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Life Perspective Rhythm Model Joyce Fitzpatrick Introduction Life Perspective Rhythm Model is a nursing model developed by Joyce J Fitzpatrick. She conceptualized her model from Martha Rogers' Theory of Unitary Human beings. About the Theorist

"A developing discipline whose central concern is the meaning attached to life (health) Primary purpose of nursing is the promotion and maintenance of an optimal level of wellness.

The human is unitary, continuously coconstituting patterns of relating. The human is transcending multidimensionally with the possibles

About Becoming

Metaparadigm It refers to the transitions through basic metaparadigm concepts of person, environment, health and nursing. Conclusion Life Perspective Rhythm Model is a complex nursing model which contribute to nursing knowledge by providing taxonomy for identifying and labeling nursing concepts to allow for their universal recognition and communication with others. Human Becoming Theory Rosemarie Rizzo Parse INTRODUCTION The Parse theory of human becoming guides nurses In their practice to focus on quality of life as it is described and lived (Karen & Melnechenko, 1995). The human becoming theory of nursing presents an alternative to both the conventional bio-medical approach and the bio-psycho-social-spiritual (but still normative) approach of most other theories of nursing.(ICPS) The human becoming theory posits quality of life from each person's own perspective as the goal of nursing practice.(ICPS) Rosemarie Rizzo Parse first published the theory in 1981 as the "Man-living-health" theory (ICPS) The name was officially changed to "the human becoming theory" in 1992 to remove the term "man," after the change in the dictionary definition of the word from its former meaning of "humankind." ABOUT THE THEORIST

Born in 1944 BSN - Georgetown University MS in psychiatric-mental health nursing Ohio State University PhD in nursing - New York University and an MBA from Case Western Reserve University. Fellow in the American Academy of Nursing - 1981 Presently, Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.

Becoming is unitary human-living-health. Becoming is a rhythmically coconstituting human-universe process. Becoming is the humans patterns of relating value priorities. Becoming is an intersubjective process of transcending with the possibles. Becoming is unitary humans emerging

Three Major Assumptions of Human Becoming

Meaning

Major Assumptions

Human Becoming is freely choosing personal meaning in situations in the intersubjective process of living value priorities. Mans reality is given meaning through lived experiences Man and environment cocreate

"The process of human development is characterized by rhythms that occur within the context of continuous personenvironment interaction." Nursing activity focuses on enhancing the developmental process toward health. A central concern of nursing science and the nursing profession is the meaning attributed to life as the basic understanding of human existence. The identification and labeling of concepts allows for recognition and communication with others, and the rules for combining those concepts permits thoughts to be shared through language.

Rhythmicity

Human Becoming is cocreating rhythmical patterns of relating in mutual process with the universe. Man and environment cocreate ( imaging, valuing, languaging) in rhythmical patterns

Core Concepts Rhythm Model includes four content concepts and they are:

Educated at Duquesne University, Pittsburgh MSN and Ph.D. from University of Pittsburgh Published her theory of nursing, ManLiving-Health in 1981 Name changed to Theory of Human Becoming in 1992 Editor and Founder, Nursing Science Quarterly Has published eight books and hundreds of articles about Human Becoming Theory Professor and Niehoff Chair at Loyola University, Chicago

Transcendence

Human Becoming is cotranscending multidimensionally with emerging possibles. Refers to reaching out and beyond the limits that a person sets One constantly transforms SUMMARY OF THE THEORY

Person

person health wellness-illness and metaparadigm.

Person includes both self and others. Person is seen as an open system , a unified whole characterized by a basic human rhythm. The model recognizes individuals as having unique biological, psychological, emotional, social, cultural, and spiritual attitudes.

THEORY DEVELOPMENT

Human Becoming Theory includes Totality Paradigm Man is a combination of biological, psychological, sociological and spiritual factors Simultaneity Paradigm Man is a unitary being in continuous, mutual interaction with environment Originally Man-Living-Health Theory

Health

The human becoming theory was developed as a human science nursing theory in the tradition of Dilthey, Heidegger, Sartre, Merleau-Ponty, and Gadamer and Science of Unitary Human Beings by Martha Rogers . The assumptions underpinning the theory were synthesized from works by the European philosophers, Heidegger, Sartre, and Merleau-Ponty, along with works by the pioneer American nurse theorist, Martha Rogers. The theory is structured around three abiding themes: meaning, rhythmicity, and transcendence.

Health is a dynamic state of being that results from the interaction of person and the environment. 'a human dimension under continuous development, a heightened awareness of the meaningfullness of life. Optimum health is the actualization of both innate and obtained human potential gathered from rewarding relationships with others, goal directed behavior, and expert personal care.

