Sister Callista Roy: Adaptation Model of Philosophical Assumptions

Nursing
 Persons have mutual relationships with
Biography the world and God.
 Human meaning is rooted in the omega
- Born in October 14, 1939 in Los point convergence of the universe.
Angeles  God is intimately revealed in the
- A nursing theorist, professor, and author diversity of creation and is the common
- a sister of St. Joseph of Carondelet destiny of creation.
 Persons use human creative abilities of
Roy’s Adaptation Model of Nursing
awareness, enlightenment, and faith.
- Roy's Adaptation Model (RAM) was  Persons are accountable for the
developed by Sister Callista Roy in 1976 processes of deriving, sustaining, and
- RAM is one of the widely applied transforming the universe.
nursing models in nursing practice,
Major Concepts of the Adaptation Model
education and research.
( Metaparadigm )
- aims to explain or define the provision
of nursing.  Person - humans are holistic beings that
are in constant interaction with their
Scientific Assumptions
environment.
 Systems of matter and energy progress  Environment - defined as conditions,
to higher levels of complex self- circumstances, and influences that affect
organization. humans‘ development and behavior as
 Consciousness and meaning are an adaptive system.
constructive of person and environment o Focal stimuli are that confront
integration. the human system and require
 Awareness of self and environment is the most attention
rooted in thinking and feeling. o Contextual stimuli are
 Humans, by their decisions, are characterized as the rest of the
accountable for the integration of stimuli present with the focal
creative processes. stimuli and contribute to its
 Thinking and feeling mediate human effect.
action. o Residual stimuli are the
 System relationships include acceptance, additional environmental factors
protection, and fostering of present within the situation but
interdependence. whose effect is unclear.
 Persons and the earth have common
patterns and integral relationships.  Health - defined as the state where
 Persons and environment humans can continually adapt to stimuli.
transformations are created in human Because illness is a part of life, health
consciousness. results from a process where health and
 Integration of human and environmental illness can coexist.
meanings results in adaptation.
purposefulness in the universe, and a
 Nursing sense of identity integrity.
o Goal: promotion of adaptation 3. Role Function Mode - This mode
for individuals and groups in focuses on the primary, secondary, and
each of the four adaptive modes, tertiary roles that a person occupies in
thus contributing to health, society and knowing where they stand as
quality of life, and dying with a member of society.
dignity. 4. Interdependence Mode - This mode
o Nurses are facilitators of focuses on attaining relational integrity
adaptation. They assess the through the giving and receiving of love,
patient‘s behaviors for respect and value. This is achieved with
adaptation, promote positive effective communication and relations.
adaptation by enhancing
environment interactions and Levels of Adaptation
helping patients react positively
 Integrated Process - The various
to stimuli. modes and subsystems meet the needs of
 Adaptation - the ―process and outcome the environment. These are usually
whereby thinking and feeling persons as stable processes (e.g., breathing,
individuals or in groups use conscious spiritual realization, successful
awareness and choice to create human relationship).
and environmental integration.
 Compensatory Process - The cognator
Internal Processes and regulator are challenged by the
environment‘s needs but are working to
 Regulator - s a person‘s physiological meet the needs (e.g., grief, starting with
coping mechanism. The body attempts a new job, compensatory breathing).
to adapt via regulation of our bodily  Compromised Process - The modes
processes, including neurochemical and and subsystems are not adequately
endocrine systems. meeting the environmental challenge
 Cognator - a person‘s mental coping (e.g., hypoxia, unresolved loss, abusive
mechanism. A person uses his brain to relationships).
cope via selfconcept, interdependence,
Six-Step Nursing Process
and role function adaptive modes.
 Assess the behaviors manifested from
Four Adaptive Modes
the four adaptive modes.
1. Physiological-Physical Mode - This  Assess the stimuli, categorize them as
mode‘s basic need is composed of the focal, contextual, or residual.
needs associated with oxygenation,  Make a statement or nursing diagnosis
nutrition, elimination, activity and rest, of the person‘s adaptive state.
and protection.  Set a goal to promote adaptation.
2. Self-Concept Group Identity Mode -  Implement interventions aimed at
In this mode, the goal of coping is to managing the stimuli.
have a sense of unity, meaning the  Evaluate whether the adaptive goal has
been met.
Analysis Imogene King: Theory of Goal Attachment

Applying the model to emergencies requiring Biography

quick action is difficult to complete, the
individual might have completed the whole - Born on January 30, 1923
adaptation process without the benefit of having - Died on Dec 24, 2007
a complete assessment for thorough nursing
Imogene King’s Theory of Goal Attainment
interventions.
- First introduced in the 1960s.
Adaptive responses may vary in every individual
- The Theory of Goal Attainment states
and may take a longer time compared to others.
that ―Nursing is a process of action,
Thus, the span of control of nurses may be
reaction, and interaction whereby nurse
impeded by the time of the patient‘s discharge.
and client share information about their
Strengths perception in the nursing situation" and
―a process of human interactions
o Suggests the influence of multiple between nurse and client whereby each
causes in a situation, which is a strength perceives the other and the situation, and
when dealing with multi-faceted human through communication, they set goals,
beings. explore means, and agree on means to
o The sequence of concepts in Roy‘s achieve goals.‖
model follows logically. In the
presentation of each of the key concepts, Assumptions
there is the recurring idea of adaptation
 The focus of nursing is the care of the
to maintain integrity. Every concept was
human being (patient).
operationally defined.
 The goal of nursing is the health care of
o A major strength of the model is that it
both individuals and groups.
guides nurses to use observation and
 Human beings are open systems
interviewing skills in doing an
interacting with their environments
individualized assessment of each
constantly
person. The concepts of Roy‘s model
 The nurse and patient communicate
are applicable within many practice
information, set goals mutually, and
settings of nursing.
then act to achieve those goals.
Weaknesses  Patients perceive the world as a
complete person making transactions
o Painstaking application of the model with individuals and things in the
requires a significant input of time and environment
effort.  The transaction represents a life
o Roy‘s model has many elements, situation in which the perceiver and the
systems, structures, and multiple thing being perceived are encountered.
concepts.
Propositions Major Concepts ( Metaparadigm ) and
Subconcepts
 If perceptual interaction accuracy is
present in nurse-patient interactions, the  Nursing - Nursing is an action, reaction,
transaction will occur. and interaction process in which the
 If the nurse and patient make the nurse and client communicate
transaction, the goal or goals will be information about their perceptions of
achieved. the nursing situation. The nurse and
 If the goal or goals are achieved, client discuss particular goals, concerns,
satisfaction will occur. and issues, but also ways to reach those
 If the goal or goals are achieved, goals.
effective nursing care will occur.  Health - Health is a human being's
 If transactions are made in nurse-patient dynamic life experience that involves
interactions, growth and development constant adjustment to stressors in the
will be enhanced. internal and external environment by
 If role expectations and role making the most effective use of one's
performance perceived by the nurse and resources to attain maximum daily
patient are congruent, the transaction living potential.
will occur  Individual - Individuals are cognitive,
 If role conflict is experienced by either conscious social entities. Language is
the nurse or the patient (or both), stress used by humans to express their
in the nurse-patient interaction will thoughts, behaviors, customs, and
occur. beliefs. People share features such as the
 If a nurse with special knowledge ability to perceive, think, and feel, as
communicates appropriate information well as to choose between various
to the patient, mutual goal-setting and courses of action, establish goals, and
goal achievement will occur. make wise decisions.
 Environment - The environment is the
Three Interacting Systems in the theory of background for human interactions. It is
Goal Attainment both external to, and internal to, the
individual.
 Personal System - The personal system
 Action - defined as a sequence of
concepts are perception, self, growth
activities comprising both mental and
and development, body image, space,
physical activity. The process is as
and time.
follows: first, mental action to perceive
 Interpersonal System - The concepts
the presenting conditions; next, physical
for the interpersonal system are
action to initiate actions connected to
interaction, communication, transaction,
those conditions; and lastly, mental
role, and stress.
activity to exercise control over the
 Social System - The social system
situation, together with physical action
concepts are organization, authority,
to achieve goals.
power, status, and decision-making.
 Reaction - the sequence of behaviors
described in action.
Theory of Goal Attainment and Nursing  There are many known, unknown , and
Process universal stressors, and they all have the
potential to upend a client‘s usual level
 Assessment of stability.
- Perception, communication and
interaction of nurse and client
Betty Neuman’s System Model

