NCM 131 Unit IIIC Interaction Oriented Nursing Theories

Unit IIIC.
The Nursing Theories

Interaction-Oriented Theories
Interaction theory is an
approach to questions about
social cognition, or how one
understands other people, that
focuses on bodily behaviors and
environmental contexts rather
than on mental processes.
Hildegard Peplau’s
Psychodynamic Nursing
The "mother of psychiatric nursing," and the
pioneer in the development of the theory and
practice of psychiatric and mental health
nursing.
Born September 1, 1909 in Reading,
Pennsylvannia to an immigrant parents of
German decent and Peplau died on March
17, 1999.
Her father was illiterate and workaholic while
her mother was oppressive, perfectionist.
Raised in a paternalistic family and society.
Through higher education was never discussed

at home, she was strong-willed, with motivation
and vision to grow beyond the traditional
women’s roles.
She graduated from the Pottstown,
Pennsylvania School of Nursing in 1931 and
worked as a staff nurse in Pennsylvania and
New York City.
Worked as a school nurse at Bennington

College in Vermont. Earned her Bachelor’s
Degree in Interpersonal Psychology in 1943.
Worked with the WHO by serving as an
advisor, and was a visiting professor at
universities throughout the United States and
around the world.
Consultant to the US Surgeon General, the
US Air Force, and the National Institutes of
Mental Health.
She also participated in policy-making groups
for the United States government.
As a child, she saw the devastating effects of

the flu epidemic in 1918, which greatly
influenced how she understood how illness and
death impacted families.
Peplau's theory focuses on the interpersonal

processes and therapeutic relationship that
develops between the nurse and client.
The interpersonal focus of Peplau's theory

requires that the nurse attend to the
interpersonal processes that occur between the
nurse and client.
Peplau defines nursing as a therapeutic

relationship between the nurse and the patient.
She believed that through the devise of the

therapeutic nurse-patient relationship, the nurse
could be most beneficial to human beings”
(Fawcet, 2010).
Peplau theorized that nurse-patient relationships

must pass through three phases or processes in
order to be successful: the orientation, the
working, and the termination.
1. Orientation Phase – A trusting relationship is

formed. The nurse collects data, evaluates
patient’s need, desires, potential to reach
personal and nursing goals.
2. Working Phase – This is where most of the

“work” of the relationship is done.
The nurse uses her knowledge problems. And

education to solve client’s health problems.
The patient recognizes the nurse as helping,

empathetic and providing unconditional care.
The power shifts from the nurse to patient as
they become independent with their own care
3. Termination Phase – The nurse and patient

separate as the nurse finalizes discharge plan
and helps patient transition to the next phase –
total independence.
Peplau explains that nursing is therapeutic because it is

a healing art, assisting a patient who is sick or in need of
health care. ... The nurse has a variety of roles in
Hildegard Peplau's nursing theory. The six main roles
are: stranger, teacher, resource person, counselor,
surrogate, and leader.
1. Stranger – Nurse and patient meet for the first time

The goal is to establish and build trust with the
patient. Success in this role is the foundation for
development of a therapeutic relationship and
necessary for establishment of other roles (Courey
et al, 2008)
2. Teacher – The nurse provides detailed instructions

to a patient or informally by self - modelling patterns
of health and wellness (Lego, 1998).
3. Resource Person – Using expert professional

knowledge and critical thinking skills, the nurse
provides factual health information and evaluates
plan of care.
4. Leader – Nurse collaborates with patient to work

towards treatment goals.
5. Surrogate – the nurse takes the place of family,
relative or friend.
6. Counselor – The nurse seeks to explore the

problem and feelings as well as be aware of
their anxiety – active listener and guidance /
support.
There is a 7th role that Peplau did not define in her

original theory – the technical role.
Nurses employ to provide care like physical

assessment, use of IV pumps, BP taking and
manipulating ventilators.
Man as an organism strives in its own way to reduce

tension by coping stressors or anxieties generated by
his needs.
Peplau classifies man’s anxieties into four levels: Mild,

moderate, severe, panic anxieties.
Mild anxiety is a positive state of heightened

awareness and sharpened senses, allowing the person
to learn new behaviors and solve problems.
If left unaddressed, mild anxiety can lead to

maladaptive coping strategies or more severe mental
conditions.
Moderate anxiety involves a decreased perceptual field

(focus on immediate task only); the person can learn a
new behavior or solve problems only with assistance.
Symptoms are disruptive and may succeed in managing

their anxiety with the help of a doctor or self-help
strategies.
Severe anxiety involves feelings of dread and terror as

manifested by tachycardia, diaphoresis, and chest
pain. The person cannot be redirected to a task.
Individuals with severe anxiety may turn to alcohol and

drugs as a means to cope with their symptoms.
Panic anxiety can involve loss of rational thought,

delusions, hallucinations, and complete physical
immobility and muteness.
Patient unable to cope with the anxiety, needs the nurse

for management.
Hildegard Peplau’s Psychodynamic Nursing
NURSING PATIENT
She defines it as a “human relationship Peplau defines man as an organism that
between an individual who is sick, or in need “strives in its own way to reduce tension
of health services, and a nurse specially generated by needs.” The client is an
educated to recognize and to respond to the individual with a felt need.
need for help.”.
ENVIRONMENT HEALTH
Although Peplau does not directly address Health is defined as “a word symbol that
society/environment, she does encourage implies forward movement of personality and
the nurse to consider the patient’s culture other ongoing human processes in the
and mores when the patient adjusts to direction of creative, constructive,
hospital routine. productive, personal, and community living.”
Hildegard Peplau’s Psychodynamic Nursing
Strenths Weaknesses
Peplau’s theory helped later nursing Though Peplau stressed the nurse-
theorists and clinicians develop more client relationship as the foundation
therapeutic interventions regarding of nursing practice, health promotion,
the roles that show the dynamic and maintenance were less
character typical in clinical nursing. emphasized.
Ida Jean Orlando’s Nursing Process Theory
Middle Range Theory
An Irish American born in 1926 and passed away

November 2007.
Received her nursing diploma from New York

Medical College at the Lower Fifth Avenue
Hospital School of Nursing.
Middle Range Theory
Earned her Bachelor of Science in Public Health

from St. John’s University in Brooklyn, and her
Master of Arts Degree in Mental Health Nursing
from Teachers College, Columbia University.
Middle Range Theory
Was an associate professor at Yale School of

Nursing, and served as the Director of the
Graduate Program in Mental Health Psychiatric
Nursing. She was also the project investigator of
a National Institute of Mental Health grant.
The research from this grant led to Orlando’s development of the
Deliberative Nursing Process published in The Dynamic Nurse-
Patient Relationship: Function, Process, and Principles (NLN
Classics in Nursing Theory) in 1961.
Middle Range Theory
Worked as the director of a research project at

McLean Hospital in Belmont, Massachusetts.
This research led to the publication of “The

Discipline and Teaching of Nursing Process (an
evaluative study)” in 1972.
Orlando has served as a board member of

Harvard Community Health Plan.
Middle Range Theory
The General Concepts of Ida Jean Orlando’s Theory
This means finding out and meeting the patient's immediate

needs for help. Whatever help the patient may require for
his needs to be met, it is the nurse's responsibility to see
that "the patient's needs are met, either directly by her own
activity or indirectly by calling in the help of others."
Middle Range Theory
Presenting behavior is the patient's problematic situation.

The immediate reaction is the internal response.
The nursing process discipline is the investigation into the

patient's needs toward the improvement of the patient
which is the resolution to the patient's situation
Middle Range Theory
The patient’s behavior stimulated

a nurse’s reaction, which marks
the nursing process discipline’s
beginning.
https://www.slideshare.net/JosephineAnnNecor/ida-jean-
orlandos-nursing-process-theory
Middle Range Theory
Nurses use the standard nursing

process in Orlando's Nursing Process
Discipline Theory to produce positive
outcomes or patient improvement.
Middle Range Theory
Patient is able to recover

Ida Jean Orlando’s
Nursing Process
Theory
The major dimensions is the “Dynamic Nurse-

Patient Relationship” and that the role of the
nurse is to find out and meet the patient’s
immediate needs for help. The patient’s
presenting behavior might be a cry for help.
Nursing Process
Theory
All patient behavior (verbal or non-verbal)

must be considered as a need for help and
the nurse needs to assess and validate the
problem.
Nursing Process
Theory
Because of this, nurses have to use their own action,

perception, thoughts about perception, or the feeling
engendered from their thoughts to explore the
meaning of the patient’s behavior.
Nursing Process
Theory
In this part, the beginning of the nurse-

patient relationship takes place, through its
explicit reaction (no question on what is
being presented) of the patient and
identified by the nurse.
Nursing Process
Theory
It is important to correctly evaluate the behavior of

the patient using the nurse reactions to achieve
feedback from the patient.
Nursing Process
Theory
The nurse perceives behavior of the patient

through any of the five senses, where action can
already be laid down.
Nursing Process
Theory
The perception of possible actions leads to

automatic thought where automatic thought
produces an automatic feeling.
The nurse shares reactions with the patient to

ascertain whether perceptions, thought and feelings
are accurate and inaccurate.
Nursing Process
Theory
The nurse consciously deliberates about personal

reactions and patient input inorder to produce
professional deliberate actions based on assessment
rather the automatic reactions.
Nursing Process
Theory
There are two ways in implementing nurse actions:

1. Automatic reactions/actions – nursing behaviors
that are performed to satisfy a directive order.
Nursing Process
Theory
2. Deliberative reaction/actions – nursing behavior or

response that are argued upon through correct
assessment and deliberation.
Nursing Process
Theory
Improvement is the resolution to the patient’s

problems. The result or outcome of the nurse’s
actions are evaluated to determine whether his or her
actions served to help the patient. The nurse repeats
a process of learning how he or she can help the
patient
PATIENT
NURSING
Orlando uses the concept of human as she
Orlando speaks of nursing as unique and
emphasizes individuality and the dynamic
independent in its concerns for an
nature of the nurse-patient relationship. For
individual’s need for help in an immediate
her, humans in need are the focus of nursing
situation.
practice.
ENVIRONMENT HEALTH
Orlando completely disregarded environment The theory explains that the nurse's role is to
in her theory, only focusing on the immediate find out and meet the patient's immediate
need of the patient, chiefly the relationship needs for help. Through these, the nurse's
and actions between the nurse and the job is to determine the nature of the patient's
patient (only an individual in her theory; no distress and provide the help he or she
families or groups were mentioned). needs..
Strengths Weaknesses
The guarantee that patients will be The lack of the operational
treated as individuals is very much definitions of society or environment
applied in Orlando’s theory of was evident which limits the
Deliberative Nursing Process. Each development of research hypothesis.
patient will have an active and
constant input into their own care. Orlando’s work focuses on short
term care, particularly aware and
Assertion of nursing’s independence conscious individuals and on the
as a profession and her belief that virtual absence of reference group or
this independence must be based on family members.
a sound theoretical framework.
Ernestine Weidenbach’s The
Helping Art of Clinical Nursing
Born in 1900 in Hamburg, Germany, and her family

moved to New York in 1909.
Earned a Bachelor of Arts from Wellesley College in

1922 and her Registered Nurse’s license from the
John Hopkins School of Nursing in 1925.
She got her Masters of Arts from Teachers College,

Columbia University in 1934. In 1946,
Wiedenbach earned a certificate in nurse-midwifery
from the Maternity Center Association School for
Nurse-Midwives in New York, and taught there until
1951.
In 1952, she joined the faculty of Yale University as an

instructor in maternity nursing.
She became an assistant professor of obstetric

nursing in 1954.
When the Yale School of Nursing established a

master’s degree program, she became an associate
professor and was the director of the major in
maternal and newborn health nursing.
Published Family-Centered Maternity Nursing in 1958

and Communication: Key to Effective Nursing in 1982.
Wiedenbach died in 1998.
Ernestine Weidenbach’s
The Helping Art of
Clinical Nursing
Wiedenbach’s prescriptive theory is based on

three factors.
The Central purpose of Nursing of which the
nurse recognizes as essential and important.
The Helping Art of
Clinical Nursing
Central purpose of nursing: The need of the

patient to acquire knowledge about
prevention of increased blood pressure
(hypertension).
The Helping Art of
Clinical Nursing
Prescription for the fulfillment of the central

purpose: This is the activity of the nurse or
HCP to solve the need of the patient.
The Helping Art of
Clinical Nursing
The realities in the immediate situation that

influence the central purpose. These are
aspects of the situation that influence the
nursing outcome.
The Helping Art of
Clinical Nursing
The agent or nurse practitioner who performs

the nursing action.
The recipient or patient who is vulnerable and is
dependent on others for help.
The Helping Art of
Clinical Nursing
The goal or directed outcomes the nurse wishes

to achieve.
The Helping Art of
Clinical Nursing
The means (actions, skills, experience) that

empowers the nurse to achieve the desired
goals.
The Helping Art of
Clinical Nursing
The framework consists of the human,

environmental, professional, and organizational
facilities.
The Helping Art of
Clinical Nursing
Wiedenbach’s nursing philosophy enumerated as

• Reverence for the gift of life.
• Respect for the dignity, worth, autonomy, and
individuality of each human being.
• Resolution to act dynamically in relation to one’s
beliefs.
Prescription for the fulfillment: An example
The Helping Art of
Clinical Nursing
Assessment of Patient
• Age
• Educational Level
• Occupation
• Number of children Health
• Level of awareness Instructions
to disease or and Teachings
Validation
complaint
Mutually understood and agreed upon action

by both the nurse and the patient
The Helping Art of
Clinical Nursing
Nursing Process Wiedenbach’s Nursing Process

Assessment Central Purpose of Nursing
Nursing Diagnosis
Planning Planning
Outcome Criteria Prescription in the fulfillment of
Intervention the purpose
Evaluation Evaluation
Strengths and Weaknesses

Wiedenbach’s theory is clear, consistent, and intelligible in terms of
concepts and definitions, though it may not be described as simple because
of too many relational statements. It is quite complex due to its philosophical
background that is client-centered care.
The concept for need-of-help may not be applicable to all patients, it can still
be utilized in general by nurses in their daily nursing practice.
Imogene King’s Goal Attainment Theory
and Interacting Systems Theory
Born on January 30, 1923 in West Point, Iowa.
Received her nursing diploma from St. John’s Hospital

School of Nursing in St. Louis, Missouri, in 1945.
In 1948, she earned her Bachelor of Science in

Nursing from St. Louis University, and went on to
complete her Master’s of Science in Nursing, also from
St. Louis University in 1957.
She also earned her doctoral degree from Teachers College,

Columbia University in 1961. She died on December 24, 2007.
Between 1966 and 1968, King worked as Assistant Chief of the

Research Grants Branch of the Division of Nursing in
Washington, D.C. under Dr. Jessie Scott.
She was the director of the Ohio State University School of

Nursing from 1968 until 1972, Associate Professor from 1961 until
1966 and a Professor from 1971 until 1980 at Loyola University in
Chicago.
After serving as a professor at the University of South Florida’s

College of Nursing in Tampa, Florida from 1980 until 1990, King
retired with the title Professor Emeritus.
During her career, King was an active member of the District IV

Florida Nurses Association, the American Nurses Association, and
Sigma Theta Tau International. She was also a Fellow in the
American Academy of Nursing.
Imogene King’s Goal
Attainment Theory and
Interacting Systems
Theory
Imogene King’s Theory of Goal Attainment was

first introduced in the 1960s.
Interacting Systems
Theory
The basic concept of the theory is that the nurse and patient
communicate information, set goals together, and then take
actions to achieve those goals.
Interacting Systems
Theory
The factors that affect the attainment of goals

are roles, stress, space, and time.
Interacting Systems
Theory
According to King, the patient is a social being who has three

fundamental needs: the need for health information, the need for
care that seeks to prevent illness, and the need for care when the
patient is unable to help him or herself.
Interacting Systems
Theory
She explains health as involving life experiences of the patient,

which includes adjusting to stressors in the internal and external
environment by using resources available.
Interacting Systems
Theory
The environment is the background for human interaction. It

involves the internal environment, which transforms energy to
enable people to adjust to external environmental changes, and it
involves the external environment, which is formal and informal
organizations.
Interacting Systems
Theory
A nurse is considered part of the patient’s

environment.
Interacting Systems
Theory
The three interacting systems in her Theory of Goal

Attainment are the personal system, the interpersonal
system, and the social system.
Interacting Systems
Theory
The concepts for the personal system are: perception,

self, growth and development, body image, space, and
time.
Interacting Systems
Theory
The concepts for the interpersonal system are: interaction,

communication, transaction, role, and stress. The concepts for the
social system are: organization, authority, power, status, and
decision making.
Interacting Systems
Theory
King defines nursing as “process of action, reaction

and interaction by which nurse and patient share
information about their perception in nursing situation.”
Interacting Systems
Theory
The focus is on the care of the patient, and its goal is

the health care of patients and groups of patients.
Interacting Systems
Theory
According to King, the goal of the nurse is to help

patients maintain health so they can function in their
individual roles.
Interacting Systems
Theory
The nurse’s function is to interpret information in

the nursing process, to plan, implement, and
evaluate nursing care.
Interacting Systems
Theory
The symbiotic relationship of the nurse and patient, that is after being
aware of their personal, interpersonal and social systems’ strengths
and weaknesses, the nurse can now proceed with the identification
of patient’s problems if there is some disturbance such as illness or
disability.
Interacting Systems
Theory
Therefore, the nurse can set his nursing actions, that is

to help individuals regain health or live with a chronic
illness or a disability.
Interacting Systems
Theory
Each action is associated with a reaction. This action

and reaction set is called interaction.
Interacting Systems
Theory
When both sides of interaction have a similar goal and

attempt to attain it, an effective interaction is occurred
which is called transaction.
Interacting Systems
Theory
It is during a transaction that nurse – patient effectively

perform their roles, attain their preset goals, and cope
with their environment.
Interacting Systems
Theory
This cycle includes feedback chains for continually

assessing the interpersonal system.
NURSING PATIENT
Nursing is a process of action, reaction, and Individuals are social beings who are rational
interaction whereby nurse and client share and sentient. Humans communicate their
information about their perceptions in the thoughts, actions, and beliefs as well as
nursing situation. The nurse and client share choose between alternative courses of
specific goals, problems, and concerns and action, to set goals, to select the means to
explore means to achieve a goal. achieve goals, and to make decisions.
HEALTH
Health is a dynamic life experience of a
ENVIRONMENT
human being, which implies continuous
Environment is the background for human
adjustment to stressors in the internal and
interactions. It is both external to, and
external environment through optimum use
internal to, the individual.
of one’s resources to achieve maximum
potential for daily living.
Nursing Process King’s Nursing Process
Assessment Assessment
Nursing Diagnosis
Planning Planning
Outcome Criteria Intervention
Intervention
Evaluation Evaluation
Strengths Weaknesses
A major strong point of King’s Limited application in areas of
conceptual system and Theory of nursing in which patients are unable
Goal Attainment is the ease with to interact competently with the
which it can be understood by nurse.
nurses.
Lacks applications in providing
The theory of goal attainment also nursing care to groups, families, or
does describe a logical sequence of communities.
events.
Josephine Peterson and Loretta Zherad
Humanistic Nursing
Josephine Paterson and Loretta Zderad are from the

United States. They both earned their first diplomas in
nursing, then Bachelor’s degrees in Nursing education
before continuing to graduate programs.
Their career as nursing academics got started in the

1950s when they were both employed at Catholic
University where they met. They continued to work
together and remained friends for the next 40 years.
Humanistic Nursing
They later continued on to their doctorate degrees in

the 1960s. Dr. Paterson did her graduate work at
Johns Hopkins and Dr. Zderad did hers at Catholic
University.
In the mid-fifties they were both employed at The

Catholic University and were assigned the task of
working together to create a new program that would
encompass the community health and psychiatric
component of the graduate program.
Humanistic Nursing
Subsequently, they developed a collaboration and

dialogue and friendship that have lasted for almost
40 years.
Josephine Paterson and Loretta Zderad retired in

1985 and moved South where they are currently
enjoying life. Although they are no longer active, they
are pleased at the on going interest in their theory.
The whole of
anything is
greater than
its parts
Josephine Peterson
and Loretta Zherad
Humanistic Nursing
Josephine Peterson Humanistic nursing is a
mutual subjective
and Loretta Zherad interaction between nurse
Humanistic Nursing and patient and is a
response to the situation
which aims at facilitating
recovery. It is
characterized by
empathy, respect for
human dignity, altruism,
patient autonomy, friendly
environment, and holistic
care.
Josephine Peterson Nursing Dialogue is when
and Loretta Zherad a nurse and patient come
together. The nurse
Humanistic Nursing presents themselves as a
helper ready to assist the
patient. The nurse is open
to understanding how the
patient feels with the
intention of
improvement. Openness
is an essential quality for
humanistic nursing
dialogue.
To understand the nursing
Josephine Peterson dialogue, one must put the
and Loretta Zherad experience in the context of
time:
Humanistic Nursing
the time lived as the patient
and the nurse. The nurse and
the patient may be interacting
within the same actual time
span, but the time may feel
very different to the nurse and
client.
Their experiences of time are

unique to their understanding
of the situation.
Space is the lived perception
Josephine Peterson of the world around the nurse
and patient.
and Loretta Zherad
Humanistic Nursing Space could be the hospital
room, the bed, the waiting
room, the visiting area, or any
other space in which the
interaction takes place.
The physical environment can

enhance or impede the nursing
dialogue based on how
comfortable the participants
feel and how well the space
encourages communication.
Josephine Peterson Place is another component of
and Loretta Zherad space, but it is more
personalized; it belongs to the
Humanistic Nursing patient or nurse and is highly
subjective.
It relates to “where I feel I

belong or am”. A person may
feel out of place or may feel at
home or welcomed in the
place. The nurse may feel
comfortable in the place while
the patient does not.
Josephine Peterson
and Loretta Zherad Space and time coincide within
Humanistic Nursing the nursing experience. For
example, after a longer stay in a
hospital, for example, a patient
may begin to feel at home, when
initially it was foreign.
The nursing dialogue is

reinforced when the nurse
understands how the patient
relates to their space.
Paterson and Zderad
developed the five phases of
Josephine Peterson the nursing process:
and Loretta Zherad
1. Preparation of the Nurse
Humanistic Nursing Knower For Coming to
Know:
In this stage, the nurse acts as

an investigator who willingly
takes risks and has an open
mind. The nurse must be a
risk-taker and be willing to
experience anything.
“Accepting the decision to
approach the unknown
openly”.
Josephine Peterson
Paterson and Zderad
and Loretta Zherad developed the five phases of
Humanistic Nursing the nursing process:
2. Nurse Knowing of the

Other Intuitively:
In this stage, the nurse tries to

understand the other, as in the
“I-thou” relationship, where the
nurse as the “I” does not
superimpose themselves on
the “thou” of the patient.
Paterson and Zderad
Josephine Peterson developed the five phases of
and Loretta Zherad the nursing process:
Humanistic Nursing 3. Nurse Knowing the Other
Scientifically:
The nurse as the observer

must observe and analyze from
the outside. At this stage, the
nurse goes from intuition to
analysis. The analysis is the
sorting, comparing,
contrasting, relating,
interpreting, and categorizing
Paterson and Zderad
developed the five phases of
Josephine Peterson the nursing process:
and Loretta Zherad
4. Nurse Complementarily
Humanistic Nursing Synthesizing Known
Others:
The ability of the nurse to

develop or see themselves as
a source of knowledge, to
continually develop the
nursing community through
education, and increased
understanding of their owned
learned experiences.
Josephine Peterson Paterson and Zderad
and Loretta Zherad developed the five phases of
the nursing process:
Humanistic Nursing
5. Succession Within the
Nurse From the Many to the
Paradoxical One:
In this stage, the nurse takes

the information gleaned and
applies it in the practical
clinical setting. Here the nurse
takes brings the dilemma
towards resolution.
Josephine Peterson Nursing Paradigm
and Loretta Zherad
Humanistic Nursing
PERSON: Humans are viewed as open energy fields
with special life experiences. As energy fields, they are
greater than and different from the sum of their parts
and cannot be predicted from knowledge of their
parts. Human beings are viewed as being holistic in
nature, are special, dynamic, aware, and
multidimensional, capable of abstract thought,
creativity, capable of taking responsibility.
Josephine Peterson
and Loretta Zherad
Humanistic Nursing
“HEALTH” is valued as necessary for survival

and is often proposed as the goal of nursing.
There are, in actuality, many instances of
nursing that could be described as “health-
restoring,” “health-sustaining,” or “health-
promoting.” Nurses engage in “health teaching”
and “health supervision.”
Josephine Peterson
and Loretta Zherad
Humanistic Nursing
The ENVIRONMENT represents the place where

the service is delivered, the community, or the
world. The environment can be understood as the
time and space in which the nursing experience
takes place. From the existential perspective, it is
the time and space as lived by the nurse and/or
patient during the experience.
Josephine Peterson
and Loretta Zherad
Humanistic Nursing
NURSING is a “lived experience between human

beings”. It is an evolving, affecting, and helping
relationship in which the patient and nurse engage
in a dialogue. The nurse must therefore modify
her/his response in offering a genuine presence.
STRENGTH: Emphasizes autonomy and free
Josephine Peterson will when choosing behavior- The approach
aims to find an alternative approach to
and Loretta Zherad scientific psychology (concentrates on the
Humanistic Nursing subjective experiences of individuals and its
meaning which cannot be studied in
experiments).
WEAKNESS: It is too positive when regarding

human behavior- this means that it assumes
individuals are intrinsically good and will
choose positive paths for their lives- however
free will and choice is limited for some
individuals
Joyce Travelbee Human to Human
Relationship Model
Joyce Travelbee was born in 1926 and is known for her

work as a nursing theorist.
In 1956, Travelbee earned her Bachelor of Science in

Nursing degree from Louisiana State University.
She was given a Master of Science in Nursing degree

in 1959 from Yale University. Her career dealt
predominantly with psychiatric nursing and education.
Joyce Travelbee
Human to Human
She worked as a psychiatric nursing instructor at the
Relationship DePaul Hospital Affiliate School in New Orleans,
Model Louisiana.
Worked later in the Charity Hospital School of

Nursing in Louisiana State University, New York
University, and the University of Mississippi.
She started her Doctoral program in Florida in 1973

but she was not able to finish because she died later
that year at age 47.
Joyce Travelbee
Human to Human In 1963, she started to publish articles and journals in
Relationship nursing.
Model
In 1966 and 1971, publication of her first book
entitled “Interpersonal Aspect of Nursing”
In 1969, she published her 2nd book “Intervention in

Psychiatric Nursing: Process in the One-to-One
Relationship”
She believed the spiritual values a person hold will

determine to a great extent.
Joyce Travelbee
Human to Human
Relationship
She extended the interpersonal relationship theories
Model
of Peplau and Orlando, but greatlt emphasized the
therapeutic human relationship between the nurse
and the patient.
Her model emphasizes: empathy (the ability to

understand and share the feelings of another),
sympathy (feelings of pity and sorrow for someone
else's misfortune), rapport (a close and harmonious
relationship) and emotional aspects of nursing.
Joyce Travelbee “A nurse does not only
Human to Human seek to alleviate
Relationship physical pain or render
Model physical care – she
ministers to the whole
person. The existence
of the suffering whether
physical, mental or
spiritual is the proper
concern of the
nurse.” – Joyce
Travelbee
Joyce Travelbee Rapport is experienced
Human to Human when a nurse and patient
has progresses through
Relationship
the four interlocking
Model phases preceding
rapport.
1. Original encounter –
first impression.
2. Emerging identities –
The nurse and patient
perceiving each other
as unique individuals.
Joyce Travelbee
At this time, the link of
Human to Human
the relationship begins
Relationship to form.
Model 3. Empathy – ability to
share and understand
the person’s
experiences and
feelings.
4. Sympathy – when the
nurse wants to lessen
the patient’s suffering.
Joyce Travelbee
Human to Human
Relationship
Model Communication
Therapeutic Use
of Self
Use of
Intellectual
Approach
Joyce Travelbee
Human to Human Relationship Model
NURSING
“An interpersonal process whereby the
professional nurse practitioner assists an PATIENT/PERSON
individual, family or community to prevent or person is defined as a human being. Both the
cope with experience or illness and nurse and the patient are human beings.
suffering, and if necessary to find meaning in
these experiences.”
ENVIRONMENT HEALTH
NOT clearly defined. Health is subjective and objective health
Patricia Benner’s Novice to Expert Theory
Middle Range Theory
Born in Hampton, Virginia and received her BSN from
Pasadena College in 1964 and later a master’s degree in
Medical – Surgical Nursing from University of California.
After completing her doctorate in 1982, she became an

associate professor in the Department of Physiological
Nursing at University of California, San Francisco.
She is an internationally known lecturer and researcher on

health, and her work has influenced areas of clinical
practice as well as clinical ethics.
Patricia Benner’s
Novice to Expert She believed that, “the nurse-patient relationship is not
Theory a uniform, professionalized blueprint but rather a
kaleidoscope of intimacy and distance in some of the
most dramatic, poignant, and mundane moments of
life.”
Attempts to assert and reestablish nurses’ caring

practices when nurses are rewarded more for
efficiency, technical skills, and measurable outcomes.
States that caring practices are instilled with knowledge

and skill regarding everyday human needs.
Patricia Benner’s
Novice to Expert
Theory
Seven Domains of Practice in Nursing
Patricia Benner’s
Novice to Expert
Theory Helping role: understanding how a
learner (whether a student, new or
seasoned nurse) develops skills and
understanding of a practice situation
/ event over time
Teaching role: Delivering instructions that

help students / novice / nurses learn.
Teachers must prepare effective lessons
and competencies.
Patricia Benner’s Diagnostic client-monitoring function:
Novice to Expert periodically collecting, analysing and
Theory using lab results to actively manage
patient’s needs.
Effective management of rapidly

changing situations
Patricia Benner’s Administering and monitoring
Novice to Expert therapeutic interventions and
regimens
Theory
Monitoring and ensuring quality

of health care practices
Organizational and
work-role competencies
Patricia Benner’s
Novice to Expert Nursing Process
Theory
The Steps of the Nursing Process is not

integrated.
Patricia Benner’s Patricia Benner’s Metaparadigms
Novice to Expert
Theory
Patricia Benner’s
Novice to Expert
Theory
Patricia Benner’s
Novice to Expert
Theory
Strengths and Weaknesses
Patricia Benner’s
Novice to Expert
Theory Strengths: It focuses on the behavior of nurses
depending on their level of understanding with nursing
practice – novice, advanced beginner, competent,
proficient, expert. Her theory highlights the importance
of clinical experience in developing expertise.
Limitations: The five stages (novice, advance

beginner, competent, proficient, and expert) are
poorly defined in the literature, and some of the
evidence from nursing practice presented to
support their existence is weak.

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Unit IIIC.

The Nursing Theories

Raised in a paternalistic family and society.

Through higher education was never discussed

Worked as a school nurse at Bennington

As a child, she saw the devastating effects of

Peplau's theory focuses on the interpersonal

The interpersonal focus of Peplau's theory

Peplau defines nursing as a therapeutic

She believed that through the devise of the

Peplau theorized that nurse-patient relationships

1. Orientation Phase – A trusting relationship is

2. Working Phase – This is where most of the

The nurse uses her knowledge problems. And

The patient recognizes the nurse as helping,

3. Termination Phase – The nurse and patient

Peplau explains that nursing is therapeutic because it is

1. Stranger – Nurse and patient meet for the first time

2. Teacher – The nurse provides detailed instructions

3. Resource Person – Using expert professional

4. Leader – Nurse collaborates with patient to work

6. Counselor – The nurse seeks to explore the

There is a 7th role that Peplau did not define in her

Nurses employ to provide care like physical

Man as an organism strives in its own way to reduce

Peplau classifies man’s anxieties into four levels: Mild,

Mild anxiety is a positive state of heightened

If left unaddressed, mild anxiety can lead to

Moderate anxiety involves a decreased perceptual field

Symptoms are disruptive and may succeed in managing

Severe anxiety involves feelings of dread and terror as

Individuals with severe anxiety may turn to alcohol and

Panic anxiety can involve loss of rational thought,

Patient unable to cope with the anxiety, needs the nurse

An Irish American born in 1926 and passed away

Received her nursing diploma from New York

Earned her Bachelor of Science in Public Health

Was an associate professor at Yale School of

Worked as the director of a research project at

This research led to the publication of “The

Orlando has served as a board member of

The General Concepts of Ida Jean Orlando’s Theory

This means finding out and meeting the patient's immediate

Presenting behavior is the patient's problematic situation.

The nursing process discipline is the investigation into the

The patient’s behavior stimulated

Nurses use the standard nursing

Patient is able to recover

The major dimensions is the “Dynamic Nurse-

All patient behavior (verbal or non-verbal)

Because of this, nurses have to use their own action,

In this part, the beginning of the nurse-

It is important to correctly evaluate the behavior of

The nurse perceives behavior of the patient

The perception of possible actions leads to

The nurse shares reactions with the patient to

The nurse consciously deliberates about personal

There are two ways in implementing nurse actions: