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Myra Estrin Levine

Assumptions About Individuals Each individual is an active participant in interactions with the environment constantly seeking information from it. (Levine, 1 ! " #he individual is a sentient $eing and the a$ility to interact with the environment seems inelucta$ly tied to his sensory organs. %hange is the essence of life and it is unceasing as long as life goes on. %hange is characteristic of life. (Levine, 1 &'" Assumptions About Nursing (ltimately the decisions for nursing intervention must $e $ased on the uni)ue $ehavior of the individual patient. *atient centered nursing care means individuali+ed nursing care. ,t is predicated on the reality of common e-perience. every man is a uni)ue individual, and as such he re)uires a uni)ue constellation of skills, techni)ues and ideas designed specifically for him. (Levine, 1 &'" /elationships 1. %onservation of energy is $ased on nursing interventions to conserve through a deli$erate decision as to the $alance $etween activity and the person0s availa$le energy. 1. %onservation of structural integrity is the $asis for nursing interventions to limit the amount of tissue involvement. '. %onservation of personal integrity is $ased on nursing interventions that permit the individual to make decisions for himself or participate in the decisions. 2. %onservation of social integrity is $ased on nursing interventions to preserve the client0s interactions with family and the social system to which they $elong. 3. 4ll nursing interventions are $ased on careful and continued o$servation over time.

conservation and integrity in a way that provides a nursing view different from that of the ad5unctive disciplines with which nursing shares these concepts. Levine0s work is logical. 6ne thought or idea flows from the previous one and into the ne-t. Weakness: #here are many concepts with comparatively unspecified relationships and unstated assumptions.

4lthough there are many concepts similar to that of other nursing theories, Levine0s concept of energy conservation makes it uni)ue in guiding nursing actions. 7orrowed concepts from 7ates regarding Levine0s view with the environment were not translated into how it affects the individual. #he necessity of connecting incorporated concepts is crucial when trying to develop a model for nursing so as to $e applied to human care. #he concept of conservation, adaptation and integrity can $e applied to any age group since every individual has the need to e-pend and reserve $odily energy. #he operational definition of homeostasis $y Levine is in )uestion since to achieve homeostasis, energy is continuously $eing used $y the $ody thus her statement that homeostasis is an energy sparing state is )uite vague in nature. /ewording might $e helpful in this part of her model.

Imogene M.


ing!s "on#eptual System and $heory o% &oal Attainment and $ransa#tional 'ro#ess
8ing has interrelated the concepts of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and space into a theory of goal attainment. 9er theory deals with a nurse:client dyad, a relationship to which each person $rings personal perceptions of self, role, and personal levels of growth and development. #he nurse and client communicate, first in interaction and then in transaction, to attain mutually set goals. #he relationship takes place in space identified $y their $ehaviors and occurs in forward:moving time.

#he four principles of conservation were $riefly stated. Strengths: Levine has interrelated the concepts of adaptation,

6n the open systems framework, 8ing stated (1" that each human $eing perceives the world as a total person in making transactions with individuals an

things in the environment (1" that transactions represent a life situation in which perceiver and thing perceived are encountered and in which each person enters the situation as an active participant and each is changed in the process of these e-periences. ;hen descri$ing individuals, the model states that

?urse and client perceptions, 5udgments, and actions, if congruent, lead to goal directed transactions. ,f perceptual accuracy is present in nurse:client interactions, transactions will occur. ,f nurse and client make transactions, goals will $e attained. ,f goals are attained, satisfaction will occur.

(1" individuals are social, sentient, rational, reacting $eings, and (1" individuals are controlling, purposeful, action oriented, and time oriented in their $ehavior (8ing, 1 3". /egarding nurse:client interactions, 8ing (1 <1" $elieves that (1" perceptions of the nurse and client influence the interaction process= (1" goals, needs, and values of the nurse and the client influence the interaction process= ('" individuals have a right to knowledge a$out themselves (2" individuals have a right to participate in decisions that influence their lives, their health, and community services= (3" individuals have a right to accept or re5ect care= and (!" goals of health professionals and goals of recipients of health care may not $e congruent. ;ith regard to nursing, 8ing (1 <1, 1 3" wrote that

,f goals are attained, effective nursing care will occur. ,f transactions are made in nurse:client interactions, growth and development will $e enhanced. ,f role e-pectations and role performance as perceived $y nurse and client are congruent, transactions will occur. ,f nurses with special knowledge and skills communicate appropriate information to clients, mutual goal setting and goal attainment will occur (8ing, 1 <1".

Strengths: 8ing0s theory of goal attainment does descri$e a logical se)uence of events. @or the most part, concepts are clearly defined. 4lthough the presentation appears to $e comple-, 8ing0s theory of goal attainment is relatively simple. 8ing formulated assumptions that are testa$le hypotheses for research. Weaknesses: 8ing0s theory contains ma5or inconsistencies. (1" Ahe indicates that nurses are concerned a$out the health care of groups $ut concentrates her discussion on nursing as occurring in a dyadic relationship. (1" 8ing says that the nurse and client are strangers, yet she speaks of their working together for goal attainment and of the importance of health maintenance. #he ma5or limitation in relations to this characteristic is the effort re)uired of the reader to sift through the presentation of a conceptual framework and a theory with repeated definitions to find the $asic concepts. 4nother limitation relates to the lack of development of application of the theory in providing nursing care to groups, families, or communities.

(1" nursing is the care of human $eings= (1" nursing is perceiving, thinking, relating, 5udging, and acting vis:>:vis the $ehavior of individuals who come to a health care system= ('" a nursing situation is the immediate environment in which two individuals esta$lish a relationship to cope with situational events= and (2" the goal of nursing is to help individuals and groups attain, maintain, and restore health. ,f this is not possi$le, nurses help individuals die with dignity. (elationships ?urse and patient are purposeful interacting systems.

,t is not parsimonious, having numerous concepts, multiple assumptions, many statements, and many relationships on a num$er of levels.

*ersons and the earth have common patterns and integral relationships. *ersons and environment transformations are created in human consciousness. ,ntegration of human and environment meanings results in adaptation. 'hilosophi#al Assumptions *ersons have mutual relationships with the world and Cod. 9uman meaning is rooted in the omega point convergence of the universe. Cod is intimately revealed in the diversity of creation and is the common destiny of creation. *ersons use human creative a$ilities of awareness, enlightenment, and faith. *ersons are accounta$le for the processes of deriving, sustaining, and transforming the universe.

#he social systems portion of the open systems framework is less clearly connected to the theory of goal attainment than are the personal and interpersonal systems. #he citation of the individual $eing in a social system was not clearly e-plained considering that the social system encompasses other concepts and su$concepts in her theory #he model presents interaction which is dyadic in nature which implies that its applica$ility cannot $e adapted to unconscious individuals. Bultitude of views and definition is confusing for the reader. 7ecause of multiple views on one concept such as what have $een discussed in her concept of power $lurs the point that the theorist is trying to relate to the readers.

Sister "allista (oy

$he (oy Adaptation Model
@irst, consider the concept of a system as applied to an individual. /oy conceptuali+es the person in a holistic perspective. ,ndividual aspects of parts act together to form a unified $eing. 4dditionally, as living systems, persons are in constant interaction with their environments. 7etween the system and the environment occurs an e-change of information, matter, and energy. %haracteristics of a system include inputs, outputs, controls, and feed$ack.

Strengths: #he theory suggests the influence of multiple causes in a situation, which is strength when dealing with multi:faceted human $eings. #he se)uence of concepts in /oy0s model follows logically. ,n the presentation of each of the key concepts there is the recurring idea of adaptation to maintain integrity. Every concept was operationally defined. #he concepts of /oy0s model are stated in relatively simple terms. 4 ma5or strength of the model is that it guides nurses to use o$servation and interviewing skills in doing an individuali+ed assessment of each person. #he concepts of /oy0s model are applica$le within many practice settings of nursing. Weaknesses: *ainstaking application of the model re)uires significant input of time and effort. /oy0s model has many elements, systems, structures and multiple concepts.

S#ienti%i# Assumptions Aystems of matter and energy progress to higher levels of comple- self:organi+ation. %onsciousness and meaning are constructive of person and environment integration. 4wareness of self and environment is rooted in thinking and feeling. 9umans $y their decisions are accounta$le for the integration of creative processes. #hinking and feeling mediate human action. Aystem relationships include acceptance, protection, and fostering of interdependence.

4s one of the weaknesses of the theory that application of it is time:consuming, application of the

model to emergency situations re)uiring )uick action is difficult to complete. #he individual might have completed the whole adaptation process without the $enefit of having a complete assessment for thorough nursing interventions. 4daptive responses may vary in every individual and may take longer time compared to others. #hus, the span of control of nurses may $e impeded $y the time of the discharge of the patient. (nlike Levine, although the latter tackled on adaptation, /oy gave much focus on the whole adaptive system itself. Each concept was linked with the coping mechanisms of every individual in the process of adapting. #he nurses0 roles when an individual presents an ineffective response during his or her adaptation process were not clearly discussed. #he main point of the concept was to promote adaptation $ut none were stated on how to prevent and resolve maladaptation.

practice of caring integrates $iophysical knowledge with knowledge of human $ehavior to generate or promote health and to provide ministrations to those who are ill. 4 science of caring is therefore complementary to the science of curing. #he practice of caring is central to nursing. (;atson, 1 & ". (elationships #ranspersonal caring field resides within a unitary field of consciousness and energy that transcend time, space and physicality. 4 transpersonal caring relationship connotes a spirit: to:spirit unitary connection within a caring moment, honoring the em$odied spirit of $oth practitioner and patient, within a unitary field of consciousness. 4 transpersonal caring relationship transcends the ego level of $oth practitioner and patient, creating a caring field with new possi$ilities for how to $e in the moment. #he practitioner0s authentic intentionality and consciousness of caring has a higher fre)uency of energy than noncaring consciousness, opening up connections to the universal field of consciousness and greater access to one0s inner healer. #ranspersonal caring is communicated via the practitioner0s energetic patterns of consciousness, intentionality, and authentic presence in a caring relationship. %aring:healing modalities are often noninvasive, nonintrusive, natural:human, energetic environmental field modalities. #ranspersonal caring promotes self:knowledge, self: control, and self:healing patterns and possi$ilities. 4dvanced transpersonal caring modalities draw upon multiple ways of knowing and $eing= they encompass ethical and relational caring, along with those intentional consciousness modalities that are energetic in nature that honors wholeness, healing, comfort, $alance, harmony, and well:$eing. (;atson, 1DD3"

)ean Watson
"aring S#ien#e as Sa#red S#ien#e
,n today0s world, nursing seems to $e responding to the various demands of the machinery with less consideration of the needs of the person attached to the machine. ,n ;atson0s view, the disease might $e cured, $ut illness would remain $ecause without caring, health is not attained. %aring is the essence of nursing and connotes responsiveness $etween the nurse and the person= the nurse co:participates with the person. ;atson contends that caring can assist the person to gain control, $ecome knowledgea$le, and promote health changes.

%aring can $e effectively demonstrated and practiced only interpersonally. %aring consists of carative factors that result in the satisfaction of certain human needs. Effective caring promotes health and individual or family growth. %aring responses accept a person not only as he or she is now $ut as what he or she may $ecome. 4 caring environment is one that offers the development of potential while allowing the person to choose the $est action for himself or herself at a given point in time. %aring is more healthogenic than is curing. #he

Strengths: ;atson0s work can $e used to guide and improve practice. ,t can provide the nurse with the most satisfying aspects of practice and can provide the client with holistic care. #he theory is relatively simple.

;atson0s work is logical in that the carative factors are $ased on $road assumptions that provide a supportive framework. #he carative factors are logically derived from the assumptions and related to the hierarchy of needs. #he carative factors delineate nursing from medicine. Weakness: ;atson0s theory $ecomes more comple- when entering the area of e-istential:phenomenology, for many nurses may not have the li$eral arts $ackground to provide the proper foundation for this area.

,t is undenia$le that technology has already $een part of nursing0s whole paradigm with the evolving era of development. ;atson0s suggestion of purely caring without giving much attention to technological machineries cannot $e solely applied $ut then her statement is praiseworthy $ecause she dealt with the importance of the nurse patient interaction rather than a practice confined with technology. ;atson stated the term soul:satisying when giving out care for the clients. 9er concepts guide the nurse to an ideal )uality nursing care provided for the patient. #his would further increase the involvement of $oth the patient and the nurse when the e-perience is satisfying. ,n providing the enumerated clinical caritas processes, the nurse $ecomes an active co: participant with the patient. #hus, )uality of care offered $y the nurse is enhanced.