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THEORETICAL

FOUNDATIONS OF
NURSING
Contessa M. Gabriel, RM,RN,MAN
Professor
Ramon Magsaysay Technological University Iba Zambales

A. ENVIRONMENTAL THEORY

Florence Nightingale (1860)

I think ones feelings waste themselves in words;


they ought all to be distilled into actions which
bring results.

Florence Nightingale (1860)


Florence Nightingale defined Nursing the
act of utilizing the environment of the patient
to assist him in his recovery (1860/1969) ,
that it involves the nurse 's initiative to
configure environmental settings
appropriate for the gradual restoration of the
patient's health, and that external factors
associated with the patient's surroundings
affect life or biologic and physiologic
processes , and his development.

Disease is a reparative process, and that the


manipulation of the environment - ventilation,
warmth, light, diet, cleanliness, and noise - would
contribute to the process and health of the patient
Did not agree with the germ theory of disease
although she accepted the ill effects of
contamination from organic materials from the
patients and the environment hence found
sanitation as important
Also renowned for pioneering statistical analysis
of healthcare.

Environmental Factors Affecting Health:

pure or fresh air


pure water
sufficient food supplies
efficient drainage
Cleanliness
light (especially direct sunlight )

Adequate ventilation has also been regarded


as a factor contributing to changes of the
patients process of illness recovery. Any
deficiency in one or more of these factors
could lead to impaired functioning of life
processes or diminished health status.

She also emphasized in her environmental


theory is the provision of a quiet or noisefree and warm environment, attending to
patients dietary needs by assessment,
documentation of time of food intake, and
evaluating its effects on the patient.

Nightingale believed that the environment


was the major component creating illness in
a patient; she regarded disease as the
reactions of kindly nature against the
conditions in which we have placed
ourselves. Her theory Contains three major
relationships:
1) environment to patient
2) nurse to environment
3) nurse to patient

B. INTERACTIVE THEORIES

Hildegard Peplau (1952)

The kind of person that the nurse


becomes makes a substantial difference
in what each patient will learn as he or
she receives nursing care.

Hildegard Peplau (1952)


Psychodynamic Nursing; Mother of Psychiatric
Nursing
She defined Nursing as an interpersonal process
of therapeutic interactions between an individual
who is sick or in need of health services and a
nurse especially educated to recognize, respond to
the need for help.
Stressed the importance of the nurses ability to
understand ones own behavior to help others
identify felt difficulties.

Dr. Peplau emphasized the nurse-client


relationship as the foundation of nursing
practice. At the time, her research and
emphasis on the give-and-take of nurseclient relationships was seen by many as
revolutionary. She described the nursepatient relationship as a four-phase
phenomenon. Each phase is unique and has
distinguished contributions on the outcome
of the nurse-patient interaction.

Phases Of Nurse-Patient Relationship


1. Orientation
Individual/family has a felt need and seeks
professional assistance from a nurse (who is a
stranger). This is the problem identification
phase.
2. Identification
Where the patient begins to have feelings of
belongingness and a capacity for dealing with the
problem, creating an optimistic attitude from
which inner strength ensues. Here happens the
selection of appropriate professional assistance.

3. Exploitation
The nurse uses communication tools to offer
services to the patient, who is expected to take
advantage of all services.
4. Resolution
Where patients needs have already been met by
the collaborative efforts between the patient and
the nurse.
Therapeutic relationship is terminated and the
links are dissolved, as patient drifts away from
identifying with the nurse as the helping person.

Nursing Roles:
In the course of the nurse-patient relationship, the
nurse assumes several roles which empower and
equip her in meeting the needs of the patient.
1. Stranger Role: Receives the client the same way
one meets a stranger in other life situations;
provides an accepting climate that builds trust.
2. Resource Role: Answers questions . Interprets
clinical treatment data, gives information.

3. Teaching Role: Gives instruct ions and provides training;


involves analysis and synthesis of the learners experience.
4. Counseling Role: Helps client understand and integrate the
meaning of current life circumstances; provides guidance
and encouragement to make changes.
5. Surrogate Role: Helps clients clarify domains of
dependence, interdependence, and independence and acts
on clients behalf as advocate.
6. Leadership Role: Helps client assume maximum
responsibility for meeting treatment goals in a mutually
satisfying way.

