Module 1 : Theoretical Foundations in Nursing - Functional Focus (what nurses do) - knowledge

History of Nursing focus or what nurses know and how they use them for
Theory thinking and decision making while taking care of a
➔ This was dated way patient. (example: Nursing)
back when Florence - Knowledge of persons, health and environment
Nightingale began to forms the basis for nursing as a discipline
assume the great - Kuhn - stated, “ the study of paradigms is what
significance of providing a clean and healthy mainly prepares the student for membership in a
environment to achieve recovery of patients and particular scientific community with which he / she
continues up to present will practice. By studying and practicing with them,
➔ She also envisioned nurses as a body of educated the clients or community involved learn their trade.”
women who organized service and caring for - Refers to a specialized field of practice founded on
wounded in wartime (Crimean War) and the theoretical structure of the science or knowledge
establishment of Nursing school in London (St. of the discipline and accompanying practice abilities.
Thomas Hospital) pioneering activities in nursing - Knowledge of that discipline and accompanying
practice and education. practice abilities.
➔ Nursing evolved through different eras. Profession - Recognition and respect for their scholarly
did not start as what it seemed to be. It started as a disciplined contribution to the health of society.
vocational course offering only skills during their
time. PROFESSION
- Refers to a specialized field of practice founded on
Nursing as a Science: Apprenticeship Model the
• Nursing process was based on principles and theoretical structure of the science or knowledge of
traditions that were handed down through practice the
seen by Florence during her time discipline and accompanying practice abilities.
• Other references note that this is a practice era - Knowledge of that discipline and accompanying
dated before the curriculum era where to be a nurse practice
can have a diploma for only 2 years under abilities.
vocational -Recognition and respect for their scholarly
disciplined
Fawcett classified nursing models as paradigms with contribution to the health of society.
in a more organized specialized meta-paradigm of
❖ Person Criteria for the Development of the Professional
❖ Environment status of Nursing:
❖ Health 1. Utilizes in its practice a well-defined and well-
❖ Nursing Concepts organized body of specialized knowledge.
2. Constantly enlarges the knowledge it uses and
Significance of Nursing Theory: improves its techniques of education and service thru
DISCIPLINE scientific method.
- Specific to academia and refers to a branch of 3. Entrusts the education of its practitioners to
education, a department of learning or a domain of universities / colleges.
knowledge. 4. Applies knowledge in practical services important
- Branch of education; theoretical works leading to to community welfare.
higher level of education and practice.
5. Functions autonomously in developing “not at all
professional policy.
6. Attracts individuals with intellectual and personal EMPIRICISM
qualities of intensifying service. • Way of looking at reality using the five senses.
7. Strives to compensate nurses by providing freedom • An object is real in so far as seen, felt, smelled,
of action, opportunity for continuous professional tasted, heard
growth and economic security. • A theory which states that knowledge comes only or
primarily
Historical Views of the Nature of Science from sensory experience
Epistemology (episteme – knowledge; logos – • Fundamental part of scientific method
study of) (experimentations)
-meaning knowledge, understanding • Knowledge is based on experience; ex. physical
- concerned with the theory of knowledge in assessment
philosophical inquiry or how knowledge came to be. • Gather information more and observe facts before
• What is real is also considered knowledge. finally
• Branch of philosophy concerned with the nature & saying a theory exists.
scope of knowledge. • Reynolds, “research-then-theory strategy”
• It is the study of knowledge & justifies beliefs. • It is inductive. (specific to general)
• It questions what knowledge is & how it can be ex: collect data → diagnose
acquired.
• This aims to discover the meaning of knowledge, & History of Nursing Science:
called it the true beginning of philosophy Early 20th century views
• Positivism emerged as the dominant view of
Philosophical Foundations of Science modern
RATIONALISM science.
• Priori reasoning -utilizes deductive; cause to effect • Modern logical positivists believed that empirical
or research
general to particular and logical analysis were two approaches that would
• Use of the rational senses in ensuring the produce scientific knowledge.
truthfulness of a • Philosopher focused on the analysis of theory
phenomenon structure.
• Understand the whole first before you can • Scientists focused on empirical research.
appreciate the • Increasing use of computers which permits the
lesser parts analysis of large data
• Regards reason as the chief source & test of
knowledge Emergent of science & theory in the late 20th
• Any view appealing to reason as a source of century
knowledge • Phenomenological Approach reduces observations
or justification (theory-the-research approach) or text to
• Criterion of truth is not sensory but intellectual & the meanings of phenomena independent of their
deductive particular
(general to specific) context. This approach focuses on the lived meaning
ex: lack of social support will lead to hospital of
readmission, experiences.
• Several authors presented analysis challenging the generally accepted as being true. An idea or set of
positivist position, thus offering the basis for a new ideas that is
perspective in science. intended to explain facts or events.
• Empiricists view phenomena objectively, collect • An idea that is suggested or presented as possibly
data and true but that
analyze it to inductively propose theory. is not known or proven to be true.
• A set of statements that tentatively describe,
Interdependence of theory & research explain, or predict relationships among concepts that
• In constructing theory, theorists must be have been systematically selected & organized as an
knowledgeable abstract representation of some phenomenon (Powers
about available empirical findings and able to take & Knapp).
these • An internally consistent group of relational
into account, because theory is concerned with statements (concepts,
organizing definitions & propositions) that present a systematic
and formalizing available knowledge of a given view about a
phenomenon. phenomenon & which is useful for description,
• The theory is subject to revision or maybe explanation, prediction
abandoned in & control (Bodie & Chitty).
favor of an alternative explanation for new • Scientifically theory implies that something has
information been proven and is
generally accepted as being true.
Science as a social enterprise • A creative & rigorous structuring of ideas that
•"Human beings do science" - Gale. It might be project a tentative,
anticipated that purposeful & systematic view of phenomenon.
social, economic, or political factors may influence Validation of existing
scientific knowledge as well as discovery of new knowledge.
enterprise. It depends on the funds, popularity of We apply theory
certain to describe, explain, predict, or prescribe nursing
ideologies. practice.
• Science progresses by the diversity of dialogue • The general principles or ideas that relate to
within the principles or ideas that relate to a particular subject.
discipline of nursing. The creation of a merged Ex. Theory of Evolution
paradigm from
many paradigms is debated in relationship to the CATEGORIES OF THEORY COMPONENTS
advancement
of nursing.

Theory Development Process

• Usually means “mere guess” or unproved
• Literally means “a vision” or “a beholding scene”
• Greek word “theoria”
• Scientifically, theory implies that something has
been proven and is
 statements are linked; add
plausibility
Linkages of operational statements provides rationale
for how
measurement variables
are
linked; permit testability
Organization of concepts and eliminates overlap
(tautology)
definitions into primitive and
Derivedterms

