NCM 131 Unit IIIC Interaction Oriented Nursing Theories

Unit IIIC.
The Nursing Theories

Interaction-Oriented Theories
Interaction theory is an approach to
questions about social cognition, or
how one understands other people, that
focuses on bodily behaviors and
environmental contexts rather than on
mental processes.
Hildegard Peplau’s Psychodynamic
Nursing
The "mother of psychiatric nursing," and the pioneer in
the development of the theory and practice of psychiatric
and mental health nursing.
Born September 1, 1909 in Reading,

Pennsylvannia to an immigrant parents of German
decent and Peplau died on March 17, 1999.
Nursing
Her father was illiterate and workaholic while her
mother was oppressive, perfectionist.
Raised in a paternalistic family and society.
Through higher education was never discussed at home,

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

Vermont. Earned her Bachelor’s Degree in
Interpersonal Psychology in 1943.
Nursing
Worked with the WHO by serving as an advisor, and
was a visiting professor at universities throughout the
United States and around the world.
Consultant to the US Surgeon General, the US Air

Force, and the National Institutes of Mental Health.
Nursing
She also participated in policy-making groups for the
United States government.
As a child, she saw the devastating effects of the flu

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

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

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

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

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

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

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

relationship is done.
The nurse uses her knowledge problems. And
education to solve client’s health problems.
The patient recognizes the nurse as helping,

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

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

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

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

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

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

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

problem and feelings as well as be aware of
their anxiety – active listener and guidance /
support.
There is a 7th role that Peplau did not define in her original theory –
the technical role.
Nurses employ to provide care like physical assessment, use of IV

pumps, BP taking and manipulating ventilators.
Man as an organism strives in its own way to reduce tension by

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

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

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

strategies or more severe mental conditions.
Moderate anxiety involves a decreased perceptual field (focus on

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

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

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

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

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

November 2007.
Received her nursing diploma from New York Medical

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

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

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

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

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

Community Health Plan.
Middle Range Theory
The General Concepts of Ida Jean Orlando’s Theory
This means finding out and meeting the patient's immediate needs for
help. Whatever help the patient may require for his needs to be met, it
is the nurse's responsibility to see that "the patient's needs are met,
either directly by her own activity or indirectly by calling in the help of
others."
Middle Range Theory
Presenting behavior is the patient's problematic situation. The

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

New York in 1909.
Earned a Bachelor of Arts from Wellesley College in 1922 and

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

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

in maternity nursing.
She became an assistant professor of obstetric nursing in 1954.

of Clinical Nursing
When the Yale School of Nursing established a master’s degree

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

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

factors.
The Central purpose of Nursing of which the nurse
recognizes as essential and important.
Nursing
Central purpose of nursing: The need of the patient

to acquire knowledge about prevention of increased
blood pressure (hypertension).
Nursing
Prescription for the fulfillment of the central purpose:

This is the activity of the nurse or HCP to solve the
need of the patient.
Nursing
The realities in the immediate situation that influence

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

action.
The recipient or patient who is vulnerable and is
dependent on others for help.
Nursing
The goal or directed outcomes the nurse wishes to

achieve.
Nursing
The means (actions, skills, experience) that empowers the

nurse to achieve the desired goals.
Nursing
The framework consists of the human, environmental,

professional, and organizational facilities.
Nursing
Wiedenbach’s nursing philosophy enumerated as

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

the nurse and the patient
Nursing
of Clinical Nursing
Nursing Process Wiedenbach’s Nursing Process

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

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

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

Louis University, and went on to complete her Master’s of
Science in Nursing, also from St. Louis University in 1957.
She also earned her doctoral degree from Teachers College, Columbia
University in 1961. She died on December 24, 2007.
Between 1966 and 1968, King worked as Assistant Chief of the Research
Grants Branch of the Division of Nursing in Washington, D.C. under Dr. Jessie
Scott.
She was the director of the Ohio State University School of Nursing from 1968
until 1972, Associate Professor from 1961 until 1966 and a Professor from
1971 until 1980 at Loyola University in Chicago.
After serving as a professor at the University of South Florida’s College of

