Theoretical Foundations in Nursing

ENVIRONMENTAL THEORYFlorence Nightingale (1860)

• “I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.”

Florence Nightingale defined Nursing as“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.

Environmental Factors Affecting HealthDefined in her environmental theory are the following factors present in the patient’s environment:•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 patient’s 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 aQuiet or noise-free andwarm environment,attending to patient’s dietary needs by assessment, documentation of time of food intake, and evaluating it’s 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:•environment to patient•nurse to environment•nurse to patient

Modern Nursing; Environmental Theory

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

THE INTERPERSONAL RELATIONS THEORY

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.” 

Dr. Peplau emphasized thenurse-client relationshipAs the foundation of nursing practice. At the time, her research and emphasis on the give-and-take of nurse-client relationships was seen by many as revolutionary. She described the nurse-patient 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 Relationship1. 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 patient’s 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 RolesIn 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 instructions and provides training; involves analysis and synthesis of the learner’s experience.4.Counseling Role:Helps client understand and integrate the meaning of current life circumstances; provides quidance 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. AdditionalRolesinclude:1. Technical expert2. Consultant3. Health teacher4. Tutor5. Socializing agent6. Safety agent7. Manager of environment8. Mediator9. Administrator10.Recorder observer11.Researcher

Definition of the Unique Function of Nursing

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 it’s recovery (or to peaceful death) that an individual would perform unaided if he had the necessary strength, will or knowledge”.She conceptualized the14 Fundamental Needs

14 Fundamental Needs of humans. These needs are:•Breathing normally•Eating and drinking adequately•Eliminating body wastes•Moving and maintaining desirable position•Sleeping and resting•Selecting suitable clothes•Maintaining body temperature within normal range•Keeping the body clean and well-groomed•Avoiding dangers in the environment•Communicating with others•Worshipping according to one’s faith•Working in such a way that one feels a sense of accomplishment•Playing/participating in various forms of recreation•Learning, discovering or satisfying the curiosity thatleads to normal development and health and usingavailable health facilities.

The Nurse-Patient RelationshipHenderson 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.

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.” 

Orlando's theory was developed in the late1950s 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.

Nursing Process; Dynamic Nurse-Patient Relationship

Focused on patient’s verbal and nonverbal expressions of need and the nurse’s 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 patient’s needs through deliberate action; advanced nursing beyond automatic response to disciplined and professional response

Key Concepts of Three Interlocking Circles Theory ( care,core and cure)

Human- to- Human Relationship Model

Lydia Hall ( 1961 )

According to Hall, Nursing is participation incare,core and cureaspects, where

CAREis thesolefunction of nurses, whereas the

COREandCUREare 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:

Cure (Disease) shared with doctors

Core (Person) addressed by therapeutic use of self; shared with psychiatry/psychology, religious ministry, etc.

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

INTERPERSONAL ASPECTS OF NURSING MODEL

• “A nurse does not only seek to alleviate physical painor 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.” Joyce Travelbee (1966)

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 compassion. She felt nursing needed a "Humanistic revolution" and a renewed focus on caring as central to nursing--she warned that if this didn't happen, consumers might seeka "new and different kind of health careworker". 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:

Series of interactional phases: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.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.Empathy- this phase is described as the ability to share in the person’s experience.4.Sympathy- It happens when the nurse wants to lessen the cause of the patient’s 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 patient’s 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.

System Model in Nursing Practice

Betty Neuman (1972)“Health is a condition in which all parts and subparts are in harmony with the whole of the client” 

Betty Neuman (1972)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 Neuman’s 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 ResistanceLines of Resistance act when the Normal Line of Defense is invaded by too much stressor, producing alterations in the client’s 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 DiseaseIt serves as a boundary for the Normal Line of Defense to adjust to situations that threaten the imbalance with in the client’s stability.Stressors These are forces that produce tensions, alterations or potential problems causing instability within the client’s 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 reactions as

Negentropy is set towards stability or wellness while

Egentropy is set towards disorganization of the system producing illness.

Behavioral System Model

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

Dorothy Johnson (1971)

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.

Seven Behavioral Subsystems

1.The Attachment or Affiliative SubsystemIs 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 Subsystemare actions 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 Subsystemrelates 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 Subsystemrelates 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 Subsystemimitates behaviors related to procreation or reproduction.6.The Aggressive Subsystemrelates to behaviors concerned with the defense and self-preservation.7.The Achievement Subsystemcontains behaviors that attempt to control the environment. Intellectual, physical, imaginative, mechanical, and communal skills are some of the areas that Johnson distinguishes.

Goal Attainment Theory

Imogene King (1971)

“If the students can’t do the fundamentals, how can they use advanced knowledge.” 

Imogene King (1971)King stated that Nursing is a process of 

actionreaction

andinteraction

whereby nurse and client share information about their perception in the nursing situation.

ActionAction is a means of behavior or activities that are towards the accomplishment of certain act. It is both physical and mental.

ReactionIn King’s 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.

Personal- how the nurse views and integrates self based from personal goals and beliefs•Interpersonal- how the nurse interrelates with a coworker or patient, particularly in a nurse-patient relationship•Social- how the nurse interacts with co-workers, superiors, subordinates and the client environment in general

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•Interacting systems:

Personal System - perception, self, body image, growth and development

Interpersonal System - role, interaction, communication, transaction, and stress

Social System - organization, power-authority status, decision making

Self-Care Theory

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(Individual’s 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- 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 unit2.Partial compensatory- 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 postoperative client to ambulate, Nurse can bring a meal tray for client who can feed himself

3.Supportive-educative- 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.

Twenty-One Nursing Problems

Faye Glen Abdellah (1960)“I never wanted to be a medical doctor because I could do all I wanted to do in nursing, which is a caring profession.” 

Faye Glen Abdellah (1960) The concept of Nursing in this theory is generally grouped into twenty-one problem areas for nurses to workout 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.To maintain good hygiene.2. To promote optimal activity; exercise, rest and sleep.

3.To promote safety.

4.To maintain good body mechanics.

5.To facilitate the maintenance of a supply of oxygen

6.To facilitate maintenance of nutrition

7.To facilitate maintenance of elimination

8.To facilitate the maintenance of fluid and electrolyte balance9.To recognize the physiologic response of the body to disease conditions10.To facilitate the maintenance of regulatory mechanisms and functions.11.To facilitate the maintenance of sensory functions12.To identify and accept positive and negative expressions, feelings and reactions13.To identify and accept the interrelatedness of emotions and illness.14.To facilitate the maintenance of effective verbal and non- verbal communication15.To promote the development of productive interpersonal relationship

16. To facilitate progress toward achievement of personal spiritual goals17.To create and maintain a therapeutic environment18.To facilitate awareness of self as an individual with varying needs.19 To accept the optimum possible goals20.To use community resources as an aid in resolving problems arising from illness.21. To understand the role of social problems as influencing factors

The Prescriptive Theory of Nursing

Ernestine Wiedenbach (1964)"My thesis is that nursing art is not comprised of rational nor reactionary actions but rather of deliberative action.”

Ernestine Wiedenbach (1964)

Wiedenbach conceptualizes nursing as the practice identification of a patient’s need for help through observation of presenting behaviors and symptoms, exploration of themeaningof those symptoms with the patient, determining the cause(s) of discomfort, and determining the patient’s 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 patient’s 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 patient’s 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 3essential components associated with a nursing philosophy:○ Reverence for life○ Respect for the dignity, worth, autonomy and individuality of each human being

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 patient’s need for help.

The Art of nursing includes understanding patient’s needs and concerns, developing goals and actions intended to enhance patient’s ability and directing the activities related to the medical plan to improve the patient’s condition . The nurses also focuses on prevention of complications related to reoccurrence or development of new concerns.

- Helping Art of Clinical Nursing

“…nursing is nurturing or caring for someone in a motherly fashion.”

Proposed that nurses identify patient’s need-for-help by: Observing behaviors regarding comfort

Exploring meanings of the behavior

Knowing the cause of discomfort

Knowing if they can solve on their own or need help

The Conservation Model

Myra Estrin Levine (1977)

"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:

conservation of energy

structural integrity

personal integrity

social integrity

Major Concepts:

Wholism (Holism)

Adaptation - process whereby patients retain integrity; establish body economy to safeguardstability:

Environment

Organismic Response - (1)Fight or flight, (2)inflammatory response, (3)response tostress, (4)perceptual awareness

Trophicogenesis - alternative to nursing diagnosis

Conservation - 4 principles of conservation - Nursing intervention is based on the conservation of the patients:

Energy

Structural Integrity

Personal Integrity

Social Integrity

Composed of 3 Theories – (1)conservation (2)redundancy (3)therapeutic intention

Adaptation Model

Sister Callista Roy (1979)“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.” 

Sister Callista Roy (1979)

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:

Regulator Subsystemtranspires through neutral, chemical and endocrine processes like the increase in vital signs-sympathetic response to stress.•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 person’s ability to cope with that change is likely to determine the person’s health status. Nursing interventions are aimed at promoting physiologic, psychologic, and social functioning or adaptation.

Proposed that humans are biophychosocial beings who exist within an environment•Environment and self provides 3 types of stimuli: (1) focal (2) residual (3) contextual•Human stimuli create needs in adaptation modes, such as physiological self-concept, role function, and interdependence• Through adaptive mechanisms, regulator and cognator, a person shows adaptive or ineffective response that need nursing intervention

Transcultural Theory

Madeleine Leininger (1985)“Care is the heart of nursing; Careis power; Care is essential to healing;Care is curing; and Care is the centraland dominant focus of nursing and transcultural nursing decisions and actions.” 

Madeleine Leininger (1985)

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 helppeople face handicaps or death.

Transcultural nursingas 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 t o provide meaningful and efficacious nursing care services t o 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.

Transcultural Care Theory; Ethnonursing•Some of the major concepts are care, caring, culture, cultural values, and cultural variations•Caring is seen as the central theme in nursing care, knowledge and practice.•Caring includes assistive, supportive, facilitative acts towards people with actual or anticipated needs

3 types of Nursing Actions

Cultural Care Preservation or Maintenance - retention of relevant care values unique to culture

Cultural Care Accommodation or Negotiation - adapting culture with professional care providers

Cultural Care Repatterning or Restructuring - changing life-ways while still respecting culture for a healthier outcome

Philosophy and Science of Caring

Margaret Jean Watson (1979)“Caring in nursing conveys physical Acts but embraces the mind-body-spirit as it reclaims the embodied spirit as its focus attention.” 

Margaret Jean Watson (1979)Watson proposesseven assumptionsabout thescience of caring andten primary carative factorsto form the framework of her theory. The basic assumptions are:•Caring can be effectively demonstrated and practicedonly interpersonally;•Effective caring promotes health and individual or family growth;•Caring responses accept a person not only as he or she is now but as what he or she may become;

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•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.• The practice of caring is central to nursing

Ten Carative Factors

1.The promotion of a humanistic- altruistic system of values

2.Instillation of faith-hope

3. The cultivation of sensitivity to one’s self and others

4. The development of a helping-trusting, human caring relationship

5.Promotion and acceptance of the expression 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

The Science of Unitary Human Beings, and Principles of Homeodynamics

Martha Rogers (1970)“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.” 

Martha Rogers (1970)

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 organizationto achieve maximum health. 

5 BasicAssumptions: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

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

Unitary Human Beings

Principles of HomeodynamicsoHelicy - spiral development in continuous, non-repeating, and innovative patterning

Resonancy - patterning changes with development from lower to higher frequency(intensity)

Integrality - continuous mutual process of person and environment

Theoretical Assertions

Energy - Man as a whole is more than the sum of his parts

Openness - Man and environment continuously exchange matter and energy

Helicy - Life evolves irreversibly and unidirectionally along space and time

Pattern and organization identify man and reflect his innovative wholeness

Sentient, thinking being - man has capacity for abstraction and imagery, language andthought, sensation and emotion

Theory of Human Becoming

Rosemarie Rizzo Parse (1981) “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 patterns or relating in mutual process in the universe

3. Human becoming is co-transcending multidimensionallywith emerging possibilities.

Human Becoming

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

In capsule, Parse's three principles are:

• 1. Meaning - man’s reality is given meaning through lived experiences.

Man and environment c0-create2. Rhythmicity - man and environment co-

create (imaging, valuaing, langauaging) in rhythmical patterns

3. Contracendence - refers to reaching out and beyond the limits that a person sets.

One constantly transforms

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

activities1. Maintain safe environment 2. Communicate 3. Breathe4. Eat and drink5. Eliminate6. Personal cleansing and dressing7. Temperature 8. Mobility9. Work and play10. Express sexuality11. Sleep12. Dying

Life span - concept of continuous change from birth to death

Dependence-independence continuum

5 factors influencing AL: Biological, Psychological, Socio-cultural, Environmental,Politicoeconomic.

The individuality of living is the way in which the individual attends to ALs in regard to place on lifespan and dependence-independence continuum and as influenced by the 5 factors

Katherine Kolcaba- Theory of Comfort•Defined healthcare needs as those needs for comfort including physical, psycho-spiritual, social, andenvironmental needs•Intervening factors influence client’s perception of comfort: age, attitude, emotional support, experience,finance, prognosis• Types of comfort:1.Relief when specific need is fulfilled2.Sense of ease, calm, and contentment3.Transcendence or rising above the problems of pain

Erikson, Tomlin and Swain- Modeling and Role-Modeling•Synthesis of multiple theories related to basic needs, developmental tasks, object attachment, and adaptivecoping potential•Views nursing as self-care based on the person’s perception of the world and adaptation to stressors•Promotes growth and development while recognizing individual differences according to worldview andinherent 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 behaviormodifies those characteristics to meet the needs of the system• The theory is based on scales developed to measure feeding, teaching, and environment

Merle Mishel- Uncertainty in Illness•Researched into experiences with uncertainty as it relates to chronic and life-threatening illness

Later reconceptualized to accommodate the responses to uncertainty over time in people with chronic conditions who may not resolve the uncertainty

Margaret 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 withinthem 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 thebeneficiary’s difficulty, the intervention of the professional, and the consequence

Nola 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.