters mutual respect and understanding between the

patient and the nurse.
K. Result: A decrease in anxiety and an increase in emotional comfort.
● Application to Nursing

Laurente’s Theory of Nursing Practice and Career explains that good nursing
care comes from caring actions like being present, showing concern, and
giving encouragement. These actions help lessen a patient’s worries and
support their healing (Prezi, n.d.). The presentation also says that some factors,
like a nurse’s age, education, and experience, as well as their beliefs,
attitudes, and past caring experiences, affect how they care for patients (Prezi,
n.d.). It also points out that the family plays an important role in patient care,
since nurses can guide them through communication, teaching, and example to
give better support and prevent problems (Prezi, n.d.). This theory reminds
nurses to always show care, involve the family, and keep learning and improving
in their careers.
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Synchronicity in Human Space Time: A Theory of Nursing Engagement in a

Global Community

THEORIST INVOLVED: Freslyn Lim-Saco, Cliford Masayon Kilat, and

Rozzano C. Locsin.

Freslyn Lim-Saco

● Assistant Professor at the College of Nursing, Silliman University.

● Education: holds a PhD in Nursing and a Master’s in Nursing
Administration.
● Research/home interests include: caring for COVID-19 patients;
simulation in nursing education; nursing informatics; end-of-life care. Her
dissertation is about the meaning of nurse-caring for persons supported by
technologies near end-of-life.
● Early life / personal: grew up in La Libertad (northern area), educated
throughout in Silliman University (elementary through college). Her father
worked at the SU Bookstore. She was active in leadership and service
even in high school (Cadet Army Training, jail fellowships).

Clifford Masayon Kilat

● A faculty member in the College of Nursing & Research Associate at St.

Paul University Dumaguete.
● Currently a PhD Nursing candidate at Silliman University.
● Involved in the publication of “Synchronicity in Human-Space-Time: A
Theory of Nursing Engagement in a Global Community.”
● Holds memberships in Sigma Theta Tau International Honor Society of
Nursing, Beta Nu Delta Nursing Society, International Association of
Human Caring.
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● Also active professionally: serves as President of the Philippine Nurses

Association, Siquijor Chapter.

Rozzano C. Locsin

● Born in 1954, in Dumaguete City, Philippines.

● BSN and MA in Nursing from Silliman University (1976, 1978). PhD in
Nursing from University of the Philippines (1988).
● Professor Emeritus at Florida Atlantic University and has had
professorial roles at Tokushima University(Japan). Also visiting/adjunct
roles in Thailand, Uganda, and the Philippines.
● Known for developing the theory Technological Competency as Caring in
Nursing. Author/co-editor of several books relating to the intersection of
technology, caring, and human experiences in nursing.

SHORT DESCRIPTION ABOUT THE THEORY: The Synchronicity in Human–

Space–Time Theory of Nursing explains nursing engagement as a dynamic
process involving interpersonal relationships, use of technology, rhythmic
connections, and transformational interactions. It emphasizes the integration of
caring and technology within nursing, highlighting the wholeness of the person
rather than fragmented care. This theory supports a human-centered, holistic,
and evolving approach to nursing that goes beyond routine practices to promote
meaningful caring experiences.
about the theor
METAPARADIGM

PERSON- An integral being within the natural world, able to self-organize and
adapt to changes. They actively engage in transformational processes and exist
in constant unity with the environment within a pandimensional universe.
HEALTH - Synchronizing with the current space and time leads to synchronic
health, allowing a person to experience wholeness and find meaning even in
illness. This is supported by a dynamic environment, whether internal or external,
that promotes healing and wholeness.
NURSING - Defined as developing, healing, and sustaining the well-being of
humans and as responding to the wholeness of human experience (Crawling,
2000).
ENVIRONMENT -.A healing environment can also be internal, meaning inside of
the human body the environment can also be external. This external environment
is called space. This space must be a healing environment that is conducive for
wholeness.
FRAMEWORK

ASSUMPTIONS
● Person are indivisible beings and always connected with their environment.
They cannot be reduced into parts but must be understood as a whole.
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● Human and environmental fields are inseparable, continuously influencing

and shaping each other through constant interaction.
● Human existence goes beyond space and time, existing in a
pandimensional reality that transcends physical and temporal boundaries.
● Encounters between nursing and person are guided by synchronicity,
meaning they occur purposefully and hold deeper significance within
human-environment connection.
● Nursing focuses on knowing persons as a whole, recognizing their
uniqueness, values ,and lived experiences rather than focusing only on
illnesses.
● Caring is universal and transcends culture, time, and place , serving as
the core of nursing that unites all people across the world.
● Nursing engagement extends to the global community, emphasizing that
nurses are interconnected with others worldwide through caring
relationships and shared humanity.
APPLICATION TO PRACTICE ( REAL-LIFE EXPERIENCE)
● Caring for the Whole Person: In nursing, synchronicity means truly seeing
each person as more than their illness. For example, when caring for a
patient with cancer, a nurse not only gives medications but also nurses
listens, comfort, and helps the patients that could give them strength and
peace within their situation.
● Connecting with the Global Community: Nurses extend their care to the
wider world by joining health missions, outreach programs, and online
communities that promote wellness and humanity. Through these acts,
they help build a healthier and more connected global society.
● Caring beyond borders: Synchronicity also reminds nurses that caring is
universal. Whether at home or in another country, nurses connect through
compassion, showing that empathy and understanding go beyond culture,
language, and distance.
● Creating a Healing Space: Healing happens best in an environment filled
with care and calm. Nurses help create this by offering gentle reassurance,
maintaining cleanliness, and fostering a peaceful atmosphere where
patients feel safe, valued, and understood.

STRENGTH
● Holistic foundation: strongly advocates for viewing the person as an
indivisible whole, countering reductionist healthcare practices.
● Integrated technology & caring: it modernly reconciles technology with
humanistic care.
● Global & equitable perspective: its principles of interconnectivity and
equitability provide a base for global health in nursing.
LIMITATIONS
● Highly abstract: concepts like pan-dimensional reality and synchronicity
are philosophical but offer little practical guidance beside for bedside care.
● Difficult to test: the metaphysical aspect of the theory makes it almost
impossible to measure or validate through scientific research.
● Risk of misinterpreting: Its abstraction can lead to inconsistent
application.
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CONCLUSION
The Synchronicity in Human Space Time: A Theory of Nursing Engagement in a
Global Community was developed by Freslyn Lim-Saco, Cliford Masayon Kilat,
and Rozzano C. Locsin. Each theorist contributed their own expertise: Lim-Saco
focused on caring, nursing education, and the experience of patients supported
by technology; Kilat emphasized professional practice, research, and global
connections in nursing; and Locsin, known for the theory of Technological
Competency as Caring in Nursing, brought in the balance of caring and
technology.
Together, they shaped a theory that reminds us nursing is more than medical
procedures—it is about caring for the whole person in harmony with their
environment and with others across the world. It highlights that health comes
from balance in space and time, and that caring is universal, connecting nurses
globally. While some ideas are abstract, its main strength is showing how nurses
can blend technology and compassion, create healing spaces, and honor each
patient’s dignity and uniqueness. In the end, this theory reinforces that the true
heart of nursing is caring for people as whole beings within a global community.

Benner Benner’s Stages OF Nursing Expertise Nursing Philosophies

________________________________________________________________
Origin and Background of the CARING, CLINICAL WISDOM, and ETHICS in
NURSING PRACTICE by Patricia Benner
Benner studies clinical nursing practice in an attempt to discover and
describe the knowledge embedded in nursing practice. Knowledge accrues over
time in a particular discipline and is developed through experiential learning and
situated thinking and reflection on practice in particular practice situations.
Benner acknowledges that her thinking in nursing has been influenced greatly by
Virgina Henderson.
She built her theory upon the Dreyfus Model of Skill acquisition to describe
how nurses develop expertise through distinct stages: Novice, Advanced
Beginner, Competent, Proficient, and Expert. The "From Novice to Expert”
model emphasises that practical experiences, not just theoretical knowledge,
foster this progression. This framework highlights the crucial role of
experience and caring in developing clinical judgement , and how this
knowledge shapes ethical practice within the nurse-patient relationship. Her
approach is rooted in philosophical ideas, particularly those who differentiated
between “ knowing that” (theoretical knowledge) and “ knowing how” (practical,
embodied knowledge), or tacit knowledge.
________________________________________________________________
Background of theorist

Born: August 1, 1942

Place of Birth: Hampton, Virginia
Education: Benner earned her PhD from the University of California,
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Berkeley, and has had a significant impact on nursing

education as a faculty member at the University of California,
San Francisco.
Significance: Considered a leading authority in nursing theory, Patricia
Benner, an educator and researcher, has authored several
books on the subject such as “From Novice to Expert”,
published in 1948 and co-authored “The Primary of Caring”
in 1989.
________________________________________________________________
Metaparadigm: Person

“Self-interpreting being, that is, the person does not come into the world
predefined but gets defined in the course of living a life.”
Benner stated that a "self-interpreting being, that is, the person does not
come into the world predefined but gets defined in the course of living a life. A
person also has... an effortless and non-reflective understanding of the self in the
world. The person is viewed as a participant in common meanings." (Tomey,
2002).
Benner believed that there are significant aspects that make up a person.
She had conceptualized the major aspects of understanding that the person must
deal as:
1. The role of the situation
2. The role of the body.
3. The role of personal concerns.
4. The role of temporarily.
________________________________________________________________
Metaparadigm: Health
Experience of living, being healthy, and being ill.

Defied as what can be assessed, whereas well-being is the human experience of

health or wholeness.
________________________________________________________________
Metaparadigm: Environment
Benner uses the term situation rather than environment.
“Personal interpretation of the situation is bounded by the way the individual is in
it.”
- A person’s past, present, and future influences their current situation.
- She used the phenomenological terms of being situated and situated,
which are defined by the person’s engaged interaction, interpretation, and
understanding of the situation.
________________________________________________________________
Metaparadigm: Nursing
The actions, roles, and responsibilities of the nurse to care for patients.
- A caring relationship, an ‘enabling condition of connection and concern’.
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- “Caring is primarily because caring sets up the possibility of giving help

and receiving help.”
- “Nursing is viewed as a caring practice whose science is guided by the
moral art and ethics of responsibility.”
_____________________________________________________________
Stages of Nursing Expertise (Novice to Expert Model)

The model is situation-based and is not trait-based. The level of

performance is not an individual characteristic of an individual performer, but
instead is a function of a given nurse; Familiarity with a

p articular
situation in combination with their educational background.

Novice
● The person has no background experience of the situation in which he is
involved.
● Contest-free rules and objective attributes must be given to guide
performance.
● This level applies to students of nursing.

Advanced Beginner
● A person can demonstrate marginally acceptable performance, having
coped with enough real situations to note.
● Has enough experience to grasp aspects of the situation.
● They require experience based on recognition in the contest of the
situation.
● Nurses functioning at this level are guided by rules and are oriented by
task completion.
● They have difficulty grasping the current patient situation in terms of larger
perspectives.
● Feel highly responsible for managing patient care, yet they still rely on the
help of those who are most experienced.
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Component
● Considerable conscious and deliberate planning that determines which
aspects of current and future situations are important and which can be
ignored.
● Consistency, predictability, and time management.
● A sense of mastery is acquired through planning and predictability.
● Level of efficiency is increased.
● Devises new rules and reasoning procedures for a plan, while applying
learned rules for action on the basis of relevant facts of that situation.

Proficient
● Performers perceive the situation as a whole (the total picture) rather than
in terms of aspects, and the performance is guided by maxims.
● Demonstrate a new ability to see changing relevance in a situation,
including recognition and implementation of skilled responses to the
situation as it evolves.
● Increased confidence in their knowledge and abilities.

Expert
● The expert performer no longer relies on analytical principal *i.e., rule,
guideline, maxim) to connect an understanding of the situation to an
appropriate action.
● Demonstrating a clinical grasp and resource-based practice.
● Possessing embodied know-how.
● See the big picture.
● Thinks and sees the unexpected.

Significance of the Theory

● The theory changed the profession’s understanding of what it means to be
an expert, placing this designation not on the nurse with the most highly
paid or most prestigious position, but on the nurse who provided the most
exquisite nursing care.
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KATIE ERIKSSON: CARATIVE CARING THEORY

THEORY AND THEORIST:

Background of Katie Eriksson:
- Katie Eriksson (1943–2019) was a Finland-Swedish nurse, educator, and
theorist who made significant contributions to the field of caring science.
She completed her nursing education in 1965 and later became a nursing
instructor at the Helsinki Swedish Medical Institute. Eriksson went on to
work as a professor of health sciences at Åbo Akademi University in
Vaasa, where she established a master’s degree program in health
sciences and developed a four-year postgraduate program leading to a
doctoral degree in health sciences.

Who is Katie Eriksson?

- Katie Eriksson was one of the first nursing theorists in the Nordic countries
to focus on the science of care. Beginning her work in the 1970s, she
developed a systematic framework for studying care, laying the foundation
for caring science as a distinct academic discipline. She also promoted
international cooperation in research and education related to care.

What is Katie Eriksson Known For?

● Theory of Caritative Caring – Eriksson is best known for this theory, which
emphasizes that caring is based on caritas (love, charity, and respect for
human dignity).
● She distinguished between caring ethics (the practical relationship
between patient and nurse) and nursing ethics(ethical principles guiding
nurses’ decisions).
● Her model views caring as a natural human activity, characterized by
tending (love and warmth), playing(creativity and expression), and
learning (growth and development).
● She argued that lack of genuine caritative care leads to suffering and
violates human dignity.
● She contributed to establishing caring science as a scientific discipline in
the Nordic countries and beyond.

The caritative caring theory, the substance and core of caring is described as 'to
care is to tend, play and learn in faith, hope and love'. The starting point is love,
mercy, human kindness, compassion and a caring relationship. Caring is healing
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and sharing-a will to care, which is founded in faith and life energy. Caring
promotes humanity and people's health, and thus a feeling of wholeness,
integration, growth and inner freedom. The goal is to promote and protect health
and life and alleviate suffering. Health means wholeness and holiness. Katie
Eriksson's theory of caritative caring ethics and the theory of evidence, are
described. Both theories are anchored in caritas, that is love, mercy and
compassion. The theory of caritative caring ethics was first described by Eriksson
in 1995, where seven assumptions or basic categories were elaborated. These
were: the human being's dignity, the care relationship, invitation, responsibility,
virtue, obligation or duty, and good and evil.