Nursing in Tampa, Florida from 1980 until 1990, King retired with the title
Professor Emeritus.
During her career, King was an active member of the District IV Florida Nurses
Association, the American Nurses Association, and Sigma Theta Tau
International. She was also a Fellow in the American Academy of Nursing.
Imogene King’s Goal
Attainment Theory and
Imogene King’s Theory of Goal Attainment was first

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

stress, space, and time.
According to King, the patient is a social being who has three fundamental
needs: the need for health information, the need for care that seeks to prevent
illness, and the need for care when the patient is unable to help him or herself.
She explains health as involving life experiences of the patient, which includes
adjusting to stressors in the internal and external environment by using
resources available.
The environment is the background for human interaction. It involves the

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

The three interacting systems in her Theory of Goal Attainment

are the personal system, the interpersonal system, and the social
system.
The concepts for the personal system are: perception, self, growth
and development, body image, space, and time.
The concepts for the interpersonal system are: interaction, communication,

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

interaction by which nurse and patient share information about
their perception in nursing situation.”
The focus is on the care of the patient, and its goal is the health
care of patients and groups of patients.
According to King, the goal of the nurse is to help patients

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

the nursing process, to plan, implement, and
evaluate nursing care.
Therefore, the nurse can set his nursing actions, that is to help
individuals regain health or live with a chronic illness or a
disability.
Each action is associated with a reaction. This action and reaction

set is called interaction.
When both sides of interaction have a similar goal and attempt to

attain it, an effective interaction is occurred which is called
transaction.
It is during a transaction that nurse – patient effectively perform

their roles, attain their preset goals, and cope with their
environment.
This cycle includes feedback chains for continually assessing the

interpersonal system.
NURSING PATIENT
Nursing is a process of action, reaction, and Individuals are social beings who are rational and
interaction whereby nurse and client share information sentient. Humans communicate their thoughts,
about their perceptions in the nursing situation. The actions, and beliefs as well as choose between
nurse and client share specific goals, problems, and alternative courses of action, to set goals, to select the
concerns and explore means to achieve a goal. means to achieve goals, and to make decisions.
HEALTH
ENVIRONMENT Health is a dynamic life experience of a human being,
Environment is the background for human which implies continuous adjustment to stressors in
interactions. It is both external to, and internal to, the the internal and external environment through
individual. optimum use of one’s resources to achieve maximum
potential for daily living.
Nursing Process King’s Nursing Process
Assessment Assessment
Nursing Diagnosis
Planning Planning
Outcome Criteria Intervention
Intervention
Evaluation Evaluation
Strengths Weaknesses
A major strong point of King’s conceptual Limited application in areas of nursing in
system and Theory of Goal Attainment is the which patients are unable to interact
ease with which it can be understood by competently with the nurse.
nurses.
Lacks applications in providing nursing care
The theory of goal attainment also does to groups, families, or communities.
describe a logical sequence of events.
Josephine Peterson and Loretta Zherad
Humanistic Nursing
Josephine Paterson and Loretta Zderad are from the United States.
They both earned their first diplomas in nursing, then Bachelor’s
degrees in Nursing education before continuing to graduate
programs.
Their career as nursing academics got started in the 1950s when

they were both employed at Catholic University where they met.
They continued to work together and remained friends for the next
40 years.
Humanistic Nursing
They later continued on to their doctorate degrees in the 1960s.

