Thesis (Chap2) Students and Rle

7/31/2019 Thesis (Chap2) Students and Rle

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CHAPTER IITHEORETICAL FRAMEWORK

Review of Related Literature

Tell me, I might forget;Teach me and I might remember;Involve me and I learn!

-Benjamin Franklin

Nursing as a profession is the integration of the theoretical basis of itsdistinguished body of knowledge in the actual delivery of care to patients. Innursing education, learning takes place in various settings, in the classroom or inthe affiliated hospitals of the institution. In addition, as identified by Dr Benjamin S.Bloom (1956), there are three learning domains, namely the cognitive, affective,and the psychomotor domain which are essential in the acquisition and application

of new bodies of knowledge. Therefore, lectures, demonstrations, and various skillscultivation is important in the pursuit of the professional nursing practice.

NURSINGNursing is a healthcare profession focused on the care of individuals,

families, and communities so they may attain, maintain, or recover optimal healthand quality of life from birth to the end of life.

The authority for the practice of nursing is based upon a social contract thatdelineates professional rights and responsibilities as well as mechanisms for publicaccountability. In almost all countries, nursing practice is defined and governed by

law, and entrance to the profession is regulated at national or state level.

The aim of the nursing community worldwide is for its professionals to ensurequality care for all, while maintaining their credentials, code of ethics, standards,and competencies, and continuing their education.

NURSING EDUCATIONNursing education consists of the theoretical and practical training

provided to nurses with the purpose to prepare them for their duties as nursingcare professionals. This education is provided to nursing students by experiencednurses and other medical professionals who have qualified or experienced for

educational tasks. Courses leading to autonomous registration as a nurse typicallylast for four years. There are a number of educational paths to becoming aprofessional nurse, which vary greatly worldwide, but all involve extensive study ofnursing theory and practice and training in clinical skills.

NURSING THEORIES


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Nursing theory is the term given to the body of knowledge that is used tosupport nursing practice. In their professional education nurses will study a rangeof interconnected subjects which can be applied to the practice setting. Thisknowledge may be derived from experiential learning, from formal sources such asnursing research or from non-nursing sources. Nursing models are conceptualmodels, constructed of theories and concepts. They are used to help nurses assess,

plan, and implement patient care by providing a framework within which to work.They also help nurses achieve uniformity and seamless care.

Unlike most sciences, Nursing theories seem primarily concerned with what"Nursing" is or should do, rather than a phenomenon of "Nursing". All nursingmodels involve some method of assessing a patient's individual needs andimplementing appropriate patient care. An essential portion of each nursing modelis measurable goals in order that the process can be evaluated in order to providebetter, is used to determine a patient's treatment by nurses, doctors and otherhealthcare professionals and auxiliary workers. These documents are considered tobe living documents they are changed and evaluated on a daily basis as the

patients condition and abilities change.A good theory must have the following characteristics:

1. Theories can interrelate concepts in such a way as to create a differentperspective in looking at a particular phenomenon.

2. Theories must be logical in nature.3. Theories can be simple yet generalized.4. Theories can be bases for hypotheses that can be tested or for theory to be

regenerated; and5. Theories can contribute to and assist in increasing the general body of

knowledge within the discipline through the research implemented tovalidate them.

6. theories can be used by practitioners to guide and improve their practice7. Theories must be consistent with other validated theories, laws and principles

but will serve open unanswered questions that need to be investigated.

Common Concepts in Nursing Theories. Four concepts common in nursingtheory that influence & determine nursing practice are:

1. The person (patient).2. The environment3. Health4. Nursing (goals, roles, functions)

Each of these concepts is usually defined & described by a nursing theorist,often uniquely; although these concepts are common to all nursing theories. Of thefour concepts, the most important is that of the person. The focus of nursing,regardless of definition or theory, is the person.

Purposes of nursing theoriesIn Practice:

1. Assist nurses to describe, explain, and predict everyday experiences.


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2. Serve to guide assessment, interventions, and evaluation of nursingcare.

3. Provide a rationale for collecting reliable and valid data about thehealth status of clients, which are essential for effective decisionmaking and implementation.

4. Help to describe criteria to measure the quality of nursing care.

5. Help build a common nursing terminology to use in communicatingwith other health professionals.6. Ideas are developed and words are defined.7. Enhance autonomy (independence and self-governance) of nursing

through defining its own independent functions.In Education:

1. Provide a general focus for curriculum design2. Guide curricular decision making.

In Research:1. Offer a framework for generating knowledge and new ideas.2. Assist in discovering knowledge gaps in the specific field of study.

3. Offer a systematic approach to identify questions for study; selectvariables, interpret findings, and validate nursing interventions.

Nightingales Environmental Theory. Florence Nightingale (1820-1910),considered the founder of educated and scientific nursing and widely known as"The Lady with the Lamp", wrote the first nursing notes that became the basis ofnursing practice and research. The notes, entitled Notes on Nursing: What it is,What is not (1860), listed some of her theories that have served as foundations ofnursing practice in various settings, including the succeeding conceptualframeworks and theories in the field of nursing. Nightingale is considered the firstnursing theorist. Her theory was the Environmental Theory, which incorporated the

restoration of the usual health status of the nurse's clients into the delivery ofhealth careit is still practiced today.

She stated in her nursing notes that nursing "is an act of utilizing theenvironment of the patient to assist him in his recovery" (Nightingale 1860/1969),that it involves the nurse's initiative to configure environmental settingsappropriate for the gradual restoration of the patient's health, and that externalfactors associated with the patient's surroundings affect life or biologic andphysiologic processes, and his development.

Defined in her environmental theory are the following factors present in the

patient's environment:1. Pure or fresh air2. Pure water3. Sufficient food supplies4. Efficient drainage5. Cleanliness6. Light (especially direct sunlight)


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Any deficiency in one or more of these factors could lead to impairedfunctioning of life processes or diminished health status.

Hendersons Need Theory (14 Fundamental Needs). Virginia AvenelHenderson (November 30, 1897 March 19, 1996) was an American nurse,researcher, theorist and author.

She was born in Kansas City, Missouri, the fifth of eight children of LucyAbbot Henderson and Daniel B. Henderson. She graduated from the Army School ofNursing, Washington, D.C. in 1921. She graduated from Teachers College, ColumbiaUniversity with a M.A. degree in nursing education.

Henderson is famous for a definition of nursing: "The unique function of thenurse is to assist the individual, sick or well, in the performance of those activitiescontributing to health or its recovery (or to peaceful death) that he would performunaided if he had the necessary strength, will or knowledge"

Henderson's focus on individual care is evident in that she stressed assistingindividuals with essential activities to maintain health, to recover, or to achievepeaceful death.

She proposed 14 components of basic nursing care to augment herdefinition:

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 environment8. Keep the body clean and well groomed and protect the integument9. Avoid dangers in the environment and avoid injuring others.10. Communicate with others in expressing emotions, needs, fears,

or opinions.11. Worship according to ones 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 normaldevelopment and health and use the available health facilities.

The first 9 components are physiological. The tenth and fourteenth arepsychological aspects of communicating and learning. The eleventh component isspiritual and moral. The twelfth and thirteenth components are sociologicallyoriented to occupation and recreation

The major assumption of the theory is that:


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1. Nurses care for patients until patient can care for themselves onceagain.

2. Patients desire to return to health, but this assumption is not explicitlystated.

3. Nurses are willing to serve and that nurses will devote themselves tothe patient day and night

4. A final assumption is that nurses should be educated at the universitylevel in both arts and sciences.

Hendersons Theory and the Four MetaparadigmsIndividual

1. Have basic needs that are component of health.2. Requiring assistance to achieve health and independence or a peaceful

death.3. Mind and body are inseparable and interrelated.4. Considers the biological, psychological, sociological, and spiritual

components.

5. The theory presents the patient as a sum of parts with biopsychosocialneeds, and the patient is neither client nor consumer.

Environment1. Settings in which an individual learns unique pattern for living.2. All external conditions and influences that affect life and development.3. Individuals in relation to families4. Minimally discusses the impact of the community on the individual and

family.5. Supports tasks of private and public agencies6. Society wants and expects nurses to act for individuals who are unable

to function independently.7. In return she expects society to contribute to nursing education.8. Basic nursing care involves providing conditions under which the

patient can perform the 14 activities unaided

Health1. Definition based on individuals ability to function independently as

outlined in the 14 components.2. Nurses need to stress promotion of health and prevention and cure of

disease.3. Good health is a challenge.

4. Affected by age, cultural background, physical, and intellectualcapacities, and emotional balance

5. Is the individuals ability to meet these needs independently?

Nursing1. Temporarily assisting an individual who lacks the necessarystrength, will and knowledge to satisfy 1 or more of 14 basic needs.2. Assists and supports the individual in life activities and theattainment of independence.


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3. Nurse serves to make patient complete whole", or"independent."4. The nurse is expected to carry out physicians therapeutic plan5. Individualized care is the result of the nurses creativity inplanning for care.6. Use nursing research

7. Categorizedi. Nursing : nursing careii. Non nursing: ordering supplies, cleanliness and serving food.

8. In the Nature of Nursing that the nurse is and should be legally,an independent practitioner and able to make independent judgmentsas long as s/he is not diagnosing, prescribing treatment for disease, ormaking a prognosis, for these are the physicians function.9. Nurse should have knowledge to practice individualized andhuman care and should be a scientific problem solver.10. In the Nature of Nursing

i. Nurses Role is, to get inside the patients skin and supplement

his strength will or knowledge according to his needs.ii. And nurse has responsibility to assess the needs of the individual

patient, help individual meet their health need, and or provide anenvironment in which the individual can perform activity unaided.

Abdellahs Typology of 21 Nursing Problems. Faye Glenn Abdellah (bornMarch 13, 1919) is a pioneer in nursing research that has been recognized with 77professional and academic honors. She was the first nurse officer to receive therank of a two-star rear admiral. Her more than 150 publications, including herseminal works, Better Nursing Care through Nursing Research and Patient-CenteredApproaches to Nursing, changed the focus of nursing theory from a disease-

centered to a patient-centered approach and moved nursing practice beyond thepatient to include care of families and the elderly.

Abdellahs patient-centred approach to nursing was developed inductivelyfrom her practice and is considered a human needs theory. The theory was createdto assist with nursing education and is most applicable to the education of nurses.Although it was intended to guide care of those in the hospital, it also hasrelevance for nursing care in community settings.

Major Assumptions, Concepts & Relationships. The language of Abdellahsframework is readable and clear. Consistent with the decade in which she was

writing, she uses the term she for nurses, he for doctors and patients, and refersto the object of nursing as patient rather than client or consumer. She referred toNursing diagnosis during a time when nurses were taught that diagnosis was not anurses prerogative.

Assumptions were related to:1. change and anticipated changes that affect nursing;2. The need to appreciate the interconnectedness of social enterprises and

social problems;


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3. the impact of problems such as poverty, racism, pollution, education, and soforth on health care delivery;

4. changing nursing education5. continuing education for professional nurses6. development of nursing leaders from under reserved groups

Abdellah and colleagues developed a list of 21 nursing problems. They alsoidentified 10 steps to identify the clients problems and 11 nursing skills to be usedin developing a treatment typology.

10 Steps To Identify the Clients Problems1. Learn to know the patient2. Sort out relevant and significant data3. Make generalizations about available data in relation to similar nursing

problems presented by other patients4. Identify the therapeutic plan5. Test generalizations with the patient and make additional generalizations

6. Validate the patients conclusions about his nursing problems7. Continue to observe and evaluate the patient over a period of time to

identify any attitudes and clues affecting his behavior8. Explore the patients and familys reaction to the therapeutic plan and

involve them in the plan9. Identify how the nurses feels about the patients nursing problems10. Discuss and develop a comprehensive nursing care plan

11 Nursing Skills1. Observation of health status2. Skills of communication

3. Application of knowledge4. Teaching of patients and families5. Planning and organization of work6. Use of resource materials7. Use of personnel resources8. Problem-solving9. Direction of work of others10. Therapeutic use of the self11. Nursing procedures

The Twenty One Nursing Problems. There are three major categories.

Physical, sociological, and emotional needs of clients; Types of interpersonalrelationships between the nurse and patient; and common elements of client care.

BASIC TO ALL PATIENTS1. To maintain good hygiene and physical comfort2. To promote optimal activity: exercise, rest and sleep3. To promote safety through the prevention of accidents, injury, or other

trauma and through the prevention of the spread of infection4. To maintain good body mechanics and prevent and correct deformities


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SUSTENAL CARE NEEDS5. To facilitate the maintenance of a supply of oxygen to all body cells6. To facilitate the maintenance of nutrition of all body cells7. To facilitate the maintenance of elimination8. To facilitate the maintenance of fluid and electrolyte balance

9. To recognize the physiological responses of the body to disease conditions10. To facilitate the maintenance of regulatory mechanisms and functions11. To facilitate the maintenance of sensory function

REMEDIAL CARE NEEDS12. To identify and accept positive and negative expressions, feelings, and

reactions13. To identify and accept the interrelatedness of emotions and organic

illness14. To facilitate the maintenance of effective verbal and non verbal

communication

15. To promote the development of productive interpersonal relationships16. To facilitate progress toward achievement of personal spiritual goals17. To create and / or maintain a therapeutic environment18. To facilitate awareness of self as an individual with varying physical ,

emotional, and developmental needs

RESTORATIVE CARE NEEDS19. To accept the optimum possible goals in the light of limitations,

physical and emotional20. To use community resources as an aid in resolving problems arising

from illness

21. To understand the role of social problems as influencing factors in thecase of illness

Abdellah's 21 problems are actually a model describing the "arenas" or concernsof nursing, rather than a theory describing relationships among phenomena. In thisway, the theory distinguished the practice of nursing, with a focus on the 21nursing problems, from the practice of medicine, with a focus on disease and cure.

Abdellahs Theory and the Four MetaparadigmNursing

1. Nursing is a helping profession. In Abdellahs model, nursing care is doingsomething to or for the person or providing information to the person withthe goals of meeting needs, increasing or restoring self-help ability, oralleviating impairment.

2. Nursing is broadly grouped into the 21 problem areas to guide care andpromote use of nursing judgment.

3. She considers nursing to be comprehensive service that is based on art andscience and aims to help people, sick or well, cope with their health needs.


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Person1. Abdellah describes people as having physical, emotional, and sociological

needs. These needs may overt, consisting of largely physical needs, orcovert, such as emotional and social needs.

2. Patient is described as the only justification for the existence of nursing.3. Individuals (and families) are the recipients of nursing

4. Health, or achieving of it, is the purpose of nursing services.

Health1. In Patient Centered Approaches to Nursing, Abdellah describes health as a

state mutually exclusive of illness.2. Although Abdellah does not give a definition of health, she speaks to total

health needs and a healthy state of mind and body in her description ofnursing as a comprehensive service.

Society/Environment1. Society is included in planning for optimum health on local, state, national,

and international levels. However, as she further delineated her ideas, thefocus of nursing service is clearly the individual.

2. The environment is the home or community from which patient comes.

Watsons Theory of Human Caring / Transpersonal Theory. Jean Watsonwas born in a small, close-knit town in the Appalachian Mountains of West Virginiain the 1940s. Watson graduated from the Lewis Gale School of Nursing in Roanoke,Virginia, in 1961. She continued her nursing studies at the University of Colorado atBoulder, earning a B.S. in 1964, an M.S. in psychiatric and mental health nursing in1966, and a Ph.D. in educational psychology and counseling in 1973.

Watson proposes even assumptions about the science of caring. The basicassumptions are:

1. Caring can be effectively demonstrated and practiced only interpersonally.2. Caring consists of carative factors that result in the satisfaction of certain

human needs.3. Effective caring promotes health and individual or family growth.4. Caring responses accept person not only as he or she is now but as what he

or she may become.5. A caring environment is one that offers the development of potential while

allowing the person to choose the best action for himself or herself at a givenpoint in time.

6. Caring is more healthogenic than is curing. A science of caring iscomplementary to the science of curing.

7. The practice of caring is central to nursing.

The Ten Primary Carative Factors. The structure for the science of caring isbuilt upon ten carative factors. These are:

1. The formation of a humanistic-altruistic system of values.2. The installation of faith-hope.3. The cultivation of sensitivity to ones self and to others.


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4. The development of a helping-trust relationship5. The promotion and acceptance of the expression of positive and negative

feelings.6. The systematic use of the scientific problem-solving method for decision

making7. The promotion of interpersonal teaching-learning.

8. The provision for a supportive, protective and /or corrective mental, physical,socio-cultural and spiritual environment.9. Assistance with the gratification of human needs.10. The allowance for existential-phenomenological forces.

The first three carative factors form the philosophical foundation for thescience of caring. The remaining seven carative factors spring from the foundationlaid by these first three.

1. The formation of a humanistic- altruistic system of values

Begins developmentally at an early age with values shared with the parents.

Mediated through ones own life experiences, the learning one gains andexposure to the humanities.

Is perceived as necessary to the nurses own maturation which thenpromotes altruistic behavior towards others.

2. Faith-hope

Is essential to both the carative and the curative processes.

When modern science has nothing further to offer the person, the nurse cancontinue to use faith-hope to provide a sense of well-being through beliefswhich are meaningful to the individual.

3. Cultivation of sensitivity to ones self and to others

Explores the need of the nurse to begin to feel an emotion as it presentsitself.

Development of ones own feeling is needed to interact genuinely andsensitively with others.

Striving to become sensitive, makes the nurse more authentic, whichencourages self-growth and self-actualization, in both the nurse and thosewith whom the nurse interacts.

The nurses promote health and higher level functioning only when they formperson to person relationship.

4. Establishing a helping-trust relationship

Strongest tool is the mode of communication, which establishes rapport andcaring.

She has defined the characteristics needed to in the helping-trustrelationship. These are:

Congruence

Empathy

Warmth

Communication includes verbal, nonverbal and listening in a manner whichconnotes empathetic understanding.


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5. The expression of feelings, both positive and negative

According to Watson, feelings alter thoughts and behavior, and they need tobe considered and allowed for in a caring relationship.

According to her such expression improves ones level of awareness.

Awareness of the feelings helps to understand the behavior it engenders.6. The systematic use of the scientific problem-solving method for decision making

According to Watson, the scientific problem- solving method is the onlymethod that allows for control and prediction, and that permits self-correction.

She also values the relative nature of nursing and supports the need toexamine and develop the other methods of knowing to provide an holisticperspective.

The science of caring should not be always neutral and objective.7. Promotion of interpersonal teaching-learning

The caring nurse must focus on the learning process as much as the teachingprocess.

Understanding the persons perception of the situation assist the nurse toprepare a cognitive plan.

8. Provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment

Watson divides these into eternal and internal variables, which the nursemanipulates in order to provide support and protection for the personsmental and physical well-being.

The external and internal environments are interdependent.

Watson suggests that the nurse also must provide comfort, privacy andsafety as a part of this carative factor.

9. Assistance with the gratification of human needs

It is grounded in a hierarchy of need similar to that of the Maslows. She has created a hierarchy which she believes is relevant to the science of

caring in nursing.

According to her each need is equally important for quality nursing care andthe promotion of optimal health. All the needs deserve to be attended to andvalued.

Watsons ordering of needso Lower order needs (biophysical needs)

a) The need for food and fluidb) The need for elimination

c) The need for ventilationo Lower order needs (psychophysical needs)

a) The need for activity-inactivityb) The need for sexualityc) Watsons ordering of needs

o Higher order needs (psychosocial needs)

a) The need for achievementb) The need for affiliation


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o Higher order need (intrapersonal-interpersonal need)

a) The need for self-actualization

Research findings have established a correlation between emotional distressand illness. According to Watson, the current thinking of holistic careemphasizes that:

Factors of the etiological component interact and produce change through

complex neuro-physiological and neuro-chemical pathways Each psychological function has a physiological correlate

Each physiological component has a psychological correlate10. Allowance for existential-phenomenological forces

Phenomenology is a way of understanding people from the way thingsappear to them, from their frame of reference.

Existential psychology is the study of human existence usingphenomenological analysis.

This factor helps the nurse to reconcile and mediate the incongruity ofviewing the person holistically while at the same time attending to thehierarchical ordering of needs.

Thus the nurse assists the person to find the strength or courage to confrontlife or death.

Watsons Theory and the Four MetaparadigmHuman being1. She adopts a view of the human being as: a valued person in and of him

or herself to be cared for, respected, nurtured, understood and assisted; ingeneral a philosophical view of a person as a fully functional integrated self.He, human is viewed as greater than and different from, the sum of his or her

parts.

Health1. Watson believes that there are other factors that are needed to be included in

the WHO definition of health. She adds the following three elements:

A high level of overall physical, mental and social functioning

A general adaptive-maintenance level of daily functioning

The absence of illness (or the presence of efforts that leads its

absence)

Environment/society1. According to Watson caring (and nursing) has existed in every society. A

caring attitude is not transmitted from generation to generation. It istransmitted by the culture of the profession as a unique way of coping with itsenvironment.

Nursing


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1. According to Watson nursing is concerned with promoting health, preventingillness, caring for the sick and restoring health.

2. It focuses on health promotion and treatment of disease. She believes thatholistic health care is central to the practice of caring in nursing.

3. She defines nursing as

A human science of persons and human health-illness experiences that are

mediated by professional, personal, scientific, esthetic and ethical humantransactions.

Peplaus Psychodynamic Theory. Hildegard Peplau, Ed.D (September 1,1909, Reading, Pennsylvania 17 March 1999) was a nursing theorist whoseseminal work Interpersonal Relations in Nursing was published in 1952.Dr. Peplauemphasized the nurse-client relationship as the foundation of nursing practice. Atthe time, her research and emphasis on the give-and-take of nurse-clientrelationships was seen by many as revolutionary. Peplau went on to form aninterpersonal model emphasizing the need for a partnership between nurse andclient as opposed to the client passively receiving treatment (and the nurse

passively acting out doctor's orders).The essence of Peplau's theories is thecreation of a shared experience. Nurses, she thought, could facilitate this throughobservation, description, formulation, interpretation, validation, and intervention.

Peplau's Six Nursing Roles illustrate the dynamic character roles typical to clinicalnursing.

1. Stranger role: Receives the client the same way one meets a stranger in otherlife situations; provides an accepting climate that builds trust.

2. Resource role: Answers questions, interprets clinical treatment data, givesinformation.

3. Teaching role: Gives instructions and provides training; involves analysis and

synthesis of the learner's experience.4. Counseling role: Helps client understand and integrate the meaning of current

life circumstances; provides guidance and encouragement to make changes.5. Surrogate role: Helps client clarify domains of dependence, interdependence,

and independence and acts on clients behalf as advocate.6. Active leadership: Helps client assume maximum responsibility for meeting

treatment goals in a mutually satisfying way.

Specific roles are variable with-in each nurse-client situation being limited onlyby the imagination and skill of the nurse.

The four phases of nurse-patient relationships are:1. Orientation: During this phase, the individual has a felt need and seeks

professional assistance. The nurse helps the individual to recognize andunderstand his/ her problem and determine the need for help.

2. Identification: The patient identifies with those who can help him/ her. Thenurse permits exploration of feelings to aid the patient in undergoing illnessas an experience that reorients feelings and strengthens positive forces in thepersonality and provides needed satisfaction.


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3. Exploitation: During this phase, the patient attempts to derive full value fromwhat he/ she are offered through the relationship. The nurse can project newgoals to be achieved through personal effort and power shifts from the nurseto the patient as the patient delays gratification to achieve the newly formedgoals.

4. Resolution: The patient gradually puts aside old goals and adopts new goals.

This is a process in which the patient frees himself from identification with thenurse.

Peplaus Theory and the Four MetaparadigmPerson1. A developing organism that tries to reduce anxiety caused by needs

Environment1. Existing forces outside the organism and in the context of culture

Health

1. A word symbol that implies forward movement of personality and otherongoing human processes in the direction of creative, constructive,productive, personal and community living.

Nursing1. A significant therapeutic interpersonal process. It functions cooperatively

with other human process that makes health possible for individuals incommunities.

LEARNINGIs the process of acquiring knowledge, skills, and attitude through study,

experience, or teaching, which causes a change of behavior that is persistent,measurable, and specified or allows an individual to formulate new mentalconstruct or revise a prior mental construct. According to Hirni and Craven (2003),learning is the acquisition of a skill or knowledge by practice or instruction.Moreover, as stated by Bailey (2005), learning is a development of the individualscapacities. It motivates and shows the maximum potential of knowledge, skill,talent, and to mention the other area of multiple intelligence. In addition, accordingto Illeris (2002), a common definition of learning is a process that brings togethercognitive, emotional, and environmental influences and experiences for acquiring,enhancing, or making changes in one's knowledge, skills, values, and world views.

DOMAINS OF LEARNINGHumans are lifelong learners. From birth onward humans learn and

assimilate what man has just learned into what man already know.

There is more than one type of learning. The domains of learning are used toclassify learning. These classifications allow teaching to be able to organizeinstruction and therefore provide better structure and improve clarity.


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There are three basic domains of learning that are adapted from BenjaminBloom.

Cognitive Domain. This domain deals with the recognition of knowledge and thedevelopment of intellectual abilities and skills. This is the domain in which most ofthe work in curriculum development has taken place. There are six major

categories, starting from the simplest behavior (recalling facts) to the mostcomplex (Evaluation). The six Educational Objectives is discussed as follows;

1. Knowledge of terminology & specific facts; ways and means of dealingwith specifics (conventions, trends and sequences, classifications andcategories, criteria, methodology); universals and abstractions in a field(principles and generalizations, theories and structures):Knowledge is defined as the remembering (recalling) of appropriate,previously learned information.

Key Words: defines, describes, identifies, knows, labels, lists, matches,

names, outlines, recalls, recognizes, reproduces, selects, states.

2. Comprehension: Grasping (understanding) the meaning of informationalmaterials. Understand the meaning, translation, interpolation, andinterpretation of instructions and problems. State a problem in one's ownwords.

Keywords: classifies; cites; converts; describes; discusses; estimates;explains; generalizes; gives examples; illustrates; makes sense out of;paraphrases; restates (in own words); summarizes; traces; understands.

3. Application: The use of previously learned information in new and concretesituations to solve problems that have single or best answers. Applies whatwas learned in the classroom into novel situations in the workplace.

Keywords: acts; administers; applies; articulates; assesses; charts; collects;computes; constructs; contributes; controls; demonstrates; determines;develops; discovers; establishes; extends; implements; includes; informs;instructs; operationalizes; participates; predicts; prepares; preserves;produces; projects; provides; relates; reports; shows; solves; teaches;transfers; uses; utilizes.

4. Analysis: The breaking down of informational materials into their componentparts, examining (and trying to understand the organizational structure of)such information to develop divergent conclusions by identifying motives orcauses, making inferences, and/or finding evidence to supportgeneralizations. Distinguishes between facts and inferences.

Keywords: analyzes; breaks down; categorizes; compares; contrasts;correlates; diagrams; differentiates; discriminates; distinguishes; focuses;


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illustrates; infers; limits; outlines; points out; prioritizes; recognizes;separates; subdivides.

5. Synthesis: Builds a structure or pattern from diverse elements. Put partstogether to form a whole, with emphasis on creating a new meaning orstructure. Creatively or divergently applying prior knowledge and skills to

produce a new or original whole.

Keywords: adapts; anticipates; collaborates; combines; communicates;compiles; composes; creates; designs; develops; devises; expresses;facilitates; formulates; generates; hypothesizes; incorporates; individualizes;initiates; integrates; intervenes; invents; models; modifies; negotiates; plans;progresses; rearranges; reconstructs; reinforces; reorganizes; revises;structures; substitutes; validates.

6. Evaluation: Judging the value of material based on personal values/opinions,resulting in an end product, with a given purpose, without real right or wrong

answers.

Keywords: appraises; compares & contrasts; concludes; criticizes; critiques;decides; defends; interprets; judges; justifies; reframes; supports.

Affective Domain. This domain is concerned with attitude, beliefs, and the entirespectrum of the value and value systems. This area is often considered the moredifficult domain to structure instruction. The five major categories listed in orderare:

1. Receiving phenomena: Awareness, willingness to hear, selected attention.

Keywords: asks, chooses, describes, follows, gives, holds, identifies, locates,names, points to, selects, sits, erects, replies, uses.

2. Responding to phenomena: Active participation on the part of thelearners. Attends and reacts to a particular phenomenon. Learning outcomesmay emphasize compliance in responding, willingness to respond, orsatisfaction in responding (motivation).

Keywords: answers, assists, aids, complies, conforms, discusses, greets,helps, labels, performs, practices, presents, reads, recites, reports, selects,

tells, writes.

3. Valuing: The worth or value a person attaches to a particular object,phenomenon, or behavior. This ranges from simple acceptance to the morecomplex state of commitment. Valuing is based on the internalization of a setof specified values, while clues to these values are expressed in the learnersovert behavior and are often identifiable.


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Keywords: completes, demonstrates, differentiates, explains, follows, forms,initiates, invites, joins, justifies, proposes, reads, reports, selects, shares,studies, works.

4. Conceptualizing Vvalues: completes, demonstrates, differentiates,explains, follows, forms, initiates, invites, joins, justifies, proposes, reads,

reports, selects, shares, studies, works.

Keywords: adheres, alters, arranges, combines, compares, completes,defends, explains, formulates, generalizes, identifies, integrates, modifies,orders, organizes, prepares, relates, synthesizes.

5. Internalizing values (characterization): Has a value system that controlstheir behavior. The behavior is pervasive, consistent, predictable, and mostimportantly, characteristic of the learner. Instructional objectives areconcerned with the student's general patterns of adjustment (personal,social, emotional).

Keywords: acts, discriminates, displays, influences, listens, modifies,performs, practices, proposes, qualifies, questions, revises, serves, solves,verifies.

Psychomotor Domain. This domain attempts to classify the coordination aspectsassociated with movements and integrate cognitive and affective outlay with bodilyactions and performance. The psychomotor domain includes physical movement,coordination, and use of the motor-skill areas. Development of these skills requirespractice and is measured in terms of speed, precision, distance, procedures, ortechniques in execution. The seven major categories listed in order are:

1. Perception: The ability to use sensory cues to guide motor activity. Thisranges from sensory stimulation, through cue selection, to translation.

Keywords: chooses, describes, detects, differentiates, distinguishes,identifies, isolates, relates, selects.

2. Set: Readiness to act. It includes mental, physical, and emotional sets. Thesethree sets are dispositions that predetermine a persons response to differentsituations (sometimes called mindsets).

Keywords: begins, displays, explains, moves, proceeds, reacts, shows, states,volunteers.

3. Guided response: The early stages in learning a complex skill that includesimitation and trial and error. Adequacy of performance is achieved bypracticing

Keywords: copies, traces, follows, react, reproduce, responds


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4. Mechanism: This is the intermediate stage in learning a complex skill.Learned responses have become habitual and the movements can beperformed with some confidence and proficiency.

Keywords: assembles, calibrates, constructs, dismantles, displays, fastens,fixes, grinds, heats, manipulates, measures, mends, mixes, organizes,

sketches.

5. Complex Overt Response: The skillful performance of motor acts thatinvolve complex movement patterns. Proficiency is indicated by a quick,accurate, and highly coordinated performance, requiring a minimum ofenergy. This category includes performing without hesitation, and automaticperformance. For example, players are often utter sounds of satisfaction orexpletives as soon as they hit a tennis ball or throw a football, because theycan tell by the feel of the act what the result will produce.

Keywords: assembles, builds, calibrates, constructs, dismantles, displays,

fastens, fixes, grinds, heats, manipulates, measures, mends, mixes,organizes, sketches. NOTE: The key words are the same as Mechanism, butwill have adverbs or adjectives that indicate that the performance is quicker,better, more accurate, etc.

6. Adaptation: Skills are well developed and the individual can modifymovement patterns to fit special requirements.

Keywords: adapts, alters, changes, rearranges, reorganizes, revises, varies.

7. Origination: Creating new movement patterns to fit a particular situation or

specific problem. Learning outcomes emphasize creativity based upon highlydeveloped skills.

Keywords: arranges, builds, combines, composes, constructs, creates,designs, initiate, makes, originates.

RELATED LEARNING EXPERIENCEClinical experience is recognized as the core of nursing education. Quality

clinical placements across a variety of venues are vital to the development ofcapable and competent professionals.

Clinical placements are essential to becoming a competent professionalnurse. Although a theoretical and research-based education is essential forcontemporary nursing, on its own it is not enough. Learning in the clinical settingprovides the real world context where nursing students develop the knowledge,skills, attitudes and values of a registered nurse. Students have experiences onclinical placements that cannot be realistically provided in a classroom orlaboratory setting. They communicate with patients and their families, interact withand learn from the health-care team, practice skills under supervision and learn to


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deal with the complexity of competing priorities. When students are on clinicalplacements they receive feedback on their real world performance and are guidedto reflect on their lived experiences as individuals and nurses (Clare et al. 2003;Madjar et al. 1997).

The Importance of Training

The significance and value of training has long been recognized. Consider thepopular and often repeated quotation, Give a person a fish and you feed him for aday. Teach a person to fish and you feed him for a lifetime. This simple butprofound saying is attributed to the wisdom of Confusius who lived in the 5th

century BC. Given todays business climate and the exponential growth intechnology with its effect on the economy and society at large, the need fortraining is more pronounced than ever.Training, in the most simplistic definition, is an activity that changes peoplesbehavior. Increased productivity is often said to be the most important reason fortraining. But it is only one of the benefits. Training is essential not only to increaseproductivity but also to motivate and inspire workers by letting them know how

important their jobs are and giving them all the information they need to performthose jobs (Anonymous, 1998). McNamara (n.d.) lists the following as generalbenefits from employee training: increased job satisfaction and morale increased motivation increased efficiencies in processes, resulting in financial gain increased capacity to adopt new technologies and methods increased innovation in strategies and products reduced employee turnover

Benefits to Students

How do students benefit from work-based learning experiences? It has beenargued (Ashworth, Saxton & Buckle, 1989) that the following are principalmotivators, from a teaching and learning perspective, of placing students in theworkplace: (1) linking theory and practice; (2) gaining work experience generally,and within a particular function; (3) gaining personal insight -- including jobpreferences; (4) entering into a professional role; (5) gaining knowledge of theworking of the particular organization; (6) acquiring knowledge and attitudesrelevant to future learning; (7) exercising skills of thinking in a practical context;and (8) developing personal maturity. According to Knowles (1970), growth inpersonal maturity implies more autonomy, broader awareness, extendedcapacities, more ability to take on responsibilities, greater clarity of self in work

role, more self acceptance, and greater tolerance for ambiguity. There is empiricalevidence (Hopkins, J. R. Stone, Stern & McMillion, 1990) to support the contentionthat well-designed formal school-to-work transition programs can contribute toenhancing many of these factors. Stern, J. R. Stone, Hopkins, McMillion, andCagampang (1992) compared typical teenage work experiences (with noconnection to school) with school-supervised work experiences, concluding thatschool-supervised work better developed some of these crucial factors whichcontribute to adult success in the workplace.


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Benefits to EmployersHow do employers benefit from participating with schools in providing work-

based learning opportunities? According to the National Alliance of Business(1992) , employers who provide youth apprenticeship opportunities can expect toexperience the following benefits:

o Obtain an expanded pool of qualified applicants

o Gain a direct chance to recruit and screen potential employeeso Evaluate potential employees in work settings prior to hiring

o Develop a quick, reliable source of skilled labor

o Meet contractual and legal obligations for affirmative action and equal

employmento Improve the quality of life and skills in the community

o Reduce turnover of entry-level employees

o Influence curriculum development to meet industry requirements

M. A. Hamilton and S. H. Hamilton (1993) describe the learning process of anapprentice as follows: (1) attend coaching and mentoring; (2) try out in practice

what is taught; (3) process learning to comprehend, apply and transform it; (4)produce, or get work done; (5) initiate learning by seeking out people who canteach and by noticing opportunities for learning; and (6) reflect on workexperiences. It can thus be argued that, through mentor involvement andobservation of and exposure to the apprentice learning process, employees andorganizations may recognize that the improved training and development effortsrepresent an investment in learning for the entire workforce in the organization.Initial observations of a youth apprenticeship program in Broome County, New Yorkadd to our belief that youth apprenticeship brings in tools and examples for humanresource development. Starting in the sixth month of that program's existence,employees were demanding to receive the same type of training and cross-training

that was provided to apprentices (S. H. Hamilton, 1993). Similar initial findings in arecent study of six youth apprenticeship sites by the National Center for Researchin Vocational Education (NCRVE) also support this conclusion

CHED MEMORANDUM ORDER NUMBER 5, SERIES OF 2008A person is a unique bio-psycho-socio-cultural and spiritual being, always in

constant interaction with the environment. These interactions affect individuals,families, population groups and societal health status.The nurse assumes the caring role in the promotion of health, prevention ofdiseases, restoration of health, alleviation of suffering and, when recovery is notpossible, in assisting patients towards peaceful death. The nurse collaborates withother members of the health team and other sectors to achieve quality healthcare.Moreover, the nurse works with the individuals, families, population groups,community and society in ensuring active participation in the delivery of holistichealthcare.

Within the context of the Philippine society, nursing education with caring as itsfoundation, subscribes to the following core values which are vital components inthe development of a professional nurse and are emphasized in the BSN program:


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1.1 Love of God1.2 Caring as the core of nursing

a. Compassionb. Competencec. Confidenced. Conscience

e. Commitment (commitment to a culture of excellence, discipline,integrity and professionalism)1.3 Love of People

a. Respect for the dignity of each person regardless of creed, color,gender and political affiliation.

1.4 Love of Countrya. Patriotism (Civic duty, social responsibility and good governance)b. Preservation and enrichment of the environment and culture

heritage

A strong liberal arts and sciences education with a transdisciplinary approach,

enhances this belief. The BSN program therefore, aims to prepare a nurse who,upon completion of the program, demonstrates beginning professionalcompetencies and shall continue to assume responsibility for professionaldevelopment and utilizes research findings in the practice of the profession. Thefollowing are the Key Areas of Responsibility for which the nurse shoulddemonstrate competence:

1. Safe and quality nursing care2. Management of resources and environment3. Health education4. Legal responsibility5. Ethico-moral responsibility

6. Personal and professional development7. Quality improvement8. Research9. Record Management10. Communication11. Collaboration and teamwork

Section 8. Curriculum OutlineA. Outline of Total Units of General Education (GE) Courses: 87 Units

Language and Humanities 21English 1 & 2 (Communication Skills) 6

English 3 (Speech and Communication) 3Filipino 1 & 2 6Philosophy of the Human Person 3Logic and Critical Thinking 3Mathematics, Natural Sciences &Information Technology 22Mathematics (College Algebra) 3Biostatistics 3


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General Chemistry 3/2 5Biochemistry 3/2 5Physics 2/1 3Nursing Informatics 2/1 3Health Sciences 9Anatomy & Physiology 3/2 5

Microbiology & Parasitology 3/1 4* Science, Technology and Society course could be integrated in any professionalcourses

Social Sciences 15General Psychology 3Sociology/Anthropology 3Humanities [ World Civilization & Literature] 3Health Economics with Taxation & Land Reform 3Bioethics 3Mandated Subjects 6Life, Works and Writings of Rizal 3Philippine History with Governance andConstitution 3Physical Education & NSTP 14PE 1 to 4 8National Service Training Program 1& 2 6

B. Outline and Units of Professional Courses 125 UnitsTheoretical Foundations in Nursing 3Health Assessment (2/1) 3Community Health Nursing (3/2) 5

Nutrition and Diet Therapy (3/1) 4Teaching Strategies in Health Education 3Pharmacology 3Nursing Research 1 3Nursing Research 2 2Competency Appraisal I 3Competency Appraisal 2 3NCM 100 Fundamentals of Nursing Practice(3/2) 5NCM 101 Care of Individuals and Family withMaternal and Child Health (6/6) 12

NCM 102 Care of Clients Across the Lifespan withMother, Child and Family/Population Group -at-risk or With Problems (6/6) 12NCM 103 Care of Clients Across the Lifespan withProblems in Oxygenation, Fluid & ElectrolyteBalance, Metabolism and Endocrine (8/6) 14NCM 104 Care of Clients Across the Lifespan withProblems in Perception and Coordination,Adjustment and Maladaptive Behaviors (8/6) 14


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NCM 105 Related Learning Experiences (4 RLE) 4NCM 106 Care of Clients Across the Lifespan andPopulation Group with Problems in Inflammatoryand Immunologic Reactions, CellularAberrations,Acute Biologic Crisis, IncludingEmergency and Disaster Nursing (8/8) 16

NCM 107 Nursing Leadership and Management(8/8) 16

Total Number of Units = 212

At the end of the B. S. Nursing program, the total number of exposure/contacthours in the clinical laboratory is as follows:

Courses

RLECreditUnit

RLE ContactHours (1 creditunit =51hours)

Health Assessment 1 1 51Community Health

Nursing 2 2 102Nursing CareManagement 100 2 2 102Nursing CareManagement 101 6 6 306Nursing CareManagement 102 6 6 306Nursing CareManagement 103 6 6 306Nursing CareManagement 104 6 6 306

Nursing CareManagement 105 4 4 204Nursing CareManagement 106 8 8 408Nursing CareManagement 107 8 8 408Total 49 2499

Section 13. Facilities and Equipment

13.4. Clinical Facilities and Resources:Related Learning Experiences (RLEs) are teaching-learning opportunities thatare designed to develop the competencies of students utilizing processes invarious health situations. These could be sourced from, but not limited to lying-in clinics, schools, industrial establishments, community, out-patient clinics andgeneral and specialty hospitals.

Base Hospital. The base hospital is a health facility being utilized by a highereducation institution with nursing program offering as a source of basic orprimary related learning experiences. The hospital maybe independent or


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owned or operated by the institution or utilized by the institution in accordancewith an effective and duly notarized Memorandum of Agreement between theinstitution and the base hospital which clearly specifies the responsibilities ofeach party.

The base hospital of a nursing school should meet the following requirements:

a. Has current accreditation by the DOH-Bureau of Licensing and Regulationas Level IV Hospital (Tertiary Care/Teaching/Training Hospital). However, LevelIII Hospitals (Secondary Care Hospitals) may be considered provided that thehospital can provide the following:

a.1 adequate case load for the number of students enrolled asstipulated in Article VII, Section 15-f. 9.a.2 adequate facilities for the teaching and learning needs of the

students.

b. Should be accessible and located within the region where the nursing

school is situated. In the case of nursing schools located in Metro Manila, thebase hospital should be located within Metro Manila.

c. Sixty per cent (60%) of the total bed capacity of the base hospital shall beused for the RLEs of students.

Affiliation Hospital is a health facility being utilized by the higher educationinstitution in specialized areas for supplementary clinical learning of studentssuch as mental, orthopedics and communicable diseases. A Contract ofAffiliation shall be used as a legal document to show the terms of referencesamong involved parties.

Parties to the contract of affiliation should provide and maintain anenvironment conducive to the attainment of the teaching-learning objectives.The nursing school and the hospital agency should establish effectivecoordination and cooperation. Open communication should exist among themedical staff and the school personnel.

Cross regional affiliations will not be allowed unless in cases where specialtyareas cannot be found in the region.

The base hospital/s, affiliation hospital/s and community health agency/ies

being used by the students for RLEs either conducted in urban or ruralcommunity should have the following facilities:

a. classroom for conferenceb. libraryc. comfort roomd. dressing roome. loungef. locker


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Provision should be made for adequate physical facilities, supplies andequipment for effective nursing care and learning experiences of students.

The nursing service should be provided with a designated trainingcoordinator and the required staffing composed of qualified professional andnonprofessional personnel.

The faculty and the nursing service personnel of the affiliation agency shouldwork together in the planning, implementation and evaluation of the relatedlearning experiences of students.

There should be an adequate number of patients varying in age, sex,level/acuity and types of illness desired for teaching-learning experience ofdifferent curricular levels.

13.5. Virtual Nursing Skills Laboratory:

Higher education institutions are encouraged to put up Virtual SkillsLaboratory to supplement and complement the related learning experiencesprior to actual experience.

Section 14. The institution must maintain a high standard of instruction, utilizingappropriate and updated course syllabi/references and instructionalmethods/strategies taking into consideration the key areas of responsibility (SafeQuality Care, Communication, Collaboration & Teamwork, Legal Responsibility,Ethico-Moral,Personal & Professional Development, Research, Quality Improvement, RecordsManagement and Environmental Management) that contribute to quality nursing

education. The following should be strictly observed:

a. The offering of professional nursing subjects with the corresponding RLEsmust be strictly adhered to, taking into consideration the prerequisites,sequencing, continuity and integration requirements.

b. Credit for the completion of the course is based on the fulfillment ofcurricular requirements.

c. The Related Learning Experiences are organized around the objectives and

competencies set forth by the course which all students must be able to achieve.RLE requirements must conform to PRC Policies and Guidelines.

d. The ratio of faculty to student in science laboratory class is 1:25 while regularclassroom is 1:50. The institution shall provide for a systematic and continuing planof evaluation of the students progress through a marking system that is consistentand congruent to set objectives.


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Section 15. The Related Learning Experiences (RLEs) are carefully selected todevelop competencies utilizing the nursing process in varying health situations. Thefollowing conditions must be observed:

a. There shall be close correlation of theoretical knowledge to relatedlearning experience. Classroom and RLE activities must be congruent.

b. Classroom and RLE is a continuous process. Faculty teaching in theclassroom shall continue to teach the students in their RLE.

c. Letters of intent to utilize affiliation agencies shall be available at the initialyear of operation.

d. A documented RLE rotation plan showing distribution of students andfaculty supervision in each clinical area of base hospital and affiliation agenciesshall be made available.

e. Faculty compensation shall be based on the computation that one (1) hourRLE is equivalent to one (1) lecture hour.

f. Effectiveness and efficiency of the related learning experience, shallconsider the following factors:

f.1 Quality of supervision of clinical instructors and teaching-learningprocessf.2 Readiness and capability of the learnerf.3 Quality of the learning resources both in institutions and

communities

f.4 Adequate number and variety of clientelef.5 Utilization of appropriate feedback mechanismf.6 Adequate number of qualified nursing staff and other personnelf.7 Quality of nursing care servicesf.8 Compliance with the required equivalence of fifty one (51) hours toto one (1) unit RLEf.9 Ratio of student to clientele depends upon the objectives and thecapacity of the student.

The ratio of student to clientele shall be:

Level

1stSemester

2ndSemester

II 1:1 1:2III 1:2-3 1:3-4IV 1:5 1:6

The ratio of faculty to student ratio shall be:


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Level

1stSemester

2ndSemester

II 1:8 1:8III 1:10-12 1:10-12

IV 1:12-15 1:12-15

g. For government recognition, an increase in student population shall besubject to proportionate increase of resources both in classroom and clinical areasubject to CHED approval. For this purpose, CHED Regional Offices shall strictlymonitor compliance herein.

h. Nursing schools that are in existence for a period of five (5) years areencouraged to undergo program accreditation.

Conceptual Framework


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The conceptual framework above shows the interconnection between theBSN Students together with their PLE exposures and the learning of their nursingtheories. It also shows two arrows presenting the importance and impact of RLE

and Nursing Theories learned to one another. This correlation can be seen in thestudents performance and application of Nursing theories in their area of exposureand how their RLEs can maximize the learning of these theories.

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Thesis (Chap2) Students and Rle

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