METAPARADIGM
Person:
- The patient is viewed as a unique and dignified individual with intrinsic
value. Nursing care goes beyond mere treatment, focusing on recognizing
and addressing the patient's suffering with empathy and compassion. The
approach to care is holistic, considering the physical, psychological, and
spiritual dimensions of the patient, all of which are interconnected and
essential to the patient's overall well-being.
Health:
- Katie Eriksson defines health as wholeness and holiness, where the body,
mind, and spirit form an inseparable whole. Health is not only the absence
of illness but also the experience of completeness, vitality, and life energy.
It involves a balance of being, becoming, and doing and is closely linked
to caring, which promotes well-being and reduces suffering. Suffering is
considered part of health because it can foster growth, inner strength, and
a deeper understanding of life.
Environment:
- The environment includes both positive and negative circumstances that
impact a patient's well-being. These encompass the patient's larger
psychological, social, and spiritual contexts in addition to their physical
surroundings, which include friends, family, and medical facilities.
Moreover, according to this theory, nursing is a kind and moral profession
that works to relieve suffering and encourage holistic healing, and the
environment is crucial to a patient's general well-being and recovery.
Nursing:
- The metaparadigm concept of nursing is anchored in caritas, that is love,
mercy, and compassion. Nursing is not merely about a set of clinical tasks
but an act of caritas that promotes caring that focuses on the patient’s
world. This emphasizes taking care of other people with compassion,
ethical practices aimed at alleviating suffering and promoting well-being
rooted in the patient's physical, psychological, social, and spiritual aspects.
- Eriksson claims that having diverse scientific views of evidence is
necessary and vital for caring focused on the patient's world. Therefore,
Eriksson distinguishes caring and nursing ethics, between inner and
external ethics, and between natural and clinical ethics. Nursing ethics
concentrates on professional responsibilities guided by ethical codes and
principles while caring ethics prioritizes empathy, compassion, and
interpersonal relationships in care. Then, while external ethics refers to
institutional regulations and professional standards, inner ethics refers to a
nurse's own moral compass and integrity. Finally, clinical ethics uses
structured ethical frameworks to address complex moral issues in
healthcare, whereas natural ethics is founded on universal human values
like kindness and justice.
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MAJOR CONCEPTS
Person:
- The person is seen as a whole made up of body, soul, and spirit. Each
part is important and connected. The theory teaches that every person
has dignity just by being human, and that caring should respect this.
Caring is not only about treating illness but also about showing kindness,
presence, and respect to support the person fully.
Health:
- Health, according to Eriksson, is more than just the absence of illness; it is
a state of wholeness and well-being that includes physical, mental, and
spiritual health. True health involves achieving balance and harmony
within the individual and with their environment. Caritative caring, which is
based on selfless love and respect for the patient's dignity, plays a crucial
role in promoting this holistic sense of health.
Environment:
- Environment in the Caritative Caring Theory (CCT), influences the state
an individual can be in. A clean, quiet and safe environment allows for
peace of mind which can improve the process of healing and promote a
welcoming feeling that provides the opportunity for a person to openly
express themselves as it is in the nature of a person to act upon their
emotions and engage in activities that satisfies their desires. Eriksson’s
theory places caritas (love, mercy and compassion) as the foundation of
the environment around a person, it acts not only as a physical space but
a loving and caring atmosphere that supports dignity, alleviates suffering,
and promotes true healing.
Nursing:
- Nursing is characterized as a vocation in ethical responsibility. The nurse
is called to enter into a caring communion, to act in a way that alleviates
suffering, and to uphold the absolute dignity of the human being. Nursing
is therefore both a professional and an ethical act, where practice is
directed toward safeguarding the intrinsic value of the human being and
promoting wholeness through caritative and ethically grounded care.
CARITAS
Caritas means love and charity, symbolizing unconditional love that unites eros
and agape. It is the core of caring science and serves as the guiding motive for
all acts of caring. Through caritas, nurses express faith, hope, and love by
tending to patients with compassion and respect.
CARING COMMUNION
Caring communion refers to the deep and genuine connection formed between
the nurse and the patient. It is characterized by trust, respect, honesty, and
presence. This relationship gives meaning to caring and becomes a vital source
of comfort, healing, and strength for both individuals.
THE ACT OF CARING
The act of caring involves elements such as faith, hope, love, tending, playing,
and learning. It goes beyond performing duties—it is the art of turning simple
actions into meaningful and healing experiences that strengthen the nurse–
patient bond.
CARITATIVE CARING ETHICS
Caritative ethics is based on caritas or love as the moral foundation of care. It
emphasizes the ethical relationship between the nurse and the patient, focusing
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on compassion, respect, and the affirmation of human dignity. It differs from

nursing ethics, which focuses mainly on professional duties and rules.
DIGNITY
Dignity is a fundamental concept that affirms each person’s worth and
uniqueness. It includes absolute dignity, which every human possesses
inherently, and relative dignity, shaped by culture and life experiences.
Respecting both forms of dignity is essential in ethical and compassionate care.

INVITATION
Invitation refers to welcoming the patient into a caring relationship that offers
safety, trust, and acceptance. It represents genuine hospitality, where the patient
feels valued, respected, and free to express their needs without fear or judgment.
SUFFERING
Suffering is a human experience involving the struggle between good and evil,
loss and healing. It is not only physical pain but also emotional and spiritual
distress. Through reconciliation, suffering can lead to personal growth, renewal,
and wholeness.
SUFFERING RELATED TO ILLNESS, CARE, AND LIFE
 Eriksson identifies three types of suffering:
 Illness-related suffering: caused by disease or medical treatment.
 Care-related suffering: caused by neglect, lack of respect, or poor care.
 Life-related suffering: arises from personal, emotional, or existential struggles.

THE SUFFERING HUMAN BEING

The patient is viewed as a suffering human being—a person who endures pain
and seeks healing not only physically but also emotionally and spiritually. This
view reminds nurses to provide care that honors the person’s whole being.
RECONCILIATION
Reconciliation is the process of finding peace and meaning in one’s suffering. It
allows a person to accept pain, rebuild wholeness, and move forward with
understanding and hope. Achieving reconciliation leads to inner balance and
acceptance.
CARING CULTURE
Caring culture refers to the shared values, traditions, and attitudes that shape the
caring environment. It promotes respect, compassion, and cooperation, creating
a space where both patients and caregivers feel safe, valued, and supported.
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IMOGENE KING: GENERAL SYSTEMS FRAMEWORK NURSING

CONCEPTUAL MODEL

Imogene King
- Born on January 30, 1932 in West Point, Iowa
- Died on December 24, 2007
- Education
● 1945: Nursing diploma from Saint John’s Hospital School of Nursing, St.
Louis, Missouri
● 1948: Bachelors in Science in Nursing, St. Louis University
● 1957: Master in Science in Nursing, St. Louis University
● 1961: Doctoral of Education Degree from Teacher's College, Columbia
University in New York City
- Career
● 1961-1966: Associate director at Loyola University in Chicago
● 1966-1968: Assistant Chief of the Research Grants Branch of the Division
of Nursing in Washington, D.C
● 1968-1973: Director of the Ohio State University School of Nursing
● 1971-1980: Professor at Loyola University in Chicago

History
● 1971: King proposed a conceptual system for nursing around four
concepts she considered universal to the discipline of nursing: social
systems, health, perception, and interpersonal relationships.
● 1981: King presented a more formalized conceptual system of personal,
interpersonal, and social systems, and the Theory of Goal Attainment
● 1990s: The concepts of learning and coping were added; the concept of
space was redefined as personal space; and the concept of stress was
expanded to include stressors

Metaparadigm in Nursing:
● Nursing
- Refers to an observable behavior found in the health care systems in
society
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- A goal-seeking system where the performance of roles and responsibilities

assists human beings to attain, maintain, and restore health
● Person
- An individual has the ability to perceive, think, feel, choose, set goals,
select means to achieve such goals, and to make decisions
- Open, social beings who are unique, rational, sentient, and capable of
making decisions

● Health
- A dynamic state in the life cycle, whereas illness interferes with the
process
- Calls for the continuous adjustment to stressors in the internal and
external environments causing the optimum use of one’s resources to
achieve maximum potential for daily living
● Environment
- It is the background for human interactions
-
Conceptual System and Middle-Range Theory of Goal Attainment Theory
- Introduced in the 1960s, emphasizes that nurses and patients work
together by sharing information, setting goals, and taking actions to
achieve them.
- Goal attainment is influenced by roles, stress, space, and time. The
nurse’s main role is to help patients maintain health so they can function in
their roles, using the nursing process: Interpreting, planning, implementing,
and evaluating care.
- King defines patients as social beings with three basic needs: Health
information, illness prevention, and care when unable to help themselves.
- It emphasizes human interactions within three systems → personal,
interpersonal, and social, which serve as the foundation for her Theory of
Goal Attainment.

Assumptions
- Nursing focus is the care of human beings
- Nursing goals are the health care of individuals and groups
- Human beings are open systems interacting constantly within their
environment
- Nurse and client communicate information, set goals mutually, and then
act to attain these goals; is also the basic assumption of the nursing
process
- “Each human being perceives the world as a total person in making
transactions with individuals and things in the environment.”
- “Transaction represents a life situation in which the perceiver and the
object perceived are encountered and in which person enters the situation
as an active participant and is changed in the process of these
experiences.”
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Propositions of King's Theory

1. If perceptual interaction accuracy is present in nurse-client interactions,
transactions will occur.
2. If the nurse and client make a transaction, the goal will be attained.
3. If the goal is attained, satisfaction will occur in both nurse and patient.
4. If transactions are made in nurse-care interactions, growth and
development will be enhanced.
5. If role expectations and clients are congruent, transactions will occur.
6. If role conflict is experienced by either the nurse, client, or both, stress in
nurse-client interaction will occur.
7. If nurses with social knowledge and skills communicate 1aPappropriate
information to the client, mutual goal setting and goal attainment will occur.
8. If goal attainment is achieved, there is decreased anxiety in nursing
situations.

3 Interacting Systems:

Personal System

- made up of individuals and include the client and nurse functioning as a

total system

Seven Dimensions:

● Perception – process of interpreting information from the environment

and one’s senses; gives meaning to one’s experience, represents one’s
image of reality, and influences one’s behavior.
● Self – individual’s awareness of who they are; provides a sense of identity
and uniqueness “I”.
● Growth and Development – the continuous changes across a person’s
life span
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● Body image – how a person views their physical self and how they
believe others perceive them
● Learning – a process of sensory perception, conceptualization, and
critical thinking involving multiple experiences in which changes in
concepts, skills, symbols, habits, and values can be evaluated in
observable behaviors and inferred from behavioral manifestations
● Space – physical and psychological are surrounding a person
● Time – unique experience for each individual. Represent how a person
perceives duration between events and their relation to past, present, and
future

Interpersonal System

- how a person views their physical self and how they believe others
perceive them

Concepts:

● Interaction – process of two or more people communicating and behaving

toward one another, either verbal or non-verbal
● Communication – exchange of information between people, where a
change occurs from one state to another; essential for understanding
perceptions and for decision-making in nursing
● Transaction – it is the core of King’s Theory of Goal Attainment; a
process of interacting where humans communicate, share information, set
goals, and take action to achieve goals with others and the environment
● Role – expected behaviors of a person in a social system; influences
interactions and responsibilities
● Stress – dynamic state resulting from interactions with environment,
which involves an exchange of energy and information between the
person and the environment for regulation and control of stressors, and
can affect growth and performance
● Coping – ability of individuals to handle stressors in interpersonal
relationships

Social System

- groups of people within a community or society who share common goals,

interests, and values, and how they impact health, roles, and interactions

Concepts:

● Organization – structured groups of people with assigned roles and

positions who use resources and abilities and work together to accomplish
personal and organization goals
● Authority – power to make decisions directing the actions of human
beings
● Power – ability to use resources and influence other to achieve goals
● Status – person’s position or rank within a group or organization; comes
with privileges, duties, and responsibilities
● Decision Making – dynamic and systematic process by which a goal-
directed choice of perceived alternatives is made, and acted upon by
individuals or groups to answer a question and attain a goal
● Control – act of being in charge, regulating, and ensuring order within
system
Assessment
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- Assessment occurs during interaction

- The nurse bring special knowledge and skills whereas the client brings
knowledge of selt and perception of problems of concern, to this
interaction
- During assessment, nurse collects data regarding the client (his/her
growth and development, perception of self and current health status,
roles, etc.)
- Communication is required to verify accuracy of perception, for interaction
and transaction

Nursing Diagnosis
- The data collected by assessment are used to make nursing diagnosis in
nursing process
- In process of attaining goal, the nurse identifies the problems, concerns,
and disturbances about which person seek help

Planning
- After diagnosis, planning for interventions to solve those problems is done
- In goal attainment, planning is represented by setting goals and making
decisions about and being agreed on the means to achieve goals
- This part of transaction and client’s participation is encouraged in making
decisions on the means to achieve the goals

Implementations
- In nursing process, implementation involves the actual activities to achieve
the goals
- In goal attainment, it is the continuation of transaction

Evaluation
- It involves finding out whether goals are achieved or not
- King’s description of evaluation speaks about attainment of goal and
effectiveness of nursing care
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Myra Estrine Levin: Conservation Theory

The Conservation Model of Nursing

The Conservation Model is a nursing theory developed by Myra Estrin
Levine. It is a holistic framework that guides nurses in supporting patients
through the process of adaptation to achieve and maintain wholeness, or overall
well-being, following an illness or injury.
The central idea is that a person's health is a state of wholeness achieved
through successful adaptation to their environment. When this adaptation is
threatened, nursing intervenes to promote healing by conserving, or protecting,
the patient's resources. The ultimate goal of nursing, according to Levine, is to
enable the patient to conserve their energy and integrity, thereby participating in
their own healing with the least amount of effort.

Conservation Model

Conservation model for the improvement of a person’s physical and

emotional well-being by the four domains of conservation principles.

