Module 1 : Theoretical Foundations in Nursing
History of Nursing
Theory
➔ This was dated way
back when Florence
Nightingale began to
assume the great
significance of providing a clean and healthy
environment to achieve recovery of patients and
continues up to present
➔ She also envisioned nurses as a body of educated
women who organized service and caring for
wounded in wartime (Crimean War) and
establishment of Nursing school in London (St.
Thomas Hospital) pioneering activities in nursing
practice and education.
➔ Nursing evolved through different eras. Profession
did not start as what it seemed to be. It started as a
vocational course offering only skills during their
time.
Nursing as a Science: Apprenticeship Model
• Nursing process was based on principles and
traditions that were handed down through practice
seen by Florence during her time
• Other references note that this is a practice era
dated before the curriculum era where to be a nurse
can have a diploma for only 2 years under
vocational
Fawcett classified nursing models as paradigms with
in a more organized specialized meta-paradigm of
❖ Person
❖ Environment
❖ Health
❖ Nursing Concepts
Significance of Nursing Theory:
DISCIPLINE
- Specific to academia and refers to a branch of
education, a department of learning or a domain of
knowledge.
- Branch of education; theoretical works leading to
higher level of education and practice.
- Functional Focus (what nurses do) - knowledge
focus or what nurses know and how they use them for
thinking and decision making while taking care of a
patient. (example: Nursing)
- Knowledge of persons, health and environment
forms the basis for nursing as a discipline
- Kuhn - stated, “ the study of paradigms is what
mainly prepares the student for membership in a
particular scientific community with which he / she
will practice. By studying and practicing with them,
the clients or community involved learn their trade.”
- Refers to a specialized field of practice founded on
the theoretical structure of the science or knowledge
of the discipline and accompanying practice abilities.
- Knowledge of that discipline and accompanying
practice abilities.
- Recognition and respect for their scholarly
disciplined contribution to the health of society.
PROFESSION
- Refers to a specialized field of practice founded on
the
theoretical structure of the science or knowledge of
the
discipline and accompanying practice abilities.
- Knowledge of that discipline and accompanying
practice
abilities.
-Recognition and respect for their scholarly
disciplined
contribution to the health of society.
Criteria for the Development of the Professional
status of Nursing:
1. Utilizes in its practice a well-defined and well-
organized body of specialized knowledge.
2. Constantly enlarges the knowledge it uses and
improves its techniques of education and service thru
scientific method.
3. Entrusts the education of its practitioners to
universities / colleges.
4. Applies knowledge in practical services important
to community welfare.
5. Functions autonomously in developing “not at all
professional policy.
6. Attracts individuals with intellectual and personal EMPIRICISM
qualities of intensifying service. • Way of looking at reality using the five senses.
7. Strives to compensate nurses by providing freedom • An object is real in so far as seen, felt, smelled,
of action, opportunity for continuous professional tasted, heard
growth and economic security. • A theory which states that knowledge comes only or
primarily
Historical Views of the Nature of Science from sensory experience
Epistemology (episteme – knowledge; logos – • Fundamental part of scientific method
study of) (experimentations)
-meaning knowledge, understanding • Knowledge is based on experience; ex. physical
- concerned with the theory of knowledge in assessment
philosophical inquiry or how knowledge came to be. • Gather information more and observe facts before
• What is real is also considered knowledge. finally
• Branch of philosophy concerned with the nature & saying a theory exists.
scope of knowledge. • Reynolds, “research-then-theory strategy”
• It is the study of knowledge & justifies beliefs. • It is inductive. (specific to general)
• It questions what knowledge is & how it can be ex: collect data → diagnose
acquired.
• This aims to discover the meaning of knowledge, & History of Nursing Science:
called it the true beginning of philosophy Early 20th century views
• Positivism emerged as the dominant view of
Philosophical Foundations of Science modern
RATIONALISM science.
• Priori reasoning -utilizes deductive; cause to effect • Modern logical positivists believed that empirical
or research
general to particular and logical analysis were two approaches that would
• Use of the rational senses in ensuring the produce scientific knowledge.
truthfulness of a • Philosopher focused on the analysis of theory
phenomenon structure.
• Understand the whole first before you can • Scientists focused on empirical research.
appreciate the • Increasing use of computers which permits the
lesser parts analysis of large data
• Regards reason as the chief source & test of
knowledge Emergent of science & theory in the late 20th
• Any view appealing to reason as a source of century
knowledge • Phenomenological Approach reduces observations
or justification (theory-the-research approach) or text to
• Criterion of truth is not sensory but intellectual & the meanings of phenomena independent of their
deductive particular
(general to specific) context. This approach focuses on the lived meaning
ex: lack of social support will lead to hospital of
readmission, experiences.
• Several authors presented analysis challenging the
positivist position, thus offering the basis for a new
perspective in science.
• Empiricists view phenomena objectively, collect
data and
analyze it to inductively propose theory.
Interdependence of theory & research
• In constructing theory, theorists must be
knowledgeable
about available empirical findings and able to take
these
into account, because theory is concerned with
organizing
and formalizing available knowledge of a given
phenomenon.
• The theory is subject to revision or maybe
abandoned in
favor of an alternative explanation for new
information
Science as a social enterprise
•"Human beings do science" - Gale. It might be
anticipated that
social, economic, or political factors may influence
scientific
enterprise. It depends on the funds, popularity of
certain
ideologies.
• Science progresses by the diversity of dialogue
within the
discipline of nursing. The creation of a merged
paradigm from
many paradigms is debated in relationship to the
advancement
of nursing.
Theory Development Process
• Usually means “mere guess” or unproved
• Literally means “a vision” or “a beholding scene”
• Greek word “theoria”
• Scientifically, theory implies that something has
been proven and is
generally accepted as being true. An idea or set of
ideas that is
intended to explain facts or events.
• An idea that is suggested or presented as possibly
true but that
is not known or proven to be true.
• A set of statements that tentatively describe,
explain, or predict relationships among concepts that
have been systematically selected & organized as an
abstract representation of some phenomenon (Powers
& Knapp).
• An internally consistent group of relational
statements (concepts,
definitions & propositions) that present a systematic
view about a
phenomenon & which is useful for description,
explanation, prediction
& control (Bodie & Chitty).
• Scientifically theory implies that something has
been proven and is
generally accepted as being true.
• A creative & rigorous structuring of ideas that
project a tentative,
purposeful & systematic view of phenomenon.
Validation of existing
knowledge as well as discovery of new knowledge.
We apply theory
to describe, explain, predict, or prescribe nursing
practice.
• The general principles or ideas that relate to
principles or ideas that relate to a particular subject.
Ex. Theory of Evolution
CATEGORIES OF THEORY COMPONENTS
 statements are linked; add
plausibility
Linkages of operational statements provides rationale
for how
measurement variables
are
linked; permit testability
Organization of concepts and eliminates overlap
(tautology)
definitions into primitive and
Derivedterms

Organization of statements and eliminates

10 Phases of Concept Building Process:
inconsistency
1. Write a meaningful practice story.
linkages into premises and derived
2. Name the central phenomenon in the practice
hypotheses and equations
story.
3. Identify a theoretical lens for viewing the
phenomenon.
SCIENTIFIC LAW vs THEORY
4. Link the phenomenon to existing literature.
SCIENTIFIC LAWS
5. Gather a story from someone who has lived the
• A statement of fact that aims to explain, in brief and
phenomenon.
simple terms, an action or set
6. Reconstruct the shared story and create mini-saga
of actions
that captures its message
• Generally accepted to be true and universal and can
7. Identify the core qualities of the phenomenon.
occasionally be expressed
8. Use the core qualities to create a definition.
in terms of a single mathematical equation
9. Createa model of the phenomenon
• SIMPLE, TRUE, UNIVERSAL & ABSOLUTE
10. Write a mini synthesis that integrates the
• Governs a single action, foundations for all science
phenomenon with a population to suggest research
• Statement based on repeated experimental
direction.
observations that describes some aspects of the
universe
• Always applies under same conditions, & implies
Relational Statement: Statements in a theory may
that there is a causalrelationship involving its
state definitions or relations among
elements
concepts
•ex. Law of Universal Gravitation by Newton
Theoretical Statements: Relate concepts to one
another; permit analysis
THEORY
Operational Statements: Relate concepts to
• More complex & dynamic; maybe replaced
measurements
• Explains an entire group
• Can be changed or improved without changing the
Linkages and Ordering:
overall truth
Linkages of theoretical statements provide rationale
• Developed from the scientific method
of why theoretical
• ACCEPTED AT TRUE & PROVED
HYPOTHESIS
• an educated guess based upon observation
• Can be supported or proven false by
experimentation or continued observation
• an idea or theory that is not proven but leads to
further study or discussion
• an assumption made for the sake of argument
•HAS NOT BEEN PROVED
• ex. watching excessive amounts of TV reduces a
person’s ability to concentrate; smoking leads to
lung cancer
Contemporary Issues in Nursing Theory
Development:
▪ Theoretical Boundaries and Levels to Advance
Nursing Science
▪ Nursing Theory, Practice and Research
Nursing Philosophies sets for the meaning of nursing
phenomena through analysis, reasoning and logical
argument. Are works that provide broad
understanding that advances the discipline and its
professional application.
The history of nursing theory was dated way back
when Florence Nightingale began to assume the great
significance of providing a clean and healthy
environment to achieve faster recovery of patients
and continues up to present.
FLORENCE NIGHTINGALE
• Nightingale’s (1859-1992) Notes on Nursing
presents the nursing theory that focuses on the
manipulation of the environment for the benefits of
the patient.
• Although Nightingale did not present her work as a
nursing theory, it has directed nursing practice for
over 140 years. She is known as the Mother of
Modern Nursing.
• Daughter of William Nightingale of Embley Park,
Hampshire and was born in Italy, on the 12th day of
May, 1820.
In March 1853, the Crimean War broke out between
Russia and Turkey. It was during this war where
Florence Nightingale volunteered her services and
was eventually given permission to take a group of
38 nurses to Turkey
She found the conditions as:
• soldiers lay in filth straw pallets in crowded
hallways
• rats and insects crawled the floors and walls
• hospitals lack basic supplies, such as cots,
mattresses, bandages, washbasins, soap, and towels
• water was rationed, and available in totally
inadequate amounts
• wounded armies were wearing unwashed uniforms
that were stiff with dirt and gore
• diseases such as typhus, cholera, and dysentery
were the primary reasons why the death rate was high
• She recognized that overcrowding, filth, and poor
ventilation all contributed to the illness of the
soldiers.
• At night, she carried a lamp through the corridors,
stopping to help the suffering of the wounded
soldiers, for this, she was nicknamed, “The Lady
with the Lamp”
Post-War Contributions
• Nightingale returned to England as a national
heroine in 1856
•She published two books: Notes on Hospital (1859)
and Notes on Nursing (1859)
• She raised enough funds and used this to establish
the Nightingale School and Home for Nurses at St.
Thomas Hospital.
• Nightingale’s work greatly influenced John Stuart
Mill’s book on women’s rights.
ENVIRONMENTAL THEORY
“Nursing is the art of utilizing the patient’s
environment for his or her recovery.”
Environment – defined as the external conditions and
influences affecting the life and development of an
organism and capable of preventing, suppressing, or
contributing to disease, accidents, or deaths.
Components of Environment:
Proper Ventilation.
Nightingale believed that nurses have the
responsibility to keep the air that the patient breathes
pure as the external air without necessarily chilling
him. She recognized the possibility that inadequate
ventilation may be the source of disease.
Adequate Light.
Direct sunlight has quite as real and tangible effects
on the human body who has not observed the
purifying effect of light, and especially of direct
sunlight.
Cleanliness.
She advocated taking a bath daily and that nurses
should also bathe daily while keeping their duty
uniforms clean and their hands washed clean
Warmth
Nightingale outlined a procedure for measuring the
body’s temperature through palpation of, or feeling
for the extremities in order to assess for heat loss.
One of the nurse’s role is to manipulate the
environment. Positioning the patient, opening the
windows, and regulating the room temperature are
ways of maintaining this balance.
Quiet
Nightingale described unnecessary noise can actually
be harmful to the patient who is ill.
Diet
Nightingale maintained that one of the nurse’s role is
to assess both the meal schedule and its effect on the
patient, in addition to assessing the patient’s dietary
intake.
Management
The nurse is actually in control of the environment,
physically, and administratively. The nurse is
responsible for controlling the environment so that
the patient is protected from physical and
psychological harm.
Theory in View of Metaparadigms:
Nursing
Nightingale’s view of nursing was comparable to that
of motherly instincts. She believed that every woman
would be a nurse because nursing is having the
responsibility for someone else’s health – a
characteristic shared by women, especially mothers.
Her “Notes On Nursing” provided guidelines to
women who wanted to become nurses and gave
advice on how to think like a nurse. Nursing is a
vocation that needs formal learning and application
of scientific principles in the care of patients. Nursing
personnel were thus having more skill in terms of
assessment and reporting of the patient’s health
status. At the same time, the nurse is also able to
perform nursing interventions that will allow the
patient to heal and recover
Person
The person is the patient himself. Patients are the
recipient of our care. A passive patient is a patient
who depends wholly on the nurse for tasks and
control of his environment. The nurse is totally in
control of the patient and his environment.
Nightingale viewed the patient as a person who
needed nursing care regardless of the patient’s social
worth
Health
Nightingale viewed health as being well. Health is
also living up to one’s potential to the fullest extent.
Disease and illness are viewed as reparative
processes that are instituted by Mother Nature herself
when the person did not attend to his personal health
concerns. Nightingale emphasized the promotion and
maintenance of health and prevention of diseases
through prudent control of the environment and
social responsibility
Environment
The environment was viewed as “those elements
external to and which affect the health of the sick and
healthy person” and included “everything from the
patient’s food and flowers to the patient’s verbal and
nonverbal interactions.” Central to Nightingale’s
theory is the concept of a therapeutic environment
that will enhance the comfort and recovery of the
patient.
Application to Nursing:
• Nursing Practice: Ventilation, warmth, quiet, diet,
and cleanliness are still important aspects of nursing
care. We, nurses, thus need to maintain adequate
ventilation, promote adequate and appropriate
nutrition, maintain normal homeostatic body
temperature, and observe basic hygiene and comfort
measures, including environmental sanitations.
• Nursing Education: Nightingale had established the
St. Thomas Hospital and King’s College Hospital in
London, which was able to provide a framework for
the establishment of nursing training schools through
a universal template that contains principles of
nursing training. She also advocated the separation of
nursing training from the hospital to a more
appropriate learning environment in the school or
university setting
• ursing Research: Nightingale is considered the
mother of nursing research because of her interest in
the scientific methods of inquiry and statistics. She
was able to gather and analyze data efficiently and
resourcefully. She was the first to use polar diagrams
in presenting study data. The concepts of
Nightingale’s theory still serve as a basis for current
research. In the 1990s, research studies that tested
and expanded nursing theory were numerous.
WATSON'S PHILOSOPHY & THEORY OF
TRANSPERSONAL CARING “Nursing is the
human science of persons and human health – illness
experiences that are mediated by professional,
personal, scientific, aesthetic, and ethical human care
transactions.”
JEAN WATSON
• born and grew up in a small town of Welch West
Virginia; youngest of the eight children
• began developing her theory while she was
assistant dean of the undergraduate program at
University of Colorado
• in 1978-1981, she served as coordinator and
director of the PhD program
• worked from 11 curative factors to formulate her
10 carative factors
• modified 10 factors slightly over time and
developed the caritas processes, which have a
spiritual dimension and use a more fluid and
evolutionary language
• authorized 11 books which reflect the evolution of
her theory of caring
• 1st book – Nursing: The Philosophy and Science of
Caring (1979), use 10 carative factors but evolved to
include “caritas” (connection between caring and
love)
• 2nd book – Nursing: Human Science and Human
Care – A Theory of Nursing (1985), addressed her
conceptual and philosophical problem in nursing
Transpersonal Caring Relationship
• foundational of her theory; it is a special kind of
human care relationship
• a union with another person-high regard for the
whole person and their being in the world
• “Caritas” originates from the Greek vocabulary,
meaning to cherish and to give special loving
attention
• Watson uses the term “carative” instead of curative
10 Elements of Carative Factors:
• Humanistic-altruistic system of value - Practice of
loving kindness and equanimity (self-
control/composure) within context of caring
consciousness.
• Faith-hope- being authentically present, and
enabling and sustaining the deep belief system and
subjective life world of self and the one-being-cared-
for
• Sensitivity to self and others - cultivation of one’s
own spiritual practices and transpersonal self, going
beyond ego self, opening to
others with sensitivity and compassion.
Helping-trusting, human care relationship -
Developing and sustaining a helping-trusting,
authentic caring relationship
• Expressing positive and negative feelings - Being
present to, and supportive of, the expression
ofpositive and negative feelings as a connection with
a deeper spirit of self and the one-being-cared-for
• Creative problem-solving caring process - Creative
use of self and all ways of knowing as part of the
caring process to engage in artistry of caring-healing
practices.
• Transpersonal teaching- learning - Engaging in
genuine teaching-learning experience that attends to
unity of being and meaning, attempting to stay within
other’s frames of reference.
• Supportive, protective, and/or corrective mental,
physical,
societal, and spiritual environment - Creating a
healing environment at all levels (physical as well as
non-physical), subtle environment of energy and
consciousness, whereby wholeness, beauty, comfort,
dignity, and peace are potentiated.
• Human needs assistance- Assisting with basic
needs, with an intentional caring consciousness,
administering “human care essentials”, which
potentiate alignment of mind-body-spirit,
wholeness, and unity of being in all aspects of care,
tending to both the embodied spirit and evolving
spiritual emergence.
• Existential-phenomenological- spiritual forces -
Opening and attending to spiritual-mysterious and
existential dimensions of one’s own life-death; soul
care for self and the one-being-cared-for
Transpersonal caring relationship
characterizes a special kind of human care
relationship that depends on:
• the nurse’s moral commitment in protecting and
enhancing human dignity as well as the deeper/higher
self ➢ the nurse’s caring consciousness
communicated to preserve and honor the embodied
spirit, therefore, not reducing the person to the moral
status of an object
• the nurse’s caring consciousness and connection
having the potential to heal since experience,
perception, and intentional connection are taking
place
➔ The theory acknowledges the unity of the
person’s mind-bodyspirit.
➔ The mind is the point of access to the body and
the spirit.
➔ The spirit relates to a person’s soul, the inner
self,
the essence of the person, the spiritual self.
Theory Assertions
• It is the spirit that allows the person to transcend the
“here and now” coexisting with past, present, and
future, all at once through creative imagination and
visualization.
• Watson ascertains that the care of the soul remains
the most powerful aspect of the art of caring in
nursing.
Major Assumptions
• Nurse’s ability to connect with another at this
transpersonal spirit to spirit level is translated via
means of communication, into nursing human art and
acts or intentional caring- healing modalities.
• Caring-healing modalities within the context of
transpersonal caring/ caritas consciousness potentiate
harmony, wholeness and unity of being by releasing
some of the disharmony.
• Ongoing personal & professional development and
spiritual growth.
• Nurse’s own life history, previous experiences etc.
Are valuable teachers for this work.
• Other facilitators are personal growth experiences
such as psychotherapy and other models for spiritual
awakening.
• Continuous growth for developing and maturing
within a transpersonal caring model is ongoing.
Theory in View of Metaparadigms
Nursing
Nursing is the human science of persons and human
health – illness experiences that are mediated by
professional, personal, scientific, aesthetic, and
ethical human care transactions.
Person Personhood (human being)
• a unity of mind/body/spirit/nature
• Unitary Transformative Paradigm-Holographic
thinking: “…unity within an evolving emergent
world viewconnectedness of all…”
• three words: Mind, Body, Soul
• “… humans cannot be treated as objects and that
humans cannot be separated from self, other, nature,
and the larger universe.”
Health
•“…illness is not necessarily disease; [instead it is a]
subjective turmoil or disharmony within the spheres
of the person, for example, in the mind, body, and
soul, either consciously or unconsciously.”
Environment
•Society – provides the values that determine how
one should behave and what goals one should strive
toward. Watson stated, “Caring (and nursing) has
existed in every society. Every society has had some
people who have cared for others. A caring attitude is
not transmitted from generation to generation by
genes. It is transmitted by the culture of the
profession as a unique way of coping with its
environment.”
Application to Nursing:
• Nursing Practice (Administration & Leadership): It
calls for administrative practices and embrace caring,
even in a health care environment of increased acuity
levels of hospitalized individuals, short hospital stays,
increasing complexity of technology, and rising
expectations in the task of nursing.
• Nursing Education: Watson’s writings focus on
educating graduate nursing students and providing
them with ontological, ethical, and epistemological
bases for their practice, along with research
directions. Watson’s caring framework has been
taught in numerous baccalaureate nursing curricula.
• Nursing Research: Watson’s theory to reduce
distress experienced by infertile women. Her theory
and the application of theory of clinical practice
hospital organizations have been their major
weakness of research. Nelson and Watson report on
studies carried out in seven countries.
Implications of the Theory:
• One major implication of the theory is in the realm
of bedside nursing where nurses of today have
particularly begun to neglect. The essence of nursing
is in the caring aspect and caring is taking the
wholeness, the totality, of the patient in
consideration.
• More importantly, nurses of today should try to care
for a patient for who he is. After all, all of us were
created equal and in His likeness.
MODULE 3 PATRICIA BENNER’S STAGES OF
NURSING EXPERTISE MARILYN ANNE
RAY’S BUREAUCRATIC CARING
PATRICIA BENNER:
CARING, CLINICAL WISDOM AND ETHICS IN
NURSING PRACTICE
• born in Hampton, Virginia
• baccalaureate of arts degree from Pasadena College
in 1964
• Master’s degree in Nursing with major emphasis in
medical-surgical nursing from University of
California, San Francisco, School of Nursing
• has a wide range of clinical experience
“Nursing is a caring relationship and practice that
cares for and studies the lived experiences of
patients on health, illness, and disease, and the
relationships among these three elements.” -
Patricia Benner
"The Nurse - Patient Relationship is not a uniform,
professionalized blueprint but rather a Kaleidoscope
of intimacy and distance in some of the most
dramatic, poignant, and mundane moments of life".
DREYFUS MODEL
• Novice (0 to 1 year)
• Advanced Beginner (1 to 2 years)
• Competent (2 to 3 years)
• Proficient (3 to 5 years) – intuitive •Expert (>5
years) – clinical eye
• proposes that as a person improves in skill level,
there is a corresponding change in the performance of
a given skill:
•Movement from reliance on abstract principles
and rules to use of past, concrete experience.
•Shift from reliance on analytical, rule-based
thinking to intuition,
• Change in the learner’s perception of the
situation from viewing it as a compilation of equally
relevant pieces to viewing it as an increasingly
complex whole in which some parts stand out as
more or less relevant.
SKILL
refers to nursing interventions and clinical judgment
skills in actual clinical situations.
EXPERTISE
is developed when the clinician tests and modifies
principlebased expectations in the actual setting.
NOVICE STAGE
• a person who lacks background experience of the
situation he or she is involved in
• simple rules and objectives, attributes should be
given
• examples are nursing students and professional
nurses who have been assigned to an area totally
different from the one they are accustomed to
ADVANCED BEGINNER
• has enough experience to grasp aspects of a
situation but not within the context of the situation
• should be guided by rules and are oriented by the
completion of tasks
• feels highly responsible for managing patient care
but will still need the help of other nurses who are
more experienced than her
• examples are newly registered professional nurses
COMPETENT NURSE
• considerable conscious and deliberate planning
which determines the important aspects of present
and future situations
• exhibits a sense of mastery, increased level of
efficiency, consistency, predictability, and time
management
PROFICIENT NURSE
• already has a holistic view of a particular situation
• the nurse’s performance is guided by maxims by
this stage
• can already show an intuitive grasp of the situation
based on background understanding
• can see changing relevance in a given situation
including recognition and implementation of skilled
responses to the situation as it evolves
EXPERT NURSE
• does not rely anymore on the analytical principles
of rules, guidelines, and maxims to connect her
understanding of the situation to an appropriate
action
• characterized by the following vital traits:
• demonstrate a clinical grasp and resource-based
practice
• possess embodied know-how
• see the big picture
• see the unexpected
Competency – defined as an interpretively defined
area of skilled performance identified and described
by its intent, functions, and meanings.
Experience – the active process of refining and
changing preconceived theories, notions, and ideas
when confronted with actual situations; it reflects that
there is communication between what is found in
practice and what is expected
. Maxim – a mysterious description of skilled
performance.
✔ It requires a certain level of experience to
recognize the implications of the instructions.
 ✔ Paradigm case is a clinical experience that
stands out.
✔ It alters the way the nurse will perceive and
understand and open new clinical viewpoints
and alternatives.
Hermeneutics - interpretive; it describes meaningful
human activities or phenomena in a careful and
detailed manner.
✔ The description is free from analytical
assumptions. It is based purely on practical
understanding of thephenomena.
THEORY IN VIEW OF METAPARADIGMS
NURSING
• Described as a caring relationship and practice that
cares for and studies the lived experiences of
• patients on health, illness, and disease, and the
relationships among these three elements.
PERSON
• It is viewed as a self-interpreting being. The person
does not come into the world predefined. He gets
defined in the course of living a life. He has an
effortless and non-reflective understanding of the self
in the world. He is a participant in common meanings
and he is embodied.
Embodiment refers to the body’s capacity to respond
to meaningful situations with 5 dimensions:
1.The unborn complex – the fetus and
newborn baby does not yet have any signs of
the effects of culture
2. The habitual skilled body – refers to the
body language of a person as he learned
through time by the processes of
identification, imitation, and trial and error
3. The projective body – refers to the
predetermined action of the body in response
to a situation; for example, walking or
running
4. The actual projected body – refers to the
body’s capacity to fit or be skilled in a given
situation; for example, driving an automobile
5. The phenomenal body – refers to the
body’s awareness of itself and its ability to
imagine and describe touch sensations
HEALTH
• This is defined as what can be assessed. Well-being
is the human experience of health or wholeness.
• Wellbeing and being ill are understood as distinct
ways of being in the world. Health is not merely the
absence of disease or illness. A person may also have
a disease but not an illness.
