COURSE OUTLINE: PREFINALS ● involve the basic needs and ways of dealing with

adaptation.
1. Sister Callista Roy
● example: resting when tired and using face masks
2. Imogene King
this pandemic
3. Betty Neuman
4. Dorothy Johnson
5. Hildegard Peplau 2. SELF- CONCEPT MODE (PSYCHIC INTEGRITY)
6. Ida Jean Orlando ● determined by the client's interaction with others.
7. Jean Watson ○ PERSONAL SELF: self-ideal, self-consistency,
moral-ethical self
REFERENCE BOOK ○ PHYSICAL SELF: sensation and body image
Theoretical Basis for Nursing 5th Edition by Melanie ● for example: the woman experienced breast
McEwen and Evelyn M. Wills removal, the woman should be still positive as she
realize that it is only part of the body, she is more
than her breast and that she is still beautiful
CALLISTA ROY
3. ROLE-FUNCTION MODE (SOCIAL INTEGRITY)
ADAPTATION THEORY ● based on the performance of duties and
expectations.
SR. CALLISTA ROY ● example: shifting or changing of roles (a mother is a
● contemporary theorist plain housewife but suddenly her husband died, so
● grounded on humanism there is a change in roles in which she needs to
● “person is an adaptive system with coping apply for work in order to provide the needs of the
mechanisms” children)
● example: adding roles or task (teachers now need
GOAL OF NURSING to be techy when the mode of learning shifted to
online classes)
● To promote the person’s adaptation along with the
four adaptive modes:
○ Physiologic Mode 4. INTERDEPENDENCE MODE
○ Self-Concept Mode ● all adaptation mode in one
○ Role-function Mode ● affection, love, affirmation, interpersonal
○ Interdependence Mode ● For example: the stimulus is board exams and the
STIMULI goal is to pass it. In applying interdependence
● factor capable of inciting a physiological change. mode, you need to have intervention in the first
● environment (internal or external) that can elicit a three modes. For instance, in physiological mode,
response or action. you need to sleep early and wake up at 3AM since
that is the time that learning is effective. In
self-concept mode, you need to stay positive that
1. FOCAL STIMULI you can pass the exams, and in role function mode,
● most immediate stimuli you told your parents that you will just do your
● example: lecture (stimuli) & jotting down notes household chores on weekends since you need to
(response) devote your time studying on weekdays.
● main problem
THEORETICAL FRAMEWORK
2. CONTEXTUAL STIMULI
● all other stimuli in the external and internal
environment.
● does not require an immediate response.
● For example: when a professor gave classwork and
the deadline is two weeks from now, students will
have a delayed response by not doing the
requirement immediately
● Contributors to the main problem

3. RESIDUAL STIMULI
● factors whose effects are unclear.
● poses a big question mark as responses are
unclear. IMOGENE KING
Putting in context the different stimuli: GOAL OF ATTAINMENT THEORY
Focal stimuli: A person diagnosed with stage 3 breast
cancer IMOGENE KING
Contextual: the treatment is costly ● Nursing is the process of human interaction with a
Residual; the family of the person believes a folk healer can patient or client.
help in the condition of their daughter. ● each person perceives the other and the situation
between the nurse & patient. (NPI)
ADAPTIVE MODES ● “Human beings are open systems in constant
● coping mechanisms interaction with their environment.”
● these adaptive modes can be effective or not
FOCUS ON NURSING
● human beings are interacting with the environment
1. PHYSIOLOGICAL MODE
NURSING GOAL

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 ● maintenance of individuals and groups ○ Members of the Healthcare Team
■ with interpersonal interaction, we
GOAL ATTAINMENT THEORY can gain knowledge.
○ factors: interaction, communication,
transaction, role, stress

3. SOCIAL SYSTEM
● interaction of a nurse on a bigger scale
○ Workplace
○ Community
○ Organization
● Concerns/factors: decision-making, organization,
authority, power, status

EXAMPLE relating to three systems:

