THEORETICAL FOUNDATION OF NURSING
Lydia Hall
Introduced the model on Nursing: Whatis It?, Click to edit the outline format Consiststext of three tenets
Outline Level The frst is Second that nursing functions differently inthe three interlocking Third Outline circles that constitute Level aspects of the patient 1 Fourth Outline
The 3 circles are: Level Fifth Outline CARE - The patients body2 Level CURE -The diseaseaffecting Sixth the body3 Outline CORE -The person of the patient which is being affectedLevel by each of the
Types of theories
Grand theories
These theories that have a very broad scope
Each of the grand theories shares the common ground offering a structure that enables description and explanation of essential conceptualization of nursing
Examples
Leninger
Newman
Middle Range Theories
As those “that lie between the minor but necessary working hypotheses that evolve in abundance during day to day research and all – inclusive systematic efforts to develop unifed theory
Principle ideas of middle range theories are relatively simple
Means rudimentary straight forward ideas that sum from the factors of discipline
Thus, middle range theories is basic, usable structure of ideas, less abstract than grand theories and more abstract than emperical generalizations or micro-range theories
Examples: Orlando, Peplau, Watson, Modelling and Mercer’s
Micro – Range Theory
Situation specifc
Focus on specifc nursing phenomenon that refect clinical practice and that are limited to specifc populations or to particular feld of practice
These theories offer a blue print that is more readily operational and or less has more accessible utilization clinical situation
Example: Korean immigrant women learned to adopt to chronic illness.
NURSING PARADIGM
Nursing has a model or paradigm that explains the linkages of science, philosophy, and theory that is accepted and applied by the discipline.
The elements of Nursing paradigm direct the activity of the nursing profession, including knowledge development, philosophy, theory, educational experience, research, practice and literature identifed with the profession
Nursing identifed its domain in a paradigm that includes four linkages: the person, health, environment/ situation, and nursing
NURSING
PERSON
HEALTH
ENVIRONMENT
Four Major Concepts of Nursing Theories 1.
PERSON – Refers to all human beings1
2.
ENVIRONMENT – Include factors that affect individuals internally and externally2
3.
HEALTH – Addresses the person’s state of well – being
4.
NURSING – is central to all nursing theories. Defnitions of nursing describe what nursing is, what nurses do, and how nurses interact with clients. It is the “diagnosis and treatment of human responses to actual or potential health problems” (ANA, 1995).3
Florence Nightingale
Clickdescribed to edit thethe outline Developed and frst text format Nursing Theory
Second Outline Nightingale believed that diseaseLevel was a reparative process that the Thirdand Outline manipulation of Level the patient’s surroundings-ventilation, warmth, Fourth Outline light, diet, cleanliness, and noise Level She focused on changing and manipulating the environment Fifth Outline in order to put the patient in the best possible conditions Level for nature to act. Sixth She provided the nursing profession the “legacy of caring” Outline Florence Nightingale = Environment Level
13 Canons
She identifed the following aspects as major areas of the physical, social, and psychological environment that the nurse could control:
Health of houses
Ventilation and warming
Light
Noise
Variety
Bed and bedding
Cleanliness or rooms and walls
Personal Cleanliness
Nutrition and taking food
Chattering hopes and advices
Observation of the sick
CONCEPTS
ENVIRONMENT: can be defned as anything that can be manipulated to place a patient in the best possible condition for nature to act
This theory has both physical and psychological components
The physical components of the environment refer to ventilation, warmth, light, nutrition, medicine, stimulation, room temperature and activity
PERSON: the one who is receiving care; a dynamic and complex being
Nightingale envisioned the person as comprising physical, intellectual, emotional, social and spiritual components
HEALTH: Nightingale wrote, “healthy is not only to be well, but to be able to use well every power we have.”
She believed in the prevention and health promotion in addition to nursing patients from illness to health
NURSING: Nightingale believed nursing to be a spiritual calling. Nurses were to assist nature to repair the patient
She defoned different types of nursing as “ nursing prioper” (nursing the sick), “general nursing” (health promotion), and “midwifery nursing”
Nightingale viewed nursing the “Science of environmental management”
Nurses were to use common sense, observation, and ingenuity to allow nature to effectively repair the patient
Nightingale believed, “observation may always be improved with training – seldom be present without training; for otherwise the nurse
Application
Miss angel gonzaga is a 25 year old female who had been admitted to the medical unit with the chief complaint of frequent, watery stool since last night. This is accompanied by abdominal cramps, N&V. her VS are as follows: T=38.6, P=98, RR23, BP=100/70. she complains of weakness, thirst, dryness of mouth. Her skin is warm, fushed, and dry. Her urine is dark yellow in color
She claims, she had eaten oysters for dinner. She lives in a crowded community close to landfll and shares toilet with 4 other families. Their source of drinking is from pump well in the community. She does not practice good handwashing after using the toilet. SE revealed salmonellosis
She is tearful. She express great concern over her absence from her job in a garment factory and over her health and expense for hospitalization
A. Nursing the Sick
A. Assessment 1.
Fluid and electrolyte losses related to frequent, watery stools, nausea and vomiting as manifested by changes in the VS; weakness; dryness of mouth; warmth, fushed, dry skin; dark-colored urine.
2.
Pain related to abdominal cramps
3.
Inadequate food intake related to nausea and vomiting
4.
Fever (T=38.6’C) related to infection (salmonellosis) and dehydration
B. Plan Fluid and electrolyte losses
1.
Provide fuid and electrolyte replacement
Administer medications to relieve frequent , watery stools and nausea and vomiting as prescribed
Provide good oral care for dryness of mouth
Promote rest to relieve weakness
Monitor intake and output. To assess fuid balance status
Provide good perianal care Pain related to abdominal cramps
1.
Provide low fber diet ® to reduce peristalsis
Promote rest ® to reduce peristalsis and to promote comfort
Avoid gas forming foods ® fatulence worseness abdominal pain
Inadequate food intake
3.
Provide small frequent feeding. This better tolerated by patients with nausea
Provide ice chips to relieve nauses
Administer antiemitic as prescribed ® relieve nausea and vomiting Fever related to infection and dehydration
3.
Provide adequate room ventilation
Keep the room airy and free of odor.
Increase fuid intake
Administer antibiotic and antipyretic as prescribed
Render TSB
Keep skin clean and dry
Change gowns and bedding
B. Physical Environment
A. Home, Community/ Neighborhood and Workplace Assessment 1.
Pure water. Assess for adequate working water system and storage that is free from contamination
2.
Cleanliness.
Assess for sanitation conditions of food sources and preparation and hygienic practices
Assess for the means to maintain sanitation conditions of toilets. To keep food and water supply free from contamination
Home, Community/Neighborhood and Workplace Plan Water
1.
Have water checked for contamination in coordination with local Department of Health personnel
Educate the client on water purifcation and storage methods
Keep garbage and other refuse away from water supply or any parts of the water system
Cleanliness
1.
Educate the client on proper food handling; the importance of handwashing especially when preparing foods and before and after using the toilet; proper waste disposal and personal
Home and workplace Assessment
3.
Light. Assess for adequate windows and working light sources
Pure air. Assess for ventilation, offensive odors, eg. Odors of the garbage and landfll
Water. Assess for working system that is free from contamination
Drainage. Assess the home and workplace for means to keep the areas clean, and freedom from excessive dust, mold, mildew, pet droppings (from cats and dogs), offensive odors, “dust catcher” things (fles of papers, unused jars, plastic container, unused old clothes, etc)
Bed and bedding. Assess the bed for space and comfort. Assess the bedding for cleanliness and availability of areas for laundry and drying of bedding (for home environment only).
Noise. Assess the area for loud, offensive and unnecessary noise
C. Psychological Environment
Assessment and Plan
Miss Angel Gonzaga has psychological concerns. She is worried over her absence from her job, her health, and expenses for hospitalization 1.
Anxiety. Assess the client’s activities before illness. Attempt to stimulate variety in the room and with the client during her hospital stay – with cards, fowers, magazines, books, music. Encourage visits of relatives and friends
2.
Chattering hopes and advices. Refrain from giving the patient your opinion. Provide factual information about health. Allow her to verbalize her fears, feelings and concerns
Critical Thinking
Miss Sarah Alonzo, a 22 year old female had consulted the health center because of fever since three days ago. This accompanied by loss of appetite to eat, body malaise, headache, abdominal pains, dizziness. Her VS sre as follows T=38.7, PR=86, RR=21, BP=90/60. Miss alonzo claims that she had lost weight because of her fever and loss of appetite to eat. She lives in a crowded community which is constantly submerged in water due to foods. This causes severe problems in sanitation and source of water supply. Laboratory test and physical examination revealed DHF
Miss alonzo is extremely worried because she had a neighbor who died because of DHF few months ago. In addition, she is concerned over fnancial expenses for her illness and her absence from her job as a crew in a fastfood center. She also verbalizes diffculty of sleeping in unfamiliar environment like the hospital
Nursing the Sick
1.
Assessment
Plan
Physical environment
1.
Home, community/neighborhood and workplace assessment
Home, community/neighborhood and workplace plan
Psychological environment
1.
1.
Assessment and plan
Nutrition
Virginia Henderson
Introduced the Nature of Nursing Model Click to edit the outline text format She identifed the 14 basic needs Second Outline Level She postulated that the unique Third Outline function of theLevel nurse is to assist the client sick or well in the Fourth Outline performance of those activities Levelor its contributing to health recovery, that clients Fifth wouldOutline perform Level unaided if they had the necessary Sixth strength, will or knowledge* Outline Virginia Henderson =Level 14 Basic Needs
14 Basic needs Breath Normally
Eat and drink adequately
Eliminate Body Waste
Move and maintain desirable postures
Sleep and rest
Select suitable clothes – dress and undress
Maintain body temperature within normal range by adjusting clothing and modifying the environment
Keep body clean and well groomed and protect the integument
Avoid dangers in the environment and avoid injuring others
Communication with others in expressing emotions, needs, fears, or opinions
Worship according one’s faith
Work in such a way that there is a sense of accomplishment
Play or participate in various forms of recreation
Faye Glenn Abdellah
Introduced Click to edit patientthe outline centered text format Approaches to Nursing Model Second Outline Level She identifed 21 nursing Third Outline problems Level Outline She defnedFourth nursing as a service to Level individuals and Fifth to Outline families; therefore the Level society* Sixth Faye Glenn Abdellah= 21 Outline Level
21 Nursing Problems
To maintain good hygiene and physical comfort
To promote optimal activity; exercise; rest and sleep
To promote safety through prevention of accident, injury, or other trauma and through the prevention of the spread of infection
To maintain good hygiene and physical comfort
To promote optimal activity: exercise, rest and sleep
To promote safety through the prevention of accidents, injury, or other trauma and through the prevention of the spread of infection
To maintain good body mechanics and prevent and correct
To identify and accept positive and negative expressions, feelings, and reactions
To identify and accept the interrelatedness of emotions and organic illness
To facilitate the maintenance of effective verbal and non verbal communication
To promote the development of productive interpersonal relationships
To facilitate progress toward achievement of personal spiritual goals
To create and / or maintain a therapeutic environment
To facilitate awareness of self as an individual with varying
To facilitate the maintenance of a supply of oxygen to all body cells
To facilitate the maintenance of nutrition of all body cells
To facilitate the maintenance of elimination
To facilitate the maintenance of fuid and electrolyte balance
To recognize the physiological responses of the body to disease conditions
To facilitate the maintenance of regulatory mechanisms and functions
To facilitate the maintenance of sensory function.
To accept the optimum possible goals in the light of limitations, physical and emotional
To use community resources as an aid in resolving problems arising from illness
To understand the role of social problems as infuencing factors in the case of illness
Dorothy Johnson
Conceptualized Click tothe edit Behavioral the outline System Model text format
Subsytems Second Outline Level Third Outline Ingestive Level
Eliminative
Fourth Outline Level Affliative Fifth Outline Dependence Level Achievement Sixth Sexual and role identityOutline behavior Level
In addition she viewed that each person strives to achieve balance and stability both internally and externally and to function effectively by adjusting and adapting to environmental forces through learned patterns of response
Furthermore, she believed that the patient strives to become a person whose behavior is commensurate with social demands; who is able to modify his behavior in ways that support biologic imperatives; who is able to beneft to the fullest extent during illness from the health care professional’s knowledge and skills; and whose behavior does not give evidence of unecessary trauma as a consequence of illness
Dorothy Johnson – Behavioral Systems model
Dorothea Orem
Developed the self-care and selfcare defcit Theory Click to edit the outline She defned textdefned format self care as the “practice of activities that individuals Second Outline initiate and perform on theirLevel own behalf in maintaining health and Third life, Outline well being.” Level Outline She conceptualizesFourth three Nursing systems as follows:Level Fifth Outline Wholly compensatory Level Partially compensatory Sixth Outline Supportive educative Level
Madeline Linenger
Developed Transcultural Nursing Model Click to edit the outline She advocated that Nursing text format is a humanistic and scientifc Outline Level modeSecond of helping a client specifc cultural through Third Outline caring process* Level to improve or maintain health condition Fourth Outline Levelcaring is Advocated that Fifth Outline universal and varies transculturally. Level Major concepts include care, caring, Sixth cultural values Outline and cultural variations Level
Furthermore, Leininger believed that caring serves to ameliorate or improve human conditions and life base. And that care is the essence and the dominant, distinctive and unifying feature of nursing
Madeleine Leininger - Transcultural
Imogene King
Postulated the Goal attainment Theory Click to edit the She described nursing as outline a helping textthat format profession assists individuals and groups Second in society to attain, Outline Level maintain, and restore health* Third Outline In addition, kingLevel viewed nursing as an interaction process between Fourth Outline client and nurse whereby Level during perceiving, setting goals, acting Fifthand Outline on transactions occurLevel and goals are achieved Sixth Imogene King = GoalOutline Attainment Level Theory
Myra Levin
She advocated that nursing is a human interaction and Click four to edit the outline proposed conservation text format principles of nursing which are concerned with unity and Second Outline Level integrity of the individual. Third Outline Described the LevelFour Conservation Principles Fourth Outline Conservation Level of Energy Fifth Outline Conservation of Structural Level Integrity Sixth Conservation of Personal Outline Integrity Level
Conservation of energy – the human body functions by utilizing energy. The human needs energy producing input (food, oxygen, fuids) to allow energy utilization as output
Conservation of structural integrity – the human body has a physical boundaries (skin and mucous membrane) that must be maintained to facilitate health and prevent harmful agents from entering the body
Censervation of personal integrity – the nursing interventions are based on the conservation of the individual client’s personality. Every individual has a sense of identity, self worth and self esteem, which must be preserved and enhanced by nurses
Conservation of social integrity – the social integrity of the client refects the family and the community in which the client functions. Healthcare institutions may separate individuals from their family. It is important for the nurses to consider the individual in the context of the family
Myra LEVIN – Conservation
Hildegard Peplau
Introduced Click to the editInterpersonal the outline Model text format
Second nursing Outline Level She defned as an interpersonal process of Third Outline therapeutic Level interactions between an individual who’s Fourth Outline sick or in need of health Level services and a nurse Fifth Outline especially educated to recognize and Level respond to the need for helpSixth Outline Level
She identifed the four phases of the nurse-client relationship namely
Orientation – the nurse and the client initially do not know each other’s goal and testing the role each will assume1
Identifcation – the client responds to the professionals or the signifcant others who can meet the identifed needs2
Exploitation – the client utilizes all available resources to move toward a goal of maximum health or functionality
Resolution – Refers to the termination phase of the nurse – client relationship3
Hildegard PepLau – Interpersonal Model
Martha Rogers
Conceptualized the Science of Unitary Human Beings Energy Field Click to edit the outline text format
Human Field*
Environmental Field*
Second Outline Level
Third Outline Level feld in constant Unitary Man is an energy interaction with the environment Fourth Outline Level The unitary human being and the Fifththerefore Outline environment are integral and Level viewed as a whole* Furthermore, she believed that human being is characterized by Sixth the capacity for abstraction and imagery, language and thought, Outline sensation and emotion Level
Click to edit the outline text format Second Outline Level
Martha ROgers – UNItary maN
Third Outline Level Fourth Outline Level Fifth Outline Level Sixth Outline Level
Sister Callista Roy
Presented the adaptation model
Clickperson to edit outline She viewed each as the unifed textsystem formatin constant biopsychosocial interaction with a changing environment1
Second Outline Level
The system consists of input, control Third Outline process, output and feedback
Level
In addition she advocated that allOutline people Fourth have certain needs which they endeavor to Level meet in order to maintain integrity2
Fifth Outline Accordingly she believed that adaptive human behaviorLevel is directed as an attempt to maintain homeostatis or integrity of the individual by conserving energy and promoting the survival, growth,Sixth production and Outline mastery of human system Level RAM – Roy’s Adaptation Model
Nursing operates in all three circles, but it shares them with other professions to different degrees
Care – nurturance and exclusive to nursing* Click to edit the outline
format Core – involves thetext therapeutic use of self and emphasizes the use of refection*
Second Outline Level
Cure – Pathological conditions are focuses on nursing Third Outline related to the physician’s orders*
Level
Second, relates to the core postulate of her theory
Fourth Outline As the patient needs less medical Levelcare, he or she needs more professional Nursing care and teaching Fifth Outline Third , wholly professional nursing care will hasten recovery Level Describes the concept of team nursing, which gives the Sixth care of less complicated cases to caregivers with less Outline training Level Lydia HALL – CaRE, CoRE, CuRE
Ida Jean Orlando (Pellitier)
Conceptualized Click toThe edit Dynamic the outline Nurse –text Patient format Relationship Model Second Outline Level She believedthat theOutline nurse helps Third patients meet aLevel perceived need that the patients cannot meet for Fourth Outline themselves Level Fifth Outline She observed that the nurse Level to provides direct assistance meet an immediate need Sixthfor help in order to alleviate distress Outline or helplessness* Level
She also indicated that nursing actions can be automatic1 or deliberative2
She also advocated that the three elements composing nursing situation are: client behavior, nurse reaction and nurse action
Ida Jean Orlando – Nursing Process Theory
Jean Watson
Conceptualized the Human Caring Click toHuman edit the outline Model (Nursing: Science and text format Human Care).
Second Outlinethe Level She emphasized that nursing application of theThird art and human Outline Science through Level transpersonal caring transactions to help person achieve Fourth Outline mind-body soul harmony*
Level She included health promotion and Fifth Outline treatment of illness in nursing Level She believed that a person is valued being to be cared for, Sixth respected, nurtured, understood and assisted; a fully functional Outline integrated self Level Jean Watson –Science and Philosophy of Caring
10 Carative Factors in Nursing
Forming humanistic – altruistic value system
Instilling faith- hope
Cultivating sensitivity to self and others
Developing helping – trust relationship
Promoting expression of feelings
Using problem – solving for decision making
Promoting teaching - learning
Promoting supportive environment
Assisting with gratifcation of human needs
Allowing for existential- phenomenological forces
Rosemarie Rizzo Parse
Introduced Click the Science to edit the of human outline Becoming text format
Second OutlineofLevel She emphasized free choice personal meaning in relating value Third Outline properties, co-creating Level of rhythmical patterns, in exchange Fourth Outline with the environment, and Level contrascending in many dimensions Fifth Outline as possibilities unfold* She believed that each choice open certain opportunities Level while closing others Sixth Since each individual makes his or her own personal choices, Outline the role of the nurse is that of guide, not a decision maker Level
Rosemarie Riso Parse –Theory OF HUMAN BeCOminG
Joyce Travelbee
She advocatedSecond that theOutline goal ofLevel Nursing is to assist individual or Third Outline family in preventing or coping with Level illness, regaining health, fnding Fourth Outline meaning in illness, or maintaining Level maximal degree of health Outline She further viewed that interpersonal process isFifth a human – Level to – human relationship formed during illness and Sixth “experience of suffering”* Outline The H2H in nursing situations, is the means through which Level the purpose of nursing is accomplished
She postulated Clickthe to Interpersonal edit the outline aspects of Nursing text format Model.
The H2H relationship is established when the nurse and the recipient of her care attain a rapport after having progressed through the stages of original encounter, emerging identities, empathy and sympathy. (continuum of suffering)
Transitory feeling of displeasure
Extreme anguish
Malignant phase of despairful not caring
Terminal Phase of apathetic indifference
She believed that a person is a unique, irreplaceable individual who is in a continuous process of becoming,
Patricia Benner to edit the outline Dr PatriciaClick Benner introduced textthat format the concept expert nurses Outline Level develop skillsSecond and understanding of patient care over Third time Outline through a soundLevel educational Fourth Outline base as well as a multitude of Level experiences. She further explains that the development of knowledge
Fifth Outline in applied disciplines such as medicine and nursing is She proposed that one could Level composed of the extension of practical knowledge skills gain knowledge and Sixth (know how) through research and the characterization Outline ("knowing how") without and understanding of the "know how" of clinical ever Level learning the theory ("knowing experience.
Benner’s Stages of clinical competence
Stage 1: Novice
Beginners have had no experience of the situations in which they are expected to perform. Novices are taught rules to help them perform.
The rules are context-free and independent of specifc cases; hence the rules tend to be applied universally.
The rule-governed behavior typical of the novice is extremely limited and infexible.
As such, novices have no "life experience" in the application of rules."Just tell me what I need to do and
Stage 2: Advanced Beginner
Advanced beginners are those who can demonstrate marginally acceptable performance, those who have coped with enough real situations to note, or to have pointed out to them by a mentor, the recurring meaningful situational components.
These components require prior experience in actual situations for recognition.
Principles to guide actions begin to be formulated.
Stage 3: Competent
Competence, typifed by the nurse who has been on the job in the same or similar situations two or three years, develops when the nurse begins to see his or her actions in terms of long-range goals or plans of which he or she is consciously aware.
For the competent nurse, a plan establishes a perspective, and the plan is based on considerable conscious, abstract, analytic contemplation of the problem.
The conscious, deliberate planning that is characteristic of this skill level helps achieve effciency and organization.
The competent nurse lacks the speed and fexibility of the profcient nurse but does have a feeling of mastery and the ability to cope with and manage the many contingencies of clinical nursing.
The competent person does not yet have enough experience to
Stage 4: Profcient
The profcient performer perceives situations as wholes rather than in terms of chopped up parts or aspects, and performance is guided by maxims.
Profcient nurses understand a situation as a whole because they perceive its meaning in terms of long-term goals.
The profcient nurse learns from experience what typical events to expect in a given situation and how plans need to be modifed in response to these events.
The profcient nurse can now recognize when the expected normal picture does not materialize.
This holistic understanding improves the profcient nurse's decision making; it becomes less labored because the nurse now has a perspective on which of the many existing attributes and aspects in the present situation are the important ones.
Stage 5: The Expert
The expert performer no longer relies on an analytic principle (rule, guideline, maxim) to connect her or his understanding of the situation to an appropriate action.
The expert nurse, with an enormous background of experience, now has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnoses and solutions.
The expert operates from a deep understanding of the total situation. The chess master, for instance, when asked why he or she made a particularly masterful move, will just say: "Because it felt right; it looked good."
The performer is no longer aware of features and rules;' his/her performance becomes fuid and fexible and highly profcient.
This is not to say that the expert never uses analytic tools. Highly
Rozzano Locsin Click to edit the outline text format
Credentials
Second Outline Level
PhD: University Third Outline
Level
of the Fourth Outline Level PhilippinesFifth Outline Level Sixth (1988) - Manila, Outline PhilippinesLevel
Teaching
Philosophies of Science Grounding Nursing
Introduction to Nursing as Discipline and Profession
Nursing Research
Arts as Healing Modalities in Nursing
Philosophical & Theoretical Foundations of Advanced Practice Nursing
Advancing Technology, Caring, and Nursing
Research interest
Experiences of Caring for/Being Cared for
Awards
Academic Excellence Award, Philippine American Society, 2010
Balik Scientist (Returning Scientist) Program, Department of Science & Technology, Philippines 2009
University Research of the Year - Professor, Scholarly & Creative Works, FAU 2006
Outstanding Alumni Award – Lifetime Achievement in Nursing Education St. Paul University of Dumaguete, Dumaguete City, Philippines 2004
Fulbright Alumni Initiative Award Center for International Exchange of Scholars, Washington, D.C. 2004-2006
Edith Moore Copeland Award for Excellence in Creativity (Founders Award) Sigma Theta Tau International Honor Society of Nursing - Indianapolis (37th Biennial Convention – November 1-5) 2003
Julita V. Sotejo Medallion of Honor: Lifetime Achievement Award University of the Philippines, Nursing Alumni International Inc., Los Angeles, California 2003
He describes nursing as caring through technological competency
In his chapter, Locsin described how technological competency in nursing practice is an expression of caring.
He outlined his theory in his book by stating “the practice of the 21st century nursing is conducted in environment that rely on complex biomedical machine technology, practice environments that differ vastly from those of an earlier era.
The core of nursing, the basic service of nursing, however has not changed.
Caring continues to be the most essential and the most direct expression of nursing service.
Nurses now face the challenge of creating an environment of personal care in the context of highly sophisticated, although impersonal, health care technology
He provided a description of nursing practice, and implied the potential for objectifcation of clients due to technological competency.
Locsin explored the dichotomy between technology and caring, and through references to current literature about nursing as caring, he developed a harmonious merger of this dichotomy
