Nursing is a profession that requires not only technical skills and knowledge, but also interpersonal skills and compassion. Nurses are often faced with challenging situations that demand their composure and empathy. How can nurses maintain their composure and provide quality care to their patients?

One possible answer is to apply the nursing theory of Carmelita C Divinagracia, a Filipino cardiologist nurse who has been praised for developing the art and competency of teaching nursing. She is a graduate of Bachelor of Science in Nursing at University of East Ramon Magsaysay Memorial Medical Center, Inc. (UERMMMC) in 1962, Master of Nursing in 1975 at UP Manila, and Doctoral of Philosophy in Nursing 2001 in UP Manila. She has lectured and written about her work as a nurse and how she has used her hands-on experience to develop better ways to teach nursing.

Her theory is based on her study titled “Advance Nurse Practitioners’ Composure Behavior and Patient’s Wellness Outcome”, which aimed to determine the effects of composure behavior of the advanced nurse practitioner on the wellness outcome of the selected cardiac patients. She defined composure behavior as “a set of behaviors or nursing measures that the nurse demonstrates to selected cardiac patients”. She identified seven composure behaviors: competence, presence and prayer, open-mindedness, stimulation, understanding, respect and relaxation, and empathy.

According to her theory, these composure behaviors can enhance the patient’s wellness outcome, which is “a condition of being in a state of well-being, a coordinated and integrated living pattern that involves the dimension of wellness”. She argued that by demonstrating these behaviors, the nurse can establish a therapeutic relationship with the patient, promote trust and confidence, reduce anxiety and stress, facilitate coping and adaptation, and improve health status and quality of life.

The nursing theory of Carmelita C Divinagracia can be applied to various nursing settings and situations, especially those involving critical care, chronic illness, or emotional distress. By following her theory, nurses can improve their professional practice and patient outcomes.

How can nurses demonstrate composure behaviors in their daily practice? Here are some examples of how nurses can apply the seven composure behaviors identified by Dr. Carmelita C Divinagracia:

• Competence: Nurses can show competence by updating their knowledge and skills, following evidence-based guidelines, adhering to ethical standards, and seeking feedback and guidance when needed.
• Presence and prayer: Nurses can show presence and prayer by being attentive and supportive to their patients, offering spiritual care or referrals when appropriate, and respecting the patient’s beliefs and values.
• Open-mindedness: Nurses can show open-mindedness by being flexible and adaptable to changing situations, respecting diversity and cultural differences, and being willing to learn from others.
• Stimulation: Nurses can show stimulation by providing positive reinforcement and encouragement to their patients, engaging them in meaningful activities, and promoting their autonomy and self-care.
• Understanding: Nurses can show understanding by listening actively and empathically to their patients, acknowledging their feelings and concerns, and validating their experiences.
• Respect and relaxation: Nurses can show respect and relaxation by treating their patients with dignity and courtesy, maintaining their privacy and confidentiality, and helping them cope with stress and anxiety.
• Empathy: Nurses can show empathy by putting themselves in their patient’s shoes, expressing genuine care and concern, and being sensitive to their needs and preferences.

The nursing theory of Carmelita C Divinagracia has several benefits for both nurses and patients. By practicing composure behaviors, nurses can:

• Improve patient satisfaction: Patients who receive compassionate nursing care are more likely to be satisfied with their care, trust their nurses, and adhere to their treatment plans.
• Reduce burnout and turnover: Nurses who practice composure behaviors are more likely to experience job satisfaction, personal fulfillment, and professional growth. They are also less likely to suffer from burnout, compassion fatigue, or intention to leave.
• Increase teamwork and collaboration: Nurses who practice composure behaviors are more likely to communicate effectively, share information, support each other, and resolve conflicts. They are also more likely to collaborate with other health professionals and improve patient safety.

While the nursing theory of Carmelita C Divinagracia is appealing and beneficial, it is not without challenges. Some of the challenges that nurses may face when trying to practice composure behaviors are:

• Lack of time and resources: Nurses often work in busy and demanding environments, where they have to deal with multiple tasks, patients, and demands. They may not have enough time or resources to provide optimal care or engage in composure behaviors.
• Lack of support and recognition: Nurses may not receive adequate support or recognition from their managers, peers, or organizations. They may feel undervalued, overworked, or isolated. They may also face barriers such as policies, regulations, or hierarchies that limit their autonomy or creativity.
• Lack of training and education: Nurses may not have sufficient training or education on how to practice composure behaviors or how to deal with challenging situations. They may lack the skills or confidence to apply the theory in practice or evaluate its effectiveness.