Through perception or body image(Personal system), you
feel that you have COVID symptoms. Then through
communication or interaction (interpersonal system), you will
To set a goal, the first step is Nurse-Patient Interaction tell your relatives and family about your condition. Lastly, you
(NPI); there should be a planned conversation and every will coordinate with city risk management about your
interaction is purposive. The nurse should be able to get the condition and will do contact tracing (social system).
confidence and trust of the patient so that it will be easy to youtube links:
perform nursing interventions as the patient will cooperate. Imogene King
Then, a transaction takes place; it can be between Imogene King Part II
client-nurse or patient-nurse. After the transaction, goal
setting develops (What is it that I want to achieve) and goal
is later on achieved — effective, safe, quality nursing care. BETTY NEUMAN
RA 9173 Philippine Nursing Act of 2002 HEALTHCARE SYSTEMS MODEL
-highlights that every nurse should have a certain
competency. HEALTHCARE SYSTEMS MODEL
-11 key areas of responsibilities ● based on two components
○ stress
○ reaction to stress
INTERACTING COMPONENTS ● client: individual, group, or community and is an
open system in interaction with the environment
● four concepts
○ client
○ environment
○ health
○ nursing
● Has potential to alter system stability due to internal
and external stressors
○ provides resources for managing stressors

CLIENT

1. PERSONAL SYSTEMS
● interaction to one’s self.
● nurse or patient interacts with their own self.
○ intrapersonal (self-reflection, meditate, etc.)
○ Introspection is the observation or examination
of one’s own mental or emotional process.
■ why do nurses need this? one
cannot give if one does not have
● factors: perception, self-growth and development,
body image, space, learning, time
○ example: LEARNING: As a health educator, he follow the thin arrows, NOT the superimposable lines
should be sure that he knows what he is saying
flexible line of defense- outermost part
and all information is correct. With these, he will
try to remember all the learning he had when he normal line of defense- black part/middle part
was still a student or will gather information. lines of resistance-gray part
core- innermost; us
2. INTERPERSONAL SYSTEM
● According to Imogene King, it is the most common LINES OF DEFENSE
interaction.
● communication or interaction with others 1. FLEXIBLE LINE OF DEFENSE
○ Nurse-Patient interaction
● keeps the system free from stressors reactions or
○ Nurse-Client interaction
symptomatology

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 ● coping mechanisms LEVELS OF PREVENTION
● Support system
● Positive self-affirmation 1. PRIMARY
● to encourage optimal health and to increase the
2. NORMAL LINE OF DEFENSE person’s resistance to illness
● usual level of wellness ● seeks to prevent a disease or condition at a
● absence of disease/sickness pre-pathologic state; to stop something from
● a standard used to measure deviation from health happening
○ health promotion (proper handwashing)
3. LINES OF RESISTANCE ○ specific protection
○ Disease prevention
● consists of internal defense processes ● common primary prevention
● immune system/response ○ quit smoking
○ avoid/limit alcohol intake
ENVIRONMENT ○ exercise regularly
● has a potential to alter system stability due to ○ eat well-balanced diet
internal and external stressors ○ reduce fat and increase fiber in the diet
● also provides resources for managing stressors ○ take adequate fluids
○ avoid overexposure to sunlight
STRESSORS ○ maintain ideal body weight
○ complete immunization program
○ wear hazard devices in work sites

2. SECONDARY
● also known as health maintenance
● seeks to identify specific illnesses or conditions at
an early stage with prompt intervention to prevent or
limit disability
○ early diagnosis/detection/screening
○ prompt treatment to limit disability
● common secondary prevention
○ have an annual physical examination
1. INTERPERSONAL ○ regular Pap’s smear(procedure to test for
● between two or more individuals cervical cancer) or test for women
● parent-child expectations or conflict among ○ sputum examination for tuberculosis
colleagues ○ annual stool test and rectal examination for
clients over age 50 years
2. INTRAPERSONAL additional information (treatment for tuberculosis: RIPES)
● within the self Rifampicin
● anger, physical abilities Isoniazid
● intelligence → overthinking Pyrazinamide
● doubts Ethambutol
● anxiety Streptomycin
● frustration
3. TERTIARY
3. EXTRAPERSONAL ● Focus is rehabilitation
● combination of two but of a higher degree ● supports the client’s achievement of successful
● too much for the person to handle adaptation to known risks, optimal reconstitution,
● unemployment, microorganisms (presence of and establishment of high-level wellness
disease), peer pressure, radiation (undergo ● occurs after the disease or disability has occurred
treatment like chemotherapy) and the recovery process has begun
● stressors that we cannot imagine or predicted ● assists the person in obtaining an optimal health
● beyond our control status
○ rehabilitation
HEALTH ● common tertiary prevention
○ self-monitoring of blood glucose level among
Conditions which all parts and subparts are in harmony with
diabetics
the whole client
○ physical therapy after cerebrovascular
accident or stroke, cardiac rehabilitation after
RECONSTITUTION Myocardial infarction
● process by which a person progresses from his or ○ attending self-management education for
her normal line of defense to a higher or lower state diabetes
of wellness. ○ undergoing speech therapy after
laryngectomy
WELLNESS
● occurs after adaptation of stressors.
○ If stressors are handled properly, wellness is DOROTHY JOHNSON
obtained.
BEHAVIORAL SYSTEMS

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 BEHAVIORAL SYSTEMS ● identified as the first response system to develop in
● TWO-SUBSYSTEMS: the individual.
○ Behavioral subsystem ○ A person experience it once they are born and
○ Biological subsystem have skin to skin contact to her mother
● BEHAVIORAL SUBSYSTEM (KANGAROO CARE)
○ addressed by nursing interventions ● allows “social inclusion, intimacy and the formation
● BIOLOGICAL SUBSYSTEM and maintenance of a strong social
○ addressed by medical interventions bond”
FOCUS OF NURSING: Colostrum - first milk produced (rich with antibodies)
Behavioral modification to foster equilibrium immediately following delivery of the newborn.

NURSING VS. MEDICINE 2. DEPENDENCY

● are “succoring” behaviors that precipitate nurturing
behaviors from other individuals
NURSING MEDICINE
in the environment.
focuses on identifying identifies disease ● result: “approval, attention or recognition, and
human response to health physical assistance”
and illness
3. INGESTIVE
describes problems treated describes problems for ● relates to the behaviors surrounding the intake of
by the nurse within the which the physician directs
food related to the biological system
scope of independent the primary treatment
nursing practice
4. ELIMINATIVE
changes from day to day as remains the same for as ● relates to behaviors surrounding the excretion of
the client responses long as the disease is waste products from the body
change present
5. SEXUAL
GOALS OF NURSING ● reflects behaviors related to procreation.
● demonstrate behavior commensurate to social
demands 6. AGGRESSIVE
○ parenting ● relates to behaviors concerned with protection and
● modify behavior to support the biological needs self-preservation as one that generates defensive
○ increase rest periods responses from the individual when life or territory is
○ educating a chain-smoker patient on the bad threatened.
effects of smoking
● Benefit from the physician’s skill and knowledge. 7. ACHIEVEMENT
○ administration of medications ● provokes behavior that attempts to control the
■ checking medication: 3 times. environment.
(1st) from cabinet (2nd) ● recognizes intellectual, physical, creative,
preparing the drug (3rd) before mechanically and social skills
administration of medicine.
● Demonstrate behavior that does not give evidence
What do nurses do when the patient is sleeping and
of unnecessary trauma.
there is a need to take vital signs?
○ “Principle of Nonmaleficence”
■ DO NO HARM
Answer: case to case basis:
■
A. Not close monitoring and has no severe problems
7 BEHAVIORAL SUBSYSTEMS - Vital signs taking can be adjusted

B. Close monitoring and in critical condition

- Vital signs must be executed

Dorothy Johnson (Nursing Theorist)

HILDEGARD PEPLAU
INTERPERSONAL CARING
INTERPERSONAL CARING THEORY
● The purpose of nursing is to educate and to be a
maturing force to a patient, for him/her to get a new
view of himself or herself.
● Focus: therapeutic process
1. ATTACHMENT OR AFFILIATIVE (INTIMACY) ● INTERACTION:

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 ○ Therapeutic Communication ● A nursing function is concerned with providing direct
■ brings about healing. assistance to individuals in whatever setting to
■ When caring for mentally challenged avoid, diminish, relieve an individual's sense of
patient, the words should be therapeutic. helplessness.
○ Therapeutic Use of Self
■ use of self properly to bring the best for TYPES OF NURSING RESPONSE
the patient.

