The Emergence of the Theory of Direction and Diversion: A Pathway to Quality Caring in Nursing

The Emergence of the Theory of Direction and Diversion: A Pathway to Quality Caring in Nursing

Barretto, Bernard Lance Anthony, Candido, Julius Cezar, Santos, Geo, Alforque, Jose Mari Louis

Cebu Normal University – College of Nursing and Allied Health Sciences

DOI: https://doi.org/10.51244/IJRSI.2024.1108047

Received: 30 July 2024; Accepted: 05 August 2024; Published: 05 September 2024

ABSTRACT

Life situations of varying degrees influence a person’s perspective in making decisions that are either directly or alternatively beneficial to their well-being.  Encountering these life situations brings a person to both ends of the life spectrum, to both positive and negative situations.  In situations wherein, it may not be favourable to the person, a divergence to alternative mechanisms is presented that helps the person to be in control of the situation.  This study aimed to develop a theory that explores the concept of Direction (directly facing the situation) and Diversion (different opportunities for solutions) as a pathway to quality caring in nursing.  The emerging theory of direction and diversion was developed using an axiomatic approach.  This study implored a deductive-axiomatic approach to develop a theory that explains and describes the occurrence of the phenomenon through an extensive literature review that delves into identified concepts that are relative to main of concept of Direction and Diversion.  Several axiomatic statements where derived that helped in the development of the emerging Theory of Direction and Diversion.  The emerged theory states that a person in a given situation takes better control of the situation either by directing oneself to confront the life encounter or diverging to a purposeful path which influences the person in taking better steps in handling several life situations.  These life situations may place a person in situations of varying levels, which entails a variety of considerations that affects the well-being on the individual.  Having a sense of Direction leads to the attainment of one’s set goals; whereas a sense of Diversion presents opportunities that are made beneficial to the person.

Keywords: axioms, deductive approach, direction, diversion, theory development

INTRODUCTION

Background of the Study

In our day to day lives, we encounter a variety of situations. Some might bring us joy, but there is no doubt that others become stressors. These negative situations, if left unchecked, become detrimental to our health and are a root cause of multiple diseases. People nowadays, do everything in their power to avoid and alleviate such causes. Some find recreational activities, or any other means to keep their minds off of it, while, some face it head-on and find a concrete solution. This theory was made from scratch and developed through our own personal experiences. We saw in ourselves that when we experience different types of stressors, we usually either divert our attention or directly solve the cause of it. This mainly focuses on whether a person chooses to divert his/her attention away (diversion) from the problem or directly tackle the problem (direction).

Nursing situations are any life encounters that a person experiences every day.  These life encounters arise to give the person a sense of meaning and direction.  These life encounters are said to be purposive in its nature.  Encounters in nursing can either be with the nurse to the nursed, the nurse to other nurses, the nursed to their environment, the person being nursed to nursing, and any other situations that highlights the interaction of several entities in the human caring experience.  Pokorny (2010) described ‘encounter’ as something more fundamental that precedes nursing care, in that nursing is accomplished through human-to-human relationships that begin with the original encounter, which progresses through the stages of emerging identities.  Martinsen (2013; in Holopainen, Nystrom & Kasen, 2019) noted that the encounter is an abstract space created in closeness and distance between individuals in which in any given nursing situation, there is a direct invitation to that opens to true caring in the relationship between the nurse and the patient.

It is the aim of the researcher to develop a theory that explores into the importance of life decisions which leads to a path of ‘Direction’ or ‘Divergence’.  A person has the capacity to care for oneself and be able to make sound decisions that affects their quality of life.  In any given circumstances, there are instances in which there are hurdles in health that affects our capacity to decide for ourselves.  We are given the capacity to decide, however, making the best decision to gear us back to good health is a must and it is important for nurses to be able to guide persons they are caring for to make responsible decisions of the kind of care that they need to bring them back to a good state of health.  In any day-to-day life situation, a person is at a standpoint to make decisions that is affects their state of health.  Nurses on the frontline is responsible to always value their interaction with the persons they are caring for and understand their worth and value as a thinking individual.

Purpose of the Study

The study aimed at developing a theory that explores on the concept of Direction and Diversion as a pathway that guides the practice of nurses towards quality care in nursing.  This situates the perceptions and understanding of the three influencing concepts of the study which are the 1.) the Nursed (the one being cared for) in their understanding of their present health situation; 2.) the Nurse (the one facilitating the care) in their perception of the situation of the Nursed; and, 3.) the Others (the involved entities apart from the Nurse and the Nursed) in their perception of the situation of the Nursed.

Significance of the Study

This study allows nurses and the significant others of a nursed to be able to help them process their thoughts, emotions, and plan of actions when they are facing distress.  Direction gives straightforward guidance in facing the situation head-on, while Diversion eases the Nursed into accepting, processing, and dealing with their situation by providing methods and mechanisms that allow them to properly understand the situation they are going through.

REVIEW OF RELATED LITERATURE

Existentialism

Existentialism was popularized by Jean Paul Sarte in the mid-20^th century following the horrific evens of the World War II.  Existentialism is the philosophical belief that each are responsible for creating purpose or meaning in our own lives (The Ethics Centre, 2018).  Our individual purpose and meaning are not given to us by Gods, government, teachers, or any other governing authorities.  As people questioned how something as catastrophically terrible as the Holocaust could have a predetermined purpose, existentialism provided a possible answer that perhaps it is the individual who determines their essence, not an omnipotent being.  While not necessarily atheist, existentialists believe that there is no divine intervention, fate or outside forces actively pushing one in particular directions.  Every decision made is ours.  We create our own purpose through our actions.

Like rationalism and empiricism, existentialism is a term that belongs to intellectual history.  The term was explicitly adopted as a self-description by Jean-Paul Sartre, and through the wide dissemination of the post-war literary and philosophical output of Sartre and his associates – notably Simone de Beauvoir, Maurice Merleau-Ponty, and Albert Camus – existentialism became identified with a cultural movement that flourished in Europe in the 1940s and 1950s.  From the existential view, to understand what a human being is it is not enough to know all the truths that natural science – including the science of psychology – could tell us (Crowell, 2020).  The dualist who holds that human beings are composed of independent substances – “mind and body” – is no better off in this regard than is the physicalist who holds that human existence can be adequately explained in terms of the fundamental physical constituents of the universe.  Existentialism does not deny the validity of the basic categories of physics, biology, psychology, and the other sciences (categories such as matter, causality, force, function, organism, development, motivation, and so on).  It claims only that human beings cannot be fully understood in terms of them.  Nor can such an understanding can be gained by supplementing our scientific picture with a moral one.  Existentialism, therefore, may be defined as the philosophical theory which holds a further set of categories, governed by the norm of authenticity, is necessary to grasp human existence.

Sartre’s slogan – “existence precedes essence” – may serve to introduce what is most distinctive of existentialism, namely, the idea that no general, non-formal account of what it means to be human can be given, since that meaning is decided in and through existing itself.  Existence is “self-making-in-a-situation” (Fackenheim, 1961: 37).  Webber (2018:14) puts the point this way: “Classical existentialism is… the theory that existence precedes essence,” that is “there is no such thing as human nature” in an Aristotelian sense.  A person does not have an inbuilt set of values that they are inherently structured to pursue.  Rather, the values that shape a person’s behavior result from the choices that have made.  In contrast to other entities, whose essential properties are fixed by the kind of entities they are, what is essential to a human being – what makes her who she is – is not fixed by her type but by what she makes of herself, whom she becomes.  The fundamental contribution of existential thought lies in the idea that one’s identity is constituted neither by nature nor by culture, since to “exist” is precisely to constitute such an identity.  It is in light of this idea that key existential notions such as facticity, transcendence (project), alienation, and authenticity must be understood.  Because existence is co-constituted by facticity and transcendence, the self cannot be conceived as a Cartesian ego but is embodied being-in-the-world, a self-making in situation.  It is through transcendence – or what the existentialists also refer to as “projects” – that the world is revealed, takes on meaning; buts such projects are themselves factic or “situated” – not the product of some antecedently constituted “person” or intelligible character but embedded in a world that is decidedly not our representation.  By understanding an individual’s pattern of behavior – that is, by reconstructing the meaningful world that such behavior reveals – one can uncover the “fundamental project” of basic choice of oneself that gives distinctive shape to an individual life.

Humanism

Humanism is a system of education and mode of inquiry that originated in northern Italy during the 13th and 14th centuries which later spread throughout Europe. The term humanism was first used by 19th-century German scholars, as humanismus, to designate the Renaissance emphasis on classical studies on education. The studies were pursued by educators known as umanisti, or professors or students of classical literature. The word derived from the studia humanitatis which itself was based on the Roman statesman Marcus Tullius Cicero’s concept of humanitas, an educational and political ideal that was made as the intellectual basis of the movement. Renaissance humanism defined itself in its straining towards this ideal. Therefore, no discussion of humanism can have validity without an understanding of humanitas.

Humanitas meant the development of human virtue to its fullest extent. The term implied not only the qualities that are associated with the modern word humanity, such as understanding, benevolence, compassion, and mercy, but also more assertive characteristics such as fortitude, judgment, prudence, eloquence and love of honor. Humanitas called for a balance of action and contemplation, born out of complementarity. Humanism may be accurately defined as the Renaissance movement which had at its central focus the ideal of humanitas.

Self-Efficacy and Health Decision

The concept of self-efficacy is a prominent concept that is being coined by the famous Albert Bandura.  Self-efficacy, as defined by Bandura (1977; cited in Shorey & Lopez, 2021) is an individual’s perception of one’s ability to perform particular behaviors through four processes including cognitive, motivational, affective and selection processes.  It is one of the most frequent terms which relates to different dimensions; social, psychological, counselling, education and health literatures.  Several literatures look into the concept of self-efficacy in health situations that involves the process of decision-making.  White, Cohen, Berger, Kupzyk, Swore-Fletcher & Bierman (2017) conducted a study which analyzed the concept of self-efficacy in relation to symptom management in patients with cancer.  It was found out in the study that if patients with cancer are not able to manage their symptom, it influences the outcomes of the condition leading into a increased in symptom distress, poor prognosis and a decreased in quality of life.  Robb (2012) pointed out in his study on the influence of self-efficacy on the behaviors of nursing students on goal attainment.  It revealed that the following approaches significantly influence the student’s level of self-efficacy on the following areas: clinical simulations, cooperative learning, and personalized classroom structure.  With a marked level of self-efficacy, it influences their level of making decisions in application to their care of patients in the clinical area.

Autonomy and Rationality

Our philosophy of mind seeks not primarily to characterize the human mind’s distinctiveness but to show how our minds fit into the natural world, and the demand that human mentality be conceived as fundamentally continuous with the mentality of other animals looks to many like just a piece of naturalistic sense.  For whatever we mean by calling our minds “rational”, surely this must be compatible with a recognition that the human mind is a species of animal mind, which has arisen through the same sorts of evolutionary processes that also produced the minds we call “nonrational”.  And the more we learn about the cognitive, behavioural, and neurophysiological similarities between ourselves and other animals, and about the extent to which we “rational” creatures frequently think and choose in ways that systematically deviate from what rational principles would dictate, the more we seem compelled to regard the specialness of our minds as merely a matter of degree, not a difference in kind.

The selection of one option at the expense of another requires an individual to put in place an overall assessment of the alternatives, using specific methods of reasoning and information processing (Bailo, et al, 2019; Kondlylakis et al, 2017; Kou et al, 2014).  In most cases, decision-making means thinking in conditions of uncertainty: we cannot predict with certainty the future outcomes of the available alternative, but in the best of cases we can only estimate the probability of these outcomes.  Savioni, Triberti, Durosini & Pravettoni (2022) pointed out that all life choices are influenced by the context and relationship with others, as the choices are made within a society and for this reason, they can influence both one’s own and others’ lives.

METHODS

The research design utilized in the study is a deductive-axiomatic approach.  A process of conceptual development.  The emerging theory of direction and diversion was developed using an axiomatic approach.  This study implored a deductive-axiomatic approach to develop a theory that explains and describes the occurrence of the phenomenon. This method is similar to logic, in that it starts with an existing theory that supports the phenomenon in issue and leads to a new hypothesis (Streubert & Carpenter 2011).  Deductive reasoning as noted by Sternberg (2011) is a systematic and logical technique for arriving at a conclusion based on the agreement of several premises that are widely accepted to be true.  Using deductive reasoning as pointed out by Creswell & Clark (2007) by the researcher entails the researcher from working from the ‘top down’, beginning with a theory, hypotheses, and finally facts to support the or refute the theory.  A comprehensive review of related literature and studies was done initially to provide related knowledge and bases for the formulation of relevant axioms and propositions in the study.  Alligood & Tomey (2010) described the deductive process as the form in which specific assumptions are deduced from more general premises or assertions.  Reasoning proceeds from general statements to specific conclusions.  A theory that is established deductively follows a process with a series of premises called axioms, that is, statements or propositions that are consequent from broader premises.  The concluding statement is unknown which leads to the prediction of the theory and the formation of a hypothesis to be empirically tested.

The consistency of the axioms is presupposed from the beginning of the axiomatization process.  There are different ways to prove the consistency of the axioms of a theory.  This is due to the fact that the choice of the axioms can be motivated in different ways.  Since truths and other non-falsities in a theory are all (intended to be) determined by the axioms, they have to be in the reaches of logical consequences drawn from the axioms (Karadakilar, 2016).  If the structures that are intended to be studied by axiomatizations do not exist and the axiom in question is not consistent, the whole process becomes nothing but a meaningful manipulation of figures.  There are two ways of understanding consistency.  First is where the axioms are presupposed to hold true in the structures they determine.  Second is where they are presupposed to be not false in the structures.  In both ways, the ultimate presupposition of axiomatization is the existence of the structures and the objects involved.  Hence, consistency is presupposed in axiomatization from the very beginning.

Aristotle’s conception of the axiomatic method can be seen as deduction-oriented in the following way: According to Aristotle, axioms speak about real entities which have cognitive dependencies with further truths. That is to say, the axioms are taken to be true as well.  That is, their logical consequences belong to the same system of truths as the axioms.  In such system, we have some given knowledge in terms of the axioms.  Starting from the axioms we seek further knowledge in terms by asking further questions.  The cognitive meaning of the axioms (as well as of the terms they involve) is either obvious or definable by what is obvious.  So that axioms require further proof.  Unlike the axioms, further truths are deducible from the axioms by syllogism.

Steps In Theory Development

Figure 1. Deductive Axiomatic Approach in Theory Development

(Adapted from Padua, 2012)

A deductive axiomatic system or theory is build using the deductive process. The essence of axiomatic approach, as employed in logic and mathematics, is that set of claims called propositions is obtained by applying deductive logic to a more fundamental set of statements known as axioms (Padua, 2012).  In a deductive system, axioms reflect the basis statements.  The steps that the paper followed are reflective of the deductive axiomatic approach in generating the theory (Padua, 2012), as illustrated in the Figure 1.

RESULTS AND DISCUSSION

There were five axioms that were derived from the literatures and studies explored and reviewed which served as basis for the development of the theory.  A literature review involves the researching, reading, analyzing, evaluating, and summarizing of scholarly literature (typically journals and articles) about a specific topic.  The following axioms were derived from several kinds of literature that helped in developing the emerging theory of direction and diversion:

Man is a rational being capable of making life decisions (Axiom 1).  Man by nature seeks to know and his ultimate goal is to know everything even beyond sensible.  Aristotle in his view of metaphysics, argued that man’s nature of being a rational animal makes him distinct from other animals or the highest among the level of being.  The desire of man to know is indispensable.  According to tradition reaching back to at least as far as Aristotle, human beings are set apart from other terrestrial creatures by their rationality (Boyle, 2002).  Other animals, according to this tradition, are capable of sensation and appetite, but they are not capable of thought, the kind of activity characteristic of the rational part of the soul.  Human beings, by contrast, rational animals, and an understanding of our minds must begin from a recognition of this distinctiveness.  For, the tradition holds, the presence of rationality does not just add one more power to the human mind, or increase the scope and efficacy of mental powers already present in nonrational creatures. Rather, rationality transforms all of our principal mental powers, making or minds different in kind from the minds of nonrational animals.

Man is free and is responsible for everything he does (Axiom 2).  Freedom is usually presented positively but Sartre posed that our level of freedom is so great it’s painful.  To fully comprehend our freedom, we have to accept that only we are responsible for creating or failing to create our personal purpose.  Without rules or order to guide us, we have so much choice that freedom is overwhelming.  A syllogism was presented in a study by Schwartz & Cheek (2017) which states that:

The more freedom people have, the more well-being they have

The more choices people have, the more freedom they have

Therefore, the more choice people have, the more well-being they have.

The syllogism relates on the importance of enhancing opportunities for choice, with enhanced freedom and well-being, both enables people to get exactly what they want and by enabling people to express their own sense of identities.  People should be given the free avenue to choose the kind of lives they lead, and the more choices these individuals have, the more freedom they acquire.  Individuals know best what serves their interest, and the more choices people have, the more likely they are to find precisely the thing that they are looking for.  Bone, Christensen & Williams (2014) pointed out that freedom and autonomy are essential for well-being; for a person to attain a certain level of happiness and of being healthy.  People need to be able to make choices for themselves and to feel that they can direct their own lives.

Man is a social being (Axiom 3).  The need to seek and maintain interpersonal relationships is a basic need of all human beings.  Humans need the acceptance, presence and comfort of others to feel psychologically and socially well.  In his Politics, Aristotle believed man was a “political animal” because he is a social creature with the power of speech and moral reasoning.  Man is a social being with independence, creativity and consciousness.  Herein lies the perfect elucidation of man.  As a biological organism, man is born, grows and dies, with the natural and biological attributes, according to the biological law.  This is a well-known fact.  It is true that man has a biological organism and natural and biological attributes commensurate with it, but the essential feature of man is not there.  What is essential and important for a man is the social aspect.  Therefore, only when one starts from the fact that man is a social being, it is possible to correctly find the essential attributes of man in the social attributes, in the philosophical consideration of man.

As a social being, this implies that they are beings who live in a social relationship; a term used to distinguish man from a natural being.  When man is referred to as a social being, it means a being who lives and conducts activity in social relationship differently from natural being.  Man lives in the society unlike the other loving matters.  Man’s life and activity are possible only in the social collective that is organically linked on the basis of social relations.  For the existence and development of man, the social relations become an indispensable and permanent conditions and herein lies the essential meaning that man is a social being.

A person’s life decision is influenced by experience (Axiom 4).  Existentially, a person embraces their choices and their plans with an eye towards the possibilities, not the past (Legg, 2020).  The past can be instructive; however, it isn’t meant to inform anything you currently do or want from life.  A person uses creativity, love and other life-enhancing experiences to help them make decisions and determine their behaviors for the future, in this process, one learns to think and act without concern for anxiety or fear of messing up one’s life.  Each person has the right to make decisions and have choices about how they live their life.  Each person has different ideas about what is important and what makes them feel best.  Making our own choices about the things we do is very important because it gives our life meaning.

Every choice that we had decided in doing can impact our lives in a good or in a bad way; it helps shapes us to identify who we are to ourselves and to other people. At the theoretical level, decision-making is a process of making a choice from a number of alternatives to achieve the desired result (Eisenfuhr, 2011).  This definition has three key elements. First, decision-making involves making a choice from a number of options, resources, opportunities. Second, decision-making is dynamic, involves a number of factors and sub-processes. Thirdly, the “desired result” involves a purpose or target resulting from the mental activity that the decision-maker engages in to perform the choice.  So, decision-making usually requires evaluating at least two options that differ from one another in one or more respects.

Every person has their own form of coping with different life adversities (Axiom 5).  Coping is figuring out ways to deal with or work around these challenges.  It is the way that we adjust to the difficulties or disappointments that come our way.  Over time, we get to know what works and what does not to face problems and challenges.  This allows us to handle more and more complex challenges on our own.  Most of the time, learning about coping / coping strategies happens naturally and unconsciously.  It usually goes something like this – we assess the problem (we try to see how a particular problem is similar to or different from problems we’ve faced in the past), try to understand why it’s challenging, and then we identify tools within ourselves or in our environment that we can get used to get through it.  Developing an understanding that not all method of coping work is unique and never alike for everyone and not all methods work in every type of situation.  Circumstances provide us with alternatives in how we deal with a problem, giving us an opportunity to try different ways until we find the most appropriate approach that works and helps us manage the challenge at hand.  With each new experience of coping on our own, our confidence builds up and our ability to cope will make it easier to try new things and test out new situations.

Major Assumptions

1. The theory is based on the sharing of the intervention for the nursed; either indirectly or directly.
2. The theory is applicable to both the process of sharing the means of intervention as well as the intervention itself.
3. Diversion and Direction are not linear, the theory can begin with one then end with the other or vice versa.
4. The concepts of Direction and Diversion can both be used in giving a more sensitive approach to The Nursed.
5. In some situations, only one concept (Diversion OR Direction) is needed to provide Care for The Nursed.
6. The theory begins with the company of interaction with others, but it does not necessarily mean that when the interaction is halted the theory ceases.
7. Interactions between The Nurse and The Nursed, The Nursed and their self, and The Nursed and The Others are situational, in that the interaction of three concepts are governed by the current status of the nursed.
8. The Nurse and The Others are able to interact with one another through The Nursed.
9. The concept of Diversion is centered around diverting the thoughts of the nurse away from the current problem at hand, then gradually returns to it.
10. The concept of Direction is centered around giving direct information and instructions with the goal of guiding the nursed towards solving or amending the problem they are currently experiencing.
11. Care is attained when The Nursed has successfully faced and conquered their problem.

Limitations

1. If the patient, or the one being nursed, signifies unbearable pain, direction must be applied instead of diversion, as physical condition of the one being nursed must be prioritized.
2. The interacting concepts are limited to the willingness of the patient to participate since interaction is necessary in such cases.
3. The interaction of these subjects: The Nurse and The Others, needs the presence of The Nursed being the intermediary between the two aforesaid subjects and that The Nursed is the subject who can execute Diversion, Direction, or both.
4. If the Nursed is unwilling to perform Diversion and/or Direction, hence, the theory cannot be further applied and cannot further progress.

 Figure 2. The Schematic Diagram of the Theory of Direction and Diversion

(Barretto et al, 2022)

The Theory of Diversion and Direction’s conceptual framework depicts the relationship of the factors and interactions that encapsulate this theory. Beginning with the outer shell we have the factors that affect the theory, these are namely: Person, Environment and Health. These three factors are on the outer shell because they have the capability to influence the other concepts, and they serve as the general viewpoint of the theory. Person describes the age, the culture and the social standing of the Nursed, the Nurse and the Others. Environment describes the conditions on how the Nursed, the Nurse, and the Others have been developed, both within their own divisions as well as around each other. Health describes the current wellness status, both physical and mental, of the Nursed, the Nurse and the Others. The theory sees these factors as important when deciding on how to effectively utilize the main concepts of the theory, because the theory is applicable to a wide range of situations.

Moving inwards on the framework, the structure is a top-to-bottom design that depicts an overview of the process on how the theory is utilized. Beginning with the top portion we have the divisions of Diversion and Direction, as well as arrows that move back and forth in between them. This is because when using the theory an individual may start their interaction with diversion then follow it up with direction or vice versa. In some cases only one of the two concepts may be needed to provide care to the nursed. The arrows of both concepts then point down and proceed to the middle portion of the framework.

The middle portion depicts the three interactions that are possible when applying the theory. The interactions are; the Nurse, the Nursed, and the Others. These interactions, similar to the concepts, are in their own divisions, depicting that they are independent of one another, but they have arrows that move back and forth between them implying that they have the capacity to interact and influence one another.

Lastly there is the bottom portion of the framework. As seen previously, there is only one arrow that points down towards the bottom portion, and that arrow comes from The Nursed. This is because the bottom portion depicts Care, and its attainment and the main goal of the theory is to attain and provide satisfactory Care to The Nursed.

To further discuss the subjects of the theory, let us break each of them down. the Nursed is at the center of the middle portion because they are the main focus of care for the theory, it is in its own division because the theory of diversion and direction, in some cases, can be applied by the Nursed to themselves, although this self-application is commonly initiated by one or both of the other interactions.

On the right of the middle portion, we have the Nurse. The Nurse is one of the two interactions that can apply the theory for the benefit of the Nursed, they apply this theory through their daily interactions and their association with the Nursed when applying care, i.e. checking up on the well-being of the Nursed as well as discussing the medications that the Nursed must take to recover. The second interaction is The Others, this interaction encompasses the significant people in the life of the Nursed, such as Family, Friends or Significant Others.

To better understand the developed Theory of Direction and Diversion, an exemplar is presented below, showing how the theory is being applied in a given health situation.

Exemplar

The Theory of Diversion and Direction may be applied in high-stress situations wherein a patient and those around them might feel pressured because of the current medical situation they are in. This theory aims to help both patients and those who are with them remain calm under pressure as they weigh their options and clearly assess the situation, they are in to guide them towards a favorable outcome for their future. We are able to see how this theory takes place in the following situation:

A poor 30-year-old man with a family has second thoughts about getting life-saving surgery due to insufficient funds.

Let us first divide the theory into 2 parts: The Diversion aspect and the Direction aspect. In accordance with the given situation, we can see the Diversion aspect take place when the nurse talks to the patient about his current situation and tries to take the patient’s mind off of the surgery for a moment. If the patient is cooperative, the nurse will talk about the patient’s family with him and other important aspects of his life that he wishes to achieve or stay by for a longer period of time. This indirectly helps the patient realize the importance of his life and the surgery that may save it, possibly persuading him to go through with the surgery.

In the Direction aspect of the theory, if the patient is willing to go through with the surgery, then the nurse or another medical practitioner will guide the patient to the various ways he can reduce his overall bill. By referring him to organizations that hold donation drives to help those who cannot finance their medical care or instructing him to ask for a payment system wherein the man can pay the bills over time are a few of the various ways that a medical professional can help and guide the patient with his financial struggles.

The exemplar presented depicts an application of the theory by being with the Nursed and helping them go through their journey to recovery, either by facilitating the process of providing Diversion or Direction. It is also worth mentioning that the Nurse and the Others are able to interact with each other through the Nursed, the Nurse can apply the theory to the Others by helping them process and understand the current situation that the Nursed is facing.

CONCLUSION

The Emerging Theory of Direction and Diversion revealed an implication in the practice of nursing which serves as ‘A Pathway to Quality Caring in Nursing’.  The theory developed purports that man is a rational being capable of making life decisions and be responsible for it, in constant interaction with others where life decisions are influenced by experience and with every adversity, has the ability for form their own coping. It is understood that a defined pathway to quality caring in nursing begins with a mindful understanding of the nursing situation and a responsible decision of the person to signify a direction of how to frame the care that is needed.  With the exploration on the relevant axiomatic statements from relevant literatures, it highlights the importance of decision-making among persons in any given health situations and that the process of decision-making influences the outcome of the quality of the well-being of the individual.  A person in a given situation takes better control of the situation either by directing oneself to confront the life encounter or diverging to a purposeful path which influences the person in taking better steps in handling several life situations.  These life situations may place a person in situation of varying levels, which entails a variety of considerations that affects the well-being on the individual.  Having a sense of Direction leads to the attainment of one’s set goals; whereas a sense of Diversion presents opportunities that is made beneficial to the person.

Implication to Nursing Education

In the academe, the theory challenges individuals on the field to look at the delivery of care form another perspective; not only through a direct approach but through consideration of alternative mechanisms that still aim for goal attainment and promote the well-being of the patient.  The theory does not only benefit the one being nursed but as well as those who are nurses in the making and are consumers of knowledge in the academe – nursing students.  Even the studying modality of nursing students can be refined through the application of strategies that conform with the concepts of the theory.

Implication to Nursing Practice

This theory supplements the existing body of knowledge that serves as the basis for nursing practice in any place where the care and well-being of an individual must be attended to.  As this theory is psychosocial in nature, it becomes a stepping stone for further application of the various psychosocial techniques that alleviate patient stress at a physiological, psychological and social levels.  In nursing practice, the theory is most applicable when applying care and providing comfort towards the patients through the careful decision of the healthcare provider whether to utilize the concept of direction when actualizing a specific intervention or search for alternative mechanisms underscoring the diversion aspects of the theory.

Declaration of Conflicting Interest

The authors declare no conflict of interest in this study.

Funding

The research did not obtain any funding for research from any agency.

ACKNOWLEDGEMENT

The authors would like to acknowledge the support of the College of Nursing of the Cebu Normal University, Cebu City, Cebu, Philippines

REFERENCES

1. Bailo, M.D., Penke, L., Schmukle, S.C., Sachse, K., Borkenau, P. & Asendorpf, J.B. (2011). Why mate choices are not as reciprocal as we assume: The role of personality, flirting and physical attractiveness. European Journal of Personality. 25(2), 120-132
2. Bandura, A. (1977). Self-efficacy: Towards a unifying theory of behavioral change. Psychological Review. 84(2), 191-215
3. Bone, S. A., G. L. Christensen and J. D. Williams (2014), ‘Rejected, shackled, and alone: The impact of systematic restricted choice on minority consumers’ construction of self’. Journal of Consumer Research. 41: 451–474
4. Boyle, M. (2002). Forthcoming. Essentially rational animals. In Rethinking epistemiology. Abel, G. & Conant, J. (eds.). Berlin, Germany: Walter de Grutyer.
5. Crowell, S. (2020). Existentialism. In Zalta, Edward (ed). Stanford Encyclopedia of Philosophy. Retrieved at: https://www.plato.stanford.edu/archives/sum2020/entries/existentialism/
6. Eisenfuhr, F. (2011). Decision making. Springer.
7. Fackeinheim, E. (1961). Metaphysics and historicity. Milwaukee: Marquette University Press.
8. Holopainen, G., Nystrom, L & Kasen, A. (2017). The caring encounter in nursing. Nursing Ethics. 26(1), pp. 7 – 16
9. Kondylakis, H., Bucur, A., Dong, F., Renzi, C., Manfrinati, A., Graf, N, …& Tsiknakis, M. (2017). imanagerCancer: Developing a platform for empowering patients and strengthening self-management in cancer diseases. In 2017 IEEE 30^th International Symposium on Computer-based Medical Systems (CBMA). Pp. 775-760. IEEE
10. Kou, G., Ergu, D., & Shang, J. (2014). Enhancing data consistency in decision matrix: Adapting Hadamard model to mitigate judgment contradiction. European Journal of Operational Research. 236(1), 261-271
11. Legg, T. (2020). What is existential theory and how is it used in therapy? Healthline. Retrieved at: https://www.healthline.co./health/mental-health/existential-theory
12. Martinsen, A.H. (2013). Philosophy of caring. In: Alligood, M.R. (ed.) Nursing theorist and their work. 8^th St. Louis, MO: Elsevier Health Sciences/Mosby. pp. 42- 58
13. Pokorny, M.E. (2013). Nursing theorist of historical significance. In: Alligood, M.R. (ed) Nursing theorists and their work. 8^th St. Louis, MO: Elsevier Health Sciences/Mosby. pp. 147 – 170
14. Robb, M. (2012). Self-efficacy with application to nursing education: A concept analysis. Nursing Forum. 47(3), 166-172
15. Savioni, L., Triberti, S., Durosini, I., & Pravettoni, G. (2022). How to make big decisions: A cross-sectional study on the decision-making process in life choices. Current Psychology. https://doi.org/10.1007/s12144-022-02792-x
16. Schwartz, B. & Cheek, N. (2017). Choice, freedom, and well-being: Considerations for public policy. Behavioural Public Policy. 1(01), 106-121. DOI:10.1017/bpp.2016.4
17. Shorey, S. & Lopez, V. Self-efficacy in a nursing context. In: Haugan, G., Erikson, M. (eds) Health Promotion in Health Care – Vital Theories and Research. Sprnger, Cham. https://doi.org/10.1007/978-3-030-63135-2_12
18. The Ethics Centre. (2018). Ethics explainer: Existentialism. Retrieved at: https://www.ethics.org.au/ethics-explainer-existentialism/
19. Webber, J. (2018). Rethinking existentialism. Oxford: Oxford University Press
20. White, L.L., Cohen, M.Z., Berger, A.M., Kupzyk, K.A., Swore-Fletcher, B.A. & Bierman, P.J. (2017). Perceived self-efficacy: A concept analysis for symptom management in patients with cancer. Clinical Journal of Oncology Nursing. 21(6), E272-e9