1.

In reflection, how did theoretical

foundations impact you in terms of
where you are now as a person and
as a professional? What is its
relevance to your practice?
A people without
knowledge of their past history,
origin and culture is like a tree
without roots (Marcus Garvey).
Understanding nursing theory and
how it has developed throughout
the decades allows us to know what
the root of our profession entails.
As a person, the
knowledge I acquired from studying
theoretical foundations gave me
awareness that empowered me to
justify, explain, and promote my
ideas about nursing and its practice.
It allowed me to communicate
effectively with colleagues and
engage ourselves in clearly thought-
out plans to enhance our personal
lives and nursing careers.
As a professional, my
familiarity with the various nursing
theories helped me deal with the
issues of complexities of both
patient care and the healthcare
system. I worked on a medical-
surgical unit in an acute care
setting, and caring is a central
concept to the delivery of medical
care. The patients I encounter are
often frightened with the knowledge
of their illnesses, imminent death
and their unfamiliar surroundings.
They rely on the nurse and the
delivery of care to help them feel
physically better. I also view the
patient as a spiritual being. That
means reaching out to the patient
and forming a deeper connection to
the spiritual self.
Consciously or
unconsciously, I hold and apply
certain nursing theories in
performing my job, because
addressing such issues require a
firm foundation of knowledge and
skills in order to render care and
service that will positively affect
patient treatment and organizational
outcomes. Learning these theories
also allowed me to gain insight in
my own theoretical positions,
validated my existing practice, and I
became self-affirming. My
theoretical understanding also
offered me tools for recognizing,
analyzing, and dealing with the
issues I encounter in a more
focused, logical, and effective
manner.
Nursing theories help to
distinguish what should form the
basis of practice by explicitly
describing nursing. The benefit of
having a defined body of theory in
nursing include better patient care,
enhanced professional status for
nurses, improved communication
between nurses and guidance for
research and education provides a
framework for nursing practice,
research, education and
administration and provides
professional boundaries, grounding
nursing as an
independent profession. I strongly
believe that all nursing practice
environments should be grounded
on at least one nursing
theorist/model providing nurses
working together with a shared
viewpoint and language, along with
a framework which supports and
grounds nursing as an independent
profession. If nursing is to gain the
professional recognition and
autonomy that it deserves, it must
integrate and accentuate nursing
theories/models into research,
practice, education and
administration.
Additionally, nursing
theory provides the foundation for
nursing research, which is important
to help develop nursing practice.
Because of nursing research,
nurses are no longer putting Maalox
on pressure ulcers like they did in
previous years. I believe my
education from a few years ago is
still relevant in terms of clinical
knowledge. Some of the things that
I learned in nursing schools became
obsolete even before I entered my
third year anniversary as a
registered nurse because of
evidence based practices. The
theoretical foundations are still there
in terms of basic nursing
knowledge. By giving nurses a
sense of identity, nursing theory can
help patients, managers and other
healthcare professionals to
recognize the unique contribution
that nurses make to the healthcare
service. Providing a definition of
nursing theory also helps nurses to
understand their purpose and role in
the healthcare setting.

2. In your own standpoint, critique
two theories that have been
discussed in class. How are they
similar or different? How will its
application impact nursing
practice/service?
My two theories are
Peplaus Interpersonal Relations
Theory and Kings Goal Attainment
Theory. The selection of these two
theories was favorable for me
because they match rather well.
Hildegard E. Peplau was
the first theorist to present the first
published theoretical development
in nursing in the twentieth century.
She viewed the person as a
developing organism trying to
reduce anxiety, environment as
forces outside the person, health as
forward movement of personality
and nursing as a therapeutic
interpersonal process. In my own
standpoint, her definition of the
person is a little lax. The person is
more complicated and should be
defined accordingly. Her focus is on
the interpersonal process between
a nurse and a client and the roles
played by the nurse in this process.
The interpersonal process occurs in
three phases: orientation phase,
where the client seeks help and the
nurse assists the client to
understand the problem and extent
of the need for help; working phase,
wherein the client assumes a
posture of dependence,
interdependence, or independence
in relation to the nurse; and lastly
the termination phase, where client
derives full value from what the
nurse offers through the
relationship. Relationships are a
very important aspect of patient
care. The way in which Peplau
explored the different primary roles
of the nurse was interesting. It is
easy to see the importance of the
nurse when it is broken down like
she did throughout her theory.
Power shifts from the nurse to the
client. To utilize this theory in the
nursing practice, the nurse
recognizes that the client move from
one phase of dependence to
independence during the nurse-
patient interaction for the provision
of health care.
Imogene M. King
developed a general systems
framework and a theory of goal
attainment. The framework speaks
to three levels of systems
individual or personal, group or
interpersonal, and society or social.
The theory of goal attainment
speaks to the importance of
interaction, perception,
communication, transaction, self,
role, stress, growth and
development, time, and personal
space. King emphasized that both
the nurse and the client bring
important knowledge and
information to the relationship and
that they work together to achieve
goals. Research has supported that
when the nurse and client
communicate and work together
toward mutually selected goals, the
goals are more likely to be attained.
This theory can be utilized in the
practice by being aware that goals
are attained by the nurse and the
client after they interact and this
interaction is affected by perception,
judgment, stress, growth and
development, time, and personal
space. King developed a cause-
and-effect idea about her goal
attainment theory. For example,
mutual respect among patient and
client will cause a transaction to
happen. Expected performance of
perceived roles between nurse and
patient being compatible can lead to
further transactions. Should the
roles become unclear, patient-nurse
relation could be compromised and
cause stress on the relationship. If
the transactions between the nurse
and the patient sustain harmony, it
can cause enrichment of
development. When this growth
occurs, goals can be set and
attained mutually among patient
and nurse. Finally, if that goal is
attained, satisfaction will occur. This
scheme of if-then situations is very
reasonable, and here it is used to
put Imogene Kings theory in a
manner that helps people
understand it further. The essence
of goal attainment theory is that the
nurse and the patient work together
to define and reach goals that they
set together, (King Theory, n.d.).
The key word together used to
describe this theory would indicate
that there is a necessary and
unavoidable relationship that must
take place between the patient and
the nurse in order for the goal to be
reached in a timely and effective
manner. Peplau further explored the
idea of relationships and their
effects on patient care and
recovery.
On a broad perspective,
both theories intend to explain the
course of interaction that occurs
between the nurse and the patient.
Kings fundamental assumption of
her theory is that the nurse and the
patient communicate information,
set goals mutually, and takes action
to attain those goals. The same can
actually be said with Peplaus
theory wherein she states that
nursing is an interpersonal process
because it involves interaction
between two or more individuals
with a common goal, the attainment
of which is achieved through the
use of a series of steps, and that
the nurse and patient work together
so both become mature and
knowledgeable in the process. A lot
of similarities can be seen from both
works as they try to explain the
nursing process in a nurse-patient
interaction level. In both theories,
the concepts of person, health,
environment and nursing are almost
similar, as they integrate it with
each of their own interaction
models.

The deviation between
the two theories occur where the
focus of their study lie in the current
nursing practice. Peplau made the
phases of interpersonal relationship
the focus of her study. On the other
hand, King focused on the major
concept of interacting systems:
Personal, interpersonal and social
systems, and how the accuracy of
determining which system is most
applicable would lead to eventual
transaction.
The relationship between
nurse and patient is extremely
important in setting the goal and
also in the actual achievement of
that goal. If there is not an amicable
relationship, it might take longer for
the goal to be reached or might
even prevent it from being
accomplished at all. Therefore, the
theories of interpersonal
relationships and goal attainment go
hand-in-hand and have important
part in our professional practice.

3. From among the theories
discussed, in your own point of
view, which theory is most suitable
in the current day practice of
nursing? How will you align it with
nursing education in terms of the
related learning experience of our
students? Design a program for the
clinical experience of the students
utilizing the theory that you have
identified.
In these times, where
diversity of the worlds population
has reached a point where it is
imperative to address and more
importantly to understand,
Madeleine Leiningers Transcultural
Theory of Culture Care Diversity
and Universality fits in the current
practice of nursing. The general
premise of this theory suggests that
people of different cultures can
define ways they experience and
perceive nursing care and can also
relate their experiences to their
general health beliefs and practices
(George, 2007). Leininger believed
that people of different cultures can
inform and direct professionals in
such a manner to receive the kind
of care they desire from others
(Tomey & Alligood, 2006).
As professional nurses, it
is inevitable that we encounter
individuals from many different
cultures and regions of the world in
our practice. Some may have things
in common with us and some may
have differences that we are not
familiar with or understand. Each
culture has different practices
related to caring for sick people
based upon their values, beliefs,
and traditions, and these practices
among cultures with respect to care,
health, and illness are extremely
challenging for nurses to provide
effective nursing care. Yes, our
patients will have different cultural
values, beliefs and practices from
our own, but we must still show
them respect. Cultural competence
in nursing is evolving as the
standard of care. Nursing and other
health care providers must employ
knowledge of various social and
cultural influences in the care
setting to promote patient-centered
care (Mitchell, Fioravanti, Founds,
Hoffmann, & Libman, 2010). It is
crucial to recognize and appreciate
the relevance of diversity in the
acute care setting to set standards
of culturally competent nursing care,
and improve care delivery through
meeting and improving these
standards. Nursing practice
includes providing care that is
holistic, it should address the
physical, psychological, social,
emotional, and spiritual needs of
patients. In order to provide holistic
care, nurses must also account for
cultural differences in their care
plans. This helps ensure that nurses
provide holistic care because care
plans are formulated based on
individuals needs and cultures.
Thus, nurses must be culturally
competent in order to provide
optimal care for their patients.
Social justice entails valuing and
respecting diversity for all persons
in decision making. In the acute
care setting, this includes evaluating
what is culturally appropriate for the
patient and staff population. Health
care facilities also need to ensure
that tools, such as interpreters and
teaching materials in other
languages are in place to effectively
provide care. Another way to value
diversity is implementing the use of
cultural knowledge to device a
patients plan of care. It is essential
to be accepting of others beliefs to
improve care and the institutions
current standards. Cultural
competency is a continuous
learning experience as nurses
determine how their views affect
patient outcomes and decision
making, while avoiding stereotypes.
When adhering to the standards of
culturally competent care, it is
important that nurses are cognizant
of various biases that exist between
cultures and how these biases set
the expectations of care. For
example, when dealing with a
Middle Eastern family in the acute
care setting, there are stereotypes
that exist about them being difficult
and challenging families. It is
important that nurse possess the
capacity to assess oneself and
recognize the stereotypes, and not
allow it to determine the level of
care they provide. It is important to
explain the plan of care and identify
needs and expectations to help
ease any tension, and develop trust
between the nurse, patient, and
family.

Nursing schools are
positioned to increase the cultural
awareness of nursing students and
potentially change the practice.
Student nurses must value the
development of cultural awareness
and competency within the
profession in order to encourage
and address all stages of holistic
nursing practice as it is meaningful
to todays multicultural society.
Although progress has been made
in incorporating transcultural
nursing concepts in nursing
curricula abroad, however, it is still
lacking here in the Philippines.
During my undergraduate years, we
were taught the theoretical aspects
of transcultural and universal
nursing, but the actual application
was very limited to the communities
we were immersed to. A clinical or
field experience is vital as it
provides an opportunity for students
to encounter individuals from
different backgrounds or
environment. In line with that, an
organizing framework should be
developed by the nurse-governing
body (BON) together with the CHED
to guide faculty members in
designing, facilitating, and
evaluating culturally focused field
experiences.

My suggested program
would focus on the following:
a. Theoretical foundation on
transcultural nursing
b. Health issues worldwide
c. Cultural health assessment
d. Health and illness beliefs based
on various cultures
e. Healing and care modalities
based on various cultures
f. Intercultural communication

4. Given the following case
scenario, apply one theory that has
been discussed and apply the
Nursing Care utilizing the nursing
process which is specific to the
theory that you have chosen.
I have chosen Lydia Halls
aspects of Care, Cure and Core for
the given case scenario. Because
some causes of abdominal pain are
life-threatening, triaging patients
quickly and accurately is crucial.
Using Halls theory, Client X is a
patient who needs the interventions
of nurses and doctors in order to
gain back his optimum health
equilibrium. Theory of Lydia Hall
describes that a patient or a client is
a recipient of care and needs
interventions from the nurses and
other medical professionals to
regain homeostasis within his
environment. This is where the
concepts of 3 Cs of Lydia Hall
theory derived from:

The Core relates to the
person or client to whom the
nursing care would be delivered.
The core is the person or patient to
whom nursing care is directed and
needed. The core has goals set by
himself and not by any other
person, and that these goals need
to be achieved. The core, in
addition, behaved according to his
feelings, and value system. The
core on the above case is none
other than Client X.

The Care explains the role of
nurses which is uniquely distinctive
from other medical health team
members. The care circle explains
the role of nurses, and focused on
performing that noble task of
nurturing the patients, meaning the
component of this model is the
motherly care provided by nurses,
which may include imited to
provision of comfort measures,
provision of patient teaching
activities and helping the patient
meet their needs where help is
needed. It is easy to understand
from the model that in all of the
circles of the model, the nurse is
always presents the bigger role she
takes belongs to the care circle
where she acts a professional in
helping the patient meet his needs
and attain a sense of balance. The
Care in connection to Client Xs
case will be the nursing
interventions for a patient
experiencing abdominal pain with
nausea and vomiting. These are the
following:

Perform a comprehensive
pain assessment covering
the location, severity and
type of pain
Observation of non-verbal
discomfort.
Instruct the patient to rest and
the use of relaxation
techniques.
Provide the patient with
accurate information
regarding the NPO order.
Minimize factors that can
cause nausea and vomiting.
Monitor laboratory work up
especially serum electrolytes
since the patient has episodes of
vomiting.
Monitor patient for signs of
infection.

The Cure pertains to the
attention given by the doctors to
treat the disease itself. A medical
approach. The main aim of
treatment are to alleviate
symptoms, enhance quality life and
improve life expectancy. The cure,
on the other hand is the attention
given to patients by the medical
professionals. The model explains
that the cure circle is shared by the
nurse with other health
professionals. These are the
interventions or actions geared on
treating or curing the patient from
whatever illness or disease he may
be suffering from. Since the patient
is on NPO, the administration of
intravenous fluid to provide
hydration and for delivery of
medications (analgesics,
antiemetics) may be necessary.


5. Do you see yourself teaching the
same subject in the next 5-10
years? Why or why not?
A profound understanding
of the nursing theories is important.
Maybe not to the extent that some
schools cover it, but as
professionals, it is important that we
are familiar with this aspect of our
profession. To be a nurse educator
is included in my plans after
finishing my Masters Degree, and I
would like to focus on mental health
nursing. Though my existing
knowledge in nursing theories
greatly helped and changed my
views regarding the nursing
profession in whole, there is still a
lot to learn and work on to be
considered as an effective
theoretical foundation professor.