Avoid asking the question “WHY” 1. DELIBERATIVE

-it overly bombard patients. ● based on correct identification of the patient's
needs.
-it is a probing question; it may trigger any traumatic
ex: double-checking the medication ordered by the
experience or behaviour in the past. doctor

● nurse-patient relationship is attained thru: healthy

npr. 2. AUTOMATIC RESPONSE
● a nurse’s reflex action.
PHASES OF NURSE-PATIENT RELATIONSHIP ○ checking vital signs, change of bed linens,
(NPR) etc.

1. ORIENTATION (Pre-orientation) STEPS IN RESPONDING TO A PATIENT’S NEEDS

● leveling off the experience of the nurse and client in
terms of expectation.

2. IDENTIFICATION (Orientation)
● selective response of the client to those who can
meet his or her needs.
○ talk to the patient or start activities as this
establishes the identity of who is the nurse and
who is the patient.

Why is there psychiatric nursing?

- to return the patient back to reality.
How to check orientation to reality?
- ask the patient : NAME, TIME & PLACE

Countertransference
-when the nurse unciously and inappropriately dispaces onto
patient’s feelings
PATIENT’S NEEDS CORRESPONDING WITH THE
NURSING PROCESS:
3. EXPLOITATION (Working) Patient has a need : Assessment
● the client takes control of the situation by extracting
Nurse validates to correctly identify the problem:
help from the nurse.
Diagnosis ; Exploring: Plan
4. RESOLUTION (Termination) Nurse performs deliberative action : Implementation
● evaluation of care and discharge of patients. The need for help is relieved : Evaluation

Before NPR, the nurse should undergo self-awareness 1. ASSESSMENT PHASE

(genuine expression of one’s feelings) to identify his/her ● systematic and continuous collection, organization,
weakness and strength. This avoids the nurse to develop validation, and documentation of date
countertransference (what patient feels transfers to nurse) ● carried all throughout the nursing process
○ Diagnosing
IDA JEAN ORLANDO ○ Planning
■ information in assessment is crucial
DYNAMIC NURSE RELATIONSHIP ○ Implementation
■ before performing nursing care
DYNAMIC NURSE RELATIONSHIP THEORY ○ Evaluation
● nursing is a disciplined professional response ■ Assessing the current status to compare
○ follows the steps of the nursing process : with previous status
A - assessment
Chief Complaint (CC)
D - diagnosis
P - planning - patient seeks professional help/advise
I - implementation
E - evaluation
Assessment can be anywhere in the nursing process
(ADPIE)

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2. DIAGNOSING PHASE ○ It provides advancement and breakdown
● Nurses use critical thinking skills to interpret data to help improve the scope of the nursing
and identify client strengths and problems. profession.
● Promotion of interpersonal teaching-learning
Medical Diagnosis ● Provision of supportive, protective and corrective
mental, physical, socio-cultural and spiritual
- diagnosis is done by the physician
environment
Nursing Diagnosis ● Assistance with the gratification of human needs
- identification of the problem is done by a nurse ● Allowance for existential-phenomenological
factors.
-diagnosis is based on assessment.
Jean Watson Interview 2_Caring Science Theory

3. PLANNING PHASE
● a deliberative, systematic phase that involves
decision making and problem-solving
● formulating client goals with the patient
● designing nursing interventions

4. IMPLEMENTING PHASE
● consists of doing and documenting the nursing care
given to the patient
● putting the care into action

5. EVALUATION PHASE
● determine client’s progress
● to determine the effectiveness of the care plan
● to determine as to what extent the nursing goals --------END OF PRE FINALS REVIEWER-------
have been met
Evaluation Criteria:
1. Met - goals are fully met
2. Partially Met - goals are not entirely met
3. Unmet - goals are not met
Video link: The Nursing Process Easy Steps

JEAN WATSON
PHILOSOPHY & SCIENCE OF
CARING
PHILOSOPHY & SCIENCE OF CARING
● nursing is the science of caring
● caring is more “healthogenic” than curing
● main focus of nursing
○ on ten carative elements (derived from
humanistic perspectives combined with a
scientific basis)

TEN CARATIVE ELEMENTS

● Formation of Humanistic-altruistic value system
○ service orientedness
● Faith-Hope
○ instill faith and hope
● Cultivation of sensitivity to self and others
○ sensitive to the needs of self and others.
● Establishing a helping-trusting relationship
○ allowing the person to express their
emotions either positive or negative.
● Expression of feelings; both positive and
negative
● Research and systematic problem-solving

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