Additional Roles include:


1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)

Technical expert
Consultant
Health teacher
Tutor
Socializing agent
Safety agent
Manager of environment
Mediator
Administrator
Recorder observer
Researcher

Virginia Henderson (1955)


The nurse is temporarily the consciousness of the
unconscious, the love of life for the suicidal, the leg of the
amputee, the eyes of the newly blind, a means of locomotion
for the infant, knowledge and confidence for the mother, the
mouthpiece for those too weak or withdrawn to speak and so
on.

Henderson defined Nursing as assisting


the individual, sick or well, in the
performance of those activities contributing
to health or its recovery (or to peaceful
death) that an individual would perform
unaided if he had the necessary strength,
will or knowledge.

The unique function of the nurse is to


assist the individual, sick or well, in the
performance of those activities contributing
to health or to recovery (or to a peaceful
death) that he would perform unaided if he
had the necessary strength, will, or
knowledge and to do this in such a way as
to help him gain independence as rapidly as
possible

She conceptualized the 14 Fundamental Needs of humans .


1) Breathing normally
2) Eating and drinking adequately
3) Eliminating body wastes
4) Moving and maintaining desirable position
5) Sleeping and resting
6) Selecting suitable clothes
7) Maintaining body temperature with in normal range

8) Keeping the body c lean and well groomed


9) Avoiding dangers in the environment
10) Communicating with others
11) Worshipping according to ones faith
12) Working in such a way that one feels a sense of
accomplishment
13) Playing/participating in various forms of recreation
14) Learning, discovering or satisfying the curiosity that
leads to normal development and health and using
available health facilities.

The Nurse-Patient Relationship:


Henderson stated that there are three levels
comprising the nurse-patient relationship:
1. The nurse as a substitute for the patient. In
times of illness, when the patient cannot function
fully, the nurse serves as the substitute as to what
the patient lacks such, as knowledge, will, and
strength in order to make him complete, whole
and independent once again.

2. The nurse as a helper to the patient. In


situations where the patient cannot meet his basic
needs, the nurse serves as a helper to accomplish
them.
3. The nurse as a partner with the patient. As
partners , the nurse and the patient formulate the
care plan together. Both as an advocate and as a
resource person, the nurse can empower the
patient to make effective decisions regarding his
care plans.

Ida Jean Orlando (1961)

Dynamic Nurse-Patient Relationship


The role of the nurse is to find out and meet the
patient's immediate need for help. The patient's
presenting behavior may be a plea for help,
however, the help needed may not be what
it appears to be.

Nursing Process; Dynamic Nurse-Patient


Relationship
Orlando 's theory was developed in the late 1950s
from observations she recorded between a nurse
and patient.
Despite her efforts, she was only able to
categorize the records as "good" or "bad" nursing.
It then dawned on her that both the formulations
for "good" and "bad" nursing were contained in
the records. From these observations she
formulated the deliberative nursing process.

Therefore, nurses need to use their perception, thoughts


about the perception, or the feeling engendered from their
thoughts to explore with patients the meaning of their
behavior. This process helps the nurse find out the nature
of the distress and what help the patient needs.
Orlando's theory remains one the of the most effective
practice theories available. The use of her theory keeps the
nurse's focus on the patient. The strength of the theory is
that it is clear, concise, and easy to use. While providing
the overall framework for nursing, the use of her theory
does not exclude nurses from using other theories while
caring for the patient.

Focused on patients verbal and nonverbal expressions of


need and the nurses reactions to the behavior
3 Elements of a Nursing Situation
1) Patient behaviors
2) Nurse reactions
3) Nurse actions
Used the nursing process to meet patients needs through
deliberate action; advanced nursing beyond automatic
response to disciplined and professional response

Lydia Hall (1961)


Key Concepts of Three Interlocking Circles Theory
According to Hal l , Nursing is participation in care, core
and cure aspects, where CARE is the sole function of
nurses, whereas the CORE and CURE are shared with
other members of the health team.

The major purpose of care is to achieve an


interpersonal relationship with the
individual that will facilitate the
development of the core.

The theory consists of 3 major tenets:


The nurse functions differently in the 3 interlocking
aspects of the patient:
1) Cure (Disease) shared with doctors
2) Core (Person) addressed by therapeutic use of self; shared
with psychiatry/psychology, religious ministry, etc.
3) Care (Body) exclusive to nurses; involves intimate bodily
care like feeding, bathing and toileting
As the patient needs less medical care, he needs more
professional nursing care
Wholly professional nursing care will hasten recovery

Joyce Travelbee (1966)


Human-to-Human Relationship Model
A nurse does not only seek to alleviate physical
pain or render physical care- she ministers to the
whole person. The existence of suffering, whether
physical, mental or spiritual is the proper concern
of the nurse.

Travelbee's experience in initial psych nursing practice at a


Catholic charity hospital led her to believe that the care
given in these type of institutions lacked compass ion. She
felt nursing needed humanistic revolution" and a
renewed focus on caring as central to nursing--she
warned that if this didn't happen, consumers might seek a
"new and different kind of health care worker". Travelbee
's ideas have greatly influenced the hospice movement.

In her human-to-human relationship model, the nurse and


the patient undergoes the following series of interactional
phases:
1) 1. Original Encounter- this is described as the first
impression by the nurse of the sick person and vice versa.
The nurse and patient see each other in stereotyped or
traditional roles.
2) 2. Emerging Identities- this phase is described by the
nurse and patient perceiving each other as unique
individual. At this time, the link of relationship begins to
form.
3) 3. Empathy- this phase is described as the ability to share
in the persons experience.

4. Sympathy- I t happens when the nurse wants to lessen the


cause of the patients suffering. It goes beyond empathy.
The nurse at this time should use a disciplined intellectual
approach together with therapeutic use of self to make
helpful nursing actions.
5. Rapport- this is described as nursing interventions that
lessens the patients suffering. The nurse and the sick
person are relating as human being to human being. The
sick person shows trust and confidence in the nurse.

Betty Neuman (1972)


Health is a condition in which all parts and subparts
are in harmony with the whole of the client

Her theory incorporated the concept of a whole


person and an open system approach. The concept
is aimed towards the development of a person in a
state of wellness having the capacity to function
optimally. The main role of the nurse in her theory
is to help a person to adapt with environmental
stimuli causing illnesses back to a state of
wellness.

Terms Related to Neumans System Theory Client


Variables
The clients variables can be one or combination of
the following: physiological, sociocultural, developmental
and spiritual. These variables function to achieve
stability in relation to the environmental stressors
experienced by the client.

Lines of Resistance
Lines of Resistance act when the Normal Line of Defense
is invaded by too much stressor, producing alterations in
the clients health.

Normal Line of Defense


To achieve the stability of the system, the Normal Line of
Defense must act in coordination with the normal wellness
state. It must reflect the actual range of responses that is
normally acted by clients in response to any stressors. It is
the baseline in determining the level of client within the
continuum of health.

Flexible Line of Disease


It serves as a boundary for the Normal Line of
Defense to adjust to situations that threaten the
imbalance within the clients stability.
Stressors
These are forces that produce tensions, alterations
or potential problems causing instability within the
clients system.

Reaction
These are the outcomes or produced results of
certain stressors and actions of the lines resistance
of a client. It can be positive or negative
depending on the degree of reaction the client
produces to adjust and adapt with the
situation . Neuman specified these reaction as
negentropy or egentropy. Negentropy is set
towards stability or wellness while Egentropy is
set towards disorganization of the system
producing illness.

Dorothy Johnson (1971)

Behavioral System Model


Each individual has a predisposition to act, with
reference to the goal, in certain ways rather than in
other ways

Johnson believes that each individual has a


focusing and repeating ways of acting which
covers a behavioral system distinct to that
individual. These behaviors are logical, fixed,
predictable and adequately secure and persistent to
be satisfying to depiction and clarification.

Considered attachment or affiliative subsystem as


cornerstone of social organizations
Nursing problems arise because there are disturbances in
the structure or function of the subsystems:
1) Dependency
2) Achievement
3) Aggressive
4) Ingestive
5) Eliminative
6) Sexual

Seven Behavioral Subsystems


1. The Attachment or Affiliative Subsystem is
well known as the earliest response system to expand
in the individual. The most favorable functioning
of this subsystem allows social inclusion,
closeness, and the pattern and continuance of a
strong public bond.
2. The Dependency Subsystem are act ions that
trigger nurturing behaviors from other individuals
in the environment. The product of dependency
behavior is consent, interest or appreciation, and
physical support.

3. The Ingestive Subsystem relates to the behaviors


surrounding the ingestion of food. Behaviors
related to the ingestion of food may relate more to
what is socially satisfactory in a specified culture,
than to the biological necessities of the human
being.
4. The Eliminative Subsystem relates to behaviors
surrounding the secretion of waste products from
the body. Human cultures have defined different
socially acceptable behaviors for excretion of
waste, but the continuation of such an outline
remains from culture to culture.

5. The Sexual Subsystem imitates behaviors real ted to


procreation or reproduction.
6. The Aggressive Subsystem relates to behaviors
concerned with the defense and self-preservation.
7. The Achievement Subsystem contains behaviors that
attempt to control the environment. Intellectual, physical,
imaginative, mechanical, and communication skills are
some of the areas that Johnson distinguishes.

Imogene King (1971)

Goal Attainment Theory

If the students cant do the fundamentals,


how can they use advanced knowledge.

Interacting Systems Framework; Goal Attainment


Theory
Nursing is a process of human interaction between
nurses and patients who communicate to set goals,
explore means of attaining goals, and agree on
what means to use
Perceptions, judgment and actions of nurse and
patient lead to reaction, interaction and transaction

King stated that Nursing is a process of action, reaction,


and interaction whereby nurse and client share
information about their perception in the nursing situation.
Action
Action is a means of behavior or activities that are
towards the accomplishment of certain act. It is both physical
and mental.

Reaction
In Kings theory, reaction is not specified but
somehow relates reaction as part of action.
According to her, reaction is a response to a
stimuli.
Interaction
Interaction, as defined by King, is any situation
wherein the nurse relates and deals with a clientele
or patient.

Open System
It is the absence of boundary existence, where a
dynamic interaction between the internal and
external environment can exchange information
without barriers or hindrances.
King proposed that the nurse interacts in the
system simultaneously at three different levels.
These levels are independent and at the same time
co-exist to influence over-all nursing practice.

Interacting systems:
1) Personal- how the nurse views and integrates self based
from personal goals and beliefs.
perception, self, body image, growth and development.
2) Interpersonal- how the nurse interrelates with a
coworker or patient, particularly in a nurse-patient
relationship.
role, interaction, communication, transaction, and stress.
3) Social- how the nurse interacts with co-workers,
superiors, subordinates and the client environment in
general
organization, power-authority status, decision making.

Dorothea Orem (1971)

Individuals, families, groups and communities need


to be taught self-care.

Orem defined Nursing as The act of assisting others in


the provision and management of self-care to
maintain/improve human functioning at home level of
effectiveness.
The theory focuses on activities that adult individuals
perform on their own behalf to maintain life, health and
well-being. It has a strong health promotion and
maintenance focus.

She identified 3 related concepts:


1. Self-care - activities an Individual performs
independently throughout life to promote and
maintain personal well-being.
2. Self-care deficit - results when self - care agency
(Individuals ability) is not adequate to meet the
known self-care needs.
3. Nursing System - nursing interventions needed
when Individual is unable to perform the
necessary self-care activities:

1) Wholly Compensatory - do for the patient.


nurse provides entire self-care for the client.
Example: care of a new born , care of client recovering
from surgery in a post-anesthesia care unit
2) Partly Compensatory - help the patient do for himself.
nurse and client perform care, client can perform selected
self-care activities, but also accepts care done by the nurse
for needs the client cannot meet independently.
Example: Nurse can assist post operative client to
ambulate, Nurse can bring a meal tray for client who can
feed himself.

3)

Supportive Educative - help the patient learn to do for


himself; nurse has important role in designing nursing
care.
nurse s actions are to help the client develop/learn their
own self-care abilities through knowledge, support and
encouragement.
Example: Nurse guides a mother how to breastfeed her
baby. Counseling a psychiatric client on more adaptive
coping strategies.

Faye Glen Abdellah (1960)


Twenty-One Nursing Problems
I never wanted to be a medical doctor because I
could do all I wanted to do in nursing, which is a
caring profession.

Problem solving was seen as the way of


presenting nursing(patient) problems as the patient
moved towards health.
Contributed to nursing theory development
through the systematic analysis of research reports
to formulate the 21 nursing problems that served
as an early guide for comprehensive nursing care

The concept of Nursing in this theory is generally


grouped into twenty-one problem areas for nurses
to work out their judgment and appropriate care.
Abdellah considers nursing to be an all-inclusive
service that is based on the disciplines of art and
science that serves individuals, sick or well with
their health needs.

Typology of Twenty-one Nursing Problems


1)
2)
3)
4)
5)
6)
7)
8)

To maintain good hygiene.


To promote optimal activity; exercise, rest and sleep.
To promote safety.
To maintain good body mechanics
To facilitate the maintenance of a supply of oxygen
To facilitate maintenance of nutrition
To facilitate maintenance of elimination
To facilitate the maintenance of fluid and electrolyte
balance

9) To recognize the physiologic response of the body to


disease conditions.
10) To facilitate the maintenance of regulatory mechanisms
and functions.
11) To facilitate the maintenance of sensory functions
12) To identify and accept positive and negative expressions,
feelings and reactions
13) To identify and accept the interrelatedness of emotions
and illness.
14) To facilitate the maintenance of effective verbal and nonverbal communication
15) To promote the development of productive in terpersonal
relationship

16) To facilitate progress toward achievement of personal


spiritual goals
17) To create and maintain a therapeutic environment
18) To facilitate awareness of self as an individual with
varying needs.
19) To accept the optimum possible goals
20) To use community resources as an a id in resolving
problems arising from illness.
21) To understand the role of social problems as influencing
factors

Ernestine Wiedenbach (1964)

Helping Art of Clinical Nursing


"My thesis is that nursing art is not comprised of rational
nor reactionary actions but rather of deliberative action."

nursing is nurturing or caring for someone in a


motherly fashion.
Proposed that nurses identify patients need-forhelp by:
1) Observing behaviors regarding comfort
2) Exploring meanings of the behavior
3) Knowing the cause of discomfort
4) Knowing if they can solve on their own or need
help

Wiedenbach conceptualizes nursing as the practice


identification of a patients need for help through
observation of presenting behaviors and symptoms,
exploration of the meaning of those symptoms with the
patient, determining the cause(s) of discomfort, and
determining the patients ability to resolve the discomfort
or if the patient has a need for help from the nurse or other
healthcare professionals.

Nursing primarily consists of identifying a patients need


for help. If the need for help requires intervention, the
nurse facilitates the medical plan of care and also creates
and implements a nursing plan of care based on needs and
desires of the patient. In providing care, a nurse exercises
sound judgment through deliberative, practiced, and
educated recognition of symptoms. The patients
perception of the situation is an important consideration to
the nurse when providing competent care.

According to Wiedenbach there are four elements to


clinical nursing (1): philosophy, (2) purpose, (3)
practice, and (4) art.
The nurses philosophy was their attitude and belief about
life and how that effected reality for them. Philosophy is
what motivates the nurse to act in a certain way.
Wiedenbach also believed that there were 3 essential
components associated with a nursing philosophy:
1) Reverence for life
2) Respect for the dignity, worth, autonomy and
individuality of each human being
3) Resolution to act on personally and professionally held
beliefs

Nurses purpose is that which the nurse wants to


accomplish through what she does. It is all of the activities
directed towards the overall good of the patient.
Practices are those observable nursing actions that are
affected by beliefs and feelings about meeting the patients
need for help.
The Art of nursing includes understanding patients needs
and concerns, developing goals and actions intended to
enhance patients ability and directing the activities related
to the medical plan to improve the patients condition.
The nurses also focuses on prevention of complications
related to reoccurrence or development of new concerns.

Myra Estrin Levine (1977)


The Conservation Model
"Ethical behaviour is not the display of one's moral rectitude
in times of crisis. It is the day-to-day expression of one's
commitment to other persons and the ways in which human
beings relate to one another in their daily interactions.

She defined nursing as supportive & therapeutic


interventions based on scientific or therapeutic knowledge.
Nursing actions based on four principles:
1) conservation of energy
2) structural integrity
3) personal integrity
4) Social integrity

Major Concepts:
1) Wholism (Holism)
2) Adaptation - process whereby patients retain integrity; establish body economy
to safeguard stability:
a) Environment
b) Organismic Response - (1)Fight or flight, (2)inflammatory response,
3)response to stress, (4)perceptual awareness
c) Trophicogenesis - alternative to nursing diagnosis
3) Conservation - 4 principles of conservation - Nursing intervention is based on
the conservation of the patients:
1) Energy
2) Structural Integrity
3) Personal Integrity
4) Social Integrity

Sister Callista Roy (1979)


Adaptation Model
The model provides a way of thinking about people
and their environment that is useful in any setting. It
helps one prioritize care and challenges the nurse to
move the patient from survival to transformation.

She viewed humans as biopsychosocial beings constantly


interacting with a changing environment and who cope
with their environment through Biopsychosocial adaptation
mechanisms. There are two categories of coping
mechanisms according to Roy namely the regulator and the
cognator subsystems:
1) Regulator Subsystem transpires through neutral,
chemical and endocrine processes like the increase in vital
signs-sympathetic response to stress.
2) Cognator Subsystem, on the other hand, occurs through
cognitive-emotive processes. For instance, are the effects
of prolonged hospitalization for a four-year old child.

The degree of internal or external environmental change


and the persons ability to cope with that change is likely
to determine the persons health status. Nursing
interventions are aimed at promoting physiologic,
psychologic, and social functioning or adaptation.

Madeleine Leininger (1985)

Transcultural Theory
Care is the heart of nursing; Care is power; Care is
essential to healing; Care is curing; and Care is the
central and dominant focus of nursing and transcultural
nursing decisions and actions.

She stated that Nursing is a learned humanistic and


scientific profession and discipline which is focused on
human care phenomena and activities in order to assist,
support, facilitate, or enable individuals or groups to
maintain or regain their well being (or health) in culturally
meaningful and beneficial ways, or to help people face
handicaps or death.

Transcultural nursing as a learned subfield or branch of


nursing which focuses upon the comparative study and
analysis of cultures with respect to nursing and health
illness caring practices, beliefs and values with the goal to
provide meaningful and efficacious nursing care services
to people according to their cultural values and health
illness context. It focuses on the fact that different cultures
have different caring behaviors and different health and
illness values, beliefs, and patterns of behaviors.
Awareness of the differences allows the nurse to design
culture-specific nursing interventions.

Margaret Jean Watson (1979)


Philosophy and Science of Caring
Caring in nursing conveys physical Acts but embraces
the mind-body-spirit as it reclaims the embodied spirit as
its focus attention.

Philosophy and Science of Caring; Carative Factors


Caring is a universal social phenomenon that is only
effective when practiced interpersonally. Nurses should be
sensitized to humanistic aspects of caring.
Watson proposes seven assumptions about the science of
caring and ten primary carative factors to form the
framework of her theory. The basic assumptions are:
1) Caring can be effectively demonstrate d and practiced
only interpersonally;
2) Effective caring promotes health and individual or family
growth;

3) Caring responses accept a person not only a s he or she is now but as what he
or she may become;
4) A caring environment is one that offers the development of potential while
allowing the person to choose the best action for himself or herself at a given
point in time
5) Caring is more healthogenic than is curing. The practice of caring integrates
biophysical knowledge of human behavior to generate or promote health and
to provide care to those who are ill. A science of caring is therefore
complementary to the science of curing.
6) The practice of caring is central to nursing.

Ten Carative Factors


1. The promotion of a humanistic - altruistic sys tem of values
2. Instillation of faith - hope
3. The cultivation of sensitivity to ones self and others
4. The development of a helping-trusting, human caring
relationship
5. Promotion and acceptance of the express ion of positive
and negative feelings.

6. The systemic use of the scientific problem-solving method


for decision making
7. The promotion of interpersonal teaching- learning
8. The provision for supportive , protective and corrective
mental, physical, socio-cultural and spiritual environment
9. Assistance with the gratification of human needs
10.The allowance for existential phenomenological forces

Martha Rogers (1970)


The Science of Unitary Human Beings, and Principles of
Homeodynamics
Nursing is an art and science that is humanistic and
humanitarian. It is directed toward the unitary human and is
concerned with the nature and direction of human
development.

Nursing interventions seek to promote harmonious


interaction between persons and their environment,
strengthen the wholeness of the individual and redirect
human and environmental patterns or organization to
achieve maximum health.
There are 5 Basic Assumptions:
1. The human being is a unified whole , possessing individual
integrity and manifesting characteristics that are more than
and different from the sum of parts.

2. The individual and the environment are continuously


exchanging matter and energy with each other
3. The life processes of human beings evolve irreversibly
and unidirectionally along a space-time continuum
4. Patterns identify human being and reflect their innovative
wholeness
5. The individual is characterized by the capacity for
abstraction and imagery, language and thought,
sensation and emotion

Rosemarie Rizzo Parse (1981)


Theory of Human Becoming
Nursing is a scientific discipline, the practice of
which is a performing art.

Three assumptions about Human Becoming


1) Human becoming is freely choosing personal meaning in
situation in the inter-subjective process of relating value
priorities
2) Human becoming is co-creating rhythmic pat terns or
relating in mutual process in the universe
3) Human becoming is co- transcending multidimensionally
with emerging possibilities.

A unique, humanistic approach instead of a physiological basis for


nursing
Nursing is a human science that is not dependent on medicine or any
discipline for its practice.
Major concepts include:
1) Imaging
2) Connecting-separating
3) Valuing
4) Powering
5) Languaging
6) Originating
7) Revealing-concealing
8) Transforming
9) Enabling-limiting

Merle Mishel - Uncertainty in Illness


Researched into experiences with
uncertainty as it relates to chronic and lifethreatening illness
Later reconceptualized to accommodate the
responses to uncertainty over time in people
with chronic conditions who may not
resolve the uncertainty

Margaret A. Newman - Model of Health


Major concepts are movement, time, space and
consciousness. Movement is a reflection of
consciousness. Time is a function of movement. Time is a
measure of consciousness.
The goal of nursing is not to promote wellness or to
prevent illness, but to help people use the power within
them as they evolve toward a higher level of
consciousness.

Evelyn Adam - Conceptual Model for Nursing


Used a model from Dorothy Johnson and definition of
nursing from Virginia Henderson
Identified assumptions, beliefs, and values, and major units
Included goal of the profession, beneficiary of the
professional service, role of the professional, source of the
beneficiarys difficulty, the intervention of the
professional, and the consequence.

Nola J. Pender - Health Promotion Model


The goal of nursing care is the optimal health of the
individual
Developed the idea that promoting optimal health
supersedes disease prevention
Identifies cognitive-perceptual factors of a person, like
importance of health-promotion behavior and its perceived
barriers, and these factors are modified by demographics,
biology, interpersonal influences, and situational and
behavioral factors.

Katherine Kolcaba - Theory of Comfort


Defined healthcare needs as those needs for comfort
including physical, psycho-spiritual, social, and
environmental needs
Intervening factors influence clients perception of
comfort: age, attitude, emotional support, experience,
finance, prognosis
Types of comfort:
1) Relief when specific need is fulfilled
2) Sense of ease, calm, and contentment
3) Transcendence or rising above the problems of pain

Erikson, Tomlin and Swain - Modeling and RoleModeling


Synthesis of multiple theories related to basic needs,
developmental tasks, object attachment, and adaptive
coping potential
Views nursing as self-care based on the persons
perception of the world and adaptation to stressors
Promotes growth and development while recognizing
individual differences according to worldview and inherent
endowment

Ramona Mercer - Maternal Role


Attainment
Focused on parenting and maternal role
attainment in diverse populations
Developed a complex theory to explain the
factors impacting the maternal role over
time

Kathryn Barnard - Parent-Child Interaction;


Child Health Assessment Interaction Theory
Individual characteristics of each member
influence the parent-infant system and that
adaptive behavior modifies those characteristics to
meet the needs of the system
The theory is based on scales developed to
measure feeding, teaching, and environment

Patricia Benner - Novice to Expert


Validated the Dreyfus Model of Skill
Acquisition in nursing practice with the
systematic description of the 5 stages
(Novice, Advanced beginner, Competent,
Proficient, and Expert)

Roper, Logan, and Tierney - Model for Nursing Based on a Model of Living
Conceptual Components
12 Activities of Living (AL) - complex process of living in the view of an
amalgam of activities
1) Maintain safe environment
2) Temperature
3) Communicate
4) Mobility
5) Breathe
6) Work and play
7) Eat and drink
8) Express sexuality
9) Eliminate
10) Sleep
11) Personal cleansing and dressing
12) Dying

Life span - concept of continuous change from birth to


death
Dependence-independence continuum
5 factors influencing AL: Biological, Psychological, Sociocultural, Environmental, Politicoeconomic.
The individuality of living is the way in which the
individual attends to ALs in regard to place on life span
and dependence-independence continuum and as
influenced by the 5 factors

THANK YOU!