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TFN Theorist Notes PREFINALS
TFN Theorist Notes PREFINALS
Betty Neuman
The Theory
Focus around human beings being a total person as a client system and a layered
multidimensional being
Clients have a core circle with several protective layers
Layers consist of subsystems/variables that influence the state of wellness or illness
1. Physiological-physicochemical structure and function of the body
2. Psychological- mental processes and emotions
3. Sociocultural- relationships and social/cultural expectations and activities
4. Spiritual- spiritual beliefs
5. Developmental- development over a person's lifespan
Client is exposed to internal and external stressors requiring lines of defense and reactions
Person-Open system interacting with the environment through interpersonal and extra-personal
factors
o A dynamic composite of the 5 variables
o Continuously exposed to various beneficial and noxious stressors in the environment and
are able to respond by adjusting to the environment or adjusting the environment
o Maintains system harmony and balance through interactions and adjustments
Internal and external
o Contains:
Central Core:
made of normal temp range, organ strength, weakness ego structure, and
knowns or commonalities
Protective Layers:
Flexible line of defense- outer layer
Dynamic and rapid changing buffer of stressors
Highly vulnerable to internal factors
No sleep or hunger
Normal line of defense
Evolves over time
Maintains steady state
Made of coping patterns, lifestyle, and individual ways of handling stress
Lines of Resistance-innermost layer
internal factors attempting to stabilize individual and restore normal line
of defense when stressors break through
Health- continuum of well-being and illness
o Reflected in the harmony or balance of the individual's interaction and adjustment to the
environment
o Level of wellness- needs are met and more energy is stored than is expelled
o Evident In clients with optimal system stability
o Illness-needs are not sufficiently satisfied and more energy is used than there is
stored/available
Environment- internal and external factors or stressors
o factors considered noxious or beneficial stimuli that produce tension or disrupt system and
stability/harmony
o Stressors-vary in nature, timing, degree, change potential require energy to cope and return
to stability
Any situation, condition, force, or potential source that's capable of creating instability
within the individuals or reduce their lines of defense/resistance
Types:
Intrapersonal- operating within the individual
Interpersonal- forces operating between the individual and others
Extra-personal- forces outside the individual
Nursing- Maintaining the client's stability by reducing reactions or possible reactions to stressors
o Goals: attain or maintain the client's system balance and conserve energy by controlling
variables affecting the client
o Intervention happens when stressor is suspected or identified
Based on 4 factors:
Client's degree of reaction
Resources
Goals
Anticipated outcomes
3 levels:-useful guide for planning nursing interventions
Primary Prevention- initiated before or after an encounter with a stressor
Includes: decreasing possibility of meeting with a stressor, strengthening
flexible lines of defense when there's stressors, maintenance of wellness,
environmental protection and sanitation, immunization, maintaining ideal
body weight, protection from hazards, personal hygiene, accident
protection, health education/promotion
Secondary Prevention- initiated after encounter with a stressor
Includes: early case finding and treatment of symptoms and reactions to
stressor, breast self exams, and newborn screening
Tertiary Prevention- initiated after treatment
Focuses on re-adaptation, reeducation, and maintenance of stability
Model is applicable to all components of nursing and across all clinical areas
Can be used for individuals, families, and communities
o Views client as a composite of the 5 variables
Holistic approach
o Each system of subsystem on the whole must be considered
Paradigm Definitions
Person-Open system interacting with the environment through interpersonal and extra-personal
factors
o A dynamic composite of the 5 variables
o Continuously exposed to various beneficial and noxious stressors in the environment and
are able to respond by adjusting to the environment or adjusting the environment
o Maintains system harmony and balance through interactions and adjustments
Internal and external
o Contains:
Central Core:
made of normal temp range, organ strength, weakness ego structure, and
knowns or commonalities
Protective Layers:
Flexible line of defense- outer layer
a. Dynamic and rapid changing buffer of stressors
b. Highly vulnerable to internal factors
i. No sleep or hunger
Normal line of defense
a. Evolves over time
b. Maintains steady state
c. Made of coping patterns, lifestyle, and individual ways of handling stress
Lines of Resistance-innermost layer
a. internal factors attempting to stabilize individual and restore normal line
of defense when stressors break through
Health- continuum of well-being and illness
o Reflected in the harmony or balance of the individual's interaction and adjustment to the
environment
o Level of wellness- needs are met and more energy is stored than is expelled
o Evident In clients with optimal system stability
o Illness-needs are not sufficiently satisfied and more energy is used than there is
stored/available
Environment- internal and external factors or stressors
o factors considered noxious or beneficial stimuli that produce tension or disrupt system and
stability/harmony
o Stressors-vary in nature, timing, degree, change potential require energy to cope and return
to stability
Any situation, condition, force, or potential source that's capable of creating instability
within the individuals or reduce their lines of defense/resistance
Types:
Intrapersonal- operating within the individual
Interpersonal- forces operating between the individual and others
Extra-personal- forces outside the individual
Nursing- Maintaining the client's stability by reducing reactions or possible reactions to stressors
o Goals: attain or maintain the client's system balance and conserve energy by controlling
variables affecting the client
o Intervention happens when stressor is suspected or identified
Based on 4 factors:
Client's degree of reaction
Resources
Goals
Anticipated outcomes
Lydia Hall
About the Theorist
Birth: Sept 21, 1906
o New York City
Education:
o Basic nursing- 1927 York hospital school of nursing York, Pennsylvania
o BS Public Health- 1937 Teachers college Columbia University New York
o MA in teaching Natural Science- 1942 ""
First director of Loeb center for nursing and rehabilitation until death
Death: 1969
Nursing experiences: clinical, educational, research and supervisory components
Articulated her basic philosophy of nursing which the nurse may base patient care
The Theory
Contains 3 independent but interconnected circles
o Can’t function independently but interrelated
Hall said individuals could be conceptualized in 3 separate domains:
1. The Core (the person)
o Based on social sciences
o Involves therapeutic use of self and is shared among members of the health care team
o Developing interpersonal relationships with the patients allows for them to express verbally
how they are feeling about their disease and recovery
2. The Care (the body)
o Represents nurturing component
o Exclusive to nurses
o Nurses provides patient bodily care and help to complete basic daily biological functions
o Nursing Goal- comfort the patient
o Nurse and Patient can get close when nurse provides care (basic needs)
o Nurses apply knowledge of natural and biological sciences providing a strong theoretical
base for nursing implementations
o Patient views nurse as potential comforter
3. The Cure (the illness)
o Nurse helps patient and their family through medical, surgical, and rehabilitative
prescriptions made by a physician
o Nurse is active advocate for the patient
The Theory
Her theory developed in the late 1950's
o Observations she recorded between a nurse and a patient
Categorized nursing as good or bad but realized that her records contained both good and bad
o Formulated her nursing process
Nurse Role: to find and meet the patient's immediate need for help
A patient's plea is for help but may not be for what they need
o Nurse needs to use their perception, their thoughts about their perceptions, and the
feelings about their thoughts in order to find meaning about the patient's behavior with
them
o Helps the nurse discover the nature of the patient's distress
Nurse Action
Takes place when nurses are providing care
Automatic Reactions
o Created from nursing behaviors performed to satisfy a directive order instead of the
patient's need for help
o Actions don't evolve talking with the patient's immediate expressed need for help
o Non-deliberative behavior
o Following medical orders
Deliberative Reactions
o Disciplined professional response
o Actions are from the nurse's assessment determined to achieve mutual help between the
nurse and the patient's health
o Criteria is as follows:
1. Correct Identification and Validation
Actions result from identification of patient needs by validating the nurse's
reaction to patient behavior
2. Nurses explore meanings of actions with the patient and its relevance to meeting their
need
3. Nurse validates action's effectiveness after compelling it
4. Nurse is free from stimuli non-related to the patient's need during process of actions
Paradigm Definitions
Human/Person- an individual in need
o Unique individual that behaves verbally or nonverbally
o Assumed that individuals can satisfy their needs by themselves sometimes or need help
from others
Health- being without emotional or physical discomfort and having a sense of well-being
contributing to healthy state
o Experiences of being helped culminate over periods of time in greater degrees of
improvement
Environment- nursing situation occurring when a nurse and patient make contact and perceive,
think, feel, and act in immediate situation
o Any environmental aspect can cause the patient to become distressed
o Environment is meant to be therapeutic
Nursing- distinct profession providing direct assistance to individuals to help them avoid, diminish,
or cure their sense of helplessness
o Professional nursing- finding out and meeting the client's immediate need for help
The Theory
Ideas first showed up in graduate papers written at UCLA (1964)
Her theory framework crystallized during the 1970's, 80's, and 90's
o Identified her theory's central questions:
1. Who is the focus of nursing care?
2. What is the target of nursing care?
3. When is nursing care indicated?
Focus of model: A set of processes by which a person adapts to environmental stressors
o People are unified bio-psychosocial system constantly reacting with the environment
When environmental stimuli demands too much or the person's adaptive mechanisms are too low
o =behavioral responses are ineffective for coping
Person- adaptive system consisting of input, control processes, output, and feedback
o Input- stimuli from the external environment and internal self
Includes info from cognator and regulator mechanisms
o Control Processes- a person's biological and psychological coping mechanisms and their
cognator and regulator responses
o Output- adaptive and ineffective behavioral response of the person
o Feedback- info regarding the behavioral responses that's conveyed as input in the system
Each person gets affected by stressors=stimuli
o Focal- change immediately confronting the person
Require adaptive responses
o Contextual- all other stimuli present in the person or environment
o Residual- beliefs attitudes/traits that affect the person's present situation
Contextual and residual stimuli contribute to the effect of the focal stimuli
o Determine the level of stress of adaptation
Person's ability to adapt to changing stimuli determined by their Adaptation Level
o point is constantly changing based on collective effect of the stimuli that can be tolerated at
given time points
Basic internal Processes used in Adaptation
Regulator Subsystem- receives/processes changing stimuli from external environment and
internal self through neural-chemical-endocrine channels
1. Produces automatic, unconscious reactions targeting organs/tissues that create body
responses as feedback systems
2. Cognator Subsystem- receives varying internal and external stimuli involving psychological and
social factors
Includes physical and physiological factors
Changing stimuli are controlled through cognitive/emotive pathways
o Include perception/info processing, learning, judgement, and emotion
The subsystems produce behavioral responses in 4 effector modes:
o Physiological: includes…
1. Oxygenation
2. nutrition
3. elimination
4. activity/rest
5. skin integrity
6. senses
7. fluids/electrolytes
8. neurological and endocrine function
Psychosocial- includes
o Self-concept
o Role function
o Interdependence
o Self-Concept- includes individual's feelings/beliefs given at given points of time that
influence behavior. Includes…
1. Psychic integrity
2. Physical self
3. Personal self
4. Self-consistency
5. Self-ideal/self-expectancy
6. Moral-ethnical-spiritual self
7. learning
8. inner self-concept
9. Self esteem
o Role Function: includes…
1. Role
2. Position
3. Role performance
4. Role mastery
5. Social integrity
6. Primary role
7. Secondary role
8. Tertiary role
9. Instrumental and expressive behaviors
o Interdependence- addresses ability to love, respect, value others, and respond to others on
this manner. Includes…
1. Affectional adequacy
2. Nurturing
3. Significant others
4. Support systems
5. Receptive behaviors
6. Contributing behaviors
Paradigm Definitions
Environment- internal and external stimuli
o Including focal, contextual, and residual stimuli= person's adaptation level/ zone of coping
ability
o Includes all conditions, circumstances, and influences surrounding the development, family,
and culture
Person- adaptive system that responds to internal and external environment stimuli in the 4
adaptive modes
o Adaptation levels are determined by the intensity of focal, contextual, and residual stimuli
o Nursing promotes the patient's adaptation level by manipulating the environmental stimuli
Reduces ineffective responses or reinforce adaptive behaviors
Health- a state or a process of being and becoming an integrated and whole person
o Through adaptation a person is freed of trapped energy from ineffective coping attempts
When free the energy can be used for promoting integrity, healing, and enhancing
health
Nursing- science and practice of promoting adaptation for holistic functioning of a person though
application of nursing processes to effect healthy in a positive way
o Aim- increase the person's adaptive responses by decreasing the energy needed to cope in
situations that would normally require more energy than they have
o Promotes adaptation of all 4 modes
Contribute to health, life quality, and dying with dignity
The Theory
Based model on Nightingale's idea- nurses should create an environment where the patient can
heal
Used works from Tiilich- unity principle of life
4 Conservation Principles
1. Adaptation
o Def: ongoing process of change in which patient maintains his integrity within the realities of
environment
o Individuals have a range of adaptive responses
Responses vary by heredity, age, gender, or challenges from the illness
Responses are the same
o Timing and manifestation of responses are unique to each individual
o Achieved though "frugal, economic, contained and controlled" use of environmental
resources by individuals
2. Wholeness
o Exist when interactions/constant adaptations to the environment permits the assurance of
integrity
o Gets promoted by conservation principle use
3. Conservation
o The outcome of the adaptation principle
o "Keeping the life system together"
o Getting a balance of energy and demand that's within the biological realities of the person
4. Conservation Principle
o Conservation of Energy:
Basic to the natural/universal law of conservation
Energy- identifiable, measurable, and manageable
Patients can be encouraged to conserve energy by limiting themselves from activities
o Conservation of Structural Integrity
Focus is on the healing process
The patient's ability to be whole physically after illness
The body's ability to renew itself
Ex. Nurses ensure proper positioning and range of motion of the patient to prevent
deformities
o Conservation of Personal Integrity
Focus- to give patient's a sense of self
An intensely private, unique and secret knowledge that the patient uses to
describe themselves
People have a public and private self
Some part of the private is not known to anyone else
o Conservation of Social Integrity
A definition of the person that goes beyond the individual and includes the holiness of
the person
Ex. Relationships
Social Identity is connected to:
Family
Friends
Community
Workplace
School
Culture
Ethnicity
Religion
vacation
Vocation
Education
Socio-economic status
Paradigm Definitions
Person:
o Holistic being constantly striving to preserve wholeness and integrity
o Continually adapting and interacting with the environment
Adaptation leads to conservation
o Need nurses when suffering occurs and independence can be set aside to accept the
services of another
Health: -Includes disease
o Patterns of adaptive changes
o Adaptations seek to fit within the environment
o Successful adaptations are those that achieve fitting the environment the best and do so in
a conserving manner
o The goal of conservation
Environment:
o There are 3 types:
Operational: undetected natural forces effecting an individual
Perceptual: info that's recorded by the sensory organs
Conceptual: influenced by language, culture, ideas and cognition
o It is difficult to measure
Nursing:
o The purpose- take care of other when they need to be taken care of
Therefore nursing will exist when someone needs care to any extent
o The created dependency is temporary
Jean Watson
About the Theorist
Birth:
o Southern West Virginia
Education:
o Lewis Gale School of Nursing-Roanoke, Virginia
o BSN, Master of Science (psychiatric mental), Doctorate in education psychology- University
of Colorado
Distinguished Professor of Nursing
Has a chair in Caring Science at the Univ. of Colorado Health Sciences Center
Founded Center for Human Caring in Colorado
Fellow of the American Academy of Nursing
Career:
o Dean of Nursing- Univ. of Health Sciences Center
o President of National League for Nursing
Awards:
o International Kellogg Fellowship- Australia
o Fulbright Research- Sweden
o 6 Honorary Doctoral Degrees
3 International Honorary Doctorates- Sweden, UK, Quebec
Research is in human caring and loss area
Publications:
o "The Philosophy and Science of Caring"
The Theory
Transpersonal Human Caring- moral ideal of nursing and a caring process
o Moral idea-transpersonal and inter-subjective interactions with people
o Caring Process- commitment to protect, enhance, and preserve humanity by restoring
dignity, inner harmony, and facilitating healing
o Nurses help others get self-knowledge, self-control, and readiness for healing
Helping them regain a sense of inner harmony
The nurse responds to patient's subjective world through dynamic interpersonal caring
transactions
o Assists clients to find meaning in their existence by exploring the meaning of their
disharmony, suffering, and turmoil
o Transactions shine light on the mystery of life and able the self-healing process
Theory- consists of Watson's values and her respect for the mysteries of the healing and caring
process; combined with 10 carative factors
o Formation of Humanistic-altruistic system of values
o Installation of faith-hope
o Cultivation of sensitivity to one's self and to others
o Development of a helping-trust relationship
o Promotion and Acceptance of expressing positive and negative feelings
o Systemic use of scientific problem solving methods for decision making
o Promotion of interpersonal teaching-learning
o Provision for a supportive, protective and/or corrective mental, physical, socio-cultural and
spiritual environment
o Assistance with gratifying human needs
o Allowance for existential-phenomenological forces
Paradigm Definitions
Nursing:
o A human science of health-illness-healing experiences that are mediated by professional,
personal, scientific, aesthetic, and ethical human care transactions
o An art and science based with knowledge of clinical and technical competencies
o Directed toward protection, enhancement, and preservation of human dignity, health,
healing, and transcendence
o GOAL- enhance mental-spiritual growth and discover one's inner power and self-control
"help people gain a higher degree of harmony within the mind, body, and soul, which
generates self-knowledge, self-reverence, self-healing, and self-care processes while
allowing increased diversity"
o Nurses use intuition, aesthetic skills, geist, and behaviors to relate to others
Person:
o A living, growing, gestalt, possessing 3 spheres of being-mind, body, and soul which get
influenced by the concept of self
o Client-person or group needing assistance with health-illness decisions that promote
harmony, self-control, choice, and self-determination
o People can be their own change agents that can heal themselves through their own mental-
spiritual powers
o People progress to higher levels of consciousness when they find meaning and harmony in
their existence from using their mind
Health:
o The unity and harmony within the mind, body, and soul
o Harmony between self and others and between self and nature
o Illness-disharmony within a person's inner self
Incongruence between self and other/nature/experience
Environment:
o Occurrences or occasions involving caring interactions and choices by the nurse and
individual
o If caring occasion is transpersonal= client and nurse expand leading to personal growth,
maturations, and development of the self
Madeline Leininger
Birth:
o Nebraska
Education:
o Basic Nursing 1948: St. Anthony's School of Nursing- Denver, Colorado
o B of Science 1950: Mount St. Scholastica College- Atchison, KS
o Master of Science 1954: Catholic Univ. of America- Washington DC
o PhD 1965: Unv. Of Washington Seattle
Fellow in:
o American Academy of Nursing
Honorary Doctorates:
o Benedictine college
o Univ. of Indianapolis
o Univ. Kuopoio, Finland
1998 earned the name "Living Legend" by American Academy of Nursing
The Theory
Transcultural nursing addresses the cultural dynamics present that influence the nurse-client
relationship
Developed with a goal to provide culturally congruent wholistic care
Assumptions of Theory
1. Care is the essence and central focus of nursing
2. Caring is essential for health and well-being, healing, growth, survival, and facing illness/death
3. Culture care is broad and wholistic perspective to guide nursing care practices
4. Nursing central purpose= serve human beings in health, illness and dying
5. No cure is possible without giving and receiving care
6. Culture care concepts have different and similar aspects among all cultures
7. Every culture has folk remedies, professional knowledge, and professional care
o Nurses must identify and address factors in every action to provide culturally congruent care
8. Cultural care values, beliefs, and practices are influenced by world views and language
(ethnohistorical and environmental factors)
9. Beneficial, healthy, satisfying culturally based nursing enhances the client's well-being
10. Culturally beneficial nursing care occurs when cultural care values, expressions, or patterns are
known and used correctly by the nurse
11. Nurses who can't be reasonably culturally congruent with their client will experience stress,
cultural conflict, noncompliance, and ethical moral concerns
The Theory
Introduced the idea that expert nurses develop skills and understand patient care over time
through sound educational base and experiences
Expert nurses need experience along with book knowledge to be actual professionals
Paradigm Definitions
Person:
o Individual is a whole
o A self-interpreting being that doesn't enter the world predefined but becomes defined as
life happens
Health/ Well-being
Congruence between one's possibilities and one's actual practices and lived meanings as is
based on caring and feeling cared for
Environment/ Situation:
o A situation implying a social definition and meaningfulness
o Individual experiences with situations affect how that person perceives the world
Nursing:
o A caring practice whose science is guided by the moral art and ethics of care and
responsibility
Nola Pender
Birth:
o 1941- Lansing, Michigan
o Only child of parents who were advocates of women's education
Education:
o Nursing Diploma 1962: S.O.N. West Suburban Hospital-Oak Park, Illinois
o BSN 1964: Michigan State University- East Lansing
o MA (human growth and development) 1965: Michigan State Univ.
o PhD (psychology) 1969: Northwestern Univ.- Evanston, Illinois
Publications:
o 1975-" A Conceptual Model for Preventive Health Behavior"
How individuals make decisions about their own health care in a cursing context
o 1982-"Health Promotion in Nursing Practice"
Honorary Doctorates:
o 1992-Widener Univ.
o 1988-Distinguished Research Award- Midwest Nursing Research Society
o 1997-American Psychology Association Award
Outstanding contributions to nursing and health psychology
The Theory
Presents that each person has unique personal characteristics and experiences that affect
subsequent actions
Desired result= Health promoting behavior resulting in improved health, enhanced functional
ability, and better quality of life
Perceived Self-Efficacy
A person's judgement of their personal capability to organize and execute a health promoting
behavior
Perceived self-efficacy influences perceived barriers to action
o Higher efficacy=lowered perceptions of barriers to behavior performance
Interpersonal Influences
Def: Cognition concerning behaviors, beliefs, or attitudes of others
Include:
1. Norms (expectations)
2. Social support (instrumental and emotional encouragement)
3. Modeling (learning through observation)
The primary sources are families, peers, and healthcare providers
Situational Influences
Def: personal perceptions and cognitions of situations/contexts that can facilitate of impede
behavior
Includes:
1. Perceptions of available options
2. Demand characteristics
3. Aesthetic features of environment where care is taking place
Can have direct or indirect influences on health behavior
Behavioral Outcome
Commitment to Plan of Action
Concept of intention and identification of planned strategies leading to the implementation of
health behavior
Theory of Caring
Theorist: Kristin Swanson
The Theory: offers explanation of what it means to practice nursing in a caring manner
Caring: a nurturing way of relating to a valued other toward when one feels a personal
sense of commitment and responsibility
Basic Concepts/processes
Concept of maintaining belief
Concept of knowing
Concept of being with
Concept of doing for
Concept of enabling
Metaparadigm
Health: to live the subjective, meaning-filled experience of wholeness
Nursing: informed caring for the well-being of others where the goal is to promote well-
being