CHED i) Commission on Higher Education ii) Executive Director Dr.

WILLIAM MEDRANO ADPCN i) Association of Deans of Philippine Colleges of Nursing ii) Supported MO #5 APHP i) Association of Private Hospitals in the Philippines COCOPEA i) Coordinating Council of Private Educational Associates ii) Did not support MO #5 Memorandum Order (MO) #5 i) Released by CHED on March 14, 2008 which requires THEORETICAL FOUNDATIONS OF NURSING during the FIRST SEMESTER and FOUNDATIONS OF NURSING during the SECOND SEMESTER. THEORY i) From Greek word THEORIA a) Meaning LOOKING AT VIEWING BEHOLDING ii) Organized system of accepted knowledge intended to explain a set of facts. Composed of: a) CONCEPTS BUILDING BLOCKS of Theories An idea formulated by the mind or an experience perceived and observed b) MAJOR CONCEPT c) DEFINITIONS WOULD GIVE MEANING TO CONCEPTS Composed of various descriptions which convey a general meaning and reduces vagueness in understanding a set of concepts d) ASSUMPTIONS ACCEPTED TRUTHS THAT ARE FUNDAMENTAL TO THEORIES Statement that specifies the relationship or connection of factual concepts or phenomena e) PROPOSITIONS f) PURPOSE iii) We look for an explanation of an EMPIRICAL (Observed and Experienced) phenomena iv) Compilation of similar concepts that seems to explain a phenomena v) CHARACTERISTICS OF A THEORY a) SYSTEMATIC, LOGICAL AND COHERENT (Orderly reasoning / No Contradictions) b) Creative Structuring of Ideas c) TENTATIVE (temporary) in nature NURSING THEORY i) Body of knowledge used to support nursing practice ii) Aims to view the essence of Nursing Care iii) Group of interrelated concepts that are developed from various studies of disciplines and related experiences NURSING METAPARADIGM i) Definition

Patterns used to show relationship between theoretical concepts in nursing ii) Root words a) META meaning WITH b) PARADIGM meaning PATTERN Another term for CONCEPTUAL FRAMEWORK or MODEL iii) 4 Elements of Nursing Paradigms (Clue: P-H-E-N) a) Person The recipient of nursing care b) Health State of complete physical, mental, social, emotional and spiritual well-being and not only in the absence of disease WHO definition c) Environment External and Internal aspects of life that influence the person d) Nursing Interventions of the nurse rendering care in support of or in cooperation with the client NURSING PHILOSOPHY i) Next knowledge level after MetaParadigm ii) Sets forth the meaning of Phenomena through analysis, reasoning and logical argument iii) Works that specify philosophical approaches to Nursing a) i.e. Nightingales Environmental Theory THEORETICAL MODELS i) Highly established set of concepts that are TESTABLE ii) As proposed by Lynda Hall: a) The Person as THE CORE Social Sciences Therapeutic use of self b) The Body as THE CARE Natural and Biological Sciences Intimate bodily care c) The Disease as THE CURE Pathological and Therapeutic Sciences Seeing patient and family through medical care

a)

CONCEPTUAL MODELS i) DERIVED FROM A PERSONS OWN POINT OF VIEW ii) Representations of an idea or body of knowledge based on the own understanding or perception of a person