Theory Of Four Conservation Principles

Levine’s Conservation Model is focused on promoting adaptation and
maintaining wholeness using the principles of conservation. The model guides
the nurse to focus on the influences and responses at the organismic level. The
nurse accomplishes the goals of the model through the Conservation of Energy,
Structural, Personal, and Social integrity.
● Conservation of Energy . This aspect emphasizes balancing activity and
rest to prevent exhaustion, optimizing nutrition to fuel the body, and
managing fatigue to maintain the energy necessary for healing and
everyday function.
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● Conservation of Structural Integrity . The focus here is on maintaining

the physical function of the body, preventing tissue damage, and
supporting rehabilitation. This ensures that the body’s structural integrity is
preserved during recovery and that physical abilities are restored or
maintained.
● Conservation of Personal Integrity . This principle emphasizes
respecting the patient’s dignity, protecting their privacy, and supporting
their autonomy. It ensures that the person is treated with respect and their
individuality and personal choices are honored.
● Conservation of Social Integrity . This area focuses on preserving the
patient's family connections, honoring cultural values, and supporting their
social roles. This ensures the patient remains connected to their
community and social support systems, which are critical for their
emotional and mental well-being.
ADAPTATION
refers to the ongoing process by which individuals respond to
environmental changes while maintaining stability and function. It results from the
continuous interaction between the individual and their surroundings. The extent
to which a person engages effectively with their environment is influenced by
their capacity for adaptation. An individual's ability to manage health-related
changes may influence how they respond to medical care and treatment.

Conservation
Conservation results from adaptation. The term comes from the Latin word
meaning “to keep together.” It refers to how complex systems can keep working
even when they face serious challenges. Through conservation, people can face
difficulties, adjust properly, and keep their individuality. The main aim of
conservation is to maintain health and the ability to handle disabilities. The
principles of conservation and integrity apply to every nursing situation where
care is needed.

The levels of organismic response include:

Fighting Right Mechanism .

Most primitive response. Hospitalization illness and new experiences trigger a
response. An individual may turn away, “flight” or face his condition. “Fight” to
assure his safety and well-being.
Inflammatory Immune Response.
A way of healing, a defense mechanism to protect itself from insult in a hostile
environment.
Stress response.
According to Selye, stress response syndrome is a predictable non-specifically
induced organismic change.
Perceptual Awareness.
Information seeking response used by the individual to seek and maintain safety
for himself. It includes the basic orienting, synaptic, auditory, visual, and taste
smell system.
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Myra Estrin Levine

Myra Estrin Levine (1921–1996) was a
nursing theorist best known for her
Conservation Model, which promotes
adaptation and wholeness through four
principles of conservation. Beyond her
professional influence, she was also a
devoted family woman, educator,
scholar, and advocate for a global view
of nursing.

Career

Levine’s career spanned clinical practice, teaching, and administration. She

worked as a private duty nurse, U.S. Army civilian nurse, surgical supervisor, and
nursing director. She taught at Cook County School of Nursing, Loyola University,
the University of Illinois, and Rush University, where she developed graduate
programs in oncology nursing. She also served as visiting professor in Israel at
Tel Aviv University (1974) and Ben Gurion University (1982). In 1987, she was
named Professor Emerita at the University of Illinois at Chicago.

Works and Contributions

Though she did not initially intend to create a nursing theory, Levine developed
the Conservation Model, which promotes adaptation and wholeness through four
principles of conservation. She authored several works, including Introduction to
Clinical Nursing (1969, 1973, 1989), Renewal for Nursing (1971), For Lack of
Love Alone, and The Pursuit of Wholeness.

METAPARADIGM
1. PERSON
The person is a holistic being who is aware of the past and oriented to the
future. The person responds to change in an integrated, sequential yet singular
fashion while in constant interaction with the environment. A person can be an
individual, family or community.

2. HEALTH
Health and disease are patterns of adaptive change. From a social
perspective, health is the ability to function in social roles. Health is culturally
determined. Health is an individual response that may change over time in
response to new situations; new life challenges; ageing or social, political,
economic or spiritual factors. Health implies unity and integrity. The goal of
nursing is to promote health.

3. ENVIRONMENT
The environment completes the wholeness of an individual. The individual
has both an internal and external environment. The internal environment
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combines the physiological and pathophysiological aspects of the individual and

is constantly challenged by the external environment. The external environment
includes factors that impinge on and challenge the individual. The external
environment consists of three levels:

● Perceptual environment
It includes aspects of the world that individuals are able to interpret
through senses and respond to with their sense organs. It includes light,
sound, touch, temperature, etc.
● Operational environment
It includes factors that may physically affect individuals but are not
directly perceived by them such as radiation, microorganisms and
pollution.
● Conceptual environment
It includes cultural patterns characterized by spiritual existence and
mediated by language, thought and history. Factors that affect behaviour
such as norms, values, beliefs are also part of the conceptual environment.

[Link]
Nursing is human interaction. The goal of nursing is to promote adaptation
and maintain wholeness. The goal is accomplished through the use of
conservation principles: energy, structural, personal and social integrity. Nursing
care is both therapeutic and supportive.

●
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Joyce Travelbee

Human-to-Human Relationship Theory

A theory that focuses on establishing a meaningful, genuine, and real connection
of patient and nurse. According to the model, nursing is accomplished through
relationships between humans beginning with an original encounter and then
progressing through stages of emerging identities, developing feelings of
empathy and sympathy.
In the final stage, the nurse and patient build rapport to achieve nursing goals,
which depend on forming a true human-to-human connection. This relationship
develops through five phases: the first encounter, recognition of each other’s
identities, empathy, sympathy, and the establishment of mutual understanding
and trust.
Travelbee’s model is grounded in Kierkegaard’s existentialism and Frankl’s
logotherapy. Existentialism holds that people continually face choices and
conflicts and are responsible for their decisions, while Logotherapy views finding
life’s meaning as key to emotional stability and well-being. Travelbee’s model
builds on logotherapy and existentialism by applying them to nursing care. It
recognizes that patients face struggles like freedom, isolation, suffering, and
death, especially when sick. Instead of avoiding these, the model encourages
nurses to face them with patients through real human connections.
The nurse-patient relationship is key, as it helps patients find meaning in their
situation, gain hope, and build strength. By doing so, nurses not only care for
their health but also support personal growth, self-discovery, and a sense of
purpose even in difficult times.

Human-to-Human Relationship Model

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Who is Joyce Travelbee?

Travelbee graduated from Louisiana State University in 1956 with a Bachelor of

Science in Nursing and later earned a Master of Science in Nursing from Yale
University in 1959. She served as a psychiatric nursing instructor at DePaul
Hospital Affiliate School in New Orleans and also taught at Charity Hospital
School of Nursing, New York University, and the University of Mississippi.
In her influential work, "Interpersonal Aspects of Nursing" (1966, 1971),
Travelbee developed the Human-to-Human Relationship Model, drawing
inspiration from Danish existentialist Soren Kierkegaard and German
psychologist Viktor Frankl. She emphasized the importance of finding meaning in
the nurse-patient relationship, advocating that the essence of nursing is realized
through these human connections.
7 Basic Concepts of the Human-to-Human Relationship
SUFFERING
- Suffering is placed at the center of Travelbee’s theory. It was described as
a human experience that varies in intensity, duration, depth which range
from mild unease to severe pain, not only physical pain but also emotional
or existential pain. For this theory, it recognizes a person’s suffering as the
starting point for any meaningful nursing interaction.
MEANING
- It refers to an individual’s personal meaning for suffering or illness. People
interpret events through their values, beliefs, and life story and nurses
help patients find a reason or lesson so the suffering feels less heavy.
HOPE
- Hope helps a person survive and find purpose during illness. It is when
believing that something good can still happen, even when times are hard.
It also gives people the strength and motivation to move forward. Nurses
encourage a person by supporting realistic possibilities and coping and
not by giving false promises.

- 6 important factors characteristics of hope :

- Strongly associated with dependence on other people
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- Future oriented
- Linked to elections from several alternatives or escape routes out of
its situation
- The desire to possess any object or condition, to complete a task or
have an experience
- Confidence that others will be there one when you need them
- The hoping person is in possession of courage to be able to
acknowledge its shortcomings and fears and go forward

COMMUNICATION

- Effective communication is crucial for establishing relatedness,

understanding the patient’s meaning, and giving a healing environment for
the patient's overall well-being. Travelbee stressed that communication
must enable mutual understanding as it is the principal tool for entering
the patient’s world.

NURSING

- Nursing’s purpose is to help individuals and families prevent or cope with

illness and suffering — and, when possible, to assist them in finding
meaning in their experience. It’s not merely technical care but a
relationship-based practice grounded in ethical/spiritual awareness.

SELF-THERAPY

- It is the ability of a nurse to use one’s own personality, presence, and

interpersonal skills intentionally to establish relatedness and structure
interventions. Self-therapy implies nurse self-awareness and emotional
maturity so that the nurse’s presence becomes healing rather than
intrusive.

TARGETED INTELLECTUAL APPROACH

- It is when the nurses use a systematic, thoughtful, and analytical way to

understand each patient’s situation. The nurses think carefully and use
what they know and combine empathy and caring with knowledge, logic,
and professional judgment to make the best help for the patient.

Five Phases of the Human-to-Human Relationship

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1. Original Encounter - First impression of the nurse to the sick patient and
vice versa. “Breaking the connection of categories in order to perceive the
human being in the patient”. Patients are the same people as us and our
families, with the exception that they require the assistance of other
people, notably nurses and doctors, in order to stay healthy.
2. Emerging Identities - separating oneself and one’s experiences from
others and recognizing the different qualities that each possess are tasks
in the second phase, as well as transcending roles by separating self and
experiences from one another.
3. Empathy - This phase entails sharing another' s mental state while
remaining detached and not exchanging feelings. It is defined as the
“ability to predict another person’s actions”
4. Sympathy - Nurses can share and understand patients’ feelings, but must
channel sympathy into meaningful care to ease suffering—going beyond
empathy.
5. Establishing Mutual Understanding and contact/ rapport - This stage
of nursing actions that relieve a patient’s pain are considered rapport. This
occurs when the nurse and the patient engage in genuine human-to-
human interaction. The patient, in turn, develops trust and confidence in
the nurse.

Nurse-Patient Interaction

An experience or series of experience between nurse and patient, and refers to

any contact between a nurse and an ill person

Therapeutic use of self

Ability to use one’s personality consciously and full awareness in an attempt to
establish relatedness and to structure nursing intervention
Metaparadigm
Person : Human being is a unique, irreplaceable individual who is in the
continuous process of becoming, evolving, and changing
Health : Subjective and objective
a. Subjective Health : an individually defined state of well being in accord
with self-appraisal of physical-emotional-spiritual status
b. Objective Health : an absence of discernible disease, disability, or defect
as measured by physical examination, laboratory tests, assessment by
spiritual director or psychological counselor
Environment : Definition was not clearly defined. She defined human conditions
and life experiences encountered by all men as sufferings, hope, pain and illness.
Nursing : “An interpersonal process whereby the professional nurse practitioner
assists an individual, family, or community to prevent or cope with experience of
illness and suffering and, if necessary, to find meaning in these experiences”.

Assumptions
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● Human beings are an open system that reacts and adjusts itself to the
environment
● They rely on a delicate chemical and environmental balance to secure
their survival
● Without the balance, the entire system will crash

GROUP 3 - Ida Jean Orlando

Deliberative Nursing Process Theory (Nursing Process Theory)

Ida Jean Orlando was one of the first nursing authors to emphasize the
importance of the nursing process and the patient’s active role in it. Her theory
highlights the reciprocal relationship between the nurse and the patient, where
what they say and do during their interaction influences both of them.

According to Orlando, the main function of a professional nurse is to

identify and meet the patient’s immediate need for help. Nursing actions should
focus on improving the patient’s behavior, and evidence of relief from distress
can be seen in positive changes in the patient’s observable actions and
responses.

Orlando (1961) explained that people become patients when they have
needs for help that they cannot meet on their own. This may be due to physical
limitations, negative reactions to their environment, or experiences that prevent
them from expressing their needs. Such unmet needs often cause distress or
helplessness. Orlando also proposed that the longer these needs remain unmet,
the greater the patient’s distress becomes. For this reason, immediacy is a key
principle of her theory. When individuals are able to meet their own needs, they
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do not experience distress and, therefore, do not require professional nursing

care.

The theory was developed to strengthen nurse-patient relationships and

improve patient outcomes through effective communication. Orlando believed
that the active participation of patients in the nursing process greatly influences
their recovery. When patients cannot meet their needs, they may feel weak,
anxious, or distressed. Conversely, when their needs are met, they experience
relief and no longer require nursing intervention.

Orlando’s work shifted nursing away from a purely task-oriented practice

and toward a patient-centered approach. Her theory emphasizes that
communication builds trust, prevents misunderstandings, and ensures that
nurses provide the most appropriate care. It also highlights that the nurse-patient
relationship is dynamic, each party is affected by the behavior and actions of the
other.

Biography

Birth: August 12, 1926

Death: November 28, 2007

Education

● 1947 – Earned her Diploma in Nursing from New York Medical College, Lower
Fifth Avenue Hospital School of Nursing.
● 1951 – Completed her Bachelor of Science in Public Health Nursing at St.
John’s University, Brooklyn, New York.
● 1954 – Obtained her Master’s Degree in Mental Health Nursing from Teachers
College, Columbia University.

Career

● Worked as a staff nurse, consultant, researcher, and educator.

● Served as a faculty member at Yale University School of Nursing, where
she first developed her theory.
● Became a recognized psychiatric mental health nurse and significantly
influenced how nurses respond to patient needs.
● Played an essential role in shifting nursing from a task-oriented to a patient-
centered practice.
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Contributions to Nursing

● Authored works on The Nursing Process, highlighting the importance of

understanding and validating patients’ needs before acting.
● Emphasized that nursing actions must be based on validated patient
needs, not assumptions.
● Introduced the structured framework of the Nursing Process:
○ Assessment → Diagnosis → Planning → Implementation → Evaluation
(ADPIE)
● Her theory became foundational in nursing curricula and continues to shape
how the nurse–patient relationship is taught and practiced worldwide.

Legacy

Ida Jean Orlando is remembered as one of the pioneers of modern nursing

theory. Her work laid the groundwork for patient-centered care and helped
establish the Nursing Process as the universal standard in nursing practice.

