4.

Removal of the pathology in itself will not change the pattern

of the individual
5. If becoming ill is the only way an individual's pattern can
“Health is the expansion of consciousness.” manifest itself, then that is health for that person
According to Newman‘s theory, no matter how 6. Health is an expansion of consciousness.
terrible a person‘s situation, the person can tune into
their own self-consciousness and become one with Nursing Paradigms
herself or himself and find a greater meaning and Nursing Nursing is ―caring in the human health
opportunity for connectedness with others. experience‖.
Nursing is seen as a partnership between the
Theoretical Sources nurse and client, with both grow in the ―sense
1. Prigogine – Theory of Dissipative Structure of higher levels of consciousness‖
2. Arthur Young – The Theory of Process Person ―The human is unitary, that is cannot be
3. David Bohm – The Theory of Implicate divided into parts, and is inseparable from the
4. Martha Rogers -Theory of Unitary Human Beings larger unitary field‖
5. Itzhak Bentov – The concept of evolution of ―Persons as individuals, and human beings as a
consciousness species are identified by their patterns of
consciousness‖…
Use of Empirical Evidence ―The person does not possess consciousness-
Evidence for the theory of health emanated from the person is consciousness‖.
Newman‘s early personal family experiences. Her Persons are ―centers of consciousness‖ within
mother‘s struggle with a chronic illness and her an overall pattern of expanding consciousness‖
dependency on Newman sparked an interest in Environment Environment is described as a ―universe of
nursing. From that experience evolved the idea that open systems‖
―illness reflected the life patterns of the person and Health ―Health and illness are synthesized as health -
that what was needed was the recognition of that the fusion on one state of being (disease) with
pattern and acceptance of it for what it meant to that its opposite (non-disease) results in what can
person.‖ be regarded as health‖.
Research has been conducted on the theoretical
sources used. ―The theory has progressed to include the health of
all persons regardless of the presence or absence of
Major Concepts and Definitions disease.
Movement – essential property of matter and change that the According to Newman understanding the pattern is
change occurs between two states of rest. essential. The expanding consciousness is the pattern
Space – is in conjunction with time and movement. recognition.
Pattern – characterized by movement, diversity, and rhythm. The nurse helps to understand people to use the
Occurs as human energy fields penetrate one another and power within to develop the higher level of
transformation occurs. consciousness.
Pattern recognition – prediction of the next event in sequence
without certainty. Strengths and Weaknesses
Strengths
Pattern Can be applied in any setting.
A person is identified by her or his pattern, which ―Generates caring interventions‖
reflects the pattern of the person within the larger Weaknesses
pattern of the environment. The pattern is evolving Abstract
through various permutations of order and disorder, Multi-dimensional
including what in everyday language is called health Qualitative
and disease. Little discussion on environment
Pattern recognition emerges from a process of
uncovering meaning in a person‘s life. Meaning is Practice
inherent in pattern, and vice versa. Newman‘s model of Health is useful in the practice of nursing
Consciousness because it contained concepts used by the nursing profession.
defined as the informational capacity of the system (in Movement and time are an intrinsic part of nursing
this case, the human being); that is, the ability of the intervention, that is, range-of- motion, ambulation, turning,
system to interact with the environment (Bentov, coughing, and deep- breathing. These parameters are used
1978). each day by the nurse in practice.
Three Correlates of Consciousness:
Movement Education
Time Newman did not advocate one model as the sole basis for
Space curriculum. Rather, students should have the opportunity to
study various approaches to health and nursing and to choose
Major Assumptions what is relevant to them in their practice and research.
1. Health encompasses conditions heretofore described as
illness, or, in medical terms, pathology Research
2. These pathological conditions can be considered a Some researchers have attempted to test Newman‘s
manifestation of the total pattern of the individual propositions of time, space, and movement.
3. The pattern of the individual that eventually manifests itself *A negative correlation was found between
as pathology is primary and exists prior to structural or depression and subjective time – findings do not
functional changes support an increasing level of consciousness with age.

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 Cooperative inquiry or interactive, integrative
participation - Newman stated that research should
center around ―participatory investigations in which A Model for Practice provides insight and answers
subjects (clients) are our partners, our core-searchers, into how nurses can express their nursing by being
in our search for health patterns.‖ technologically competent. As such, Locsin sustains
the understanding that being technological competent
is being caring.
Locsin's theory book explores, clarifies, and advances
the conception of technological competency as caring
First published the theory in 1981 as the ―Man- in nursing. His theory is essential to modeling a
Living-Health‖ theory – synthesize concepts from practice of nursing from the perspective of caring. It is
Martha Rogers theory. a practical illumination of excellent nursing in a
1992 – Theory of Human Being technological world.

Using Parse‘s 1992 language revision, the original nine About the Author
assumptions now read as four assumptions concerning humans Locsin was born in 1954. He is a registered nurse, a native of
& five assumptions concerning becoming. They are: Dumaguete City, Philippines who resides and practices his
HUMAN nursing profession at Tokushima University, Tokushima, Japan
The human is coexisting while coconstituting as a Professor of Nursing. He is a Professor emeritus of Florida
rhythmical patterns with the universe. Atlantic University in Boca Raton, Florida, USA. Dr. Rozzano
The human is an open being, freely choosing meaning Locsin earned his PhD in Nursing from the University of the
in situation, bearing responsibility for decisions. Philippines in 1988, and his MA in Nursing and Bachelor of
The human is a living unity continuously Science in Nursing from Silliman University in 1978 and 1976
coconstituting patterns of relating. respectively in the Philippines.
The human is transcending multidimensionally with He is a professor of nursing at Tokushima University (Japan);
the possibles. Professor Emeritus of Florida Atlantic University (United
BECOMING States); Visiting Professor –St. Paul University Philippines,
Becoming is an open process, experienced by the (Philippines); Silliman University (Philippines); Prince of
human. Songkla University (Thailand); Mbarara University of Science
Becoming is rhythmically coconstituting process of and Technology (Uganda).
the human-universe interrelationship. Locsin is known for the middle-range theory, ―Technological
Becoming is the human‘s pattern of relating value Competency as Caring in Nursing‘‘
priorities. Dr. Locsin is a multi-awarded nurse scholar and educator. He
Becoming is an intersubjective process of held the Lillian O. Slemp Endowed Chair in Nursing at the
transcending with the possibles. University of Texas Pan American (Edinburg, Texas), and the
Becoming is human unfolding. John F. Wymer Distinguished Professor of Nursing at Florida
Atlantic University (Boca Raton, Florida). Dr. Locsin was a
The three themes in Parse‘s assumptions are: Fulbright Scholar to Uganda, and Fulbright Senior Specialist in
meaning, rhythmicity & contranscendence. Global and Public Health and International Development. He is
a Fellow of the American Academy of Nursing (FAAN).
Three Principles in the theory:
1. Structuring meaning multidimensionality is cocreating Assumptions
reality through the languaging of valuing & imaging. Technological Competency as Caring in Nursing is a middle
2. Cocreating rhythmical patterns of relating is living the range theory grounded in Nursing as Caring. It is illustrated in
paradoxical unity of revealing-concealing and enabling- the practice of nursing grounded in the harmonious coexistence
limiting while connecting-separating. between technology and caring in nursing.
3. Contranscending with the possibles is powering the
unique ways of originating in the process of transforming. The Process of Nursing
A. Knowing
Nursing Paradigm The process of knowing person is guided by
Human The unitary human is one who ―co-participates technological knowing in which persons are
in the universe in creating becoming and who is appreciated as participants in their care rather than as
whole, open, free to choose ways of becoming. objects of care. The nurse enters the world of the
Health A way of being in the world; it is not a other.
continuum of healthy to ill, nor it is a B. Designing
dichotomy of health or illness, rather it is the Both the nurse and the one nursed (patient) plan a mutual
living of day-to-day ways of being. care process from which the nurse can organize a
Nursing A scientific discipline, the practice of which is rewarding nursing practice that is responsive to the
a performing art. She places nursing in the patient‘s desire for care.
company of drama, music, and dance, in each C. Participation in appreciation
of which the artist creates something unique. The simultaneous practice of conjoined activities
Environment The world, the universe and those who occupy which are crucial to knowing persons.
spaces along with others who freely choose to D. Verifying knowledge
be in the situation. Knowledge about the person that is derived from
knowing, designing, and implementing further
informs the nurse and the one nursed.

Dimensions of Technological Value in the Theory

Technology as completing human beings to re-
formulate the ideal human being such as in

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 replacement parts, both mechanical (prostheses) or The CASAGRA Transformative Leadership Theory is
organic (transplantation of organs.) classified as a Practice Theory basing on the characteristics of
Technology as machine technologies, e.g. computers a Practice Theory stated by McEwen (2007), which are the
and gadgets enhancing nursingactivities to provide following:
quality patient care such as Penelope or Da Vinci in a. Complexity/Abstractness, Scope -Focuses on a narrow view
the Operating Theatres; of reality, simple and straightforward;
Technologies that mimic human beings and human b. Generalizibility/Specificity -Linked to a special populations
activities to meet the demands of nursing care or an identified field of practice;
practices, e.g. cyborgs (cybernetic organisms) or c. Characteristic of Scope –Single, concrete concept that is
anthropomorphic machines and robots such as operationalized;
‗nursebots‘ d. Characteristic of Proposition –Propositions defined;
e. Testability –Goals or outcomes defined and testable;
Technological Competency as Caring in Nursing f. Source of Development –Derived from practice or deduced
Technology brings the patient closer to the nurse. from middle range theory or grand theory.
Conversely, technology can also increase the gap
between the nurse and nursed. Purpose
When technology is used to know persons The present day demands in the nursing profession challenge
continuously in the moment, the process of nursing is nursing educators to revisit their basic responsibility of
lived. educating professional nurses who are responsive to
technological, educational and social changes happening in the
Philippines society today.
Nursing education is faced with a new concern that is
The Proponent: Sr. Carolina S. Agravante, SPC, RN, PhD is globalization of nursing services for the international market.
famous for being the first Filipina theorist for writing the Therefore, a need to develop globalization of care with focus on
CASAGRA Transformative Leadership Model. developing caring nurses.
The title of the theory was derived from her name, CArolina S. The formation of new nursing leaders is urgently needed;
AGRAvante. leaders with new vision who will venture new traits and who
She finished her secondary education at St. Paul University- have gone through new formation in order to serve the society
Manila (formerly St. Paul College -Manila) as class as professional nurse.
salutatorian. In 1964, she earned her BS Nursing degree in the
same school as magna cum laude. In the same year, she passed Main Propositions
the nurse licensure examinations as the board topnotcher. 1. CASAGRA Transformative Leadership is a psycho-
From 1967 to 1969, she studied Master‘s Degree in Nursing spiritual model, was an effective means for faculty to
Education at Catholic University of America as a full-fledged become better teachers and servant-leaders.
scholar. In 2002, she earned her Doctoral Degree in Philosophy 2. Care complex is a structure in the personality of the
at University of the Philippines Manila -the same year her caregiver that is significantly related to the leadership
theory was published. She served as the president of St. Paul behavior.
University -Iloilo, where she taught research subjects among 3. The CASAGRA servant-leadership formula is an effective
senior students. modality in enhancing the nursing faculty‘s servant-
She was a former president of the Association of Deans of the leadership behavior.
Philippines Colleges of Nursing (ADPCN) as she became the 4. Vitality of Care Complex of the nursing faculty is directly
representative in the International Nursing Congress that was related to leadership behavior.
held in Brunei in 1996. A year after, she was a part of a
delegation that participated in the International Council of Key Concepts.
Nursing in Vancouver, Canada. She received a Service Award Servant-leader formula is the enrichment package
from the Philippine Accreditation Association of Schools, prepared as intervention for the study which has three
Colleges and Universities (PAASCU) for being one of the parts that parallel the three concepts of the
accreditors, and is one of the founding members of the CASAGRA transformative leadership model, namely:
Integrated Registered Nurses of the Philippines (IRNP). the care complex primer, a retreat-workshop on
Currently, she is the President of St. Paul College -Ilocos Sur Servant-leadership, and a seminar-workshop on
while performing the duties of the Vice-President for Transformative Teaching for nursing faculty.
Academics. Moreover, she also functions as the program chair
of the school's Department of Nursing. Three-Fold Transformative Leader Concept
1. The Servant-Leadership Spirituality
Definition of the Theory This formula consists of a spiritual exercise, the
The complete title of the model is: The CASAGRA determination of the vitality of the care complex in the
Transformative Leadership Model: Servant –Leader personality of an individual and finally a seminar
Formula & the Nursing Faculty’s Transformative workshop on transformative teaching.
Leadership Behavior. The theory ―CASAGRA The servant-leader formula prescription includes a
Transformative Leadership‖ is a psycho spiritual model. spiritual retreat that goes through the process of
The model is a Three-Fold Transformation Leadership awareness, contemplation, story-telling, reflection,
Conceptrolled into one, comprising of the following elements: and finally commitment to become servant-leaders in
1. Servant-Leader Spirituality; the footsteps of Jesus.
2. Self-Mastery expressed in a vibrant care complex; 2. The Self-Mastery
3. Special Expertise level in the nursing field one is engaged in. consists of a vibrant care complex possessed to a
These elements rolled into one make-up the personality of the certain degree by all who have been through formal
modern professional nurse who will challenge the demands of studies in a care giving profession such as nursing.
these crucial times in society today. 3. The Special-Expertise
level is shown in a creative, caring, critical,
contemplative and collegial teaching of the nurse

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 faculty who is directly involved with the formation of to promote self-discovery by knowing strengths
the nursing. and weakness as well as to practice controlling
internal thought processes that will eventually
Paradigm of the Theory influence emotions, ideas and behaviors.
The conceptual framework is logical because the Lastly, Agravante introduced the concept of The
variables are very well explained on how Special Expertise which states that it is the level of
transformative-leadership model be applicable competence of a professional nurse in the particular
through care complex, transformative teaching nursing area is engaged into.
servant-leader spirituality, and servant-leader
behavior. Implications To Nursing Administration
The framework explains and predicts the continuous The Casagra Transformational Leadership Model is
formation of nursing leadership behavior in nursing suitable for nursing educators, particularly those who
faculty that will eventually affect their teaching are administrators in the educational setting
function. (Magallanes, 2009). It has a psycho-spiritual model
which can be utilized as a formula for faculty and
Strengths administrators to become better teachers and servant
It provided the task of the formation of the nurse leaders.
leaders at the baccalaureate level so that the The theory is based on Biblical teachings of Jesus
profession assured the graduates possess the mind and Christ, which would impact on the ethical practice
heart of a nursing leader who is of the nursing that must be followed in the nursing field.
profession.
It can also be used in other educational settings not Implications To Nursing Research
just on Nursing Profession. Like other aspects of nursing, nursing research has
Limitations been influenced by recent and progressive changes in
CASAGRA transformative leadership limits only on the health care system. The CASAGRA Theory is one
Roman Catholic and Christians nursing educators; of these game changers. Sr. Agravante's theory of
it did not consider other religion to this study. In the Transformational Leadership Theory is focused
Philippines we have a variety of religion present. primarily on the educational and psycho-spiritual
Every religion has its own traditions and practices to aspect of nursing.
be considered.
According to the study, the control and study groups
were selected from the same faculty in the two
schools, it is highly possible that experience could Maslow's hierarchy of needs is one of the best-known theories
have been discussed casually in faculty room and in of motivation. According to humanist psychologist Abraham
some way must contaminated the intervention. Maslow, our actions are motivated in order to achieve
certain needs.
Implications To Nursing Practice Maslow first introduced his concept of a hierarchy of needs in
In our shifts, it is important that one of the nurses will his 1943 paper "A Theory of Human Motivation" and his
take on the lead, in our institution, it is the charge subsequent book Motivation and Personality. This hierarchy
nurse who takes on this role. The charge nurse will suggests that people are motivated to fulfill basic needs before
serve as the captain of the ship, so it is vital that he moving on to other, more advanced needs.
or she take on the job with outmost care and While some of the existing schools of thought at the time (such
compassion. While the charge nurse mainly serves as psychoanalysis and behaviorism) tended to focus on
leadership functions, there are times that they also problematic behaviors, Maslow was much more interested in
become educators, especially to young nurses who are learning about what makes people happy and the things that
just starting their careers. they do to achieve that aim.

Implications To Nursing Education Needs at the bottom of the pyramid are basic physical
In Agravante's Theory of Transformative Leadership requirements including the need for food, water, sleep, and
Model, she initially mentioned the concept of servant- warmth. Once these lower-level needs have been met, people
leadership spirituality. For nurse educators, they can move on to the next level of needs, which are for safety
can apply this concept by being passionate about and security.
their craft. As people progress up the pyramid, needs become increasingly
This concept was coined by Robert K. Greenleaf, psychological and social. Soon, the need for love, friendship,
and in the later years, Larry S. Spears added that in and intimacy becomes important.
order to accomplish this concept, a servant leader Further up the pyramid, the need for personal esteem and
should have the following important characteristics: feelings of accomplishment take priority. Like Carl Rogers,
1. Listening 6. Conceptualization Maslow emphasized the importance of self-actualization,
2. Empathy 7. Foresight which is a process of growing and developing as a person in
3. Healing 8. Stewardship order to achieve individual potential.
4. Awareness 9. Building community
5. Persuasion 10. Commitment to the Deficiency Needs vs. Growth Needs
growth of people Maslow believed that these needs are similar to
instincts and play a major role in motivating behavior.
Moving forward, Agravante introduced her second Physiological, security, social, and esteem needs are
concept which is "The Self-Mastery." In spite of our deficiency needs, which arise due to deprivation.
world's empirical culture wherein newly accepted Satisfying these lower-level needs is important in
norms that focus on the external rather the internal or order to avoid unpleasant feelings or consequences.
mental thought process, people tend to have a direct Maslow termed the highest level of the pyramid as
reaction and an emotional response. This theory aims growth needs. These needs don't stem from a lack of

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 something, but rather from a desire to grow as a The theory is difficult to test
person.
Why Was Maslow's Hierarchy Influential?
Physiological Needs Regardless of these criticisms, Maslow‘s hierarchy of
The basic physiological needs are probably fairly needs represents part of an important shift in
apparent—these include the things that are vital to our psychology. Rather than focusing on abnormal
survival. Some examples of physiological needs behavior and development, Maslow's humanistic
include: psychology was focused on the development of
Food, Water, Breathing, Homeostasis healthy individuals.
In addition to the basic requirements of nutrition, air
and temperature regulation, the physiological needs
also include such things as shelter and clothing.
Maslow also included sexual reproduction in this level Erik Erikson was born on June 15, 1902, in Frankfurt,
of the hierarchy of needs since it is essential to the Germany.His young mother, raised Erik by herself for a time
survival and propagation of the species. before marrying a physician, Dr. Theodore Homberger. The
Security and Safety Needs fact that Homberger was not his biological father was
At this level, the needs for security and safety become concealed from Erikson for many years. When he finally did
primary. learn the truth, Erikson was left with a feeling of confusion
People want control and order in their lives. So, this about who he really was.
need for safety and security contributes largely to This early experience helped spark his interest in the formation
behaviors at this level. of identity. He would later explain that as a child he often felt
Some of the basic security and safety needs include: confused about who he was and how he fit into his community.
Financial security, Health and wellness, Safety against While this may seem like merely an interesting anecdote about
accidents and injury his heritage, the mystery over Erikson's biological parentage
Finding a job, obtaining health insurance and health served as one of the key forces behind his later interest in
care, contributing money to a savings account, and identity formation.
moving into a safer neighborhood are all examples of Erikson maintained that personality develops in a
actions motivated by the security and safety needs. predetermined order through eight stages of psychosocial
Together, the safety and physiological levels of the hierarchy development, from infancy to adulthood. During each stage, the
make up what is often referred to as the basic needs. person experiences a psychosocial crisis which could have a
positive or negative outcome for personality development.
Social Needs For Erikson, these crises are of a psychosocial nature because
The social needs in Maslow‘s hierarchy include such they involve psychological needs of the individual (i.e., psycho)
things as love, acceptance, and belonging. At this conflicting with the needs of society (i.e., social).
level, the need for emotional relationships drives According to the theory, successful completion of each stage
human behavior. results in a healthy personality and the acquisition of basic
Some of the things that satisfy this need include: virtues. Basic virtues are characteristic strengths which the ego
Friendships Romantic attachments can use to resolve subsequent crises.
Community groups Social groups Failure to successfully complete a stage can result in a reduced
Family Churches and religious organizations ability to complete further stages and therefore an unhealthy
Esteem Needs personality and sense of self. These stages, however, can be
At this point, it becomes increasingly important to resolved successfully at a later time.
gain the respect and appreciation of others. People
have a need to accomplish things and then have their Erikson’s Stages of Psychosocial Development
efforts recognized. 1. Trust vs. Mistrust
In addition to the need for feelings of accomplishment Trust vs. mistrust is the first stage in Erik
and prestige, esteem needs include such things as self- Erikson's theory of psychosocial development.
esteem and personal worth. This stage begins at birth continues to
Together, the esteem and social levels make up what is known approximately 18 months of age.
as the psychological needs of the hierarchy. During this stage, the infant is uncertain about
the world in which they live, and looks towards
Self-Actualization Needs their primary caregiver for stability and
According to Maslow‘s definition of self- consistency of care.
actualization, "It may be loosely described as the full 2. Autonomy vs. Shame and Doubt
use and exploitation of talents, capabilities, This stage occurs between the ages of 18 months
potentialities, etc. Such people seem to be fulfilling to approximately 3 years.
themselves and to be doing the best that they are According to Erikson, children at this stage are
capable of doing. They are people who have focused on developing a sense of personal
developed or are developing to the full stature of control over physical skills and a sense of
which they capable." independence.
Self-actualizing people are self-aware, concerned with 3. Initiative vs. Guilt
personal growth, less concerned with the opinions of These years are particularly lively, rapid-
others, and interested in fulfilling their potential. developing period in a child‘s life. During this
period the primary feature involves the child
Criticisms of Maslow’s Theory regularly interacting with other children at
Maslow's theory has become wildly popular both in and out of school. Central to this stage is play, as it provides
psychology. The fields of education and business have been children with the opportunity to explore their
particularly influenced by the theory. While popular, Maslow's interpersonal skills through initiating activities.
concept has not been without criticism. Chief among these:
Needs don't follow a hierarchy

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4. Industry vs. Inferiority marine, he worked on a ship that had been hired by Haganah,
Occurs during childhood between the ages of five the Zionist military organization, to smuggle Jewish war
and twelve. refugees into Palestine, past the British blockade. The ship was
It is at this stage that the child‘s peer group will intercepted, however, and Kohlberg was imprisoned in a British
gain greater significance and will become a internment camp in Cyprus. Returning to the U.S. in 1948, he
major source of the child‘s self-esteem. The child enrolled at the University of Chicago, where he completed a
now feels the need to win approval by B.A. in psychology in one year and a Ph.D. in psychology in
demonstrating specific competencies that are 1958. He subsequently held teaching positions at various
valued by society and begin to develop a sense of institutions before settling at Harvard University in 1968.
pride in their accomplishments. Kohlberg is an American psychologist and educator known for
5. Identity vs. Role Confusion his theory of moral development. He died January 17, 1987,
It occurs during adolescence, from about 12-18 Boston, Massachusetts.
years. During this stage, adolescents search for a
sense of self and personal identity, through an His work modified and expanded upon Jean Piaget's previous
intense exploration of personal values, beliefs, work to form a theory that explained how children develop
and goals. moral reasoning. Piaget described a two-stage process of moral
This is a major stage of development where the development. Kohlberg extended Piaget's theory, proposing
child has to learn the role she will occupy as an that moral development is a continual process that occurs
adult. It is during this stage that the adolescent throughout the lifespan. His theory outlines six stages of moral
will re-examine his identity and try to find out development within three different levels.
exactly who he or she is.
During this period, they explore possibilities and Level 1. Preconventional Morality
begin to form their own identity based upon the The earliest stages of moral development, obedience
outcome of their explorations. Failure to establish and punishment, are especially common in young
a sense of identity within society ("I don‘t know children, but adults are also capable of expressing this
what I want to be when I grow up") can lead to type of reasoning. At this stage, Kohlberg says, people
role confusion. Role confusion involves the see rules as fixed and absolute.
individual not being sure about themselves or Level 2. Conventional Morality
their place in society. Often referred to as the "good boy-good girl"
6. Intimacy vs. Isolation orientation, the stage of the interpersonal relationship
This stage takes place during young adulthood of moral development is focused on living up to social
between the ages of approximately 18 to 40 yrs. expectations and roles. There is an emphasis on
During this stage, the major conflict centers on conformity, being "nice," and consideration of how
forming intimate, loving relationships with other choices influence relationships.
people. During this stage, we begin to share Level 3. Postconventional Morality
ourselves more intimately with others. We At this stage, people follow these internalized
explore relationships leading toward longer-term principles of justice, even if they conflict with laws
commitments with someone other than a family and rules.
member.
7. Generativity vs. Stagnation Criticisms on the theory
This stage takes place during middle adulthood Kohlberg's theory is concerned with moral thinking,
(ages 40 to 65 years). but there is a big difference between knowing what
Psychologically, generativity refers to "making we ought to do versus our actual actions. Moral
your mark" on the world through creating or reasoning, therefore, may not lead to moral
nurturing things that will outlast an individual. behavior. This is just one of the many criticisms of
During middle age individuals experience a need Kohlberg's theory.
to create or nurture things that will outlast them, Critics have pointed out that Kohlberg's theory of
often having mentees or creating positive moral development overemphasizes the concept of
changes that will benefit other people. justice when making moral choices. Factors such as
We give back to society through raising our compassion, caring, and other interpersonal feelings
children, being productive at work, and becoming may play an important part in moral reasoning.
involved in community activities and Kohlberg's critics, have suggested that Kohlberg's
organizations. Through generativity we develop a theory was gender-biased since all of the subjects in
sense of being a part of the bigger picture. his sample were male. Kohlberg believed that women
8. Ego Integrity vs. Despair tended to remain at the third level of moral
This stage begins at approximately age 65 and development because they place a stronger emphasis
ends at death. It is during this time that we on things such as social relationships and the welfare
contemplate our accomplishments and can of others.
develop integrity if we see ourselves as leading a
successful life.

Lawrence Kohlberg was born on October 25, 1927 in

Bronxville, New York, Kohlberg was the youngest of four
children of Alfred Kohlberg, a successful silk merchant of
Jewish ancestry, and Charlotte Albrecht Kohlberg, a Protestant
and a skilled amateur chemist.
Kohlberg graduated from Phillips Academy in Andover,
Massachusetts, in 1945. After serving in the U.S. merchant

Page | 6
 emotional, and spiritual they often implement continuous
feedback.
ASSUMPTION
Dr. Carmelita Divinagracia had her Master in Nursing in 1975. The outcome of the health of the patient is based on how the
She is also a Doctoral Degree holder, a Cardiologist nurse, and nurse take care of his/her patient.
an Advance nurse practitioner. She is the Dean -College of STRENGTH
Nursing [president] U.E.R.M Memorial medical center / The intervention focuses on patients in the Coronary Care
ADPCN Aurora Blvd, Quezon City, Philippines. Unit which should receive quality care by the use of
COMPOSURE behavior from Advanced Nurse Practitioners.-
COMPOSURE Behaviors Divinagracia‘s COMPOSURE behavior is used when providing
Competence is an in-depth knowledge and clinical expertise care to the patient to achieve wellness.
demonstrated in caring for patients. LIMITATION
Presence and prayer is a form of nursing measure which There are clients who do not receive quality care thus resulting
means being with another person during times of need. This in poor wellness outcomes.
includes therapeutic communication, active listening, and APPLICATION OF THE THEORY TO NURSING
touch. PRACTICE
Open-mindedness is a form of nursing measure which means Nursing goes beyond taking care and curing a patient
being receptive to new ideas or to reason. rather nursing forms an intimate relationship with a patient
Stimulation is a form of nursing measure demonstrated by and the nurse such a relationship would include faith, hope and
means of providing encouragement that conveys hope and friendship. Divinagracia (2001) stated that nursing is a
strength, guidance in the form of giving explanation and profession that surpasses time and aspects of the individual as
supervision when doing certain procedures to patient, use of one of its clients.
complimentary words or praise and smile whenever
appropriate.
Understanding, according to her conveys interest and Prof. Letty Gurdiel Kuan was born on November 19, 1936 in
acceptance not only of patient‘s condition but also his entire Katipunan-Dipolog, Zamboanga del Norte. Sister Letty G.
being. Kuan is a nurse with two (2) Master‘s Degrees, MA in Nursing
Respect is acknowledging the patient‘s presence. Use of and MS in Education major in Guidance Counselling. She
preferred naming in addressing the patient, po and opo, is a sign holds a Doctoral Degree in Education major in Guidance
of positive regard. It is also shown through respectful nods and Counselling. All these postgraduatestudies were obtained from
recognition of the patient as someone important. Relaxation the University of the Philippines -Diliman, Quezon City.
entails a form of exercise that involves alternate tension and For her vast contributions to the University of the Philippines -
relaxation of selected group of muscles. College of Nursing faculty and academic achievements, she
Empathy senses accurately other person‘s inner experience. was awarded the distinctive post of Professor Emeritus, a title
The empathic nurse perceives the current positive thought and awarded only to a few who met the strict criteria set by the
feelings and communicates by putting himself in the patient‘s University of the Philippines in September 2004.
place. As a Professor Emeritus, aside from University of the
Philippines -Manila she is affiliated in several schools namely
Patient Wellness Outcome Siliman University in Dumaguete, Cebu Normal University,
This refers to the anticipated wellness of selected Father Urios University in Butuan, St. Joseph's College in
orthopedic patients after receiving nursing care in terms of Quezon City, San Pedro College in Davao.
physiologic and biobehavioral. She has clinical fellowship and specialization in
Many illnesses are curable and may have only a Neuropsychology obtained from University of Paris, France in
temporary effect on health. Others, such as diabetes, are (Salpetriere Hospital). Neurogerontology in Watertown, New
not curable but can be managed with proper eating, York (GoodSamaritan Hospital) and Syracuse University, New
physical activity, and sound medical supervision. It should York. She further added this field ofspecialization in Geneva in
be noted that those possessing manageable conditions may the Centre des Soins Intensifs pour les troisieme age group.She
be more at risk for other health problems, so proper also had Bioethics formal training at Institute of Religion,
management is essential. For example, unmanaged diabetes Ethics and Law at BaylorCollege of Medicine in Houston,
is associated with high risk for heart disease and other health Texas from 1991 -1997.
problems. Two patient wellness outcomes which have been She authored several books giving her insights in the areas of
categorized as: Gerontology, Care of Older Persons and Bioethics and Essence
Biobehavioral of Caring
Physiologic Concepts of illness and health care intervention in an urban
These patient wellness outcomes emulate their needs community.by Kuan, Letty Gurdiel; [Quezon City]: 1975.
as their illness turns to restoration and reclamation. These Understanding the Filipino elderly: a textbook for nurses and
needs must be met through elevated quality nursing care, none related health professional by Kuan, Letty G.; Dipolog City:
other than through self-control behaviors. Imperturbability Jesus G. Kuan Foundation, 1993. Essence of Caring by Letty
behaviours have been inspired to the principle of entire care G. Kuan, National Teacher Training Center for the Health
wherein a patient wellness outcome can be accomplished Professions, University of the Philippines Manila, Learning
through a series of quality virtues of nurses, which procure to Resources Unit, 1993. Pag-aaruga sa mga taong may edad na
every angle of patient wellness, may it be biobehavioral or by Kuan, Letty G.; Quezon City: UP-KAT, 1998. Bioethic in
physiologic wellness conclusion. Nursing by Kuan, Letty G.; Manila: Educational Pub. House,
Physiologic Wellness Outcome - This refers to the grasped 2006.
wellness of preferred orthopedic patients after receiving She is a recipient of the Metrobank Foundation Outstanding
nursing care in terms of vital signs, bone pain sensation, and Teachers Award in 1995, the first faculty to win such an award
complete blood count. representing the UP Manila, and an Award for Continuing
Biobehavioral Wellness Outcome - This refers to the Integrity and Excellence in Service (ACIES) in 2004.
witnessed wellness of chosen orthopedic patients after
receiving nursing care in terms physical, intellectual,
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Her religious community is the Notre Dame de Vie founded in Metaparadigm
France in 1932. Human being/Person
As a former member of the Board of Nursing, her legacy to the Aged people or the elderly. (Age group reaching the mid 70‘s –
Nursing Community is undeniable and indisputable. But aside 80‘s)
from all the awards, trophies, medals and certificates she Gerone: Given to people who are old but are still able to fulfill
received, the greatest victory of her theory is evidenced by her their duties in the community and is an exemplary federation of
own life, how she entered aging and how she managed faithfulness to the life of prayer.
retirement per se. Nursing
Influence and Inspirations Is preparing the person to have fulfillment in their retirement
Prof. Letty Kuan‘s study on aging was influenced years, and assisting them in their elderly years in leaving a
majorly by her observations of daily life. She saw the legacy.
world, she saw the environment, but most of all she Health
saw the people in it --all in a different perspective. It is defined as aging. It is a low process of growth
The difficult patients, terror teachers, strict towards maturity of mind, body, and spirit.
supervisors, corrupt government officials and the Environment - It is not defined on this model.
cranky old people led her to the question, why are
these people behaving this way? Thus, the theory Contributions in the field of Nursing
Graceful Aging was born. Dr. Kuan's services to the nursing profession are not only
Theory Development Strategy in her capacity as an educator and consultant, but most
Her interest in old people paved way for the study. significantly, as a mentor to students and nurses seeking
Guided by inductive or grounded reasoning, this careers in higher education and leadership.
theory is a result of twenty years of researching, She selflessly shares with her mentees all the experience,
organizing retreats and conducting conferences to all expertise, and talents she has gained along her journey to being
the social sectors of humanity –the nurses, doctors, who she is today.
guidance counsellors, etc, nationwide.

Basic Assumptions and Concepts

Physiological Age is the endurance of cells and tissues to Carmencita M. Abaquin is a nurse with Master‘s and Doctoral
withstand the wear-and-tear phenomenon of the human body. Degree in Nursing obtained from the University of the
Some individuals are gifted with strong genetic affinity to stay Philippines College of Nursing. She is an expert of Medical
young for a long time. Surgical Nursing with subspecialty in Oncologic Nursing,
Role refers to the set of shared expectations focused upon a which made her known both here and abroad. She had served
particular position. These may include beliefs about what goals the University of the Philippines College of Nursing, her Alma
or values the position incumbent is to pursue and the norms that Matter, as faculty and held the position as Secretary of the
will govern his behavior. It is also the set of shared College of Nursing. Her latest appointment as a Chairman of
expectations from the retiree‘s socialization experiences and the the Board of Nursing speaks of her competence and integrity in
values internalized while preparing for the position as well as the field she has chosen.
the adaptations to the expectations socially defined for the The Theory: PREPARE ME
position itself. ―To Nursing... may be able to provide the care that our clients
Change of Life is the period between near retirement and post need in maintaining their quality of life and being instrumental
retirement years. In medico-physiologic terms, this equates in ―birthing‖ them to external life.‖
with the climacteric period of adjustment and readjustment to
another tempo of life. Basic Assumptions and Concepts:
Retiree is an individual who has left the position occupied for PREPARE ME (Holistic Nursing Interventions) are the nursing
the past years of productive life because he/she has reached the interventions provided to address the multi-dimensional
prescribed retirement age of has completed the required years problems of cancer patients that can be given in any setting
of service. where patients choose to be confined.
Role Discontinuity is the interruption in the line of status This program emphasizes a holistic approach to nursing care.
enjoyed or role performed. The interruption may be brought PREPARE ME has the following components:
about by an accident, emergency, and change of position or Presence–being with another person during the times of need.
retirement. This includes therapeutic communication, active listening, and
Coping Approaches refer to the interventions or measures touch.
applied to solve a problematic situation or state in order to Reminisce Therapy –recall of past experiences, feelings and
restore or maintain equilibrium and normal functioning. thoughts to facilitate adaptation to present circumstances.
Prayer
Determinants of positive perceptions in retirement and Relaxation-Breathing–techniques to encourage and elicit
positive reactions toward role discontinuities: relaxation for the purpose of decreasing undesirable signs and
1. Health Status –refer to physiological and mental state of the symptoms such as pain, muscle tension, and anxiety.
respondents, classified as either sickly or healthy. Meditation–encourages an elicit form of relaxation for the
2. Income –(economic level) refers to the financial affluence of purpose of altering patient‘s level of awareness by focusing on
the respondent which can be classified as poor, moderate or an image or thought to facilitate inner sight which helps
rich. establish connection and relationship with God. It may be done
3. Work Status through the use of music and other relaxation techniques.
4. Family Constellation –means the type of family Values Clarification–assisting another individual to clarify his
composition described either close knit or extended family own values about health and illness in order to facilitate
where three more generations of family members live under effective decision-making skills. Through this, the patient
one roof; develops an open mind that will facilitate acceptance of disease
5. Self-Preparation state or may help deepen or enhance values. The process of
values clarification helps one become internally consistent by
achieving closer between what we do and what we feel.

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 Research to develop the guide found that communication gaps
A multifaceted construct that encompasses the individual's between patients and caregivers can occur when hospitals do
capacity and abilities with an aim of enriching life when it not address the issues that patients think are most important.
cannot longer be prolonged. Another factor is that available few tools are to give health
providers insights into patients' needs and concerns. As a result,
Metaparadigms and Interventions efforts by patients, families and health providers to
Person/Patient. Her theory is specific to patients in advanced communicate more effectively with each other can fall short of
stages of cancer. They are holistic being with physical, their goal.
psychological, social, religious, level of independence, and Each strategy includes educational tools and resources for
environmental aspects. Patients who are terminally-ill or those patients and families, training materials for health care
with incurable diseases as with cancer must be approached in professionals and real-world examples that show how strategies
multifaceted care to improve their quality of life. are being implemented in hospital settings. The strategies
Environment. Just like all the other paradigms, environment describe how patients and families, working with hospital staff,
was not defined accurately. Nevertheless, we can assume that can: be advisors; promote better communication at the bedside
environment is an aspect or dimension integrated to the cancer to improve quality; participate in bedside shift reports; and
patient. Her quality of life can also be assessed in this aspect prepare to leave the hospital.
thus it must be given consideration in the provision of care.
Health - The concept of her theory revolves around illness, Anxiety - a mental state of fear or nervousness about what
particularly cancer and the provision of holistic care to improve might happen.
quality of life despite their terminal cases. Nurse‘s Caring behavior that affect patient anxiety:
Quality of life is defined as a multifaceted construct that PRESENCE-person to person contact between the client and
encompasses the individuals capabilities and abilities of the nurses
enriching life when it can no longer be prolonged. This includes CONCERN-development in the time through mutual trust
proper care and maintaining integrity of the body, mind and nurse and the patient.
spirit despite the limitations brought about by the present STIMULATION-nurse stimulation through words tops the
condition. The quality of life is seen through the patient's many powerful resources of energy of person for healing.
dimensions.
Nursing. The goal of nursing care is the improvement of Enhancing factors
quality of life for advance stage cancer patients despite their One‘s caring experience, beliefs and attitude
current situation. Her concept of providing holistic nursing care Feeling good about work
in addressing the multidimensional problems that cancer Learning caring at school
patients face is summarized in the acronym PREPARE ME. What patients tell about the nurse coping mechanism to
problems encountered.
PREPARE ME theory provides a framework on non- Communication
pharmacologic, non-surgical approach of care to advanced Predisposing Factors
cases of cancer patients. The focus is not on cure but on Age Sex
assisting the patient to explore her humanity and internal Civil Status Educational Background
serenity as one is faced with the challenge of life and death. Length of work Experience
Nurses must be seen not as mere caregivers but facilitators of
peaceful acceptance of condition.

The HST theory is a study of caring, HST, and the perspective

Cecilia M. Laurent graduated in 1967with the degree ofBSN at of synchronicity and nursing engagement. This theory aims to
University of the Philippines, and in 1973with the degree of enlighten nurses in their practice through an innovative
Masters of Nursing. She worked as a staff nurse from 1968to demonstration of nursing care processes grounded on authentic
1969, Head Nurse from1970to 1972. She became a Nursing intentions of caring transcending extant reductionistic
Supervisor at Philippine General Hospital from 1973 to 1976, approaches.
worked at Metropolitan Hospital in Michigan USA in 1977 – Furthermore, (SHSTTNE)is a useful theoretical base for future
1979. She was an instructor at the University of The Philippines research that aims to describe the meaningful connectedness in
College of Nursing and was the Dean of the College from 1966 human experiences of transcendence, interconnectivity,
–2002. emancipation, and equitability with humanistic approaches in
Cecilia M. Laurente " Categorization of Nursing Activities as the discipline of nursing.
Observed in Medical-Surgical Ward Units in Selected
Government and Private Hospitals in Metro Manila", January- The Principles of the Synchronicity Theory: Application of
June 87. the Nursing Engagement Process
In the recent study of Laurente, she states that another entry The four life principles of the Synchronicity in the Human-
point of helping the patient is though the family, when nurses Space-Time Theory of Nursing Engagement (SHSTTNE) are
can be of great assistance to prevent at the very beginning interconnectivity, equitability, emancipation and human
serious complications. The nurse can help strengthen the transcendence. They guide the nurses in translating the
family‘s term of knowledge, skills, and attitude through theoretical assumptions and caring elements of the SHSTTNE
effective communication, employed informative, into practice.
psychotherapeutic, modeling, behavioral, cognitive-behavioral,
and/or hypnotic techniques are summarized and evaluated. Interconnectivity
is a principle of human interconnectedness of energy.
Communication is key when getting nurses to engage Energy is continuously moving from ―subatomic
patients and families in their care. particles to the biosphere, including the planet Earth,
all forming a whole‖.

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 Interconnectivity leads to the understanding of holism transcendence is revealed in the expansion of self-
that the bio-psycho-social-spiritual dimensions of boundaries that enhances well-being human
persons are interrelated and that the whole being is transcendence is also evident in the ability to go
more than the sum of its organs or systems. beyond the limits of the HST through nursing
The nurse does not focus only on biological curing but engagement that fosters human health and well-being.
considers the healing aspect of the whole person’s Resilience, for example, is meaningfully connected
being. The nurse becomes more cognizant of the with well-being through human transcendence.
whole integrated person interacting with and
influenced by both internal and external
environments.
Equitability The Change Theory of Nursing was developed byKurt Lewin,
is a principle of justice and fairness in human caring who is considered the father of social psychology. This theory
across healthcare systems. It revolves around the is his most influential theory. He theorized a three-stage model
value-based concept of equity implying fairness in of change known as unfreezing-change-refreeze model that
access to health care related to the situated context requires prior learning to be rejected and replaced.
despite differences in methods, utilization, and Kurt Lewin was born on September 9, 1890 in Mogilno,
outcomes. Germany (now in Poland)was born in Germany, later emigrated
It can also mean fairness in access to services within to the US.
an organization. An understanding of the He is well known for his writings on group dynamics, group
interconnections among space, time, movement and therapy and social psychology. He introduced his field theory
consciousness as health manifestations leads to concepts, emphasizing that the group differs from the simple
meaningful relationships within the HST and beyond. sum of its parts.
When there are meaningful relationships of persons Lewin coined the term group dynamics in 1939.His field
(i.e., among patients, family, and healthcare team), the theory states that "one‘s behavior is related both to one‘s
nurse is enabled to express equity in nursing care personal characteristics and to the social situation in which one
through prioritization, triage, and cost-effective finds oneself."
measures in the processes of nursing engagement. He died on February 12, 1947, in Massachusetts, United States
In applying equitability, the nurse is cognizant of the
difference between equality and equity.
Lewin’s Change Theory
Emancipation His most influential theory was his model of the
is a principle of liberating the self and others from the change process in human systems.
limits of human-space-time realities. Kurt Lewin theorized a three-stage model of change
The human-space-time realities of health care could that is known as the unfreezing-change-refreeze
include human factors or attributes such as fear, model that requires prior learning to be rejected and
shame, lack of communication skills, lack of replaced.
knowledge, powerlessness and human resources. Lewin's theory states behavior as "a dynamic balance
Space factors could mean internal and external of forces working in opposing directions."
environmental limitations. Internal environmental
limitations are physiologic, psychologic, emotional Concepts
and spiritual conditions while the external Driving forces
environment limitations refer to the socio-economic- Driving forces are forces that push in a direction that
political challenges as well as the organizational causes change to occur. Driving forces facilitate
dynamics that influence the nurse and the nursed. change because they push the person in the desired
The time limit is indicated by the constraints it has on direction.
every person such as how long it takes for the nurse to They cause a shift in the equilibrium towards change.
spend for every patient before his/her shift ends, or on
the part of the patient how long it takes for him/her to Restraining forces
stay in the hospital bed. Restraining forces are forces that counter driving
Emancipatory knowing is applied in praxis and in the forces.
integration of knowing, doing and being. In the Restraining forces hinder change because they push
application of the NEP, to emancipate is to know what the person in the opposite direction.
the nurse can know, doing what one can do, and be Restraining forces cause a shift in the equilibrium
with the patient in the present given the limitations of which opposes change
the HST. Equilibrium
Both principles of equitability and emancipation are Equilibrium is a state of being where driving forces
essential in the application of the NEP when equal restraining forces and no change occurs
―unveiling the dynamics that sustain inequity creates Equilibrium can be raised or lowered by changes that
(the) freedom to see and act in a way that improves occur between the driving and restraining forces.
the health for all. Stages of change theory
Human transcendence 1. Unfreezing
―When people transcend their own egos, dedicate The process which involves finding a method of
their energy to something greater than the individual making it possible for people to let go of an old
self, and learn to build order against the trend of pattern that was counterproductive in some way,
disorder‖ then the principle of human transcendence is facilitating individuals in overcoming resistance
applied. and group conformity.
Human transcendence indicates personal growth of In this stage, disequilibrium occurs to disrupt the
persons and professional growth among nurses. system, making it possible to identify the driving
Through human transcendence, nurses and the nursed forces for the change and the likely restraining
can rise beyond their present difficulties. Just as self- forces against it.

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 Unfreezing is necessary to overcome the strains Interpersonal Security: feelings associated with relief of
of individual resistance and group conformity. anxiety, the point when all needs are met or a sense of total
Unfreezing can be achieved by the use of three well-being
methods: Parataxic Distortion: a person‘s fantasy perception of another
1.First, increase the driving forces that direct person‘s attributes without consideration of important
behavior away from the existing situation or personality differences
status quo. Selective Inattention: how people cope with the anxiety
2.Second, decrease the restraining forces that caused by the undesired trait
negatively affect the movement from the existing
equilibrium. Sullivan focused on anxiety as being a consequence of faulty
3.Third, find a combination of the two methods social interactions. He believed people developed a
listed above. personification of self and others through the integration of
2. ―Moving to a new level or Changing‖ or Movement ―good me, bad me, and not me‖ perception (the self-system)
This stage involves a process of change in thoughts, Self -System: The collection of experiences or security
feeling, behavior, or all three, that is in some way measures to protect against anxiety
more liberating or more productive. : represents what people like about
Lewin describes three actions that can assist in themselves and is willing to share with others.
movement: : what people don‘t like about themselves and
(1) persuading others that the status quo is not not willing to share. Develops in response to negative
beneficial and encouraging others to view a problem feedback with feelings of discomfort, displeasure, and
with a fresh perspective distress. The ―Bad Me‖ creates anxiety.
(2) working with others to find new, relevant : the aspects of self that are so anxiety-
information that can help effect the desired change provoking that the person does not consider them
(3) connecting with powerful leaders who also support apart of the person. It contains feelings of horror, and
the change This second stage is often the most dread. This part of the self is primarily unconscious
difficult due to the fact that there is a level of (dissociative coping).
uncertainty and fear associated with change Sullivan believed that all psychological disorders have an
3. Refreezing interpersonal origin and can be understood only with reference
The third stage is necessary to ensure that the change to the patient‘s social environment.
implemented (in the second stage) will ―stick‖ over To understand a person‘s drives for behavior, 2 needs are
time Success at this stage will create a new involved: satisfaction (sleep, sex, hunger) & security
equilibrium state known to be the new norm or higher (conforming to social norms of the person‘s reference group). If
level of performance expectation. the 2 drives of ―self-system‖ are interfered with, mental illness
Refreezing is establishing the change as a new habit, occurs.
so that it now becomes the ―standard operating
procedure.‖ Without this stage of refreezing, it is easy
to go back to the old ways.

Infancy 0-18mths Oral gratification; anxiety

first occurs
Childhood 18mths-6y Delayed gratification
Herbert ―Harry‖ Stack Sullivan (1892–1949) was an American
Juvenile 6-9y Forming peer-relationships
Neo-Freudian psychiatrist and psychoanalyst who held that the
personality lives in a complex of interpersonal relations. Harry Preadolescence 9-12y Same-sex relationship
was the oldest existing son of poor Irish Catholic parents, Early 12-14y Opposite-sex relationships
lonely childhood existence, and a poor relationship with father. Adolescence
Academically gifted, Sullivan graduated from high school as Late 14-21y Self-identity is developed
valedictorian at age 16. He then entered Cornell University Adolescence
intending to become a physicist, although he also had an
interest in psychiatry.
However, his academic performance at Cornell was a disaster
and he was suspended after a year and possibly suffered a General Systems Theory
schizophrenic breakdown. Eventually, Dr. Sullivan graduated A set of components or units interacting with each other within
from Chicago College of Medicine and Surgery, despite his a boundary that filters both the king & rate of flow inputs &
academic struggles. Dr. Sullivan had no formal training in outputs to & from the system.
psychiatry but devoted years of clinical and research work to
help people with psychotic illnesses, especially patients with
schizophrenia. 1. Made up of identifiable elements or parts that are
Overall, Dr. Sullivan was a prominent theorist with regard to interrelated
understanding the magnitude of interpersonal relationships. 2. Each identifiable element or part is differentiated from
Hildegard Peplau also credited her theoretical approach of others by a real or imaginary line called boundaries
nursing interventions with psychiatric patients based on 3. A system interacts or relates with its environment by
Sullivan‘s theory. It is unfortunate that he doesn‘t get more receiving something from it & by giving something in
recognition but that‘s why additional context was given to return.
provide more consideration.

1. Structure –the static arrangement of a system‘s parts

Assumptions and Key Concepts at any moment in a three -dimensional space
Anxiety: the ―main disruptive force‖ in interpersonal relations 2. Function or Process-dynamic change in matter,
Basic Anxiety: fear of rejection by significant persons energy or information contained in a system overtime

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 3. - There are certain processes that allow a
system to achieve in the input-output exchanges, the
Openness structure of the systems remains the same
Wholeness
Hierarchical arrangement

Universal theory Dealing with health-related

1. adaptation to the environment Provides conceptual problems is through
2. Integration of system parts links across different multidisciplinary approach
3. Decision-making about allocation of resources disciplines
Human beings are holistic & Roy‘s adaptation Model
Transactional mode goal directed Nurse value the client
The process system in which the system decides whether or not centered approach in her
to exchange matter, energy or information depending on provision of nursing care
specific premises Views person as an open - Concepts of interrelatedness,
systems who strive to inter-dependence & dynamic
maintain harmony & balance interaction among organisms
between their internal &
1. - based on the premise that the system & its external environment
environment are committed to each other. (ecologic view)
Example: Family (exchanges for the common good of the Individuals at the subsystems Interpersonal contribute
system level carry out networking to social systems.
2. - the system & its environment within their environment in Imogene King‘s
responds to each other because ―it is their duty or It is the hierarchically arranged Interacting systems
policy. systems of increasing framework & goal
Example: workplace, school (we are all obliged to comply complexity attainment theory
with rules and regulations set by the institution Patient as seen as
3. - the system & the environment personal system who co-
recognize that each system has something to contribute in exist with other personal
order to achieve a common goal. systems
Example: civic organizations, study groups, sports team Individuals from a group
4. - when a system has needs & goals different that will now
from those of its subsystem or it‘s environment, it can compromise the so-called
negotiate in order to meet these needs & goals. interpersonal system
Example: businesses Emphasizes relationships as Nurse patient as systems
5. - Systems makes use of force, threat or deception well as components of the interacting with one
to obtain what is necessary for the system‘s survival; system another, processing
lessens the opportunity for growth learning because of its inputs, throughputs &
punitive character. outputs to achieve a
Example: groups that disobey the rules of society specific goal
Hildegard Peplau‘s
Theory of interpersonal
- the process of importing matter, energy or information; Relations
consists of measurable event or series of events occurring
outside a system
- Once the matter, energy or information has
entered the system, it is transformed, created & recognized.
- Matter, energy or information will be exported or
transported out of the system continuously

Boundary Maintenance
1. Retaining within the system the matter, energy or
information required by the system
2. Obtaining from the environment the needed matter, energy
and information
3. Containing within the environment that which is not
required
4. Disposing of matter, energy or information

1. -The former status is altered as the system

adjust or modifies some of its elements based on the
dynamics of the past; Can be achieved by the process of
known as feedback mechanism
2. - The tendency to reach characteristics final
state from the different initial states in various ways on the
dynamic interaction in an open system

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