Clients Behavior Guarding behavior at the pain site d) Interventions Care of the client in pain e) Practices that are utilized in nursing theories and metaparadigms c) SCIENCE i) SCIENTIA meaning KNOWLEDGE ii) System of acquiring knowledge based on empirical method and organizing knowledge based on research iii) Scientific Method: a) Observation b) Gathering Information / Data c) Forming Hypothesis d) Experimental Investigation e) Conclusion of Theoretical Explanation KNOWLEDGE i) Information, skills and expertise acquired by a person through various life experiences or through formal/informal learning ii) Types of Cognitive Process a) Perception Achieving understanding of sensory data b) Association Combining two or more concepts/ideas to form a new concept c) Learning Acquiring experience, skills, information and values d) Reasoning Mental process of seeking conclusions through reason e) Communication Transferring data from sender to receiver using different mediums or tools of communication f) Sources of Knowledge Traditional knowledge Nursing practice which is passed down from generation to generation Authoritative knowledge Is an idea by a person of authority which is perceived as true because of his or her expertise Scientific knowledge Type of knowledge which came from a scientific method through research i.e. Tepid Sponge Bath (TSB) 1. Rationale is heat transfer through evaporation PHENOMENON i) Sets of empirical data or experiences that can be physically observed or tangible such as crying or grimacing when in pain ii) In Nursing, a phenomena can be: a) Clinical or environmental setting of nursing i.e. Health Center b) Disease process i.e. Stomach Ulcer HYPOTHESIS - A testable relationship statement RESEARCH - Use of systematic methods to study a phenomenon and create a general knowledge TWO TYPES OF REASONING i) INDUCTION a) A type of reasoning that uses specific details to form a general conclusion ii) DEDUCTION a) A type of reasoning wherein general conclusions are made based from specific concepts IMPORTANCE OF NURSING THEORIES i) Developed to improve the quality of care rendered by nurses to their clients ii) In Education: a) Provides a general focus for curriculum design b) Guides curricular decision-making iii) In Research: a) Offers a framework for generating knowledge and new ideas b) Assists in discovering knowledge gaps BLANK SPOT No known knowledge base BLIND SPOT Little known knowledge iv) In Clinical Practice: a) Assists nurses to describe, explain and predict everyday experiences b) Provides basis for assessment, intervention and evaluation EXAMPLES OF NURSING THEORIES i) ENVIRONMENTAL THEORY a) Proponent is FLORENCE NIGHTINGALE Mother/Founder of Modern Nursing b) Environmental aspects as integral part of nursing care Good ventilation Sanitation Water treatments ii) PSYCHODYNAMIC NURSING a) Proponent is HILDEGARD PEPLAU b) Emphasized the development of Inter-personal relationship between the patient and the nurse iii) 14 COMPONENTS OF BASIC NURSING CARE a) Proponent is VIRGINIA HENDERSON b) Nurses as direct care giver help patients to become independent iv) HUMAN TO HUMAN RELATIONSHIP MODEL a) Proponent is JOYCE TRAVELBEE

b) Finding meaning in illness and suffering enables the patient not only to accept illness but it will also serve as a self-actualizing experience v) SYSTEMS MODEL a) Proponent is BETTY NEUMAN b) Goal-oriented, integrated and holistic approach to client care vi) GOAL ATTAINMENT THEORY a) Proponent is IMOGENE KING b) Developed the Goal-Oriented Nursing Record (GONR) vii) ADAPTATION MODEL a) Proponent is Sister Callista Roy b) Nurses enhance the interaction of person and their environment thus improving health viii) PHILOSOPHY AND SCIENCE OF NURSING a) Proponent is JEAN WATSON b) Caring as an essential field in nursing ix) PRIMACY OF NURSING a) Proponent is PATRICIA BENNER b) CARE is central to the essence of nursing. It sets up what matters THE FOUR WAYS OF KNOWING Proponent is BARBARA A. CARPER a) Defined 4 Ways of Knowing: Based on scientific knowledge of human behavior in health and in illness Aesthetic perception of significant human experience Personal understanding of unique individuality of self-capacity to make choices involving moral judgment i) ETHICAL KNOWING a) Ethics Component of MORAL KNOWLEDGE (right conduct) in Nursing b) Requirements: Experiential knowledge of social values 3 Core Filipino Values Kapwa Justice / Equality Pakiramdam Empathy Kagandahang loob Goodness Ethical Reasoning Core Nursing Values / Ethical Principles BENEFICENCE - Doing good NONMALEFICENCE To do No Harm JUSTICE - Fair / Equitable VERACITY - Truth telling FIDELITY - Faithfulness AUTONOMY Freedom to make own decisions c) Focus of Ethical Knowing Right and Wrong Ethical Codes in Nursing Moral Obligation Confronting and resolving conflicting values, norms and interests d) Sources of Ethical Knowing

Ethical Codes and Professional standards in Nursing Different Philosophical positions Consequentialism The end justifies the means Deontology Based on Morality laws The end DOES NOT justify the means Justice ii) PERSONAL KNOWING a) Self-Awareness b) Engage in Therapeutic Use of Self c) Personal reflection d) Openness to experience o o Transference - Patients reactions, behaviors, thoughts, and feelings toward the Nurse Countertransference - nurses reactions, behaviors, thoughts, and feelings toward the patient

iii) AESTHETIC KNOWING a) The ART of Nursing b) Intuition-based c) Based on PATRICIA BENNERs Novice to Expert Theory Novice Empirical Knowledge Advanced Beginner Aesthetic Knowledge Competent - Aesthetic Knowledge Proficient - Aesthetic Knowledge Expert - Aesthetic Knowledge iv) EMPIRICAL KNOWING a) Evidence-based Practice b) Most theory and research development are concentrated c) Turning Knowing into Knowledge: Problem-based Learning Clinical setting EVOLUTION OF NURSING i) Evolved around the works of Florence Nightingale especially during the Crimean War ii) Nursing was traditionally assigned ONLY to women a) Female SLAVES are usually the ones who provide physical maintenance and comfort for the sick b) Usually ordered by a master, healer or priest iii) In early times, providing care evolved around the use of: a) Magical thinking b) Superstitious Beliefs c) Religious Beliefs Christians used the parable of the GOOD SAMARITAN as basis for providing care iv) IN EGYPT a) Goddess ISIS and son HORUS Believed to manipulate the dreams of the sick v) IN BABYLONIA a) Advanced SURGICAL PROCEDURES b) CODE OF HAMMURABI Law in the practice of surgery that was governed by LEX TALIONIS Law Retribution / Retaliation

vi) IN GREECE AND ROME a) Care of the sick revolves around Mythology b) DOCTRINE OF THE FOUR HUMORS Blood Wet Diseases Black Bile Dry Diseases Yellow Bile Warm Diseases Phlegm Cold Diseases c) EUCRASIA The 4 Humors are BALANCED d) DYSCRASIA The 4 Humors are UNBALANCED e) HIPPOCRATES FATHER OF MEDICINE Hippocratic Oath Doctors Code of Ethics vii) IN CHINA a) Magical b) Religious c) Herbal NURSING IN THE EARLY 20TH CENTURY i) POSITIVISM a) Declares that natural sciences are the ONLY source of TRUE KNOWLEDGE ii) Focused on two opposing use of reason to prove nursing science: a) RATIONALISM Reason gained thru expert study, tested theory and established facts to evidently prove something Uses DEDUCTIVE type of reasoning b) EMPIRICISM Uses objective and tangible data Source of Data: FIVE SENSES Uses INDUCTIVE type of reasoning NURSING IN THE LATE 20TH CENTURY i) PROFESSIONAL Roles of Nurses a) CAREGIVER / CARE PROVIDER Nurturer, Comforter, Provider Mothering nature Provider direct care Promote Comfort b) TEACHER Provide information and health teachings Encourage compliance with prescribed therapy c) COUNSELOR Help client recognize and cope with stressful situations d) CHANGE AGENT Administer change in behavior e) CLIENT ADVOCATE Protect right to CONFIDENTIALITY Protect right to AUTONOMY

Protect right to LIFE MANAGER Makes decisions and coordinates activities g) RESEARCHER Investigative role which further improves the nursing practice ii) EXPANDED ROLES / ADVANCED ROLES a) Clinical Specialist b) Nursing Practitioner c) Nurse Midwife d) Nurse Anesthetist e) Nurse Entrepreneur f) Nurse Administrator f) CATEGORIES OF THEORIES i) GRAND THEORIES a) General / Abstract / Vague b) Define CARE as the SPECIALTY of Nursing c) Creates a perspective in Nursing d) Differentiates Nursing from Medicine e) Used to: Guide the practice of Nursing Aid in the Professionalization of Nursing Provide a framework for Nursing education f) Almost as broad as nursing models but absolutely differ from them ii) MIDDLE-RANGE THEORIES a) Theories that include details specific to nursing practice b) Specify health conditions, patient population (age group), the location of practice and the different interventions of the nurse c) Arrive at the intersection of research and practice iii) MICRO-RANGE THEORIES a) Situation-specific theories and limited to particular populations or fields of practice b) A linking of concrete concepts into a statement that can be observed in practice and research c) Two levels of Micro-range theories: High Abstraction Micro-range Low Abstraction Micro-range HEIRARCHY OF NEEDS according to ABRAHAM MASLOW SELF-ACTUALIZATION ESTEEM LOVE AND BELONGING SAFETY AND SECURITY PHYSIOLOGICAL NEEDS

* * * MidTerms * * *
FLORENCE NIGHTINGALE VIRGINIA HENDERSON i) Born on March 19, 1897 ii) Born in Kansas City, Missouri iii) Died on November 30, 1996 iv) Fifth child from a family of 8 v) Lived in Virginia during her formative years vi) Parents: a) Father practiced law in Washington BOSTON COLLEGE THOMAS JEFFERSON UNIVERSTY EMERY UNIVERSITY c) 1985 The International Council of Nurses presented her with the 1ST CHRISTAN REIMANN PRIZE ix) Books by Virginia Henderson: a) THE NATURE OF NURSING, 1966 b) BASIC PRINCIPLES OF NURSING CARE, 1960, 1997 c) THE NATURE OF NURSING REFLECTIONS AFTER 25 YEARS Published in 1991 Each chapter contains changes in her views and opinions relative to the 1966 first edition

VIRGINIA HENDERSON AND NURSING i) Interest in nursing evolved during WWI, wanting to help sick and wounded military personnel ii) She enrolled Army School of Nursing in Washington, DC HENDERSONS DEFINITION OF NURSING a) Graduated in 1921 i) This was influenced by two events: iii) 1926 began continuation of Education at COLUMBIA a) First, the revision of TEXTBOOK OF THE UNIVERSITY TEACHERS COLLEGE PRINCIPLES AND PRACTICE OF NURSING, a) 1932 graduated with BS degree written with Canadian nurse BERTHAN HARMER b) 1934 graduated with MA degree Henderson needed to clear the functions of the c) Taught clinical nursing courses with emphasis on nurse analytical processes from 1934 to 1948 Book was published in 1939 iv) 1948 to 1953 Worked with HARMER on the revision b) Second, her EXTENSIVE EXPERIENCE as a of the 5th edition of THE PRINCIPLES AND student, teacher, practitioner, author and participant PRACTICE OF NURSING in conferences v) 1953 Appointed as FACULTY at YALE ii) Hendersons first definition of nursing was published in UNIVERSITY SCHOOL OF NURSING another revision of Bertha Harmers book in 1955 a) 1953 to 1958 She was on the SURVEY AND iii) 14 Components of Basic Nursing Care ASSESSMENT OF NURSING RESEARCH Summary of Components: STAFF First 9 are PHYSIOLOGICAL Project was directed by Leo W. Simmons 10TH and 14TH are PSYCHOLOGICAL b) 1955 to 1978 Hendersons major publications aspects of communicating and learning were copyrighted; very productive years 11TH is SPIRITUAL c) Directed the NURSING STUDIES INDEX 12TH and 13TH are SOCIOLOGICAL PROJECT i) Breathe normally vi) THE INTERNATIONAL NURSING INDEX ii) Eat and drink adequately a) Henderson played an important role in its iii) Eliminate body wastes publication in 1966 iv) Move and maintain desirable postures b) Result and production of the PROMOTIONAL v) Sleep and rest EFFORTS OF THE INTERAGENCY ON vi) Select suitable clothes dress and undress LIBRARY RESOURCES IN NURSING vii) Maintain body temperature within normal range by vii) 1980s adjusting clothing and modifying the environment a) Henderson supported the idea that nursing must viii) Keep the body clean and well groomed and protect accept the responsibility for conducting the integument investigations on nursing practice and focus should ix) Avoid dangers in the environment and avoid on on: injuring others CONSUMER WELFARE x) Communicate with others in expressing emotions, SATISFACTION needs, fears or opinions COST-EFFECTIVENESS xi) Worship according to ones faith viii) Recognitions / Citations / Honoraries xii) Work in such a way that there is a sense of a) SIGMA THETA TAU International Nursing Library accomplishment b) Honorary Doctoral Degrees from: xiii) Play or participate in various forms of recreation CATHOLIC UNIVERSITY OF AMERICA xiv) Learn, discover or satisfy the curiosity that leads to PACE UNIVERSITY normal development and health and use the UNIVERSITY OF ROCHESTER available health facilties UNIVERSITY OF WESTERN ONTARIO b) 1966 In her book The Nature of Nursing, Hendersons YALE UNIVERSITY ultimate definition of nursing was published OLD DOMINION UNIVERITY

i)

She described the definition as THE CRYSTALLIZATION OF MY IDEAS ii) DEFINITION: The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he has the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible HENDERSONs THEORY AND NURSING PARADIGM i) Henderson considered these components in viewing the concept of human or individual: a) Biological b) Psychological c) Sociological d) Spiritual ii) The mind and body are INSEPARABLE iii) Hendersons beliefs about HEALTH were related to human functioning iv) Theory was focused on what the individual can do independently rather than what the environment can do for the individual a) INDIVIDUALIZED CARE HENDERSON AND THE NURSING PROCESS i) Henderson viewed nursing process as REALLY THE APPLICATION OF THE LOGICAL APPROACH TO THE SOLUTION OF A PROBLEM ii) Individualized care is the result of the nursing process iii) PHASES of the Nursing Process a) Assessment Phase Assess needs of individual based on the 14 components of basic nursing b) Nursing Diagnosis Identify individuals ability to meet own needs with or without assistance c) Outcomes Establish desired outcomes based on return to independence d) Planning Phase Document how the nurse can assist the individual, sick or well e) Implementation f) Evaluation iv) Issues that Henderson raised regarding Nursing process: a) Is the nursing process peculiar (unique) to nursing? Comparison of the nursing process with the traditional steps of the medical process b) Is problem solving all there is in nursing? c) Where does the art of nursing fit into the nursing process? d) The nursing process lacks collaboration among other health care workers, the patient and the family v) According to Henderson, the nurse needs to ANALYZE the data gathered from all 14 components to complete the assessment phase of the nursing process vi) Nursing needed by an individual is affected by: a) AGE b) CULTURAL BACKGROUND

c) EMOTIONAL BALANCE d) PATIENTS PHYSICAL CAPACITIES e) PATENTS INTELLECTUAL CAPACITIES Official statements on the nursing function were published by the ANA in 1932 and 1937 ANNIE W. GOODRICH i) First Dean of the Yale University School of Nursing ii) Agreed with Henderson that nursing education during their time was merely an extension of medical practice a) Lecturers were physicians and they focused only on disease, diagnosis and treatment BOSTON FLOATING HOSPITAL i) Where she had her PEDIATRIC NURSING experience ii) More positive and introduced three concepts of care: a) PATIENT-CENTERED b) CONTINUITY OF c) TENDER, LOVING CARE iii) Shortcoming was lack of family-centered care HENRY STREET VISITING NURSE AGENCY i) Based in New York ii) Where she had her COMMUNITY NURSING CARE xp NORFOLK PROTESTANT HOSPITAL i) Based in Virginia ii) She served as a teacher for their diploma program iii) 5-year contract iv) Subsequently, she was enrolled in Columbia University Teachers College for her BS and MA STRONG MEMORIAL HOSPITAL i) Based in Rochester, New York ii) Worked as a Teaching supervisor after finishing her degrees at Columbia University Teachers College FAYE ABDELLAH i) Born on March 13, 1919 ii) Born in New York City iii) Graduated Magna Cum Laude from FITKIN MEMORIAL HOSPITAL SCHOOL OF NURSING in 1942 iv) COLUMBIA TEACHERS UNIVERSITY COLLEGE a) 1945 BS b) 1947 MA c) 1955 Ed.D. v) Accomplishments a) U.S. Public Health Service Chief Nurse Officer Deputy U.S. Surgeon General b) Uniformed Services University of Health Sciences Founder and First Dean, Graduate School of Nursing c) Yale University School of Nursing Nursing Instructor d) 2000 - Inducted into the National Womens Hall of Fame vi) Research

a)

Assisted in international nursing research studies during the Korean War (China, Japan, Australia, Russia) b) Abdellahs research findings led to the first federally-tested coronary care unit in Connecticut c) Theory and research data led to the establishment of the Office of Long-Term Care vii)

i)

ii)

iii) WORKS i) Nursing is the use of problem-solving approach with key nursing problems related to the health needs of people ii) Main components of Abdellahs theory: a) Health b) Nursing Problems Overt Apparent Covert Hidden or concealed c) Problem-solving iii) The 21 Nursing Problems a) To maintain good hygiene and physical comfort b) To promote optimal activity; exercise, rest and sleep c) To promote safety through the prevention of accident, injury or other trauma and through the prevention of the spread of infection d) To maintain good body mechanics and prevent and correct deformities e) To facilitate the maintenance of a supply of oxygen to all body cells f) To facilitate the maintenance of nutrition of all body cells g) To facilitate the maintenance of elimination h) To facilitate the maintenance of fluid and electrolyte balance i) To recognize the physiological responses of the body to disease conditions- pathological, physiological and compensatory j) To facilitate the maintenance of regulatory mechanisms and functions k) To facilitate the maintenance of sensory functions l) To identify and accept positive and negative expressions, feelings and reactions m) To identify and accept the interrelatedness of emotions and organic illness n) To facilitate the maintenance of effective verbal and nonverbal communication o) To promote the development of productive interpersonal relationships p) To facilitate progress toward achievement of personal spiritual goals q) To create and/or maintain a therapeutic environment r) To facilitate awareness of self as an individual and varying physical, emotional and developmental needs s) To accept the optimum possible goals in the light of limitations, physical and emotional t) To use community resources as an aid in resolving problems arising from illness u) To understand the role of social problems as influencing factors in the cause of illness ABDELLAHS THEORY iv) v) vi)

Abdellahs model describes concerns of nursing rather than a theory describing relationships among phenomena. Her theory provides a foundation for determining and organizing nursing care Nursing is based on an art and science that mold the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs Originated from nursing practice & desire to promote patient-centered comprehensive care Shifts focus of the profession from disease centered to patient centered Concepts of health, nursing problems, and problem solving are interrelated Describes nursing as a service to society

PATIENT-CENTERED APPROACHES TO NURSING i) A HUMAN NEEDS THEORY a) Human beings have universal and objective needs for health and autonomy and a right to their optimal satisfaction. b) FOCUS Nursing Education Nursing Practice c) PURPOSE To guide patient care in the hospital and community settings PURPOSE OF TOPOLOGY OF NURSING PROBLEMS i) To provide a method to evaluate a students experiences and means of evaluating a nurses competency based on outcome measures ii) Three Areas a) Physical, sociological, and emotional needs of the patient b) Types of interpersonal relationships between the nurse and the patient c) The common elements of patient care

10 WAYS TO IDENTIFY A CLIENTS PROBLEM i) Learn to know the patient ii) Sort out relevant and significant data iii) Analyze and make generalizations about available data iv) Identify the therapeutic plan v) Test generalizations with the patient and make additional generalizations vi) Validate the patients conclusion about his nursing problems vii) Continue to observe and evaluate the patient over time to identify Any attitudes and clues affecting his behavior viii) Explore the patients and familys reaction to the therapeutic plan and involve them in the plan ix) Identify how the nurse feels about the patients nursing problems x) Discuss and develop a comprehensive nursing care plan REQUIREMENT OF CARES, classified in 4 Levels i) Sustenal Care ii) Remedial Care iii) Restorative Care

iv) Preventative Care 21 NURSING PROBLEMS, sorted into 4 groups i) Problems r/t comfort, hygiene and safety ii) Physiologic Balance iii) Psychological and Social Factors iv) Sociologic and Community Factors MADELEINE LEININGER i) TRANSCULTURAL THEORY IN NURSING a) A.k.a CULTURE CARE (latest title) b) Theory was presented in 1985 c) Care is: The heart of nursing Power Essential to healing; Curing; The central and dominant focus/culture of nursing and transcultural nursing decisions and actions ii) EDUCATION a) Basic nursing education at ST. ANTHONYs SCHOOL OF NURSING in Denver, Colorado She graduated in 1948 b) Bachelor of Science degree from BENEDICTINE COLLEGE in Atchison, Kansas c) Master of Science/Doctor of Philosophy in Anthropology from UNIVERSITY OF WASHINGTON d) Honorary recipient of LhD (Doctor of Humane Letters) given by Benedictine College iii) INFLUENCES a) 1950S Culture-shocked in MidWestern United States where she observed that children had recurring behavioral differences She identified a lack of knowledge of the childrens cultures as the missing chain in nursing to understand the variations in care of clients LEININGER AND NURSING METAPARADIGM i) Person a) Human care is COLLECTIVE and seen in all cultures b) Caring science should extend to FAMILIES GROUPS COMMUNITIES TOTAL CULTURES INSTITUTIONS WORLDWIDE HEALTH INSTITUTIONS ii) Environment a) Social culture b) Environment Framework Totality of an event, situation or experience Centers on a particular group/society iii) Health a) Components of Health: Health systems Health care practices

Changing health patterns Health promotions Health maintenance b) Health is universal across cultures but distinct within each culture in a way that represents beliefs, values and practices of the particular culture iv) Nursing a) Three types of nursing actions that are culturallybased Cultural care preservation/maintenance Cultural care accommodation/negotiation Cultural care repatterning/restructuring DOROTHEA OREM i) SELF-CARE DEFICIT THEORY OF NURSING a) Individuals, families, groups and communities need to be taught self-care ii) BACKGROUND a) 1914 - Born in Baltimore, Maryland b) EDUCATION Diploma at Providence Hospital School of Nursing in Washington DC BS Nursing Education at Catholic University of America in 1939 MS Nursing Education at Catholic University of America in 1946