NURSING PARADIGMS AND PARSE'S THEORY

Person Open being who is more than and different from the sum of the parts Environment Everything in the person and his experiences Inseparable, complimentary to and evolving with Health Open process of being and becoming. Involves synthesis of values Nursing A human science and art that uses an abstract body of knowledge to serve people SYMBOL OF HUMAN BECOMING THEORY

ASSUMPTIONS About man

Wellness-llness

Nursing

Professional nursing is rooted in the promotion of wellness practices.

The human is coexisting while coconstituting rhythmical patterns with the universe. The human is open, freely choosing meaning in situation, bearing responsibility for decisions.

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Black and white = opposite paradox significant to ontology of human becoming and green is hope Center joined =co created mutual human universe process at the ontological level & nurse-person process Green and black swirls intertwining = human-universe co creation as an ongoing process of becoming

Makes a substantial difference in the lives of clients and nurses

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3. RESEARCH ON PARSE'S THEORY 1. 2. 3. 4. Nursing practice in human becoming: the "Parse nurse" in French Switzerland The lived experience of suffering: a parse research method study On joy-sorrow: a paradoxical pattern of human becoming Human becoming criticism--a critique of Florczak's study on the lived experience of sacrificing something important A Human Becoming perspective on quality of life Feeling respected: a Parse method study Health As Expanding Consciousness Margaret Newman Health is the expansion of consciousness. Newman, 1983 INTRODUCTION 4. 5.

STRENGTH AND WEAKNESSES Strengths

6.

These pathological conditions can be considered a manifestation of the total pattern of the individual The pattern of the individual that eventually manifests itself as pathology is primary and exists prior to structural or functional changes Removal of the pathology in itself will not change the pattern of the indivdual If becoming ill is the only way an individual's pattern can manifest itself, then that is health for that person Health is an expansion of consciousness.

DESCRIPTION OF THE THEORY The theory of health as expanding consciousness (HEC) was stimulated by concern for those for whom health as the absence of disease or disability is not possible. Nurses often relate to such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness. The theory has progressed to include the health of all persons regardless of the presence or absence of disease. The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world (Newman, 2010). Humans are open to the whole energy system of the universe and constantly interacting with the energy. With this process of interaction humans are evolving their individual pattern of whole. According to Newman understanding the pattern is essential. The expanding consciousness is the pattern recognition. The manifestation of disease depends on the pattern of individual so the pathology of the diseases exists before the symptoms appear so removal of disease symptoms does not change the individual structure. Newman also redefines nursing according to her nursing is the process of recognizing the individual in relation to environment and it is the process of understanding of consciousness. The nurse helps to understand people to use the power within to develop the higher level of consciousness. Thus it helps to realize the disease process, its recovery and prevention. Newman also explains the interrelatedness of time, space and movement. Time and space are the temporal pattern of the individual, both have complementary relationship. Humans are constantly changing through time and space and it shows unique pattern of reality. NURSING PARADIGMS Health

Weaknesses

5. Differentiates nursing from other disciplines Practice - Provides guidelines of care and useful administration Useful in Education Provides research methodologies Provides framework to guide inquiry of other theories (grief, hope, laughter, etc.) 6.

Research considered to be in a closed circle Rarely quantifiable results - Difficult to compare to other research studies, no control group, standardized questions, etc. Does not utilized the nursing process/diagnoses Negates the idea that each person engages in a unique lived experience Not accessible to the novice nurse Not applicable to acute, emergent care

The theory of health as expanding consciousness stems from Rogers' theory of unitary human beings. The theory of health as expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible, (Newman, 2010). The theory has progressed to include the health of all persons regardless of the presence or absence of disease, (Newman, 2010). The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world, (Newman, 2010).

APPLICATION OF THE THEORY Nursing Practice

Research

A transformative approach to all levels of nursing Differs from the traditional nursing process, particularly in that it does not seek to fix problems Ability to see patients perspective allows nurse to be with patient and guide them toward desired health outcomes Nurse-person relationship cocreates changing health patterns

BACHGROUND OF THE THEORIST

Born on October 10, 1933. Bachelors degree - University of Tennessee in 1962 Masters degree - University of California in 1964 Doctorate - New York University in 1971 She has worked in - University of Tennessee, New York University, Pennsylvania State University, University of Minnesotat, University of Minnesota Link to her Biography