Metaparadigm

● Person/Human Being - Orlando employs the concept of the human to

emphasize individuality and the dynamic nature of the nurse-patient relationship.
According to Orlando, individuals in need constitute the primary focus of nursing
practice.
● Health - Health is seen as meeting immediate needs. When needs are unmet,
the person feels distress and helplessness, which triggers nursing care. Nurses
restore well-being by addressing these needs, relieving distress, and helping
individuals regain their ability to cope.
● Environment - Orlando completely disregarded the environment in her theory,
only focusing on the patient’s immediate need, chiefly the relationship and
actions between the nurse and the patient (only an individual in her theory; no
families or groups were mentioned). The effect that the environment could have
on the patient was never mentioned in Orlando’s theory.
● Nursing - Nursing is a deliberate process of identifying and meeting the
patient's immediate needs for help. It involves a continuous cycle of assessment,
action, and evaluation, with the nurse and patient engaging in a mutual process
of understanding and addressing the patient's distress.
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GROUP 4 - Lydia Eloise Hall (September 21, 1906 – February 27, 1969)

BIOGRAPHY
● Lydia Hall was born on September 21, 1906, in New York City as Lydia
Eloise Williams.
● In 1945, she married Reginald A. Hall, who was a native of England.
● She was the eldest child of Louis V. Williams and Anna Ketterman
Williams and was named after her maternal grandmother.
● At a young age, her family decided to move to York, Pennsylvania,
where her father was a general practice physician that’s why she pursued
a nursing career.

EDUCATION
● Lydia Hall graduated from York Hospital School of Nursing in 1927 with
a diploma in nursing.
● She entered Teacher’s College at Columbia University in New York and
earned a Bachelor of Science degree in public health nursing in 1932.
● She continued her academic pursuits, obtaining a master’s degree in the
teaching of natural life sciences in 1942.

CAREER
● She spent her early years as a registered nurse working for the Life
Extension Institute of the Metropolitan Life Insurance Company in
Pennsylvania and New York, where the main focus was on preventative
health.
● She also had the opportunity to work for the New York Heart Association
from 1935 to 1940.
● In 1941, she became a staff nurse with the Visiting Nurses Association
of New York and stayed there until 1947.
● Hall also managed to be an advocate of community involvement in
public health issues.
● In 1950, she became a professor at Teacher’s College at Columbia,
where taught nursing students to function as medical consultants.
● She was also a research analyst in the field of cardiovascular disease.
She became involved in the establishment of the Loeb Center for Nursing
and Rehabilitation at the Montefiore Medical Center (MMC) in the Bronx,
New York, and served as its first Director.

ACHIEVEMENTS
● Established and directed the Loeb Center for Nursing and Rehabilitation
at Montefiore Hospital in Bronx, New York (1963).
● Most notable publication is "Care, Core, and Cure Model", one of her
most revolutionary contributions to nursing.
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● Served as:
○ Research analyst in cardiovascular disease, Heart Disease
Control Branch, U.S. Public Health.
○ Project director for the Public Health System, Division of Chronic
Disease and Tuberculosis.
○ Published 20+ articles on the Loeb Center, long-term care, and
chronic disease control.

Care, Core, and Cure Model

● Also known as the “Three Cs of Lydia Hall.”
● Lydia Hall used her knowledge of psychiatry and nursing experiences in
the Loeb Center to formulate this theory.
● It contains three independent but interconnected circles: the Core, the
Care, and the Cure.
● Her theory defined Nursing as “a participation in care, core and cure
aspects of patient care, where CARE is the sole function of nurses,
whereas the CORE and CURE are shared with other members of the
health team.”
● It emphasizes the importance of a holistic approach to nursing care.
Nurses must be able to provide care that addresses the patient's physical,
emotional, and psychosocial needs. They must also be able to collaborate
with other healthcare professionals to ensure that the patient receives
comprehensive and coordinated care.
● The size of each circle constantly varies and depends on the state of the
patient. A nurse functions in all three circles but to different degrees.

HALL'S THREE ASPECTS OF THEORY

1. Care – “ The Body”
2. Core – “ The Person”
3. Cure – “The Disease”

Cure Circle
● Represents the disease and the application of pathological and
therapeutic sciences.
● Focuses on medical and nursing interventions to treat the underlying
cause of illness.
● A shared responsibility between nurses and other health professionals
(e.g., physicians, physical therapists).
● Aims to restore a patient's health through coordinated actions and
treatments.
● Nurse’s role includes:
○ Administering prescribed medications and treatments
○ Ensuring accuracy and appropriateness of treatments
○ Acting as a strong advocate for patients and families
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● In this theory, nursing is presented as the cure, primarily through the

administration of medications and treatments. Nurses collaborate with
other health professionals, including physicians and physical therapists, to
implement interventions aimed at treating patients' illnesses or diseases
while actively advocating for their needs.

CARE COMPONENT FUNCTION

The care component in Lydia Hall’s theory highlights the hands-on,
nurturing side of nursing. It involves direct care activities like bathing, feeding,
and positioning, which meet basic needs, provide comfort, and build trust
between the nurse and patient. Hall believed that nursing is identified with “care”
because it centers on comfort, support, and the intimate bodily needs of patients.

Contents:
Comfort Measures
● Bathing and grooming (Personal Hygiene)
● Positioning and turning to prevent bedsores
● Providing clean and dry linens and clothes
● Maintaining warmth (e.g., blankets, room temperature)

Assistance with Activities of Daily Living

● Feeding patients who cannot feed themselves
● Assisting with drinking and hydration
● Helping patients dress or change clothes
● Supporting mobility (helping them walk, use wheelchair, or transfer to
bed/chair)

Physical Needs to Promote Health

● Ensuring proper rest and sleep
● Supporting adequate oxygenation (e.g., positioning for breathing)
● Providing elimination needs (bedpans, urinals, helping to the bathroom)
● Keeping the environment clean and safe

Supportive Interaction
● Being present to comfort anxious or fearful patients
● Offering words of encouragement and emotional support during
procedures
● Showing empathy and compassion to establish trust and nurse–patient
relationship

ROLES OF THE NURSE IN CARE COMPONENT

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The nurse’s primary responsibility in this circle:

● Provide hands-on physical care that the patient can not perform due to
illness, weakness, or hospitalization.
● Create an environment of comfort and dignity for healing and recovery.
● Build trust and rapport with the patient, which also helps in improving
cooperation with treatment.

CORE COMPONENT FUNCTION

The core refers to the patient’s inner self, including their social, emotional,
and psychological aspects. It urges nurses to see patients as whole individuals,
not just their illness, by understanding who they are beyond their medical
condition.

In Hall’s Conceptualization, the core deals with:

● The patient’s internal self – This includes their feelings, thoughts, values,
beliefs, and experiences that shape how they perceive their illness and
treatment. When nurses engage with the core component, they recognize
that each patient brings their unique life story and perspective to the
healthcare encounter.
● Therapeutic relationships – The core component functions through
meaningful nurse-patient interactions that go beyond procedural care. Hall
believed that by developing authentic connections with patients, nurses
could help them tap into their own internal resources for healing.
● Patient autonomy and self-determination – The core component
emphasizes the patient’s right and capacity to participate in their own care
decisions. According to Lydia Hall, nursing that addresses the core helps
patients express their needs and preferences, empowering them to take
an active role in their recovery process.

Core: Nurses engage deeply with the patient’s individuality by focusing on their
personal feelings, beliefs, values, and emotional health. This includes therapeutic
communication, empathy, and empowering the patient to participate actively in
their recovery based on their personal goals. The nurse supports patients’
psychosocial and spiritual well-being alongside physical healing.

CURE COMPONENT FUNCTION

The integration of the Cure Theory aspect into Hall’s Nursing Model
enhances its comprehensiveness by addressing the medical dimension of patient
care, thereby completing the model’s holistic framework.

1. ROLE OF CURE THEORY

● Medical Expertise: Strengthens the “cure” component by emphasizing
evidence-based practices, clinical judgment, and adherence to medical
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protocols, ensuring nurses actively participate in treatment beyond

passive task execution.
● Interdisciplinary Collaboration: Highlights the nurse’s role as a
collaborator with physicians and other professionals, fostering teamwork
for optimal patient outcomes.
● Patient Education: Integrates teaching patients about their conditions
and treatments, empowering them to engage in their own care.
● Monitoring and Adaptation: Encourages dynamic assessment of patient
responses to treatments, enabling timely adjustments to care plans.

2. HOLISTIC COMPLETION
● Without the cure aspect, Hall’s model would lack actionable medical strategies.
Cure Theory ensures that scientific, procedural, and educational elements are
systematically incorporated, balancing the physical (care), emotional (core), and
clinical (cure) needs of patients.
● Modern advancements in Cure Theory (e.g., technology integration, patient-
centered care) update Hall’s 1960s model, making it relevant to contemporary
practice.

3. SYNERGY
● The Cure Theory bridges the gap between compassionate care (care/core) and
medical rigor, ensuring nurses address all facets of healing. This synergy fosters
a patient-centered approach where medical treatment is delivered alongside
empathetic support, promoting holistic recovery.

Cure: In this role, nurses collaborate with the medical team to facilitate and
implement treatments and therapies prescribed for the patient’s disease or
condition. Nurses monitor patient responses, educate patients about their
treatments, and communicate with healthcare professionals to adjust care as
needed. This strengthens the medical and technical intervention side of care.

KEY ASPECTS OF THE CURE CIRCLE

● Medical interventions: The cure circle encompasses the administration of
medications, therapies, and procedures prescribed by physicians and other
healthcare providers.
● Nursing interventions: Nurses play a crucial role in implementing and
coordinating medical interventions, ensuring that they are administered safely,
effectively, and in a patient-centered manner.
● Monitoring and evaluation: Nurses continuously monitor patients' responses to
treatment and evaluate the effectiveness of interventions.
● Collaboration: The cure circle requires collaboration among various healthcare
professionals, including physicians, nurses, pharmacists, and therapists, to
ensure a comprehensive and coordinated approach to treatment.
● Patient education: Nurses provide patients with clear and understandable
information about their treatment plans, potential side effects, and self-care
strategies related to the treatment.
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TRAINING THAT ENHANCES NURSES’ APPLICATION OF LYDIA HALL’S

CARE, CURE, AND CORE MODEL

1. Therapeutic Communication and Relationship Building: Training to develop

skills in empathetic listening, emotional support, and patient-centered
communication helps nurses effectively engage with the patient's core,
supporting their psychosocial and emotional needs.

2. Clinical and Medical Competency: Education on evidence-based medical

procedures, medication administration, monitoring treatment effects, and
interdisciplinary collaboration enhances nurses' ability to perform in the cure
aspect of the model.
3. Holistic and Hands-On Nursing Care: Practical training focusing on physical
care skills such as hygiene assistance, comfort measures, and patient education
strengthens the care component by honing nurturing and supportive nursing
actions.

5. Interdisciplinary Collaboration: Workshops and simulations that foster

teamwork with physicians, therapists, and other healthcare providers prepare
nurses to coordinate effectively within the cure circle.

6. On-The-Job and Simulation-Based Learning: Based Learning: Continuous

professional development through clinical practice, case-based learning, and
technology-assisted simulations (e.g., virtual reality scenarios) enhances nurses’
confidence and integration of the model in real-world care.

CHALLENGES

1. Limited Generalizability: The theory is designed primarily for patients aged 16

and above, which restricts its application in pediatric nursing and broader
populations. It also focuses on individuals rather than families or communities,
limiting its scope in family- or community-centered care.
2. Nurse Preparedness: Successful application requires nurses to function with
minimal structure, which can be difficult for those whose personality, education,
and experience do not prepare them for this autonomous and holistic approach.
3. Integration Complexity: The theory's emphasis on balancing care, cure, and
core needs simultaneously can be challenging in busy clinical environments
where nursing care tends to be task-oriented and medical treatment might
overshadow psychosocial support.
4. Acute Illness Focus: The model is suited for patients past the acute stage of
illness and may not address nursing contact in health maintenance, disease
prevention, or care of healthy individuals, thus limiting its wider clinical relevance.
5. Theory-to-Practice Gap: Like many nursing theories, Hall’s model faces
criticism for perceived complexity, vague language, or lack of clarity, which can
lead nurses to consider it less applicable or relevant to everyday clinical practice.

METAPARADIGM
Individual
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The individual human who is 16 years of age or older and past the acute stage of
long-term illness focuses on nursing care in Hall’s work. The source of energy
and motivation for healing is the individual care recipient, not the health care
provider. Hall emphasizes the individual’s importance as unique, capable of
growth and learning, and requiring a total person approach.

Health
Health can be inferred as a state of self-awareness with a conscious selection of
optimal behaviors for that individual. Hall stresses the need to help the person
explore the meaning of his or her behavior to identify and overcome problems
through developing self-identity and maturity.

Environment
The concept of environment is dealt with in relation to the individual. Hall was
credited with developing the concept of Loeb Center for Nursing because she
assumed that the hospital environment during the treatment of acute illness
creates a difficult psychological experience for the ill individual. Loeb Center
focuses on providing an environment conducive to self development in which the
action of nurses is for assisting the individual in attaining a personal goal.

Nursing
Nursing is identified as participating in the care, core, and cure aspects of patient
care.

ASSUMPTION
1. The motivation and energy necessary for healing exist within the patient rather
than in the healthcare team.
2. The three aspects of nursing should not be viewed as functioning
independently but as interrelated.
3. The three aspects interact, and the circles representing them change the size,
depending on the patient’s total course of progress

STRENGTHS:
Lydia Hall’s nursing model is characterized by its logical simplicity and is
regarded as a philosophical approach to nursing, centered on the three Cs: care,
core, and cure, with an emphasis on the care circle.

WEAKNESSES:
However, its plain presentation may pose challenges for nurses lacking
the personality traits, education, and experience to operate effectively within its
minimal structure. Additionally, the model's applicability is limited by an age
requirement of 16 years and older, omitting considerations for pediatric patients.
Furthermore, while it addresses individual patient needs, it inadequately explores
the roles of families and communities in nursing practice.
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KEY POINTS OF THEORY:

● Holistic Nursing: Nursing is not just treating disease—it’s about caring for the
whole person (body, mind, and spirit).
● Nurse-Patient Relationship: The nurse-patient relationship is therapeutic and
central to healing.
● Independence: Her theory aimed to help patients gain independence and not
be overly dependent on the healthcare team.
● Practical Application: Widely applied in rehabilitation nursing, psychiatric
nursing, and long-term care settings.

CONCLUSION:
Lydia Hall's Care, Core, and Cure Theory is structured around three
interconnected elements: the core (the patient), the cure (medical and nursing
interventions), and the care (nurturing by nurses). While her concepts were
designed for patients aged 16 and above, they can be adapted for all age groups.
The theory highlights the totality of the patient, stressing the interdependence of
all three aspects, and requires that nursing practice occurs after an acute illness
stage, without contact with healthy individuals, emphasizing health maintenance
and disease prevention.

GROUP 5 - ABRAHAM MASLOW – HIERARCHY OF NEEDS THEORY

1. BACKGROUND

Abraham Maslow was an American psychologist best known for creating

Maslow’s Hierarchy of Needs. He was born on April 1, 1908, in Brooklyn, New
York, as the eldest of seven children of Russian-Jewish immigrants. Although his
parents were not highly educated, they valued learning, which inspired Maslow to
spend much of his time reading and finding comfort in books.

He described his early life as unhappy and lonely, often facing racism and
bullying. He attended high school in Brooklyn and later enrolled at the City
College of New York, where he first studied law but eventually shifted to
psychology. He went on to pursue graduate studies at the University of
Wisconsin, earning his bachelor’s degree in 1930, a master’s degree in 1931,
and a PhD in psychology in 1934. After completing his studies, Maslow taught at
several institutions, including Columbia University, before joining Brooklyn
College in 1937.
In 1951, Maslow became the head of the psychology department at
Brandeis University, where he worked until 1969. He introduced his famous
hierarchy of needs in his 1943 paper A Theory of Human Motivation and later
expanded on the idea in books like Motivation and Personality (1954) and
Toward a Psychology of Being (1962). His ideas about self-actualization, peak
experiences, and being-values became key concepts in humanistic psychology,
also called the “third force” in psychology after behaviorism and psychoanalysis.
In 1928, he married his first cousin, Bertha Goodman, and they had two children
together. Later in life, Maslow suffered a serious heart attack in 1967 and sadly
passed away on June 8, 1970, in Menlo Park, California, at the age of 62.

2. THEORY
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Theory of Hierarchy of Needs

Maslow’s Theory of Human Motivation, more commonly known as the

Hierarchy of Needs, states that there are five stages of human needs that
motivates a person's behavior. It says that human beings are motivated by
different needs arranged in a hierarchy.
This hierarchy ranges from basic and fundamental needs people need to
attain for survival to a higher level of concept like personal growth and fulfillment.
Maslow also stated that when a lower need is met and is satisfied, the next need
on the hierarchy triangle becomes the next focus.

A. SELF-ACTUALIZATION
It is the desire to become the persona we want to be at its greatest
form. This is the highest part of the hierarchy, unlocking a person’s full
potential and realization, which could be difficult to satisfy. Maslow
described it as the desire ‘to become everything one is capable of
becoming. Maslow also did not believe that not all of us can satisfy this
level. It includes the following characteristics:
1. They perceive reality efficiently and can tolerate uncertainty;
2. Accept themselves and others for what they are;
3. Spontaneous in thought and action;
4. Problem-center (not self-centered);
5. Unusual sense of humor;
6. Able to look at life objectively;
7. Highly creative;
8. Resistant to enculturation, but not purposely unconventional;
9. Concerned for the welfare of humanity;
10. Capable of deep appreciation of basic life-experience;
11. Establish deep satisfying interpersonal relationships with a
few people;
12. Peak experiences;
13. Need for privacy;
14. Democratic attitudes;
15. Strong moral/ethical standards.

B. ESTEEM
The respect of a person towards themselves, and to others. The
feeling of accomplishment. The typical human desire to be positively
perceived and valued by others. It is classified into two categories: 1.)
Esteem for oneself (dignity, independence, and 2.) the desire for
reputation or respect from others (status, recognition). Maslow
emphasized that the need for respect is the most important for children
and adults and precedes dignity.
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C. LOVE AND BELONGING

People seek connection, acceptance, and affection from others.

Humans naturally crave relationships such as family bonds, friendships,
and intimacy. When this need is met, individuals feel secure and valued;
when unmet, feelings of loneliness and isolation arise. In nursing, this
reminds us that care is not just physical, it also means creating an
environment where patients feel emotionally supported and trusted.
D. SAFETY NEEDS
Refers to a person’s desire for predictability, order, and control in
life. These include protection from harm, emotional, and physical security,
job and financial stability, health, law and order, and social stability. Once
physiological needs are met, individuals seek safety through family and
societal systems such as police, schools, businesses, and healthcare.
Feeling safe is essential before progressing to higher-level needs like love
and belonging.
E. PHYSIOLOGICAL NEEDS
Refers to the most basic physical needs of an individual for their
survival, such as breathing, maintaining temperature, drinking when thirsty,
eating when hungry, and sleeping when tired. Maslow considers
physiological needs one of the most essential. And again as stated, when
the need is met and sufficiently satisfied, we get motivated to do the next.
ADDITIONAL FACTORS OF THE MODEL…
1. TRANSCENDENCE
This is the level beyond self-actualization, where life becomes more
than just about oneself. A person at this stage is motivated by values that
reach beyond personal goals, finding meaning in serving others,
connecting spiritually, or seeking truth and beauty in the universe. It’s
about moving past individual success and aiming for a higher purpose. In
nursing, transcendence shows when we help patients find meaning in their
struggles and give care not just as a duty but as a calling. Members of this
stage include spiritual figures, sages, and saints.
2. AESTHETIC NEEDS
Involve the appreciation and pursuit of beauty, balance, and form
through art, music, nature and other creative expressions. These
experiences provide emotional and physiological satisfaction, not just
physical appeal. Fulfilling aesthetic needs leads to a deeper sense of
harmony, as individuals seek environments that resonate with their inner
sense of order, elegance, and emotional connection.
3. COGNITIVE NEEDS
As an individual grows, they naturally want to understand the world
better. Cognitive needs is the desire that makes us ask questions, explore
new things, and seek out learning.
Deficiency Needs and Growth Needs in Maslow’s Hierarchy
Maslow divided human needs into two categories:
● Deficiency needs:
○ These are the first four levels in the hierarchy:
■ Physiological needs
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■ Safety needs
■ Love and Belonging needs
■ Esteem needs
○ They are called deficiency needs because a person becomes
motivated to act when these needs are unmet or lacking.
○ For example, the longer you go without food or water, the more
desperate you become to eat or drink
● Growth needs:
○ These are the last four levels in the hierarchy:
■ Cognitive needs
■ Aesthetic needs
■ Self-actualization needs
■ Self-transcendence needs
○ These are motivated from a person's desire to grow, develop, and
reach their potential as a person
○ Growth needs become stronger when they are fulfilled. For
example, when an individual grows intellectually or creatively, the
more motivated they are to continue exploring and creating.

3. METAPARADIGM (one-two sentences per factor only)

● PERSON - The individuals driven to fulfill their needs in a hierarchical
order, ranging from basic physiological needs to more complex
psychological needs.
● HEALTH Health is attained as an individual's needs are fulfilled step by
step from fundamental survival to self-actualization, enabling them to
maintain balance, adapt to obstacles, and realize their maximum potential.
● ENVIRONMENT Maslow’s concept of environment emphasizes that the
conditions surrounding a person physical safety, social support, cultural
acceptance play a key role in meeting needs and achieving full potential
● NURSING - Nurses use Maslow's hierarchy to understand patient needs,
prioritizing to basic needs for stability before addressing on higher-level
goals

ERIK ERIKSON

Psychosocial Development Theory

Erikson's Psychosocial Development Theory is a thorough model that

characterizes human development as a sequence of psychological and social
difficulties that people encounter throughout their lives. It highlights how human
behavior and personality are shaped by social contact, culture, and identity
development.
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Fundamentally, Erikson's theory posits that personality evolves through

eight phases of psychosocial development in a specific order. The person
encounters a particular conflict or crisis at each stage, which serves as a
developmental turning point. A person's psychological health at that point and
their capacity to handle obstacles in the future are both influenced by how they
handle each disagreement.

Main Points of the Theory

1. Psychosocial Conflicts

A primary psychological conflict between the person's internal needs and

exterior social pressures is presented at each stage. These are typical
developmental obstacles rather than pathological catastrophes. Core virtues—
positive attributes that support the formation of a healthy personality—are
developed as a result of successful resolution.

2. Epigenetic Principle

The epigenetic principle, which holds that development proceeds in a

particular order and that each stage builds on the results of earlier stages, is the
foundation of Erikson's theory. Psychosocial development follows a natural,
organized process, much like physical development (e.g., crawling before
walking).

3. Lifespan Perspective

Erikson expanded developmental theory to encompass the whole human

lifespan, from infancy to old age, in contrast to Freud, who concentrated mostly
on early childhood. This was a noteworthy addition, acknowledging that identity
formation and psychological development persist into maturity and beyond.

4. Role of Social and Cultural Influences

Erikson highlighted that the way each psychosocial conflict is experienced

and resolved is significantly influenced by social interactions, cultural norms, and
historical background. Identity is shaped by interactions with others, including
friends, family, institutions, and society at large.

5. Development of Ego Strength

Successfully resolving psychosocial problems leads to the development of

what Erikson referred to as "ego strengths" or virtues, including competence,
hope, will, and purpose. These act as internal resources that promote healthy
functioning and additional development.
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6. Balance Between Opposing Forces

Erikson did not think that every dispute had to be settled completely in the
positive pole's favor. It is essential to strike a balance between the two sides,
such as mistrust and trust. Excessive amounts of either can cause issues; for
instance, blind trust can be just as damaging as complete mistrust.

Erik Erikson Stages of Development

Each stage presents a central psychosocial conflict or crisis that an
individual must successfully resolve to develop psychological strengths and a
healthy personality. Failure to overcome these challenges can result in difficulties
in later stages.

STAGE 1
Trust vs. Mistrust (Infancy) / 0 to 18 Months
This is the first stage of the Erikson psychosocial development theory;
Trust versus Mistrust, in which infants learn a basic sense of trust in themselves,
their parents or caregivers, and the world around them. During this stage, the
infant constantly satisfies his or her needs, including nourishment, warmth and
affection, thus building trust and the belief that the world is a safe place and
others are reliable. On the other hand, when parents or caregivers are careless,
inconsistent or cruel, the infant may end up developing mistrust and therefore
thinking that the world is unpredictable and people cannot be trusted.

STAGE 2
Autonomy vs. Shame and Doubt (Early Childhood) / 18 months – 3 years old
Once the child attains 18 months to 3 years of age, they pass into an
Autonomy versus Shame and Doubt stage, where children develop a sense of
personal agency and independence in making their own decisions about their
physical capabilities. By encouraging the child to feed or even dress themselves
(even when it leads to messiness) by helping them gain independence, the child
learns to be autonomous and confident in their ability to manage their actions
and make decisions. On the other hand, when caregivers or parents are too
controlling, too critical, and deprive a child of choice, he/she may also develop
feelings of shame and doubt, which are feelings of incompetence or fear of
attempting new things.

STAGE 3
Initiative vs. Guilt (Preschool) / 3 - 5 years old
From ages 3 to 5 years old, children go through Erik Erikson’s stage of
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Initiative vs. Guilt. During this period, children begin to assert power and control
over their environment through directing play and other social interactions. They
start to develop initiative by making simple decisions, such as choosing what to
wear or what game to play. When encouraged and supported, they feel capable
and develop a sense of purpose. However, if their efforts are overly controlled,
criticized, or punished, they may feel guilt for their desires and actions. This guilt
can lead them to doubt their abilities and hold back from taking initiative in the
future.
STAGE 4
Industry vs. Inferiority (School Age) / 5 - 13 years old
From 5 to 13 years old, children enter the stage of Industry vs. Inferiority.
This stage focuses on developing a sense of competence through learning,
schoolwork, and social activities. Children begin to take pride in
accomplishments and skills, especially when their efforts are recognized by
teachers, parents, or peers. Positive reinforcement builds confidence and
encourages them to be industrious—motivated to work hard and achieve goals.
However, constant failure or lack of support may make them feel inferior or
incapable compared to others. Balancing encouragement and realistic
expectations helps children develop a strong work ethic and belief in their own
abilities.
STAGE 5
Identity vs. Role Confusion (Adolescence) / 12 – 18 years old
Adolescence is the period where individuals start asking “Who am I?” and
begin exploring different roles in life. They try out hobbies, friend groups, styles,
and values to see what feels right for them. Guidance and support from parents,
peers, and media can influence how they shape their identity. When this stage is
successful, they develop fidelity, which is the ability to stay true to their values,
goals, and beliefs. On the other hand, failure leads to role confusion, where they
feel insecure, lost, or unsure of their direction. This confusion may show in
constant changes of interests, difficulty making decisions, or struggles with
belonging. The result of this stage becomes the foundation for future choices in
career, relationships, and personal growth.

STAGE 6
Intimacy vs. Isolation (Young Adulthood) / 18-40 years old
Young adulthood focuses on forming close, meaningful relationships. A
strong identity fosters true intimacy, allowing open sharing without losing oneself.
Intimacy involves trust, love, and belonging, creating lasting bonds. Fear of
rejection or lack of self-awareness can lead to isolation, causing emotional
distance and loneliness. Success in this stage yields supportive relationships,
providing strength and preparing one for later adulthood with love and security.
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Conversely, failure to achieve intimacy can result in profound feelings of

loneliness and detachment.

STAGE 7
Generativity vs. Stagnation (Middle Adulthood) / 40-65 years
In middle adulthood, the focus is now on the care stage. Adults now shift
their psychological energies toward the challenge of guiding the next generation.
This stage centers on the ritual of psychosocial discourse on generativity. Adults
now wish to leave their mark on the world through community, work, and family.
Generativity focuses on the creative and constructive, and those who care for the
young and the old. Care is built on the multiplicative. Generativity will bring care,
and selffocus will bring stagnation. Adults who feel unproductive, self-absorbed,
and watch passively as the world rolls by will experience stagnation.

STAGE 8
Integrity vs. Despair (Late Adulthood) / 65 years and older
This stage is reflected in late adulthood, as people look back on the life
they have lived and their accomplishments. Erikson deemed it necessary to
focus on the accomplishments, pride, and most importantly, integration to arrive
at a stage of completion. If a person has lived their life the way they wished,
there is a realization of peace. If a person reflects on their life more negatively
and harbors regrets, the person will experience depression and hopelessness.

Why did he develop this theory?

➢ It’s to extend Sigmund Freud’s Psychosexual Theory who emphasizes the

role ego and consciousness on personal choices.

➢ His motivation was to provide a comprehensive model that showed

development as a lifelong process involving specific tasks and conflicts at
each stage of life.

➢ Through his theory, he sought to explain how successfully resolving these

psychosocial conflicts leads to a healthy and competent personality, while
failure could result in difficulties in future stages.

➢ Freud focused mainly on biological drives and early childhood, highlighting

unconscious forces shaping personality, while Erikson expanded on this
by emphasizing social context and lifelong development, with a focus on
identity and social relationships shaping who we become. Erikson saw the
ego as an active, conscious player in growth, whereas Freud emphasized
unconscious processes more.

Significance of the Theory

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➢ It bridges psychological and social domains, offering a holistic view of

human development.

➢ It highlights that identity is not fixed in childhood but evolves across time.

➢ The theory is used in various fields: education, psychotherapy, counseling,

social work, and organizational development.

ERIK ERIKSON AS A THEORIST

➢ His theory highlights the importance of social relationships and challenges

at different life phases, from infancy through old age.

➢ Erikson expanded on Freud’s foundation by shifting focus from biological

sexual drives to social and emotional development throughout the entire
human lifespan, making his theory broader and more applicable to later
life stages. While both view development as stage-based with conflicts to
resolve, Erikson’s model emphasizes lifelong growth and social context,
whereas Freud concluded development by adolescence with a focus on
unconscious sexual energy.

HIS CONTRIBUTIONS

His theory : Each stage in his theory presents a central conflict crucial for
healthy personality development, emphasizing social and emotional challenges
over biological drives.

➢ He popularized the notion of an “identity crisis”, especially in adolescence,

underscoring the importance of exploring and establishing personal
identity as a key developmental task.
Example: A teenager experiments with different social groups and career
ideas during adolescence, navigating an identity crisis to form a stable
self-identity.

➢ His work has informed field of Psychology such as education, counseling,

psychotherapy, and social work, providing a useful framework for
understanding developmental challenges and promoting personal growth
across the lifespan.
Example: Educators use Erikson’s theory to create age-appropriate
curriculum and support systems tailored to the psychosocial challenges of
children and adolescents, such as facilitating identity formation in high
school students.

➢ He expanded on Freud’s work by emphasizing the strength and adaptive

functions of the ego, portraying it as a positive force that develops identity
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and manages psychosocial challenges rather than just a mediator of

unconscious drives
Example: Middle-aged adult uses ego strength to manage conflicts
between generativity (contributing to society) and stagnation (self-
absorption), demonstrating adaptive psychological functioning.

➢ Erikson emphasized the role of culture, society, and historical context in

shaping individual development, making his theory more comprehensive
and applicable across different environments.
Example: In a collectivist culture, a person’s development focuses more
on fulfilling social roles and obligations, showing how cultural context
shapes the way psychosocial stages manifest.

Biography of Erik H. Erikson (1902–1994)

Early Life and Background

➢ Erik H. Erikson was born on June 15, 1902 in Frankfurt, Germany. His
mother, Karla Abrahamsen, was Jewish, and for a time raised Erikson
alone before marrying a physician named Dr. Theodore Homberger. The
truth of Erikson’s paternity was kept secret from him for many years; he
eventually discovered that his “stepfather” was not his biological father,
creating a deep sense of identity confusion that would influence much of
his later work.

➢ Growing up, Erikson experienced confusion about his identity. He looked

Nordic with his blond hair and blue eyes, which made him stand out
among Jewish classmates, while his Jewish background led to exclusion
in German schools. This dual sense of not fully belonging to either group
deeply influenced his later theories on identity and psychosocial
development.

Education and Early Career

➢ Initially, Erikson pursued art and studied at an art school rather than
following a traditional academic path. Instead, he studied subjects like
history, Latin, and art in secondary school. His stepfather had encouraged
him toward a medical career, but Erikson resisted and eventually dropped
out of art school to wander and reflect upon his identity and purpose.
However, his life changed when he accepted a teaching position at a
progressive school founded by Dorothy Burlingham, where he met Anna
Freud, the daughter of Sigmund Freud. She encouraged him to train as a
psychoanalyst.
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➢ He received certification from both the Vienna Psychoanalytic Institute and

the Montessori Teachers Association, while undergoing psychoanalysis
himself with Anna Freud. This experience shaped his unique approach,
blending psychoanalysis with educational and cultural perspectives

Move to the United States

➢ In 1930, Erikson married Joan Serson, a Canadian dancer and teacher.

Together, they had three children, including Kai Erikson, who became a
noted sociologist.

➢ With the rise of Nazism, the Eriksons emigrated to the United States in
1933. Despite lacking a formal degree in medicine or psychology, Erikson
quickly earned recognition. He worked at Harvard Medical School and
later held positions at Yale, the University of California at Berkeley, the
San Francisco Psychoanalytic Institute, the Austen Riggs Center, and the
Center for Advanced Study in the Behavioral Sciences.

➢ It was during this period that he adopted the name Erik H. Erikson—
possibly as a symbolic act of defining his own identity.

Contributions to Psychology

➢ Erikson became famous for his theory of psychosocial development,

which expanded on Freud’s ideas. Unlike Freud, who focused mainly on
childhood and psychosexual stages, Erikson argued that development
continues across the entire lifespan.

➢ He outlined eight stages of psychosocial development, each defined by a

central conflict (such as trust vs. mistrust in infancy or identity vs. role
confusion in adolescence). How these conflicts are resolved determines
personality growth and psychological well-being.

➢ Erikson also introduced the influential concept of the “identity crisis”,

describing the challenges of forming a personal identity, especially during
adolescence.

Major Works and Recognition

His writings include:

➢ Childhood and Society (1950) – introduced his psychosocial theory

➢ Identity: Youth and Crisis (1968)

➢ Gandhi’s Truth – which won him both the Pulitzer Prize and the National
Book Award
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➢ Life History and the Historical Moment (1975) and The Life Cycle
Completed (1982)

➢ Erikson also conducted anthropological field studies, working with the

Sioux of South Dakota and the Yurok of Northern California, integrating
cultural insights into his theories.

Later Life and Legacy

➢ Erikson continued to write, teach, and practice throughout his life, often
with the collaboration of his wife Joan, who was also a thinker and writer.

➢ He died on May 12, 1994, at the age of 91.

➢ Erikson’s legacy lives on through his lifespan approach to development,

his concept of identity crisis, and his integration of culture, history, and
psychology. His theories remain widely taught and applied in psychology,
education, counseling, and social sciences today.
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LAWRENCE KOHLBERG

Theory of Moral Development

Group 2

➢ Born on October 25, 1927 in Bronxville, New York

➢ an American psychologist and educator

➢ Graduated from Phillips Academy in Andover, Massachusetts (1945)

➢ B.A. in Psychology (1948) and Ph.D. in Psychology (1958) from the University of
Chicago in Chicago, Illinois

➢ Worked as an assistant professor of psychology at Yale University (1958-1961)

➢ Worked at the Center for Advanced Study in the Behavioral Sciences in

California (1961-1962)

➢ Worked as an assistant and associate professor at the University of Chicago

(1962-1967)

➢ Worked as a professor of Education and Social Psychology at Harvard University

(1968)

➢ Published several books, including notable works such as "The Philosophy of

Moral Development" and "The Psychology of Moral Development"

➢ Died on January 17, 1987 in Boston, Massachusetts

BIOGRAPHY

Lawrence Kohlberg, an American psychologist and theorist, was born in

Bronxville, New York, USA, on October 25, 1927. He is a son of Alfred Kohlberg, a silk
merchant, and Charlotte Albrecht, an amateur chemist, and he was the youngest of four
children. His parents split when they were young; each of the children was ordered by
the court to choose which parent he or she would live with. Lawrence and the other
younger sibling chose his father, and the two older children went to their mother.

Kohlberg studied at Phillips Academy in Andover, Massachusetts, in 1945. After

that, he joined the U.S. Merchant Marine, where he helped smuggle Jewish refugees
into Palestine. past the British blockade. The ship was intercepted, and Kohlberg was
briefly imprisoned in a British internment camp in Cyprus before returning to the United
States. In 1948, he went to study psychology at the University of Chicago, where he
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completed his Bachelor of Arts in psychology in only one year and, in 1958, a Ph.D. in
psychology. After that, he taught at a number of different schools before going to
Harvard University in 1968. Inspired by Jean Piaget's work on the moral development of
children, his idea of moral development is what made him widely recognized. He
interviewed participants about challenging circumstances, such as whether stealing
medication to save a life could be justified, in order to study how children and later
adults develop moral reasoning. He created a six-stage model of moral reasoning
based on these interviews, which are divided into three stages: preconventional,
conventional, and postconventional. These stages show how people think, from viewing
morality in terms of punishment and rewards to social approval and law and finally to
abstract principles of justice and ethics.

Kohlberg’s theory widely influenced psychology and education by focusing on

how moral reasoning develops. However, it was criticized, especially by Carol Gilligan,
who said it was focused on male perceptions and ignored women’s perspectives.
Despite this, his work is still very influential in moral psychology. In 1971, while doing
research in Belize, Kohlberg became ill because of a parasitic infection that caused him
to be physically ill and depressed through much of the rest of his life. In 1987, he
committed suicide by walking into the icy Boston Harbor.

THEORY OF MORAL DEVELOPMENT

Lawrence Kohlberg's theory of moral development is an influential cognitive

theory proposing that individuals progress through six sequential stages of moral
reasoning, categorized into three levels: Preconventional, Conventional, and
Postconventional morality. Based on responses to moral dilemmas, the theory
emphasizes that the reasoning behind a decision, not the action itself, reveals a
person's stage. This reasoning evolves from self-interest and avoiding punishment to
upholding societal laws, and, ultimately, to basing judgments on universal ethical
principles.

Pre-conventional Stage

As kids we did good based on what we're told to or what we might gain from it.
Obeying commands to get rewarded for it, treating the elderly with traditional Filipino
practices like saying "po" and "opo", and "pagmamano" when meeting them to avoid
another lesson of Courtesy 101. All these are under the first level of Kohlberg's Moral
Development Theory, also known as the Pre-conventional Level. At this level, a child's
morality is solely driven by external factors such as their parents and environment. It is
then divided into two stages being the Obedience and Punishment Orientation, and the
Self-interest or Instrumental Orientation:
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➢ Moral Development Theory, the Obedience and Punishment Orientation, is

what a child first encounters on building their morality. In this stage, fear is our
main driving factor in doing something right as we obey rules to avoid being
punished. "Touch this and you'll get in trouble", "Don't eat sweets before eating
or you'll get a scolding", these phrases used by our parents to make us comply
with them consciously and unconsciously shape our concept of what's good and
bad to do.

➢ Self-interest or Instrumental Orientation, a child does something good in

exchange for a reward. Early on, our parents "bribe" us to do good. However, this
doesn't come only from our parents but also from people around us, especially
the elders. From simple treats such as a lollipop after a successful checkup with
the doctor to a brand new phone gifted after you got high grades, these rewards
also shape our belief that if we do good, we demand something in return.
Because of this rewards we tend to do more good deeds but lack of proper
discipline and control during this stage may contribute to future issues.

Conventional Stage

As we get older, our moral focus shifts from just ourselves to our place in society.
This is the Conventional Level of Kohlberg's theory. Instead of obeying to get a reward
or avoid a punishment, we start caring about social rules, group, expectations, and
being seen as a good person. Our morality is now based on conforming to what our
family, friends, and community believe is right. For instances, a student wouldn’t cheat
on a test because they believe it’s wrong to break the school’s rules and policies, and
they want their peers and teachers to see them as an honest student. At this level, we
have internalized society’s standards. The Conventional Level is split into two stages:

➢ Good Interpersonal Relationships or the “ Good Boy/Good Girl” , in this stage,

we are driven by the need for approval and maintaining loyalty in our
relationships. We define “good” as whatever pleases others and helps us keep
our connections with them. We think “A good friend would never let me down”
and act based on what will gain praise or avoid blame from people close to us.
For example, a student will agree to tutor a classmate after school, even if they
should be at home already, because they want to be seen by their friends and
teachers as a helpful, loyal, and kind student.

➢ Authority and Maintaining Social Order, Here, morality is focused on

upholding laws and rules for the sake of the whole society. We believe rules are
necessary for a stable and orderly society. We feel a duty to obey laws and
respect authority without a question. We follow rules, like traffic laws, not just
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because we’ll get a violation or consequence, but because those laws keep
everyone safe and prevent worst case scenarios. A great example of this, is
when a teacher strictly enforces all standardized testing procedures, even those
minor ones they personally disagree with, because they believe that the integrity
and fairness of the entire learning system depend on everyone fulfilling their legal
obligations. While this mindset is important for a stable society, people at this
level generally accept the laws as they are, without yet thinking about wether
those laws are fundamentally just or fair.

Post-conventional Stage

At the Post-Conventional Level of Kohlberg’s Moral Development Theory, an

individual’s sense of morality goes beyond the expectations of society and authority.
People at this level base their moral reasoning on personal principles and universal
ethical values rather than simply following laws or seeking approval. They begin to
realize that not all rules are just, and some may even go against the fundamental rights
of human beings. This level is often reached in adulthood, when a person develops
independent thinking and a deeper understanding of justice and equality. The Post-
Conventional Level is divided into two stages:

➢ Social Contract and Individual Rights, people start to see that laws are social
agreements meant to protect the welfare of everyone. However, when these laws
become unfair or oppressive, individuals believe they should be questioned or
changed. For instance, a citizen who peacefully protests against corruption or
inequality does so not because they want to break rules, but because they
believe that fairness and justice must prevail over blind obedience. These
individuals understand that true morality means protecting human dignity and the
common good.

➢ Universal Ethical Principles stage, at this highest level of moral reasoning,

individuals base their actions on deeply held moral principles such as justice,
respect, equality, and compassion. These principles are self-chosen and followed
even when they conflict with laws or public opinion. A person at this stage acts
according to conscience, guided by integrity and a sense of moral duty. A well-
known example would be figures like those who fought against discrimination or
human rights violations—standing firm for what is right despite the risk of
punishment or rejection

METAPARADIGM

1. Person

Moral development is the process by which people develop the distinction between right
and wrong (morality) and engage in reasoning between the two (moral reasoning). The
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purpose of his theory is to explain why and how our senses when it comes to “right and
wrong” develop and evolve as we grow up. It also emphasizes that instead of judging a
person solely based on the moral choice they made, the theory is interested in
understanding the thought process behind that choice.

Children: Understanding the theory of moral development is essential in guiding the

adult ones to lead their children as they develop their sense of moral sensitivity. This
Moral sensitivity is a first-step-necessity for ethical decision-making.

Teens and Adults: The theory states that moral presence guides teenagers and adults
in making decisions within the community and society, encouraging them to think about
what is ethically right and fair (Stages 4-6). It also emphasizes that morality helps
individuals recognize others’ perceptions and understand the impact of their own
decisions on others.

Medical Field: The theory helps the individuals in medical sectors to understand that
Patients should be viewed as partners in moral reasoning, capable of understanding,
evaluating, and deciding. This partnership encourages open communication and mutual
respect in clinical decision-making (Stage 6).

2. Environment

Lawrence Kohlberg’s theory focuses on how people develop their understanding of right
and wrong over time. While he did not clearly define his theory in terms of the
environment, it still highlights how important the surroundings and social world are in
shaping moral thinking. According to Kohlberg, people move through different stages of
moral development, and this growth happens through their experiences and interactions
with others (Sanders et al., 2025).

Key environmental aspects in Kohlberg’s theory include:

➢ Social Environment: Interactions with family, friends, teachers, and others help
shape how people think about moral issues. These relationships give individuals
chances to face moral questions and learn from different views.

➢ Moral Climate: The general tone or atmosphere of the environment—whether it is

fair, respectful, and open to discussion—can affect how someone develops
morally. Environments that support fairness and open thinking are more likely to
help people reach higher levels of moral understanding.

➢ Cultural Context: Some have criticized Kohlberg’s theory for focusing mostly on
Western values. This shows that different cultures may influence moral
development in different ways, and it is important to consider cultural differences
when applying the theory.
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Even though Kohlberg didn’t directly talk about the environment as a main part of his
theory specifically providing his metaparadigm, it’s clear that social and cultural
surroundings play a key role in how people grow morally.

3. Health

In this is a holistic state of well-being, It can be seen as the moral health or development
of ethical principles.

Nurses play a role in promoting ethical decision making and moral well-being in patients.

➢ A nurse's role is to promote the patient's ethical well-being by acting as a guide

through moral conflicts. A nurse can support the patient's ethical maturity and
help them make reasoned decisions about their own health.

● Moral Health: When a patient is experiencing an ethical dilemma, such as

whether to continue a difficult treatment, a nurse can facilitate a discussion that
helps the patient explore their own moral reasoning. This promotes their "moral
health" by helping them navigate the situation in a principled way.

4. Nursing

This focuses on the actions of the nurse. Nurses act as moral agents, guiding patients
through ethical principles.

➢ The theory informs professional conduct, ethical decision-making, and patient

advocacy. A nurse who has developed post-conventional reasoning (Stage 5 or 6)
will not just follow hospital policy but will challenge

➢ it if it infringes on a patient's rights or dignity. This allows them to function as true

patient advocates, grounded in universal ethical principles.

➢ Moral Agent: A nurse who identifies an unethical or unjust hospital policy that
harms patients can use post-conventional reasoning to challenge the policy and
advocate for systemic changes, even if it risks professional consequences. In this
way, the nurse's actions are guided by ethical principles that transcend rules or
social approval.
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KURT LEWIN

Theory of Planned Change

Group 3

This provides the background of the German-American psychologist Kurt Lewin.

This includes the planned change models developed by Kurt Lewin. These models

outline the processes that need to be followed for successful change realization. Lewin's

three-step model of change is one of the models discussed. Further, there is a

discussion on Kurt Lewin's force field analysis, which helps recognize the driving and

restraining forces involved in change. Examples are given for demonstration of how a

force field analysis should be carried out.

BIOGRAPHY

Who is Kurt Lewin?

Kurt Zadek Lewin “Kurt Lewin” has been regarded as the Father of Modern
Social Psychology and Change Management. He was the first to develop an
understanding of and incorporate the psychology of human behaviors into an
organization and the changes that take place within it. Lewin was able to develop the
concepts of "field theory" and "force field analysis” which were revolutionary. Due to this,
he developed planned change theory by implementing his field theory and seeing how
to shift human behavior.
Early Life and Education

Kurt Lewin is considered by many to be the most charismatic psychologist of his

generation. He was born on September 9, 1890, in Mogilno, Germany (now part of
Poland). He grew up in a Jewish family and showed great interest in science and
philosophy at an early age.

In 1909, he was studying medicine at the University of Freiburg, but then he

changed to the natural sciences at the University of Berlin. He got his Ph.D. in
psychology in 1916.

Career and Contributions

He received an Iron Cross after serving in the German Army as a private and
rising to the rank of lieutenant during World War I (1914). Lewin worked under Karl
Stumpf at the University of Berlin's Psychological Institute in 1921. Lewin also worked
with other Gestalt psychologists, including Max Wertheimer and Wolfgang Kohler.. This
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influenced his later studies about group dynamics, behavior, and change. After the war,
he became a professor at the University of Berlin and conducted pioneering research in
psychology and human behavior.

In 1932, Lewin came to the United States as a visiting professor at Stanford

University. His influence on America was sudden. With Fritz, a fellow refugee and close
friend from Berlin, and his American wife, Grace, he wrote Kurt Lewin’s Principles of
Topological Psychology. In 1933, when Adolf Hitler rose to power, He emigrated to the
United States. There, he taught at Cornell University, the University of Iowa, and the
Massachusetts Institute of Technology (MIT). At MIT, he founded the Research Center
for Group Dynamics. Lewin developed the ‘change’ experiment, which led to modern
sensitivity training. Carl Rogers described this training as “the most significant social
invention of this century.” This method became the basis of an organization started in
1947 as a direct result of the ‘change’ experiment (National Training Laboratories).

Death and Legacy

Kurt Lewin died on February 12, 1947, at the age of 56, in Newtonville,
Massachusetts, USA. Even after his death, his theories continue to influence nursing
education, management, psychology, and social sciences. He is often called the “Father
of Change Management” for his lasting contributions to understanding human behavior
and organizational transformation.

MAJOR THEORIES AND CONCEPT

Lewin is best known for developing the Field Theory and the Change Theory,
which are important in both psychology and nursing practice. Field Theory suggests that
behavior is a result of the individual and their environment (known as the “life space”).

Change Theory (Unfreeze–Change–Refreeze Model)

Explains how change occurs in three stages:

I. Unfreezing – recognizing the need for change.

II. Changing (or Moving) – implementing new behaviors or ideas.

III. Refreezing – stabilizing the new behavior as part of daily practice.

In nursing, Lewin’s Change Theory is widely used in nursing leadership, patient

care improvement, and organizational change. It helps nurses understand how to guide
individuals or groups through transitions, such as adopting new health practices or
implementing hospital policies.
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KURT LEWIN’S FIELD THEORY

● Force-Field Analysis

1. Field

A field can be viewed as a system. When a change occurs in one part or

aspect of the system, the whole system must be examined to determine the effect of

that change.

Example: The workplace in the hospital, where there are patients, parts of the

nursing staff , and families of patients.

2. Force

Directed entity that has the characteristics of direction, focus, and strength.

Lewin states that change is a move from the status quo that results in a

disruption in the balance of forces or forces or disequilibrium between opposing

factors. disequilibrium between opposing factors.

Example: The patients come and go all the time, doctors and nurses

running in and out of wards, and families of patients waiting or screaming for their

loved one to be cured.

● Two Forces

1. Driving Force

Encourages or facilitates movement to a new direction, goal, or outcome.

It should be identified and accentuated.

Example: Two doctors mid-performance on a patient in lapcolon surgery,

1 figuring out if what they are cutting is an artery or a vein, and 1 directing to

which part of the organ they should cauterize. Surgery ends successfully by not

cutting into an important artery.

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2. Restraining Force

Block or impede progress towards the goal. It should also be identified

and minimized to achieve the desired outcome or change.

Example: A janitor's cart parked in the middle of the hallway and gets in

the way of doctors trying to get from one patient to another, and stopping nurses

and trainees from delivering daily doses of medication to patients all around, the

solution is to move the cart out of harm's way.

● The Process

I. Define the Problem

The first step in force-field analysis is to carefully define the problem at

hand. Sometimes the need for change has more to do with taking advantage of

opportunities in the marketplace (e.g., a business may have the opportunity to

expand into a different kind of market). At other times, the change is needed to

fix a problem, such as an upgrade to a new computer system that will

computerize work that was previously done manually.

II. Describe the Outcome

Once the problem or opportunity has been thoroughly defined, the user

can outline the desired outcome of the process. What is the business or

organization hoping to achieve? What is the desired end result of the process?

This description should be as specific as possible and include measures for

results where appropriate.

Example: One business might measure results as a percentage of

increase in sales in a quarter or year; another might look at the percentage of

decrease in employee turnover over a specific period.

III. Identify the Driving Forces

Next, the user should consider all the factors or forces that support the

change. The factors under consideration will be highly dependent on the type of
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organization and the desired change. Some of the common factors might include

employees, customers, economic realities, future opportunities, and so on.

Example: the owner of a textile factory might wish to upgrade equipment

to produce a greater number of textiles more quickly, thus maximizing profits.

Some of the driving forces to be considered would include profit potential, an

increase in market share, ability to retain customers, ability to attract new

customers, employee eagerness to learn new technologies, and so on.

IV. Identify the Restraining Forces

On the opposite end of the spectrum are the forces that resist changes or

new opportunities. These forces may be related to the driving forces or they may

be other factors entirely. Some barriers to change can include money, employee

resistance, customer resistance, feelings of job insecurity, personality conflicts, a

lack of skills, a lack of training, problems with communications, difficulty with the

management structure, outdated equipment, and so on.

Example: Some restraining forces would include outdated equipment, a

lack of space, a need for training, unskilled workers, resistance to change, fear of

job loss, money or other resources spent purchasing the new items, and so on.

V. Develop an Action Plan

Once the driving and restraining forces have been identified, an action

plan can be set into place. This action plan is often part of a larger change

management strategy. Change management is a systematic process that

includes specific steps and activities to execute change in a workplace. Change

can occur by adding more impactful driving forces, turning a restraining force into

a driving force, or eliminating a restraining force where necessary.

CONCLUSION

Kurt Lewin's Field Theory is a technique used to analyze complex decisions in a

systematic, objective way. Force-field analysis is the process of identifying and

considering the factors or forces that both compel and resist change. Although force-
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field analysis can be used to consider problems at the individual level, it is generally

used to analyze obstacles that impact larger groups, such as corporations.

KURT LEWIN’S THEORY OF PLANNED CHANGE

Change does not appear randomly but needs a structured approach (Budoian,

2024). In order to improve the system, behavior, and performance, structured change

needs to be done. One of the most noteworthy theories for managing change is Kurt

Lewin’s Theory of Planned Change, developed in the 1940s. Lewin, as one of the

modern pioneers of social, organizational, and applied psychology, proposed that

successful change involves three key stages: unfreezing, change (or movement), and

refreezing. His model is still being widely used due to its simplicity and practicality.

Planned change is the process of preparing an entire organization, or a

significant part of it, to achieve new goals or move in a new direction (Pop, 2022). To

successfully achieve this goal, it involves proper strategy, preparation, and control.

Lewin’s model provides a clear process for how change can be effectively introduced

and stabilized.

Lewin’s Three-Stage Model of Change Theory:

1. Unfreeze

The first stage, unfreezing, focuses on preparing individuals or groups to accept

that change is necessary. This means challenging the current status quo—the

existing habits, attitudes, and behaviors that people are comfortable with.

Key actions in this stage include:

➢ Communicating the rationale for change to create awareness.

➢ Address fears and uncertainties

➢ Motivate people to let go of old ways.

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Example: Before implementing new enterprise software, the

organization’s leadership might conduct workshops to explain the benefits and

address concerns. These activities aim to reduce resistance and build

momentum.

2. Change

The change process as described by Lewin occurs when people begin to

support the changes that are being implemented. By demonstrating the benefit of

the desired change, people begin to feel more comfortable and accepting of the

new behavior (Stone and Hartzell, 2023).

Key actions in this stage include:

➢ Providing training and resources to build the necessary skills.

➢ Offering continuous support through coaching or mentoring.

➢ Monitoring progress and making adjustments as needed.

Example: They begin to suggest related changes that should occur, and

they begin to transition to the new way of doing things.

3. Refreeze

Refreeze is the final stage, aimed at stabilizing and embedding the

change into the organization’s culture. Without this stage, there’s a risk that

people will revert to the old ways of working. The goal is to reinforce new

behaviors and ensure they’re sustained over time (Prosci, 2024).

Key actions in this stage include:

➢ Establishing new policies and procedures to support the change.

➢ Recognizing and rewarding adherence to the new way of working.

➢ Continuously gathering feedback to identify areas for improvement.

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Example: A company implementing a new software, then providing

ongoing training, recognizing employees who use it correctly, and updating job

descriptions to reflect the new processes, thereby solidifying the change into

daily operations.

CONCLUSION

Kurt Lewin’s Theory of Planned change remains relevant because of its simplicity

and accessibility. His model’s three stages are easy to understand and diverse,

preventing any source of confusion, and is applicable across various industries and

organizational contexts. Lewin’s theory provides leaders with the tools to plan, execute,

and sustain transformation successfully. Ultimately, it emphasizes that change is not

just about new systems or structures—it’s about people adapting, learning, and growing.

METAPARADIGM

PERSON — The individual or group who experiences change, whose behaviors are

influenced by both internal and external forces.

➢ In Lewin's Theory, a person is viewed as a behavioral system that actively

responds to forces that can come from internally or externally. In a nursing

setting, a nurse's task to understand and consider these forces is important to

promote positive change.

Example: A person who realized they are sick and became motivated to

restore their health by changing their habits.

HEALTH — A dynamic state of equilibrium that is influenced by driving and restraining

forces, both of which exist within a field or environment.

➢ In Lewin's theory, health is defined as a state of balance that can be achieved

when driving and restraining forces are balanced in a positive way. Although

Lewin did not exactly define health, his theory suggests that it represents a state

of equilibrium influenced by forces that can induce positive or negative change.

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Additionally, in nursing, refreezing means achieving a healthier state through

effective change.

Example: A patient who has successfully changed his or her habits and

adopts a health-promoting lifestyle, achieves a healthier equilibrium.

ENVIRONMENT — In the stage of unfreezing, the environment supports individuals in

realizing the need to adapt during the phase of unfreezing by raising awareness and

challenging existing behaviors. In the changing stage, it provides supportive

circumstances. like psychological assistance, guidance, and access to essential

resources. which encourages individuals to accept new behaviors. Lastly, during

refreezing, the environment needs to remain stable and reinforcing to ensure that the

new behaviors are well sustained and established in their daily life.

NURSING — In the unfreezing stage, the nurse helps the individual recognize the

necessity for change by raising awareness and encouraging reflection on their current

behaviors. During the changing stage, the nurse encourages the adoption of new and

better behaviors by providing guidance, psychological support, and necessary

resources. Lastly, in the refreezing stage, the nurse ensures that the new behaviors are

maintained and become a regular part of the individual's daily life, supporting their

stability and ongoing growth.

IMPORTANCE

❖ Provides a Structured Framework for Change

➢ Based on Lewin’s theory the three main stages are Unfreezing, Change,

and Refreezing— that serve as a clear and organized guide for

implementing change. It prevents confusion and promotes deliberate

planning before action is taken. In the nursing field, this helps leaders and

staff to adapt new procedures smoothly, such as infection control

protocols or patient care guidelines.

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❖ Enhances the Quality, Efficiency, and Safety of Care

➢ Using the planned change process ensures that healthcare interventions

are introduced in a controlled and measurable way. It allows nurse leaders

to monitor progress, evaluate outcomes, and make evidenced-based

adjustments throughout implementation.

❖ Highlights the Role of Leadership and Force-Field Analysis

➢ Lewin introduced the concept of Force Field Analysis, which identifies

driving forces (factors that support change) and restraining forces (factors

that oppose it). By analyzing these forces, nurse leaders can develop

targeted strategies to strengthen drivers and minimize barriers. This

approach supports strategic decision-making, enabling leaders to

anticipate challenges and manage them effectively.

❖ Reduces Resistance to Change

➢ One of the greatest challenges in healthcare is staff resistance to new

policies or systems. Lewin’s model addresses this by emphasizing the

unfreezing stage, where awareness and readiness for change are created.

Through communication and participation, everyone, especially nurses,

will understand more the concept of change and support it

SUMMARY

Kurt Lewin's Theory of Planned Change provides a clear representation

for organizational change, having three stages: UNFREEZE - CHANGE - It

points out the necessity for individuals to prepare for acceptance of change, for

acquiring new behavior, and for normalizing such changes into organizational

culture. In addition, Lewin's Field Theory gives the concept of force-field analysis,

which scans driving and restraining factors of change. A field is regarded as a

structure of mutually interdependent connections such that anything changed has

implications for the entire [Link] influences push one towards a desired end,

while restraining influences create resistance. Change management requires

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effective identification of such influences, strengthening the drivers, lessening the

blockers, and designing a clear course of action

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JEAN PIAGET
Cognitive Development Theory

Jean Piaget was a Swiss psychologist, biologist, and genetic epistemologist,

born on August 9, 1896, in Neuchâtel, Switzerland. Renowned as one of the most
influential figures in the field of psychology, Piaget was the first to conduct a systematic
study about the acquisition of knowledge and understanding among children. His early
interest in biology and natural sciences influenced his view that human intelligence
evolves through adaptation to the environment.
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Through his pioneering work, Piaget established the foundation of developmental

psychology, influencing the fields of education, psychology, and nursing in
understanding how individuals think across the lifespan. He passed away on September
16, 1980, in Geneva, where he left a profound intellectual legacy that continues to
inform and inspire contemporary studies of human growth and cognition.

B IOGRA PHY
Fundamental Years

➢ At age 11, Piaget began his scientific career when he wrote and published a
short paper about his observation of an albino sparrow.

➢ During his teenage years, he developed a strong interest in mollusks and

became recognized as a young malacologist, making him publish several papers.

➢ After graduating from high school, he pursued natural sciences at the University
of Neuchâtel, where he later earned his Ph.D. and published two philosophical
essays that became the guiding light of his intellectual development.

➢ Piaget briefly attended the University of Zurich, where he became interested in

psychoanalysis, which furthered his understanding of the human mind.

➢ He then moved to Paris and worked at Alfred Binet’s laboratory, where he

standardized Burt’s intelligence test and conducted his first experimental studies
on children’s thinking processes. He noticed that children's incorrect answers
followed patterns that reflected differences in thinking rather than a lack of
knowledge.

➢ In 1921, Piaget was appointed Director of Studies at the J.J. Rousseau Institute
in Geneva, where he began his research on children’s cognitive development.
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➢ He married in 1923 and had three children, Jacqueline, Lucienne, and Laurent,
and studied his children's intellectual development from infancy.

➢ Between 1923 and 1929, he published a series of influential works on children’s

reasoning and moral judgment, both of which laid the foundation for his theory of
cognitive development.

➢ From 1929 to 1967, he worked at the International Bureau of Education and held
several academic positions in the social sciences field at different universities in
Switzerland. He promoted education that respected the stages of a child’s
intellectual growth.

➢ He was originally trained in the areas of biology and philosophy and considered
himself a "Genetic Epistemologist".

➢ In 1955, Piaget founded the International Center for Genetic Epistemology in

Geneva, which focuses on studying the origins and development of knowledge.

Significant Contributions

1) Constructivism in Nursing Education

➢ The Cognitive Development Theory posits that learners require active

participation and educational approaches that encourage interaction for the
organization and acquisition of knowledge. Through this, he encouraged
constructivist thought, that is, building an individual’s own knowledge and
understanding through their experiences and reflections.

➢ Jean Piaget’s theory had a great influence on the emergence of

developmental psychology as a distinctive subfield within psychology and
contributed greatly to the field of education. Through the Cognitive
Development Theory, pediatric nurses gain a deeper understanding of the
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stages of a child’s intellectual growth, enabling them to provide more age-

appropriate education tailored to a child’s respective cognitive abilities.

2) Theory of Moral Development

➢ The Theory of Moral Development by Jean Piaget serves as the foundation

of understanding how children develop their morality. Moral development
refers to the process through which children develop the standards of right
and wrong within their society, based on social and cultural norms and laws.

➢ Lawrence Kohlberg built upon the work of Jean Piaget and outlined how
individuals develop their sense of right and wrong through three levels and
six stages in his moral development theory. This provided emphasis on the
way a person responds to a problem, instead of simply focusing on the
action done itself.

THE THREE COMPONENTS OF COGNITIVE DEVELOPMENT THEORY

The theory formulated by Piaget is made up of three different components which

each helps to explain children’s cognitive development and the way in which they
construct their understanding of the world.

➢ Schemas

➢ Three Adaptation Processes

➢ Four Stages of Cognitive Development

Schema (plural: schemata)

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➢ It is a building block that provides a mental structure or framework that helps

individuals organize and interpret information.

➢ It represents a unit of knowledge

○ Example: A child's schema for a “dog” includes having four legs, fur, and
barking.

➢ In general, the learner actively builds schemata and revises them through
repeated exposure to new information—allowing them to understand complex
ideas over time.

The Process of Adaptation

➢ Piaget identified processes explaining how people adapt and build knowledge.

1. Assimilation

○ It is where a child applies an existing schema to a new experience or

object.

■ Example: A child who knows what a dog is may call a cat “dog”
because it fits their existing schema for four-legged animals.

2. Accommodation

○ It is where a child adjusts or changes existing schema when the new

information does not fit.

■ Example: The child learns that a cat is different from a dog and
forms a new schema for “cat.”
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3. Equilibration (Equilibrium)

○ where a child moves their development forward through accommodating

new knowledge and experiences.

■ Example: The child who thought the cat was a dog will need that
information to adjust their schema.

○ Essentially, it is the balance between assimilation and accommodation,

which further drives cognitive growth.

■ When new experiences challenge existing schemata,

disequilibrium occurs, which prompts learning to happen until
balance is restored.

COGNITIVE DEVELOPMENT THEORY

Cognitive Development Theory is a psychological framework proposed by Swiss

psychologist Jean Piaget, published in 1936 in his book The Origins of Intelligence in
Children. This theory refers to how children’s intelligence and their understanding of the
world advance through four progressive stages, namely: Sensorimotor, Preoperational,
Concrete Operational, and Formal Operational stages. And in each stage, the
development happens through processes of adaptation.

1. Sensorimotor Stage

➢ The first stage lasts from birth to 2 years old. On this stage, infants use
their senses (sight, touch, smell, and hearing) and physical movements to
explore and learn more about their environment.
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➢ According to Piaget, developing object permanence is one of the most

important accomplishments, like a game of peek-a-boo, for example. An
infant will believe that the other person or object has actually vanished and
will act shocked when the object reappears.

2. Preoperational Stage

➢ It begins around the age of 2 to 7 years old. During this stage, children
engage in symbolic play and learn to manipulate symbols (Language
Development) as evidenced by their increased playing and pretending.

➢ For example, a child can use an object to represent something else, such
as pretending a broom is a horse.

3. Concrete Operational Stage

➢ Children between the ages of 7 to 11 years old can think logically about
concrete objects and can thus add and subtract. The child also
understands conservation. The important processes during this stage are:

○ Seriation involves the ability to mentally arrange items along a

quantifiable dimension, such as height or weight.

○ Reversibility is the understanding that numbers or objects can

change

○ Classification is the ability to name and identify sets of objects

according to appearance

○ Conservation understands quantity, length, or numbers

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○ Transitivity, a concept from Piaget's theory of cognitive

development, states that children develop reversibility during the
concrete operational stage between ages 7 and 11.

○ Overcoming Egocentrism develops the ability to take others’

perspectives, understanding that thoughts, feelings, and viewpoints
differ from one's own.

4. Formal Operational Stage

➢ It begins around age 11 and lasts through adulthood. The adolescent can
reason abstractly and think in hypothetical terms.

○ Scientific Reasoning is the cognitive process of making evidence-

based decisions and forming beliefs systematically and objectively,
involving critical thinking to understand, interpret, and evaluate
scientific information.

○ Moral Reasoning, as we engage in deciding on what we ought or

ought not to do, or what is the most reasonable or just position or
policy regarding a particular issue. Effective moral decision-making
depends on good critical-thinking skills, familiarity with basic moral
values, and the motivating force of moral sentiments.

○ Critical Analysis involves deeply examining and interpreting a text,

concept, or work to gain a deeper understanding of its content and
implications.

○ Perspective-taking is the cognitive ability to intentionally consider a

situation from another person's point of view, understanding their
thoughts, feelings, beliefs, and experiences, rather than just your
own.
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○ Continual Language Development, the ongoing process where

humans acquire, understand, and use language, progressing from
basic sounds and words to complex grammar, vocabulary, and
sophisticated communication.

APPLICATION TO METAPARADIGM

Person

➢ The nurse should know the patient’s development stages to provide appropriate
care and education based on the learner’s level of thinking. This theory focuses
on the mental development of the child, stating that the nurse can provide care
and support for learning and growth.

Health

➢ It is defined as explaining how learning, thinking, and understanding can change

a person as they grow. By knowing each stage, nurses can promote health by
understanding patients in different developmental stages, and they can also
adjust their communication to fit the patient’s level of understanding.

Environment

➢ The environment shapes cognitive development through interaction and

experience. Piaget saw it as essential for learning. In nursing, it should support
the patient’s developmental stage, creating a safe, stimulating, and
developmentally appropriate environment that supports learning, adaptation, and
overall cognitive growth.

Nursing

➢ It focuses on helping patients learn according to their developmental stages.

Nurses should adjust their communication and teaching methods to match
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patients' understanding levels. This method encourages patients to take an

active role in their care, leading to better health outcomes and effective self-
management.
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SIGMUND FREUD
Psycho-sexual Theory of Human Development

Theorist:
Sigmund Freud was an Austrian neurologist and the founder of psychoanalysis. He is
best known for developing theories that explain human behavior through unconscious
motives, desires, and early childhood experiences. Freud believed that personality
develops through a series of stages centered on erogenous zones, which he called the
psychosexual stages of development — oral, anal, phallic, latency, and genital. Each
stage represents a conflict that must be resolved for healthy psychological growth. His
ideas introduced key concepts such as the id, ego, and superego, which describe the
structure of the human mind and how behavior is influenced by both conscious and
unconscious processes. Despite being controversial, Freud’s work has had a major
influence on psychology, psychiatry, and nursing, especially in understanding human
emotions and developmental behavior.

Biography:
Born: May 6, 1856, Sigmund Freud’s Psychosexual Theory of Human
Development
Birthplace: Freiberg, Moravia
Died: September 23, 1939
Location of death: London, England
Cause of death: Euthanasia [1]
Remains: Cremated, Golders Green Crematorium, London, England

Gender: Male
Religion: Atheist
Race or Ethnicity: White
Occupation: Psychiatrist
Nationality: Austria
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Executive summary: Die Traumdeutung

PSYCHOSEXUAL THEORY OF DEVELOPMENT

Sigmund Freud’s psychosexual theory explains how personality develops through a

series of stages centered on different pleasure-seeking areas of the body. He believed
that early childhood experiences play a crucial role in shaping an individual’s behavior
and personality.

Freud identified five stages of psychosexual development:

1. Oral Stage (0–1 year) – Pleasure focuses on the mouth (sucking, biting).
2. Anal Stage (1–3 years) – Focus on controlling bowel and bladder movements.
3. Phallic Stage (3–6 years) – Focus on genitals; development of Oedipus/Electra
complex.
4. Latency Stage (6–puberty) – Sexual feelings are inactive; focus on learning and
social skills.
5. Genital Stage (puberty–adulthood) – Maturation of sexual interests and establishment
of mature relationships.
If a person becomes fixated at a certain stage due to unresolved conflicts, it may lead to
personality issues in adulthood.

METAPARADIGM CONCEPT | FREUD’S PERSPECTIVE & NURSING IMPILATION

Person

➢ A person is more than the body or the conscious mind—they also have
unconscious processes, internal conflicts, and defense mechanisms. In nursing,
this means recognizing that patient behavior may not always be fully “rational,”
 PAMANTASAN NG LUNGSOD NG MARIKINA
COLLEGE OF NURSING

and that hidden motives or past experiences influence responses.

Health

➢ Health is a dynamic balance among psychic forces (id, ego, superego) and the
ability to manage conflict adaptively. Illness may manifest when unresolved
internal conflicts or repressed impulses disrupt psychological equilibrium.

Environment

➢ Environment includes early childhood context, family relationships, social norms,

and external stressors that shape personality development and unconscious
patterns. Nurses must see the patient in the context of their life history and social
relationships.

Nursing

➢ From Freud’s lens, nursing involves more than physical care—it includes
therapeutic communication, interpretation of patient cues (verbal & nonverbal),
and managing transference/countertransference in nurse–patient relationships.
Nurses should be aware of how unconscious dynamics could influence care, and
maintain self-awareness and boundaries.

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