Sunday, September 7, 2008

Betty Neuman (System Model in Nursing Practice)

Betty Neuman
System Model in Nursing Practice
(1924 - present)

“Health is a condition in which all parts and subparts
are in harmony with the whole of the client.”

Life Story

Betty Neuman was born in 1924 on a farm near Lowell, Ohio.

Her father was a farmer and her mother was a home maker. She grew up in the rural Ohio where she developed love for the land and her compassion for people in need.

1947, Neumans initial nursing education was completed with double honors at People's Hospital School of Nursing (now General Hospital) in Akron, Ohio.

She then moved to Los Angeles to live with relatives in California, she worked in variety of nursing roles that include hospital staff and head nurse, school nurse, and industrial nurse.

She was also involved in clinical teaching in University of Southern California Medical Center, Los Angeles in the areas of medical surgical, communicable disease and critical care.

She had always been interested in human behavior.

She attended the University of California at Los Angeles (UCLA) with a double major in Public Health and Psychology. She completed her Baccalaureate Degree with Honors in Nursing in 1957.

A very supportive and loving wife who helped established and managed her husband's medical practice.

1966, she received her Master's Degree in Mental Health, Public Health Consultation from UCLA.

1985, She- received a Doctoral Degree in Clinical Psychology from Pacific Western University in 1985.

Neuman and Donna Aquilina were the first two nurses to develop the nurse counselor role within Los Angeles based community crisis centers.

She developed her first explicit teaching and practice model for mental health consultation m the late 1960s before the creation of her systems model. Neuman was a pioneer of nursing involvement in mental health. She developed taught, and refined a community mental health program for postmasters level nurses at UCLA.

Books and Publications
Neuman designed a conceptual model for nursing in 1970 in response to request from UCLA graduate students who wanted a course emphasizing breadth rather than depth in understanding the variables in nursing. Initially, the model was developed to integrate students' understanding of client variables that extend nursing beyond the medical model. The Neuman model included such behavioral science concepts as problem identification and prevention. Neuman first published her model in 1972.
She spent the following decade further defining and refining various aspects of the model in preparation for her book, the Neuman System Model: Application to Nursing Education and Practice. Further development and revisions of the model are illustrated in the second (1989) and third (1995) editions. Neuman stated that the fourth edition will offer an integrative review of use of the model with guidelines for application of the model in practice, research, education and administration.

She is a Fellow of the American Association of Marriage and Family Therapy.
She contuse in active, private practice as a licensed clinical marriage and family therapist, with an emphasis on Christian Counseling. Neuman lives in Ohio and maintains a leadership role as Director of Neuman Systems Model Trustees Group, Inc. until 2009.
She serves as a consultant internationally for nursing schools theory-based practice.

Theoretical Sources
1. Gestalt theory - homeostasis process.
2. Marx - properties of parts are determined partly by the larger wholes.
3. de Chardin - philosophy of wholeness of life.
4. Han Selye - General Adaptation Syndrome and Stress Theory.
5. Caplan - prevention levels of nursing.
Metaparadigm in Nursing
- the concept of a whole person and an open system approach.

The concept is aimed towards the development of a person in a state of wellness having the capacity to function optimally by adaptation with environmental stimuli causing illnesses back to a state of wellness

Neuman believes that nursing requires a holistic approach that considers all factors affecting a client's health—physical, physiological, psychological, mental, social, cultural, developmental and spiritual well-being.

Neuman regarded the concept of a person as an individual family community or the society.
She sees a person as an open system that works together with other parts of its body as it interact with the environment.

Open system is characterized by the presence of an exchange of information and
reaction with other factors surrounding a person.

Neuman considers health as dynamic in nature in which the person’s health is as the level of health continuum—wellness or illness.

Wellness exists when all the part or system of person works harmoniously.

The environment can be an internal and external.
Stressors are the forces created by the environment. Stressors are tensions that produce alterations in the normal flow of the environment. These stressors can be:
1. Intrapersonal - occurs within the self and comprises of man as a psycho-spiritual being
2. Interpersonal - occurs between one or more individual and consists of man as a social being
3. Extrapersonal - occurs outside the individual and may include environmental factors

System Model in Nursing Practice
1. Client Variables
- physiological, sociocultural developmental and spiritual—function to achieve stability in relation to the environmental stressors experienced by the client.

2. Lines of Resistance
- acts when the Normal Line of Defense is invaded by too much stressor causing alteration in the normal health pattern to facilitate coping and overcome the stressors that are present within the individual.

3. Normal Line of Defense
- acts in coordination with the normal wellness state. It is the normal reaction of the client in response to stress – the baseline determinants of wellness within the health continuum.

4. Flexible Line of Defense
- helps the body to adjust to situations that threaten the imbalance within the client's stability.

5. Stressors
Stressors are forces that produce tensions, alterations or potential problems causing instability within the clients system.

6. Reaction
Reactions are the outcomes or produced results of certain stressors and actions of the lines resistance of a client. It can be positive or negative depending on the degree of reaction the client produces to adjust and adapt with the situation.
a. Negentropy is set towards stability or wellness
b. Egentropy is set towards disorganization of the system producing illness

7. Prevention
Prevention is used to attain balance within the continuum of health

Three Levels of Prevention according to this theory:
A. Primary prevention – focuses on foreseeing the result of an act or situation and preventing its unnecessary effects as possible. It also aims to strengthen the capacity of a person to maintain an optimum level of functioning while being interactive with the environment. Ex. health promotion and disease prevention.

B. Secondary prevention – focuses on helping alleviate the actual existing effects of an action that altered the balance of health. It aims to reduce environmental influences that cause an alteration in the stability of the client. Ex. Early diseases detection and prompt treatment.

C. Tertiary prevention – focuses on the actual treatments or adjustments to facilitate strengthening of person after being exposed to stressor. Aims to prevent regression and recurrence of the disease. Ex. Rehabilitation

8. Reconstitution
A state of returning back to old health self.

1. Holistic approach in the care of the patients.

1. Effective in conceptual transition among all levels of nursing education.
2. Basis for continuing education after graduation facilitating professional growth.
3. Validate nursing roles and activities and its applicability beyond nursing practice.

1. Widely used framework used in nursing research that guides enhancement of nursing care.

1. It is simple for people especially health/medical related professionals whom can understand the concepts of health continuum.

1. Applicable in any health care settings.
2. The theory is comprehensive and adaptable.

Emperical Precision
1. Utilizes empiricism, wherein the theory is testable by mere use of observation.

1. Congruent with traditional nursing values.
2. Consistent with other non-nursing theories.

Derivable Consequences
1. Introduction of the nursing process (assessment, nursing diagnosis, planning, implementation and evaluation)
2. Provides guidelines for professional nurses.

Octaviano, E.F. & Balita, C.E. (2008). Theoretical Foundations of Nursing: The Philippine Perspective. Philippines: Ultimate Learning Series, 101-107.
Tomey, A.M. & Alligood, M.R. (2002). Nursing Theorists and Their Work. 5th ed. Missouri: Mosby, 299-316.

Journal Reading


Because the model is flexible and adaptable to a wide range of groups and situations, people have used the model globally, and for more than two decades. Neuman’s first book, The Neuman Systems Model: Application to Nursing Education and Practice, was published in 1982 as a response to requests for data and support in applying the model. Neuman published two additional editions of the book, with the third edition published in 1995 in response to expanded use of the model globally. The third edition includes applications of the Neuman Systems Model to nursing education, practice, administration, and research.

Application of the Neuman Systems Model to Nursing Education

In the 1980s exploration and use of the model greatly accelerated in education at all levels of practice in varied settings. These settings include the United States and locations such as Canada, Europe, Australia, and the Far East. There are many schools of nursing in the United States that have chosen to use the Neuman Systems Model as a curriculum framework or for selected courses. Most schools surveyed indicated reasons they chose the Neuman model. Generally, the reason for choosing the model was consistency with the school in one or more of the following areas: the school’s beliefs; philosophy; and concepts of humans, health, nursing, and environment. Associate degree nursing programs that have used the model include Athens Area Technical Institute, Athens, Georgia; Cecil Community College, North East, Maryland; Central Florida Community College, Ocala, Florida; Los Angeles County Medical Center School of Nursing, Los Angeles Valley College, Van Nuys, California; Santa Fe Community College, Gainesville, Florida; and Yakima Valley Community College, Yakima, Washington.

Baccalaureate nursing programs that have used the model include California State University, Fresno; Indiana University; Indianapolis; Purdue University, Fort Wayne, Indiana; University of Tennessee; and the University of Texas, Tyler. Gustavus Adolphus College, and St. Peter and St. Olaf College, Northfield, Minnesota, also have used the model.

Educational programs in the United States reported benefits with using the model. The model (1) facilitated cultural considerations in the curriculum related to the populations the schools and graduates served, (2) provided a nursing focus as opposed to medical focus, (3) included the concept of clients as holistic beings, (4) allowed flexibility in arrangement of content and conceptualization of program needs, (5) was comprehensive and facilitated seeing the person as composites of the five variables, (6) provided a framework to study individual illness and reaction to stressors, (7) was broad enough to allow educational programs to consider family as the context within which individuals live or as the unit of care, and (8) considered the created environment. Education programs have developed evaluation instruments to determine the effects of using the model as a framework for nursing knowledge.

The primary instrument that is cited in the nursing literature is the Lowry-Jopp Neuman Model Evaluation Instrument. This instrument was developed and used to evaluate the efficacy of using the model at Cecil Community College. The results of a five-year longitudinal study showed that the graduates used the model most of the time when fulfilling roles of care provider and teacher. All classes in the study claimed colleagues rarely knew, accepted, or encouraged model use. Therefore, colleagues in work settings tended to have a negative effect on the use of models. The model is also being used internationally. Craig reported on the experiences of 10 educational institutions in Canada that represent six Canadian provinces. These institutions include the University of Saskatchewan, University of Prince Edward Island, University of Calgary, Brandon University of New Brunswick, Université de Moncton, University of Western Ontario, University of Windsor, Okanagan College, University of Toronto, and University of Ottawa.

Model strengths were reported by educational institutions in Canada. The holistic approach that addressed levels of prevention guided the student to focus on the client in his or her own environment. The model also assisted the student to carry out in-depth assessments, to categorize comprehensive data, and to plan specific interventions with the client. The students did report some difficulty in understanding the complexity of the model, and the developmental and spiritual variables. The students reported that it was not always easy to differentiate between the lines of defense and resistance, or to assess the degree of stressor penetration.

The Neuman Model is also being used in educational institutions in South Australia, the United Kingdom, and Sweden. McCulloch reported that a survey of all Australian university programs showed that four undergraduate programs used the model as the major organizational curriculum framework, and another 16 programs introduced undergraduate and postgraduate students to the Neuman Model as one of several models. Vaughan and Gough found that many nursing and midwifery students chose to use the model in their own practice in the United Kingdom. They also reported that Avon and Gloucestershire College of Health used the model as the guiding principle behind curriculum development for child care. Engberg reported that most colleges throughout Sweden use the Neuman Systems Model as the theoretical framework in the module of primary health in nursing education.

Application of the Neuman Systems Model to Nursing Practice

The Neuman Systems Model is being used in diverse practice settings. In the United States, the model is used to guide practice with clients with cognitive impairment, meeting family needs of clients in critical care; to provide stable support groups for parents with infants in neonatal intensive care units; and to meet the needs of home caregivers, with emphasis on clients with cancer, HIV/AIDS, and head traumas. The model is used in psychiatric nursing, gerontological nursing, perinatal nursing, and occupational health nursing. Internationally, the model is being used in Canada, the United Kingdom, Sweden, the Nether- lands, New Zealand, Australia, Jordan, Israel, Slovenia, and several East Asian countries (e.g., Japan, Korea, and Taiwan). Practice areas include community/ public health care.

Nursing Administration and the Neuman Systems Model

The Neuman Systems Model has been used in diverse nursing administration settings in the United States. These settings include a community nursing center, psychiatric hospital, a continuing care retirement community, and Oklahoma State Public Health Nursing. Poole and Flowers demonstrated how the model is used in case management of pregnant substance abusers. Kelley and Sanders presented an assessment tool that intertwines the management process, the Neuman Systems Model, and environmental dimensions. Walker demonstrated how the model and total quality management are used to prepare health-care administrators for the future.

Nursing Research and the Neuman Systems Model

Gigliotti acknowledged that the Neuman Model’s use as a guide in directing nursing education and clinical practice has received much national and international attention. However, the model’s use as a guide to nursing research and the generation of nursing theory based on the research is in the early stages of development, although growing. In order to facilitate the use of nursing research with the Neuman Systems Model, Meleis has elaborated on principles and approaches that may be used to develop a futuristic agenda to validate the Neuman Systems Theory. Fawcett has offered guidelines for constructing Neuman Systems Model–based studies. Neuman revisited these guidelines in her 1996 article in Nursing Science Quarterly. She acknowledged that the Neuman model has guided a range of study designs, from qualitative descriptions of relevant phenomena to quantitative experiments that tested the effects of prevention interventions on a variety of client-system outcomes. She provided numerous examples of descriptive studies, correlational research, and experimental and quasi-experimental studies. Neuman elaborated on how to construct Neuman Model–based research. Smith and Edgil have proposed a plan for testing middle-range theories with the model. Their plan involved the creation of an Institute for the Study of the Model to formulate and test theories through collaboration, including interdisciplinary as well as multi-site efforts. They suggested directions for the work to be done, an organizing structure, and a task analysis of what and who would be appropriate to participate in task completion. Breckenridge has actually used the Neuman model to develop a middle-range theory based on nephrology practice. Gigliotti has identified conceptual and empirical concerns imposed upon her when she operationalized Neuman’s lines of defense and resistance in her research. She concluded that the Neuman Model offers an excellent and comprehensive framework from which to view the metaconcepts relevant to the discipline of nursing: person, environment, health, and nursing. Gigliotti says it is time to institute the comprehensive research program proposed by Smith and Edgil.

Projections For Use Of The Model In The Twenty-First Century

Neuman believes her model is “both concept and process relevant as a directive toward nursing and other health care activities in the challenging 21st Century”. This model has been used to make projections about the future of nursing and health care. Procter and Cheek and Tomlinson and Anderson provided two examples of this use. Procter and Cheek used the model to project the role of the nurse in world catastrophic events, and Tomlinson and Anderson used the model to project family health as a system. Procter and Cheek studied experiences of Serbian Australians at the time of the civil war in the former Yugoslavia using the Neuman Systems Model to understand the experiences. As a result of the study, the researchers came up with implications for the role of nursing in world catastrophic events. The researchers suggested the goal of nursing in such worldwide events should be to assist individuals and communities to retain maximum wellness and system stability as they strive for a sense of inner peace and contentment against impossible odds.

Tomlinson and Anderson recognized that there is an increasing focus on the family system as a health entity. They acknowledged, however, that there is not a universally accepted definition of “family health” as a systems phenomenon. Tomlinson and Anderson proposed that the nurse who uses the broad concepts of the Neuman Model along with a shared family health systems perspective, in which the whole family is the client in the health promotion enterprise, will be well prepared to meet future nursing challenges.

The Neuman Systems Model has been used for over 2 decades; first as a teaching tool and later as a conceptual model to observe and interpret the phenomena of nursing and health care globally. Dr. Neuman wrote: “The future of the Neuman Systems Model looks bright.” She believes her model can readily accommodate future changes in health care delivery. The reader has been introduced to the model and some of the global applications of the model.
Parker, M.E. (2001). Nursing Theories and Nursing Practice. Philadelphia: F.A. Davis Company, 338-341.