Organization of statements and eliminates

10 Phases of Concept Building Process:
inconsistency
1. Write a meaningful practice story.
linkages into premises and derived
2. Name the central phenomenon in the practice
hypotheses and equations
story.
3. Identify a theoretical lens for viewing the
phenomenon.
SCIENTIFIC LAW vs THEORY
4. Link the phenomenon to existing literature.
SCIENTIFIC LAWS
5. Gather a story from someone who has lived the
• A statement of fact that aims to explain, in brief and
phenomenon.
simple terms, an action or set
6. Reconstruct the shared story and create mini-saga
of actions
that captures its message
• Generally accepted to be true and universal and can
7. Identify the core qualities of the phenomenon.
occasionally be expressed
8. Use the core qualities to create a definition.
in terms of a single mathematical equation
9. Createa model of the phenomenon
• SIMPLE, TRUE, UNIVERSAL & ABSOLUTE
10. Write a mini synthesis that integrates the
• Governs a single action, foundations for all science
phenomenon with a population to suggest research
• Statement based on repeated experimental
direction.
observations that describes some aspects of the
universe
• Always applies under same conditions, & implies
Relational Statement: Statements in a theory may
that there is a causalrelationship involving its
state definitions or relations among
elements
concepts
•ex. Law of Universal Gravitation by Newton
Theoretical Statements: Relate concepts to one
another; permit analysis
THEORY
Operational Statements: Relate concepts to
• More complex & dynamic; maybe replaced
measurements
• Explains an entire group
• Can be changed or improved without changing the
Linkages and Ordering:
overall truth
Linkages of theoretical statements provide rationale
• Developed from the scientific method
of why theoretical
• ACCEPTED AT TRUE & PROVED
HYPOTHESIS
• an educated guess based upon observation In March 1853, the Crimean War broke out between
• Can be supported or proven false by Russia and Turkey. It was during this war where
experimentation or continued observation Florence Nightingale volunteered her services and
• an idea or theory that is not proven but leads to was eventually given permission to take a group of
further study or discussion 38 nurses to Turkey
• an assumption made for the sake of argument
•HAS NOT BEEN PROVED She found the conditions as:
• ex. watching excessive amounts of TV reduces a • soldiers lay in filth straw pallets in crowded
person’s ability to concentrate; smoking leads to hallways
lung cancer • rats and insects crawled the floors and walls
• hospitals lack basic supplies, such as cots,
Contemporary Issues in Nursing Theory mattresses, bandages, washbasins, soap, and towels
Development: • water was rationed, and available in totally
▪ Theoretical Boundaries and Levels to Advance inadequate amounts
Nursing Science • wounded armies were wearing unwashed uniforms
▪ Nursing Theory, Practice and Research that were stiff with dirt and gore
• diseases such as typhus, cholera, and dysentery
were the primary reasons why the death rate was high
Nursing Philosophies sets for the meaning of nursing • She recognized that overcrowding, filth, and poor
phenomena through analysis, reasoning and logical ventilation all contributed to the illness of the
argument. Are works that provide broad soldiers.
understanding that advances the discipline and its • At night, she carried a lamp through the corridors,
professional application. stopping to help the suffering of the wounded
soldiers, for this, she was nicknamed, “The Lady
The history of nursing theory was dated way back with the Lamp”
when Florence Nightingale began to assume the great
significance of providing a clean and healthy Post-War Contributions
environment to achieve faster recovery of patients • Nightingale returned to England as a national
and continues up to present. heroine in 1856
•She published two books: Notes on Hospital (1859)
and Notes on Nursing (1859)
FLORENCE NIGHTINGALE • She raised enough funds and used this to establish
• Nightingale’s (1859-1992) Notes on Nursing the Nightingale School and Home for Nurses at St.
presents the nursing theory that focuses on the Thomas Hospital.
manipulation of the environment for the benefits of • Nightingale’s work greatly influenced John Stuart
the patient. Mill’s book on women’s rights.
• Although Nightingale did not present her work as a
nursing theory, it has directed nursing practice for
over 140 years. She is known as the Mother of
Modern Nursing. ENVIRONMENTAL THEORY
• Daughter of William Nightingale of Embley Park, “Nursing is the art of utilizing the patient’s
Hampshire and was born in Italy, on the 12th day of environment for his or her recovery.”
May, 1820.
Environment – defined as the external conditions and Theory in View of Metaparadigms:
influences affecting the life and development of an Nursing
organism and capable of preventing, suppressing, or Nightingale’s view of nursing was comparable to that
contributing to disease, accidents, or deaths. of motherly instincts. She believed that every woman
would be a nurse because nursing is having the
Components of Environment: responsibility for someone else’s health – a
Proper Ventilation. characteristic shared by women, especially mothers.
Nightingale believed that nurses have the Her “Notes On Nursing” provided guidelines to
responsibility to keep the air that the patient breathes women who wanted to become nurses and gave
pure as the external air without necessarily chilling advice on how to think like a nurse. Nursing is a
him. She recognized the possibility that inadequate vocation that needs formal learning and application
ventilation may be the source of disease. of scientific principles in the care of patients. Nursing
Adequate Light. personnel were thus having more skill in terms of
Direct sunlight has quite as real and tangible effects assessment and reporting of the patient’s health
on the human body who has not observed the status. At the same time, the nurse is also able to
purifying effect of light, and especially of direct perform nursing interventions that will allow the
sunlight. patient to heal and recover
Cleanliness.
She advocated taking a bath daily and that nurses Person
should also bathe daily while keeping their duty The person is the patient himself. Patients are the
uniforms clean and their hands washed clean recipient of our care. A passive patient is a patient
Warmth who depends wholly on the nurse for tasks and
Nightingale outlined a procedure for measuring the control of his environment. The nurse is totally in
body’s temperature through palpation of, or feeling control of the patient and his environment.
for the extremities in order to assess for heat loss. Nightingale viewed the patient as a person who
One of the nurse’s role is to manipulate the needed nursing care regardless of the patient’s social
environment. Positioning the patient, opening the worth
windows, and regulating the room temperature are
ways of maintaining this balance. Health
Quiet Nightingale viewed health as being well. Health is
Nightingale described unnecessary noise can actually also living up to one’s potential to the fullest extent.
be harmful to the patient who is ill. Disease and illness are viewed as reparative
Diet processes that are instituted by Mother Nature herself
Nightingale maintained that one of the nurse’s role is when the person did not attend to his personal health
to assess both the meal schedule and its effect on the concerns. Nightingale emphasized the promotion and
patient, in addition to assessing the patient’s dietary maintenance of health and prevention of diseases
intake. through prudent control of the environment and
Management social responsibility
The nurse is actually in control of the environment,
physically, and administratively. The nurse is Environment
responsible for controlling the environment so that The environment was viewed as “those elements
the patient is protected from physical and external to and which affect the health of the sick and
psychological harm. healthy person” and included “everything from the
patient’s food and flowers to the patient’s verbal and
nonverbal interactions.” Central to Nightingale’s • began developing her theory while she was
theory is the concept of a therapeutic environment assistant dean of the undergraduate program at
that will enhance the comfort and recovery of the University of Colorado
patient. • in 1978-1981, she served as coordinator and
director of the PhD program
• worked from 11 curative factors to formulate her
10 carative factors
Application to Nursing: • modified 10 factors slightly over time and
• Nursing Practice: Ventilation, warmth, quiet, diet, developed the caritas processes, which have a
and cleanliness are still important aspects of nursing spiritual dimension and use a more fluid and
care. We, nurses, thus need to maintain adequate evolutionary language
ventilation, promote adequate and appropriate • authorized 11 books which reflect the evolution of
nutrition, maintain normal homeostatic body her theory of caring
temperature, and observe basic hygiene and comfort
measures, including environmental sanitations. • 1st book – Nursing: The Philosophy and Science of
• Nursing Education: Nightingale had established the Caring (1979), use 10 carative factors but evolved to
St. Thomas Hospital and King’s College Hospital in include “caritas” (connection between caring and
London, which was able to provide a framework for love)
the establishment of nursing training schools through • 2nd book – Nursing: Human Science and Human
a universal template that contains principles of Care – A Theory of Nursing (1985), addressed her
nursing training. She also advocated the separation of conceptual and philosophical problem in nursing
nursing training from the hospital to a more
appropriate learning environment in the school or Transpersonal Caring Relationship
university setting • foundational of her theory; it is a special kind of
• ursing Research: Nightingale is considered the human care relationship
mother of nursing research because of her interest in • a union with another person-high regard for the
the scientific methods of inquiry and statistics. She whole person and their being in the world
was able to gather and analyze data efficiently and • “Caritas” originates from the Greek vocabulary,
resourcefully. She was the first to use polar diagrams meaning to cherish and to give special loving
in presenting study data. The concepts of attention
Nightingale’s theory still serve as a basis for current • Watson uses the term “carative” instead of curative
research. In the 1990s, research studies that tested
and expanded nursing theory were numerous. 10 Elements of Carative Factors:
• Humanistic-altruistic system of value - Practice of
WATSON'S PHILOSOPHY & THEORY OF loving kindness and equanimity (self-
TRANSPERSONAL CARING “Nursing is the control/composure) within context of caring
human science of persons and human health – illness consciousness.
experiences that are mediated by professional, • Faith-hope- being authentically present, and
personal, scientific, aesthetic, and ethical human care enabling and sustaining the deep belief system and
transactions.” subjective life world of self and the one-being-cared-
for
JEAN WATSON • Sensitivity to self and others - cultivation of one’s
• born and grew up in a small town of Welch West own spiritual practices and transpersonal self, going
Virginia; youngest of the eight children beyond ego self, opening to
others with sensitivity and compassion. • the nurse’s caring consciousness and connection
Helping-trusting, human care relationship - having the potential to heal since experience,
Developing and sustaining a helping-trusting, perception, and intentional connection are taking
authentic caring relationship place
• Expressing positive and negative feelings - Being ➔ The theory acknowledges the unity of the
present to, and supportive of, the expression person’s mind-bodyspirit.
ofpositive and negative feelings as a connection with ➔ The mind is the point of access to the body and
a deeper spirit of self and the one-being-cared-for the spirit.
• Creative problem-solving caring process - Creative ➔ The spirit relates to a person’s soul, the inner
use of self and all ways of knowing as part of the self,
caring process to engage in artistry of caring-healing the essence of the person, the spiritual self.
practices.
• Transpersonal teaching- learning - Engaging in Theory Assertions
genuine teaching-learning experience that attends to • It is the spirit that allows the person to transcend the
unity of being and meaning, attempting to stay within “here and now” coexisting with past, present, and
other’s frames of reference. future, all at once through creative imagination and
• Supportive, protective, and/or corrective mental, visualization.
physical, • Watson ascertains that the care of the soul remains
societal, and spiritual environment - Creating a the most powerful aspect of the art of caring in
healing environment at all levels (physical as well as nursing.
non-physical), subtle environment of energy and
consciousness, whereby wholeness, beauty, comfort, Major Assumptions
dignity, and peace are potentiated. • Nurse’s ability to connect with another at this
• Human needs assistance- Assisting with basic transpersonal spirit to spirit level is translated via
needs, with an intentional caring consciousness, means of communication, into nursing human art and
administering “human care essentials”, which acts or intentional caring- healing modalities.
potentiate alignment of mind-body-spirit, • Caring-healing modalities within the context of
wholeness, and unity of being in all aspects of care, transpersonal caring/ caritas consciousness potentiate
tending to both the embodied spirit and evolving harmony, wholeness and unity of being by releasing
spiritual emergence. some of the disharmony.
• Existential-phenomenological- spiritual forces - • Ongoing personal & professional development and
Opening and attending to spiritual-mysterious and spiritual growth.
existential dimensions of one’s own life-death; soul • Nurse’s own life history, previous experiences etc.
care for self and the one-being-cared-for Are valuable teachers for this work.
• Other facilitators are personal growth experiences
Transpersonal caring relationship such as psychotherapy and other models for spiritual
characterizes a special kind of human care awakening.
relationship that depends on: • Continuous growth for developing and maturing
• the nurse’s moral commitment in protecting and within a transpersonal caring model is ongoing.
enhancing human dignity as well as the deeper/higher
self ➢ the nurse’s caring consciousness Theory in View of Metaparadigms
communicated to preserve and honor the embodied Nursing
spirit, therefore, not reducing the person to the moral Nursing is the human science of persons and human
status of an object health – illness experiences that are mediated by
professional, personal, scientific, aesthetic, and • Nursing Research: Watson’s theory to reduce
ethical human care transactions. distress experienced by infertile women. Her theory
and the application of theory of clinical practice
Person Personhood (human being) hospital organizations have been their major
• a unity of mind/body/spirit/nature weakness of research. Nelson and Watson report on
• Unitary Transformative Paradigm-Holographic studies carried out in seven countries.
thinking: “…unity within an evolving emergent
world viewconnectedness of all…” Implications of the Theory:
• three words: Mind, Body, Soul • One major implication of the theory is in the realm
• “… humans cannot be treated as objects and that of bedside nursing where nurses of today have
humans cannot be separated from self, other, nature, particularly begun to neglect. The essence of nursing
and the larger universe.” is in the caring aspect and caring is taking the
wholeness, the totality, of the patient in
Health consideration.
•“…illness is not necessarily disease; [instead it is a] • More importantly, nurses of today should try to care
subjective turmoil or disharmony within the spheres for a patient for who he is. After all, all of us were
of the person, for example, in the mind, body, and created equal and in His likeness.
soul, either consciously or unconsciously.”
MODULE 3 PATRICIA BENNER’S STAGES OF
Environment NURSING EXPERTISE MARILYN ANNE
•Society – provides the values that determine how RAY’S BUREAUCRATIC CARING
one should behave and what goals one should strive PATRICIA BENNER:
toward. Watson stated, “Caring (and nursing) has CARING, CLINICAL WISDOM AND ETHICS IN
existed in every society. Every society has had some NURSING PRACTICE
people who have cared for others. A caring attitude is • born in Hampton, Virginia
not transmitted from generation to generation by • baccalaureate of arts degree from Pasadena College
genes. It is transmitted by the culture of the in 1964
profession as a unique way of coping with its • Master’s degree in Nursing with major emphasis in
environment.” medical-surgical nursing from University of
California, San Francisco, School of Nursing
Application to Nursing: • has a wide range of clinical experience
• Nursing Practice (Administration & Leadership): It
calls for administrative practices and embrace caring, “Nursing is a caring relationship and practice that
even in a health care environment of increased acuity cares for and studies the lived experiences of
levels of hospitalized individuals, short hospital stays, patients on health, illness, and disease, and the
increasing complexity of technology, and rising relationships among these three elements.” -
expectations in the task of nursing. Patricia Benner
• Nursing Education: Watson’s writings focus on
educating graduate nursing students and providing "The Nurse - Patient Relationship is not a uniform,
them with ontological, ethical, and epistemological professionalized blueprint but rather a Kaleidoscope
bases for their practice, along with research of intimacy and distance in some of the most
directions. Watson’s caring framework has been dramatic, poignant, and mundane moments of life".
taught in numerous baccalaureate nursing curricula.
DREYFUS MODEL
• Novice (0 to 1 year)
• Advanced Beginner (1 to 2 years) COMPETENT NURSE
• Competent (2 to 3 years) • considerable conscious and deliberate planning
• Proficient (3 to 5 years) – intuitive •Expert (>5 which determines the important aspects of present
years) – clinical eye and future situations
• proposes that as a person improves in skill level, • exhibits a sense of mastery, increased level of
there is a corresponding change in the performance of efficiency, consistency, predictability, and time
a given skill: management
•Movement from reliance on abstract principles
and rules to use of past, concrete experience. PROFICIENT NURSE
•Shift from reliance on analytical, rule-based • already has a holistic view of a particular situation
thinking to intuition, • the nurse’s performance is guided by maxims by
• Change in the learner’s perception of the this stage
situation from viewing it as a compilation of equally • can already show an intuitive grasp of the situation
relevant pieces to viewing it as an increasingly based on background understanding
complex whole in which some parts stand out as • can see changing relevance in a given situation
more or less relevant. including recognition and implementation of skilled
responses to the situation as it evolves
SKILL
refers to nursing interventions and clinical judgment EXPERT NURSE
skills in actual clinical situations. • does not rely anymore on the analytical principles
EXPERTISE of rules, guidelines, and maxims to connect her
is developed when the clinician tests and modifies understanding of the situation to an appropriate
principlebased expectations in the actual setting. action
NOVICE STAGE • characterized by the following vital traits:
• a person who lacks background experience of the • demonstrate a clinical grasp and resource-based
situation he or she is involved in practice
• simple rules and objectives, attributes should be • possess embodied know-how
given • see the big picture
• examples are nursing students and professional • see the unexpected
nurses who have been assigned to an area totally Competency – defined as an interpretively defined
different from the one they are accustomed to area of skilled performance identified and described
by its intent, functions, and meanings.
ADVANCED BEGINNER Experience – the active process of refining and
• has enough experience to grasp aspects of a changing preconceived theories, notions, and ideas
situation but not within the context of the situation when confronted with actual situations; it reflects that
• should be guided by rules and are oriented by the there is communication between what is found in
completion of tasks practice and what is expected
• feels highly responsible for managing patient care . Maxim – a mysterious description of skilled
but will still need the help of other nurses who are performance.
more experienced than her ✔ It requires a certain level of experience to
• examples are newly registered professional nurses recognize the implications of the instructions.
 ✔ Paradigm case is a clinical experience that 4. The actual projected body – refers to the
stands out. body’s capacity to fit or be skilled in a given
✔ It alters the way the nurse will perceive and situation; for example, driving an automobile
understand and open new clinical viewpoints 5. The phenomenal body – refers to the
and alternatives. body’s awareness of itself and its ability to
imagine and describe touch sensations

HEALTH
Hermeneutics - interpretive; it describes meaningful • This is defined as what can be assessed. Well-being
human activities or phenomena in a careful and is the human experience of health or wholeness.
detailed manner. • Wellbeing and being ill are understood as distinct
✔ The description is free from analytical ways of being in the world. Health is not merely the
assumptions. It is based purely on practical absence of disease or illness. A person may also have
understanding of thephenomena. a disease but not an illness.
• Illness is the human lived experience of loss of
THEORY IN VIEW OF METAPARADIGMS function or dysfunction.
NURSING • A disease is a state that can be assessed physically.
• Described as a caring relationship and practice that
cares for and studies the lived experiences of ENVIRONMENT
• patients on health, illness, and disease, and the • Benner talked about situations instead of
relationships among these three elements. environment. Situation is described as the social
environment with a social definition and
PERSON meaningfulness. Each person’s past, present, and
• It is viewed as a self-interpreting being. The person future, including their own personal meanings, habits,
does not come into the world predefined. He gets and perspectives, influence the present situation.
defined in the course of living a life. He has an • Benner’s contribution to the nursing profession is
effortless and non-reflective understanding of the self the use of phenomenal approaches to nursing
in the world. He is a participant in common meanings practice.
and he is embodied. • Phenomenal approaches have resulted in the
development of clinical promotion ladders, new
Embodiment refers to the body’s capacity to respond graduate orientation programs, and clinical
to meaningful situations with 5 dimensions: knowledge development seminars.
1.The unborn complex – the fetus and • Her model is instrumental in differentiating
newborn baby does not yet have any signs of knowledge development and career progression in
the effects of culture nursing. This allowed nursing educators to realize
2. The habitual skilled body – refers to the that learning needs at the early stages of clinical
body language of a person as he learned knowledge development are different from those
through time by the processes of required at later or higher stages
identification, imitation, and trial and error • It is important to understand that different
3. The projective body – refers to the employees will have different levels of skills.
predetermined action of the body in response • It is important to emphasize the importance of
to a situation; for example, walking or learning the skill of involvement and caring through
running practical experience, articulation of knowledge with
practice, and the use of narratives in undergraduate – a complex transcultural, relational process
education. grounded in an ethical, spiritual context (charity and
• It is important for nursing students and professional right action, love as compassion in response to
nurses alike to learn through experience or by suffering and need and justice or fairness of what to
experiential learning. be done)
• Learning by experience will allow you to gain
mastery of a given skill. Spirituality
– involves creativity and choice and is revealed in
MARILYN ANN RAY attachment, love, and community Spiritual- Ethical
• 1958 – went to LA, CA work at OB-Gyn, ER, CCU caring for nursing focuses on the facilitation of
• 1960 – US Citizen, US Air Force- flight nurse, choices for the good of others
clinician, administrator, educator, researcher with a
rank of Colonel. The first nurse to go to the Soviet Educational
Union with the Aerospace Medical association – formal and informal educational programs, use of
• 1965 – BSN-MSN in MCN at the University of audiovisual media to convey information and other
Colorado; Dr. Madeleine Leininger, a nurse forms of teaching and sharing information
anthropologist, influenced Ray's life.
• 1973 – went back to Canada to be with her family, Physical
faculty in McMaster University – related to the physical state of being, including
• 1989 – appointed as an Eminent Scholar at Florida biological and mental patterns (mind and body)
Atlantic University and continues as Professor
Emeritus
• Her research interests continue to focus on nurses, Social-Cultural
nurse administrators and patients in critical care and – ethnicity & family structures, intimacy with friends
intermediate care, and in nursing administration in and family, communication; social interaction and
complex hospital organizational cultures support. Legal
– meaning of caring include responsibility and
THEORETICAL SOURCES accountability; rules and principles to guide
• Dr. Leininger – transcultural nursing and behaviors such as policies, procedures informed
ethnographic-ethnonursing research methods. consent; right to privacy
• Hegel – posited the interrelationship among thesis,
antithesis, and synthesis. Technological
• Chaos Theory – describes simultaneous order and – nonhuman resources, like machinery to maintain
disorder, and order within disorder. Ray compares the physiological well-being of the patient, diagnostic
change in complex organizations with this creative tests, knowledge and skills needed to utilize these
process and challenges nurses to step back and renew resources
their perceptions of everyday events, to discover the
embedded meanings. Economic
– includes money, budget, insurance systems,
MAJOR CONCEPTS & DEFINITIONS limitations and guidelines imposed by managed care
Holography organizations, allocation of human and material
– everything is a whole in one context and a part in resources to maintain services
another, with each part being in the whole and the
whole being in the part Caring Political
– power structure within health care administration, • The theory of Bureaucratic Caring has direct
pattern of decision making in the organization; role application for nursing.
and gender stratification among health care providers; • This synthesis of behaviors and knowledge reflects
competition for scarce human and material resources the holistic nature of the theory.
• This can transform the working environment,
MAJOR ASSUMPTIONS fostering ethical choices, respect, and trust, resulting
• The meaning of caring is highly differential, to successful organizations
depending on its structures (social-cultural, • Nursing Education: Useful in nursing education in
educational, political, economic, physical, terms of its broad focus on caring in nursing and its
technological, legal). conceptualization of the health care system.
• Caring is bureaucratic as well as spiritual/ ethical, Interconnectedness of all things
given the extent to which meaning can be understood • Nursing Research: Particularly significant because
in relation to the organizational structure. it is grounded in the philosophy of humanism and
• Caring is the primordial construct and caring, and it encourages nurses to utilize
consciousness of nursing phenomenological-hermeneutics through the lens of
caring
THEORY IN VIEW OF METAPARADIGMS
NURSING IMPLICATIONS OF THE THEORY
NURSING Clarity major structures are defined clearly,
holistic, relational, spiritual and ethical caring that consistent with definitions commonly used by
seeks the good of self and others in complex practicing nurses
community, organizational and bureaucratic cultures Simplicity the theory simplifies the dynamics of
PERSON complex bureaucratic organizations
a spiritual and cultural being. are created by God, the Generality the theory addresses the nature of nursing
Mystery of Being and engage co-creatively to find as caring, "What is the nature of caring in nursing?”,
meaning and value. "What is the nature of nursing practice as caring?".
Philosophies are broad and provide direction for the
discipline.
HEALTH Accessibility has undergone continued revisions
provides a pattern of meaning for individuals, based largely on research, empirical precision is high
families, and communities. Beliefs and caring with concepts grounded in observable reality
practices about illness and health are central features Importance issues that confront nurses today include
of culture. economic constraints in the managed care
ENVIRONMENT environment and the effects of these constraints
a complex spiritual, ethical, ecological, and cultural (staffing ratio) on the nurse patient relationship.\
phenomenon. It embodies knowledge and conscience
about the beauty of life forms and symbolic systems MODULE 5 MYRA E. LEVINE'S
or patterns of meaning. These patterns are transmitted CONSERVATION MODEL MARTHA E.
historically and are preserved or changed through ROGER’S SCIENCE OF UNITARY HUMAN
caring values, attitudes, and communication. BEING CONCEPTUAL MODELS OF NURSING

APPLICATION TO NURSING MYRA E. LEVINE'S CONSERVATION

• Nursing Practice (Administration & Leadership) MODEL
 • “Nursing is a human interaction that promotes ✔ providing meaningful social
adaptation and maintains wholeness either by acting activities for residents and staff,
in the therapeutic sense or by providing supportive considering the family and resident as a
care in order to influence adaptation favorably, or unit
toward renewed social wellbeing.”
✔ This is focused on the preservation of the Major Concepts & Definitions
individual’s wholeness or totality. CONSERVATION
✔ She believed that nursing activities were → describes the way complex systems are able to
conservation activities, a keeping-together function continue to function even when severely challenged
that promotes wholeness in the patient. → it is through conservation that man is able to
Four Principles confront obstacles, adapt accordingly, and maintain
1. Conservation of Energy – all physiologic their uniqueness and individuality, from Latin word
and psychological processes that sustain conservation which means “to keep together”
life depend on the body’s energy balance WHOLENESS
✔ adjusting to life in the nursing home → emphasizes a sound, organic, progressive,
✔ improving nutritional status, mutuality between diversified functions and parts
balancing resident activity within an entirety, the boundaries of which are open
✔ controlling resident anxiety and pain and fluent
2. Conservation of Structural Integrity – all → it connotes integrity – the oneness of persons,
body systems decline with aging; chronic highlighting their capacity to respond in an integrated
illness also produces bodily structural and singular fashion to environmental challenges
changes ADAPTATION
✔ maintaining or promoting mobility → the process of change wherein the person is able to
✔ preventing injury keep his integrity within situations and circumstances
✔ preventing infection of his environment, both internal and external
✔ maintaining skin integrity → it is the bridge; the process by which individuals
3. Conservation of Personal Integrity – self- fit the environments in which they live → health and
identity is intrinsically bound to disease are patterns of adaptive change
wholeness and all individuals cherish the → the goal of adaptive change is the conservation of
sense of self; it includes recognition of wholeness (health) and integrity
the holiness of each person → the result of adaptation is conservation which has
✔ respecting one’s privacy and 3 characteristics:
property ✔ Historicity – patterned responses passed on
✔ enhancing self-esteem through good through genetics
personal hygiene, grooming and dressing ✔Specificity – unique adaptive responses to
✔ fostering independence through specific environmental challenges
choice and rehabilitation ✔ Redundancy – availability of multiple
✔ promoting self-identity for those adaptive responses
who are cognitively impaired → Levine suggests “the possibility exists that aging
✔ obtaining advance directives for itself is a consequence of failed redundancy of
treatment physiological and psychological processes”
4. Conservation of Social Integrity –
individual life has meaning only in the
context of social life ENVIRONMENT
→ Internal environment – composed of the NURSING
physiologic and pathophysiologic domains of the • “Nursing intervention must be founded not only on
person scientific knowledge, but specifically on recognition
→ External environment has three levels: of the individual’s behavioral responses which
1.Perceptual level – includes all aspects of the indicate the nature of the adaptation taking place.”
world wherein the person is able to intercept and • The goal of nursing care is to support adaptation
interpret with his sense organs. and the strong drive of the individual to seek
2. Operational level – refers to things that wholeness. Because of the uniqueness of each
physically affect the individual but may not be individual, nursing care for each patient must be
perceived by the individual himself. highly individualized. Nursing interventions are both
3. Conceptual level – the environment is the therapeutic and supportive.
product of cultural patterns, characterized by
spirituality, and moderated by language, history, PERSON
and thought. • This refers to holistic being; wholeness is integrity.
ORGANISMIC RESPONSE Integrity means a person has a freedom of choice and
→ refers to the person’s ability to adapt to his or her movement.
environment and is made up of four levels of HEALTH
Integration: • This is the ability to function in a reasonable
1. Fight or flight – the most primitive response; the manner. Theory in View of Metaparadigms:
person either “fights” or “flies away” from a
perceived stressor in order to ensure his own safety ENVIRONMENT
and well-being • This is not a passive backdrop, the individual
2. Inflammatory response – body defense actively participates in his environment. The process
mechanism that protects the body tissue from of interaction is adaptation.
insults in an unfriendly environment
3. Response to stress – refers to the wear and tear Application to Nursing Community
of body tissues that reflect the body’s continued • Conservation principles have been used as a
response and adaptation to stressful situations framework for numerous practice settings by
4. Perceptual awareness / Sensory response – it identifying the activities it encompasses and giving
occurs as the person experiences life and the world the scientific principles behind them.
around him
TROPHICOGNOSIS MARTHA E. ROGER’S SCIENCE OF
→ a scientific method of reaching a nursing care UNITARY HUMAN BEING CONCEPTUAL
judgment; an alternative recommendation of Levine MODELS OF NURSING
to Nursing Diagnosis “Nursing is an art and science that seeks to promote
symphonic interaction between the environment and
Theoretical Assertions man, to strengthen the coherence and integrity of the
• "A holistic approach to care of all people, well or human beings, and to direct and redirect patterns of
sick." interaction between man and his environment for the
✔ Decisions for nursing interventions must be realization of maximum health potential.”
based on the unique behavior of the individual • It provides a framework for nursing practice,
patient. education, and research that promises a move away
from the previous predominant medical model
Theory in View of Metaparadigms: approach to the delivery of nursing care.
• Rogers formulated five basic assumptions that which cannot be predicted form knowledge of the
describe man and the life process in man. parts”
• These assumptions or “building blocks” underlay The environmental field
the conceptual framework and consist of the concepts → is integral with the human field; each
of wholeness, openness, unidirectionality, pattern and environmental field is specific to its given human
organization, and sentience and thought. field Universe of open system
→ holds that energy fields are infinite, open, and
integral with one
• Four “critical elements” that are basic in the theory: Pattern
q Energy fields → is the “distinguishing characteristic of the energy
• Open system field perceived as a single wave”, which gives
• Pattern identity to the field
• Pan-dimensionality – was previously known as → human behavior can be regarded as manifestations
multidimensionality, and prior to that, four- of changing pattern
dimensionality → the pattern is constantly changing and might be
regarded as an indication of pain, illness or disease
MAJOR CONCEPTS AND DEFINITIONS → sentience and thought states that all of life, human
Wholeness beings are the only ones capable of abstraction and
→ refers to the state in which the human being is imagery, language and thought, sensation and
regarded as a unified whole which is more than and emotion
different from the sum of the parts Pan-dimensionality
Openness → is a nonlinear domain without spatial or temporal
→ where the individual and the environment are attitudes; it describes an infinite domain without
continuously exchanging matter and energy with each limits
other Open systems (openness) → it short, it is a unitary whole
→ describe the open nature of the fields, the
preferred terminology being that there is a Theory Assertions
“continuous process” without the mention of energy • Rogers viewed the person as an open system in
or matter constant process with the open system of the
Unidirectionality environment.
→ refers to where the life process exists along an • She added that man is a unified whole possessing
irreversible space time continuum his own integrity and manifesting characteristics
→ pattern and organization identify individuals and more than and different from the sum of his parts.
reflect their innovative wholeness • In continuously exchanging matter and energy with
Energy fields the environment, identified by pattern and
→ are the “fundamental unit of the living and the organization and reflects his innovative wholeness.
non-living” • This is characterized by the capacity for abstraction
→ they consist of the human energy field and the and imagery, language and thought, sensation, and
environment energy field emotion.
The human field
→ an “irreducible, indivisible, pan-dimensional Theory in View of Metaparadigms
energy field identified by pattern and manifesting Nursing
characteristics that are specific to the whole and
A learned profession and is both a science and an art caring for the ill and infirm was disappearing with the
Person An open system in continuous process with advent of increasingly technical care and treatment,
the open system that is the environment and whether nurses were becoming administrators
and researchers who increasingly relinquished the
Health Passive health concrete execution of care to other occupational
– to symbolize wellness and the absence of disease groups.
and major illness. ✔ Based on this work, she attained the doctor of
Environment philosophy degree from the University of Bergen in
-Associated to open systems 1984.

8 Concepts in Roget’s Nursing Theory Theoretical Sources: In analysis of profession of

• energy field nursing in the early 1970s, she looked to three
• resonance
• openness philosophers in particular:
• helicy
• pattern ▪ Karl Marx, the German philosopher, politician, and
• integrality
• pan- social theorist
dimensionality ▪ Edmund Husserl, the German philosopher and
• hemodynamic principles founder of phenomenology
Module 4: KARI MARTINSEN’S PHILOSOPHY OF ▪ Maurice Merleau-Ponty, the French philosopher and
CARING; KATIE ERIKSSON’S CARITATIVE phenomenologist of the body
CARING THEORY

KARI MARTINSEN’S PHILOSOPHY OF

CARING
• “Nursing is founded on caring for life, on
neighborly love, … At the same time, it is necessary Major Concepts & Definitions:
that the nurse is professionally educated…” Care
• This “forms not only the value base of nursing, but
Summary of Credentials and Background: is a fundamental precondition for our lives. Care is
✔ From 1972 to 1974, she attended the Department of the positive development of the person through the
Philosophy at the University of Bergen Good”.
✔ In her work for the graduate degree in philosophy → Care is a trinity: relational, practical, and moral
(Magister Artium), she grappled philosophically with simultaneously. Caring is directed outward toward
questions that had disturbed her as a citizen, a the situation of the other. In professional contexts,
professional, and a healthcare worker caring requires education and training.
✔ The dissertation Philosophy and Nursing: A → “Without professional knowledge, concern for the
Marxist and Phenomenological Contribution created patient becomes mere sentimentality”. She is clear
an instant debate and received much critical attention that guardianship negligence or sentimentality are not
✔ Period from 1976 to 1986 can be described as a expressions of care.
historical phase in her work & published several Professional judgment and discernment
historical articles → It is through the exercise of professional judgment
✔ Published a “lit torch” of a book with the in practical, living contexts that we learn clinical
provocative title, Caring Without Care? In this book, observation. It is “training not only to see, listen and
they raised important questions about whether nurses touch clinically, but to see, listen and touch clinically
were “moving away” from the sickbed, whether in a good way”.
→ “Because perception has an analogue character, it nature. It refers to boundaries for which we must
evokes variation and context in the situation”. have respect.
→ Discretion expresses professional knowledge → The untouchable zone creates a certain protective
through the natural senses and everyday language. distance in the relation; it ensures impartiality and
Moral practice is founded on care demands argumentation, theory, and professionalism.
→ “Moral practice is when empathy and reflection In caring, the untouchable zone is united with its
work together in such a way that caring can be opposite, which is openness, in which closeness,
expressed in nursing”. Morality is present in concrete vulnerability, and motive have their correct place.
situations and must be accounted for. Our actions → Openness and the untouchable zone constitute a
need to be accounted for; they are learned and unifying contradiction in caring
justified through the objectivity of empathy. Vocation
→ This means in concrete terms to discover how the → a demand life makes to us in a completely human
other will best be helped. Sincerity and judgment way, is given as a law of life concerning neighborly
enter into moral practice. love which is foundationally human
Person-oriented professionalism → an ethical demand to take care of neighbor, so
→ This is “to demand professional knowledge which nursing requires a personal refinement in addition to
affords the view of the patient as a suffering person, professional knowledge
and which protects his integrity. It challenges The Eye of the Heart
professional competence and humanity in a → the concept stems from the parable of good
benevolent reciprocation, gathered in a communal Samaritan
basic experience of the protection and care for life… → the heart says something about the existence of
It demands an engagement in what we do, it is about the whole person, about being touched or moved by
having an understanding of one’s position within a the suffering of the other and the situation the other
life context that demands something from us, and experiences
about placing the other at the centre, about the caring The Registering Eye
encounter’s orientation toward the other”. → objectifying, the perspective is that of the
observer; concerned with finding connections,
systematizing, ranking, classifying and placing in a
system
Sovereign life utterances → represents alliance between modern natural
→ These are phenomena that accompany the science, technology and industrialization
Creation itself. They exist as pre-cultural phenomena
in all societies; they are present as potentials.
→ They are beyond human control and influence.
Sovereign life utterances are openness, mercy, trust,
hope, and love. Theoretical Assertions:
→ Sovereign life utterances are preconditions for ✔ People are created dependent and relational. The
care, simultaneously as caring actions are necessary person is fundamentally dependent upon community
conditions for the realization of sovereign life and the creation.
utterances in the concrete life. ✔ To the created belong the sovereign life utterances.
The untouchable zone ✔ These are phenomena present in the service of life.
→ This refers to a zone that we must not interfere ✔ They create life, they release life's possibilities.
with in encounters with the other and encounters with
Theory in View of Metaparadigms:
Nursing formulation of how to understand and approach
▪ Caring is fundamental to nursing. patients and nursing. The ability to promote reflection
▪ Trinity of Caring: upon nursing practice in different contexts.
✔ Relational means that caring requires at least ▪ Nursing Education: Most nursing colleges make
two people. One has concern for the other. One good use of her texts, and works form part of the
suffers, the other will "grieve" and provides for the curriculum at a variety of educational levels.
alleviation of pain. Caring is the most natural and ▪ Nursing Research: Countless dissertations based on
fundamental aspect of the person's existence. practical, concrete, and more theoretical issues
✔ Practical is about concrete and practical action. discuss the relationship between empirical experience
Caring is t trained and learned through its practice. in light of her terminology and philosophy.
✔ Moral refers to "if caring is to be genuine, must
relate to the other from an attitude which Implications of the Theory:
acknowledges the other in light of his situation”. Clarity
Must NOT overestimate or underestimate his Clearly states that life has been created and given to
ability to help himself. us.
Person Created in dependence on each other and on nature.
This means bearing fellowship of tradition that turns Caring for each other and for nature is fundamental.
the individual into a person. Simplicity She used a poetic and philosophical rather
✔ Parallel between the person and the body than a scientific mode of speaking.
✔ Bodies that we relate to ourselves, to others and Wrote general phenomena that affect us all, and that
to the world. It is the unit of soul and flesh, or could easily recognize in our personal lives,
spirit and flesh. occupational or daily lives.
✔ As bodies, we both perceive and understand. Generality
Health Health does not only reflect the condition of This seems to be relevant for all patients who,
the organism. It is also an expression of the current because of illness or other reasons, need help and
level of competence in medicine. The tendencies of assistance:
the modern concept of health are such that if one Accessibility
has an unnecessary 'defect' or an organ which The patient's and the nurse's worlds of experience are
'could' be better, one is not completely healthy. diverse, nuanced, and multifaceted. A nuanced and
✔ IMPORTANT is to cure sometimes, help often varied language is required to deal with a
and comfort always. multifaceted reality. This enables us to performed
Environment situation- dependent, good nursing - a professional
Space and situation – a person is always in a moral practice. Importance Caring community is not
particular situation in a particular space. In space are dictatorial, nor is it society's passive arm. It exists
found time, ambience, and power. ✔ Our only to the extent that we struggle for its existence.
interaction with each other, use of objects, words, we must form it through solidarity, through morally
knowledge, our being-in-theroom- all set the tone and responsible action, through the fight for greater
color the situation and the space. equality and for community and social integration.
✔ Our challenge is to give patients and each other Caring is an active and radical concept
dignity in these spaces.
Application to Nursing:
▪ Nursing Practice: Caring is practically relevant as
an overarching/general philosophy of nursing. It is KATIE ERIKSSON’S CARITATIVE CARING
clearly articulated and encompasses a precise THEORY
“Caritative caring means that we take “caritas” into → It is a form of intimate connection that
use when caring for the human being in health and characterizes caring. Caring communion requires
suffering… meeting in time and space, an absolute, lasting
Caritative caring is a manifestation of the love that presence.
‘just exists’… → This is characterized by intensity and vitality, and
Caring communion, true caring, occurs when the one by warmth, closeness, rest, respect, honesty, and
caring in a spirit of caritas alleviates the suffering of tolerance. It cannot be taken for granted but pre-
the patient.” supposes a conscious effort to be with the other.
→ Caring communion is seen as the source of
Summary of Credentials and Background: strength and meaning in caring.
✔ From 1972 to 1974, she attended the Department of The act of caring
Philosophy at the University of Bergen. → This contains the caring elements (faith, hope,
✔ She is one of the pioneers of caring science in the love, tending, playing, and learning), involves the
Nordic countries. She has the ability from the categories of infinity and eternity, and invites deep
beginning to design caring science as a discipline, communion.
while bringing to life the abstract substance of caring. → The act of caring is the art of making something
✔ She was born on November 18, 1943, in Jakobstad, very special out of something less special.
Finland. Dignity
→ This constitutes one of the basic concepts of
Theoretical Sources: caritative caring ethics. Human dignity is partly
Her leading thoughts have been not only to develop absolute dignity, partly relative dignity.
the substance of caring, but also to develop caring → Absolute dignity is granted the human being
science as an independent discipline. through creation, while relative dignity is influenced
C She wanted to go back to the Greek classics by and formed through culture and external contexts.
Plato, Socrates, and Aristotle, from whom she found → A human being’s absolute dignity involves the
her inspiration for the development of both the right to be confirmed as a unique human being.
substance and the discipline of caring science. Invitation
▪ From her basic idea of caring science as a → This refers to the act that occurs when the carer
humanistic science, she developed a meta-theory that welcomes the patient to the caring communion.
she refers to as “the theory of science for caring → The concept of invitation finds room for a place
science”. where the human being is allowed to rest, a place that
breathes genuine hospitality, and where the patient’s
Major Concepts & Definitions: appeal for charity meets with a response.
Caritas Suffering
→ Caritas means love & charity.In caritas, eros and → This is an ontological concept described as a
agapé are united, and caritas is by nature human being’s struggle between good and evil in a
unconditional love. state of becoming.
→ Caritas, which is the fundamental motive of caring → Suffering implies in some sense dying away from
science, also constitutes the motive for all caring. something, and through reconciliation, the wholeness
→ It means that caring is an endeavor to mediate of body, soul, and spirit is recreated, when the human
faith, hope, and love through tending, playing, and being’s holiness and dignity appear.
learning. → Suffering is a unique, isolated total experience and
Caring communion is not synonymous with pain. Suffering related to
illness, to care, and to life
→ This is related to illness and is experienced in → Established it in empiricism by systematically
connection with illness and treatment. When the employing a hermeneutical and hypothetical
patient is exposed to suffering caused by care or deductive approach. In conformity with a human
absence of caring, the patient experiences suffering science and hermeneutical way of thinking, Eriksson
related to care, which is always a violation of the developed a caring science concept of evidence.
patient’s dignity. → Her main argument for this is that the concept of
→ Not to be taken seriously, not to be welcome, evidence in natural science is too narrow to capture
being blamed, and being subjected to the exercise of and reach the depth of the complex caring reality.
power are various forms of suffering related to care. → Her concept of evidence is derived from
In the situation of being a patient, the entire life of a Gadamer’s Concept of Truth, which encompasses the
human being may be experienced as suffering related true, the beautiful, and the good.
to life.
The suffering human being Major Assumptions:
→ This is the concept that Eriksson uses to describe Eriksson distinguishes between two kinds of major
the patient. The patient refers to the concept of assumptions:
patiens (Latin), which means “suffering”. 1.Axioms as fundamental truths in relation to the
→ The patient is a suffering human being, or a conception of the world.
human being who suffers and patiently endures. 2.Theses are fundamental statements concerning
Reconciliation the general nature of caring science.
→ It refers to the drama of suffering. Reconciliation
implies a change through which a new wholeness is Axioms as fundamental truths in relation to the
formed of the life the human being has lost in conception of the world. These are as follow:
suffering. ✔ The human being is fundamentally an entity of
→ In reconciliation, the importance of sacrifice body, soul, and spirit.
emerges. Having achieved reconciliation implies ✔ The human being is fundamentally a religious
living with an imperfection with regard to oneself and being.
others but seeing a way forward and a meaning in ✔ The human being is fundamentally holy. Human
one’s suffering. dignity means accepting the human obligation of
→ Reconciliation is a prerequisite of caritas. serving with love, of existing for the sake of others.
Caring culture ✔ Communion is the basis for all humanity. Human
→ Concept that Eriksson uses instead of beings are fundamentally interrelated to an abstract
environment. It characterizes the total caring reality and/or concrete other in a communion.
and is based on cultural elements such as traditions, ✔ Caring is something human by nature, a call to
rituals, and basic values. serve in love.
→ It transmits an inner order of value preferences or ✔ Suffering is an inseparable part of life. Suffering
ethos. and health are each other’s prerequisites.
→ Respect for the human being, dignity and holiness, ✔ Health is more than the absence of illness. Health
forms the goal of communion and participation in a implies wholeness and holiness.
caring culture. ✔ The human being lives in a reality that is
→ The origin of the concept of culture is to be found characterized by mystery, infinity, and eternity.
in such dimensions as reverence, tending, cultivating, ✔ Ethos confers ultimate meaning on the caring
and caring; these dimensions are central to the basic context.
motive of preserving and developing a caring culture. ✔ The basic motive of caring is the caritas motive.
Use of empirical evidence ✔ The basic category of caring is suffering.
✔ Caring communion forms the context of meaning belonging in a larger communion. The human being
of caring and derives its origin from the ethos of love, is fundamentally dependent on communion; where he
responsibility, and sacrifice, namely, caritative ethics. can give and receive love, experience faith and hope,
and be aware that his existence now has meaning. the
Theses are fundamental statements concerning the human being we meet in care is creative and
general nature of caring science. These are as follow: imaginative, has desires and wishes, and is able to
✔ Health means a movement in becoming, being, and experience phenomena; So, a human being only in
doing while striving for wholeness and holiness, terms of his needs is insufficient. When the human
which is compatible with endurable suffering. being is entering the caring context, he becomes a
✔ Caring implies alleviation of suffering in charity, patient in the original sense of the concept — a
love, faith, and hope. Natural basic caring is suffering human being.
expressed through tending, playing, and learning in a Health
sustained caring relationship, which is asymmetrical Defines health as soundness, freshness, and well-
by nature. being. Implies being whole in body, soul, and spirit.
→ These kinds of major assumptions had their Health means as a pure concept wholeness and
validity tested through basic research. holiness. She sees health as both movement and
→ Axioms and theses jointly constitute the ontology integration. Health as movement implies a change; a
of caring science and therefore also are the human being is being formed or destroyed, but never
foundation of its epistemology. completely; health is movement between actual and
potential; health is movement in time and space;
Theory in View of Metaparadigms: health as movement is dependent on vital force and
Nursing on vitality of body, soul, and spirit; the direction of
Love and charity, or caritas, as the basic motive of this movement is determined by the human being’s
caring, principal idea. The foundation of the caring needs and desires; the will to find meaning, life, and
professions through the ages has been an inclination love constitutes the source of energy of the
to help and minister to those suffering. movement; and health as movement strives toward a
Caring is something natural and original. Eriksson realization of one’s potential.
thinks that the substance of caring can be understood ENVIRONMENT
only by a search for its origin. This origin is in the Good caring and true knowledge become visible
origin of the concept and in the idea of natural caring. through ethos. Ethos originally refers to home, or to
The fundamentals of natural caring are constituted by the place where a human being feels at home. It
the idea of motherliness, which implies cleansing and symbolizes a human being’s innermost space, where
nourishing, and spontaneous and unconditional love. he appears in his nakedness. Ethos means that we feel
Person called to serve a particular task. This ethos she sees
The conception of the human being in Eriksson’s as the core of caring culture. Ethos, which forms the
theory is based on the axiom that the human being is basic force in caring culture, reflects the prevailing
an entity of body, soul, and spirit. The human being priority of values through which the basic
is fundamentally holy, and this axiom is related to the foundations of ethics and ethical actions appear.
idea of human dignity, which means accepting the
human obligation of serving with love and existing Application to Nursing: Nursing Practice:
for the sake of others. The human being is seen as Eriksson’s thinking and process model of caring are
constantly becoming; he is constantly in change. The general, the nursing care process model has proved to
dual tendency of the human being also emerges in his be applicable in all contexts of caring, from acute
effort to be unique, while he simultaneously longs for
clinical caring and psychiatric care to health- • Every new concept becomes a part of an ever more
promoting and preventive care. comprehensive whole in which an element of internal
It has been influential in nursing leadership and logic can be seen clearly.
nursing administration, where the caritative theory of Her main thesis has always been that basic
nursing forms the core of the development of nursing conceptual clarity is needed before developing the
leadership at various levels of the nursing contextual features of the theory.
organization. Used concept analysis and analysis of ideas as central
Her ideas about caring and her nursing care methods, which has led to semantic and structural
process model work in practice has been verified by clarity.
everything from a multiplicity of essays and tests of Simplicity
learning in clinical practice to master’s theses, •The theoretical clarity of Eriksson’s theory reflects
licentiates’ theses, and doctoral dissertations the simplicity of the theory by showing the general in
produced all over the Nordic countries. a clear and logical conceptual entirety.
•The hermeneutic approach has deepened the
Application to Nursing: understanding of the substance and thus contributed
Nursing Education: to the simplicity of the theory formulates this process
•Eriksson’s theory has been integrated into the by the statement that “ideals reach reality and reality
education of nurses at various levels, and her books reaches the ideals”. Implications of the Theory: \
have been included continuously in the examination Generality
requirements in various forms of nursing education •The theory is general in the sense that it aims at
has been based entirely on Eriksson’s ideas, and her creating an ontological and ethical basis of caring,
caritative caring theory forms the core of the while at the same time it constitutes the core of the
development of substance in education and research. discipline and thus involves epistemology as well. It
• Development of the caring science was stressed the importance of describing the core
–centered curriculum and caring didactics continued concepts on an optimal level of abstraction in order to
in the educational and research program in caring include all of the complex caring reality that
science didactics offered as part of continuing simultaneously carries a wealth of signification that
education for those who work in clinical practice. opens up understanding in various caring contexts.
•Sees caring science not as profession oriented but as Accessibility
a “pure” academic discipline, it has aroused interest •Eriksson’s thinking as a whole has reached an
among students in other disciplines, that genuine understanding that extends to other disciplines and
interdisciplinary cooperation is needed between professions. She has developed a language and a
caring science and medicine. rhetoric that has reached researchers as well as
• Most nursing colleges make good use of her texts, practitioners in the human scientific field.
and works form part of the curriculum at a variety of •The empirical precision of Eriksson’s theory
educational levels. demonstrated in multiple deductive testing manifests
a combination of the clarity, simplicity, and
Countless dissertations based on practical, concrete, generality of the theory combined with a rich
and more theoretical issues discuss the relationship substance and clearly formulated ethos.
between empirical experience in light of her
terminology and philosophy. Importance
• Eriksson’s work on developing her caritative caring
Implications of the Theory: theory for 30 years has been successful, and
Clarity particularly in the Nordic countries there is abundant
evidence that her thinking is of great importance to that the thought of human holiness and dignity is
clinical practice, research, and education, and also to always kept alive in all phases of the search for
the development of the caring discipline. By her knowledge. Ethics precedes ontology in theory as
development of the caritative theory of care, Eriksson well as in practice.
created her own caring science tradition, a tradition ▪ Eriksson’s caring science tradition and discipline of
that has grown strong and has set the tone for nursing caring science form a basis for the activity at the
advancement and caring science. Department of Caring Science. Eriksson’s caritative
caring theory and the discipline of caring science
Summary: have inspired many, and they are used as the basis for
▪ She has been a guide and visionary who has gone research, education, and clinical practice.
before and “ploughed new furrows” in theory
development. Eriksson’s caritasbased theory and her
whole caring science thinking have developed over
years. Characteristic of her thinking is that while she
is working at an abstract level developing concepts
and theory, rooted in clinical reality and teaching.