 Nursing Diagnosis - The neuman systems model, which is

- process of attaining goal the nurse based on a theory, depicts living things
identifies the problems, concerns and as open systems that interact with one
disturbances about which person seek another and their surroundings.
help. - The client in the neuman model could be
 Planning a person,family, a group, a community,
- Decision making about the goals otr another social organization. Each
- Be agree on the means to attain the client system is unique, a mixture of
goals. features and qualities withing a specific
 Implementation range of responses, according to akey
- The process and continuation of tenet of the neuman theory.
transaction. System Model
 Evaluation
- involves to finding out whether goals are 1. Physiological – refers to bodily
achieved or not structure and internal function.
2. Socio-Cultural – refers to the combined
Conclusion effects of social cultural conditions and
According to Imogene King's Theory of Goal influences.
Attainment, accurate knowledge of relationships 3. Developmental – refers to age-related
and effective communication are among the developmental processes and activities.
essential prerequisites of nursing practice. An 4. Psychological – refers to mental
effective nurse patient relationship assists nurses processes and interactive environmental
in better understanding patients' conditions, effects, both internally and externally.
enhancing care quality, and improving patients' 5. Spiritual – refers spiritual beliefs and
quality of life. influences.

Betty Neuman’s System Model Major Concepts of the Model

( Metaparadigm )
Biography
 Person – basic structure or the central
- Born on 1924 in Lowel, Ohio core consists of basic survival factors,
such as genetic features.
The Basic Assumptions of the Morel are: Flexible line, Normal line,& Lines of
resistance. Essentially as protective
 A unique composite of factors and
mechanisms for the basic structure to
characteristics within a rang of
preserve client system integrity.
responses contained in a basic structure
makes up every patient system
 Health Levels of Prevention
o Flexible Line Defense - It
ideally keeps the client system  Primary – occurs before the system
free of stressor reactions by reacts to a stressors. Can strengthen a
Resisting Stressor Invasion. person. Health promotion & injury
o Normal Line Defense – prevention. Lower the risk of coming in
represents the client‘s current contact with stressors.
state, the state to which the  Secondary – occurs after the stressor
client has evolved over time, or has affected the environment. Seek to
the level of wellness. avoid damage to the internal core. Early
o Line of Resistance – contains case findings.
certain known and unknown  Tertiary – occurs after secondary
inner and external resource prevention measures have been used to
factors that support the client‘s treat the system. Focus on support.
basic structure & normal Research to prevent future problems.
defense line. Checking of stability.
o Line of Defense and Hildegard Peplau: Interpersonal Relation
Resistance – instristic to life
Theory
style, copying, expectations, and
motivation, ultimately Biography
protecting fundamental
structure. - 1909-1999
 Environment –include intrapersonal, - Mother of psychiatric nursing
interpersonal, and extra-personal - Born on September 1, 1909 in Reading,
stressors which affect the normal line of Pennsylvania
defense and the stability of the system. - Career: psychiatric nurse expert,
o Internal Environment – within educator, author, and nursing leader and
the client system theorist.
o External Environment –
Interpersonal Relations in Nursing
outside the client system.
 Nursing – focus should be on the entire - Published in 1952, Interpersonal
person because they are seen as a whole relations in Nursing by Peplau is about
- Which tasks the nurse performs depends the theory of interpersonal relations as it
in how much she reacts to stressors and was relevant to the work of nurses.
how much she prevents it. - Focuses on the therapeutic nurse-client
- The type of work nurse does depends on relationship by using problem solving
how they respond to stressors and how techniques to meet the patient need.
much prevention they practice. - Influenced by the interpersonal
 Nursing Intervention – can take place relationship theories of Freud, Maslow,
before or after stressors. and Sullivan as well as by
- Viewing the client as an open system
conremporaneus psychoanalytical
that interacts with the environment via
model.
interpersonal and extrapersonal factors.
Nursing Concept  Man – ―strives in its own way to reduce
tension generated by needs.‖
Nursing is an interpersonal process because  Health - a word symbol that implies
it involves interaction between two or more forward movement of personality and
individuals with a common goal. other ongoing human processes in the
direction of creative, constructive,
Assumptions
productive, personal, and community
 Nurse and the patient can interact living.
 Communication and interviewing  Society/ Environment - the nurse to
skills remain fundamental nursing consider the patient‘s culture and mores
tools. when the patient adjusts to the hospital
 both the patient and nurse mature as routine.
the result of the therapeutic  Nursing - significant, therapeutic,
interaction. interpersonal process.
 nurses must clearly understand 
themselves to promote their client‘s
growth and avoid limiting their Therapeutic nurse-client relationship - A
choices to those that nurses value. professional and planned relationship between
client and nurse focuses on the client‘s needs,
Major Concepts of this Model feelings, problems, and ideas. It involves
( Metaparadigm ) interaction between two or more individuals
with a common goal.
The theory explains nursing‘s purpose is to help
others identify their felt difficulties and that The 4 phases of therapeutic nurse patient
nurses should apply principles of human relationship:
relations to the problems that arise at all levels
of experience.  Orientation - defines the problem
 Exploition - uses professional assistance
 Nursing – the human relationhip for problem solving alternatives.
between an individual who is sick or in  Identification - includes the selection of
need of health services, and a nurse the appropriate assistance by a
specially educated to recognize and professional
respond to the need for help.  Resolution - termination of the
 Environment - existing force outside professional relationship
the organism and in the context of
culture. Peplau’s Theory of Interpersonal
 Health - a word symbol that implies Relationships ( Factors influencing
forward movement of personality and orientation phase )
other ongoing human processes in the
Nurse
direction of creative, constructive,
productive, personal and community  Values
living.  Culture race
 Person – a developing organism that  Beliefs
tries to reduce anxiety caused by needs.  Past experiences
 Expectations
 Preconceived ideas only with assistance. Another person can
redirect the person to the task.
Patient 3. Severe anxiety - involves feelings of
 Values dread and terror. The person cannot be
 Culture race redirected to a task; he or she focuses
 Beliefs only on scattered details and has
physiologic symptoms of tachycardia,
 Past experiences
 Expectations diaphoresis, and chest pain.
4. Panic anxiety - can involve loss of
rational thought, delusions,
Roles of the Nurse in the Therapeutic hallucinations, and complete physical
relationship immobility and muteness. The person
may bolt and run aimlessly, often
 Stranger - offering the client the same exposing himself or herself to injury.
acceptance and courtesy that the nurse
would respond to any stranger. Interpersonal Theory and Nursing Process
 Resource – providing specific answers
Peplau‘s Interpersonal Relations Theory and the
to questions within a larger context
Nursing Process are sequential and focus on the
 Teacher - helping the client to learn
therapeutic relationship by using problem-
formally or informally
solving techniques for the nurse and patient to
 Counselor – providing physical care
collaborate on to meet the patient‘s needs. Both
for the patient and operates equipment
use observation communication and recording as
 Surrogate - serving as a substitute for basic tools utilized by nursing.
another such as a parent or a sibling
 Technical Expert: providing physical Nursing Process
care for the patient and operates
equipment Assessment

Anxiety - defined as the initial response to a o Continuous data collection and analysis
psychic threat. There are four levels of anxiety o May not be a felt need
described below. Nursing Diagnosis & Planning
Four Levels of Anxiety o Mutually set goals
1. Mild anxiety - is a positive state of
Implementation
heightened awareness and sharpened
senses, allowing the person to learn new o Plans initiated towards achievement of
behaviors and solve problems. The mutually set goals
person can take in all available stimuli o May be accomplished by patient, nurse,
(perceptual field). or significant other.
2. Moderate anxiety - involves a
decreased perceptual field (focus on the Evaluation
immediate task only); the person can
o Based on mutually expected behaviors
learn a new behavior or solve problems
o May led to termination and initiation of
new plans.
Therapeutic Relation Conclusion

Orientation Peplau‘s theory has proved greatly used to later

nurse theorists and clinicians in developing more
o Non-continuous data collection sophisticated and therapeutic nursing
o Felt need interventions, including the seven nursing roles,
o Definite needs which show the dynamic character roles typical
in clinical nursing.
Identification

o Interdependent goal setting Ida Jean Orlando: Deliberative Nursing

Process
Exploitation
Biography
o Patient actively seeking and drawing
help - Born on August 12, 1926
o Patient-initiated - Psychiatric Health Nurse, Theorist,
Researcher
Resolution
Major Concepts of this Theory
o Occurs after other phases are completed ( Metaparadigm )
successfully
o Leads to termination  Person - uses the concept of human as
she emphasizes individuality and the
Strengths dynamic nature of the nurse-patient
relationship.
- helped later nursing theorists and  Health - replaced by a sense of
clinicians develop more therapeutic helplessness as the initiator of a
interventions regarding the roles that necessity for nursing.
show the dynamic character typical in  Nursing - unique and independent in its
clinical nursing. concerns for an individual‘s need for
- phases provide simplicity regarding the help in an immediate situation.
nurse-patient relationship‗s natural
progression, which leads to adaptability Deliberative Nursing Process Theory
in any nurse-patient interaction, thus
providing generalizability. Ida Jean Orlando developed her theory from a
study conducted at the Yale University School
Weaknesses of Nursing, integrating mental health concepts
into a basic nursing curriculum. She proposed
- Health promotion and maintenance were that ―patients have their own meanings and
less emphasized. interpretations of situations and therefore nurses
- Also, the theory cannot be used in a must validate their inferences and analyses with
patient who doesn‘t have a felt need, patients before concluding. ‖
such as with withdrawn patients.
5 Concepts of Deliberative Nursing Process
Theory

 Function of Professional Nursing

 Presenting Behaviour Improvement
 Immediate Reaction
 Nursing Process Discipline Improvement is the resolution to the
 Improvement patient‘s situation. In the resolution, the nurse‘s
actions are not evaluated. Instead, the result of
Function of Professional Nursing his or her actions are evaluated to determine
whether his or her actions served to help the
The function of professional nursing is patient communicate his or her need for help and
the organising principle. This means finding out how it was met. In each contact, the nurse
and meeting the patient‘s immediate needs for repeats a process of learning how he or she can
help. According to Orlando, nursing is help the patient.
responsive to individuals who suffer or who
anticipate a sense of helplessness. 5 Stages of Deliberative Nursing Process

Presenting Behaviour 1. Assessment - the nurse completes a

holistic assessment of the patient‘s
Presenting behavior is the patient‘s needs. The nurse uses a nursing
problematic situation. Through the presenting framework to collect both subjective and
behavior, the nurse finds the patient‘s immediate objective data about the patient.
need for help. To do this, the nurse must first 2. Diagnosis - the nurse‘s clinical
recognize the situation as problematic. judgement about health problems. The
Regardless of how the presenting behavior diagnosis can then be confirmed using
appears, it may represent a cry for help from the links to defining characteristics, related
patient. factors, and risk factors found in the
patient‘s assessment.
Immediate Reaction
3. Planning - addresses each of the
The immediate reaction is the internal problems identified in the diagnosis.
response. The patient perceives objects with his Each problem is given a specific goal or
or her five senses. These perceptions stimulate outcome, and each goal or outcome is
automatic thought, and each thought stimulates given nursing interventions to help
an automatic feeling, causing the patient to act. achieve the goal.
These three items are the patient‘s immediate 4. Implementation - the nurse begins
response. using the nursing care plan.
5. Evaluation - the nurse looks at the
Nursing Process Discipline patient‘s progress toward the goals set in
the nursing care plan. Changes can be
The nursing process discipline is the
made to the nursing care plan based on
investigation into the patient‘s needs. Any
how well (or poorly) the patient is
observation shared and explored with the patient
progressing toward the goals.
is immediately useful in ascertaining and
meeting his or her need, or finding out he or she
has no needs at that time.
Joyce Travelbee: Theory of Human to therapeutic use of self. It occurs when
Human Relationship Model the nurse wishes to relieve the patient's
suffering.
Biography 5. Rapport - Nursing intervention that
- 1926, Joyce Travelbee, an American relieves a patient's pain. The nurse and
the sick person are related as human
psychiatric nurse, author, and educator,
beings. It is when the client or patient
was born in New Orleans, Louisiana,
expresses assurance and trust in the
USA.
nurse.
Human to Human Relationship
Major Concepts of this Model
- Travelbee's expansive theory of Human- ( Metaparadigm )
to-Human Relationships provides nurses
 Nurse - an interpersonal process during
with the theoretical foundation they
which a professional nurse helps an
need to engage in therapeutic
individual, family, or community in
communication with others. The
avoiding suffering and illness and, if
assumptions concern humans who work
possible, finding meaning within those
as nurses and interact with humans who
experience.
are distressed or may be in pain.
 Person - A human being is one-of-a-
- This theory's concept originated with her
kind, irreplaceable, and constantly
first book, " Intrapersonal Aspects of
changing and evolving. As a result,
Nursing," which was published in 1961.
nurses and patients are classified as
5 Phases of Interaction Process humans.
 Health - as determined by subjective
1. Original Encounter - Both the nurse and objective health.
and the patient have stereotypical or o Subjective Health - a self-
traditional perceptions of each other. assessed state of well-being that
This first encounter characterizes the includes physical, emotional,
nurse's first impression of the sick and spiritual well-being.
person and conversely. o Objective Health - exclusion of
2. Emerging Identities - The nurse and detectable disease, impairment
the client presented themselves as of deformity as measured by
separate individuals. However, the physical examination,
relationship link starts to develop at that laboratory test, and spiritual
point. director or psychological
3. Empathy - refers to the willingness to counseling assessment.
discuss another person's experience. The  Environment - despite the fact that the
capacity to anticipate the behavior of a definition of this environment is not
person with whom she/he empathized is explicitly specified in this theory Joyce
the result of the compassionate and Travelbee characterizes the human
caring process. condition and the life experiences that
4. Sympathy - to provide effective nursing all men face as illness, suffering, pain,
care, the nurse must use a structured hope, and hopelessness.
intellectual approach as well as
 Illness - a grouping and classification of knowing and understanding different cultures
subjective and objective criteria. with respect to nursing and health illness caring
o Objective Criteria - largely practices beliefs and values with the goal to
decided by the outward provide meaningful and efficacious nursing care
manifestations of illness on the services to people according to their cultural
individual. values and health illness context.
o Subjective Criteria - describe
the manner in which an Major Concepts of this Theory
individual understands himself ( Metaparadigm )
or herself to be ill.  Human Being - Believed to be caring
Suffering - a state of displeasure varying from and capable of being concerned about
minor mental, physical, or spiritual the desire, welfare, and continued
unpleasantness to extreme anguish as well as the existence of others.
stages beyond anguish.  Health - A state of wellbeing that is
culturally defined and constituted. It is a
Pain - pain itself is not visible; only its effects state of being to maintain and the ability
are. Each person's experience with pain is to help individuals or groups to perform
different. their daily role activities in culturally
expressed beneficial care and patterned
Hope - the motivation to attain a goal or gain an ways‖ (Leininger et al, 2006, p.10)
outcome, associated with some degree of  Environment - a varied dimension that
aspirations that what is preferred or decided to exists in all cultures. It requires a very
seek is attainable. extensive geophysical and social
Hopelessness - being devoid of optimism. knowledge
 Nursing - ―it is not logical to use
Madeleine Leininger: Transcultural Nursing nursing to explain nursing. It is a
Theory theoretical and logical contraindication
to use the same term to explain or
Biography predict the same phenomenon.‖
(Leininger et al, 2006, p. 7)
- Born on July 13, 1925, in Sutton,
Nebraska, USA Major Components of the Theory
- Died on August 10, 2012 (87 years old)
- Founder of the theory of Transcultural  Worldview - how people look at the
Nursing/ Culture Care Theory world, or the universe, and form a
- Former CEO of The American Nurses ―picture or value stance‖ about the
Association world and their lives.
- Living legend by the American  Cultural and Social Structure
Academy of Nursing Dimensions - defined as involving the
- "Margaret Mead of Nursing" dynamic patterns and features of
interrelated structural and organizational
Transcultural Nursing Theory factors of a particular culture (subculture
or society)
The transcultural nursing theory or culture care
theory by Madeleine Leininger involves
 Environmental Context - the totality of educational institutions that are
an event, situation, or particular used to provide assistive,
experience that gives meaning to human supportive, enabling, or
expressions, interpretations, and social facilitative acts to orfor another
interactions in particular physical, individual or group to improve a
ecological, socio political, and/or human health condition (or
cultural settings. wellbeing), disability, lifeway,
 Transcultural Nursing - A learned or to work with dying clients.
subfield or branch of nursing that  Culture - The learned, shared, and
focuses upon the comparative study and transmitted values, beliefs, norms, and
analysis of cultures concerning nursing life ways of a particular group that
and health-illness caring practices, guides their thinking, decisions, and
beliefs, and values to provide actions in patterned ways.
meaningful and efficacious nursing care  Culture Care - The subjectively and
services to their cultural values and objectively obtained values, beliefs, and
health-illness context. outlines of the life ways that assist,
 Ethnonursing - The study of nursing support, facilitate, or empower another
care beliefs, values, and practices as individual/group to maintain well-being,
cognitively perceived and known by a and health, and deal with illness,
designated culture through their direct handicaps, or death.
experience, beliefs, and value system o Culture Care Diversity -
(Leininger, 1979). Indicates the variabilities and/or
 Care - Assists others with real or differences in meanings,
anticipated needs in an effort to improve patterns, values, life ways, or
human condition of concern, or to face symbols of care within or
death. between collectives related to
o Cultural Congruent Nursing assistive, supportive, or
Care - A cognitively based enabling human care
assistive, supportive, expressions.
facilitative, or enabling acts or o Culture Care Universality -
decisions that are tailor-made to Indicates the common, similar,
fit with the individual, group, or or dominant uniform care
institutional, cultural values, meanings, patterns, values, life
beliefs, and life ways to provide ways, or symbols manifest
or support meaningful, among many cultures and reflect
beneficial, and satisfying health assistive, supportive,
care, or well-being services. facilitative, or enabling ways to
 Caring - action or activity directed help people. (Leininger, 1991)
towards providing care.  Culture Shock - a time when a person
o Professional Nursing Care ( becomes aware of the differences and/or
Caring ) - Formal and conflicts in values and customs between
cognitively learned professional their home culture and the new culture
care knowledge and practice they are in. Culture shock may lead to
skills obtained through anger and can be reduced by seeking
knowledge of the culture before before the changes were laid out with
encountering that culture the clients.
 Culture Imposition - Refers to the
outsider‘s efforts, both subtle and not so The Sunrise Model - Enables nurses to develop
subtle, to impose their own cultural critical and complex thoughts about nursing
values, beliefs, behaviors upon an practice.
individual, family, or group from Assumptions
another culture. (Leininger, 1978)
 Generic ( Folk or Lay) Care Systems -  Care is an essential component for
Formally educated, and instructed human growth, development, and
professional care, health, illness, survivorship.
wellness, and related knowledge and  Care is essential for the curing and
practice skills that exist in professional healing process as there will be no cure
institutions usually with without care.
multidisciplinary personnel to give  Every culture has generic care according
service to clients. to their beliefs
 Therapeutic nursing care can occur
Three Modes of Nursing Care Decisions and when cultural values, expressions, and
Actions practices are known and used in
providing care.
1. Cultural Care Preservation or
 Differences between caregiver and care
Maintenance - Caring skilled actions
receiver expectations need to be
and decisions that people of a certain
understood in order to provide
culture retain important care values so
congruent care.
that they can keep up their well-being,
 Culturally congruent or universal care
recover from illness, or face handicaps
modes are essential to the health of
or death
every human being.
2. Cultural Care Accommodation or
 Nursing is essentially a transcultural
Negotiation - The supporting,
profession
facilitative, or enabling specialized
actions and decisions that help people of Importance of Transcultural Nursing
designated culture to adapt to others for
a beneficiary or satisfying health  Cultural conflicts, clashes, and violence
outcome with professional care that have an impact on health care as
providers. more cultures interact with one another
3. Culture Care Repatterning or  Increase in legal suits resulting from
Restructuring - The assistive, cultural conflict, negligence, ignorance,
sustaining, facilitative, or enabling and imposition of health care practices.
professional actions and decisions that  Increase in traveling and working in
help clients greatly change lifeways for many different parts of the world.
new, different and beneficial healthcare  Rise in feminism and gender issues,
patterns while regarding the client's with new demands on health care
cultural values and beliefs and still systems to meet the needs of woman and
giving a beneficial or healthier lifeway children.
 There has been an increased demand for - MSN and Ph.D. from University of
community and culture based health Pittsburgh
care services in diverse environmental - Name changed to Theory of Human
contexts. Becoming in 1992

Steps to Attain Cultural Supremacy Human Becoming Theory of Nursing

 Adopt Attitudes to Promote - guides nurses in their practice to focus

Transcultural Nursing Care on quality of life as it is described and
 Develop Awareness for Cultural lived (Karen & Melnechenko, 1995).
Differences - presents an alternative to both the
 Perform a Cultural Assessment conventional biomedical approach and
the bio-psycho-social-spiritual (but still
Strengths normative) approach of most other
- Leininger has developed the Sunrise theories of nursing.
Model in a logical order to demonstrate - quality of life from each person's
the interrelationships of the concepts in own perspective as the goal of nursing
her theory of Culture Care Diversity and practice.
Universality. - Parse first published the theory in 1981
- Leininger‘s theory is essentially as the "Man-living-health" theory.
parsimonious in that the necessary - The name was officially changed to "the
concepts are incorporated in such a human becoming theory" in 1992 to
manner that the theory and its model can remove the term "man" after the change
be applied in many different settings. in the dictionary definition of the word
- It is highly generalizable. The concepts from its former meaning of
and relationships presented are at a level "humankind".
of abstraction, which allows them to be Theory Development
applied in many different situations.
- Though not simple in terms, it can be - developed as a human science nursing
easily understood upon the first contact. theory in the tradition of Dilthey,
Heidegger, Sartre, Merleau-Ponty, and
Weakness Gadamer and Science of Unitary Human
Beings by Martha Rogers.
- The theory and model are not simple in
terms. - The assumptions underpinning the
theory were synthesized from works by
Rosemarie Rizzo Parse: Human Becoming the European philosophers, Heidegger,
Theory of Nursing Sartre, and Merleau-Ponty, along with
works by the pioneer American nurse
Biography theorist, Martha Rogers.
- The theory is structured around three
- Published her theory of nursing, Man-
abiding themes: meaning, rhythmicity,
Living-Health in 1981
and transcendence.
- Studied at Duquesne University,
Pittsburgh
Three Abiding  Becoming is an intersubjective process
of
 Meaning - Human Becoming is freely transcending with the possibles.
choosing personal meaning in situations  Becoming is the unitary human‘s
in the inter subjective process of living emerging.
value priorities. Man‘s reality is given
meaning through lived experiences. Major Concepts of this Theory (
Man, and environment co-create. Metaparadigm )
 Rhythmicity - Human Becoming is co-
creating rhythmic patterns of relating in  Nursing - A human science and art that
mutual process with the universe. Man, uses an abstract body of knowledge to
and environment co-create (imaging, serve people
valuing, languaging) in rhythmical  Person - Open being who is more than
patterns and different from the sum of the part
 Transcendence - Human Becoming is  Environment - Everything in the person
co transcending multidimensional with and his experiences. Inseparable,
emerging possible. Refers to reaching complimentary to and evolving with
out and beyond the limits that a person  Health - Open process of being and
sets. One constantly transforms. becoming. Involves synthesis of values

Assumptions about man Symbol of Human Becoming Theory

 The human is coexistent while co- Black and white = opposite paradox significant
constituting rhythmical patterns with to ontology of human becoming and green is
the universe. hope.
 The human is open, freely choosing o Center joined = co-created mutual
meaning in a situation, as well as human universe process at the
bearing responsibility for decisions ontological level & nurse-person process
made.
o Green and black swirls intertwining =
 The human is unitary, continuously co- human-universe co creation as an
constituting patterns of relating. ongoing process of becoming
 The human is transcending
multidimensionally with the possibles. Another Major Concepts of this Theory

Assumptions about becoming  Structuring - the way individuals see

the world. How they visualize (imaging)
 Becoming is unitary with human-
it is their reality. They create this reality
living-health.
with others and they show (languaging)
 Becoming is a rhythmically co-
their reality in the ways they speak and
constituting the human-universe
remain silent and in the ways they move
process.
and stay still.
 Becoming is the human‘s patterns of
 Languaging - how persons symbolize
relating
and express their imagined reality and
value priorities.
their value characteristics. Their
behavior communicates their inner
thoughts and their perception of their direction of their cherished hopes and
reality through either speaking it out or dreams.
remaining silent.
 Co-creating - the person‘s creation of Principles of this Theory
patterns in daily life activities the
describe the person‘s personal meanings
and values.
 Revealing-concealing - the way
individuals disclose and keep hidden the
persons they are becoming. This is done
simultaneously and is evident in the
popular notion that we have more to tell
and more to know about ourselves.
 Enabling-limiting - are the freedoms
and opportunities that become
observable in the event of restrictions
and obstacles of everyday living. Dr. Joyce J. Fitzpatrick:Life Perspective
Rhythm Model
 Connecting - patterns that show the
person‘s value priorities. This is Biography
exemplified by the behavior of people to
separate from a group of people and join - Nurse Educator
another group. - an advocate for nursing, geriatrics,
 Co-transcending - describes persons as psychological care, and nursing theory.
always engaging with and choosing - was born in 1944
from an infinite number of possibilities - a Fellow of the National Academy of
about ―how to be a person, what attitude Practice (FNAP).
or approach to have, who to relate with,
and what interests or concerns to be Life Perspective Rhythm Model
bothered with‖ - a construct to assist with the
 Powering - the capacity to act and live professional practice of nursing.
with purpose among possibilities for Theorist Dr. Joyce Fitzpatrick based her
affirming and holding what is cherished model of practice on Martha Rogers‘
and at the same time, living with loss theory of Unitary Human Beings. While
and the risk of death and rejection. Rogers‘ theory covered eight separate
 Originating - Describes people‘s areas, Dr. Fitzpatrick has built her
tendency to be someone else while nursing theory on four subdivisions
maintaining their own uniqueness. It is involving the delivery of nursing care.
becoming like someone else but wanting - [Link] Fitzpatrick published her
to be different. theory on 1989 in Conceptual Models of
 Transforming - reflects the purposive, Nursing, second edition, which is an
deliberate change and the shifting views anthology of nursing theory. This theory
of persons about their lives. Allows is based on her interest in nursing and
people to change and move in the psychology.
- She chose to look at the various knowledge drives how the client responds to
components of completing a life changes in their life.
experience as rhythms. Often, the
medical field is consulted when one or  Health - an area that focuses on the
more of these rhythms reaches an apex health of the client and their
or bottoms out. The job of nursing then, surroundings. Health includes all the
is to understand and assist the client people and society that affect the client.
with putting their rhythms together to To maintain optimum health requires the
support all of the body‘s other rhythms assistance of care providers, a client
and return to a state of health. willing to change and follow guidelines
 Rhythm - ―movement, fluctuation or for a healthful life and surrounding the
variation marked by regular recurrence client with supportive family and
or natural flow.‖ It also offers this friends. Optimum health is the goal of
definition ―a regularly recurrent nursing interactions which goes beyond
quantitative change in a variable professional interactions that occur only
biological process.‖ Rhythms can be when the client is distressed by their
described, measured and will be unhealthy state. Nursing professionals
repeated. Thus, the stages of life and strive to improve health through any
illness can be equated to rhythms. interaction with clients.
 Person - The first of her four areas are  Wellness - Professional nursing has
the concept of person. The person not matured into its current focus of
only includes the client but all people promoting wellness. Wellness is the
whom he or she interacts with in their state of optimum health. Essentially, the
environment. She considers a human an focus of health exams has become
open system with a set group of preventative care. Not only do health
rhythmic behaviors. These behaviors are professionals treat illnesses, they
drawn from a variety of fields, including promote lifestyle changes and habits that
biology, psychology, human will lower the chances of experiencing
development, theology, philosophy and illness during one‘s lifetime. Health
the culture of the client with their workers need to learn techniques to
surrounding society. Clearly, this promote wellness.
involves a large area to assess. Major Concepts of this Model
Areas of the Life Perspective Rhythm Model ( Metaparadigm )

The model frames itself around four separate  Person- the totality of the person or
areas. Understanding these areas in each client. Everything known about the
person‘s life will lead to successful outcomes for client and his life
clients. This model is also useful to  Environment – the environment of the
communicate treatment techniques to other client. The social construct that
cultures. [Link] Fitzpatrick proposed this surrounds the client and its effect on the
model because it included elements of the client.
client‘s culture. She defines a major concept of  Wellness – client‘s current level of
human development that is important to nursing wellness. This establishes which items
as the value each person places on their life. This
of health that health care workers need - began her career in nursing in 1966
to address - grew up in Kaukauna, Wisconsin
 Nursing – nursing‘s responsibility and
duty toward the client. The nursing Biography ( Savina Schoenhofer )
theory, actions and treatments that the
- resided in the Amazon for three years
nurse needs to bring to bear to return the
and also volunteered for community
client to the top level of wellness
development.
possible.
- involved in nursing research and
Dr. Fitzpatrick expects that the nursing publications.
profession will have theory, practice and
Overview of the Theory of Nursing as Caring
procedures that are standardized to support the
client in each situation. Using the life - first published in 1990 and 1991
perspective rhythm model should integrate a - a general or grand nursing theory that
total professional action plan for each client. can be used as a framework to guide
Each client is in a different situation and needs nursing practice. The fundamental
to have their own care plan formulated. Nursing assumption is that all persons are caring.
also needs to communicate with its practitioners - The theory of caring, acts as a roadmap
all over the world. Using a concept that includes for nursing practitioners, helping them
the life cycle, wellness and maintenance can be to manage their everyday
applied to any culture or setting. responsibilities.
 Caring is lived by each person moment
The life perspective rhythm model is a
to moment and is an essential
newer theory that is still being integrated into the
characteristic of being human. Caring is
profession. It remains to be seen the effect of
a process, and throughout life, each
this theory on moving the profession to a world-
person grows in the capacity to express
wide model. Many nursing theories do not take
caring.
one of her four areas into consideration, and thus
 Person therefore is recognized as
are difficult to translate to a new culture,
constantly unfolding in caring. From the
environment or a different level of health.
perspective of the theory,
Anne Boykin & Savina Schoenhofer: Theory ―fundamentally, potentially, and actually
of Nursing as Caring each person is caring‖ even though
every act of the person might not be
The first author of this theory is Anne Boykin understood as caring. Knowing the
person as living caring and growing in
Biography ( Anne Boykin )
caring is foundational to the theory.
- currently the Director of the Anne
Nursing as Caring ground the practice of nursing
Boykin Institute for the Advancement of
in knowing, enhancing, and illuminating the
Caring in Nursing of the FAU College
caring between the nurse and the one nursed.
of Nursing.
The Theory of Nursing as Caring reveals the
- has a longstanding commitment to the
essentiality of recognizing caring between the
advancement of knowledge in the
nurse and the one nursed as substantive
discipline, especially regarding the
knowledge that nurses must pursue. From this
phenomenon of caring.
perspective, the outcomes of nursing care reflect
the valuing of person in ways that communicate  Nursing - said to be a discipline and a
―value added‖ richness of the nursing profession. It focuses on the idea of
experience. nursing as being grounded by caring and
Major Key Assumptions of this Theory that nursing revolves around caring
people not just physically but in all
 Persons are caring by virtue of their aspects as well. The theory also shows
humanness
that the essence of caring is most
 Persons are whole and complete in the
essential in the process of providing a
moment
 Persons live caring, moment to moment holistic care needed by the patient.
 Personhood is living life grounded in
Margaret Newman: Newman’s Health as
caring
 Personhood is enhanced through Expanding Consciousness
participating in nurturing relationships
Biography
with caring others
 Nursing is both a discipline and a - Born on October 10, 1933.
profession
- a fellow in the American Academy of
Metaparadigm of this Theory Nursing.
- Has been honoured as an outstanding
 Person - all persons are caring; that to
alumna by two universities.
be a human means to be caring; and that
being a person is living in caring. Caring Theory Development
is innate to an individual and that a
o Martha Rogers (1970) - Martha Rogers
person lives their lives growing the
theory of Unitary Human Beings was
capacity of caring.
the main basis of the development of
 Health - it is believed that overall health
her, Health as Expanding Consciousness
is achieved with the application of
o Arthur Young (1976) The Theory of
caring in all matters that deals with the
Process.
patient. Since this Theory of Caring is a
o Itzhak Bentov (1977) - The concept of
grand theory, it can be used in
evolution and consciousness
collaboration with other theories that
o David Bohm (1980) - The Theory of
further help a patient to improve the
Implicate
quality of nursing care given to them so
that they can achieve overall health. Metaparadigm of this Theory
 Environment - The Theory of Caring as
Nursing suggest that a person should  Health - the major concept of
have an environment that radiates a Newman‘s theory of health as
sense of nurturing atmosphere which expanding consciousness . A fusion of
helps an individual to grow in caring disease and non- disease creates a
while revealing the richness of nursing. synthesis regarded as health.
 Nursing - ―caring in the human health possible. Nurses frequently interact with
experience‖. Newman emhasizes the who are dealing with the uncertainty,
primary of relationship as a focus of debilitation, loss, and eventual mortality
nursing, both nurse-clients relationship that comes with chronic disease. The
and relationship within client‘s lives. theory has evolved to cover all people's
 Person - individuals, and human beings health, independent of illness, presence
as a species are identified by their or absence.
patterns of consciousness. The person - Human behaviour consists of being
does not possess consciousness – the unitary, an open system in continuous
person is consciousness. Persons are interconnection with the open system
―centers of consciousness‖ within an universe, and constantly involved in a
overall pattern of expanding growing pattern of the whole.
consciousness. - Time and space are the individual's
 Environment - coextensive in the temporal patterns, and they are
universe and resides in all matter. complimentary. Humans are continually
evolving over time and space, creating a
Major Assumptions
unique pattern of reality.
 Health encompasses conditions between - describes the relationship between time,
heretofore described as illness or, in space, and movement.
medical term, pathology. - The manifestation of illness is based on
 These ―pathological‖ conditions can be the pattern of the person, thus disease
considered a manifestation of the total pathology exists before symptoms
pattern of the individual occur, and removing disease symptoms
 The patter of the individual that does not affect the individual's structure.
eventually manifests itself as pathology - Nursing, according to Newman, is the
is primary exists before structural or process of identifying the individual in
functional changes. connection to the environment, as well
 Removal of the pathology in itself will as the process of comprehending
not change the pattern of the individual consciousness.
 It becoming ―ill‖ is the only way an - The nurse assists individuals in
individual‘s pattern can manifest itself, understanding how to utilize their
then that is health for that person. internal ability to attain a higher level of
 Health as Expanding Consciousness consciousness.
- Newman established a link connecting
Description of the Theory her concept of health as expanding
consciousness and Young's idea of
- The theory of health as expanding
human evolution.
consciousness (HEC) was enhanced by
concern for those for whom health as the
absence of disease or disability is not
Critique on the Theory terminology, "being in the world of
nursing."
 Clarity - There is semantic clarity in the
- The emotional states of our patients and
definitions, descriptions, and dimensions
ourselves—the main actors in the drama
of the concepts of the theory.
of providing healthcare—as well as
 Simplicity - The deeper meaning of the
emotions like pain, grief, fear,
theory of health as expanding
desperation, joy, laughter, and even
consciousness is complex. The theory
stillness—are all reflected in this
must be understood as a whole rather
murmuring sound. The need for
than isolating the concepts.
humanistic nursing "comes into being"
 Generality - The theory has been
as a result.
applied in many cultures and cross the
- Helping people attain their greatest
spectrum of nursing care situations.
potential, regardless of their particular
 Accessibility - The theory is used with
circumstances, is the fundamental goal
individuals as well as with groups and is
of humanistic nursing.
used to influence health policy. The
- To share with other nurses and
hermeneutic dialectic approach
incorporate them into their nursing
developed subsequently has been used
practice, nurses can use the Humanistic
extensively for full explication of its
Nursing Theory to shed light on the
meaning and applications,
values and meanings that are
demonstrating areas of application as
fundamental to their lived experiences.
well as its modality for clinical practice.
- This process of clarifying one's
Josephine Paterson: Humanistic Nursing underlying meanings and ideals is
Theory referred to as "phenomenological
reflection on experiences" by Paterson
Biography and Zderad.

- Born: September 1, 1924, in Freeport, Highlights of the Theory

New York
- Dr. Paterson conceptualized and taught - a multifaceted theory.
humanistic nursing to graduate students, - connects to the fundamental ideas of
faculty and staff in a variety of Settings. nursing and embraces the dynamics of
being, becoming, and change.
Overview of the Theory - response to a call, a nurse, a team of
nurses, or the entire nursing profession
- Paterson and Zderad created the
acts in a way that will assist the caller
Humanistic Nursing Theory in an effort
with their medical need.
to enhance circumstances for nurses and
- nursing—the "and" in "call and
their patients as they engaged in daily
response"—has been going on.
nursing practice, or, to use existential
- strategy is phenomenological examples of the several separate theories
investigation (Paterson & Zderad, 1976). that make up the Humanistic Model of
- a common misconception among Nursing.
students studying humanistic nursing - The patient is viewed as an individual,
philosophy that the nurse must fulfill the and each scenario is viewed as unique,
patient's requests. according to the humanistic nursing
- the nurse's reaction depends on every model. There is no set formula or
aspect of the patient. process for patient care in this nursing
practice. Each patient is evaluated and
Conceptual Framework for the Humanistic
cared for on an individual basis.
Nursing Theory
Major Concepts of this Theory
- A dynamic process, humanistic nursing
takes place in the context of living,  Getting the Nurse Knower Ready for
breathing people who engage and Learning: During this phase, the nurse
interact with other people and other assumes the role of an intrepid
objects in the environment. investigator who is willing to take
- A person who calls for help with a chances and is open-minded. The nurse
medical problem is referred to as a must be adventurous and open to new
patient. experiences. Accepting the choice to
- It is important to emphasize that each face the unknown head-on.
nurse and each patient are seen as  Knowing the Other Intuitively as a
unique human beings with their own Nurse: In this level, the nurse tries to
unique gestalt in the humanistic nursing comprehend the patient as the "thou" in
paradigm. a "I-thou" connection rather than
- As a result, a nurse and a patient imposing herself as the "I" on the
perceive and respond to each other as a patient.
gestalt rather than just as the  Knowing the other scientifically
presentation of a set of qualities. requires the nurse to observe and
- We see that every individual is believed evaluate from a distance. The nurse
to exist "all at once" in humanistic transitions from intuition to analysis at
nursing. this point. Sorting, contrasting,
- Through this approach, they were able comparing, relating, interpreting, and
to formulate a new theory—the categorizing are all aspects of analysis.
Humanistic Nursing Theory—while also  The ability of the nurse to create or
beginning to identify and consider their consider herself as a source of
nursing practice experience. knowledge, to consistently develop the
- The From Novice to Expert Model of nursing community through education,
Nursing by Patricia Benner and Jean and an expanded comprehension of their
Watson's Theory of Caring are two own learning experiences are all
examples of the nurse complementarily definition of health as the absence of
synthesizing known others. disease is implied by nursing as a human
 From the Many to the Paradoxical response. Nursing cares more about a
One: In this phase, the nurse transfers person's more-being, or assisting him in
the knowledge learned in the classroom being more humanly possible in his
to the real-world clinical environment. specific life position, than just their
The nurse brings the conundrum in this physical well-being.
case.  Environment: The location where the
service is provided, the neighborhood,
Metaparadigm of this Theory or the entire world are all represented by
 Person: In Paterson and Zderad's the environment, according to Patterson
humanistic theory, people are seen as and Zderad. The time and location of the
open energy fields with unique life nursing experience might be thought of
experiences. People believe that humans as the environment. Provide valuable
are unique, dynamic, aware, and insights into important nursing
multifaceted beings who are capable of phenomena, such as presence, empathy,
abstract cognition, creativity, and comfort, timing. ‖
accountability. Persons, including
Put the experience in the context of time—the
families and communities, should be
time spent as the patient and the nurse—to
cherished, respected, nourished, and
comprehend the nursing discussion. Even though
given the opportunity to make educated
the nurse and patient are conversing at the same
decisions about their health.
period of time, to them it may feel very
 Health: (well-being and more-being)
differently. Their perceptions of time are
The nursing act is intrinsically linked to
particular to how they perceive the
a man's own survival or, more generally,
circumstances. Space is the lived perception of
to the health-illness quality of the human
the world around the nurse and patient.
situation. It goes without saying that
Depending on how at ease the participants are
nursing is involved with health and
and how well the setting promotes
illness. It is unclear how the two are
communication, the physical atmosphere can
connected. ―health-restoring,‖ ―health-
help or hurt the nursing conversation. Another
sustaining,‖ or ―health-promoting.‖
element of space is place, however this one is
Nurses engage in ―health teaching‖ and
more subjective and belongs to the patient or
―health supervision.‖On the other hand,
nurse. It has to do with "where I feel like I fit in
as indicated, there are situations in
or am." A person could feel out of place, at
which health, defined in its most
home, or accepted in the environment. The
restrictive sense as independence from
patient might not feel at ease there, but the nurse
sickness, is not considered as an
might.
attainable aim. The value of some
human potential beyond the limited
 Nursing - described as a "living Zderad relationship to Paterson
experience between human beings" by
- Met in the 1950‘s while working at
Paterson and Zderad. The discussion
Catholic University, where their task
between the patient and nurse is one that
was to create a new program that would
is developing, impacting, and beneficial.
include Psychiatric and Community
As a result, the nurse must alter her or
Health components as part of the
his answer to demonstrate a sincere
graduate program.
presence. An inter-human, transactional,
- Their career as nursing academics got
interrelated dialogue in which one
started in the 1950‘s when they were
provides care while acknowledging and
both employed at Catholic University
expressing one's own true humanness
where they met. They continued to work
and responding to the patient's particular
together and remained friends for the
humanness.
nexr 40 years. They later continued on
This is accomplished by awareness of the nurse's to their doctorate degrees in the 1960s.
own worldview, values, comprehension, and - Friendship that has lasted over 35 years
responses, as well as responding to the others' - Shred experiences, ideas and insight to
replies and knowledge, according to Paterson form a concept that evolved into the
and Zderad. The nurse can engage in a real, Formal Theory of Humanistic Nursing.
therapeutic interchange of experience, - First published their book Humanistic
understanding, and being through Nursing in 1976.
comprehending both the self and the other. - Their initial commitment commitment to
creativity conceptualize nursing
The humaneness of nursing is inextricably
constructs developed into ―Nursology‖,
linked to the nursing profession. Since nursing is
a Phenomenological approach to
a "human transaction," it involves all of the
studying nursing as an existential
human limits, emotions, and potentials of each
experience ― Human Experience‖
patient. This exchange has an impact on the
nurse, who then responds by expressing her/his Major Concepts of this Theory
perspective and real self, which has an impact on
the patient. As well, the nurse's "character of - Humanistic theory is ―
being in the circumstance" shapes everything Multidimensional‖ and it is an ―
she does physically. Interactive Theory‖
- In the theory the components identified
Loretta Zderad: Humanistic Nursing Theory as humans are the patient ( can refer to
the person, family, community) and the
Biography
nurse.
- Born on June 7, 1925, Chicago, Illionis
Zderad and Paterson’s Humanistic Nursing - also describing human methods and
Theory primarily concerned with describing
human experience in such a way that the
- A nursing practice that is developed
fullness of experience is absorbed.
from lived experience of the nurse and
 Humanistic nursing is an existential-
the person receiving care
phenomenological-humanistic approach
- The articulated vision of experience
referring to a reverence for life that
- Concerned with the Phenomenological
values the need for human interaction in
experiences of individuals and the
order to determine the meaning that
exploration of human experiences. It
comes from the individual's unique way
requires entering the nursing situation
of experiencing the world.
fully aware of the ―lenses‖ that we wear.
- Nursing occurs within the context of
- Knowing what values, biases, myths,
relationship. It is a nurturing response of
and expectations we bring to the nursing
one person to another in a time of need
experience. And we need to fully
that aims toward the development of
appreciate the values, biases, myths, and
well being and more being .
expectations others bring to the nursing
- Nursing is a unique blend of Theory
experience.
and Methodology. Theory cannot exist
- The practice of humanistic nursing is
without the practice of nursing , for it
rooted in existential thought.
depends on the experience of nursing
Existentialism is a philosophical
and the reflection of that experience. Its
approach to understanding life.
methodology, is a unique blend of art
Individuals are faced with possibilities
and science. Science which consists of
when making choices. These choices
rules, laws, principle and theories that
determined the direction and meaning of
guide us and give direction to the
one‘s life. Since individuals are faced
nursing practice remain meaningless
with freedom of choice, there is always
unless they are applied to living
a possibility of making errors.
situation which becomes the art of
- As a philosophy, existentialism is
nursing.
particularly applicable to nursing within
- The process of nursing as "quality care
the framework of holistic health because
based in the concept of community"
of the emphasis on self- determination,
free choice, and self- responsibility. Conceptual Framework of this Theory
 Phenomenology- the study of the
Person who sends call for help is the patient
meaning of a phenomenon to a
particular individual. It describes data of
the immediate situation that help people
understand the phenomena in question. Person who recognizes and responds to the call
is the nurse
Metaparadigms of this Theory Phenomenological Description

 Person - viewed as an "incarnatebeing" The existential literature, description of what

always becoming in relation with man man has come to know and understand in his
and things in a world of time and space". experience, has evolved from the use of the
Have the capability of self reflection phenomenological approach.
 Nursing - conceptualized as a lived
In phenomenology a statement's validity is based
human act, a response to a human act, as
on whether or not it describes the phenomenon
a response to human situation. The
accurately.
dialogical quality of nursing is
emphasized; nursing is viewed as a Phases of Phenomenological Description
transaction between persons.
 Humanistic Nursing - Transactional 1. Preparation of the nurse knower for
relationship whose meaningfulness coming to know
demands conceptualization founded on a 2. Nurse knowing the other intuitively
nurse's existential awareness of self and 3. Nurse knowing the other scientifically
the other. Aims at the development of 4. Nurse complementarily synthesizing
human potential, at well being and more known others
being 5. Succession within the nurse from the
 Health - Nursing's concern is said to be many to the paradoxical one.
'not merely with a person's wellbeing
Evidence Based Practice
but within his morebeing; with helping
him become more as humanly possible Humanistic nursing theory : application
in his particular life situation. Wellbeing to hospice and palliative care.
and Morebeing, that health is  Wu HL, Volker DL
conceptualized as somewhat more than  2011 Jul 20
the freedom from disease.
 Environment - View person as actually Discussion
living in two worlds. Theoretical concepts relevant to hospice and
o An angular, inner world, also palliative nursing included call-and-response,
described as biased or shaded inter subjective transaction, and uniqueness-
reality. otherness.
o The objective world, of persons
and things. Openness to and Ludwig Bertalanffy: General System Theory
acceptance of the other's inner
Biography
world is essential for true
interaction between persons. - was born in September 19, 1901 in
Atzgersdorf, Vienna, Austria
- Died: June 12, 1972, Buffalo, New  Rogers 's Theory of Unitary Human
York, United States Beings
- His Nationality is Austrian, Canadian  King‘s theory
- cons idered to be a founder and one of
the principal author s of the interdi scipl Principle of Systems Theory
inary school of thought known as Healthcare workers should find the guiding ideas
general systems theory. According to of systems theory to be mostly intuitive.
Weckowicz (1989)
- "occupies an important position in the Basic Concept of General System Theory
intellectual history of the twentieth
A system is a set consisting of integrated,
century.
interesting parts or components that function as
General System Theory a whole. Each part is necessary to make a
complete and meaningful whole.
- A general science of wholeness
- Has been applied in developing nursing Components
theories and conducting nursing research
 Share a common purpose or goal.
- Known by different names: system
 Form a whole which is more than the
theory, theory of open systems, systems
sum of its parts
model, and family systems theory.
- A general science theory of systematical Four Propositions
approach . It is a holistic approach to
systematical theories. It has been a basis 1. External direction is required to reach a
of which many other theorists have built final state in system function.
off. This generalized theory and 2. there are internal structures determining
approach can be very helpful in the processes and outcomes
nursing profession 3. an open system results in a steady state
- Could be applied equally to their own from interactions between an individual
fields, such as chemistry, physics, and and the environment
social sciences. 4. intelligent purposive processes occur in
- can be applied to nursing in how nurses systems
care for their patients. Nurses look at the Embracing systems theory in healthcare can
whole picture with their patients, not reduce adverse events and improve patient care
just the one issue at hand. They help without ignoring individual accountability.
patients in all aspects of their life and
health, anyway they can. Characteristics of Systems Theory

Many nursing theorists have drawn from the  Communication - Communication

works of von Bertalanffy on systems theory. mechanism must be in place for
organization system to exchange
 Neuman's Systems Theory
relevant information with is Key Takeaways
environment. Provides for the flow of
1. Sister Callista Roy
information among the subsystem.
- Adaptation Model
 Holistic View - System theory focuses
- Defines adaptation as the process and
on the arrangement of and relations
outcome whereby the thinking and
between the parts that connect them into
feeling person uses conscious awareness
a whole. The mutual interaction of the
and choice to create human and
parts makes the whole bigger than the
environmental integration
parts themselves.
- Goal of the model is to enhance life
 System, Subsystem and Supersystem
processes through adaptation in four
o System - set interrelated parts
adaptive modes
that inputs into output through
o Physiologic mode
processing.
o Self-concept mode
o Subsystem - do the processing
o Role-function mode
o Supersystem - are other
o Interdependence mode
systems in the environment that
the system continue to process. 2. Betty Neuman
- Health Care System Model
Types of Systems - Asserted that nursing is a unique
profession in that it is concerned with all
 Open System - continuously interacts
the variables affecting the individual‘s
with the environment. There is exchange
response to stress, which are
of materials , energy and information
intrapersonal stressors (within the
with the environment
individual), interpersonal (occurs
 Closed System - theoretical systems
between individuals) and extrapersonal
that do not interacts with the
(outside the person) in nature
environment. Not influence by
- Nursing interventions focus on retaining
surrounding.
or maintaining system stability.
Strengths of Systems Theory 3. Imogene King
- Goal Attainment Theory
 Deals with complexity - Viewed nursing as an interaction
 Takes as Holistic View process between patient and nurse that
 Can easily manage change through lead to goal attainment
interaction with the environment - Patient has 3 interacting system
 Utilizes feedback - easy to improve o Operational system (individuals)
 Recognizes the importance of o Interpersonal system (nurse-
supersystems patient)
o Social system (health care
system)
4. Hildegard Peplau expressions, process and patterns; it is
- Psychodynamic (Interpersonal largely culturally derived
Relations) Model - Presents 3 intervention modes;
- Use of therapeutic relationship between o Culture care preservation and
nurse and the client maintenance
- 4 Phases: Orientation, Identification, o Culture care accommodation,
Exploitation, Resolution negotiation or both
5. Ida Jean Orlando o Culture care restructuring and
- The Dynamic Nurse – Patient repatterning
Relationship Model 8. Rosemarie Rizzo Parse
- Nurse provides direct assistance to meet - Human Becoming Theory
an immediate need for help in order to - Proposes 3 assumptions about human
avoid or to alleviate distress or becoming
helplessness o Human becoming is freely
- She advocated that the three elements choosing personal meaning in
composing nursing situation are: Client situations in the intersubjective
behavior, Nurse reaction, Nurse action process of relating value
6. Joyce Travelbee priorities
- Theory of Human to Human o Human becoming is cocreating
Relationship Model rhythmic patterns or relating in
- Provides nurses with the theoretical mutual process with the
foundation they need to engage in universe
therapeutic communication with others.
o Human becoming is
- an interpersonal process whereby the
contrascending
nurse assists a patient/family to prevent
or cope with experience or illness and multidimensional with the
suffering and, if necessary, to find emerging possibilities.
meaning in these experiences. Emphasizes how individuals
- 5 phases of interaction process choose and bear responsibility
o Original Encounter for patterns of personal health.
o Emerging Identities 9. Joyce J. Fitzpatrick
o Empathy - Life Perspective Rhythm Model
o Sympathy - a complex nursing model which
o Rapport contribute to nursing knowledge by
7. Madeline Leininger providing taxonomy for identifying and
labeling nursing concepts to allow for
- Transcultural Nursing Model (Cultural
their universal recognition and
Care Diversity and Universality Theory)
communication with others.
- Emphasizes that human caring, although 10. Anne Boykin and Savina
universal, varies among cultures in its Schoenhoffer
- Theory of Nursing as Caring
- a general or grand nursing theory that o From the many to the
can be used as a framework to guide paradoxical one.
nursing practice. The theory is grounded 13. Loretta Zderad
in several key assumptions: persons are
- Humanistic Nursing Theory
caring by virtue of their humanness.
- Same kay Josephine
persons live their caring moment to
moment. persons are whole or complete - Defined, Humanistic nursing is an
in the moment. existential-phenomenological-
11. Margaret Neuman humanistic approach referring to a
- Newman‘s Health as Expanding reverence for life that values the need
Consciousness for human interaction in order to
- asserts that every person in every determine the meaning that comes from
situation, no matter how disordered and the individual's unique way of
hopeless it may seem, is part of the
experiencing the world.
universal process of expanding
- Phenomenological Description -
consciousness.
- Arose from Roger‘s Theory of Unitary description of what man has come to
Human Beings know and understand in his experience,
- was stimulated by concern for those for has evolved from the use of the
whom health as the absence of disease phenomenological approach.
or disability is simply not possible - Phases of Phenomenological
12. Josephine E. Paterson Description:
- Humanistic Nursing Theory o Preparation of the nurse knower
- ―emphasizes the lived experience of for coming to know
nursing‖ (Kleiman, 2010) and builds on o Nurse knowing the other
the ―affirmation of being and becoming intuitively
of both the patient and nurse, who are o Nurse knowing the other
actualized through the choices they scientifically
make and the intersubjective o Nurse complementarily
relationships in which they engage‖ synthesizing known others
- 5 Major concepts o Succession within the nurse
o Getting the nurse knower ready from the many to the
for learning paradoxical one.
o Knowing the other intuitively as 14. Systems Theory ( Open & Closed )
a nurse - Ludwig Bertalanffy
o Knowing the other scientifically - means that the safety and health of
requires the nurse to observe patients is the result of how a healthcare
and evaluate form a distance. system is structured. The entire system
o The ability of the nurse to create needs to be dedicated to improving the
or consider herself as a source lives of patients. It forms theories that
of knowledge. turn into practices on how to make a
healthcare system more efficient.