• Illness is the human lived experience of loss of
function or dysfunction.
• A disease is a state that can be assessed physically.
ENVIRONMENT
• Benner talked about situations instead of
environment. Situation is described as the social
environment with a social definition and
meaningfulness. Each person’s past, present, and
future, including their own personal meanings, habits,
and perspectives, influence the present situation.
• Benner’s contribution to the nursing profession is
the use of phenomenal approaches to nursing
practice.
• Phenomenal approaches have resulted in the
development of clinical promotion ladders, new
graduate orientation programs, and clinical
knowledge development seminars.
• Her model is instrumental in differentiating
knowledge development and career progression in
nursing. This allowed nursing educators to realize
that learning needs at the early stages of clinical
knowledge development are different from those
required at later or higher stages
• It is important to understand that different
employees will have different levels of skills.
• It is important to emphasize the importance of
learning the skill of involvement and caring through
practical experience, articulation of knowledge with
practice, and the use of narratives in undergraduate
education.
• It is important for nursing students and professional
nurses alike to learn through experience or by
experiential learning.
• Learning by experience will allow you to gain
mastery of a given skill.
MARILYN ANN RAY
• 1958 – went to LA, CA work at OB-Gyn, ER, CCU
• 1960 – US Citizen, US Air Force- flight nurse,
clinician, administrator, educator, researcher with a
rank of Colonel. The first nurse to go to the Soviet
Union with the Aerospace Medical association
• 1965 – BSN-MSN in MCN at the University of
Colorado; Dr. Madeleine Leininger, a nurse
anthropologist, influenced Ray's life.
• 1973 – went back to Canada to be with her family,
faculty in McMaster University
• 1989 – appointed as an Eminent Scholar at Florida
Atlantic University and continues as Professor
Emeritus
• Her research interests continue to focus on nurses,
nurse administrators and patients in critical care and
intermediate care, and in nursing administration in
complex hospital organizational cultures
THEORETICAL SOURCES
• Dr. Leininger – transcultural nursing and
ethnographic-ethnonursing research methods.
• Hegel – posited the interrelationship among thesis,
antithesis, and synthesis.
• Chaos Theory – describes simultaneous order and
disorder, and order within disorder. Ray compares
change in complex organizations with this creative
process and challenges nurses to step back and renew
their perceptions of everyday events, to discover the
embedded meanings.
MAJOR CONCEPTS & DEFINITIONS
Holography
– everything is a whole in one context and a part in
another, with each part being in the whole and the
whole being in the part Caring
– a complex transcultural, relational process
grounded in an ethical, spiritual context (charity and
right action, love as compassion in response to
suffering and need and justice or fairness of what to
be done)
Spirituality
– involves creativity and choice and is revealed in
attachment, love, and community Spiritual- Ethical
caring for nursing focuses on the facilitation of
choices for the good of others
Educational
– formal and informal educational programs, use of
audiovisual media to convey information and other
forms of teaching and sharing information
Physical
– related to the physical state of being, including
biological and mental patterns (mind and body)
Social-Cultural
– ethnicity & family structures, intimacy with friends
and family, communication; social interaction and
support. Legal
– meaning of caring include responsibility and
accountability; rules and principles to guide
behaviors such as policies, procedures informed
consent; right to privacy
Technological
– nonhuman resources, like machinery to maintain
the physiological well-being of the patient, diagnostic
tests, knowledge and skills needed to utilize these
resources
Economic
– includes money, budget, insurance systems,
limitations and guidelines imposed by managed care
organizations, allocation of human and material
resources to maintain services
Political
– power structure within health care administration,
pattern of decision making in the organization; role
and gender stratification among health care providers;
competition for scarce human and material resources
MAJOR ASSUMPTIONS
• The meaning of caring is highly differential,
depending on its structures (social-cultural,
educational, political, economic, physical,
technological, legal).
• Caring is bureaucratic as well as spiritual/ ethical,
given the extent to which meaning can be understood
in relation to the organizational structure.
• Caring is the primordial construct and
consciousness of nursing
THEORY IN VIEW OF METAPARADIGMS
NURSING
NURSING
holistic, relational, spiritual and ethical caring that
seeks the good of self and others in complex
community, organizational and bureaucratic cultures
PERSON
a spiritual and cultural being. are created by God, the
Mystery of Being and engage co-creatively to find
meaning and value.
HEALTH
provides a pattern of meaning for individuals,
families, and communities. Beliefs and caring
practices about illness and health are central features
of culture.
ENVIRONMENT
a complex spiritual, ethical, ecological, and cultural
phenomenon. It embodies knowledge and conscience
about the beauty of life forms and symbolic systems
or patterns of meaning. These patterns are transmitted
historically and are preserved or changed through
caring values, attitudes, and communication.
APPLICATION TO NURSING
• Nursing Practice (Administration & Leadership)
• The theory of Bureaucratic Caring has direct
application for nursing.
• This synthesis of behaviors and knowledge reflects
the holistic nature of the theory.
• This can transform the working environment,
fostering ethical choices, respect, and trust, resulting
to successful organizations
• Nursing Education: Useful in nursing education in
terms of its broad focus on caring in nursing and its
conceptualization of the health care system.
Interconnectedness of all things
• Nursing Research: Particularly significant because
it is grounded in the philosophy of humanism and
caring, and it encourages nurses to utilize
phenomenological-hermeneutics through the lens of
caring
IMPLICATIONS OF THE THEORY
Clarity major structures are defined clearly,
consistent with definitions commonly used by
practicing nurses
Simplicity the theory simplifies the dynamics of
complex bureaucratic organizations
Generality the theory addresses the nature of nursing
as caring, "What is the nature of caring in nursing?”,
"What is the nature of nursing practice as caring?".
Philosophies are broad and provide direction for the
discipline.
Accessibility has undergone continued revisions
based largely on research, empirical precision is high
with concepts grounded in observable reality
Importance issues that confront nurses today include
economic constraints in the managed care
environment and the effects of these constraints
(staffing ratio) on the nurse patient relationship.\
MODULE 5 MYRA E. LEVINE'S
CONSERVATION MODEL MARTHA E.
ROGER’S SCIENCE OF UNITARY HUMAN
BEING CONCEPTUAL MODELS OF NURSING
MYRA E. LEVINE'S CONSERVATION
MODEL
 • “Nursing is a human interaction that promotes
adaptation and maintains wholeness either by acting
in the therapeutic sense or by providing supportive
care in order to influence adaptation favorably, or
toward renewed social wellbeing.”
✔ This is focused on the preservation of the
individual’s wholeness or totality.
✔ She believed that nursing activities were
conservation activities, a keeping-together function
that promotes wholeness in the patient.
Four Principles
1. Conservation of Energy – all physiologic
and psychological processes that sustain
life depend on the body’s energy balance
✔ adjusting to life in the nursing home
✔ improving nutritional status,
balancing resident activity
✔ controlling resident anxiety and pain
2. Conservation of Structural Integrity – all
body systems decline with aging; chronic
illness also produces bodily structural
changes
✔ maintaining or promoting mobility
✔ preventing injury
✔ preventing infection
✔ maintaining skin integrity
3. Conservation of Personal Integrity – self-
identity is intrinsically bound to
wholeness and all individuals cherish the
sense of self; it includes recognition of
the holiness of each person
✔ respecting one’s privacy and
property
✔ enhancing self-esteem through good
personal hygiene, grooming and dressing
✔ fostering independence through
choice and rehabilitation
✔ promoting self-identity for those
who are cognitively impaired
✔ obtaining advance directives for
treatment
4. Conservation of Social Integrity –
individual life has meaning only in the
context of social life
✔ providing meaningful social
activities for residents and staff,
considering the family and resident as a
unit
Major Concepts & Definitions
CONSERVATION
→ describes the way complex systems are able to
continue to function even when severely challenged
→ it is through conservation that man is able to
confront obstacles, adapt accordingly, and maintain
their uniqueness and individuality, from Latin word
conservation which means “to keep together”
WHOLENESS
→ emphasizes a sound, organic, progressive,
mutuality between diversified functions and parts
within an entirety, the boundaries of which are open
and fluent
→ it connotes integrity – the oneness of persons,
highlighting their capacity to respond in an integrated
and singular fashion to environmental challenges
ADAPTATION
→ the process of change wherein the person is able to
keep his integrity within situations and circumstances
of his environment, both internal and external
→ it is the bridge; the process by which individuals
fit the environments in which they live → health and
disease are patterns of adaptive change
→ the goal of adaptive change is the conservation of
wholeness (health) and integrity
→ the result of adaptation is conservation which has
3 characteristics:
✔ Historicity – patterned responses passed on
through genetics
✔Specificity – unique adaptive responses to
specific environmental challenges
✔ Redundancy – availability of multiple
adaptive responses
→ Levine suggests “the possibility exists that aging
itself is a consequence of failed redundancy of
physiological and psychological processes”
ENVIRONMENT
→ Internal environment – composed of the
physiologic and pathophysiologic domains of the
person
→ External environment has three levels:
1.Perceptual level – includes all aspects of the
world wherein the person is able to intercept and
interpret with his sense organs.
2. Operational level – refers to things that
physically affect the individual but may not be
perceived by the individual himself.
3. Conceptual level – the environment is the
product of cultural patterns, characterized by
spirituality, and moderated by language, history,
and thought.
ORGANISMIC RESPONSE
→ refers to the person’s ability to adapt to his or her
environment and is made up of four levels of
Integration:
1. Fight or flight – the most primitive response; the
person either “fights” or “flies away” from a
perceived stressor in order to ensure his own safety
and well-being
2. Inflammatory response – body defense
mechanism that protects the body tissue from
insults in an unfriendly environment
3. Response to stress – refers to the wear and tear
of body tissues that reflect the body’s continued
response and adaptation to stressful situations
4. Perceptual awareness / Sensory response – it
occurs as the person experiences life and the world
around him
TROPHICOGNOSIS
→ a scientific method of reaching a nursing care
judgment; an alternative recommendation of Levine
to Nursing Diagnosis
Theoretical Assertions
• "A holistic approach to care of all people, well or
sick."
✔ Decisions for nursing interventions must be
based on the unique behavior of the individual
patient.
Theory in View of Metaparadigms:
NURSING
• “Nursing intervention must be founded not only on
scientific knowledge, but specifically on recognition
of the individual’s behavioral responses which
indicate the nature of the adaptation taking place.”
• The goal of nursing care is to support adaptation
and the strong drive of the individual to seek
wholeness. Because of the uniqueness of each
individual, nursing care for each patient must be
highly individualized. Nursing interventions are both
therapeutic and supportive.
PERSON
• This refers to holistic being; wholeness is integrity.
Integrity means a person has a freedom of choice and
movement.
HEALTH
• This is the ability to function in a reasonable
manner. Theory in View of Metaparadigms:
ENVIRONMENT
• This is not a passive backdrop, the individual
actively participates in his environment. The process
of interaction is adaptation.
Application to Nursing Community
• Conservation principles have been used as a
framework for numerous practice settings by
identifying the activities it encompasses and giving
the scientific principles behind them.
MARTHA E. ROGER’S SCIENCE OF
UNITARY HUMAN BEING CONCEPTUAL
MODELS OF NURSING
“Nursing is an art and science that seeks to promote
symphonic interaction between the environment and
man, to strengthen the coherence and integrity of the
human beings, and to direct and redirect patterns of
interaction between man and his environment for the
realization of maximum health potential.”
• It provides a framework for nursing practice,
education, and research that promises a move away
from the previous predominant medical model
approach to the delivery of nursing care.
• Rogers formulated five basic assumptions that
describe man and the life process in man.
• These assumptions or “building blocks” underlay
the conceptual framework and consist of the concepts
of wholeness, openness, unidirectionality, pattern and
organization, and sentience and thought.
• Four “critical elements” that are basic in the theory:
q Energy fields
• Open system
• Pattern
• Pan-dimensionality – was previously known as
multidimensionality, and prior to that, four-
dimensionality
MAJOR CONCEPTS AND DEFINITIONS
Wholeness
→ refers to the state in which the human being is
regarded as a unified whole which is more than and
different from the sum of the parts
Openness
→ where the individual and the environment are
continuously exchanging matter and energy with each
other Open systems (openness)
→ describe the open nature of the fields, the
preferred terminology being that there is a
“continuous process” without the mention of energy
or matter
Unidirectionality
→ refers to where the life process exists along an
irreversible space time continuum
→ pattern and organization identify individuals and
reflect their innovative wholeness
Energy fields
→ are the “fundamental unit of the living and the
non-living”
→ they consist of the human energy field and the
environment energy field
The human field
→ an “irreducible, indivisible, pan-dimensional
energy field identified by pattern and manifesting
characteristics that are specific to the whole and
which cannot be predicted form knowledge of the
parts”
The environmental field
→ is integral with the human field; each
environmental field is specific to its given human
field Universe of open system
→ holds that energy fields are infinite, open, and
integral with one
Pattern
→ is the “distinguishing characteristic of the energy
field perceived as a single wave”, which gives
identity to the field
→ human behavior can be regarded as manifestations
of changing pattern
→ the pattern is constantly changing and might be
regarded as an indication of pain, illness or disease
→ sentience and thought states that all of life, human
beings are the only ones capable of abstraction and
imagery, language and thought, sensation and
emotion
Pan-dimensionality
→ is a nonlinear domain without spatial or temporal
attitudes; it describes an infinite domain without
limits
→ it short, it is a unitary whole
Theory Assertions
• Rogers viewed the person as an open system in
constant process with the open system of the
environment.