▪ The whole caritative theory and the caring that are

built up around the theoretical core get their Module 6: Theoretical Foundations in Nursing DOROTHEA
OREM’S SELF-CARE DEFICIT MODEL IMOGENE KING’S
distinctive character and deeper meaning. The INTERACTING SYSTEMS FRAMEWORK AND GOAL
ultimate goal of caring is to alleviate suffering and ATTAINMENT THEORY
serve life and health.
▪ Knowledge formation, which Eriksson sees as a Dorothea Orem’s Self-Care Deficit Model
hermeneutic spiral, starts from the thought that ethics “ Nursing is a helping profession of assisting patients
precedes ontology. In a concrete sense, this implies overcome or compensate for their healthassociated
limitations and engaging in actions to regulate their • Based on the philosophy “patients wish to care for
own functioning and development or that of their themselves”
dependents.” • When unable to meet own self-care requisites,
• The model is a collection of three interrelated • Duty and obligation of the professional nurse to
theories recognize and identify these deficits in order to define
• Nursing systems a support intervention
• Self-care • Self-care deficit
• The focus of Orem’s model is to enhance the MAJOR DEFINITIONS
person’s ability for selfcare and this also extends to SELF-CARE
the care of dependents • Practice of activities that maturing and mature
• A person’s self-care deficits are the result of individuals initiate and perform
environmental situations • Ensures maintaining life, healthful functioning,
• Theoretical sources continuing personal development and vital to human
• Philosophical system of moderate realism functioning •
• Three systems that exist within this model SELF-CARE Requisites
1. Wholly Compensatory System 1. Universal self-care requisites
• Nurse provides total care 2. Developmental self-care requisites
2. Partially Compensatory System 3. Health deviation requisites
• Nurse and patient share
responsibility for care 1.Universal self-care requisites
3. Supportive-Educative System • Needs that all people have
• Client has primary responsibility for • Air, water, food, elimination, activity and rest,
personal health, with nurse acting as a solitude and social interaction, hazard prevention,
consultant and promotion of normal functioning
2.Developmental self-care requisites
• Needs related to the development of the
individual
• Engagement in self-development, overcoming
effects of human conditions, life situations
affecting human development
3.Health deviation requisites
• Needs that arise as a result of a patient’s
condition
• Pathological conditions, defects, deformities
and disabilities

Therapeutic self-care demand

• Totality of nursing care measures important at
certain times or over a period of time
• Basic Premise is that individuals can take Nursing agency
responsibility for their health and the health of others • Developed capabilities of nurses to meet the
• Individuals have the capacity to care for themselves therapeutic self-care demands of a patient
or their dependents
 3. Social system Interacting System
Self-care agency Framework
• Complex acquired ability of mature and maturing 1. Personal Systems
individuals to know and meet their continuing • Body image
requirements for human functioning and development • Growth and Development
• Dependent-care agent • Perception
• Maturing adolescent who accepts and fulfills the • Self
responsibility to know and meet the therapeutic self- • Space and Time
care demand • When two or more persons interact, they form an
• Nursing systems interpersonal system
• Series and sequences of deliberate practical actions Interpersonal system
of nurses • Two or more persons interact
• Communication
Theoretical Assertions • Interaction
• Nursing systems are action systems formed by • Role
nurses • Stress
• Deliberate action, intentionality, diagnosis, • Transaction
prescription and regulation • A comprehensive interacting system is composed of
• Self-care is performed by the person himself or groups that make a society
have them performed by another person in order to 3. Social system
maintain life, health, development, and well-being • Authority • Irreversible
• Decision making • Moving forward in
Application to Nursing Community • Organization time Power
• Emphasis on education and supportive measures • • Status • Personal
Important aspect of clinical nursing- • Dynamic
Gain Attainment Theory
HEALTH TEACHINGS IMOGENE KING’S • Middle-Range Theory
INTERACTING SYSTEMS FRAMEWORK AND • Product of developments from Interacting
GOAL ATTAINTMENT THEORY Systems Framework
“Nursing is an observable behavior found in the • Mutual Goal-Setting between a nurse and a client
health care systems in society that aims to help • Nurse Assessment of clients concerns, problems,
individuals maintain their health so they can function and disturbances in health
in their roles” • Nurse and Client perceptions of the interference
• Nurse and Client sharing of information
Interacting System Framework • Nurses interact with family when clients cannot
• This theory emphasizes the importance of the participate
interaction between the nurse and patients • Focused on interpersonal system specifically nurse-
• Views this interaction as an open system in client relationship
constant interaction with a variety of environmental • Open system which allows feedback
factors

• Three Interrelated Systems

1. Personal Systems 8 Propositions Related to Goal Attainment
2. Interpersonal system Theory
1. IF perceptual accuracy is present in interactions, • Perceptual
then transactions will occur • Transactional
2. IF nurse and client make transactions, then goals Role
will be attained • Reciprocity- giver or taker
3. IF goals are attained, then satisfaction will occur • Learned, social, complex and situational
4. IF goals are attained, then effective nursing care Authority
will occur • Active, reciprocal process of transaction
5. IF transactions are made, then growth and • Experience, understanding, and values influence
development will be enhanced meaning, legitimacy and acceptance
6. IF role expectations and role performance are Status
congruent, then transactions will result • Relationship of one’s place in a group to others in
7. IF role conflict is experienced, then stress in nurse- the group or other groups
relationship interactions will occur Decision-Making
8. IF nurses with special knowledge and skills • Process where choices are made related to goals
communicate appropriate information to clients, then Time
mutual goal setting and goal attainment will occur • Interval between events experienced differently by
each person
Major Concepts and Definitions
Perception Theory Assumptions
• Process where data obtained from senses and • The focus of nursing is care of the patient
memory are organized, interpreted and transformed • The goal of nursing is health care of both
Stress individuals and groups
• Keeping equilibrium to support growth and • Humans beings are open systems interacting with
development and activity the environment
• Making use of resources to meet both personal and • Nurse and patient communicate, set goals, and
organizational goals achieve goals
The Self • World as a complete person making transactions
• Thoughts and feelings related to one’s awareness of • The transaction represents a life situation
being a person
Growth and Development
• Process of moving from potential for
achievement to actualization of self Major
Concepts and Definitions
Body Image
• Both the way one perceives one’s body and
others’ reactions to one’s appearance
Space
• Territory and the behaviors of those who occupy
it
Interactions
• Observable behaviors of two or more persons in
mutual presence • Perceiver and thing being perceived
Communication • Person as active participant
• Verbal and non-verbal
 • Changed by experiences • Client derives full value from what the nurse offers
through the relationship
Resolution
• Old needs and goals are set aside and new ones are
adopted

6 Proposed Nursing Roles

1.Stranger Role
• Nurse receives client as a stranger and builds trust
2.Resource Role
• Nurse answers questions, interprets clinical data,
Module 8: Theoretical Foundations in Nursing HILDEGARD and gives information
PEPLAU’S THEORY OF INTERPERSONAL RELATIONSHIP
IDA JEAN ORLANDO’S THEORY OF DELIBERATIVE
3.Teaching Role
NURSING PROCESS • Nurse gives instructions and provides training

HILDEGARD PEPLAU’S THEORY OF 4.Counseling Role

INTERPERSONAL RELATIONSHIP • Nurse helps clients understand the meaning of
Nursing is the interpersonal therapeutic process of current life circumstances and provides guidanc
functioning cooperatively with other human 5.Surrogate Role
processes that make health possible for individuals in • Nurse helps clients clarify domains of dependence,
communities through education that aims to promote interdependence, and independence
forward movement of personality.” 6. Active Leadership Role
• Nurse helps the client assume maximum
Hildegard Peplau’s Credentials and Background responsibility for meeting treatment goal
• “Mother of Psychiatric Mental Health Nursing”
• “Nurse of the Century” Theoretical Assertions
• Executive Director and President of the American • Nurse and the patient can interact
Nurses Association (ANA) • Peplau emphasized that both the patient and nurse
• Taught 1st classes for graduate psychiatric nursing mature as a result of the therapeutic interaction
at Teachers College, Columbia University • Communication and interviewing skills remain
• Four psychological experiences: needs, frustrations, fundamental tools
conflicts, and anxieties • Peplau believed that nurses must clearly understand
themselves to promote their client’s growth and avoid
4 Phases of the Nurse-Patient Relationship limiting choices to nurses value
Orientation
• Phase where the client seeks help and the nurse
assists the client to understand the problem and extent
of help
Identification
• Client assumes posture of dependence,
interdependence or independence in relation to the
nurse
Exploitation
 • Abraham (2011) used theory to help nurses
achieve more successful patient outcomes such as
fall reduction
• Most effective practice theory for new nurses

Nursing Process Theory:

3 Basic Elements
1. The behavior of the patient
2. The reaction of the nurse
3. The nursing actions which are designed for the
patient’s benefit
IDA JEAN ORLANDO’S THEORY OF
DELIBERATIVE NURSING PROCESS
Major Concepts and Definitions
“Nursing is a profession that seeks to find out
Need
and meet the patient’s immediate need for help.”
• Requirement of the patient which relieves or
diminishes his immediate distress if this is supplied
IDA JEAN ORLANDO’S Credentials and
Presenting behavior of patient
Background
• Any observable verbal or nonverbal behavior of the
• Yale University
patient
• Integrated mental health into basic nursing
Immediate Reactions
curriculum
• The nurse’s and the patient’s individual
• Emphasized patient’s participation in nursing
perceptions, thoughts, and feelings
process
Nursing process discipline
• Theory focuses on improving patient’s behavior
• Nurse communicating with patient his or her
• Proposed that patients have their own meanings and
immediate reaction
interpretations of situations
• Ask for validation, clarification, or correction from
the patient
• “Deliberative Nursing Process”
Theory Description
Automatic nursing actions
• Theory stresses the reciprocal relationship between
• Activities decided upon for reasons other than the
patient and nurse
patient’s immediate need
• Persons become patients who need help because
• They have physical limitations
Deliberative nursing actions
• They have negative reactions to an environment
• Those decided upon after ascertaining a need and
• They have an experience that prevents them
then meeting this need
from communicating their needs
• Patients are distress or helpless because of unmet
Theory Assumptions
needs for help
• When patients cannot cope with their needs, they
• Positive correlation between length of time of
become distressed and helpless
unmet needs and degree of distress (Immediacy)
• Nursing adds to the distress of the patient
• When individuals meet their own needs, they do not
• Patients are unique and individual in how they
feel distress and do not require care from nurses
respond
• Crucial for nurses to share their perceptions,
• Nursing deals with people, the environment, and
thoughts, and feelings (Schmieding, 2006)
health
• Patients need help communicating their needs LIFE STORY
• People can be secretive or explicit about their • A psychiatric nurse, educator, and writer born in in
needs, perceptions, thoughts, and feelings 1926
• The nurse-patient situation is dynamic • 1956, she completed her BSN degree at Louisiana
• People attach meanings to situations and actions State University
• Patients enter into nursing care through medicine • 1959, she completed her Master of Science Degree
• Patient cannot state the nature and meaning of their in Nursing at Yale University
distress without the nurse’s help • She started a Doctoral program in Florida in 1973.
• Any observation shared and observed with the Unfortunately, she was not able to finish it because
patient is immediately helpful she died later that year. She passed away at the prime
• Nurses are concerned with the needs the patient is age of 47 after a brief sickness
unable to meet on his or her own WORKING EXPERIENCE
• 1952, Psychiatric Nursing Instructor at DePaul
Hospital Affiliated School, New Orleans.
• Also, she taught at Charity Hospital School of
Nursing in Louisiana University School of
Nursing, New York University, and University
of Mississippi.
• 1970, the Project Director of
GraduateEducation at Louisiana State University
of Nursing until her death.
PUBLICATIONS
• 1963, started to publish articles and journals in
nursing
• 1966 and 1971, publication of her first book
Application of the Theory entitled Interpersonal Aspects of Nursing.
• Framework will be important for nurses who are • 1969, when she published her 2nd book intervention
assigned in special clinical areas (OR, ER, and ICU/ in Psychiatric Nursing: Process in the
Critical Care Unit) One-to-One Relationship
• Reciprocal relationship between patient and nurse
remains a MOST EFFECTIVE PRACTICE THEORY CONCEPTS
THEORY • Travelbee believes the spiritual values a person
holds will determine to a great extent, his perception
of illness. The spiritual values of the nurse or her
philosophical beliefs about illness and suffering will
determine the degree to which he or she will be able
Module 9: Joyce Travelbee’s Human-to-Human to help ill persons find meaning, or no meaning, in
Relationship Model of Nursing & Ernestine Wiedenbach’s Helping
these situations.
Art of Clinical Nursing Theory
• Travelbee extended the interpersonal relationship
Joyce Travelbee’s Human-to-Human Relationship theories of Peplau and Orlando, but greatly
Model of Nursing emphasized on the therapeutic human relationship
“…human-to-human relationship is the means between the nurse and the patient.
through which the purpose of nursing is fulfilled.” • Her model emphasized: empathy, sympathy,
rapport, and emotional aspects of nursing.
• The establishment of a nurse-patient relationship Ernestine Wiedenbach’s Helping Art of Clinical
and the experience that rapport is the end of all Nursing Theory
nursing endeavors. “Nursing is the art of nurturing or caring for
• Travelbee’s other contribution to the nursing someone in a motherly fashion.”
profession included her works on illness, suffering,
pain, hope, communication, interaction, empathy,
sympathy, rapport, and therapeutical use of self.

RAPPORT
Is experiences when nurse and patient has progresses
through the four interlocking phases preceding
rapport
1. Original encounter
2. Emerging identities
3. Empathy
4. Sympathy

“A nurse is able to establish rapport because she

possesses the necessary knowledge and skills
required to assist ill persons and because she is able
to perceive, respond to and appreciate uniqueness of
the ill human being.”
“A nurse does not only seek to alleviate physical pain
or render physical care— she ministers to the whole
person. The existence of the suffering whether 4 ELEMENTS IN ART OF NURSING
physical, mental, or spiritual is the proper concern of PHILOSOPHY – what motivates the nurse to act in
the nurse.” a certain way
•Major Concept of her philosophy:
THE RAPEUTICAL USE OF S •Patient
ELF •Nurse
Ability to use one’s personality consciously and in •The nurse’s philosophy is their attitude and belief
full awareness to establish relatedness and to about life and how that affected reality for them
structure nursing intervention.
3 essential components associated with nursing
COMMUNICATION
philosophy:
vehicle through which nurse-patient relationships are
•Reverence for life
established.
•Respect for the dignity, worth, autonomy and
NURSE–PATIENTINTERACTION
individuality of each human being
An experience or series of experiences between nurse
•Resolution to act on personality and professionally
and patient.
held benefits
LOGICALFORM
PURPOSE
An inductive theory that uses specific nursing
•is that which the nurse wants to accomplish through
situations to create general ideas.
what she does
•It is all the activities directed towards the overall Are carried out to achieve a specific patient-centered
good of the patient purpose rather than completion of the skill itself
PRACTICE - are those observable nursing actions being the end goal.
that are affected by beliefs and feelings about SKILLS
meeting the patient’s need for help Are made up of a variety of action, and characterized
ART -Understanding patient’s needs and concerns by harmony of movement, precision, and effective
• Developing goals and actions intended to enhance use of self.
patient’s ability
• Directing activities related to the medical plan to
improve patient’s condition.

