PAMANTASAN NG CABUYAO

College of Nursing

Course Learning Packet – NCM100 Theoretical Foundation in Nursing

VISION
A premier educational institution of higher learning, developing globally competitive and value-laden professionals
and leaders instrumental to community development and nation building.
MISSION
As an institution of higher learning, PnC is committed to equip individuals with knowledge, skills and values that will
enable them to achieve their professional goals and provide leadership and service for national development.

COURSE TITLE: THEORETICAL FOUNDATION IN NURSING

COURSE CODE: NCM 100
PRE-REQUISITE: None

COURSE OBJECTIVES:
At the end of this course, the students should be able to:
1. Apply knowledge of nursing and related theories in the practice of nursing.
2. Engage in life-long learning with a passion to keep current with national and global developments
3. Adopt the nursing core values in the application of the nursing theories

COURSE CONTENTS:

Module 1: Evolution of Nursing

Module 2: Nursing Theories and their Works
Module 3: Nursing Conceptual Models
Module 4: Nursing Theories
Module 5: Local Theories and Models of Nursing Intervention (Philippine Setting)
Module 6: Theories Relevant to Nursing Practice

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

MODULE 1
Module Title: Evolution of Nursing

Overview:
This Module is composed of three topics that would enable the students to better understand what nursing
is all about.

Module Objectives:

At the end of module 1, the student should be able to:

 1. Integrate relevant concepts and metaparadigm of theories on Person, Health, Environment and
Nursing in the practice of Nursing.
2. Apply appropriate nursing concepts and actions holistically and comprehensively.
3. Appreciate the value of evidence based nursing practice in the application of nursing and related
models/theories.
4. Ensure a working relationship utilizing relevant concepts/theories of effective communication and
interpersonal relationship in nursing practice.

Module Coverage:

A. Topic: History of Nursing Theory and its significance for the discipline and profession
B. Topic: History and Philosophy of Science:: Rationalism, Empiricism, Early Twentieth Views and Emergent
Views
C. Topic: Structure of Nursing Knowledge
TOPIC A

Topic Title: History of Nursing Theory and its significance for the discipline and profession

Introduction:

Integrate relevant concepts and metaparadigm of theories on Person, Health, Environment and
Nursing in the practice of Nursing.

Topic Objectives:

At the end of the topic, the student should be able to:

1. Describe concept and theory
2. Explain the difference of concept and theory on a different context

Topic Contents:

Introduction to NCM 100 – Theoretical Foundation in Nursing,

NCM 100 or Theoretical Foundation in Nursing is a 3 units subject a total of 54 hours in 18 weeks.
This course deals with nursing theories as applied to nursing practice on the aspect of the metaparadigm:
person, health, environment and nursing. Likewise, it includes other theories relevant to nursing, and the
students are expected to use these theories as basis and guide in nursing practice.

Highlights of Significant Events in History

1. Florence Nightingale- 1859/1992

 “Notes on Nursing”, Presents the first nursing theory that focuses on the manipulation of environment for
the benefit of the patient.

2. The Columbia School- 1950s

- prepare nurses at the graduate level for administrative & faculty positions
- Columbia University’s Teachers College dev. Graduate education programs ( Graduates
includes: Peplau, Henderson, Hall & Abdellah )
- Johnson

3. Yale School- (1960s)

- The focus of theoretical thinking in nursing moved from problem/need and functional roles
focus to the relationship between nurse and the patient.
- Theoretical position was influenced by the Columbia Teachers College graduates who
became faculty members ( Henderson, Weidenbach, Orlando)
- Theorist in the Yale School views nursing as a process rather than an end itself, their theories
look at how nurses do, what they do, and how patient perceives his /her situation.
- Focus on what nurses do that is their functional roles. They consider patient problem and
needs to be the practice focus.
- Federal funds were made available for doctoral study for nurse educators
4. 1970s

5. 1980s

Many nursing theories were revised based on research findings. In addition, the works of D.
Johnson, Parse, Leininger, Erickson, Tomlin and Swain were added to the body of theoretical
thought in nursing
 6. 1990s

 More theories were expanded

 M. Rogers published “Nursing: Science of Unitary, Irreducible Human Beings”, The latest
refinement of her theory.
 In 1992, Parse change the name of her theory from Man-living-health to Theory of Human
Becoming. Her reason was that in the contemporary dictionary mans meaning tends to be
gender-based as opposed to meaning mankind.
 The history of theory development in nursing began with the writings of Florence
Nightingale, “Notes on Nursing” and continues to the present.
 Until the second half of the century that nurse saw the need to develop nursing knowledge
through theory development to transition from vocation to profession.
 The movement towards professionalism evolved through different eras.

The Era’s of Nursing Knowledge

A. Curriculum Era ( 1900-1940s)

 emphasizes on course included in nursing program ( A standardized curricula)
 Goal: to develop specialized knowledge & higher education
  Nursing Arts Lab. – is where procedure are taught, in later decades it is referred to
as Skills Laboratory.
 With the emergence of baccalaureate nursing, the Art of nursing was changed to
the science of nursing, thus, at present the art and science of nursing is more supported

B. Research Era ( 1950- 1970s)

 Emphasizes on roles of nurses and what to research.

 Emphasizes the need to disseminate research finding in scholarly publication
 More nurse educators are into research

C. Graduate Education Era ( 1950s- 1970s)

 During the 1960s and 1970s, curricula for masters level preparation includes research,
clinical specialty and leadership.
 Emphasis is carrying out advanced role & basis for nursing practice
- Emerging goal: to focus graduate education on knowledge development.
 Nurses into doctorate program & a shift of emphasis from research to theory

D. Theory Era ( 1980s-1990s)

 Nursing theory development stimulated phenomenal growth, which has been noted as the
corner stone of the development of the discipline of nursing( Meleis,1983)
 The emerging goal is that theory guides research & practice

E. Theory Utilization Era ( 21st Century )

 Emphasis is that nursing theory guides research, practice, education and administration.
 The emerging goal is for this era is that , nursing frameworks produce
knowledge( evidence for quality care)
 Shift from theory development to theory application and utilization.

Significance of Nursing Theory to Discipline and Profession

 Discipline is dependent on theory for its continued existence---- that is:

- Nursing can be a vocation, or nursing can be a discipline with a professional style of theory
–based practice.
- Knowledge of person, health & environment forms that basis for recognition of nursing as a
discipline, which is taught to those who enter the profession.
- A Nursing theory is essential for the existence nursing as an academic discipline. It is also
vital to the practice of professional nursing ( Mc Crae,2012)
- The use of theory amplifies knowledge development & enhances the quality of nursing
practice (supported by Alligood, Chin, Cramer etc.)
History & Philosophy of Science

- Science is a method for describing, explaining and predicting causes or outcomes of intervention.
- Scientific activity help to establish the evidence we use to guide practice in the delivery of nursing
care.

Philosophical Perspective used in Science

Rationalism

- is the epistemological view that “regards reasons as the chief sources and test of knowledge”, or
any view appealing to reason as a source of knowledge or justification

- Is defined as a methodology or theory in which the criterion of truth is not sensory but intellectual or
deductive.
- Rationalist epistemology (scope of knowledge) emphasizes the importance of prior reasoning as
an appropriate method for advancing knowledge.
- Uses deductive reasoning from the cause and effect or from generalization to a particular instance.

Empiricism

- The empiricist view is based on the central idea that scientific knowledge can be derived only from
sensory experience (seeing, feeling, hearing, etc.)
- Uses inductive method , based on the idea that the collection of fact attempts to formulate
generalization, or research-then- theory strategy

Rationalism and Empiricism

Rationalism Empiricism
- Reason is the source of all knowledge - The senses are the source of all
- Knowledge can be gained a priori (deductive logic) knowledge
- Senses are easily fooled - Knowledge is only gained a posteriori
- Uses theory-then-research strategy ( Inductive method)
- Uses research-then-theory strategy

Emergent Views of Science & theory in the Late 20 th Century

 Brown argued for an intellectual revolution in philosophy that emphasized the history of science
was replacing formal logic as the major analytical tool in the philosophy of science. One major perspective
is that science was a process of continuously building research rather than a product of findings.

Early 20th Century Views

Positivism which supports that empirical research and logical analysis (deductive and inductive) were
two approaches that would produce scientific knowledge (Brown, 1977)

Concept

 Webster: something conceived in the mind – a thought or a notion.

 It represents reality and enhances ability to communicate about it.
 Empirical – one that can be observed or experienced through the senses.
 Abstract – those that are not observable
 All concepts become abstractions in the absence of the object.
 A mental idea of a phenomenon, a comprehensive idea or generalization.
 An idea that brings diverse elements into a basic relationship.
 A unit of knowledge abstracted from a set of characteristics attributed to a class of object, relations
or entities.
 A unit of thought, a general idea formed in the mind.
 Something understood or retained in the mind, from experience, reasoning, and/or imagination; a
generalization or abstraction of a particular set of instances or occurrences.
 Examples: person, health, environment, nursing

Theory/Theories

• A set of interrelated concepts, definitions, and propositions that present a systematic way of
viewing facts/events by specifying relations among the variables, with the purpose of explaining
and predicting the fact/event. (Kerlinger 1973)
• A set of statements that tentatively describe, explain, or predict relationships among concepts that
have been systematically selected and organized as an abstract representation of some
phenomenon (Power and Knapp, 1995).
• These systematic organized perspective serves as guide for nursing action in administration,
education, research, and practice.
• A well – substantiated explanation of some aspect of the natural world; an organized system of
accepted knowledge that applies in a varied of situation/hypotheses.
• An expectation of what should happen, barring unforeseen circumstances.
• A coherent statement or set of statements that attempts to explain observed phenomena.
• An explanation for some phenomena that is based on observation, experimentation, and
reasoning.
 • A comprehensive explanation of a given set of data that has been repeatedly confirmed by
observation and experimentation and has gained general acceptance within the scientific
community but has not been yet decisively proven.
• A construct (the way to put together the “parts” of something) that accounts for or organizes some
phenomena (Barnum, 1998).

NURSING THEORY

• A body of knowledge that describes or explains nursing and is used to support nursing practice.
• An organized and systematic articulation of a set of statements related to questions in the
discipline of nursing.
• Is a set of concept, definitions, relationships and assumptions or propositions derived from nursing
models or from other disciplines and project a purposive systematic view of phenomena by
designing specific inter-relationships among concepts for the purposes of describing, explaining,
predicting and/or prescribing.

PRINCIPLE

• A basic generalization that is accepted as true and that can be used as a basis for reasoning or
conduct.

CHARACTERISTICS OF A THEORY

A Theory is

- interrelating concepts in such a way as to create a different way of looking at a particular

phenomenon
- logical in nature, generalizable
- basic for hypotheses that can be tested
- 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 principles but will leave open unanswered questions
that need to the investigated.

COMPONENTS OF THEORY

The components of a theory are as follows:

1. Concepts
2. Definitions
3. Assumptions
 4. Phenomenon

1. CONCEPTS
- A theory is composed of interrelated concepts.
- Concepts help to describe or label phenomena. Using Levine’s Conservation Model in
Nursing Practice as an example, there are concepts that affect the nursing practice – the
“why’s of nursing actions”.
- Where are three major concepts that form the basis of the model and its assumptions are
as follows:
o conservation,
o adaptation, and
o wholeness
2. DEFINITIONS

- The definitions within the description of a theory convey the general meaning of the
concepts in a manner that fits the theory.
- These definitions also describe the activity necessary to measure the constructs,
relationships, or variables within a theory (Chinn an Kramer 2004).

3. ASSUMPTIONS

- Are statements that describe concepts or connect two concepts that are factual.
- Assumptions are the “taken for granted” statements that determine the nature of the
concepts, definitions, purpose, relationships and structure of the theory.

4. PHENOMENON

- A phenomenon is an aspect of reality that can be consciously sensed or experienced.

- Nursing theories focus on the phenomena of nursing and nursing care.
o Examples of phenomena in nursing include caring, self – care, and client
responses to stress.

TYPES OF THEORIES
1. Meta-theories
- Are theories whose subject matters are some other theories.
- These are theories about theories.
 2. Grand Theories
- Are broad in scope and complex and therefore require further specification through
research before they can be fully tested (Chinn and Kramer, 1999).
- These are intended to provide structural framework for broad, abstract ideas about nursing
(Fawcett, 1995).
3. Middle – Range Theories
- Have more limited scope, less abstraction, address specific phenomena or concepts and
reflect practice (administration, clinical or teaching).
- The phenomena or concepts tend to cross different nursing fields, and reflect a wide
variety of nursing care situations, e.g.:, quality of life, uncertainty in illness, social support,
incontinence, caring.

4. Descriptive Theories
- Are the first level of theory development. They describe phenomena, speculate on why
phenomena occur, and describe the consequences of phenomena.
- They have the ability to explain, relate, and in some situations predicts nursing phenomena
(Meleis, 1997).
- Example: Theories of Growth and Development.

5. Prescriptive Theories
- Address nursing interventions and predict the consequence of a specific nursing
intervention. Prescriptive theories are action oriented, which rest the validity and
predictability of a nursing intervention.
- Example: Mishel’s Theory of Uncertainty predicts that increasing the coping skills of clients
with gynecological cancer assists their ability to deal with the uncertainty of cancer
diagnosis and treatment (Mishel and Sorenson, 1991; Mishel, 1997).

IMPORTANCE OF NURSING THEORIES

Nursing Theories:

- Aim to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs, 1978).
- Provide the foundations of nursing practice, help to regenerate further knowledge and indicate
in which direction nursing should develop in the further (Brown, 1994).
- Help to distinguish what should form the basis of practice by explicitly describing nursing.

PURPOSES OF THEORIES

A. In Practice
- Assist nurses to describe, explain, and predict every experiences.
- Serve to guide assessment, intervention, and evaluation of nursing care.
 - Provide a rationale for collecting reliable and valid data about the health status of clients, which are
essential for effective decision making and implementation.
- Help to establish criteria to measure the quality of nursing care.
- Help build a common nursing terminology to use in communicating with other health professionals.
Ideas are developed and words defined.
- Enhance autonomy (independence and self- governance) of nursing by defining its own
independent functions.

B. In Education
- Provide a general focus for curriculum design.
- Guide curricular decision making.

C. In Research
- Offer a framework for generating knowledge and new ideas.
- Assist in discovering knowledge gaps in specific field of study.
- Offer a systematic approach to identify questions for study, select variables, interpret findings and
validate nursing interventions

NURSING PARADIGM
- Nursing has a model or paradigm that explains the linkages of science, philosophy, and theory that
is accepted and applied by the discipline.
- The elements of nursing paradigm direct the activity of the nursing profession, including knowledge
development, philosophy, theory, educational experience, research, practice and literature
identified with the profession (Alligood and Marriner – Tomey, 2002).

Nursing identified its domain in a paradigm that includes four linkages: the person, health,
environment/situation, and nursing.

FOUR MAJOR CONCEPTS OF NURSING

THEORIES

1. Person
 - Refers to all human being. People are the recipients of nursing care; they include individuals,
families, communities and groups.