Thursday, September 4, 2008

JOYCE TRAVELBEE (Human-to-Human Relationship Model )

Human-to-Human Relationship Model

“A nurse does not only seek to alleviate physical pain or render physical care – she ministers to the whole person. The existence of the suffering whether physical, mental or spiritual is the proper concern of the nurse.”
- Joyce Travelbee

Life Story
A psychiatric nurse, educator and writer born in 1926.

  • 1956, she completed her BSN degree at Louisiana State University
  • 1959, she completed her Master of Science Degree in Nursing at Yale University

Working Experiences:

  • 1952, Psychiatric Nursing Instructor at Depaul Hospital Affilliate School, New Orleans.
  • Also she taught at Charity Hospital School of Nursing in Louisiana State University, New York University and University of Mississippi.
  • 1970, the Project Director of Graduate Education at Louisiana State University School of Nursing until her death.
  • 1963, started to publish articles and journals in nursing.
  • 1966 and 1971, publication of her first book entitled Interpersonal Aspects of Nursing.
  • 1969, when she published her second book Intervention in Psychiatric Nursing: Process in the One-to-One Relationship.

She started Doctoral program in Florida in 1973. Unfortunately, she was not able to finish it because she died later that year. She passed away at the prime age of 47 after a brief sickness.

Theoretical Sources

  • Catholic charity institutions
  • Ida Jean Orlando, her instructor—“The nurse is responsible for helping the patient avoid and alleviate the distress of unmet needs.” The nurse and patient interrelate with each other.
  • Viktor Frankl, a survivor of Auschwitz and other Nazi concentration camps—proposed the theory of logotherapy in which a patient is actually confronted with and reoriented toward the meaning of his life.

Nursing Metaparadigm
- Person is defined as a human being.
- Both the nurse and the patient are human beings.
- A human being is a unique, irreplaceable individual who is in continuous process of becoming, evolving and changing.

- Health is subjective and objective.
- Subjective health—is an individually defined state of well being in accord with self-appraisal of physical-emotional-spiritual status.
- Objective health—is an absence of discernible disease, disability of defect as measured by physical examination, laboratory tests and assessment by spiritual director or psychological counselor.

- Environment is not clearly defined.
- She defined human conditions and life experiences encountered by all men as sufferings, hope, pain and illness.

Illness – being unhealthy, but rather explored the human experience of illness

Suffering – is a feeling of displeasure which ranges from simple transitory mental, physical or spiritual discomfort to extreme anguish and to those phases beyond anguish—the malignant phase of dispairful “not caring” and apathetic indifference

Pain – is not observable. A unique experience. Pain is a lonely experience that is difficult to communicate fully to another individual.

Hope – the desire to gain an end or accomplish a goal combined with some degree of expectation that what is desired or sought is attainable

Hopelessness – being devoid of hope

- Nursing is an interpersonal process whereby the professional nurse practitioner assists an individual, family or community to prevent or cope with experience or illness and suffering, and if necessary to find meaning in these experiences.”

Human-to-Human Relationship Model
- humanistic revolution

Interactional Phases of Human-to-Human Relationship Model:
1. Original Encounter
- First impression by the nurse of the sick person and vice-versa.
- Stereotyped or traditional roles
2. Emerging Identities
- the time when relationship begins
- the nurse and patient perceives each others uniqueness
3. Empathy
- the ability to share in the person’s experience
4. Sympathy
- when the nurse wants to lessen the cause of patient’s suffering.
- it goes beyond empathy—“When one sympathizes, one is involved but not incapacitated by the involvement.”
- therapeutic use of self
5. Rapport
- Rapport is described as nursing interventions that lessens the patient’s suffering.
- Relation as human being to human being
- “A nurse is able to establish rapport because she possesses the necessary knowledge and skills required to assist ill persons and because she is able to perceive, respond to and appreciate the uniqueness of the ill human being.”

*phases are in consecutive and developmental process.

Logical Form
- An inductive theory that uses specific nursing situations to create general ideas.

Hospice – self-actualizing life experience. Assumption of the sick role. Meaning of life and sickness and death.

Teaches nurses to understand the meaning of illness and suffering.

Applied in the theory of caring cancer patients.

Clarity – is not consistent in clarity and origin.
1. Definition of terms came from dictionaries and books etc.
2. Used different terms for the same definition.
3. Focus more on adult individuals who are sick and the nurse’s role in helping them to find meaning in their sickness and suffering.
4. Deals in families and their needs but not in the community

Simplicity – not simple.
1. Contains different variables.

Generality – has wide scope of application but applicable only to those patients in distress and life changing events.

Empirical Precision – low measures of empirical soundness.
1. Result of lack of simplicity.
2. Defines concepts theoretically but does not define them operationally.
3. The model has not been tested.

Derivable Consequences – development of quality of caring.
1. It is useful because of its ability to describe, explain, predict and control a phenomena.
2. Explains the variables that affect the establishment of a therapeutic relationship between nurses and patients.
3. Lack of empirical precision also creates lack of usefulness.

Octaviano, E.F. & Balita, C.E. (2008). Theoretical Foundations of Nursing: The Philippine
Perspective. Philippines: Ultimate Learning Series, 93-98.
Tomey, A.M. & Alligood, M.R. (2002). Nursing Theorists and Their Work. 5th ed. Missouri:
Mosby, 418-425.

Journal Reading

The Last Hair Strands
Danela C. Oloresisimo, RN

CANCER... medically termed as CA or cellular aberration is one of the major cause of sufferings and death around the globe. It is cause by a car­cinogen (cancer causing agent) and co-carcinogen (required for carcinogen to affect human cell and this was initiated by wrong and faulty life­style. A combined of these two produces cancer cell or oncogene which trig­gers cancerous character­istics by producing pro­tein which accelerates multiplication of cells, in­creases its responsiveness and growth, thus cancer means any malignant growth in any part of the body which can metastasized or spread all over the body if severe or malignant... But whatever medical terms or mean­ings have used to refer to cancer, still cancer is a killer. Cancer is fate of hopelessness, a fate of sufferings... a fate of dy­ing and death. It is a trai­tor, a disease that has been diagnosed on unexpected times when you have nothing to do but to wait for your time.

"It's cancer! The can­cer cells have metastasized all over your body and its malignant. A chemo­therapy can be of great help but you have nothing to do but to pray... only a miracle can save you ... You have only one short year to live." These were the words have said by my doctor six months ago and now, these are the words that keep on ring­ing into my ears every time I entered the chemo­therapy room. A tinnitus that made me deaf and hopeless.

"Miss, your chemo is finish already, how does it feel? Are you feelin' good?", my chemo­therapy nurse said as I re­plied with a coerce smile. What a question? Every­one knows how difficult it is to undergo chemo­therapy, it causes pain and weakness to my body, troubles to my mind and cries to my heart. Those questions should not been asked, the answer is obvi­ous. As my nurse contin­ues, "Miss, its been 6 months of chemotherapy and ... ", I distracted her with my words, "and still I have cancer. 6 months ago, meaning I have 6 more months to wait for my death. What is the purpose of these chemo­therapy anyway if still I have to die, this therapy is useless and this made me feel weak. And look at me, I'm dying. I do look like a corpse. My skin is desquamating my hairs begun to fall. Honestly, I started to count my last hair strands." Together with the fall of my hairs are the shattered of my dreams, washed-out of my youth and end of my value into this world. I am like a flamed candle that melts as the hour runs, a cigarette that little by lit­tle die and sand in the hour glass that become exhausted. I am useless! I'm just waiting for my death to be valuable. You know how? ... My body could be a great help for worms underground and soil fertilizer for plants and grasses over my tomb." My nurse replied, "Is that the only value you've considered to yourself? And that will gonna happen after your death and besides you are waiting for 6 months to be valuable for worms and plants only. Miss, you have 6 long months more to be valuable while you are living. Why don't you make the most of it? There are so many ways to be valuable, just only take all the opportunities that will knock on your door. Please think about it."

I am very young to die. How cruel of life it could be made me suf­fered like this way at my early age. On this moment on, I should attend differ­ent night life and parties as teenagers usually do. I should go to school and finish my chosen course. Perhaps ... I should be valuable. But this cancer ruined everything, it de­stroys me!, it destroys my cared beauty, made meweak and useless, made me old and fearful be­cause of my appearance. I started to have bald-headed, my hair started to fall ... how could I go out and roamed around to enjoy my last days here on earth. I don't want to die, I want to become a suc­cessful woman, I want to build a big company, to be rich and famous. I want to raise a family of my own. I want to be valuable and fulfilled. Actually, I have so much opportunities to attain all of these, I am an only child of the richest couple in town. I am young, fresh, popular, in­telligent and beautiful. But all of these have noth­ing to do with cancer... all have faded. Before I am a very brave and coura­geous young lady taking up political science for I want to be a lawyer some­day, a fighter fighting for one's right and now I am a useless ill lady whose coward and frightened. I want to fight for my right, my right to live... my right for my life. But fate is so cruel. If s not even, I don't have any armor to fight the battle. If s not right! It is so unfair for not giving me a chance ... a chance to prove something, to be successful, to be fulfilled... to be valuable.

As my car runs along the road on my way back home while having my sensible thoughts, I have witnessed a crime, a vic­tim of hit-and-run. With the help of my personal driver and yaya, we brought this young 20 years old man to the hos­pital and the surgeon's diagnosis is a simple frac­ture of the tibial bone of his right leg, lucky for him as a vehicular accident victim. But not 'till he woke up and complained of absence of eyesight or blindness and his opthalmologist found out that fragments of his bro­ken eyeglasses have drawn into his eyes and his doctor suggested evis­ceration or removal of the contents of the eyeball only living outer sclera and muscle to prevent fur­ther spread of infections and complications and to save optical nerves from damage. Michael had un­derwent an emergency eye surgery and as a result he could not see ... he is totally blind. And the only way for him to see is the eye transplant. I found out that he is living in the squatter's area in Quezon City with his live-in part­ner Elena, 20 years old and their daughter Michaela Elleine, a 6 months old baby girl. And according to Michael he was on his way searching for a job when the acci­dent happened. Due to early marriage and pov­erty, I have realized that Michael has nothing to pay for the bills of the hos­pital so I've decided to have some charitable deeds. After Michael's operation on the same day, I went to his house and I found out that Elena is lying on the bed of sic kness because of her heart ailments which was wors­ened by her delivery to their first baby. As she dis­covered what happened to her husband, she expe­rienced difficulty of breathing and chest pain that leads to heart attack and we brought her to the hospital where Michael was confined. And again, I accepted the load of their hospital bills. Michael was very weak and blind, he does not know where is his family located and Elena was still on ICU (In­tensive Care Unit) waiting for a heart donor for trans­plant and she was totally alone for her family was a victim of fire in Tondo two years ago. And Michaela Elleine was left alone like an abandoned child. I have nothing to do but to adopt this little poor child as long as her parents re­covered or someone claims her.

I have realized how lucky I am despite of my condition and I am not the only unfortunate per­son, there are many oth­ers whose much worst and unfortunate than me ... much oppressed. With my very young age con­sidering my condition, I started to become an in­stant mother to an instant baby girl. I have experi­enced to slept late at night because I have to read her my favorite bedtime sto­ries and to wake in the middle of the night for her bottlefeed milk or changed her diapers. I have witnessed her first crawl, first sit, first stand and first steps which are all missed by her biologi­cal mother. And the most heart breaking experience is that when I have heard her voice as she speaks, "Mi-Mi", which I thought its mommy. Her cries serve as sirene which means she needs me and her smile and laughter told me "thank you" , both brings an innate joy to my soul. I have learned a lot from taking good care of her ... I've learned how to become a mother and how I wish to be the one. And now, I know how does my mother feels when I'll pass away and I feel so lonely and sorry for that... but it is our fate.

Everyday after my therapy, together with Michaela we visited her parents and after that is her monthly check-up to her pediatrician.

Days, weeks and months passed rapidly with Michaela, I really for­got about my illness... my cancer and I forgot about dying that I have only re­maining 6 months to live. Not until I have noticed the passed of time one day when I woke-up very weak and tired, its hard for me to move and get-up on bed. I feel boneless. My eyes feels so heavy considering that I have a complete hours of sleep and my vision was blurred, I look at the mir­ror and put-off my wig, I applied some oil on my scalp and removed the sticking fallen hair and I found out that I am bald already, I have few hair strands scattered all over my head and I counted it ... its 31 all in all long hair strands which before long, silky wavy blonde hair naturally. I have re­maining 31 days to go. I have realized that its get­ting nearer, my time is over. 5 very short months passed rapidly and I have still one month to go. Now, I am not thinking about myself anymore, my concerns are all for Michaela and what I have wished for myself is "Please LORD, let me wit­ness Michaela's first birth­day."

For 3 weeks, I got busy preparing Michaela's birthday party and of signing different contracts, forms, last will and testaments inspite of my worsen condition be­cause I have so many rea­sons to be strong and that are my ambitions and dreams to be fulfilled, suc­cessful and valuable. And on the first day of my last week, we celebrated Michaela Elleine's first birthday party.

6 days to go before my countdown is over, it seems that its like yester­day that I'm waiting for another 6 months to passed, feel frightened and coward to die trying to push the days ahead. And now again inside of this four-cornered white room in front of my nurse, I put-off my wig and de­cided to removed it per­manently as long as I am living ... for 6 days. I have combed my 6 long hair strands that are tightly at­tached to my scalp and it seems like me holding so tight for my life. But like my hair strands which falls everyday, I am pre­paring for my omega. And she asked, "How does it feel?", then I sim­ply smiled at her down to my heart and replied, " I know my time is over ... I have accepted my fate."

I can die now, I am successful and fulfilled. I have proven something to myself and I can say that I am valuable not only for worms and plants but be­cause I have value in the real sense in this world. Considering my age and condition, I am very lucky and too successful for I have attained my dreams. I have built a big building for the needy and for 6 months I have raised a family by helping Michael's family and I be­come a mother with Michaela. I become an at­torney by fighting for the right of Michael's family ... the right to live and the right for life.

LORD is so great to me for giving me such opportunities before of my death. My nurse was right, there are so many ways to be valuable. I gave my light to Michael, the life to Elena and my love and caring to Michaela Elleine. And even when I am on my eternal life, I am sure that I'm still helping so many angels like Michaela, times the thousands of my hair strands fallen with a cause. Because my hair strand is equal to my value into this world and now I am waiting for the fall of my one last hair strand.

"Okay, Miss, if s time for you to sleep and have some rest", my nurse said and then I replied as she holds my hand, "Thank you very much!", with a big smile. And as I closes my eyes, after of a deep breath my last hair strand fall on the floor.


I, whose name at the undersigned was leaving my both eyes to Michael and my heart to Elena for transplant immediately after my death and I am leaving Medical Plan worth of P l, 000, 000. 00 for their hospitalization.

I am also leaving them P50,000.00 for their wed­ding and another P50,000.00 for Michaela Elleine's baptis­mal plus one-fourth of my riches and properties inher­ited from my parents with an Educational Plan. And the three-fourth will be going to the orphanage I have signed with contract which has to be open soon.

To my parents, I am leaving all of my happiness and memories with you.

To all of you, especially to my nurse, thank you very much for giving me the rea­son to live and making me valuable.


A Lady With No Hair

Thanks To You - Collins, Tyler

Journal Reading (Nursing is Caring)

Nursing is Caring Doing For the Patient
(an excerpt from the article of Kristen M. Swanson)
Nursing as Informed Caring for the Well-Being of Others by Kristen M. Swanson (1993), Journal of Nursing Scholarship, vol. 5, no. 4. p. 356

Virginia Henderson captured the essence of doing for in her often quoted definition of nursing:

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 had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.(Henderson, 1966).

Doing for, simply put, is doing for the other what they would do for themselves if it were at all possible. Doing for involves actions on the part of the nurse that are performed on behalf of the client's long term well-being. There is an efficaciousness to these actions, wherein the nurse acts ultimately to preserve the other's wholeness. Short-sighted, misplaced efficiency occurs when the actions are solely toward immediate preservation of the caregiver's time, energy or finances. Classic health care examples of not doing for include administering prematurely an episiotomy on behalf of the obstetrical care provider's over-booked schedule, quickly bathing and dressing an elderly client who is perfectly capable of slowly dressing herself or hastily hauling infants off to the newborn nursery versus leaving them in proximity to their mother's loving gaze, nurturing milk and bodily warmth.

Doing for includes comforting the other, anticipating their needs, performing competently and skillfully, protecting the other from undo harm and ultimately preserving the dignity of the one done for. Although it may appear that doing for actions are primarily psychomotor nursing ministrations, this is not always the case.

In the psychosocial realm of care, doing for generally involves not so much physical ministrations, per se, as the employment of interpersonal therapeutic communication skills as well as setting up opportunities, programs or systems that provide safe arenas within which people can bring about their own healing. When nurses set up groups for teen-age incest survivors, women who miscarry or bone marrow donors, they are doing for clients what they would do for themselves, if at all possible. Recently, a group of maternal-child public health nurses from the Seattle-King County area shared some beautiful examples of psychosocial doing for. They delineated levels of supportive assistance they perform on behalf of new mothers experiencing substance abuse problems. When mothers indicate the desire to "get clean," the nurses describe assessing how capable the woman is to act on her own behalf. If it is clear that the woman is in danger and that it took all the woman had within her to even voice a desire to "quit using." the nurse might dial the substance abuse hot line for her and hand her the phone (being aware that while the woman herself must talk, she needed that extra boost to access help). If, on the other hand, the woman states she is ready to quit and would like to know where to begin, the nurse might assess whether to offer the woman a narrow range of choices ("Here are pamphlets on two treatments programs within your city. I will check back tomorrow to see which one you called."); broad options ("Look in the yellow pages under "A" tor alcoholism. Call me Thursday morning and we can talk about your decisions."); or simply a wide open response, such as "How may I be of assistance to you?" In each case, the level of nurse directiveness is the result of balancing the nurse's recognition that the woman must act on her own behalf with an understanding of the demands, constraints, and resources offered by the woman's life and environment. Doing for in each of these public health nursing examples is a balancing act between doing for the woman what she would do for herself if she had the knowledge and/or resources to do so and facilitating the woman's ultimate desire to realize life long sobriety.

Note: this article is posted for the TFN students in requirement for journal reading. No content of this article is written by the user of the blog site.

Monday, September 1, 2008

Definition of Nursing and the "14 Components of Nursing Care"

Virginia Avenel Henderson


“First Lady of Nursing”

“First Truly International Nurse”

“The nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the mother, the mouthpiece for those too weak or withdrawn to speak and so on.”

Life Story

Born in Kansas City, Missouri on Nov. 30, 1897, the 5th of eight children of Daniel B. and Lucy Minor (Abbot) Henderson. Her father was an attorney for Native American Indians. Her mother came from the state of Virginia to which Miss Henderson returned for her early schooling.

World War I developed her interest in nursing in 1918.

She was educated at the U.S. Army School of Nursing (1921) then worked as a staff nurse of the Henry Street Visiting Nurse Service in New York City.

1922, began teaching in Norfolk Protestant Hospital, Virginia.

1929, teaching supervisor in the clinics of Strong Memorial Hospital, Ronchester, New York.

Teachers College, Columbia University where she completed her B.S. (1932) and M.A. in education (1934), then taught from 1934 until 1948.

As a researcher, writer and author:

  1. Bertha Harmer’s Textbook of the Principles and Practice of Nursing, 4th edition, 1939.
  2. Bertha Harmer’s Textbook of the Principles and Practice of Nursing, 5th edition, 1955, contains her definition of nursing.
  3. Basic Principles of Nursing Care, 1960.
  4. The Nature of Nursing, 1966.
  5. The Principles and Practice of Nursing, 6th edition, 1978.

In 1953, she joined Yale School of Nursing.

Nursing Studies Index (4 volume) (Director)

Interagency Council on Information Resources for Nursing (co-founder)

New England Regional Council on Library Resources for Nursing (co-founder)

International Nursing Index Editorial Advisory Committee (Chairperson)


Honorary doctorates from University of Western Ontario, University of Rochester, Rush University, Pace University, Catholic University of America, Yale University, Old Dominion University, Boston College, Thomas Jefferson University, Emory University, and many distinguished lectures from Great Britain's Royal College of Nursing to the Sorbonne to the Japanese Nursing Association.