WAYS TO IDENTIFY PATIENTS’ NEED FOR

HELP
• Observing behavior consistent or inconsistent with
their comfort
• Exploring the meaning of their behavior
• Determining the cause of their discomfort or
incapacity
• Determining whether they can resolve their Module 10 NANCY ROPER-WINIFRED LOGAN-ALISON
TIERNEY'S MODEL OF NURSING BASED ON ACTIVITIES
problems or have a needfor-help OF LIVING & LYDIA HALL’S CARE, CURE, CORE THEORY
OF NURSING
THE PATIENT
Is any person who has entered the healthcare system NANCY ROPER-WINIFRED LOGAN-ALISON
and is receiving help of some kind, such as care, TIERNEY'S MODEL OF NURSING BASED ON
teaching, or advice. The patient need not be ill since ACTIVITIES OF LIVING
someone receiving health-related education would ✔ This model incorporates a life span approach
qualify as a patient. wherein the characteristics of the person are
NEED–FOR–HELP considered with respect to prior development, current
Is defined as any measure desired by the patient that level of development, and likely future development.
has the potential to restore or extend the ability to ✔ In conjunction with the life span approach an
cope with various life situations that affect health and independence/dependence continuum is used.
wellness. ✔ The model then incorporates a set of 12 activities
CLINICAL JUDGEMENT of living which represent those activities engaged in
Represents the nurse’s likeness to make sound by individuals whether sick or well.
decisions.
SOUND DECISIONS 12 ACTIVITIES OF LIVING
Are based on differentiating fact from assumption together these elements are referred to as a “model of
and relating them to cause and effect. It is the result living”
of discipline functioning mind and emotions and 1.Maintaining a safe environment
improves with expanded knowledge and increased 2.Breathing
clarity of professional purpose. 3.Communication
NURSING SKILLS 4.Mobilizing
5.Eating and Drinking → describe the person in the complex process of
6.Eliminating living from the perspective of an amalgam of
7. Personal cleansing and dressing activities Major
8. Maintaining body temperature Life span
9. Working and playing → refers to the concept of continuous change from
10. Sleeping 5 birth until death and may refer to developmental age
11. Expressing sexuality The dependence-independence continuum
12. Dying → relates to the factors and activities of the person
→ the continuum ranges from full incapacitation to
5 MAIN FACTORS THAT INFLUENCED THE having the ability to achieve activities of living
ADLS: → both concepts occur at anticipated points across
Biological the lifespan and at unexpected times throughout life
Psychological APPLICATION OF THE THEORY
Sociocultural • The Theory of the Elements of Nursing: A Model
Environmental Based on a Model of Living emphasizes the
Politico-economic importance of developmental assessment and of
individualizing patient care.
• No two patients can have similar reactions to a
particular disease condition or illness state because of
the concept of individuality of living.
• The first vital step towards high quality patient care
is for the nurse to individualize patient care and to
• The model has been a significant guide towards make a thorough nursing and health assessment.
advancing nursing practice, research, and education
in that it places great emphasis on the nurse’s ability
to perform continuous patient assessment, provide
assistance in the performance of activities of living LYDIA HALL’S CARE, CURE, CORE THEORY
and individualizing patient care OF NURSING
. • Health is viewed as a reflection of the person’s "Nursing is a distinct body of knowledge that
ability to perform the activities of living in the light provides nursing care to patients who are in need of
of the five factors that influence its degree of nursing care in support of medical interventions, in
performance and within the context of the person’s collaboration with other members of the health team,
developmental age. or exclusively and independently by the nurse
herself.”
Major Concepts & Definitions:
Individuality of living LYDIA HALL LIFE STORY:
→ the way in which the person attends to his ✔ Born in New York City September 21, 1906
activities of living with respect to his developmental ✔ Graduated from York Hospital School of Nursing
age or his place in the life span, on the in Pennsylvania
dependenceindependence continuum, and as ✔ Bachelor of Science & Master of Arts from
influenced by biological, psychological, Teachers College, Columbia University
environmental, and politico-economic factors ✔ Died February 27, 1969 of heart disease in Queens
The activities of living Hospital of New York
INTERESTS & RESEARCH FOCUS: ✔ As Hall says; “To look at and listen to self is often
✔ Research in the field of rehabilitation of too difficult
chronically ill patient’s brought her to develop the without the help of a significant figure (nurturer) who
Care, Cure, Core Theory has learned
✔ Interested in rehabilitative nursing and the role that how to hold up a mirror and sounding board to invite
the professional nurse played and the patient’s the behavior
recovery and welfare (Alligood & Tomey 2010) to look and listen to himself. If he accepts the
✔ She became the founder and first director of the invitation, he will
Loeb Center for Nursing and Rehabilitation at the explore the concerns in his acts and as he listens to
Montefiore Medical Center in Bronx, New York his exploration
✔ She became the founder and first director of the through the reflection of the nurse, he may uncover in
Loeb Center for Nursing and Rehabilitation at the sequence his
Montefiore Medical Center in Bronx, New York difficulties, the problem area, his problem, and
eventually the threat
Major Concepts & Definitions: which is dictating his out-of-control behavior.”
• Nursing theory in line with Lydia Hall is nothing Theory Assumptions
short of revolutionary.
• In the 1960s, she put down in her own simple
words, her thoughts about nursing.
• She did not consider herself a nurse theorist but
instead talked about her transparent thoughts and
remarkable ideas of nursing care as she learned it
over the years.
• These lead to the development of her “Care, Cure,
Core Theory” also known as the “Three C’s of Lydia
Hall”. • She believed that patients should receive care
only from professional nurses.
• Nursing involves interacting with a patient in a
complex process of teaching and learning. • The motivation and energy necessary for healing
• She was not pleased with the concept of team exist within the patient, rather than in the healthcare
nursing team.
• The three aspects of nursing should not be viewed
Theory Description as functioning
This theory defines Nursing as the “participation in independently but as interrelated.
care, core and • The three aspects interact, and the circles
cure aspects of patient care, where CARE is representing them change size, depending on the
the sole function of nurses, whereas the CORE and patient’s total course of progress.
CURE are shared
with other members of the health team.” Major Concepts & Definitions:
✔ The major purpose of care is to achieve an • Nursing theory in line with Lydia Hall is nothing
interpersonal short of revolutionary.
relationship with the individual that will facilitate the • In the 1960s, she put down in her own simple
development of words, her thoughts about nursing.
the core.
• She did not consider herself a nurse theorist but
instead talked about her transparent thoughts and Theory Assertions
remarkable ideas of nursing care as she learned it • Nursing is viewed as a distinct body of knowledge
over the years. that provides nursing care to patients who are in need
• These lead to the development of her “Care, Cure, of nursing care
Core Theory” also known as . • Care of patients can be performed in support of
the “Three C’s of Lydia Hall”. medical interventions, in collaboration with other
• She believed that patients should receive care only members of the health team, or exclusively and
from professional nurses. independently by the nurse herself. Nursing is
• Nursing involves interacting with a patient in a described as interacting with a patient in a complex
complex process of teaching and learning. process of teaching and learning.
• She was not pleased with the concept of team • The patient or person, in this case, is the recipient of
nursing. care which may come from three different domains.
SUBCONCEPTS
•Lydia Hall’s theory has three components which are Application of the Theory
represented by three independent but interconnected • Nurses are able to carry out nursing interventions
circles. The three circles are the care, the cure, and independently, dependently, or interdependently.
the core. • The core aspect of the theory maintains that it is our
•The size of each circle constantly varies and depends responsibility to make sure that the patient receives
on the state of the patient the highest level of care possible from all concerned
health professions.
• The role of the nurse is in the collaboration,
coordination, and cooperation with other members of
the health care team on matters that pertain to the
patient’s welfare.
• The cure aspect of the theory clearly delineates
nursing functions that are dependent on the members
of the medical profession.
• Examples of these include medication
administration, the performance of diagnostic
procedures, and some other interventions that need a
written order from the doctor.
• The care domain of the theory refers to the
independent roles and functions of the nurse insofar
as her knowledge and skills about the patient’s
How Do Nurses Relate?
condition will allow her to carry on with her
• She proposed many ideas of professional practice,
responsibilities.
such as the nursing process
Conclusion
• Improvement of nurses to meet the needs of the
• Hall believed patients should only receive care from
patient with better professional nursing care
professional nurses.
• Management of nursing care
• Hall defined her philosophy on the basis of the
• Establishment of the nurse-patient relationship
patient.
• Collaboration with other health professionals •
• Hall believed that patients come to the hospital in a
Deliverance of care to ill patients
biological crisis (acute episode of a disease) and that
medicine does a great job at treating this crisis but state of equilibrium or the state of adaptation
fails to treat the chronic underlying disease. This is developed and maintained over time and which is
where she felt nursing could make a significant considered normal for the person. o Second line of
difference. defense is flexible, dynamic, and can be readily and
• Hall felt that taking over this sub-acute phase was rapidly changed over a short period of time
the way for nursing to legitimize itself into a true • She classified stressors as intrapersonal,
profession interpersonal, and extrapersonal stressors.
• Man’s reaction to stress is dependent on the
integrity of the lines of resistance and defense.
• When the line of defense fails, man’s reaction will
MODULE 7 BETTY NEUMAN’S SYSTEMS MODEL SISTER now depend on the lines of resistance.
CALLISTA ROY’S ADAPTATION MODEL OF NURSING
DOROTHY JOHNSON’S BEHAVIORAL SYSTEMS MODEL
• Because of the reaction, man can adapt to a stressor
This is called reconstitution.
BETTY NEUMAN’S SYSTEMS MODEL • Therefore, nursing interventions focus on keeping
“Nursing is a unique profession that is or maintaining the stability of the open system. These
concerned with all of the variables affecting an interventions can be carried out on the three levels of
individual’s response to stress. prevention: primary, secondary, and tertiary. Major

BETTY NEUMAN’S SYSTEMS MODEL Concepts & Definitions:

• A unique, systems-based perspective that provides In holistic approach, the client as a whole, whose
a unifying focus for approaching a wide range of parts are in dynamic interaction with itself and the
nursing concerns. environment. It strongly advises the consideration of
• A comprehensive guide for nursing practice, all variables that simultaneously affect the client
research, education, and administration that is open to system.
creative implementation. In holistic approach, the client as a whole, whose
• It has the potential for unifying various health- parts are in dynamic
related theories, clarifying the relationships of interaction with itself and the environment. It
variables in nursing care and role definitions at strongly advises the
various levels of nursing practice. consideration of all variables that simultaneously
• Based on the person’s relationship to stress, his affect the client
reaction to it, and reconstitution factors that are system.
dynamic in nature.
• considers the person as an open system which is BETTY NEUMAN’S SYSTEMS MODEL
composed of a basic structure of energy resources. Open system
• These resources include physiologic, psychologic, • characterized by elements that are in continuous
sociocultural, developmental, and spiritual. exchange within a complex organization
• The basic structure, or central core, is surrounded • these exchanges may be in the form of information
by two concentric boundaries or rings called the lines or energy
of resistance. • basic to this is stress and stress reaction
• These lines represent the internal factors that aid Created environment
the person defend against a stressor. developed unconsciously by the client in order to
• The line of resistance is further surrounded by two express the wholeness of the system by using
lines of defense. o First line of defense is the person’s symbols
Client system
composed of the five system variables interacting • When examining the client’s basic makeup,
with the environment. predispositions are
1. Physiologic variables are body structure and considered. They are important because they affect
function how the client will deal with stressors.
2. Psychological variables include mental • The nurse also looks at Neuman’s five variables:
processes in interaction with the environment physiological, psychological, sociocultural,
3. Sociocultural variables are the effects and developmental and
influences of social and cultural conditions spiritual. The nurse uses these variables to
4. Developmental variables are age-related examine the person’s predispositions and stressors.
processes and activities throughout life • The client’s perception of these stressors is
5. Spiritual variables are beliefs and influences discussed and the nurse provides input.
related to spirituality • Stressors are identified as interpersonal,
Basic client structure intrapersonal or extrapersonal
composed of a central core surrounded by concentric
rings STEP 2: DIAGNOSIS,
the core reflects basic survival factors or energy PLANNING,IMPLIMENTATION
resources of the client •The next step addresses the nursing diagnosis, which
Lines of resistance describes the context of the whole client as a system.
represents resources that help the client defend •Goals are then determined in collaboration with the
against a stressor client.
normal line of defense reflects the client’s stability •Interventions are determined relative to the goals,
which serves as the guide to assess and are
deviations from the client’s usual wellness carried out at three levels: primary, secondary, and
Flexible line of defense tertiary
a protective layer for preventing stressors from prevention.
breaking through the usual wellness state
1. Intrapersonal factors occur within the individual IMPLEMENTATION STEP 3: EVALUATION
2. Interpersonal factors occur between one or more •The next step involves nursing outcomes which
individuals refers to
3. Extrapersonal factors occur outside the individualL evaluation of the effectiveness of interventions.
4. • This includes assessing changes in intrapersonal,
Reconstitution interpersonal, and extrapersonal factors.
occurs following the treatment of stressor reactions; •Any changes in the nature of the stressors are
marks the return of the client system to stability examined, as change in these areas determine the
Level of stability success of the nursing interventions.
after reconstitution, may be higher or lower than the •If change has not occurred, more data collection is
previous level before the invasion of the stresso required
and the nursing process is repeated.
Neuman employed a three-step Nursing Process:
STEP 1: ASSESSMENT Theoretical Assertions:
• In the initial assessment, the nurse looks at the • Each client system is unique, a composite of factors
client’s basic make-up and the known, unknown and and characteristics within a given range of responses.
universal stressors. • Many known, unknown, and universal stressors
exist. Each differs in its potential for disturbing a
client’s usual stability level or normal line of defense. Health is defined as the condition or degree of system
The particular interrelationships of client variables at stability and is viewed as a continuum from wellness
any point in time can affect the degree to which a to illness. When system needs are met, optimal
client is protected by the flexible line of defense wellness exists. When needs are not
against possible reaction to stressors. satisfied, illness exists. When the energy needed to
• Each client/client system has evolved a normal support life is not available, death occurs.
range of responses to the environment referred to as a Environment
normal line of defense. The normal line of defense The environment is a vital arena that is germane to
can be used as a standard from which to measure the system and its function. The environment may be
health deviation. viewed as all factors that affect and are affected by
• When the flexible line of defense is no longer the system. In Neuman Systems Model identifies
capable of protecting the client/client system against three relevant environments: (1) internal, (2) external,
an environmental stressor, the stressor breaks through and
the normal line of defense. (3) created.
Whether in a state of wellness or illness, the client is
a dynamic composite of the variables’ SISTER CALLISTA ROY’S ADAPTATION
interrelationships. MODEL OF NURSING
Wellness is on a continuum of available energy to • The model assumes that systems of matter and
support the system in an optimal system stability energy progress to higher levels of complex self-
state. organization.
Implicit within each client system are internal • Consciousness and meaning comprise person and
resistance factors known as lines of resistance, which environment
function to stabilize and realign the client to the usual integration while awareness of self and environment
wellness state is rooted in
thinking and feeling.
Theory in View of Metaparadigms • System relationships include acceptance, protection
Nursing and fostering of independence
Nursing’s primary concern is to define the • Man and his environment have common patterns
appropriate action in situations that are stress- related and integral
or concerning possible reactions of the client or client relationships and transformations are created in
system to stressors. Nursing interventions aim to help human consciousness.
the system adapt or adjust and retain, restore, or • Integration of man and environment meanings result
maintain some degree of stability between the client in adaptation.
system variables and environmental stressors, • Roy’s model of nursing is best exemplified in the
focusing nursing process.
on conserving energy.
The nursing process is a problem solving approach
Person for gathering data, identifying the capacities and
Humans are defined as “men, women, and children needs of
cared for either singly or as social units”and are the the human adaptive system, selecting and
“material object” of nurses and others who provide implementing approaches for nursing care, and
direct care. evaluating the
Health outcome of care provided. It includes the following
steps:
 • Physical and chemical processes are involved in
ASSESSMENT OFBEHAVIOR the function and activities of living organisms. These
The first step of the nursing process which involves are
gathering data about the behavior of the person as an the actual processes put in motion by the regulator
adaptive system in each of the adaptive modes subsystem.
• This mode’s basic need is composed of the needs
ASSESSMENT OF STIMULI associated with oxygenation, nutrition, elimination,
The second step of the nursing process which activity and
involves the identification of internal and external rest, and protection.
stimuli • This model’s complex processes are associated with
that are influencing the person’s adaptive behaviors. the senses, fluid and electrolytes, neurologic function,
Stimuli are classified as: and endocrine
✔ Focal – those most immediately confronting the function.
person Self-Concept Group Identity Mode
✔ Contextual – all other stimuli present that are • The goal of coping is to have a sense of unity,
affecting the situation meaning
✔ Residual – those stimuli whose effect on the the purposefulness in the universe, and a sense of
situation is unclear identity integrity. This includes body image and
NURSING DIAGNOSIS self-ideals.
Step three of the nursing process which involves the Role Function Mode
formulation of statements that interpret data about the • This focuses on the primary, secondary, and tertiary
adaptation status of the person, including the roles
behavior and most relevant stimuli that a person occupies in society and knowing where
GOAL SETTING they stand as a member of society.
The fourth step of the nursing process which involves Interdependence Mode
the establishment of clear statements of the • This mode focuses on attaining relational integrity
behavioral outcomes for nursing care through the giving and receiving of love, respect
INTERVENTION and value. This is achieved with effective
The fifth step of the nursing process which involves communication and relations.
the determination of how best to assist the person in
attaining the established goals Major Concepts & Definitions
EVALUATION Health
The sixth and final step of the nursing process which a state and process of being and becoming integrated
involves judging the effectiveness of the nursing and whole that reflects person and environmental
intervention in relation to the behavior after the mutuality
nursing intervention in comparison with the goal Adaptation the process and outcome whereby
established thinking and feeling persons, as individuals and in
groups, use conscious awareness and choice to create
Four Adaptive Modes: human and environmental integration
These are how the regulator and cognator Adaptive responses
mechanisms are manifested; in other words, responses that promote integrity in terms of the goals
they are the external expressions of the above and of the human system, that is, survival, growth,
internal processes. reproduction, mastery, and personal and
Physiological-Physical Mode environmental transformation
Ineffective responses coping mechanisms and eventually lead to better
responses that do not contribute to integrity in terms outcomes.
of the goals of the human system Person
Adaptation levels Based on Roy, humans are holistic beings that are in
represent the condition of the life processes described constant interaction with their environment. Humans
on three different levels: integrated, compensatory, use a system of adaptation, both innate and acquired,
and compromised. to respond to the environmental stimuli they
experience. Human systems can be individuals or
Theory Assertions: groups, such as families, organizations, and the
• Roy’s model views the person as an adaptive whole global community.
system with coping processes. Health
• She described the person as a whole comprising Health is defined as the state where humans can
parts and which functions as continually adapt to stimuli. Because illness is a part
a unity for some purpose. of
• It includes people as individuals or in groups life, health results from a process where health and
(families, organizations, communities, nations, and illness can coexist. If a human can continue to adapt
society as whole). holistically, they will maintain health to reach
• The person is an adaptive system with cognator and completeness and unity within themselves. If they
regulator subsystems acting to maintain adaptation in cannot
the four adaptive modes. adapt accordingly, the integrity of the person can be
• The environment is viewed as all conditions, affected negatively.
circumstances, and influences surrounding and Environment
affecting the development and behavior of persons The environment is defined as conditions,
and groups with particular consideration of mutuality circumstances, and influences that affect humans’
of person and earth resources. development and behavior as an adaptive system. The
• Nursing is the science and practice that expands environment is a stimulus or input that requires a
adaptive abilities and enhances person and person to adapt. These stimuli can be positive or
environment transformation. negative.
• The goals of nursing are to promote adaptation for
individuals and groups in the four adaptive modes, Application of the Theory
thus contributing to health, quality of life, and dying • Nursing process is cyclical in nature – beginning
with dignity. with assessment, diagnosis, planning,
• This is done by assessing behavior and factors that implementation, and evaluation – the evaluation may
influence adaptive abilities and by intervening to also serve as the assessment findings for another set
expand those abilities and to enhance environmental of nursing problems.
interactions. • It means that the assessment component of the
nursing process is the stimuli or the input and the
Theory in View of Metaparadigms planning and implementation are the throughput
Nursing processes.
In the Adaptation Model, nurses are facilitators of • The output is the evaluation which then provides the
adaptation. They assess the patient’s behaviors for necessary feedback to the goal of care. The nurse
adaptation, promote positive adaptation by enhancing then decides what necessary actions should be taken
environment interactions and helping patients react next, in the light of the patient’s response to the
positively to stimuli. Nurses eliminate ineffective
nursing interventions. This action by the nurse is • She identified 2 areas that nursing care should be
adaptation in its simplest terms. based in order to return the client to a state of
• Patients adapt, too. The nursing interventions we equilibrium:
perform ultimately elicits a response from our • Reduce stressful stimuli
patients, our patients may or may not actually adapt • Support natural and adaptive processes
according to our expectations
THEORETICAL SOURCE
DOROTHY JOHNSON’S BEHAVIORAL •Johnson’s behavioral system theory springs from
SYSTEMS MODEL Nightingale’s belief that nursing’s
• “Nursing is an external force that acts to preserve goal is to help individuals prevent or recover from
the organization of the patient’s behavior by means disease or injury.
of imposing regulatory mechanisms or by providing • The “science and art” of nursing should focus on
resources while the patient is under stress.” the patient as an individual and not on the specific
• Born August 21, 1919 in Savannah, Georgia. disease entity. The model is patterned after a systems
model; a system is defined as consisting of
Credentials and Background of Johnson: interrelated parts functioning together to form a
• Graduated BSN from Vanderbilt University in whole.
Nashville, Tennessee and her M.P.H. from Harvard • She stated that a nurse should use the behavioral
University in system as their knowledge base.
Boston.
• She was a staff nurse at the Chatham-Savannah 7 Subsystems of Human Behavior:
Health Council (1943-1944). The ultimate goal for each subsystem is expected to
• She is proud to receive the 1975 Faculty Award be the same for all individuals.
from graduate students. 1. Attachment – probably the most critical, because
• She was an early proponent of nursing as a science it forms the basis for all social organization provides
as well as an art; also believed nursing had a body of survival & security; its consequences are social
knowledge inclusion, intimacy, &
reflecting both the science and the art. formation and maintenance of a strong social bond
2. Achievement – attempts to manipulate the
environment with its function is control or mastery of
an aspect of self or environment to some standard of
• Johnson (1959) proposed that the science of nursing excellence areas of achievement behavior include
necessary for effective nursing care included a intellectual, physical, creative, mechanical, &
synthesis of key social skills
concepts drawn from basic and applied sciences. 3. Aggressive – function is protection & preservation
• In 1961, she proposed that nursing care facilitated which holds that aggressivebehavior is not only
the client’s maintenance of a state of equilibrium. learned, but has a primary intent to harm others
• She also proposed that clients were “stressed” by a however, society has placed limits when dealing with
stimulus of either an internal or external nature. self-protection and that people & their properly be
• These stressful stimuli created such disturbance, or respected and protected
“tensions”, in the patient that a state of disequilibrium 4. Dependence – promotes helping behavior that
occurred. calls for a nurturing response its consequences are
approval, attention, or recognition, and physical
assistance dependency behavior develops from the
complete reliance on others for certain resources • encompasses the patterned, repetitive, & purposeful
essential for survival an imbalance produces tension, ways of behaving
which results in disequilibrium • the system is flexible enough to allow influence that
5. Sexual – has dual functions of procreation & affect it
gratification that begins with the development of Major Concepts & Definitions
gender role identity & includes the broad range of sex Subsystems
role behaviors • mini-systems with its own particular goal &
6. Ingestive – have to do with when, how, what, how function that can be maintained as long as its
much, and under what conditions we eat relationship to the other subsystems or the
7. Eliminative – have to do with when, how, what, environment is not changed or disturbed
how much, and under what conditions we eliminate Equilibrium
• a stabilized but more or less transitory, resting state
7 Subsystems of Human Behavior: where the person is in harmony with himself & with
The ultimate goal for each subsystem is expected to be the same his environment
for all individuals.
Tension
▪ These responses are a set of behavioral responses or
• the state of being stretched or strained can be
tendencies that share a common goal developed
viewed as an end-product of a disturbance in
through experience and learning and are determined
equilibrium
by numerous physical, biological, psychological, and
Stressor
social factors.
• a stimulus, either internal or external, that produce
▪ Each subsystem has three functional requirements:
tension and result in a degree of instability
• Each subsystem must be “protected from noxious
influences with which the system cannot cope”.
Assumptions about system
• Each subsystem must be “nurtured through the
• There is “organization, interaction,
input of appropriate supplies from the environment”.
interdependency and integration of the parts and
• Each subsystem must be “stimulated for use to
elements of
enhance growth and prevent stagnation”.
behaviors that go to make up the system.”
▪ As long as the subsystems are meeting these
• A system “tends to achieve a balance among the
functional requirements, the system and the
various forces operating within and upon it, and that
subsystems are viewed as self-maintaining and self-
man strives continually to maintain
perpetuating.
• a behavioral system balance and steady-state by
more or
Major Concepts & Definitions
less automatic adjustments and adaptations to the
Behavior
natural forces occurring on him.”
• the output of intra-organismic structures and
• A behavioral system, which requires and results in
processes as they are coordinated and articulated by
regularity and constancy in behavior, is essential
& responsive to changes in sensory stimulation
to man. It is functionally significant because it serves
System
a useful purpose in social life and the
• a whole that functions as a whole by virtue of the
individual.
interdependence of its parts characterized by
• “System balance reflects adjustments and
organization, interaction, interdependency,
adaptations that are successful in some way and to
&integration of the parts & elements
some
Behavioral system
degree.
 elusive, dynamic state influenced by biological,
psychological, and social factors. A lack of balance in
the structural or functional requirements of the
subsystems leads to poor health.
Assumptions about structure
•“From the form the behavior takes and the
consequences it achieves can be inferred what ‘drive’ Environment
has been stimulated or what ‘goal’ is being sought.” The environment consists of all the factors that are
• Each person has a “predisposition to act concerning not part of the individual’s behavioral system, but
the goal, in certain ways rather than the other ways.” that
This predisposition is called a “set.” influence the system. The nurse may manipulate
•. Each subsystem has a repertoire of choices called a some aspects of the environment so the goal of health
“scope of action.” or behavioral system balance can be achieved for the
• The individual patient’s behavior produces an patient.
outcome that can be
observed. Application of the Theory:
•The subsystems are interactive and interdependent,
Assumptions about functions restoration in
1. The system must be protected from toxic one subsystem could bring about restoration of
influences with which the system behavior in
cannot cope. another or others. This means that healthcare
2. Each system has to be nurtured through the input practitioners must
of appropriate supplies direct all efforts, interventions, or actions to all the
from the environment. subsystems.
3. The system must be stimulated for use to enhance • As nurses, we should provide the highest level of
growth and prevent stagnation. quality care to
our patients by taking into consideration the whole
Theory in View of Metaparadigms person and
Nursing trying to understand the interrelatedness of its
This is viewed as an external force that acts to individual
preserve the organization of the patient’s behavior by component parts.
means of imposing regulatory mechanisms or by
providing resources while the patient is under stress.
Nursing activities are not dependent on medical
authority, rather, nursing is complementary to the
practice of medicine.
Person
This is a behavioral system with patterned, repetitive,
and purposeful ways of behaving that link the person
to his environment. The person is a system of
interdependent parts that requires some regularity and
adjustment to maintain balance or equilibrium. A
person’ attempt to regain balance may require an
unnecessary use of energy. Health Health as an