HOMEWORK

In partial requirement for the subject Theoretical

Foundations of Nursing
Submitted by: Elijah R. Quiano 1- NU 01
Submitted to: Ms. Gacuya

Theorist: Dorothy Johnson

Theory: Behavioral systems model

Description:
The theory was heavily inspired by Florence Nightingale’s book (Notes on Nursing). Used
behavioral scientist, psychology, sociology, and etc. to create the seven subsystems.

The focus of the theory is the conceptualization of a person as a behavioral system, the
behavior is seen as a whole. The systems are further clustered into seven (7) subsystems that are
linked and open. There is said to be balance within the individual’s system. These subsystems
may change depending on the maturation, experience, growth and learning. The main goal of
the nurse is to maintain the said “equilibrium”, in which the person harmonizes with his/her
environment.

The subsystems are as follows

a. Attachment
b. Dependency
c. Ingestive
d. Eliminative
e. Sexual
f. Achievment
g. Aggressive and/or Protective

Behavioral System Model Metaparadigm

Nursing: is seen as an external force -the goal is to maintain and restore an individual’s
behavioral systems balance through imposing temporary regulatory or control mechanisms
through resources.
Person: is a behavioral system with patterned, repetitive, and purposeful, ways of behaving
that link to person to the environment.
Health: a lack of balance in the structure or functional requirements of the subsystems lead
to poor health.
Environment: are all factors that are not part of a person’s behavioral system but has
influence of the behavioral system.
Theorist: Betty Neuman
Theory: Neuman Systems Model

Description:
The Neuman Systems Model is an open-systems based perspective that provides a
unifying focus that accepts a wide range of concern and/or possibilities. The system acts a
boundary for a single client, a group or even a number of groups

Client is the central core surrounded by concentric rings. The inner circle of the diagram
represents the basic survival factors or energy resources of the client.
- the core structure consists of basic survival factors common to human beings such as
innate or genetic features

Line of resistance are factors that help the client defend against a stressor.
Normal line of defense is the model’s outer solid circle. Represents adaptational level of health
developed over the course of time and serves as the standard by which to measure wellness
deviation.

Flexible line of defense is a softer shell that prevent stressors from breaking through the usual
wellness (Normal line of defense).
Stressors are tension-producing stimuli that have the potential to disrupt system stability, leading
to outcome that may be positive or negative. These are brought upon by different classifications:

Stressors:
Intrapersonal stressors are internal environmental forces that occur within the boundary of the
client system. They may include, for example, conditioned responses or autoimmune responses.

Interpersonal stressors are the external environment interaction forces that occur outside the
boundaries of the client system at the proximal range. They may include, for example,
communication patterns or role expectations.

Extrapersonal stressors are the external environmental interaction forces that occur outside the
boundaries of the client system at the distal range. They may include, for example, social
policies or financial concerns.

Neuman also included a so called “Three Relevant Environments”

a. Internal Environment
b. External Environment
c. Created Environment

Neuman also stated the Degree of Reaction

Degree of Reaction – represents the system (human’s) instability that occurs when stressors
affect and invade the normal line of defense.

With those stated, she included different kinds of interventions, level of preventions.

a. Primary Intervention
b. Secondary Intervention
c. Tertiary Intervention

Neuman Systems Model Metaparadigm

Person: An open client system in reciprocal interaction with the environment.
Health: Neuman considers her work a wellness model. She views health as a continuum of
wellness to illness that is dynamic in nature and is constantly changing.
Environment: All the internal and external factors that surround and influence the client system.
Nursing -is concerned with the whole person. A “unique profession in that it is concerned with all
the variable affecting the individual’s response to stress.”

Theorist: Imogene King

Theory: Conceptual System and Middle-Ranged Theory of Goal Attainment

Her assumptions in Nursing

1. Nursing focuses on “caring” for the human being.
2. Nursing goal is the healthcare of individuals and groups
3. Human beings – are open systems interacting with his/her environment

Description:

The human being an interacting system, she made three kinds of interactions:
1. Personal System
2. Social System
3. Interactive System

She described the systems as follows:

A. Personal System
a. Perception - A major concept. It is universal and subjective. It is also a process in
which data obtained is organized, interpreted, and transformed.
b. Self - A dynamic individual, with an open system and goal orientation. It also
includes a system of ideas, attitudes, values, and commitments
c. Growth and Development - Changes occur in orderly manner, predictable,
function of endowment and environment
d. Body Image - How one perceives both one’s body and other reactions to one’s
appearance
e. Space - Is defined by the physical area called the “territory” and by the behaviors
of those who occupy it
f. Time - A duration between one event and another as uniquely experienced by
each human being

B. Interpersonal System
a. Interaction - Characterized by values, mechanisms, universal, mutual, contains
irreversible and dynamic communication
b. Communication - A process whereby information is given from one person to
another either directly or indirectly
 c. Transaction - A process of interaction in which human beings communicate with
the environment to achieve goals that are valued
d. Role - A set of expected behaviors of those who occupy a particular position in the
social system
e. Stress - A dynamic state whereby a human being interacts with the environment
to maintain balance, which involve exchange of energy and information between
the person and the environment

C. Social System
a. Organization - Made up of human beings who have prescribed roles and positions
who make use of resources to meet goals
b. Authority - An active, reciprocal process of transaction in which the actor’s
background, perceptions, and values influence the definition and validation
c. Power - The ability to use and mobilize resources to achieve goals
d. Status - The position of an individual in a group or of a group in relation to others
in an organization
e. Decision Making - A dynamic and systematic process by which goal directed
choice of perceived alternatives is made to attain goal
Other concepts of King:
Transaction will occur if role expectations and role performance as perceived by nurse and client
are congruent
Stress in nurse-client interaction will occur if role conflict is by the nurse, client or both.
Mutual goal setting & Goal attainment will occur if the nurse with special knowledge skills
communicate appropriate information to client.
Theory of Goal Attainment and Nursing Processes
● Assessment - Assessment occurs during interaction
● The nurse brings special knowledge and skills whereas client brings knowledge of
self and perception of problems of concern, to this interaction
● During assessment nurse collects data regarding client (his/her growth and
development, perception of self, current health status, and roles)
● Perception is the base for collection and interpretation of data.
● Communication is required to verify accuracy of perception, for interaction and
transaction
 ● Nursing Diagnosis - This data collected by assessment is used to make the nursing
diagnosis in the nursing process
● In the process of attaining a goal, the nurse identifies the problems, concerns, and
disturbances about which the person seeks help
● Planning - After diagnosis, planning for interventions to solve those problems is done.
● Implementations In goal attainment, planning is represented by setting goals and
making decisions about and being agreed on the means to achieve goals
● This part of the transaction and client’s participation is encouraged in making the
decision on the means to achieve the goals
● Implementations - In the nursing process, implementation involves the actual activities to
achieve the goals
● In goal attainment, it is the continuation of transaction
● Evaluation - It involves to finding out whether goals are achieved or not
● In King’s Description, evaluation speaks about the attainment of the goal and the
effectiveness of nursing care

Conceptual System and Middle-Ranged Theory of Goal Attainment Metaparadigm

Person: human being or a person refers to a social being who are rational and sentient.
- Has the ability to perceive, feel, think, choose, set goals, select means to achieve goals,
etc.
- Human beings have three fundamental needs
o The need for the health information that is unable at the time when it is needed
and can be used
o The need for care that seeks to prevent illness
o The need for care when human beings are unable to help themselves
Health: Health involves dynamic life experiences of a human being, which implies continuous
adjustment to stressors in the internal or external environment through optimum use of one’s
resources to achieve maximum potential for daily living.
Environment: Environment is the background for human interactions
1. Internal environment - transforms energy to enable person to adjust to continuous
external environmental changes
 2. External environment - Involves formal and informal organizations. Nurse is a part of the
patient’s environment
Nursing: A process of action, reaction, and interaction by which the nurse and client share
information about their perceptions in their nursing situations. And it is also the process of
human interactions between nurse and client whereby each perceives the other and the
situation, and through communication, they set goals, explore means, and agree on means to
achieve goals
a. Action - Is defined as a sequence of behaviors involving mental and physical action
b. Reaction - Which is considered as included in the sequence of behaviors described in
action
In addition, King discussed:
1. A goal
2. A domain
3. The functions of a professional nurse
Goal of nurse - To help individuals to maintain their health so they can function in their roles
Domain of nurse - Includes promoting, maintaining, restoring health, and caring for the sick,
injured, and dying
Function of the professional nurse - To interpret in the nursing process to plan, implement, and
evaluate nursing care

Theorist: Hildegard Peplau

Theory: Theory of Interpersonal Relations
Description:

She mentioned phases of nurse-patient relationship in regards of interaction

Orientation phase -a health problem has emerged that results in a felt need and professional
assistance is sought
Working Phase - the patient identifies those who can help and the nurse permits exploration of
feelings by the patient.
- during this phase the nurse can begin to focus the patient on the achievement of new
goals.

Resolution phase - is the time when the patient gradually adopts new goals and frees himself or
herself from identification with the nurse.

She also emphasized on the “roles”of nurses in the lives of the patient and on how nurses care
for the patient in various ways.

Teacher: the nurse provides knowledge about a need or problem.

Resource: the nurse provides information to understand a problem
Counselor: the nurse helps recognize, face, accept, and resolve problems.
Leader: the nurse initiates and maintains group goals through interaction.
Technical Expert: The nurse provides physical care using clinical skills
Surrogate: The nurse may take the place of another

She also introduced the concept of Pattern Integration

- which is the identification of patterns within the interpersonal relationship between two
or more persons that link or bind them and enable them to transform energy into
patterns of action that bring satisfaction or security in the face of a recurring problem.
She then categorized the Integrating Patterns into four:
Complementary: patterns occur when the behavior of one person fits with and complements the
behavior of the other.
Mutual: patterns occur when the same or similar behaviors are used by both persons.
Alternating: patterns occur when different behaviors used by two persons alternate between the
two persons
Antagonistic patterns may occur if the behaviors of two persons do not fit but the relationship
continues

Theory of Interpersonal Relations Metaparadigm

Person: Encompasses the patient (one who has problems for which expert nursing services are
needed or sought) and the nurse (a professional with particular expertise.
Health: Implies forward movement of personality and other ongoing human processes in the
direction of creative, constructive, productive, personal and community living.
Environment: Forces outside the organism within the context of culture.
Nursing: the therapeutic, interpersonal process between the nurse and the patient.

Theorist: Joyce Travelbee

Theory: Human to Human Relationship Model
Description:
Travelbee believed nursing is accomplished through human-to-human relationships that begin
with:
 Original Encounter
- First impression by the nurse of the sick person and vice-versa.
- Stereotyped or traditional roles
 Emerging Identities
- the time when relationship begins
- the nurse and patient perceive each other’s uniqueness
 Empathy
- the ability to share in the person’s experience
 Sympathy
- when the nurse wants to lessen the cause of patient’s suffering.
- it goes beyond empathy— “When one sympathizes, one is involved but not
incapacitated by the involvement.”
- therapeutic use of self
 Rapport
- is described as nursing interventions that lessens the patient’s suffering.
- Relation as human being to human being
- “A nurse is able to establish rapport because she possesses the necessary knowledge
and skills required to assist ill persons and because she is able to perceive, respond to
and appreciate the uniqueness of the ill human being.”
Main Concepts/ Assumptions
 Suffering
o An experience that varies in intensity, duration and depth ... a feeling of unease,
ranging from mild, transient mental, physical or mental discomfort to extreme
pain and extreme tortured
  Meaning
o Meaning is the reason as oneself attributes
 Nursing
o is to help man to find meaning in the experience of illness and suffering.
o has a responsibility to help individuals and their families to find meaning.
o The nurses' spiritual and ethical choices, and perceptions of illness and suffering,
is crucial to helping to find meaning.
 Hope
o Nurse's job is to help the patient to maintain hope and avoid hopelessness.
o Hope is a faith that can and will be change that would bring something better
with it.
o Hope's core lies in a fundamental trust the outside world, and a belief that others
will help someone when you need it.
o Six important factors charecteristics of hope are:
o It is strongly associated with dependence on other people.
o It is future oriented.
o It is linked to elections from several alternatives or escape routes out of its
situation.
 The desire to possess any object or condition, to complete a task or have an experience.
 Confidence that others will be there for one when you need them.
 The hoping person is in possession of courage to be able to acknowledge its
shortcomings and fears and go forward towards its goal

Human to Human Relationship Model Metaparadigm

Person: Person is defined as a human being.
o Both the nurse and the patient are human beings.
Health: Health is subjective and objective.
- Subjective health - is an individually defined state of well-being in accord with self-
appraisal of physical-emotional-spiritual status.
- Objective health - is an absence of discernible disease, disability of defect as measured
by physical examination, laboratory tests and assessment by spiritual director or
psychological counselor.
Environment: Environment is not clearly defined.
Nursing: An interpersonal process whereby the professional nurse practitioner assists an
individual, family or community to prevent or cope with experience or illness and suffering, and
if necessary to find meaning in these experiences.

Theorist: Madeleine Leininger

Theory: Culture Care Theory of Diversity and Universality
Definitions:
Human care and caring - abstract and manifest phenomena with expressions of assistive,
supportive, enabling and facilitating ways to help self or others with evident or anticipated needs
to improve health, human condition, lifeways or face disabilities or dying.
Culture – patterned lifeways, values, beliefs, norms, symbols and practices of individuals, groups,
or institutions that are learned, shared and usually transmitted from one generation to another.

Culture Care Diversity – cultural variability or differences in care beliefs, meanings, patterns,
values, symbols and lifeways within and between cultures and human beings.
Culture Care Universality- commonalities or similar culture based care meanings (“truths”)
patterns, values, symbols and lifeways reflecting care as universal humanity.
Cultural and Social Structure Dimensions – dynamic, holistic and interrelated patterns of
structured features of a culture including religion , kinship , political characteristic , economics,
education, technology , cultural values , philosophy , history and language.
Environmental Context- Totality of an environment , situation or event with related experiences
that give interpretative meanings to guide human expressions and decisions.

• Ethnohistory – sequence of facts , events or developments over time as known,

witnessed or documented about a designated people or culture.
• Emic – local , indigenous or insider view about a phenomenon.
• Etic – outsider’s view about a phenomenon
• Transcultural Nursing – formal area of humanistic and scientific knowledge ang practices
focused on holistic Culture Care (caring) phenomena and competencies to assist
individuals or groups to maintain or regain their health (or wellbeing) and to deal with
disabilities, dying, or other human conditions in culturally congruent and beneficial ways.

Culture Care preservation or maintenance refers to those assistive, supportive, facilitative, or

enabling professional actions and decisions that help people of a particular culture to retain or
maintain meaningful care values and lifeways for their well-being, to recover from illness, or to
deal with handicaps or dying.
Culture Care accommodation or negotiation refers to those assistive, supportive, facilitative, or
enabling professional actions and decisions that help people of a designated culture (or
subculture) to adapt to or to negotiate with others for meaningful, beneficial, and congruent
health outcomes.
Culture Care repatterning or restructuring refers to the assistive, supportive, facilitative, or
enabling professional actions and decisions that help clients reorder, change, or modify their
lifeways for new, different, and beneficial health outcomes.
Culturally competent nursing care refers to the explicit use of culturally based care and health
knowledge in sensitive, creative, and meaningful ways to fit the general lifeways and needs of
individuals or groups for beneficial and meaningful health and well-being, or to face illness,
disabilities, or death.

Modalities
• There are three modalities for guiding nursing care, judgements, decisions or actions to
provide appropriate, beneficial and meaningful care:
1. Preservation or maintenance
2. Accommodation and or negotiation
3. Re-patterning or structure
These modes have substantively influenced nurses’ ability to provide culturally congruent
nursing care and have foster the development of culturally- competent nurses.

Culture care Diversity and Universality Metaparadigm

Person: Every human culture has generic (i.e., lay, folk, or indigenous) care knowledge and
practices and usually professional care knowledge and practices, which vary transculturally and
individually.
- Culture Care values, beliefs, and practices are influenced by and tend to be embedded in
the worldview, language, philosophy, religion (and spirituality), kinship, social, political,
legal, educational, economic, technological, ethnohistorical, and environmental context
of cultures.
Health: Beneficial, healthy, and satisfying culturally based care influences the health and well-
being of individuals,
families, groups, and communities within their environmental contexts.
- Culturally congruent and beneficial nursing care can occur only when care values,
expressions, or patterns are known and used explicitly for appropriate, safe, and meaningful
care.
- Culture Care differences and similarities exist between professional and client-generic care
in human cultures worldwide.
Environment: Cultural conflicts, cultural impositions practices, cultural stresses, and cultural pain
reflect the lack of Culture Care knowledge to provide culturally congruent, responsible, safe, and
sensitive care.
- The ethnonursing qualitative research method provides an important means to
accurately discover and interpret emic and etic embedded, complex, and diverse Culture
Care data
Nursing: Care is the essence of nursing and a distinct, dominant, central, and unifying focus.
- Culturally based care (caring) is essential for wellbeing, health, growth, and survival, and to
face handicaps or death.
- Culturally based care is the most comprehensive and holistic means to know, explain,
interpret, and predict nursing care phenomena and to guide nursing decisions and actions.
- Transcultural nursing is a humanistic and scientific care discipline and profession with the
central purpose to serve individuals, groups, communities, societies, and institutions.
 - Culturally based caring is essential to curing and healing, for there can be no curing
without caring, but caring can exist without curing.
- Culture Care concepts, meanings, expressions, patterns, processes, and structural forms
of care vary transculturally with diversities (differences) and some universalities (commonalities).

Theorist: Rosemarie Rizzo Parse

Theory: Human Becoming Theory
Major Concepts of her theory consists three categories of meaning
1. Structuring Meaning
2. Configuring Rhythmical Patterns
3. Contrascending with Possibles
Structuring Meaning
People coparticipate in creating what is real for them through self-expression in living their
values in a chosen way.
There are three concepts in Structuring Meaning
1. Imaging
a. An individual’s view of reality
b. Shaping of personal knowledge in these ways:
i. Explicit
1. Stating something in a clear way
ii. Tacit
1. Understood without being stated
c. Reflective
d. Prereflective

2. Valuing
a. Reflects what is important in life to a person or family
b. Process of choosing and embracing what is important

3. Languaging
a. A concept that is visible and relates to how humans symbolize and express their
imaged realities and their value priorities
 b. About the ways persons are with the world and in relationships about how to be
with others

Configuring Rhythmical Patterns

A. Revealing- Concealing - Concerns the ways persons disclose and do not disclose
meanings, thoughts, feelings, values, concerns, and hopes
B. Enabling- Limiting - Related to the potentials and opportunities that surface with the
restrictions and obstacles of everyday living
a. Every choice has potentials and restrictions
b. Choosing from the possibilities and living with the consequences of choices
C. Connecting- Separating - Concerns the ways persons can be with others while at the same
time being separate from them or how persons can be together without being in the
same location

Contrascending with Possibles

Moving beyond the ‘now’ moment is forging a unique personal path for oneself in the
midst of ambiguity and continuous change.

A. Powering - A concept that conveys meaning about struggle and life and the will to go on
despite the hardship and threat
a. The force exerted, the pushing to act and live with purpose amid possibilities for
affirming and holding what is cherished while simultaneously living with loss and
threat of non-being
i. Non-being
1. Loss of death and the risk of death and rejection

B. Originating - Human uniqueness and the ways persons create their own becoming as they
choose from all possibilities that could be

C. Transforming – The continuously changing and shifting views that people have about
their lives as they live what is becoming visible to them
a. Integrating unfamiliar ideas or activities into one’s life
Major Assumptions
Meaning
  Indicates the significance of something and is chosen by people
 Borne in the messages that persons give and take with others in speaking,
moving, silence, and stillness
 Connected with moments of day-to-day living, as well as with the meaning or
purpose of life
Rhythmicity
 About patterns and possibility
 People change their patterns when they integrate new priorities, ideas, and
dreams, and show consistent patterns that continue like threads of familiarity and
sameness throughout life.
Transcendence
 About change and possibility, the infinite possibility that is human becoming.

Human Becoming Theory Metaparadigm

Person: Open being who is more than and different from the sum of parts
Health: Open process of being and becoming
Environment: Everything in the person and his/her experiences
Nursing : A human science and art that uses an abstract body of knowledge to serve people

Theorist: Ida Jean Orlando

Theory: Nursing Process Theory
Description:
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 an appeal for help; however, the help needed may not be what it
appears to be. 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 nurse find out the nature of the distress and what help the patient
needs.

Terms

•Distress is the experience of a patient whose need has not been met.
•Nursing role is to discover and meet the patient’s immediate need for help.
•Patient’s behavior may not represent the true need.
•The nurse validates his/her understanding of the need with the patient.

•Nursing actions directly or indirectly provide for the patient’s immediate need.

•An outcome is a change in the behavior of the patient indicating either a relief from distress or
an unmet need.
•Observable verbally and nonverbally

ASSUMPTIONS
When patients cannot cope with their needs without help, they become distressed with feelings
of helplessness.

 Patients are unique and individual in their responses.

 Nursing deals with people, environment and health
 Patient need help in communicating needs, they are uncomfortable and undecided about
dependency needs
 Human beings are able to be secretive or explicit about their needs, perceptions,
thoughts and feelings,
 The nurse – patient situation is dynamic, actions and reactions are influenced by both
nurse and patient
 Nurses are concerned with needs that patients cannot meet on their own

She also included the “views” of the patient which she called “perception”

Perception of client
a. Verbal – what the client says
b. Non- Verbal – moaning, groaning, tone, volume

Concepts

Function of professional nursing – organizing principle

Presenting behavior – problematic situation
Immediate Reaction - internal response
Nursing Process discipline - investigation
Improvement – Resolution
Function of professional nursing organizing principle

Presenting behavior problematic situation

- Finding out and meeting the patients immediate needs for help
- "Nursing….is responsive to individuals who suffer or anticipate a sense of helplessness, it
is focused on the process of care in an immediate experience, it is concerned with
providing direct assistance to individuals in whatever setting they are found for the
purpose of avoiding, relieving, diminishing or curing the individuals sense of
helplessness." Orlando

Presenting behavior
● Problematic situation
● To find out the immediate need for help the nurse must first recognize the situation as
problematic
● The presenting behavior of the patient, regardless of the form in which it appears, may
represent a plea for help
● The presenting behavior of the patient, the stimulus, causes an automatic internal
response in the nurse, and the nurses behavior causes a response in the patients

Immediate reaction - internal response

• Person perceives with any one of his five sense organs an object or objects
• The perceptions stimulate automatic thought
• Each thought stimulates an automatic feeling
• Then the person acts
• The first three items taken together are defined as the person’s immediate reaction

Nursing process discipline – investigation

• Any observation shared and explored with the patient is immediately useful in ascertaining and
meeting his need or finding out that he is not in need at that time
• The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or
appropriate until she checks the validity of it in exploration with the patient
• The nurse initiates a process of exploration to ascertain how the patient is affected by what
she says or does.
• When the nurse does not explore with the patient her reaction it seems reasonably certain
that clear communication between them stops

Improvement - resolution
• It is not the nurse’s activity that is evaluated but rather its result: whether the activity serves to
help the patient communicate her or his need for help and how it is met.
• Each contact the nurse repeats a process of learning how to help the individual patient.
Major Dimensions
• 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.
• 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 nurse find out the nature of the distress and what help the patient needs.

• Nursing client – patients who are under medical care and who cannot deal with their needs or
who cannot carry out medical treatment alone
• Nursing problem – distress due to unmet needs due to physical limitations, adverse reactions
to the setting or experiences which prevent the patient from communicating his needs
• Nursing process – the interaction of 1) the behavior of the patient, 2) the reaction of the nurse
and 3) the nursing actions which are assigned for the patients benefit
• Nurse – patient relations – central in theory and not differentiated from nursing therapeutics
or nursing process
• Nursing therapeutics – Direct function: initiates a process of helping the patient express the
specific meaning of his behavior in order to ascertain his distress and helps the patient explore
the distress in order to ascertain the help he requires so that his distress may be relieved.
• Indirect function – calling for help of others, whatever help the patient may require for his
need to be met
• Nursing therapeutics - Disciplined and professional activities – automatic activities plus
matching of verbal and nonverbal responses, validation of perceptions, matching of thoughts
and feelings with action
• Automatic activities – perception by five senses, automatic thoughts, automatic feeling, action

MAJOR ASSUMPTIONS
• When patients cannot cope with their needs without help, they become distressed with
feelings of helplessness
• Patients are unique and individual in their responses
• Nursing offers mothering and nursing analogous to an adult mothering and nurturing of a child
• Nursing deals with people, environment and health
Patient need help in communicating needs, they are uncomfortable and ambivalent about
dependency needs
• Human beings are able to be secretive or explicit about their needs, perceptions, thoughts and
feelings
• The nurse – patient situation is dynamic, actions and reactions are influenced by both nurse
and patient
• Human beings attach meanings to situations and actions that are not apparent to others
• Nurses are concerned with needs that patients cannot meet on their own

Nursing Process Theory Metaparadigm

Person: developmental beings with needs, individuals have their own subjective perceptions and
feelings that may not be observable directly
Health: sense of adequacy or well-being. Fulfilled needs. Sense of comfort.
Environment: not defined directly but implicitly in the immediate context for a patient.
Nursing: is responsive to individuals who suffer or anticipate a sense of helplessness
• Process of care in an immediate experience for avoiding, relieving, diminishing or curing
the individuals sense of helplessness. Finding out meeting the patients immediate need for help
• Goal of nursing – increased sense of wellbeing, increase in ability, adequacy in better
care of self and improvement in patient’s behavior.

Theorist: Anne Boykin

Theory: Nursing as Caring
Description:
6 Major Assumptions
Major assumptions are stated by the theorists to present their values that ground the theory,
and to illuminate their worldviews . This means that you know “where they are coming from”.
The theory of Nursing As Caring in grounded in 6 major assumptions which provide distinctive
meanings:

 Persons are caring by virtue of their humanness.

 Persons are caring moment to moment.
 Persons are whole or complete in the moment.
 Personhood is living grounded in caring.
 Personhood is enhanced through participating in nurturing relationships with caring
others.
 Nursing is both a discipline and a profession.

Caring
  All persons are caring by virtue of their humanness – caring is an essential feature and
expression of being human. The view of person as caring and complete is intentional –
prevents segmenting into parts, such as mind, body, and spirit.
 Fundamentally, potentially, and actually, each person is caring.
 Each person, throughout life, grows in the capacity to express caring. Being a person
means living caring.
 Through knowing self as caring, I am able to be authentic to self and others.
 Caring is living in context of relational responsibilities.
 Caring is responsibility to self and others.
 Caring shapes relationships.

Person as Whole and Complete in the Moment

 Person as caring centers on valuing and celebrating human wholeness, that is, the human
person as living caring and growing in caring; valuing and respecting each person’s
beauty, worth, and uniqueness.
 The person is at all times whole. To encounter a person as less than whole fails to
encounter person.

Personhood is living grounded in caring

 Personhood implies living out who we are as caring persons.
 Personhood implies living the meaning of one’s life.
 Personhood implies demonstrating congruence between beliefs and behavior.

The Focus of Nursing

- The focus of nursing is nurturing persons living caring and growing in caring.

Nursing Situation
 The nursing situation is the shared, lived experience in which the caring between nurse
and nursed enhances personhood.
 (What does the nurse do?)
o It is in the nursing situation that the nurse attends to calls for caring, creating
caring responses that nurture personhood.

Calls for Nursing

 A call for nursing is a call from the one nursed, perceived in the mind of the nurse. This
call for acknowledgement and affirmation of the person living caring in specific ways in
the immediate situation.
 Calls for the nurturance that is Nursing are personal expressions that communicate in
some way - “know me as caring person and affirm me.”
Nursing responses of caring
 The nurse responds to these calls for nursing with specific caring responses to sustain
and enhance the other as caring person.
 This caring nurturance is what we call the nursing response.

The Caring Between - This full engagement within the nursing situation allows the nurse to truly
experience nursing as caring, and to share that experience with the one nursed. This is the caring
between, the shared relation within which nursing is created and experienced.

Theorist: Margaret Newman

Theory: Health as an Expanding Consciousness
Description:
HEALTH
Rogers’ insistence that health and illness are simply manifestations of the rhythmic
fluctuations of the life process is the foundation for viewing health and illness as a unitary
process moving through variations in order-disorder. From this standpoint, one can no longer
think of health and illness in the dichotomous way characterized by medical science; that is,
health as absence of disease or health as a continuum from wellness to illness. Health and the
evolving pattern of consciousness are the same.
PATTERN
A person is identified by her or his pattern, which reflects the pattern of the person
within the larger pattern of the environment. The pattern is evolving through various
permutations of order and disorder, including what in everyday language is called health and
disease. Pattern recognition emerges from a process of uncovering meaning in a person’s life.
Meaning is inherent in pattern, and vice versa.

CONSCIOUSNESS
Is defined as the informational capacity of the system (in this case, the human being);
that is, the ability of the system to interact with the environment (Bentov, 1978). Consciousness
includes not only the cognitive and affective awareness normally associated with consciousness,
but also the interconnectedness of the entire living system, which includes physiochemical
maintenance and growth processes as well as the immune system. This pattern of information,
which is the consciousness of the system, is part of a larger, undivided pattern of an expanding
universe.

Three Correlates of Consciousness:

MOVEMENT
TIME
SPACE

The relevance of movement, time and space was part of the original explication and has re-
emerged in the evolving patterning of unfolding consciousness.

To see health as the pattern of the whole, one needs to see disease not as a separate entity but
as a manifestation of the evolving pattern of person-environment interaction. The paradigm shift
is:

- From treatment of symptoms to a search for pattern.

- From viewing disease and disruption as negative to viewing them as part of the self-
organizing process of expanding consciousness.
- From viewing the nursing role as addressing the problems of disease to assisting people
to get in touch with their own pattern of expanding consciousness.

MAJOR ASSUMPTIONS
1. Health encompasses conditions heretofore described as illness, or, in medical terms,
pathology
2. These pathological conditions can be considered a manifestation of the total pattern of
the individual
4. The pattern of the individual that eventually manifests itself as pathology is primary and
exists prior to structural or functional changes
5. Removal of the pathology in itself will not change the pattern of the individual
6. If becoming ill is the only way an individual's pattern can manifest itself, then that is
health for that person
7. Health is an expansion of consciousness.

“The theory has progressed to include the health of all persons regardless of the presence or
absence of disease. The theory asserts that every person in every situation, no matter how
disordered and hopeless it may seem, is part of the universal process of expanding
consciousness – a process of becoming more of oneself, of finding greater meaning in life, and of
reaching new dimensions of connectedness with other people and the world” (Newman, 2010).

Humans are open to the whole energy system of the universe and constantly interacting with
the energy. With this process of interaction humans are evolving their individual pattern of
whole.

According to Newman understanding the pattern is essential. The expanding consciousness is

the pattern recognition.
 The manifestation of disease depends on the pattern of individual so the pathology of the
diseases exists before the symptoms appear so removal of disease symptoms does not change
the individual structure.

According to her nursing is the process of recognizing the individual in relation to environment
and it is the process of understanding of consciousness.

The nurse helps to understand people to use the power within to develop the higher level of
consciousness. Thus, it helps to realize the disease process, its recovery and prevention

Newman also explains the interrelatedness of time, space and movement. Time and space are
the temporal pattern of the individual, both have complementary relationship. Humans are
constantly changing through time and space and it shows unique pattern of reality.

Nursing as Caring Metaparadigm

Person: “The human is unitary, that is cannot be divided into parts, and is inseparable from the
larger unitary field” “Persons as individuals, and human beings as a species are identified by their
patterns of consciousness”… “The person does not possess consciousness-the person is
consciousness”. Persons are “centers of consciousness” within an overall pattern of expanding
consciousness”
Health: “Health and illness are synthesized as health - the fusion on one state of being (disease)
with its opposite (non-disease) results in what can be regarded as health”.
Environment: Environment is described as a “universe of open systems”
Nursing : Nursing is “caring in the human health experience”. Nursing is seen as a partnership
between the nurse and client, with both grow in the “sense of higher levels of consciousness”

Theorist: Josephine Paterson & Loretta Zderad

Theory: Humanistic Nursing

Description:

It is a nursing practice that is developed from lived experiences of the nurse and the
person receiving care. It is the articulated vision of experience. It is concerned with the
Phenomenological experiences of individuals and the exploration of human experiences. It
requires entering the nursing situation fully aware of the “lenses” that we wear. It is knowing
what values, biases, myths, and expectations we bring to the nursing experience. And we need
to fully appreciate the values, biases, myths and expectations others bring to the nursing
experience.
 The practice of humanistic nursing is rooted in existential thought. Existentialism is a
philosophical approach to understanding life. Individuals are faced with possibilities when
making choices. These choices determine the direction and meaning of one’s life. Since
individuals are faced with freedom of choice, there is always a possibility of making errors. As a
philosophy, Existentialism is particularly applicable to nursing within the framework of holistic
health because of the emphasis on self-determination, free choice, and self-responsibility.

Phenomenology – the study of the meaning of a phenomenon to a particular individual. It

describes data of the immediate situation that help people understand the phenomena in
question.
- it is also describing human methods and primarily concerned with describing
human experience in such a way that the fullness of experience is absorbed.
Humanistic nursing is an existential-phenomenological-humanistic approach referring to a
reverence for life that values the need for human interaction in order to determine the meaning
that comes from the individual’s unique way of experiencing the world.

Humanistic Nursing
•Nursing occurs within the context of relationship. It is a nurturing response of one person to
another in a time of need that aims toward the development of well being and more being.
• Nursing is a unique blend of Theory and Methodology. Theory cannot exist without the
practice of nursing, for it depends on the experience of nursing and the reflection of that
experience. Its methodology, is a unique blend of art and science. Science which consists of
rules, laws, principles and theories that guide us and give direction to the nursing practice
remain meaningless unless they are applied to living situations which becomes the art of nursing.
• The process of nursing as “quality care based in the concept of community

Elements of Framework for Humanistic Nursing

• Incarnate men (patient and nurse) meeting (being and becoming) in a goal-
directed (nurturing well-being and more-being), intersubjective transaction (being with
and doing with) occurring in time and space (as measured and lived by patient and nurse)
in a world of men and things.

3 concepts that provide basis (or components) of nursing

• Dialogue
• Community
• Phenomenologic Nursology

Dialogue
It is a nurse-nursed relating creatively. Humans need nursing. Nurses need to nurse. Nursing is an
intersubjective experience in which there is real sharing.
MEETING is the coming together of human beings and is characterized by the expectation that
there will be a nurse and a nursed.
RELATING is the process of nurse-nursed “doing” with each other is relating, being with each
other. It may be Subject – Object relating which refers to how we use objects and know others
through abstractions, conceptualizations, categorizing, labeling, and so on or Subject-Subject
relating when both nurse and the client are open to each other as fully human, beyond the role
of nurse and client, but as struggling, joyful, confused, and hopeful individuals facing the next
moment.

Dialogue
PRESENCE – the quality of being open, receptive, ready, and available to another person in a
reciprocal manner.
CALL AND RESPONSE – are transactional, sequential and simultaneous. Must be done “all at
once”.

Community
It is two or more persons striving together, living-dying all at once. Humanistic Nursing leads to
community, it occurs within a community, and is affected by the community. It is through the
intersubjective sharing of meaning in community that human becomings are comforted and
nurtured. Community is the experience persons, and it is through community, persons relating
to others, that it is possible to become. Humanistic nursing proposes that the nurse needs to be
fully prepared to work in and with a community, exploring and valuing its reality

Phenomenologic Nursology
1. Preparation of the nurse knower for coming to know.
2. Nurse knowing the other intuitively.
3. Nurse knowing the other scientifically.
4. Nurse complementarily synthesizing known others.
5. Succession within the nurse from the many to the paradoxical one.

Humanistic Nursing Metaparadigm

Person: Person is viewed as an “Incarnate being” always becoming in relation with man and
things in a world of time and space’’. Person have the capability of self-reflection.
Health: Nursing’s concern is said to be ‘not merely with a person’s wellbeing but within his
morebeing; with helping him become more as humanly possible in his particular life situation.
Wellbeing and Morebeing, that health is conceptualized as somewhat more than the freedom
from disease.
Environment: Views person as actually living in two worlds.
 An angular, inner world, also described as a biased or shaded reality.
 The objective world, of persons and things. Openness to and acceptance of the other’s
inner world is essential for true interaction between persons.
Nursing: Nursing is conceptualized as a lived human act, a response to a human act, a response
to human situation. The dialogical quality of nursing is emphasized; nursing is viewed as a
transaction between persons.
Theorist: Katharine Kolkaba
Theory: The Comfort Theory

Description:

The theory states that, in stressful healthcare situations, unmet needs for comfort are met by nurses
and the health care team. Interventions are successful if enhanced comfort is achieved by the patient
compared with a previous baseline. The immediate patient outcome of enhanced comfort is directly and
positively related to patients engaging in health seeking behaviors. When patients engage in health
seeking behaviors, they do better and report high satisfaction in their healthcare. High patient
satisfaction leads to better institutional outcomes and higher institutional integrity. Institutional
integrity is conceptualized as the quality or state of health care corporations being complete, sound,
upright, honest and sincere.

 Health Care Needs: identified by the patient/family in a particular practice setting.

 Comfort is the immediate experience of being strengthened by having needs for relief, ease,
and transcendence met in four contexts (physical, psychospiritual, social, and environmental).

Kolcaba’s Definition of Comfort “The state of having addressed basic needs for ease, relief, and
transcendence met in 4 contexts of experience (physical, psychospiritual, sociocultural, and
environmental)”

Types of comfort
 Comfort as a product of holistic nursing art. ( Kolcaba K, 1995)
 Relief – the state of having a specific comfort need met.
 Ease – the state of calm or contentment.
 Transcendence – the state in which one can rise above problems of pain.

Context of Comfort
 Physical – bodily sensations, homeostatic mechanisms, immune function, etc.
 Psychospiritual – internal awareness of self, including esteem, identity, sexuality, meaning in
one's life, and one's understood relationship to a higher order or being.
 Environmental – the external background of human experience such as temperature, light,
sound, odor, color, furniture, landscape etc.
 Sociocultural – interpersonal, family, and societal relationships such as finances, teaching,
health care personnel, family traditions, rituals, and religious practices etc.

Comfort Theory Metaparadigm

Person: an individual, family, or community in need of health care.
Health: optimum function of a patient/ family/ community facilitated by attention to comfort
needs.
Environment: exterior influences (physical room or home, policies, institutional, etc.) which can
be manipulated to enhance comfort.
Nursing: the intentional assessment of comfort needs, design of comfort measures to address
those needs, and reassessment of patients,' families, or community comfort after
implementation of comfort measures, compared to a previous baseline.
Sources:

Alligood, M.R.(2014).Nursing theorist and their work. St. Louis, Missouri: Elsevier Mosby