• She added that man is a unified whole possessing
his own integrity and manifesting characteristics
more than and different from the sum of his parts.
• In continuously exchanging matter and energy with
the environment, identified by pattern and
organization and reflects his innovative wholeness.
• This is characterized by the capacity for abstraction
and imagery, language and thought, sensation, and
emotion.
Theory in View of Metaparadigms
Nursing
A learned profession and is both a science and an art
Person An open system in continuous process with
the open system that is the environment
Health Passive health
– to symbolize wellness and the absence of disease
and major illness.
Environment
-Associated to open systems
8 Concepts in Roget’s Nursing Theory
• energy field
• resonance
• openness
• helicy
• pattern
• integrality
• pan-
dimensionality
• hemodynamic principles
Module 4: KARI MARTINSEN’S PHILOSOPHY OF
CARING; KATIE ERIKSSON’S CARITATIVE
CARING THEORY
KARI MARTINSEN’S PHILOSOPHY OF
CARING
• “Nursing is founded on caring for life, on
neighborly love, … At the same time, it is necessary
that the nurse is professionally educated…”
Summary of Credentials and Background:
✔ From 1972 to 1974, she attended the Department of
Philosophy at the University of Bergen
✔ In her work for the graduate degree in philosophy
(Magister Artium), she grappled philosophically with
questions that had disturbed her as a citizen, a
professional, and a healthcare worker
✔ The dissertation Philosophy and Nursing: A
Marxist and Phenomenological Contribution created
an instant debate and received much critical attention
✔ Period from 1976 to 1986 can be described as a
historical phase in her work & published several
historical articles
✔ Published a “lit torch” of a book with the
provocative title, Caring Without Care? In this book,
they raised important questions about whether nurses
were “moving away” from the sickbed, whether
caring for the ill and infirm was disappearing with the
advent of increasingly technical care and treatment,
and whether nurses were becoming administrators
and researchers who increasingly relinquished the
concrete execution of care to other occupational
groups.
✔ Based on this work, she attained the doctor of
philosophy degree from the University of Bergen in
1984.
Theoretical Sources: In analysis of profession of
nursing in the early 1970s, she looked to three
philosophers in particular:
▪ Karl Marx, the German philosopher, politician, and
social theorist
▪ Edmund Husserl, the German philosopher and
founder of phenomenology
▪ Maurice Merleau-Ponty, the French philosopher and
phenomenologist of the body
Major Concepts & Definitions:
Care
• This “forms not only the value base of nursing, but
is a fundamental precondition for our lives. Care is
the positive development of the person through the
Good”.
→ Care is a trinity: relational, practical, and moral
simultaneously. Caring is directed outward toward
the situation of the other. In professional contexts,
caring requires education and training.
→ “Without professional knowledge, concern for the
patient becomes mere sentimentality”. She is clear
that guardianship negligence or sentimentality are not
expressions of care.
Professional judgment and discernment
→ It is through the exercise of professional judgment
in practical, living contexts that we learn clinical
observation. It is “training not only to see, listen and
touch clinically, but to see, listen and touch clinically
in a good way”.
→ “Because perception has an analogue character, it
evokes variation and context in the situation”.
→ Discretion expresses professional knowledge
through the natural senses and everyday language.
Moral practice is founded on care
→ “Moral practice is when empathy and reflection
work together in such a way that caring can be
expressed in nursing”. Morality is present in concrete
situations and must be accounted for. Our actions
need to be accounted for; they are learned and
justified through the objectivity of empathy.
→ This means in concrete terms to discover how the
other will best be helped. Sincerity and judgment
enter into moral practice.
Person-oriented professionalism
→ This is “to demand professional knowledge which
affords the view of the patient as a suffering person,
and which protects his integrity. It challenges
professional competence and humanity in a
benevolent reciprocation, gathered in a communal
basic experience of the protection and care for life…
It demands an engagement in what we do, it is about
having an understanding of one’s position within a
life context that demands something from us, and
about placing the other at the centre, about the caring
encounter’s orientation toward the other”.
Sovereign life utterances
→ These are phenomena that accompany the
Creation itself. They exist as pre-cultural phenomena
in all societies; they are present as potentials.
→ They are beyond human control and influence.
Sovereign life utterances are openness, mercy, trust,
hope, and love.
→ Sovereign life utterances are preconditions for
care, simultaneously as caring actions are necessary
conditions for the realization of sovereign life
utterances in the concrete life.
The untouchable zone
→ This refers to a zone that we must not interfere
with in encounters with the other and encounters with
nature. It refers to boundaries for which we must
have respect.
→ The untouchable zone creates a certain protective
distance in the relation; it ensures impartiality and
demands argumentation, theory, and professionalism.
In caring, the untouchable zone is united with its
opposite, which is openness, in which closeness,
vulnerability, and motive have their correct place.
→ Openness and the untouchable zone constitute a
unifying contradiction in caring
Vocation
→ a demand life makes to us in a completely human
way, is given as a law of life concerning neighborly
love which is foundationally human
→ an ethical demand to take care of neighbor, so
nursing requires a personal refinement in addition to
professional knowledge
The Eye of the Heart
→ the concept stems from the parable of good
Samaritan
→ the heart says something about the existence of
the whole person, about being touched or moved by
the suffering of the other and the situation the other
experiences
The Registering Eye
→ objectifying, the perspective is that of the
observer; concerned with finding connections,
systematizing, ranking, classifying and placing in a
system
→ represents alliance between modern natural
science, technology and industrialization
Theoretical Assertions:
✔ People are created dependent and relational. The
person is fundamentally dependent upon community
and the creation.
✔ To the created belong the sovereign life utterances.
✔ These are phenomena present in the service of life.
✔ They create life, they release life's possibilities.
Theory in View of Metaparadigms:
Nursing
▪ Caring is fundamental to nursing.
▪ Trinity of Caring:
✔ Relational means that caring requires at least
two people. One has concern for the other. One
suffers, the other will "grieve" and provides for the
alleviation of pain. Caring is the most natural and
fundamental aspect of the person's existence.
✔ Practical is about concrete and practical action.
Caring is t trained and learned through its practice.
✔ Moral refers to "if caring is to be genuine, must
relate to the other from an attitude which
acknowledges the other in light of his situation”.
Must NOT overestimate or underestimate his
ability to help himself.
Person
This means bearing fellowship of tradition that turns
the individual into a person.
✔ Parallel between the person and the body
✔ Bodies that we relate to ourselves, to others and
to the world. It is the unit of soul and flesh, or
spirit and flesh.
✔ As bodies, we both perceive and understand.
Health Health does not only reflect the condition of
the organism. It is also an expression of the current
level of competence in medicine. The tendencies of
the modern concept of health are such that if one
has an unnecessary 'defect' or an organ which
'could' be better, one is not completely healthy.
✔ IMPORTANT is to cure sometimes, help often
and comfort always.
Environment
Space and situation – a person is always in a
particular situation in a particular space. In space are
found time, ambience, and power. ✔ Our
interaction with each other, use of objects, words,
knowledge, our being-in-theroom- all set the tone and
color the situation and the space.
✔ Our challenge is to give patients and each other
dignity in these spaces.
Application to Nursing:
▪ Nursing Practice: Caring is practically relevant as
an overarching/general philosophy of nursing. It is
clearly articulated and encompasses a precise
formulation of how to understand and approach
patients and nursing. The ability to promote reflection
upon nursing practice in different contexts.
▪ Nursing Education: Most nursing colleges make
good use of her texts, and works form part of the
curriculum at a variety of educational levels.
▪ Nursing Research: Countless dissertations based on
practical, concrete, and more theoretical issues
discuss the relationship between empirical experience
in light of her terminology and philosophy.
Implications of the Theory:
Clarity
Clearly states that life has been created and given to
us.
Created in dependence on each other and on nature.
Caring for each other and for nature is fundamental.
Simplicity She used a poetic and philosophical rather
than a scientific mode of speaking.
Wrote general phenomena that affect us all, and that
could easily recognize in our personal lives,
occupational or daily lives.
Generality
This seems to be relevant for all patients who,
because of illness or other reasons, need help and
assistance:
Accessibility
The patient's and the nurse's worlds of experience are
diverse, nuanced, and multifaceted. A nuanced and
varied language is required to deal with a
multifaceted reality. This enables us to performed
situation- dependent, good nursing - a professional
moral practice. Importance Caring community is not
dictatorial, nor is it society's passive arm. It exists
only to the extent that we struggle for its existence.
we must form it through solidarity, through morally
responsible action, through the fight for greater
equality and for community and social integration.
Caring is an active and radical concept
KATIE ERIKSSON’S CARITATIVE CARING
THEORY
“Caritative caring means that we take “caritas” into
use when caring for the human being in health and
suffering…
Caritative caring is a manifestation of the love that
‘just exists’…
Caring communion, true caring, occurs when the one
caring in a spirit of caritas alleviates the suffering of
the patient.”
Summary of Credentials and Background:
✔ From 1972 to 1974, she attended the Department of
Philosophy at the University of Bergen.
✔ She is one of the pioneers of caring science in the
Nordic countries. She has the ability from the
beginning to design caring science as a discipline,
while bringing to life the abstract substance of caring.
✔ She was born on November 18, 1943, in Jakobstad,
Finland.
Theoretical Sources:
Her leading thoughts have been not only to develop
the substance of caring, but also to develop caring
science as an independent discipline.
C She wanted to go back to the Greek classics by
Plato, Socrates, and Aristotle, from whom she found
her inspiration for the development of both the
substance and the discipline of caring science.
▪ From her basic idea of caring science as a
humanistic science, she developed a meta-theory that
she refers to as “the theory of science for caring
science”.
Major Concepts & Definitions:
Caritas
→ Caritas means love & charity.In caritas, eros and
agapé are united, and caritas is by nature
unconditional love.
→ Caritas, which is the fundamental motive of caring
science, also constitutes the motive for all caring.
→ It means that caring is an endeavor to mediate
faith, hope, and love through tending, playing, and
learning.
Caring communion
→ It is a form of intimate connection that
characterizes caring. Caring communion requires
meeting in time and space, an absolute, lasting
presence.
→ This is characterized by intensity and vitality, and
by warmth, closeness, rest, respect, honesty, and
tolerance. It cannot be taken for granted but pre-
supposes a conscious effort to be with the other.
→ Caring communion is seen as the source of
strength and meaning in caring.
The act of caring
→ This contains the caring elements (faith, hope,
love, tending, playing, and learning), involves the
categories of infinity and eternity, and invites deep
communion.
→ The act of caring is the art of making something
very special out of something less special.
Dignity
→ This constitutes one of the basic concepts of
caritative caring ethics. Human dignity is partly
absolute dignity, partly relative dignity.
→ Absolute dignity is granted the human being
through creation, while relative dignity is influenced
and formed through culture and external contexts.
→ A human being’s absolute dignity involves the
right to be confirmed as a unique human being.
Invitation
→ This refers to the act that occurs when the carer
welcomes the patient to the caring communion.
→ The concept of invitation finds room for a place
where the human being is allowed to rest, a place that
breathes genuine hospitality, and where the patient’s
appeal for charity meets with a response.
Suffering
→ This is an ontological concept described as a
human being’s struggle between good and evil in a
state of becoming.
→ Suffering implies in some sense dying away from
something, and through reconciliation, the wholeness
of body, soul, and spirit is recreated, when the human
being’s holiness and dignity appear.
→ Suffering is a unique, isolated total experience and
is not synonymous with pain. Suffering related to
illness, to care, and to life
→ This is related to illness and is experienced in
connection with illness and treatment. When the
patient is exposed to suffering caused by care or
absence of caring, the patient experiences suffering
related to care, which is always a violation of the
patient’s dignity.
→ Not to be taken seriously, not to be welcome,
being blamed, and being subjected to the exercise of
power are various forms of suffering related to care.
In the situation of being a patient, the entire life of a
human being may be experienced as suffering related
to life.
The suffering human being
→ This is the concept that Eriksson uses to describe
the patient. The patient refers to the concept of
patiens (Latin), which means “suffering”.
→ The patient is a suffering human being, or a
human being who suffers and patiently endures.
Reconciliation
→ It refers to the drama of suffering. Reconciliation
implies a change through which a new wholeness is
formed of the life the human being has lost in
suffering.
→ In reconciliation, the importance of sacrifice
emerges. Having achieved reconciliation implies
living with an imperfection with regard to oneself and
others but seeing a way forward and a meaning in
one’s suffering.
→ Reconciliation is a prerequisite of caritas.
Caring culture
→ Concept that Eriksson uses instead of
environment. It characterizes the total caring reality
and is based on cultural elements such as traditions,
rituals, and basic values.
→ It transmits an inner order of value preferences or
ethos.
→ Respect for the human being, dignity and holiness,
forms the goal of communion and participation in a
caring culture.
→ The origin of the concept of culture is to be found
in such dimensions as reverence, tending, cultivating,
and caring; these dimensions are central to the basic
motive of preserving and developing a caring culture.
Use of empirical evidence
→ Established it in empiricism by systematically
employing a hermeneutical and hypothetical
deductive approach. In conformity with a human
science and hermeneutical way of thinking, Eriksson
developed a caring science concept of evidence.
→ Her main argument for this is that the concept of
evidence in natural science is too narrow to capture
and reach the depth of the complex caring reality.
→ Her concept of evidence is derived from
Gadamer’s Concept of Truth, which encompasses the
true, the beautiful, and the good.
Major Assumptions:
Eriksson distinguishes between two kinds of major
assumptions:
1.Axioms as fundamental truths in relation to the
conception of the world.
2.Theses are fundamental statements concerning
the general nature of caring science.
Axioms as fundamental truths in relation to the
conception of the world. These are as follow:
✔ The human being is fundamentally an entity of
body, soul, and spirit.
✔ The human being is fundamentally a religious
being.
✔ The human being is fundamentally holy. Human
dignity means accepting the human obligation of
serving with love, of existing for the sake of others.
✔ Communion is the basis for all humanity. Human
beings are fundamentally interrelated to an abstract
and/or concrete other in a communion.
✔ Caring is something human by nature, a call to
serve in love.
✔ Suffering is an inseparable part of life. Suffering
and health are each other’s prerequisites.
✔ Health is more than the absence of illness. Health
implies wholeness and holiness.
✔ The human being lives in a reality that is
characterized by mystery, infinity, and eternity.
✔ Ethos confers ultimate meaning on the caring
context.
✔ The basic motive of caring is the caritas motive.
✔ The basic category of caring is suffering.
✔ Caring communion forms the context of meaning
of caring and derives its origin from the ethos of love,
responsibility, and sacrifice, namely, caritative ethics.
Theses are fundamental statements concerning the
general nature of caring science. These are as follow:
✔ Health means a movement in becoming, being, and
doing while striving for wholeness and holiness,
which is compatible with endurable suffering.
✔ Caring implies alleviation of suffering in charity,
love, faith, and hope. Natural basic caring is
expressed through tending, playing, and learning in a
sustained caring relationship, which is asymmetrical
by nature.
→ These kinds of major assumptions had their
validity tested through basic research.
→ Axioms and theses jointly constitute the ontology
of caring science and therefore also are the
foundation of its epistemology.
Theory in View of Metaparadigms:
Nursing
Love and charity, or caritas, as the basic motive of
caring, principal idea. The foundation of the caring
professions through the ages has been an inclination
to help and minister to those suffering.
Caring is something natural and original. Eriksson
thinks that the substance of caring can be understood
only by a search for its origin. This origin is in the
origin of the concept and in the idea of natural caring.
The fundamentals of natural caring are constituted by
the idea of motherliness, which implies cleansing and
nourishing, and spontaneous and unconditional love.
Person
The conception of the human being in Eriksson’s
theory is based on the axiom that the human being is
an entity of body, soul, and spirit. The human being
is fundamentally holy, and this axiom is related to the
idea of human dignity, which means accepting the
human obligation of serving with love and existing
for the sake of others. The human being is seen as
constantly becoming; he is constantly in change. The
dual tendency of the human being also emerges in his
effort to be unique, while he simultaneously longs for
belonging in a larger communion. The human being
is fundamentally dependent on communion; where he
can give and receive love, experience faith and hope,
and be aware that his existence now has meaning. the
human being we meet in care is creative and
imaginative, has desires and wishes, and is able to
experience phenomena; So, a human being only in
terms of his needs is insufficient. When the human
being is entering the caring context, he becomes a
patient in the original sense of the concept — a
suffering human being.
Health
Defines health as soundness, freshness, and well-
being. Implies being whole in body, soul, and spirit.
Health means as a pure concept wholeness and
holiness. She sees health as both movement and
integration. Health as movement implies a change; a
human being is being formed or destroyed, but never
completely; health is movement between actual and
potential; health is movement in time and space;
health as movement is dependent on vital force and
on vitality of body, soul, and spirit; the direction of
this movement is determined by the human being’s
needs and desires; the will to find meaning, life, and
love constitutes the source of energy of the
movement; and health as movement strives toward a
realization of one’s potential.
ENVIRONMENT
Good caring and true knowledge become visible
through ethos. Ethos originally refers to home, or to
the place where a human being feels at home. It
symbolizes a human being’s innermost space, where
he appears in his nakedness. Ethos means that we feel
called to serve a particular task. This ethos she sees
as the core of caring culture. Ethos, which forms the
basic force in caring culture, reflects the prevailing
priority of values through which the basic
foundations of ethics and ethical actions appear.
Application to Nursing: Nursing Practice:
Eriksson’s thinking and process model of caring are
general, the nursing care process model has proved to
be applicable in all contexts of caring, from acute
clinical caring and psychiatric care to health-
promoting and preventive care.
It has been influential in nursing leadership and
nursing administration, where the caritative theory of
nursing forms the core of the development of nursing
leadership at various levels of the nursing
organization.
Her ideas about caring and her nursing care
process model work in practice has been verified by
everything from a multiplicity of essays and tests of
learning in clinical practice to master’s theses,
licentiates’ theses, and doctoral dissertations
produced all over the Nordic countries.
Application to Nursing:
Nursing Education:
•Eriksson’s theory has been integrated into the
education of nurses at various levels, and her books
have been included continuously in the examination
requirements in various forms of nursing education
has been based entirely on Eriksson’s ideas, and her
caritative caring theory forms the core of the
development of substance in education and research.
• Development of the caring science
–centered curriculum and caring didactics continued
in the educational and research program in caring
science didactics offered as part of continuing
education for those who work in clinical practice.
•Sees caring science not as profession oriented but as
a “pure” academic discipline, it has aroused interest
among students in other disciplines, that genuine
interdisciplinary cooperation is needed between
caring science and medicine.
• Most nursing colleges make good use of her texts,
and works form part of the curriculum at a variety of
educational levels.
Countless dissertations based on practical, concrete,
and more theoretical issues discuss the relationship
between empirical experience in light of her
terminology and philosophy.
Implications of the Theory:
Clarity
• Every new concept becomes a part of an ever more
comprehensive whole in which an element of internal
logic can be seen clearly.
Her main thesis has always been that basic
conceptual clarity is needed before developing the
contextual features of the theory.
Used concept analysis and analysis of ideas as central
methods, which has led to semantic and structural
clarity.
Simplicity
•The theoretical clarity of Eriksson’s theory reflects
the simplicity of the theory by showing the general in
a clear and logical conceptual entirety.
•The hermeneutic approach has deepened the
understanding of the substance and thus contributed
to the simplicity of the theory formulates this process
by the statement that “ideals reach reality and reality
reaches the ideals”. Implications of the Theory: \
Generality
•The theory is general in the sense that it aims at
creating an ontological and ethical basis of caring,
while at the same time it constitutes the core of the
discipline and thus involves epistemology as well. It
was stressed the importance of describing the core
concepts on an optimal level of abstraction in order to
include all of the complex caring reality that
simultaneously carries a wealth of signification that
opens up understanding in various caring contexts.
Accessibility
•Eriksson’s thinking as a whole has reached an
understanding that extends to other disciplines and
professions. She has developed a language and a
rhetoric that has reached researchers as well as
practitioners in the human scientific field.
•The empirical precision of Eriksson’s theory
demonstrated in multiple deductive testing manifests
a combination of the clarity, simplicity, and
generality of the theory combined with a rich
substance and clearly formulated ethos.
Importance
• Eriksson’s work on developing her caritative caring
theory for 30 years has been successful, and
particularly in the Nordic countries there is abundant
evidence that her thinking is of great importance to
clinical practice, research, and education, and also to
the development of the caring discipline. By her
development of the caritative theory of care, Eriksson
created her own caring science tradition, a tradition
that has grown strong and has set the tone for nursing
advancement and caring science.
Summary:
▪ She has been a guide and visionary who has gone
before and “ploughed new furrows” in theory
development. Eriksson’s caritasbased theory and her
whole caring science thinking have developed over
years. Characteristic of her thinking is that while she
is working at an abstract level developing concepts
and theory, rooted in clinical reality and teaching.
▪ The whole caritative theory and the caring that are
built up around the theoretical core get their
distinctive character and deeper meaning. The
ultimate goal of caring is to alleviate suffering and
serve life and health.
▪ Knowledge formation, which Eriksson sees as a
hermeneutic spiral, starts from the thought that ethics
precedes ontology. In a concrete sense, this implies
that the thought of human holiness and dignity is
always kept alive in all phases of the search for
knowledge. Ethics precedes ontology in theory as
well as in practice.
▪ Eriksson’s caring science tradition and discipline of
caring science form a basis for the activity at the
Department of Caring Science. Eriksson’s caritative
caring theory and the discipline of caring science
have inspired many, and they are used as the basis for
research, education, and clinical practice.
Module 6: Theoretical Foundations in Nursing DOROTHEA
OREM’S SELF-CARE DEFICIT MODEL IMOGENE KING’S
INTERACTING SYSTEMS FRAMEWORK AND GOAL
ATTAINMENT THEORY
Dorothea Orem’s Self-Care Deficit Model
“ Nursing is a helping profession of assisting patients
overcome or compensate for their healthassociated
limitations and engaging in actions to regulate their
own functioning and development or that of their
dependents.”
• The model is a collection of three interrelated
theories
• Nursing systems
• Self-care • Self-care deficit
• The focus of Orem’s model is to enhance the
person’s ability for selfcare and this also extends to
the care of dependents
• A person’s self-care deficits are the result of
environmental situations
• Theoretical sources
• Philosophical system of moderate realism
• Three systems that exist within this model
1. Wholly Compensatory System
• Nurse provides total care
2. Partially Compensatory System
• Nurse and patient share
responsibility for care
3. Supportive-Educative System
• Client has primary responsibility for
personal health, with nurse acting as a
consultant
• Basic Premise is that individuals can take
responsibility for their health and the health of others
• Individuals have the capacity to care for themselves
or their dependents
• Based on the philosophy “patients wish to care for
themselves”
• When unable to meet own self-care requisites,
• Duty and obligation of the professional nurse to
recognize and identify these deficits in order to define
a support intervention
MAJOR DEFINITIONS
SELF-CARE
• Practice of activities that maturing and mature
individuals initiate and perform
• Ensures maintaining life, healthful functioning,
continuing personal development and vital to human
functioning •
SELF-CARE Requisites
1. Universal self-care requisites
2. Developmental self-care requisites
3. Health deviation requisites
1.Universal self-care requisites
• Needs that all people have
• Air, water, food, elimination, activity and rest,
solitude and social interaction, hazard prevention,
and promotion of normal functioning
2.Developmental self-care requisites
• Needs related to the development of the
individual
• Engagement in self-development, overcoming
effects of human conditions, life situations
affecting human development
3.Health deviation requisites
• Needs that arise as a result of a patient’s
condition
• Pathological conditions, defects, deformities
and disabilities
Therapeutic self-care demand
• Totality of nursing care measures important at
certain times or over a period of time
Nursing agency
• Developed capabilities of nurses to meet the
therapeutic self-care demands of a patient
 3. Social system Interacting System
Self-care agency Framework
• Complex acquired ability of mature and maturing 1. Personal Systems
individuals to know and meet their continuing • Body image
requirements for human functioning and development • Growth and Development
• Dependent-care agent • Perception
• Maturing adolescent who accepts and fulfills the • Self
responsibility to know and meet the therapeutic self- • Space and Time
care demand • When two or more persons interact, they form an
• Nursing systems interpersonal system
• Series and sequences of deliberate practical actions Interpersonal system
of nurses • Two or more persons interact
• Communication
Theoretical Assertions • Interaction
• Nursing systems are action systems formed by • Role
nurses • Stress
• Deliberate action, intentionality, diagnosis, • Transaction
prescription and regulation • A comprehensive interacting system is composed of
• Self-care is performed by the person himself or groups that make a society
have them performed by another person in order to 3. Social system
maintain life, health, development, and well-being • Authority • Irreversible
• Decision making • Moving forward in
Application to Nursing Community • Organization time Power
• Emphasis on education and supportive measures • • Status • Personal
Important aspect of clinical nursing- • Dynamic
Gain Attainment Theory
HEALTH TEACHINGS IMOGENE KING’S • Middle-Range Theory
INTERACTING SYSTEMS FRAMEWORK AND • Product of developments from Interacting
GOAL ATTAINTMENT THEORY Systems Framework
“Nursing is an observable behavior found in the • Mutual Goal-Setting between a nurse and a client
health care systems in society that aims to help • Nurse Assessment of clients concerns, problems,
individuals maintain their health so they can function and disturbances in health
in their roles” • Nurse and Client perceptions of the interference
• Nurse and Client sharing of information
Interacting System Framework • Nurses interact with family when clients cannot
• This theory emphasizes the importance of the participate
interaction between the nurse and patients • Focused on interpersonal system specifically nurse-
• Views this interaction as an open system in client relationship
constant interaction with a variety of environmental • Open system which allows feedback
factors

• Three Interrelated Systems

1. Personal Systems 8 Propositions Related to Goal Attainment
2. Interpersonal system Theory
1. IF perceptual accuracy is present in interactions,
then transactions will occur
2. IF nurse and client make transactions, then goals
will be attained
3. IF goals are attained, then satisfaction will occur
4. IF goals are attained, then effective nursing care
will occur
5. IF transactions are made, then growth and
development will be enhanced
6. IF role expectations and role performance are
congruent, then transactions will result
7. IF role conflict is experienced, then stress in nurse-
relationship interactions will occur
8. IF nurses with special knowledge and skills
communicate appropriate information to clients, then
mutual goal setting and goal attainment will occur
Major Concepts and Definitions
Perception
• Process where data obtained from senses and
memory are organized, interpreted and transformed
Stress
• Keeping equilibrium to support growth and
development and activity
• Making use of resources to meet both personal and
organizational goals
The Self
• Thoughts and feelings related to one’s awareness of
being a person
Growth and Development
• Process of moving from potential for
achievement to actualization of self Major
Concepts and Definitions
Body Image
• Both the way one perceives one’s body and
others’ reactions to one’s appearance
Space
• Territory and the behaviors of those who occupy
it
Interactions
• Observable behaviors of two or more persons in
mutual presence
Communication
• Verbal and non-verbal
• Perceptual
• Transactional
Role
• Reciprocity- giver or taker
• Learned, social, complex and situational
Authority
• Active, reciprocal process of transaction
• Experience, understanding, and values influence
meaning, legitimacy and acceptance
Status
• Relationship of one’s place in a group to others in
the group or other groups
Decision-Making
• Process where choices are made related to goals
Time
• Interval between events experienced differently by
each person
Theory Assumptions
• The focus of nursing is care of the patient
• The goal of nursing is health care of both
individuals and groups
• Humans beings are open systems interacting with
the environment
• Nurse and patient communicate, set goals, and
achieve goals
• World as a complete person making transactions
• The transaction represents a life situation
• Perceiver and thing being perceived
• Person as active participant
 • Changed by experiences
Module 8: Theoretical Foundations in Nursing HILDEGARD
PEPLAU’S THEORY OF INTERPERSONAL RELATIONSHIP
IDA JEAN ORLANDO’S THEORY OF DELIBERATIVE
NURSING PROCESS
HILDEGARD PEPLAU’S THEORY OF
INTERPERSONAL RELATIONSHIP
Nursing is the interpersonal therapeutic process of
functioning cooperatively with other human
processes that make health possible for individuals in
communities through education that aims to promote
forward movement of personality.”
Hildegard Peplau’s Credentials and Background
• “Mother of Psychiatric Mental Health Nursing”
• “Nurse of the Century”
• Executive Director and President of the American
Nurses Association (ANA)
• Taught 1st classes for graduate psychiatric nursing
at Teachers College, Columbia University
• Four psychological experiences: needs, frustrations,
conflicts, and anxieties
4 Phases of the Nurse-Patient Relationship
Orientation
• Phase where the client seeks help and the nurse
assists the client to understand the problem and extent
of help
Identification
• Client assumes posture of dependence,
interdependence or independence in relation to the
nurse
Exploitation
• Client derives full value from what the nurse offers
through the relationship
Resolution
• Old needs and goals are set aside and new ones are
adopted
6 Proposed Nursing Roles
1.Stranger Role
• Nurse receives client as a stranger and builds trust
2.Resource Role
• Nurse answers questions, interprets clinical data,
and gives information
3.Teaching Role
• Nurse gives instructions and provides training
4.Counseling Role
• Nurse helps clients understand the meaning of
current life circumstances and provides guidanc
5.Surrogate Role
• Nurse helps clients clarify domains of dependence,
interdependence, and independence
6. Active Leadership Role
• Nurse helps the client assume maximum
responsibility for meeting treatment goal
Theoretical Assertions
• Nurse and the patient can interact
• Peplau emphasized that both the patient and nurse
mature as a result of the therapeutic interaction
• Communication and interviewing skills remain
fundamental tools
• Peplau believed that nurses must clearly understand
themselves to promote their client’s growth and avoid
limiting choices to nurses value
 • Abraham (2011) used theory to help nurses
achieve more successful patient outcomes such as
fall reduction
• Most effective practice theory for new nurses

Nursing Process Theory:

3 Basic Elements
1. The behavior of the patient
2. The reaction of the nurse
3. The nursing actions which are designed for the
patient’s benefit
IDA JEAN ORLANDO’S THEORY OF
DELIBERATIVE NURSING PROCESS
Major Concepts and Definitions
“Nursing is a profession that seeks to find out
Need
and meet the patient’s immediate need for help.”
• Requirement of the patient which relieves or
diminishes his immediate distress if this is supplied
IDA JEAN ORLANDO’S Credentials and
Presenting behavior of patient
Background
• Any observable verbal or nonverbal behavior of the
• Yale University
patient
• Integrated mental health into basic nursing
Immediate Reactions
curriculum
• The nurse’s and the patient’s individual
• Emphasized patient’s participation in nursing
perceptions, thoughts, and feelings
process
Nursing process discipline
• Theory focuses on improving patient’s behavior
• Nurse communicating with patient his or her
• Proposed that patients have their own meanings and
immediate reaction
interpretations of situations
• Ask for validation, clarification, or correction from
the patient
• “Deliberative Nursing Process”
Theory Description
Automatic nursing actions
• Theory stresses the reciprocal relationship between
• Activities decided upon for reasons other than the
patient and nurse
patient’s immediate need
• Persons become patients who need help because
• They have physical limitations
Deliberative nursing actions
• They have negative reactions to an environment
• Those decided upon after ascertaining a need and
• They have an experience that prevents them
then meeting this need
from communicating their needs
• Patients are distress or helpless because of unmet
Theory Assumptions
needs for help
• When patients cannot cope with their needs, they
• Positive correlation between length of time of
become distressed and helpless
unmet needs and degree of distress (Immediacy)
• Nursing adds to the distress of the patient
• When individuals meet their own needs, they do not
• Patients are unique and individual in how they
feel distress and do not require care from nurses
respond
• Crucial for nurses to share their perceptions,
• Nursing deals with people, the environment, and
thoughts, and feelings (Schmieding, 2006)
health
• Patients need help communicating their needs
• People can be secretive or explicit about their
needs, perceptions, thoughts, and feelings
• The nurse-patient situation is dynamic
• People attach meanings to situations and actions
• Patients enter into nursing care through medicine
• Patient cannot state the nature and meaning of their
distress without the nurse’s help
• Any observation shared and observed with the
patient is immediately helpful
• Nurses are concerned with the needs the patient is
unable to meet on his or her own
Application of the Theory
• Framework will be important for nurses who are
assigned in special clinical areas (OR, ER, and ICU/
Critical Care Unit)
• Reciprocal relationship between patient and nurse
remains a MOST EFFECTIVE PRACTICE
THEORY
Module 9: Joyce Travelbee’s Human-to-Human
Relationship Model of Nursing & Ernestine Wiedenbach’s Helping
Art of Clinical Nursing Theory
Joyce Travelbee’s Human-to-Human Relationship
Model of Nursing
“…human-to-human relationship is the means
through which the purpose of nursing is fulfilled.”
LIFE STORY
• A psychiatric nurse, educator, and writer born in in
1926
• 1956, she completed her BSN degree at Louisiana
State University
• 1959, she completed her Master of Science Degree
in Nursing at Yale University
• She started a Doctoral program in Florida in 1973.
Unfortunately, she was not able to finish it because
she died later that year. She passed away at the prime
age of 47 after a brief sickness
WORKING EXPERIENCE
• 1952, Psychiatric Nursing Instructor at DePaul
Hospital Affiliated School, New Orleans.
• Also, she taught at Charity Hospital School of
Nursing in Louisiana University School of
Nursing, New York University, and University
of Mississippi.
• 1970, the Project Director of
GraduateEducation at Louisiana State University
of Nursing until her death.
PUBLICATIONS
• 1963, started to publish articles and journals in
nursing
• 1966 and 1971, publication of her first book
entitled Interpersonal Aspects of Nursing.
• 1969, when she published her 2nd book intervention
in Psychiatric Nursing: Process in the
One-to-One Relationship
THEORY CONCEPTS
• Travelbee believes the spiritual values a person
holds will determine to a great extent, his perception
of illness. The spiritual values of the nurse or her
philosophical beliefs about illness and suffering will
determine the degree to which he or she will be able
to help ill persons find meaning, or no meaning, in
these situations.
• Travelbee extended the interpersonal relationship
theories of Peplau and Orlando, but greatly
emphasized on the therapeutic human relationship
between the nurse and the patient.
• Her model emphasized: empathy, sympathy,
rapport, and emotional aspects of nursing.
• The establishment of a nurse-patient relationship Ernestine Wiedenbach’s Helping Art of Clinical
and the experience that rapport is the end of all Nursing Theory
nursing endeavors. “Nursing is the art of nurturing or caring for
• Travelbee’s other contribution to the nursing someone in a motherly fashion.”
profession included her works on illness, suffering,
pain, hope, communication, interaction, empathy,
sympathy, rapport, and therapeutical use of self.

RAPPORT
Is experiences when nurse and patient has progresses
through the four interlocking phases preceding
rapport
1. Original encounter
2. Emerging identities
3. Empathy
4. Sympathy

“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 uniqueness of
the ill human being.”
“A nurse does not only seek to alleviate physical pain
or render physical care— she ministers to the whole
person. The existence of the suffering whether 4 ELEMENTS IN ART OF NURSING
physical, mental, or spiritual is the proper concern of PHILOSOPHY – what motivates the nurse to act in
the nurse.” a certain way
•Major Concept of her philosophy:
THE RAPEUTICAL USE OF S •Patient
ELF •Nurse
Ability to use one’s personality consciously and in •The nurse’s philosophy is their attitude and belief
full awareness to establish relatedness and to about life and how that affected reality for them
structure nursing intervention.
3 essential components associated with nursing
COMMUNICATION
philosophy:
vehicle through which nurse-patient relationships are
•Reverence for life
established.
•Respect for the dignity, worth, autonomy and
NURSE–PATIENTINTERACTION
individuality of each human being
An experience or series of experiences between nurse
•Resolution to act on personality and professionally
and patient.
held benefits
LOGICALFORM
PURPOSE
An inductive theory that uses specific nursing
•is that which the nurse wants to accomplish through
situations to create general ideas.
what she does
•It is all the activities directed towards the overall
good of the patient
PRACTICE - are those observable nursing actions
that are affected by beliefs and feelings about
meeting the patient’s need for help
ART -Understanding patient’s needs and concerns
• Developing goals and actions intended to enhance
patient’s ability
• Directing activities related to the medical plan to
improve patient’s condition.
WAYS TO IDENTIFY PATIENTS’ NEED FOR
HELP
• Observing behavior consistent or inconsistent with
their comfort
• Exploring the meaning of their behavior
• Determining the cause of their discomfort or
incapacity
• Determining whether they can resolve their
problems or have a needfor-help
THE PATIENT
Is any person who has entered the healthcare system
and is receiving help of some kind, such as care,
teaching, or advice. The patient need not be ill since
someone receiving health-related education would
qualify as a patient.
NEED–FOR–HELP
Is defined as any measure desired by the patient that
has the potential to restore or extend the ability to
cope with various life situations that affect health and
wellness.
CLINICAL JUDGEMENT
Represents the nurse’s likeness to make sound
decisions.
SOUND DECISIONS
Are based on differentiating fact from assumption
and relating them to cause and effect. It is the result
of discipline functioning mind and emotions and
improves with expanded knowledge and increased
clarity of professional purpose.
NURSING SKILLS
Are carried out to achieve a specific patient-centered
purpose rather than completion of the skill itself
being the end goal.
SKILLS
Are made up of a variety of action, and characterized
by harmony of movement, precision, and effective
use of self.
Module 10 NANCY ROPER-WINIFRED LOGAN-ALISON
TIERNEY'S MODEL OF NURSING BASED ON ACTIVITIES
OF LIVING & LYDIA HALL’S CARE, CURE, CORE THEORY
OF NURSING
NANCY ROPER-WINIFRED LOGAN-ALISON
TIERNEY'S MODEL OF NURSING BASED ON
ACTIVITIES OF LIVING
✔ This model incorporates a life span approach
wherein the characteristics of the person are
considered with respect to prior development, current
level of development, and likely future development.
✔ In conjunction with the life span approach an
independence/dependence continuum is used.
✔ The model then incorporates a set of 12 activities
of living which represent those activities engaged in
by individuals whether sick or well.
12 ACTIVITIES OF LIVING
together these elements are referred to as a “model of
living”
1.Maintaining a safe environment
2.Breathing
3.Communication
4.Mobilizing
5.Eating and Drinking
6.Eliminating
7. Personal cleansing and dressing
8. Maintaining body temperature
9. Working and playing
10. Sleeping 5
11. Expressing sexuality
12. Dying
5 MAIN FACTORS THAT INFLUENCED THE
ADLS:
Biological
Psychological
Sociocultural
Environmental
Politico-economic
• The model has been a significant guide towards
advancing nursing practice, research, and education
in that it places great emphasis on the nurse’s ability
to perform continuous patient assessment, provide
assistance in the performance of activities of living
and individualizing patient care
. • Health is viewed as a reflection of the person’s
ability to perform the activities of living in the light
of the five factors that influence its degree of
performance and within the context of the person’s
developmental age.
Major Concepts & Definitions:
Individuality of living
→ the way in which the person attends to his
activities of living with respect to his developmental
age or his place in the life span, on the
dependenceindependence continuum, and as
influenced by biological, psychological,
environmental, and politico-economic factors
The activities of living
→ describe the person in the complex process of
living from the perspective of an amalgam of
activities Major
Life span
→ refers to the concept of continuous change from
birth until death and may refer to developmental age
The dependence-independence continuum
→ relates to the factors and activities of the person
→ the continuum ranges from full incapacitation to
having the ability to achieve activities of living
→ both concepts occur at anticipated points across
the lifespan and at unexpected times throughout life
APPLICATION OF THE THEORY
• The Theory of the Elements of Nursing: A Model
Based on a Model of Living emphasizes the
importance of developmental assessment and of
individualizing patient care.
• No two patients can have similar reactions to a
particular disease condition or illness state because of
the concept of individuality of living.
• The first vital step towards high quality patient care
is for the nurse to individualize patient care and to
make a thorough nursing and health assessment.
LYDIA HALL’S CARE, CURE, CORE THEORY
OF NURSING
"Nursing is a distinct body of knowledge that
provides nursing care to patients who are in need of
nursing care in support of medical interventions, in
collaboration with other members of the health team,
or exclusively and independently by the nurse
herself.”
LYDIA HALL LIFE STORY:
✔ Born in New York City September 21, 1906
✔ Graduated from York Hospital School of Nursing
in Pennsylvania
✔ Bachelor of Science & Master of Arts from
Teachers College, Columbia University
✔ Died February 27, 1969 of heart disease in Queens
Hospital of New York
INTERESTS & RESEARCH FOCUS:
✔ Research in the field of rehabilitation of
chronically ill patient’s brought her to develop the
Care, Cure, Core Theory
✔ Interested in rehabilitative nursing and the role that
the professional nurse played and the patient’s
recovery and welfare (Alligood & Tomey 2010)
✔ She became the founder and first director of the
Loeb Center for Nursing and Rehabilitation at the
Montefiore Medical Center in Bronx, New York
✔ She became the founder and first director of the
Loeb Center for Nursing and Rehabilitation at the
Montefiore Medical Center in Bronx, New York
Major Concepts & Definitions:
• Nursing theory in line with Lydia Hall is nothing
short of revolutionary.
• In the 1960s, she put down in her own simple
words, her thoughts about nursing.
• She did not consider herself a nurse theorist but
instead talked about her transparent thoughts and
remarkable ideas of nursing care as she learned it
over the years.
• These lead to the development of her “Care, Cure,
Core Theory” also known as the “Three C’s of Lydia
Hall”. • She believed that patients should receive care
only from professional nurses.
• Nursing involves interacting with a patient in a
complex process of teaching and learning.
• She was not pleased with the concept of team
nursing
Theory Description
This theory defines Nursing as the “participation in
care, core and
cure aspects of patient care, where CARE is
the sole function of nurses, whereas the CORE and
CURE are shared
with other members of the health team.”
✔ The major purpose of care is to achieve an
interpersonal
relationship with the individual that will facilitate the
development of
the core.
✔ As Hall says; “To look at and listen to self is often
too difficult
without the help of a significant figure (nurturer) who
has learned
how to hold up a mirror and sounding board to invite
the behavior
to look and listen to himself. If he accepts the
invitation, he will
explore the concerns in his acts and as he listens to
his exploration
through the reflection of the nurse, he may uncover in
sequence his
difficulties, the problem area, his problem, and
eventually the threat
which is dictating his out-of-control behavior.”
Theory Assumptions
• The motivation and energy necessary for healing
exist within the patient, rather than in the healthcare
team.
• The three aspects of nursing should not be viewed
as functioning
independently but as interrelated.
• The three aspects interact, and the circles
representing them change size, depending on the
patient’s total course of progress.
Major Concepts & Definitions:
• Nursing theory in line with Lydia Hall is nothing
short of revolutionary.
• In the 1960s, she put down in her own simple
words, her thoughts about nursing.
• She did not consider herself a nurse theorist but
instead talked about her transparent thoughts and
remarkable ideas of nursing care as she learned it
over the years.
• These lead to the development of her “Care, Cure,
Core Theory” also known as
the “Three C’s of Lydia Hall”.
• She believed that patients should receive care only
from professional nurses.
• Nursing involves interacting with a patient in a
complex process of teaching and learning.
• She was not pleased with the concept of team
nursing.
SUBCONCEPTS
•Lydia Hall’s theory has three components which are
represented by three independent but interconnected
circles. The three circles are the care, the cure, and
the core.
•The size of each circle constantly varies and depends
on the state of the patient
How Do Nurses Relate?
• She proposed many ideas of professional practice,
such as the nursing process
• Improvement of nurses to meet the needs of the
patient with better professional nursing care
• Management of nursing care
• Establishment of the nurse-patient relationship
• Collaboration with other health professionals •
Deliverance of care to ill patients
Theory Assertions
• Nursing is viewed as a distinct body of knowledge
that provides nursing care to patients who are in need
of nursing care
. • Care of patients can be performed in support of
medical interventions, in collaboration with other
members of the health team, or exclusively and
independently by the nurse herself. Nursing is
described as interacting with a patient in a complex
process of teaching and learning.
• The patient or person, in this case, is the recipient of
care which may come from three different domains.
Application of the Theory
• Nurses are able to carry out nursing interventions
independently, dependently, or interdependently.
• The core aspect of the theory maintains that it is our
responsibility to make sure that the patient receives
the highest level of care possible from all concerned
health professions.
• The role of the nurse is in the collaboration,
coordination, and cooperation with other members of
the health care team on matters that pertain to the
patient’s welfare.
• The cure aspect of the theory clearly delineates
nursing functions that are dependent on the members
of the medical profession.
• Examples of these include medication
administration, the performance of diagnostic
procedures, and some other interventions that need a
written order from the doctor.
• The care domain of the theory refers to the
independent roles and functions of the nurse insofar
as her knowledge and skills about the patient’s
condition will allow her to carry on with her
responsibilities.
Conclusion
• Hall believed patients should only receive care from
professional nurses.
• Hall defined her philosophy on the basis of the
patient.
• Hall believed that patients come to the hospital in a
biological crisis (acute episode of a disease) and that
medicine does a great job at treating this crisis but
fails to treat the chronic underlying disease. This is
where she felt nursing could make a significant
difference.
• Hall felt that taking over this sub-acute phase was
the way for nursing to legitimize itself into a true
profession
MODULE 7 BETTY NEUMAN’S SYSTEMS MODEL SISTER
CALLISTA ROY’S ADAPTATION MODEL OF NURSING
DOROTHY JOHNSON’S BEHAVIORAL SYSTEMS MODEL
BETTY NEUMAN’S SYSTEMS MODEL
“Nursing is a unique profession that is
concerned with all of the variables affecting an
individual’s response to stress.
BETTY NEUMAN’S SYSTEMS MODEL
• A unique, systems-based perspective that provides
a unifying focus for approaching a wide range of
nursing concerns.
• A comprehensive guide for nursing practice,
research, education, and administration that is open to
creative implementation.
• It has the potential for unifying various health-
related theories, clarifying the relationships of
variables in nursing care and role definitions at
various levels of nursing practice.
• Based on the person’s relationship to stress, his
reaction to it, and reconstitution factors that are
dynamic in nature.
• considers the person as an open system which is
composed of a basic structure of energy resources.
• These resources include physiologic, psychologic,
sociocultural, developmental, and spiritual.
• The basic structure, or central core, is surrounded
by two concentric boundaries or rings called the lines
of resistance.
• These lines represent the internal factors that aid
the person defend against a stressor.
• The line of resistance is further surrounded by two
lines of defense. o First line of defense is the person’s
state of equilibrium or the state of adaptation
developed and maintained over time and which is
considered normal for the person. o Second line of
defense is flexible, dynamic, and can be readily and
rapidly changed over a short period of time
• She classified stressors as intrapersonal,
interpersonal, and extrapersonal stressors.
• Man’s reaction to stress is dependent on the
integrity of the lines of resistance and defense.
• When the line of defense fails, man’s reaction will
now depend on the lines of resistance.
• Because of the reaction, man can adapt to a stressor
This is called reconstitution.
• Therefore, nursing interventions focus on keeping
or maintaining the stability of the open system. These
interventions can be carried out on the three levels of
prevention: primary, secondary, and tertiary. Major
Concepts & Definitions:
In holistic approach, the client as a whole, whose
parts are in dynamic interaction with itself and the
environment. It strongly advises the consideration of
all variables that simultaneously affect the client
system.
In holistic approach, the client as a whole, whose
parts are in dynamic
interaction with itself and the environment. It
strongly advises the
consideration of all variables that simultaneously
affect the client
system.
BETTY NEUMAN’S SYSTEMS MODEL
Open system
• characterized by elements that are in continuous
exchange within a complex organization
• these exchanges may be in the form of information
or energy
• basic to this is stress and stress reaction
Created environment
developed unconsciously by the client in order to
express the wholeness of the system by using
symbols
Client system
composed of the five system variables interacting
with the environment.
1. Physiologic variables are body structure and
function
2. Psychological variables include mental
processes in interaction with the environment
3. Sociocultural variables are the effects and
influences of social and cultural conditions
4. Developmental variables are age-related
processes and activities throughout life
5. Spiritual variables are beliefs and influences
related to spirituality
Basic client structure
composed of a central core surrounded by concentric
rings
the core reflects basic survival factors or energy
resources of the client
Lines of resistance
represents resources that help the client defend
against a stressor
normal line of defense reflects the client’s stability
which serves as the guide to assess
deviations from the client’s usual wellness
Flexible line of defense
a protective layer for preventing stressors from
breaking through the usual wellness state
1. Intrapersonal factors occur within the individual
2. Interpersonal factors occur between one or more
individuals
3. Extrapersonal factors occur outside the individualL
4.
Reconstitution
occurs following the treatment of stressor reactions;
marks the return of the client system to stability
Level of stability
after reconstitution, may be higher or lower than the
previous level before the invasion of the stresso
Neuman employed a three-step Nursing Process:
STEP 1: ASSESSMENT
• In the initial assessment, the nurse looks at the
client’s basic make-up and the known, unknown and
universal stressors.
• When examining the client’s basic makeup,
predispositions are
considered. They are important because they affect
how the client will deal with stressors.
• The nurse also looks at Neuman’s five variables:
physiological, psychological, sociocultural,
developmental and
spiritual. The nurse uses these variables to
examine the person’s predispositions and stressors.
• The client’s perception of these stressors is
discussed and the nurse provides input.
• Stressors are identified as interpersonal,
intrapersonal or extrapersonal
STEP 2: DIAGNOSIS,
PLANNING,IMPLIMENTATION
•The next step addresses the nursing diagnosis, which
describes the context of the whole client as a system.
•Goals are then determined in collaboration with the
client.
•Interventions are determined relative to the goals,
and are
carried out at three levels: primary, secondary, and
tertiary
prevention.
IMPLEMENTATION STEP 3: EVALUATION
•The next step involves nursing outcomes which
refers to
evaluation of the effectiveness of interventions.
• This includes assessing changes in intrapersonal,
interpersonal, and extrapersonal factors.
•Any changes in the nature of the stressors are
examined, as change in these areas determine the
success of the nursing interventions.
•If change has not occurred, more data collection is
required
and the nursing process is repeated.
Theoretical Assertions:
• Each client system is unique, a composite of factors
and characteristics within a given range of responses.
• Many known, unknown, and universal stressors
exist. Each differs in its potential for disturbing a
client’s usual stability level or normal line of defense.
The particular interrelationships of client variables at
any point in time can affect the degree to which a
client is protected by the flexible line of defense
against possible reaction to stressors.
• Each client/client system has evolved a normal
range of responses to the environment referred to as a
normal line of defense. The normal line of defense
can be used as a standard from which to measure
health deviation.
• When the flexible line of defense is no longer
capable of protecting the client/client system against
an environmental stressor, the stressor breaks through
the normal line of defense.
Whether in a state of wellness or illness, the client is
a dynamic composite of the variables’
interrelationships.
Wellness is on a continuum of available energy to
support the system in an optimal system stability
state.
Implicit within each client system are internal
resistance factors known as lines of resistance, which
function to stabilize and realign the client to the usual
wellness state
Theory in View of Metaparadigms
Nursing
Nursing’s primary concern is to define the
appropriate action in situations that are stress- related
or concerning possible reactions of the client or client
system to stressors. Nursing interventions aim to help
the system adapt or adjust and retain, restore, or
maintain some degree of stability between the client
system variables and environmental stressors,
focusing
on conserving energy.
Person
Humans are defined as “men, women, and children
cared for either singly or as social units”and are the
“material object” of nurses and others who provide
direct care.
Health
Health is defined as the condition or degree of system
stability and is viewed as a continuum from wellness
to illness. When system needs are met, optimal
wellness exists. When needs are not
satisfied, illness exists. When the energy needed to
support life is not available, death occurs.
Environment
The environment is a vital arena that is germane to
the system and its function. The environment may be
viewed as all factors that affect and are affected by
the system. In Neuman Systems Model identifies
three relevant environments: (1) internal, (2) external,
and
(3) created.
SISTER CALLISTA ROY’S ADAPTATION
MODEL OF NURSING
• The model assumes that systems of matter and
energy progress to higher levels of complex self-
organization.
• Consciousness and meaning comprise person and
environment
integration while awareness of self and environment
is rooted in
thinking and feeling.
• System relationships include acceptance, protection
and fostering of independence
• Man and his environment have common patterns
and integral
relationships and transformations are created in
human consciousness.
• Integration of man and environment meanings result
in adaptation.
• Roy’s model of nursing is best exemplified in the
nursing process.
The nursing process is a problem solving approach
for gathering data, identifying the capacities and
needs of
the human adaptive system, selecting and
implementing approaches for nursing care, and
evaluating the
outcome of care provided. It includes the following
steps:

ASSESSMENT OFBEHAVIOR
The first step of the nursing process which involves
gathering data about the behavior of the person as an
adaptive system in each of the adaptive modes
ASSESSMENT OF STIMULI
The second step of the nursing process which
involves the identification of internal and external
stimuli
that are influencing the person’s adaptive behaviors.
Stimuli are classified as:
✔ Focal – those most immediately confronting the
person
✔ Contextual – all other stimuli present that are
affecting the situation
✔ Residual – those stimuli whose effect on the
situation is unclear
NURSING DIAGNOSIS
Step three of the nursing process which involves the
formulation of statements that interpret data about the
adaptation status of the person, including the
behavior and most relevant stimuli
GOAL SETTING
The fourth step of the nursing process which involves
the establishment of clear statements of the
behavioral outcomes for nursing care
INTERVENTION
The fifth step of the nursing process which involves
the determination of how best to assist the person in
attaining the established goals
EVALUATION
The sixth and final step of the nursing process which
involves judging the effectiveness of the nursing
intervention in relation to the behavior after the
nursing intervention in comparison with the goal
established
Four Adaptive Modes:
These are how the regulator and cognator
mechanisms are manifested; in other words,
they are the external expressions of the above and
internal processes.
Physiological-Physical Mode
• Physical and chemical processes are involved in
the function and activities of living organisms. These
are
the actual processes put in motion by the regulator
subsystem.
• This mode’s basic need is composed of the needs
associated with oxygenation, nutrition, elimination,
activity and
rest, and protection.
• This model’s complex processes are associated with
the senses, fluid and electrolytes, neurologic function,
and endocrine
function.
Self-Concept Group Identity Mode
• The goal of coping is to have a sense of unity,
meaning
the purposefulness in the universe, and a sense of
identity integrity. This includes body image and
self-ideals.
Role Function Mode
• This focuses on the primary, secondary, and tertiary
roles
that a person occupies in society and knowing where
they stand as a member of society.
Interdependence Mode
• This mode focuses on attaining relational integrity
through the giving and receiving of love, respect
and value. This is achieved with effective
communication and relations.
Major Concepts & Definitions
Health
a state and process of being and becoming integrated
and whole that reflects person and environmental
mutuality
Adaptation the process and outcome whereby
thinking and feeling persons, as individuals and in
groups, use conscious awareness and choice to create
human and environmental integration
Adaptive responses
responses that promote integrity in terms of the goals
of the human system, that is, survival, growth,
reproduction, mastery, and personal and
environmental transformation
Ineffective responses
responses that do not contribute to integrity in terms
of the goals of the human system
Adaptation levels
represent the condition of the life processes described
on three different levels: integrated, compensatory,
and compromised.
Theory Assertions:
• Roy’s model views the person as an adaptive
system with coping processes.
• She described the person as a whole comprising
parts and which functions as
a unity for some purpose.
• It includes people as individuals or in groups
(families, organizations, communities, nations, and
society as whole).
• The person is an adaptive system with cognator and
regulator subsystems acting to maintain adaptation in
the four adaptive modes.
• The environment is viewed as all conditions,
circumstances, and influences surrounding and
affecting the development and behavior of persons
and groups with particular consideration of mutuality
of person and earth resources.
• Nursing is the science and practice that expands
adaptive abilities and enhances person and
environment transformation.
• The goals of nursing are to promote adaptation for
individuals and groups in the four adaptive modes,
thus contributing to health, quality of life, and dying
with dignity.
• This is done by assessing behavior and factors that
influence adaptive abilities and by intervening to
expand those abilities and to enhance environmental
interactions.
Theory in View of Metaparadigms
Nursing
In the Adaptation Model, nurses are facilitators of
adaptation. They assess the patient’s behaviors for
adaptation, promote positive adaptation by enhancing
environment interactions and helping patients react
positively to stimuli. Nurses eliminate ineffective
coping mechanisms and eventually lead to better
outcomes.
Person
Based on Roy, humans are holistic beings that are in
constant interaction with their environment. Humans
use a system of adaptation, both innate and acquired,
to respond to the environmental stimuli they
experience. Human systems can be individuals or
groups, such as families, organizations, and the
whole global community.
Health
Health is defined as the state where humans can
continually adapt to stimuli. Because illness is a part
of
life, health results from a process where health and
illness can coexist. If a human can continue to adapt
holistically, they will maintain health to reach
completeness and unity within themselves. If they
cannot
adapt accordingly, the integrity of the person can be
affected negatively.
Environment
The environment is defined as conditions,
circumstances, and influences that affect humans’
development and behavior as an adaptive system. The
environment is a stimulus or input that requires a
person to adapt. These stimuli can be positive or
negative.
Application of the Theory
• Nursing process is cyclical in nature – beginning
with assessment, diagnosis, planning,
implementation, and evaluation – the evaluation may
also serve as the assessment findings for another set
of nursing problems.
• It means that the assessment component of the
nursing process is the stimuli or the input and the
planning and implementation are the throughput
processes.
• The output is the evaluation which then provides the
necessary feedback to the goal of care. The nurse
then decides what necessary actions should be taken
next, in the light of the patient’s response to the
nursing interventions. This action by the nurse is
adaptation in its simplest terms.
• Patients adapt, too. The nursing interventions we
perform ultimately elicits a response from our
patients, our patients may or may not actually adapt
according to our expectations
DOROTHY JOHNSON’S BEHAVIORAL
SYSTEMS MODEL
• “Nursing is an external force that acts to preserve
the organization of the patient’s behavior by means
of imposing regulatory mechanisms or by providing
resources while the patient is under stress.”
• Born August 21, 1919 in Savannah, Georgia.
Credentials and Background of Johnson:
• Graduated BSN from Vanderbilt University in
Nashville, Tennessee and her M.P.H. from Harvard
University in
Boston.
• She was a staff nurse at the Chatham-Savannah
Health Council (1943-1944).
• She is proud to receive the 1975 Faculty Award
from graduate students.
• She was an early proponent of nursing as a science
as well as an art; also believed nursing had a body of
knowledge
reflecting both the science and the art.
• Johnson (1959) proposed that the science of nursing
necessary for effective nursing care included a
synthesis of key
concepts drawn from basic and applied sciences.
• In 1961, she proposed that nursing care facilitated
the client’s maintenance of a state of equilibrium.
• She also proposed that clients were “stressed” by a
stimulus of either an internal or external nature.
• These stressful stimuli created such disturbance, or
“tensions”, in the patient that a state of disequilibrium
occurred.
• She identified 2 areas that nursing care should be
based in order to return the client to a state of
equilibrium:
• Reduce stressful stimuli
• Support natural and adaptive processes
THEORETICAL SOURCE
•Johnson’s behavioral system theory springs from
Nightingale’s belief that nursing’s
goal is to help individuals prevent or recover from
disease or injury.
• The “science and art” of nursing should focus on
the patient as an individual and not on the specific
disease entity. The model is patterned after a systems
model; a system is defined as consisting of
interrelated parts functioning together to form a
whole.
• She stated that a nurse should use the behavioral
system as their knowledge base.
7 Subsystems of Human Behavior:
The ultimate goal for each subsystem is expected to
be the same for all individuals.
1. Attachment – probably the most critical, because
it forms the basis for all social organization provides
survival & security; its consequences are social
inclusion, intimacy, &
formation and maintenance of a strong social bond
2. Achievement – attempts to manipulate the
environment with its function is control or mastery of
an aspect of self or environment to some standard of
excellence areas of achievement behavior include
intellectual, physical, creative, mechanical, &
social skills
3. Aggressive – function is protection & preservation
which holds that aggressivebehavior is not only
learned, but has a primary intent to harm others
however, society has placed limits when dealing with
self-protection and that people & their properly be
respected and protected
4. Dependence – promotes helping behavior that
calls for a nurturing response its consequences are
approval, attention, or recognition, and physical
assistance dependency behavior develops from the
complete reliance on others for certain resources
essential for survival an imbalance produces tension,
which results in disequilibrium
5. Sexual – has dual functions of procreation &
gratification that begins with the development of
gender role identity & includes the broad range of sex
role behaviors
6. Ingestive – have to do with when, how, what, how
much, and under what conditions we eat
7. Eliminative – have to do with when, how, what,
how much, and under what conditions we eliminate
7 Subsystems of Human Behavior:
The ultimate goal for each subsystem is expected to be the same
for all individuals.
▪ These responses are a set of behavioral responses or
tendencies that share a common goal developed
through experience and learning and are determined
by numerous physical, biological, psychological, and
social factors.
▪ Each subsystem has three functional requirements:
• Each subsystem must be “protected from noxious
influences with which the system cannot cope”.
• Each subsystem must be “nurtured through the
input of appropriate supplies from the environment”.
• Each subsystem must be “stimulated for use to
enhance growth and prevent stagnation”.
▪ As long as the subsystems are meeting these
functional requirements, the system and the
subsystems are viewed as self-maintaining and self-
perpetuating.
Major Concepts & Definitions
Behavior
• the output of intra-organismic structures and
processes as they are coordinated and articulated by
& responsive to changes in sensory stimulation
System
• a whole that functions as a whole by virtue of the
interdependence of its parts characterized by
organization, interaction, interdependency,
&integration of the parts & elements
Behavioral system
• encompasses the patterned, repetitive, & purposeful
ways of behaving
• the system is flexible enough to allow influence that
affect it
Major Concepts & Definitions
Subsystems
• mini-systems with its own particular goal &
function that can be maintained as long as its
relationship to the other subsystems or the
environment is not changed or disturbed
Equilibrium
• a stabilized but more or less transitory, resting state
where the person is in harmony with himself & with
his environment
Tension
• the state of being stretched or strained can be
viewed as an end-product of a disturbance in
equilibrium
Stressor
• a stimulus, either internal or external, that produce
tension and result in a degree of instability
Assumptions about system
• There is “organization, interaction,
interdependency and integration of the parts and
elements of
behaviors that go to make up the system.”
• A system “tends to achieve a balance among the
various forces operating within and upon it, and that
man strives continually to maintain
• a behavioral system balance and steady-state by
more or
less automatic adjustments and adaptations to the
natural forces occurring on him.”
• A behavioral system, which requires and results in
regularity and constancy in behavior, is essential
to man. It is functionally significant because it serves
a useful purpose in social life and the
individual.
• “System balance reflects adjustments and
adaptations that are successful in some way and to
some
degree.

Assumptions about structure
•“From the form the behavior takes and the
consequences it achieves can be inferred what ‘drive’
has been stimulated or what ‘goal’ is being sought.”
• Each person has a “predisposition to act concerning
the goal, in certain ways rather than the other ways.”
This predisposition is called a “set.”
•. Each subsystem has a repertoire of choices called a
“scope of action.”
• The individual patient’s behavior produces an
outcome that can be
observed.
Assumptions about functions
1. The system must be protected from toxic
influences with which the system
cannot cope.
2. Each system has to be nurtured through the input
of appropriate supplies
from the environment.
3. The system must be stimulated for use to enhance
growth and prevent stagnation.
Theory in View of Metaparadigms
Nursing
This is viewed as an external force that acts to
preserve the organization of the patient’s behavior by
means of imposing regulatory mechanisms or by
providing resources while the patient is under stress.
Nursing activities are not dependent on medical
authority, rather, nursing is complementary to the
practice of medicine.
Person
This is a behavioral system with patterned, repetitive,
and purposeful ways of behaving that link the person
to his environment. The person is a system of
interdependent parts that requires some regularity and
adjustment to maintain balance or equilibrium. A
person’ attempt to regain balance may require an
unnecessary use of energy. Health Health as an
elusive, dynamic state influenced by biological,
psychological, and social factors. A lack of balance in
the structural or functional requirements of the
subsystems leads to poor health.
Environment
The environment consists of all the factors that are
not part of the individual’s behavioral system, but
that
influence the system. The nurse may manipulate
some aspects of the environment so the goal of health
or behavioral system balance can be achieved for the
patient.
Application of the Theory:
•The subsystems are interactive and interdependent,
restoration in
one subsystem could bring about restoration of
behavior in
another or others. This means that healthcare
practitioners must
direct all efforts, interventions, or actions to all the
subsystems.
• As nurses, we should provide the highest level of
quality care to
our patients by taking into consideration the whole
person and
trying to understand the interrelatedness of its
individual
component parts.