June 1985, she awarded the first Christianne Reimann Prize by ICN.

Mary Adelaide Nutting Award from the US National League for Nursing

Fellowship of the American Academy of Nursing

Honorary Membership in the London Association of Integrated and Degree Courses in Nursing

Fellowship in the Royal College of Nursing in England

1983, Sigma Theta Tau International’s Mary Tolle Wright Founders Award for Leadership, one of the honor society’s highest honors.

1988, ANA citation

She recognized early on the importance of an outcomes orientation, health promotion, continuity of care, patient advocacy, multidisciplinary scholarship, integration of the arts and sciences, and boundary spanning.

Her elegant definition of nursing, with its emphasis on complementing the patient's capabilities, provides a clear direction for what nursing should be.

With her silky drawl, bright blue eyes, wispy curls, and beautiful clothes, Miss Henderson was the embodiment of an impish Southern gentlewoman. She was the most gracious hostess I have ever encountered, and had a wicked sense of humor.

She was the incarnation of those Greek verities--the good, the true, and the beautiful. She was shaped by the aesthetic that produced beautiful surroundings in honey and rose colored tones (she gave up the idea of becoming an interior designer/architect when there was a need for nurses in World War I), as well as elegant arguments embellished by references to a literature much broader than just the nursing literature.

Even when her memory and hearing started to fail, she was not limited, because her curiosity and interest in people elicited from them an engagement in the issues that then set in motion her own creative juices.

Virginia Henderson was arguably the most famous nurse of the 20th century. Because that was the case, Sigma Theta Tau's International Nursing Library bears her name. She was only willing to permit use of her name if the electronic networking system to be developed would advance the work of staff nurses by getting to them current and jargon-free information wherever they were based.

Died on March 19, 1996 at the age of 98, after partaking chocolate cake and ice cream and saying goodbyes to her family and friends. A family-sponsored memorial service was held at Battel Chapel on the campus of Yale University in New Haven, CT on May 6 the first day of National Nurses week in 1996. Miss Henderson's family, including her grandniece, Catherine Burdge, who is a member of Sigma Theta Tau, requested that in lieu of flowers, memorial gifts be made to the Virginia Henderson Fund, Yale School of Nursing.

An accomplished author, avid researcher and a visionary.

Definition of Nursing and 14 Basic Human Needs

Theoretical Sources

  1. Bertha Harmer’s Textbook of the Principles and Practice of Nursing.
  2. Involvement as the committee member in a regional conference of the National Nursing Council, 1946.
  3. Annie W. Goodrich, Caroline Stackpole, Jean Broadhurst, Dr. Edward Thorndike, Dr. George Deaver and Ida Jean Orlando (Pelletier).

Use of Empirical Evidence

  1. Stockpole – maintaining physiological balance
  2. Bernard’s psychosomatic theory
  3. Thorndike and Maslow’s human needs

Key Concepts

Components of a person is operationalized by the 14 basic human needs, which under conditions of ill-health will require assistance by the family and/or nurse.

14 Fundamental Needs of Human

1. breathe normally

2. eat and drink adequately

3. eliminate body wastes

4. move and maintain desirable postures

5. sleep and rest

6. select suitable clothes—dress and undress

7. maintain body temperature within normal range by adjusting clothing and modifying the environment

8. keep the body clean and well groomed and protect the integument

9. avoid dangers in the environment and avoid injuring others

10. communicate with others in expressing emotions, needs, fears, or opinions

11. worship according to one’s faith

12. work in such a way that there is a sense of accomplishment

13. play or participate in various forms of recreation

14. learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

Nursing Metaparadigm


A complete and independent being with biological, sociological and spiritual components


The function of the nurse is to assist the individual, sick or well, in the performance of activities contributing to health or its recovery


The patient’s ability to perform independently the 14 basic needs


The effects of 7 components (light, temperature, air movement, atmospheric pressure, proper waste disposal, absence of injurious chemicals, cleanliness of surroundings) on the life and development of a person

Nurse Functions in Relation with the Patient, Physician and the Health Team

  1. Nurse-Patient Relationship
    1. As a substitute for the patient
    2. As a helper for the patient
    3. As a partner with the patient
  2. Nurse-Physician Relationship
  3. Nurse as a Member of the Health Team



  1. Assessment phase – assess the patients for 14 fundamental needs and what is/are lacking.
  2. Planning phase – plan to meet the needs fit to the doctors prescribed plan
  3. Implementation phase – uses the 14 basic needs in answering the factors contributes to the illness
  4. Evaluation phase – decides whether goals are met or not


Development of 3 phases of curriculum development that students should progress in their learning.


She supported developing nurses at baccalaureate level and advocated the use of library for research purposes. Development of the nurses responsibility to identify problems, validates practice and improving methods of care and reassuring the effectiveness of care. The concept that illness arise from the lacking needs gives rise to different researches.


- It is considered as a grand theory or philosophy in the early days.

1. Simplicity

2. Generality

3. Derivable Consequences

Octaviano, E.F. & Balita, C.E. (2008). Theoretical Foundations of Nursing: The Philippine
Perspective. Philippines: Ultimate Learning Series.
Tomey, A.M. & Alligood, M.R. (2002). Nursing Theorists and Their Work. 5th ed. Missouri: