Reflections and Insights

Anilda Q. Operario

Clinical Resource Nurse, Prince Sultan Military Medical City - Riyadh KSA

The theory of Sister Carolina Agravante post a great challenge to the values that we have now as nurses and what should we possess. Nursing in its truest sense and in its deepest meaning. Caring and service. An advocacy. A vocation.

This reminds us to continuously uphold the light of nursing profession. To provide nursing service with utmost care. Putting one’s heart to every care we give to any kind of patient we have. Providing utmost care for the optimal well-being of the patient. Despite of technological advancement, human touch and care are still of great value to our patients.

That we always have to remember we are dealing with people no matter what their condition is, bearing in mind they have emotions, they can feel and they can hear. That aside from physiological healing them, our patient needs as well emotional and spiritual support. That no matter how tired and busy we are, how demanding our work and our patient is, our heartfelt smile and prompt selfless assistance are always ready. At the end of the day, what we gave what we have done that’s all we are accountable for. It’s fulfilling. It’s worthwhile. It’s nursing.

As a leader, clinical educator and patient-safety advocate, this gave me great insight on leadership guided by spiritual belief. To be always committed to bring out the best to every member of the team. Enhancing competence in every skill, compassion to every service and empowerment to the nursing profession. Leading and at the same time be of service. Leader with values and committed to sustain compassionate nursing care regardless of the different global challenges we have in today’s new generations.

Queenella Amanda M. Ortiz
Cardiovascular Nurse, St Luke’s Medical Center Global City - Taguig, Philippines

I believe that the methods shown in this model can be beneficial to all nurses in all fields. As a nurse, it is always important to have a compassionate and caring attitude towards your patients. In Sr. Carolina's model however, this notion has been put into a much deeper level. I appreciate the fact that the author of this theory has put the Lord Jesus Christ as a pattern or basis for the nurse leader/educator to follow, and to put into practice the ideals of a servant-leader. However, the model has limitations, especially if it were to be based upon by people from other walks of faith. It can serve as a pattern in forming other psycho-spiritual models for other religions.

Elsie Anne J. Ortizo

Through CASAGRA Transformative Leadership Theory, I was convinced that a supportive organization that invests in seminars and retreats intended to uplift one’s spirituality and models Jesus, who is the Greatest Servant-Leader, can greatly affect a nurse faculty’s passion for teaching. This is in line with the concept Servant-Leader Spirituality, one of the Three-Fold Transformative Leadership Concept. A yearly spiritual retreat is of great help. Though others may practice other religious affiliation or none at all, this concept can also be practiced. A non-believer can have someone who he looks up to in the nursing profession, be inspired by his/her contribution to the profession and imitate his/her work to help improve Nursing. The second concept is Self-Mastery and has to do with the individual’s formal learning. A good foundation in education specifically in nursing is highlighted. It is important that a leader is aware of what he can contribute to the profession. He sees himself as a valuable contribution to the profession, with this in mind, he educates himself through continuous learning, attend various seminars, and is involve in religious and/or civic organizations. A nurse faculty’s Special Expertise is also stressed in this theory and is the last of the three concepts. As an expert, a nurse faculty sees himself as a major contributor in his students’ professional life. His involvement in the formation of his students plays a great role in molding their spiritual and professional being. This is achieved once the faculty shows how he is creative, caring, and embodies the values he wants his students to possess.

Meridein Sanchez Pacamana

Project Executive Secretary, Decovision Company – Royal Group - Abu Dhabi, United Arab Emirates

Being a Paulinian when I was in high school, I am formed as a person with Christ-centered, integrated, environment-caring and community-oriented individual driven by love to others. I am formed to value the finer and nobler things in life and be conscious of the Gospel of Christ by respecting myself and to recognize the dignity of others.

In Sister Carolina Agravante’s CASAGRA Transformational Leadership theory, I learned that the task of being the transformational leader is to make sure that the interest of the organization and its members are aligned. She inspires, intellectually stimulates and is considerate of them. Requiring high moral development, being a servant leader is a part of being a servant to others by using your self-mastery and special nursing expertise.

I am inspired that Sister Carolina emphasized Jesus Christ as the center of her life. Being a Christian, Jesus Christ is my life whom He gave His life to us. We the nurses, who came first to serve rather than to be served like what Jesus did to us. Our passion of being a nurse is very important where there is a caring personality within the person to care for others. Even I am at the age of young adult now, I still embraced and motivated to live by the Paulinians’ Motto “Caritas Christi urget nos!” – our love of Christ impels us. I am molded to make responsible decisions as a Nurse and to use my knowledge in my expertise and responsibilities to help others in need.

Kristine Grace B. Padrogane

Intensive Care Unit Nurse, Dr. Sulaiman Al Habib Medical Group – Riyadh, KSA

Nursing is a noble profession; with a compassionate heart, we must be ready anytime to offer our helping hands. This theory by Sr. Carolina Agravante implies here that as a nurse, we are the leader in every aspect, especially with the spiritual side as what Jesus Christ did. He became the instrument and role model that we presently follow.

As a nurse, we must always remember TLC (Tender, Loving and Caring) in every action we do inside and outside the nursing setting. CASAGRA model empowered and inspired me to serve diligently and work with passion in my profession as a nurse and to become a steward of every mankind. I'm glad to know that this theory will guide us in our daily lives and inspire us to do our best in this profession.

Catherine Lao-Paglicauan

Urology Nurse, Al Ansari Specialist Hospital - Yanbu, KSA

It made me feel glad, to know that there are Filipino theorist that exists. This theory made by sister Caroline Agravante has similarities with the works of Dr. Patricia Benner which is known as the Novice to Expert but it has some enhancement. The casagra theory aims to equipped nurses with good values first and then the skills, knowledge and experiences follows. This is very important for us nurses, because we must be aware on how to deal with patients who are currently experiencing some health issues. Nurses must prepare themselves emotionally and spiritually in order to provide the maximum quality of care needed by the patients.

Jo-earl Panggat

Emergency Room Nurse, Manila

Being introduced to the theory authored by a Filipino nurse is quite inspiring. It just shows that we are not behind on the current nursing practice compared to the rest of the world. Knowing the popular notion that nurses from the Philippines are being preferred by other countries makes me proud. And with this, guided by the CASAGRA Theory, we must remember to look again into ourselves why we are in this profession. To be able to endure the nature of our work, we must have a spiritually deep foundation to care for others.

Reynaldo Jr. Panopio
ICU Nurse, Prince Mohammad bin Abdulaziz Hospital - Riyadh, KSA

Nursing is not just a mere profession for a salary equivalent to a service provided but rather a vocation to help and care people at the weakest point of their lives. As a Christian teaching says and values, every one of us must be of HIS likeness.

Sister Agravante, the author of the said theory, stressed that with great leaders comes a productive followers. She points that transforming mentors of the nursing profession in Christ servant-leader method will yield leaders of tomorrow that are of spiritually conscious and service oriented.

As I understood and personally believe, the character of the NURSE to CARE is a result of all his /her upbringing be it psychosocially and in this context

Spiritually. We are all blessed to be of in this vocation to manifests Gods love thru selfless service to the mankind.

Lynnie Nava-Pascua

Department Manager - Heart Institute, St Luke’s Medical Center Global City - Taguig, Philippines

Servant leadership/ transformative leadership is not a very popular system of influence because it involves an insight theory both significant in scientific theories and spiritual activities. Yes, we are very aware of this natural (Psychological) yet it happens in the subconscious passions (spiritual) on the heart to serve/care.

The truth about this concept relieves the rhythms/ care, servant leader workshop and our response to this theory and frontline leading and some of the advances of natural science have been the result of an amalgamation between self-confidence (natural) and confidence in God (spiritual).

These principle (CASAGRA MODEL) empowered and enlightened me to set my mindset in developing my first love, my passion to serve and be a servant leader in the service of mankind.  It is how we influence others, to target a specific mission, vision, goals and servant leadership guided by compassion, to be respected and guided in truth, that in everything we do, we always develop our unique gifts to attain our highest calling… that is to serve. It requires harmony in our influence in other people. The evidence would rely on our commitment, to lead like Jesus who lived it to perfection.

As a Department Manager of St Luke’s Medical Center Global City, Heart Institute, I learned how to balance my time, my commitment to my family, my profession and my leadership in fulfilling my missions and dreams; Doing the loving influenced, inspiring things as a leader that requires wisdom, commitment, passion, patience, courage, endurance, sacrifices and hard work. The most rewarding things, things that will restore, revitalize and retain trust.

Putting the life of Jesus into my actions and models Jesus to others, provides excellent service and significance. A life full of inspiration, wisdom, integrity that impact a positive servant leadership legacy.

Michelle Pascual

PACU Nurse, Bareen International Hospital - Abu Dhabi, UAE

Our profession is a grace from God and we should be forever thankful because people call us Nurses. Nowadays, it is very challenging to live the CASAGRA Transformative Leadership Theory which is defined as a model which nurses learn to lead members of their practice in Jesus’ way. This is because in serving others, the motive and goal in serving others matters. If service is rendered because of underlying selfish motive like for example when our goal is centered on the praises from other people then it is no longer servanthood. Studying this theory is timely, our profession is highly competitive and we are really needed globally. But we should be reminded of Sr. Carolina’s teaching to follow the steps of Jesus as servant. Nurses as servant leaders should remain humble and at the same time competitive in their career. Let nurses serve others and put aside selfish ends for praise, power or status. They should put commitment in their service. To become a servant, even when in positions of leadership should aim to guide and touch others’ lives given in teaching for the favours of others and their necessities.

Rose Anne Paulin

Staff Nurse, Armed Forces of the Philippines Medical Center

The CASAGRA transformative leadership theory is a model theory that is applicable in the modern times of the society. Nurses, by nature are all leaders. They not only care for the ill, but also communicate and manage relationships with their colleagues in various levels of seniority. To put it simply, the theory suggests that to be a leader, the Nurse would not only be able to manage critical situations, but also be able to be a transformative leader.

The theory states that nurses should be a servant leader and it revolves around three concepts, which are the care complex primer, the retreat-workshop on servant-leadership, and a seminar-workshop on transformative teaching for nursing faculty.  The theory focused on nursing leadership in the nursing profession. CASAGRA believed that the leader influences the path to which the profession in headed to.

I believe that CASAGRA was able to formulate her theory because she is a Christian servant and an educator herself. She promoted the ideals of a model nurse educator, which is timely because numerous nurses have expressed anger and frustration in the leadership of various clinical supervisors, instructors and administrators because of their way of teaching or handling situations. Some educators just read in class or just to their jobs and do not conduct reflective teaching.

In conclusion, I believe that CASAGRA’s transformative leadership theory is an exemplary contribution to the nursing field. It is both timely and appropriate to the present situation and condition of the field. It reminds us that excellent leaders influence creative transformation of the team for the progress of the profession.

Dolly Rose Perlado

Dialysis Nurse, King Faisal Specialist Hospital & Research Center – Jeddah, KSA

I am a Paulinian I was under the care of Sister St Paul’s of Chartres for four years. The theorist Sr. Carolina Agravante, SPC was my principal and my research instructor.  Upon reading and knowing her written theory brought me back significant memories in my college years. I can remember our motto in school “Caritas Christi Urget Nos" which means 'the love of Christ impels us.' A mere acquaintance with God can change a person completely. It can transform an individual to be more charitable, caring, compassionate and loving. In accordance with her CASAGRA Servant-Leadership Model I have learned that for a nurse to be an effective leader he or she must be a servant of God. A formation of a servant-leader nurse is essential because they will pave a way for creating new nurses whose basic stand is caring.

Caroline Phodaca

The CASAGRA transformative leadership model and the servant leadership behavior of nursing faculty by Sr. Carolina Agravante are not familiar to me but when I knew the main focus of this theory which is to enhance professional nurses professionally and spiritually. As a nurse who wants to render holistic quality care to my patients, this theory give me an idea on how to improve in giving nursing services to my clients. Moreover, having the right attitude is a very important factor in order to establish rapport with patients as well as with colleagues.

Currently, I am working in a Muslim country wherein the values, cultures and traditions are different from the place where I grew up but I am still capable of renderring quality care. In spite of discrimination and problems regarding equality, I still hold on to my Faith in God and Christian beliefs. However, there were moments when I experience negativities.

Overall, this theory would really give significant influence in the nursing profession as whole, not only in the Philippines but in other parts of the world. I believe that following the footsteps of Jesus as a servant of God would give an effective professional level nursing care to any type of clients. 

Jesus Christ as a servant of God could give a quality nursing care to any type of clients.

Mark Jayson Pinlac

On the fact that the main focus of the theory is on the development of servant-leaders to the faculty of nursing, it makes me think about the possibilities on how I could apply the theory on my personal experience. Looking back, I remember that one of the function of a nurse is to become a teacher to their patients, furthermore to their colleagues or subordinate. As the CASAGRA theory states that a “nurse leader sets the vision for its practitioner, lay down the roles and functions and influence direction toward which the profession should go” I remember my duty as the head of my subordinates, I am their role model, I show them what to expect and what to follow, I give them directions and policies and memorandum, never realizing that sometimes I am becoming more of an apathetic leader. After reading the theory I have ascertain that, being a leader is not just to give orders and wait for their wrong action, it is in the heart of a leader that will bring the best out of his nurses, to encourage, to guide and reflect on. As a leader, I must learn how to follow my own rules, and sometime, step down to their points of view to better understand each situation and most specially to give myself a chance to become a better servant-leader.

The fact that the main focus of this theory is on the development of servant- leaders to the faculty of nursing, I made me think about the possibilities on how I could apply the concepts of this theory in my professional career. By looking back, I realized that one of the functions of a nurse is to educate their patients and colleagues. As the theory states, “a nurse leader sets the vision for its practitioner, lay down the roles and functions, and influence direction towards which the profession should go.” I also remembered when I became a team leader in our clinical duty in which I became the role model of my team. In addition, I showed them what to expect and gave them proper direction and guidance without realizing that I became apathetic in some instances. After reading this theory, I became certain that being a leader means not just giving orders and dwelling on staff errors but also emphatizing with staff in order to influence them positively. As a leader, I must learn how to follow proper rules and be in the shoes of the staff in order to have a better understanding on certain situations. Most especially, I have to give myself a chance to become a servant-leader.


Irvin Joseph M. Pua

Charge Nurse, Critical Care Nurse

This theory is continuously helping the nursing profession in terms of having the right perspective and ideologies in influencing others to be a transformative leader. These leaders are essential for the for the creation of an environment that is suitable for the development of leaders that will foster servanthood. As a result, the ideologies and beliefs will be passed on to the coming generations to guide them to the direction towards which the nursing profession should go.

However, there are some limitations of this study. This theory was primarily based on the Roman Catholic teachings and the subjects involved were Christian educators. For some, the creation of the concepts were formulated within the environment of Catholicism. Due to this reason, the theory might not be acceptable to other professionals who practice other religions and beliefs. Nowadays, globalization is inevitable and it promotes the easy movement of commodities and people with a variety of beliefs and principles. It is imperative that professional nurses should be the proponents of equality and culture- sensitivity.

In conclusion, this theory aims to standardize how educate future leaders of the nursing profession and we cannot deny the fact that one powerful religion had a great influence on the development of majority of the concepts. Therefore, the believers should shed light on certain ideas to prove that this theory is applicable to all nurses in every corner of the world.

Rovin B. Ramirez
King Abdullah bin Abdulaziz University Hospital - Riyadh, KSA

The CASAGRA Transformative Leadership Model is most beneficial to the Nursing Education Unit in each of the Hospitals. As an emergency nurse and at the same time a part of Clinical Education Unit of King Abdullah bin Abdulaziz University Hospital, I see myself doing the three concepts of Agravante's Theory.

From the servant–leadership where contemplating before discussing the topic is important. The day to day struggle in enriching oneself by reading evidence-based practices and its applicability in the hospital setting, the commitment to also enrich the staff's theoretical knowledge and skills. The importance of stress debriefing among educators. In our institution, we have a weekly stress debriefing, where we don't think of work for two hours. We just simply talk about life, our goals and different strategies that will help us attain it. The Nursing Affairs of KAAUH in Riyadh also made a program where all staff can have at least one-hour open forum with our Executive Director of Nursing, ask questions and motivations literally anything under the sun. In the Clinical Education Unit, we uphold with the principle of Transparency and Confidentiality. If staff needs a one on one teaching or maybe a remedial to skills check off we book the staff for the Remediation Program maintaining the privacy and an approach without judgment but fairness and enriching experience. The self- mastery concept she mentioned in her model of transformative learning is true. Educators nowadays are just focusing on the thought that they must deliver the topic/lesson to the staff or students without even evaluating oneself if the strategies were applicable to the target group of learners or not. When I present something in front of the staff I make sure that I practiced and understood my topic well and relate my special expertise to the crowd.

“Excellence is the result of the determination and passion you put at first.” – Rovin B. Ramirez

Marian M. Rigonan 

The CASAGRA Transformative Leadership theory is a very good example to remind the nurses of how and what an ideal nurse should be like—being a leader in healthcare while serving their fellow colleagues and clients. It aspires to create nursing graduates who are servants as well as leaders by transforming faculty with the servant-leader formula. According to the theory, they must aspire to lead while washing one another’s feet as Jesus did. It is very inspiring for me to know that there is an existing theory like this that proposes the nurses’ dealings to be Jesus-like.  

Nowadays, I noticed that we nurses are becoming goal oriented in working with our everyday shifts. We have mastered our daily routines and do all our task on the dot without really looking through all the needs of our patients or needs of our students if we have any. Maybe because of the high ratio between nurses and patients in wards and the low compensation we receive, we tend to just be lax at work and not give the essential part of being a nurse—to care and to serve.  

Nursing is not only a profession but also a calling, more than anything else. It is a “gift” to take care of strangers who are in their most vulnerable state; when they are sick and in pain. I always try to treat my patients like my family for them to feel that I care for them genuinely and by doing so, I would be able to practice being a servant-leader while harnessing nursing expertise. 

Zerah May E. Rodriguez

Growing in a Christian family, I believe that we are in this world for a mission and I know in my heart that mine is to serve. With the vast quantity of theories, I am glad our team decided to work on the CASAGRA Transformative Leadership Theory by Sr. Carolina S. Agravante. It was nice to encounter one that goes with my own values, beliefs and principles.

At this present time where we tend to forget the essence of Nursing and compassion is nearly lost, this theory is beneficial both for students and professional nurses, as it brings us back to the essence of what nursing is all about. More than our knowledge and skills, our attitude would also define our success as Leaders in the field.

I love how Sr. Agravante sets the focus on the leadership method of Jesus, the model and inspiration of the Nursing profession, who exhibits the qualities of a perfect leader. One who doesn’t just go around telling people what to do but rather showing how it is done in the most compassionate and tender way. The theory stimulates an individual to possess an empathetic Head, a caring Hand and a loving Heart. As the vitality of care complex of Nursing is directly related to leadership behavior, I suppose that utilizing the model would significantly improve the conduct of Nurses which in turn would lead to a better performance, harmonious nurse-patient relationship and job satisfaction.

Bess Devaras Rompal

NDP – Department of Health Region 8 - Tacloban City, Leyte

The CASAGRA Transformative Leadership Model Servant-Leader Theory aims to realign the interests of the members of an organization to be more compassionate and genuine in providing care in the most spiritual way that a modern nurse should do.

I am a Roman Catholic and I have been in Catholic schools almost my entire life, and if there is one thing that I have learned and digested is that we should always be of service to those who are in need. Nurses as we are, we are considered as leaders of health but at the same time we serve our clients. In this theory the nurse is to follow the footsteps of Jesus as he first became a servant of God and the people and then lead the people to what is right.

The theory made me realize that this is a great time to be a nurse, a nurse of the modern society who does not only rely of what he learned in school and the experiences that he has gone through his career but also putting in regard his spirituality and commitment to be Jesus-like in our daily lives. A challenge that we must live up to.

Manara Salahuddin

“The servant-leader is servant first... It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead. He or she is sharply different from the person who is leader first, perhaps because of the need to assuage an unusual power drive or to acquire material possessions. For such it will be a later choice to serve – after leadership is established. The leader-first and the servant-first are two extreme types. Between them there are shadings and blends that are part of the infinite variety of human nature. The difference manifest itself in the care taken by the servant-first to make sure that other people’s highest priority needs are being served."

-       Taken from the Servant as Leader published by Robert Greenleaf in 1970.

“Servant-Leadership is a practical philosophy which supports people who choose to serve first, and then lead as a way of expanding service to individuals and institutions. Servant- leaders may or may not hold formal leadership positions. Servant-leadership encourages collaboration, trust, foresight, listening, and the ethical use of power and empowerment.”

-       Taken from the Center for Servant Leadership web site, April 2003.

The three-fold transformation leader concept servant-leadership spirituality, self-mastery and special- expertise is essential in the modern practice of nursing. Nowadays, a lot of news on media is showing immorality and unprofessionalism both locally and abroad, this will help amend and modify our nursing management.

Spirituality in the workplace can be practiced without having to pressure individuals. In the case of effective leadership, we shall find that spirituality expresses itself not so much in words or preaching, but in the embodiment of spiritual values such as integrity, and in the demonstration of spiritual behavior such as expressing caring and concern.

 Many leadership theories emphasize the need for the leader to articulate an inspiring vision, but what is important is not so much words but rather actions: the level of ethics demonstrated, the respect and compassion shown to others.

This kind of leadership will motivate, develop and guide workers that can result in a lower cost to an organization. A high level of job satisfaction among workers leads to lower employee turnover and higher productivity. Leaders in organizations that experience higher productivity use tools such as performance appraisals, mentoring programs, training and coaching techniques to promote job satisfaction among workers. High employee turnover results in increases in recruitment, hiring and training costs. Successful leadership may result in lower employee turnover and the associated costs.