2. Environment
- Includes factor that affects individuals internally and externally. It means not only everyday
surroundings but also settings where nursing care in provided

3. Health
- Addresses the person’s state of well – being.

4. Nursing
- Is central to all nursing theories. Definitions of nursing is ,what nurses do, and how nurses
interact with clients. It is “diagnosis and treatment of human responses to actual and potential
health problems” (ANA, 1995).

================================================================================
MODULE 2

Module Title: Nursing Theories and Their Works

Overview:
This module will be discussing concepts of collaboration with interpersonal, cultural and related theories.

Module Objectives:

At the end of module 1, the student should be able to:

1. Explore each theory and
2. Apply it to the everyday activity

.
Module Coverage
A. Topic: Nightingale’s Environmental Theory
B. Topic: Watson’s Theory of Human Caring
C. Topic: Benner Benner’s Stages of Nursing Philosophies
D. Topic: Eriksson’s Caritative Caring Theory

TOPIC A

NIGTHINGALE’S ENVIRONMENTAL THEORY

 - Born on12 May 1820 in Florence, Italy and died of old age in 1910
- In 1837, when she was 17, she felt a “calling” to help people
- At the age of 31, she entered the Deaconesses School at Kaisserwerth Institute and received
her 3 months “training” in nursing.
- After training at Kaiserwerth Institute she studied at Paris with the Sisters of Charity.
- In 1854, during the Crimean War, Florence was invited by her friend Sir Sydney Herbert to take
a group of 38 female nurses to work in hospitals during the Crimea War.

CONTRIBUTIONS OF FLORENCE NIGHTINGALE DURING THE CRIMEAN WAR

 She cared for the soldiers during night time by using her LAMP that obtained her title “LADY
with a LAMP”
 She used her superb statistical & managerial skills to lower the mortality rate of soldiers and
victims of war.
 She utilized the environment in helping the soldiers.
 The school served as model for other training school.
 Nightingale focus more on developing the profession within the hospital.
 The first school that provided both theory based knowledge and clinical skills building.
 Nursing evolved as an art & science.
 Formal nursing education and nursing service begun.
 Compiled notes of her visits to hospitals & her observations of the sanitary facilities, social
problems of the places she visited.
 Not contended with the social custom imposed upon her as a Victorian Lady, she developed her
self-appointed goal: “TO CHANGE THE PROFILE OF NURSING”
 Advocated for care of those afflicted with diseases caused by lack of hygienic practices.
 Recognized as Nursing’s first SCIENTIST-THEORIST for her work: “NOTES ON NURSING: What
It Is, and What It Is Not”
 Disapproved of the restrictions on admission of patients & considered this unchristian &
incompatible with health care.
 She was the first woman to be granted the Order of Merit (OM) and the Royal Red Cross (RCC) by
Queen Victoria of Great Britain
 Her birthday marks the International Nurses Day celebration each year

NIGHTINGALE’S ENVIRONMENTAL THEORY

NURSING as “act of utilizing the environment of the patient to assist him in his recovery.
- She linked health with FIVE ENVIRONMENTAL FACTORS.
o Pure fresh air
o Pure water
o Efficient drainage
o Cleanliness
o Light (direct sunlight)

PERSON
- referred to the person as a patient
- They are defined in relationship to their environment and the impact of the environment upon them

HEALTH
- She defined health as being well and using every power that the person has to the fullest extent
- She envisioned the maintenance of health through prevention of disease via environmental control

ENVIRONMENT
- Florence believed that the sick, poor people would benefit from environmental improvements that
addressed their physical and mental aspects.
- She stressed that nurses could have special role in uplifting the social status of the poor by
improving their living situations

NURSING
- having responsibility for someone else’s health
- Nightingale stated that nursing “ought to signify the proper use of fresh air, light, warmth,
cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of
vital power to the patient.”

NIGHTINGALE CANONS

Nightingale’s Canons Nursing Process & Thought

1. Ventilation & Warmth • Check patient’s body temperature, room temperature &
ventilation.
• Create a plan to keep the room well-ventilated & free of odor
while maintaining the patient’s body temperature
2. Light • Check room for adequate light. Sunlight is beneficial to the
patient.
• Create & implement adequate light in the room without
placing the patient in direct light.
Canon means a rule or law. These canons were found in Notes on Nursing (1860/1946)
3. Cleanliness • Check room for dust, dampness & dirt.
• Keep room free from dust, dirt & dampness
4. Health of Houses • Check surrounding environment for fresh, pure water,
drainage, cleanliness & light.
• Remove garbage, stagnant water & ensure clean water &
fresh air.
5. Noise • Check noise level in the room and surroundings.
• Attempt to keep noise level in minimum
6. Bed & Bedding • Check bed & bedding for dampness, wrinkles & soiling.
• Keep the bed dry, wrinkle-free & lowest height to ensure
comfort.
7. Personal Cleanliness • Attempt to keep the patient dry & clean at all times.
• Frequent assessment of the patient’s skin is essential to
maintain good skin integrity.
8. Variety • Attempt to accomplish variety in the room & with the client.
• This is done with cards, flowers, pictures & books. Also
encourage friends & relatives.
9. Chattering Hopes & Advices • Avoid giving false advices
• Respect the patient as a person and avoid personal talk.
10. Taking Food • Check diet of the patient. Note the amount of food and fluid
ingested by the patient at every meal

11. Petty Management • This ensures continuity of care.

• Document the plan of care & evaluate the outcomes to ensure
continuity.
12. Observation of the Sick • Observe & record anything about the patient.
• Continue observation in the patient’s environment and make
changes in the plan of care if needed.
TOPIC B: JEAN WATSON

- Born in West Virginia on 10th of June 1940

- Educated: BSN, University of Colorado, 1964, MS, University of Colorado, 1966, PhD, University of
Colorado, 1973
- Dr. Jean Watson is Distinguished Professor of Nursing and holds an endowed Chair in Caring
Science at the University of Colorado Health Sciences Center.
- She is founder of the original Center for Human Caring in Colorado and is a Fellow of the American
Academy of Nursing. She previously served as Dean of Nursing at the University Health Sciences
Center and is a Past President of the National League for Nursing
- Watson believes that the main focus in nursing is on carative factors. She believes that for nurses
to develop humanistic philosophies and value system, a strong liberal arts background is
necessary. 
- This philosophy and value system provide a solid foundation for the science of caring.
- A humanistic value system thus under grids her construction of the science of caring.
- She asserts that the caring stance that nursing has always held is being threatened by the tasks
and technology demands of the curative factors.
- The focus of nursing is on carative factors that are derived from a humanistic perspective
combined with scientific knowledge base-------Jean Watson

SEVEN ASSUMPTIONS
1. Caring can be effectively demonstrated and practiced only interpersonally
2. Caring consists of carative factors that result in the satisfaction of certain human needs
3. Effective caring promotes health and individual or family growth
4. Caring responses accept a person not only as he/she is now but as what he/she may become
5. A caring environment offers the development of potential while allowing the person to choose the best
action for himself at a given time
6. Caring is more “healthogenic” than is curing. A science of caring is therefore complementary to the
science of curing.
7. The practice of caring is central to nursing.

1. Formation of Humanistic-Altruistic System of Values

- Learned in early life, but can be greatly influenced by nurse-educators
- Satisfaction through giving and extension of the sense of self

2. Instillation of Faith-Hope
- Facilitates the promotion of holistic nursing care and positive health within the patient
population
- Describes the nurse’s role in developing NPI and promoting wellness by helping the
patient adopt health-seeking behaviour

3. Cultivation of Sensitivity to Self and to Others

- Recognition of feelings leads to stabilization through self- acceptance for both nurse and
the patient
- As nurses acknowledge their sensitivity and feelings, they become more genuine,
authentic and sensitive to others

4. Development of a Helping-Trust Relationship

- Crucial for transpersonal caring
- Trusting relationship promotes and accepts the expression of both + and – feelings
- Involves:
 Congruence – being real, honest, genuine, and authentic
 Empathy – ability to experience and, thereby understand the other person’s
perceptions and feelings and to communicate those understandings
 Non-possessive warmth
 Demonstrated by a moderate speaking volume
 A relaxed, open posture
 Facial expressions that are congruent with other communications
- Involves:
 Effective communication - has cognitive, affective and behavior response
components

5. Promotion and Acceptance of the Expression of Positive and Negative Feelings

- Sharing of feelings – a risk-taking experience for both nurse and patient
- Nurse must:
  Be prepared for either + or – feelings
 Recognized that intellectual and emotional understandings of a situation differ

6. Systematic use of the Scientific Problem-Solving Method for Decision Making

- Use of the nursing process brings scientific problem-solving approach to nursing care
- Nursing process is similar to the research process in that it is systematic and organized

7. Promotion of Interpersonal Teaching-Learning

- Important concept for nursing
- It separates caring from curing
- Allows patient to be informed and shifts the responsibility for wellness and health to the
patient
- Nurse facilitates this with T - L techniques that are designed to enable patients to provide
self-care

8. Provision for Supportive, Protective, and Corrective Mental, Physical, Sociocultural and Spiritual
Environment
- Nurse must recognize the influence that internal and external environment have on health
and illness
- Internal environment:
 Mental and spiritual
 Sociocultural beliefs
- External variables:
 Comfort
 Privacy
 Safety
 Clean surroundings

9. Assistance with Gratification of Human Needs

- Nurse recognizes the biophysical, psychophysical, and intrapersonal needs of self and
patient
- Patients must satisfy lower-order needs before attempting to attain higher-order need

10. Allowance for Existential Phenomenological Forces

- Phenomenology is a way of understanding people from the way things appear to them,
from their frame of reference
- Existential psychology
 Science of human existence that uses phenomenological analysis
 Provide a thought-provoking experience leading to a better understanding of
the self and others

TOPIC C: PATRICIA BENNER

Benner Benner’s Stages of Nursing Expertise Nursing Philosophies

 - Dr. Patricia Benner introduced the concept that expert nurses develop skills and understanding of
patient care over time through a sound educational base as well as a multitude of experiences.
- She proposed that one could gain knowledge and skills ("knowing how") without ever learning the
theory ("knowing that").
- She further explains that the development of knowledge in applied disciplines such as medicine
and nursing is composed of the extension of practical knowledge (know how) through research and
the characterization and understanding of the "know how" of clinical experience.
- She conceptualizes in her writing about nursing skills as experience is a prerequisite for becoming
an expert.

Levels of Nursing experience

She described 5 levels of nursing experience as;

 Novice
 Advanced beginner
 Competent
 Proficient
 Expert

These levels reflect:

 Movement from reliance on past abstract principles to the use of past concrete
experience as paradigms and
 Change in perception of situation as a complete whole in which certain parts are relevant

NOVICE
- Novice Stage describes that a person has no background experience of the situation in which
he/she is involved.
- To guide performance, context free rules and objective attributes must be given.
- The novice has also difficulty discriminating between relevant and irrelevant aspects of a situation.
o Examples: Students or nurses placed in an unfamiliar situation

ADVANCE BEGINNER
 - Advance beginner has sufficient experience to easily understand aspects of the situation.
- It requires experience based on recognition in the background of the situation.
- Nurse at this stage feel more responsible for managing patient care, yet still rely on the help of
those more experienced.
 Example:
 Newly graduate nurses

COMPETENT
- 2 -3 years experiences
- Competent performance considers consistency predictability, and time management as essential
components.
- The sense of mastery is acquired through planning and predictability.
- Increased level of efficiency is evident. However time management & the nurses’ organization of
the task are more important than on timing in relation to the patient’s needs.

PROFICIENT
- Has 3-5 experience
- According to Dreyfus model, the performer of this stage perceives the situation as a whole rather
than in terms of aspects, and performance is guided by maxims (rule of conduct).
- The proficient level is qualitative leap beyond the competent. – the performer identifies the most
significant aspects and has a better understanding of the situation based on background
understanding.
- They no longer rely on present goals for organization and they show an increased confidence in
their knowledge and skills. There is much involvement of the patient & family.

EXPERT
- Dreyfus said that in the expert stage is accomplished when the expert performer no longer relies
on analytical principle like rules, guidelines and maxims to connect her understanding of the
situation to an appropriate action.
- Benner viewed an expert nurse as possessing an intuitive grasp of the problem without losing time
considering a range of alternative diagnosis and solutions.
- Dreyfus said that in the expert stage is accomplished when the expert performer no longer relies
on analytical principle like rules, guidelines and maxims to connect her understanding of the
situation to an appropriate action.
- Benner viewed an expert nurse as possessing an intuitive grasp of the problem without losing time
considering a range of alternative diagnosis and solutions
TOPIC D – Katie Eriksson

“Caritative caring means that we take “caritas” into use when

caring for the human being in health and suffering …. Caritative
caring is a manifestation of the love that ‘just exists’…Caring
communion, true caring, occurs when the one caring in a spirit
of caritas alleviates the suffering of the patient”
– Katie Eriksson

- One of the pioneers of caring science in the Nordic countries, born on November 18, 1943, in Jakobstad,
Finland.
- Belongs to the Finland-Swedish minority in Finland, and her native language is Swedish.
- Graduated in Helsinki Swedish School of Nursing in 1965, completed public health nursing specialty
education in 1967 at the same institution.
- In 1970 she graduated from the nursing teacher education program at Helsinki Finnish School of Nursing.
- Continued her academic studies at University of Helsinki, where she received her MA degree in philosophy
in 1974 and her licentiate degree in 1976;

MAJOR CONCEPTS & DEFINITIONS

Caritas
- Means love and charity. In caritas, eros and agapé are united, and caritas is by nature unconditional love.
Caritas, which is the fundamental motive of caring science, also constitutes the motive for all caring.
 - It means that caring is an endeavor to mediate faith, hope, and love through tending, playing, and learning.

Caring communion
- Constitutes the context of the meaning of caring and is the structure that determines caring reality. Caring
gets its distinctive character through caring communion (Eriksson, 1990). It is a form of intimate connection
that characterizes caring. Caring communion requires meeting in time and space, an absolute, lasting
presence (Eriksson, 1992c). Caring communion is characterized by intensity and vitality, and by warmth,
closeness, rest, respect, honesty, and tolerance. It cannot be taken for granted but pre-supposes a
conscious effort to be with the other. Caring communion is seen as the source of strength and meaning in
caring. Eriksson (1990) writes in Pro Caritate, referring to Lévinas:
- Entering into communion implies creating opportunities for the other—to be able to step out of the enclosure
of his/her own identity, out of that which belongs to one towards that which does not belong to one and is
nevertheless one’s own—it is one of the deepest forms of communion (pp. 28–29).
- Joining in a communion means creating possibilities for the other. Lévinas suggests that considering
someone as one’s own son implies a relationship “beyond the possible” (1985, p. 71; 1988).
- In this relationship, the individual perceives the other person’s possibilities as if they were his or her own.
This requires the ability to move toward that which is no longer one’s own but which belongs to oneself. It is
one of the deepest forms of communion (Eriksson, 1992b). Caring communion is what unites and ties
together and gives caring its significance (Eriksson, 1992a).

The act of caring

- The act of caring contains the caring elements (faith, hope, love, tending, playing, and learning), involves
the categories of infinity and eternity, and invites to deep communion. The act of caring is the art of making
something very special out of something less special.

Caritative caring ethics

- Caritative caring ethics comprises the ethics of caring, the core of which is determined by the caritas motive.
Eriksson makes a distinction between caring ethics and nursing ethics. She also defines the foundations of
ethics in care and its essential substance.
- It deals with the basic relation between the patient and the nurse—the way in which the nurse meets the
patient in an ethical sense. It is about the approach we have toward the patient. Nursing ethics deals with
the ethical principles and rules that guide my work or my decisions. Caring ethics is the core of nursing
ethics.
- The foundations of caritative ethics can be found not only in history, but also in the dividing line between
theological and human ethics in general. Eriksson has been influenced by Nygren’s (1966) human ethics
and Lévinas’ (1988) “face ethics,” among others. Ethical caring is what we actually make explicit through our
approach and the things we do for the patient in practice. An approach that is based on ethics in care
means that we, without prejudice, see the human being with respect, and that we confirm his or her absolute
dignity. It also means that we are willing to sacrifice something of ourselves. The ethical categories that
emerge as basic in caritative caring ethics are human dignity, the caring communion, invitation,
responsibility, good and evil, and virtue and obligation. In an ethical act, the good is brought out through
ethical actions (Eriksson, 1995, 2003).

Dignity
- Dignity constitutes one of the basic concepts of caritative caring ethics. Human dignity is partly absolute
dignity, partly relative dignity.
- Absolute dignity is granted the human being through creation, while relative dignity is influenced and formed
through culture and external contexts. A human being’s absolute dignity involves the right to be confirmed
as a unique human being (Eriksson, 1988, 1995, 1997a).
Invitation
- Invitation refers to the act that occurs when the carer welcomes the patient to the caring communion. The
concept of invitation finds room for a place where the human being is allowed to rest, a place that breathes
genuine hospitality, and where the patient’s appeal for charity meets with a response (Eriksson, 1995;
Eriksson & Lindström, 2000).

Suffering
- Suffering is an ontological concept described as a human being’s struggle between good and evil in a state
of becoming. Suffering implies in some sense dying away from something, and through reconciliation, the
wholeness of body, soul, and spirit is re-created, when the human being’s holiness and dignity appear.
Suffering is a unique, isolated total experience and is not synonymous with pain (Eriksson, 1984, 1993).

Suffering related to illness, to care, and to life

- These are three different forms of suffering. Suffering related to illness is experienced in connection with
illness and treatment. When the patient is exposed to suffering caused by care or absence of caring, the
patient experiences suffering related to care, which is always a violation of the patient’s dignity. Not to be
taken seriously, not to be welcome, being blamed, and being subjected to the exercise of power are various
forms of suffering related to care. In the situation of being a patient, the entire life of a human being may be
experienced as suffering related to life (Eriksson, 1993, 1994a; Lindholm & Eriksson, 1993).

The suffering human being

- The suffering human being is the concept that Eriksson uses to describe the patient. The patient refers to
the concept of patiens (Latin), which means “suffering.” The patient is a suffering human being, or a human
being who suffers and patiently endures (Eriksson, 1994a; Eriksson & Herberts, 1992).

Reconciliation
- Reconciliation refers to the drama of suffering. A human being who suffers wants to be confirmed in his or
her suffering and be given time and space to suffer and reach reconciliation. Reconciliation implies a
change through which a new wholeness is formed of the life the human being has lost in suffering. In
reconciliation, the importance of sacrifice emerges (Eriksson, 1994a). Having achieved reconciliation implies
living with an imperfection with regard to oneself and others but seeing a way forward and a meaning in
one’s suffering. Reconciliation is a prerequisite of caritas (Eriksson, 1990).

Caring culture
- Caring culture is the concept that Eriksson (1987a) uses instead of environment. It characterizes the total
caring reality and is based on cultural elements such as traditions, rituals, and basic values. Caring culture
transmits an inner order of value preferences or ethos, and the different constructions of culture have their
basis in the changes of value that ethos undergoes. If communion arises based on the ethos, the culture
becomes inviting. Respect for the human being, his or her dignity and holiness, forms the goal of
communion and participation in a caring culture. The origin of the concept of culture is to be found in such
dimensions as reverence, tending, cultivating, and caring; these dimensions are central to the basic motive
of preserving and developing a caring culture (Eriksson, 1987a; Eriksson & Lindström, 2003).

Major assumptions

Two kinds of major assumptions of Eriksson: axioms and theses.

- Axioms as fundamental truths in relation to the conception of the world;

 - Theses are fundamental statements concerning the general nature of caring science, and their
validity is tested through basic research.
- Axioms and theses jointly constitute the ontology of caring science and therefore also are the
foundation of its epistemology (Eriksson, 1988, 2001).
- The caritative theory of caring is based on the following axioms and theses, as modified and
clarified from Eriksson’s basic assumptions with her approval (Eriksson, 2002).
- The axioms are as follows:
• The human being is fundamentally an entity of body, soul, and spirit.
• The human being is fundamentally a religious being.
• The human being is fundamentally holy. Human dignity means accepting the human
obligation of serving with love, of existing for the sake of others.
• Communion is the basis for all humanity. Human beings are fundamentally interrelated to
an abstract and/or concrete other in a communion.
• Caring is something human by nature, a call to serve in love.
• Suffering is an inseparable part of life. Suffering and health are each other’s
prerequisites.
• Health is more than the absence of illness. Health implies wholeness and holiness.
• The human being lives in a reality that is characterized by mystery, infinity, and eternity.

- The theses are as follows:

• Ethos confers ultimate meaning on the caring context.
• The basic motive of caring is the caritas motive.
• The basic category of caring is suffering.
• Caring communion forms the context of meaning of caring and derives its origin from the
ethos of love, responsibility, and sacrifice, namely, caritative ethics.
• Health means a movement in becoming, being, and doing while striving for wholeness
and holiness, which is compatible with endurable suffering.
• Caring implies alleviation of suffering in charity, love, faith, and hope. Natural basic caring
is expressed through tending, playing, and learning in a sustained caring relationship,
which is asymmetrical by nature.

The human being

- The conception of the human being in Eriksson’s theory is based on the axiom that the human being is an
entity of body, soul, and spirit (Eriksson, 1987a, 1988).
- Emphasizes that the human being is fundamentally a religious being, but all human beings have not
recognized this dimension. The human being is fundamentally holy, and this axiom is related to the idea of
human dignity, which means accepting the human obligation of serving with love and existing for the sake of
others

Nursing
- Love and charity, or caritas, as the basic motive of caring has been found in Eriksson (1987b, 1990, 2001)
as a principal idea even in her early works. The caritas motive can be traced through semantics,
anthropology, and the history of ideas (Eriksson, 1992c). The history of ideas indicates that the foundation
of the caring professions through the ages has been an inclination to help and minister to those suffering
(Lanara, 1981).
 - Caring is something natural and original. Eriksson thinks that the substance of caring can be understood
only by a search for its origin. This origin is in the origin of the concept and in the idea of natural caring. The
fundamentals of natural caring are constituted by the idea of motherliness, which implies cleansing and
nourishing, and spontaneous and unconditional love.
- The Natural basic caring is expressed through tending, playing, and learning in a spirit of love, faith, and
hope. The characteristics of tending are warmth, closeness, and touch; playing is an expression of exercise,
testing, creativity, and imagination, and desires and wishes; learning is aimed at growth and change. To
tend, play, and learn implies sharing, and sharing, Eriksson (1987a) says, is “presence with the human
being, life and God” (p. 38). True care therefore is “not a form of behavior, not a feeling or state. It is to be
there—it is the way, the spirit in which it is done, and this spirit is caritative” (Eriksson, 1998, p. 4).
- Emphasizes that caritative caring relates to the innermost core of nursing. She distinguishes between caring
nursing and nursing care. She means that nursing care is based on the nursing care process, and it
represents good care only when it is based on the innermost core of caring. Caring nursing represents a
kind of caring without prejudice that emphasizes the patient and his or her suffering and desires (Eriksson,
1994a).

Environment
- Uses the concept of ethos in accordance with Aristotle’s (1935, 1997) idea that ethics is derived from ethos.
In Eriksson’s sense, the ethos of caring science, as well as that of caring, consists of the idea of love and
charity and respect and honor of the holiness and dignity of the human being.
- Ethos is said to be the sounding board of all caring. Ethos is ontology in which there is an “inner ought to,” a
target of caring “that has its own language and its own key” (Eriksson, 2003, p. 23). Good caring and true
knowledge become visible through ethos. Ethos originally refers to home, or to the place where a human
being feels at home. It symbolizes a human being’s innermost space, where he appears in his nakedness
(Lévinas, 1989). Ethos and ethics belong together, and in the caring culture, they become one (Eriksson,
2003).
- Eriksson thinks that ethos means that we feel called to serve a particular task. This ethos she sees as the
core of caring culture. Ethos, which forms the basic force in caring culture, reflects the prevailing priority of
values through which the basic foundations of ethics and ethical actions appear.

Health
- Defines health as soundness, freshness, and well-being. The subjective dimension, or well-being,
is emphasized strongly (Eriksson, 1976).
- In the current axiom of health, health implies being whole in body, soul, and spirit. Health means as
a pure concept wholeness and holiness (Eriksson, 1984).
- In the ontological conception, health is conceived as a becoming, a movement toward a deeper
wholeness and holiness. As a human being’s inner health potential is touched, a movement occurs
that becomes visible in the different dimensions of health as doing, being, and becoming with a
wholeness that is unique to human beings (Eriksson, Bondas-Salonen, Fagerström, et al., 1990).
In doing, the person’s thoughts concerning health are focused on healthy life habits and avoiding
illness; in being, the person strives for balance and harmony; in becoming, the human being
becomes whole on a deeper level of integration.

References:
https://nursekey.com/11-theory-of-caritative-caring/#:~:text=Eriksson%20emphasizes%20that%20caritative
%20caring,the%20innermost%20core%20of%20caring.
https://prezi.com/sakid_8d74lj/the-theory-of-caritative-caring/