Enhances understanding of human lived experience, health, quality of life and quality of nursing practice Expands the theory of human becoming Builds new nursing knowledge about universal lived experiences which may ultimately contribute to health and quality of life

THEORY DEVELOPMENT She was influenced by following theorists:

CRITIQUE

Congruence with personal values o Nurse must subscribe to this world view to truly use it Congruence with other professional values o Complements and competes with other health care professionals values o Exoteric foundations o Esoteric utility Congruence with social values o Fulfills societys expectations of nursing role Social Significance

Martha Rogers o Martha Rogers theory of Unitary Human Beings was the main basis of the development of her theory, Health as Expanding Consciousness Itzhak Bentov The concept of evolution of consciousness Arthur Young The Theory of Process David Bohm The Theory of Implicate

Health and illness are synthesized as health - the fusion on one state of being (disease) with its opposite (non-disease) results in what can be regarded as health.

Nursing

ASSUMPTIONS 1. Health encompasses conditions heretofore described as illness, or, in medical terms, pathology

Nursing is caring in the human health experience. Nursing is seen as a partnership between the nurse and client, with both grow in the sense of higher levels of consciousness

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Human developing awareness of self and the environment The human is unitary, that is cannot be divided into parts, and is inseparable from the larger unitary field Persons as individuals, and human beings as a species are identified by their patterns of consciousness The person does not possess consciousness-the person is consciousness. Persons are centers of consciousness within an overall pattern of expanding consciousness Introduction successful, the driving force must dominate the resistant force. Rogers' Change Theory Everette Rogers modified Lewin's change theory and created a five-stage theory of his own. The five stages are awareness, interest, evaluation, implementation and adoption. This theory is applied to long-term change projects. It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially. Spradley's Change Theory This is an eight-step process for planned change based on Lewin's theory of change. It makes provision for constant evaluation of the change process to ensure its success. The steps are: recognize the symptoms, diagnose the problem, analyze alternative solutions, select the change, plan the change, implement the change, evaluate the change and stabilize the change. Other Theories

Consciousness is a manifestation of an evolving pattern of person-environment interaction Systems Theory in Nursing

Systems theory may be considered as a specialization of systems thinking and a generalization of systems science. First proposed by Ludwig von Bertalanffy (1901-1972) as General Systems theory. General systems theory is a general science of 'wholeness'. Systems theory has been applied in developing nursing theories and conducting nursing research.

Environment

Environment is described as a universe of open systems

STRENGTHS AND WEAKNESSES Characteristics of systems Strengths

Can be applied in any setting Generates caring interventions

"Systems" refer specifically to selfregulating systems. Systems are self-correcting through feedback. Systems have a structure that is defined by its parts and processes. Systems are generalizations of reality. The various parts of a system have functional as well as structural relationships between each other. Systems tend to function in the same way. Every living organism is essentially an open system.

Reddin's, Lippitt's and Havelock's theories are based on Lewin's theory and can be used to implement planned change. The first two have seven stages, while the third has six. Real Life Application An article titled "Managing change in the nursing handover from traditional to bedside handover---a case study from Mauritius" details the use of Lewin's and Spradley's theories to implement a change in the process of handover reports between nurses. The driving force in this case was dissatisfaction with the traditional handover method, while the resistant forces were a fear of accountability, lack of confidence and fear that this change would lead to more work. Evaluation of the implemented change showed that the new process was successfully implemented.

W eaknesses

CRITIQUE Clarity

Abstract Multi-dimensional Qualitative Little discussion on environment

Systems theory and Nursing

Semantic clarity is evident in the definitions, descriptions, and dimensions of the concepts of the theory.

Simplicity

The deeper meaning of the theory of health as expending consciousness is complex. The theory as a whole must be understood, nut just the isolated concepts.

Many nursing theorists have drwan from the works of von Bertalanffy on systems theory. o Neuman's Systems Theory o Rogers 's Theory of Unitary Huamn Beings o Roy's Adaptation Model o Imogene King's Theory of Goal Attainement o Orem Self-care Deficit Theory o Johnson's Behaviour Systems Model

Development of Nursing Theories Introduction

Theories are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature. Theories are composed of concepts, definitions, models, propositions & are based on assumptions. Theory gives planners tools for moving beyond intuition to design and evaluate health behavior and health promotion interventions based on understanding of behavior.[Robert T. Croyle (2005)]. They are derived through two principal methods; deductive reasoning and inductive reasoning. Nursing theorists use both of these methods. Theory is a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena. A theory makes it possible to organize the relationship among the concepts to describe, explain, predict, and control practice

Generality

Change Theories in Nursing Change means making something different from the way it was originally. Change may be planned or unplanned. Unplanned changes bring about unpredictable outcomes, while planned change is a sequence of events implemented to achieve established goals. In nursing a change agent is a person who brings about changes that impact nursing services. The change agent may be a nurse leader, staff nurse or someone who works with nurses. Change theories are used to bring about planned change in nursing. Nurses and nurse leaders must have knowledge of change theories and select the right change theory as all the available change theories in nursing do not fit all nursing change situations. 1. "Dosimeter" is Copyrighted by Flickr user: ...eagan under the Creative Commons Attribution license.

The theory has been applied in several different cultures It is applicable across the spectrum of nursing care situations.

Empirical Precision

Quantitative methods are inadequate in capturing the dynamic, changing nature of this theory.

Derivable Consequences

Newman's theory provides an evolving guide for all health-related disciplines.

Definition CONCLUSION Newman's theory can be conceptualized as Lewin's Change Theory Kurt Lewin's change theory is widely used in nursing and involves three stages: the unfreezing stage, moving stage, and refreezing stage. Lewin's theory depends on the presence of driving and resistant forces. The driving forces are the change agents who push employees in the direction of change. The resistant forces are employees or nurses who do not want the proposed change. For this theory to be Concepts are basically vehicles of thought that involve images. Concepts are words that describe objects, properties, or events & are basic components of theory. Types: 1. 2. Empirical concepts Inferential concepts

A grand theory of nursing Humans can not be divided into parts Health is central to the theory and is seen and is seen as a process of

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3. Definitions Abstract concepts

increasing the general body of knowledge within the discipline through the research implemented to validate them. used by the practitioners to guide and improve their practice. consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated.

5.

Models are representations of the interaction among and between the concepts showing patterns. Propositions are statements that explain the relationship between the concepts. Process it is a series of actions, changes or functions intended to bring about a desired result. During a process one takes systemic & continuous steps to meet a goal & uses both assessments & feedback to direct actions to the goal. A particular theory or conceptual frame work directs how these actions are carried out. The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks & theories define the person (patient), the environment, health & nursing. The terms model and theory are often wrongly used interchangeably, which further confounds matters. In nursing, models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981). They provide an overview of the thinking behind the theory and may demonstrate how theory can be introduced into practice, for example, through specific methods of assessment. Models are useful as they allow the concepts in nursing theory to be successfully applied to nursing practice (Lancaster and Lancaster 1981). Their main limitation is that they are only as accurate or useful as the underlying theory.

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Basic processes in the development of nursing theories Nursing theories are often based on & influenced by broadly applicable processes & theories. Following theories are basic to many nursing concepts. General System Theory It describes how to break whole things into parts & then to learn how the parts work together in systems. These concepts may be applied to different kinds of systems, e.g. Molecules in chemistry, cultures in sociology, and organs in Anatomy & Health in Nursing. Adaptation Theory It defines adaptation as the adjustment of living matter to other living things & to environmental conditions. Adaptation is a continuously occurring process that effects change & involves interaction & response. Human adaptation occurs on three levels :

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8.

9.

10. 11.

12.

emotional, intellectual, social, and spiritual needs of the client and family. Orlando 1962: To Ida Orlando (1960), the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being. Johnsons Theory 1968: Dorothy Johnsons theory of nursing 1968 focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery. Rogers 1970: to maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through humanistic science of nursing Orem1971: This is self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs. King 1971: To use communication to help client reestablish positive adaptation to environment. Neuman 1972: Stress reduction is goal of system model of nursing practice. Roy 1979: This adaptation model is based on the physiological, psychological, sociological and dependenceindependence adaptive modes. Watsons Theory 1979: Watsons philosophy of caring 1979 attempts to define the outcome of nursing activity in regard to the; humanistic aspects of life.

Classification of nursing theories A. Depending On Function (Polit et al 2001) 1. 2. 3. 4. Descriptive-to identify the properties and workings of a discipline Explanatory-to examine how properties relate and thus affect the discipline Predictive-to calculate relationships between properties and how they occur Prescriptive -to identify under which conditions relationships occur

Importance of nursing theories

1. The internal (self) 2. The social (others) & 3. the physical (biochemical reactions)

Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs1978). It should provide the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964). Theory is important because it helps us to decide what we know and what we need to know (Parsons1949). It helps to distinguish what should form the basis of practice by explicitly describing nursing. The benefits of having a defined body of theory in nursing include better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education (Nolan 1996). The main exponent of nursing caring cannot be measured, it is vital to have the theory to analyze and explain what nurses do. As medicine tries to make a move towards adopting a more multidisciplinary approach to health care, nursing continues to strive to establish a unique body of knowledge. This can be seen as an attempt by the nursing profession to maintain its professional boundaries.

Developmental Theory

It outlines the process of growth & development of humans as orderly & predictable, beginning with conception & ending with death. The progress & behaviors of an individual within each stage are unique. The growth & development of an individual are influenced by heredity, temperament, emotional, & physical environment, life experiences & health status.

B. Depending on the Generalisability of their principles 1. Metatheory: the theory of theory. Identifies specific phenomena through abstract concepts. Grand theory: provides a conceptual framework under which the key concepts and

2.

C. Principles of the discipline can be identified. 1. Middle range theory: is more precise and only analyses a particular situation with a limited number of variables. Practice theory: explores one particular situation found in nursing. It identifies explicit goals and details how these goals will be achieved.

Common concepts in nursing theories Four concepts common in nursing theory that influence & determine nursing practice are:

2.

The person (patient). The environment Health Nursing (goals, roles, functions) D. Based on the philosophical underpinnings of the theories 1. 2. 3. 4. Needs theories. Interaction theories. Outcome theories. Humanistic theories.

Each of these concepts is usually defined & described by a nursing theorist, often uniquely; although these concepts are common to all nursing theories. Of the four concepts, the most important is that of the person. The focus of nursing, regardless of definition or theory, is the person. Historical perspectives and key concepts

1. Needs theories These theories are based around helping individuals to fulfill their physical and mental needs. Needs theories have been criticized for relying too much on the medical model of health and placing the patient in an overtly dependent position. 2.Interaction theories As described by Peplau (1988), these theories revolve around the relationships nurses form with patients.

The characteristics of theories Theories are: 1.

interrelating concepts in such a way as to create a different way of looking at a particular phenomenon. logical in nature. generalizable. bases for hypotheses that can be tested.

2. 3. 4.

Nightingale (1860): To facilitate the bodys reparative processes by manipulating clients environment Peplau 1952: Nursing is; therapeutic interpersonal process. Henderson 1955: The needs often called Hendersons 14 basic needs Abdellah 1960: The nursing theory developed by Faye Abdellah et al (1960) emphasizes delivering nursing care for the whole person to meet the physical,

Such theories have been criticized for largely ignoring the medical model of health and not attending to basic physical needs. General systems theory states

3. Outcome theories"

A system is defined as a whole with interrelated parts, in which the parts have a function and the system as a totality has a function. A general systems approach allows for consideration of the subsystems levels of the human being, as a total human being, and as a social creature who networks himself with others in hierarchically arranged human systems of increasing complexity. Thus the human being, from the level of the individual to the level of society, can be conceptualized as the client and becomes the target system for nursing intervention (Sills & Hall, 1977).

Stress: a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance

Betty Neumans Health Care Systems Model Betty Neuman specifies that the purpose of nursing is to facilitate optimal client system stability.

Oucome theories portray the nurse as the changing force, who enables individuals to adapt to or cope with ill health.

Outcome theories have been criticized as too abstract and difficult to implement in practice.

Normal line of defense: an adaptational level of health considered normal for an individual Lines of resistance: protection factors activated when stressors have penetrated the normal line of defense

4. Humanistic Theories An example of systems interaction Humanistic theories developed in response to the psychoanalytic thought that a persons destiny was determined early in life.

Humanistic theories emphasize a persons capacity for self-actualization. Humanists believe that the person contains within himself the potential for healthy & creative growth. Carl Rogers developed a person centered model of psychotherapy that emphasizes the uniqueness of the individual. The major contribution that Rogers added to nursing practice is the understandings that each client is a unique individual, so, person-centered approach now practice in nursing.

Input (Diet teaching) Throughput (Assimilation of information) Output (Food intake) Feedback (Weight record, Hb estimation etc.)

Neumans model, organized around stress reduction, is concerned primarily with how stress and the reactions to stress affect the development and maintenance of health. The person is a composite of physiologic, psychological, sociocultural, developmental, and spiritual variables considered simultaneously. Ideally the five variables function harmoniously or are stable in relation to internal and external environmental stressor influences (Neuman, 2002).

Two nursing models based on systems theory: 1. 2. Imogene Kings systems interaction model, and Betty Neumans health care systems model.

A person is constantly affected by stressors from the internal, external, or created environment. Stressors are tension-producing stimuli that have the potential to disturb a persons equilibrium or normal line of defense. This normal line of defense is the persons usual steady state. It is the way in which an individual usually deals with stressors.

Major Concepts as Defined in Kings Model

Models of nursing A model, as an abstraction of reality, provides a way to visualize reality to simplify thinking.

Person (Human Being)

A personal system that interacts with interpersonal and social systems

A context within which human beings Environment grow, develop, and perform daily activities dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of ones resources to achieve maximum potential for daily living A process of human interaction

A conceptual model shows how various concepts are interrelated and applies theories to predict or evaluate consequences of alternative actions.

Stressors may be of three types: 1. 2. 3. Intrapersonal: forces arising from within the person Interpersonal: forces arising between persons Extrapersonal: forces arising from outside the person

Health

According to Fawcett (2000), A conceptual model gives direction to the search for relevant questions about the phenomena of central interest to a discipline and suggests solutions to practical problems Four concepts are generally considered central to the discipline of nursing: the person who receives nursing care (the patient or client); the environment (society); nursing (goals, roles, functions); and health. These four concepts form a metaparadigm of nursing. The term metaparadigm comes from the Greek prefix meta, which means more comprehensive or transcending, and the word Greek word paradigm, which means a philosophical or theoretical framework of a discipline upon which all theories, laws, and generalizations are formulated (Merriam-Websters Collegiate Dictionary, 1994). Categories of Conceptual Models Ten conceptual models of nursing have been classified according to two criteria:

Nursing

Imogene Kings Systems Interaction Model In interaction model, the purpose of nursing is to help people attain, maintain, or restore health. Kings model conceptualizes three levels of dynamic interacting systems. 1. Individuals are called personal systems. 2. Groups (two or more persons) form interpersonal systems. 3. Society is composed of social systems. Resistance to stressors is provided by a flexible line of defense, a dynamic protective buffer made up of all variables affecting a person at any given moment the persons resistance to any given stressor or stressors. If the flexible line of defense is no longer able to protect the person against a stressor, the stressor breaks through, disturbs the persons equilibrium, and triggers a reaction. The reaction may lead toward restoration of balance or toward death. Neuman intends for the nurse to assist clients to retain, attain, or maintain optimal system stability (Neuman, 1996). Thus, health (wellness) seems to be related to dynamic equilibrium of the normal line of defense, where stressors are successfully overcome or avoided by the flexible line of defense. Neuman defines illness as a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002). Illness appears to be a separate state when a stressor breaks through the normal line of defense and causes a reaction with the persons lines of resistance. Stress/Adaptation Theory as a Framework In contrast to systems theory, stress and adaptation theories view change caused by personenvironment interaction in terms of cause and effect. The person must adjust to environmental changes to avoid disturbing a balanced existence. Adaptation

As the person interacts with the environment, he or she must continuously adjust to stressors in the internal and external environment (King, 1981). Health assumes achievement of maximum potential for daily living and an ability to function in social roles. It is the dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of ones resources to achieve maximum potential for daily living (King, 1981,). Illness is a deviation from normal, that is, an imbalance in a persons biological structure or in his psychological makeup, or a conflict in a persons social relationships (King, 1989). The goal of nursing is to help individuals and groups attain, maintain, and restore health

the world view of change reflected by the model (growth or stability); and the major theoretical conceptual classification with which the model seems most consistent (systems, stress/adaptation, caring, or growth/development).

1.Systems Theory as a Framework

Systems theory is concerned with changes caused by interactions among all the factors (variables)

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theory provides a way to understand both how the balance is maintained and the possible effects of disturbed equilibrium. This theory has been widely applied to explain, predict, and control biologic (physiologic and psychological) phenomenon. Criticisms of nursing theories To understand why nursing theory is generally neglected on the wards it is necessary to take a closer look at the main criticisms of nursing theory and the role that nurses play in contributing to its lack of prevalence in practice. Summarization - creating the circumstances where people can use their faculties and abilities at the maximum level in the pursuit of common goals 16 Filipinos , 11 of whom are children, die everyday from diarrhea 2 babies die every hour from pneumonia, diarrhea, measles and malnutrition.

The Philippines: - number I in the world for whooping cough, diphtheria and rabies. - number 3 in the world for blindness due to vitamin A. deficiency - number 1 in the Western Pacific region for tuberculosis, schistosomiasis and polio.

B. CULTURAL - relating to the representation of non-physical traits, such as values, beliefs, attitudes and customs shared by a group of people and passed from the generation to the next. 1. Practices - a customary action usually done to maintain or promote health like use of anting-anting and lucky charms. 2. Beliefs - a state or habit of mind wherein a group of people place into something or a person.

Definition Importance of Nursing Theories The characteristics of theories: Basic Processes in the Development Of Nursing Theories: Nursing theories are often based on & influenced ANA definition of Nursing Practice Common concepts in Nursing Theories: Historical Perspectives & Key Concepts Clasification of Nursing Theories Models Of Nursing Growth and Stability Models of Change Betty Neumans Health Care Systems Model Stress/Adaptation Theory as a Framework A unique body of knowledge Criticisms of nursing theories

As a result of mainly poverty, malnutrition is also a major health problem. 2 million of Filipino pre-school children are malnourished. 1.6 million Filipinos have Vitamin a, iron and iodine deficiencies. more than 50% pregnant or breastfeeding mothers are anemic. in addition to poor nutrition, poor sanitation and lack of a safe water supply make an individual susceptible to disease. 13 million Filipinos have no access to safe water - 16 million Filipinos have no access to a sanitary toilet. - in Manila alone, 5 million tons of garbage is disposed daily.

C. HEREDITY - the genetic transmission of traits from parents to offspring; genetically determined.

D. ENVIRONMENT - the sum of all the conditions and elements that make up the surroundings and influence the development of the individuals. Conclusion Theory and practice are related. A theory presents a systematic way of understanding events or situations.It is a set of concepts, definitions, and propositions that explain or predict these events or situations by illustrating the relationships between variables.Theories must be applicable to a broad variety of situations. They are, by nature, abstract, and dont have a specified content or topic area. Like empty coffee cups, theories have shapes and boundaries, but nothing inside. They become useful when filled with practical topics, goals, and problems. [Robert T. Croyle (2005)] HEALTH AS A MULTIFACTORIAL PHENOMENON FACTORS AFFECTING HEALTH A. POLITICAL Involves ones leadership how/she rules, manages and other people in decision making. 1. Safety - the condition of being free from harm, injury or loss of authority or power

The National Health Situation is intimately linked to the economic, political and sociocultural system of the society.

E. SOCIO-ECONOMIC - refers to the production activities, distribution of and consumption of goods of an individual. THE NATIONAL HEALTH SITUATION Majority of the 68,616,536 million Filipinos (millions) in the urban and 35 million in the rural areas) cannot avail of adequate health care because of misdistribution of health personnel and facilities, and high cost of medicines and services. There are 1,742 hospitals in the country; most of them are in the urban areas. Of this number, 1103 are privately owned; 639 are government owned. There are 2,385 poorly equipped Health Centers. - The Philippines is the leading exporter of nurses abroad. - Sixty eight percent (68%) of the Filipino doctors go abroad; 32% of them remain the country, but most stay in the cities 1. 2. 3. 4. 5. 6. 7. 8.

A VISION OF HEALTHY TOMORROW: Preventive , promotive health care Community participation Traditional medicine Affordable medicine Adequate food, clothing and shelter Available basic health services Accessible health care facilities Clean environment

Danger Signs: To attain the dream of healthy tomorrow, everyone should take part in working for its fulfillment. Everybody must participate in the planning, implementation, monitoring and evaluation of the communitys program COMPETENCY BASED APPROACH TO THE BSN CURRICULUM Within the context of Philippine society, nursing education, with caring as its foundation, subscribes to the following core values which are vital components in the development of a professional nurse and are therefore emphasized in the BSN program:

2. Oppression - unjust or cruel exercise of authority or power 3. Political will - determination to pursue something which is for the interest of the majority. 4. Empowerment - the ability of a person to do something

- For every 10 deaths, 6 were not seen by a doctor. - The leading causes of death and illness are predeceases and other socially related problems such as AIDS and drug abuse. Pneumonia and tuberculosis are leading cause of death 1.1 Love of God 1.2 Caring as the core of nursing a. Compassion b. Competence c. Confidence d. Conscience e. Commitment (commitment to a culture of excellence, discipline, integrity and professionalism)

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Core competency 5: evaluates the outcome of health education Legal Responsibility Core competency 1: adheres to practices in accordance with the nursing law and other relevant legislation including contracts, informed consent Core competency 2: adheres to organizational policies and procedures, local and national Core competency 3: documents care rendered to patients Ethico-moral Responsibility Core competency 1: respects the rights of individual/ groups Core competency 2: accepts responsibility and accountability for own decision and actions Core competency 3: adheres to the national and international code of ethics for nurses Personal and Professional Development Core competency 1: identifies own learning needs Core competency 2: pursues continuing education Core competency 3: gets involved in professional organizations and civic activities Core competency 4: projects a professional image of the nurse Core competency 5: possesses positive attitude towards change and criticism Core competency 6: performs function according to professional standards Quality Improvement Core competency 1: gathers data for quality improvement Core competency 2: participates in nursing audits and rounds Core competency 3: identifies and reports variances Core competency 4: recommends solutions to identified problems Research Core competency 1: gathers data using different methodologies Core competency 2: recommends actions for implementation Core competency 3: disseminates results of research findings Core competency 4: applies research findings in nursing practice Records Management Core competency 1: maintains accurate and updated documentation of patient care Core competency 2: records outcome of patient care Core competency 3: observes legal imperatives in record keeping Communication Core competency 1: establishes rapport with patients, significant others and members of the health team Core competency 2: identifies verbal and non-verbal cues Core competency 3: utilizes formal and informal channels Core competency 4: responds to needs of individuals, family, group, and Community Core competency 5: uses appropriate information technology to facilitate communication Collaboration and teamwork Core competency 1: establishes collaborative relationship with colleagues with colleagues and other members of the health team Core competency 2: collaborative plan of care with other members of the health team Source: CHED Memorandum Order (CMO) No. 14 Series of 2009 Personal & professional development Quality improvement Research Record management Communication Collaboration & teamwork LEGAL BASES Article 3 Sec.9 (c) of R.A. 9173/ Philippine Nursing Act 2002 Board shall monitor & enforce quality standards of nursing practice necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation. SIGNIFICANCE OF CORE COMPETENCY STANDARDS Unifying framework for nursing practice, education, regulation Guide in nursing curriculum development Framework in developing test syllabus for nursing profession entrants Tool for nurses performance evaluation Basis for advanced nursing practice, specialization Framework for developing nursing training curriculum Public protection from incompetent practitioners Yardstick for unethical, unprofessional nursing practice Phases of developing competency standards 1st Phase Competency identification through DACUM 2nd Phase Verification of identified competencies 3rd Phase Pilot testing ( senior student in 8 nursing colleges) 4th Phase Benchmarking with exiting standards from 3 countries + ICN

1.3 Love of People a. Respect for the dignity of each person regardless of creed, color, gender and political affiliation. 1.4 Love of Country .a Patriotism (Civic duty, social responsibility and good governance) .b Preservation and enrichment of the environment and culture heritage A strong liberal arts and sciences education with a transdisciplinary approach, enhances this core values. The BSN program therefore, aims to prepare a nurse, who, upon completion of the program, demonstrates beginning professional competencies and shall continue to assume responsibility for professional development and utilizes research findings in the practice of the profession. The following are the Key Areas of Responsibility for which a nurse should demonstrate competence in:

1. Safe and quality nursing care 2. Management of resources and environment 3. Health education 4. Legal responsibility 5. Ethico-moral responsibility 6. Personal and professional development 7. Quality improvement 8. Research 9. Record Management 10. Communication 11. Collaboration and teamwork The BSN is a four-year program consisting of general education and professional courses. Professional courses begin in the first year and threads through the development of competencies up to the fourth year level. The BSN program provides an intensive nursing practicum that will refine clinical skills from the first year level to ensure basic clinical competencies required of a beginning nurse practitioner. The BSN program aims to produce a fully functioning nurse who is able to perform the competencies under each of the Key Areas of Responsibility. Safe and Quality Nursing Care Core competency 1: demonstrates knowledge base on the health/illness status of individual / groups Core competency 2: provides sound decision making in the care of individuals / groups considering their beliefs and values Core competency 3: promotes safety and comfort and privacy of patients Core competency 4: sets priorities in nursing care based on patients needs Core competency 5: ensures continuity of care Core competency 6: administers medications and other health therapeutics Core competency 7:utilizes the nursing process as framework for nursing Management of Resources and Environment Core competency 1: organizes work load to facilitate patient care Core competency 2: utilizes resources to support patient care Core competency 3: ensures functioning of resources Core competency 4: checks proper functioning of equipment Core competency 5: maintains a safe environment Health Education Core competency 1: assesses the learning needs of the patient Core competency 2: develops health education plan based on assessed and anticipated needs Core competency 3: develops learning materials for health education Core competency 4: implements the health education plan

11 CORE COMPETENCIES KEY AREAS OF RESPONSIBILITY: CORE COMPETENCY STANDARDS FOR NURSING PRACTICE IN THE PHILIPPINES Safe & quality nursing practice Management of resources & environment Health education Legal responsibility Ethico moral responsibility