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

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

friendship that have lasted for almost 40 years.
Josephine Paterson and Loretta Zderad retired in 1985 and

moved South where they are currently enjoying life. Although
they are no longer active, they are pleased at the on going
interest in their theory.
The whole of
anything is
greater than its
parts
Josephine Peterson and

Loretta Zherad
Humanistic Nursing
Josephine Peterson and Humanistic nursing is a mutual
subjective interaction between
Loretta Zherad nurse and patient and is a
Humanistic Nursing response to the situation which
aims at facilitating recovery. It
is characterized by empathy,
respect for human dignity,
altruism, patient autonomy,
friendly environment, and
holistic care.
Josephine Peterson and Nursing Dialogue is when a
Loretta Zherad nurse and patient come
together. The nurse presents
Humanistic Nursing themselves as a helper ready to
assist the patient. The nurse is
open to understanding how the
patient feels with the intention
of improvement. Openness is
an essential quality for
humanistic nursing dialogue.
To understand the nursing dialogue,
Josephine Peterson and one must put the experience in the
Loretta Zherad context of time:
Humanistic Nursing the time lived as the patient and the

nurse. The nurse and the patient may
be interacting within the same actual
time span, but the time may feel very
different to the nurse and client.
Their experiences of time are unique

to their understanding of the
situation.
Space is the lived perception of the
Josephine Peterson and world around the nurse and patient.
Loretta Zherad Space could be the hospital room, the

Humanistic Nursing bed, the waiting room, the visiting
area, or any other space in which the
interaction takes place.
The physical environment can

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

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

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

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

Intuitively:
In this stage, the nurse tries to

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

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

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

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

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

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

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

behavior- this means that it assumes individuals are
intrinsically good and will choose positive paths for
their lives- however free will and choice is limited for
some individuals
Joyce Travelbee
Human to Human
She worked as a psychiatric nursing instructor at the DePaul
Relationship Hospital Affiliate School in New Orleans, Louisiana.
Model
Worked later in the Charity Hospital School of Nursing in
Louisiana State University, New York University, and the
University of Mississippi.
She started her Doctoral program in Florida in 1973 but she was
not able to finish because she died later that year at age 47.
Joyce Travelbee Human to Human Relationship
Model
Joyce Travelbee was born in 1926 and is known for her work as a
nursing theorist.
In 1956, Travelbee earned her Bachelor of Science in Nursing

degree from Louisiana State University.
She was given a Master of Science in Nursing degree in 1959

from Yale University. Her career dealt predominantly
with psychiatric nursing and education.
Joyce Travelbee
Human to Human In 1963, she started to publish articles and journals in nursing.
Relationship
Model In 1966 and 1971, publication of her first book entitled
“Interpersonal Aspect of Nursing”
In 1969, she published her 2nd book “Intervention in Psychiatric

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

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

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

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

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

nurses are rewarded more for efficiency, technical skills, and
measurable outcomes.
States that caring practices are instilled with knowledge and skill
regarding everyday human needs.
Patricia Benner’s
Novice to Expert
Theory
Patricia Benner’s Seven Domains of Practice in Nursing
Novice to Expert
Helping role: understanding how a learner
Theory
(whether a student, new or seasoned nurse)
develops skills and understanding of a
practice situation / event over time
Teaching role: Delivering instructions that help

students / novice / nurses learn. Teachers must
prepare effective lessons and competencies.
Patricia Benner’s Administering and monitoring
Novice to Expert therapeutic interventions and
regimens
Theory
Monitoring and ensuring quality of

health care practices
Organizational and work-role

competencies
Patricia Benner’s Diagnostic client-monitoring function:
Novice to Expert periodically collecting, analysing and using
Theory lab results to actively manage patient’s needs.
Effective management of rapidly changing

situations
Patricia Benner’s
Novice to Expert Nursing Process
Theory
The Steps of the Nursing Process is not integrated.

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

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

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NCM 131 Unit IIIC Interaction Oriented Nursing Theories

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Unit IIIC.

The Nursing Theories

Born September 1, 1909 in Reading,

Raised in a paternalistic family and society.

Through higher education was never discussed at home,

Worked as a school nurse at Bennington College in

Consultant to the US Surgeon General, the US Air

As a child, she saw the devastating effects of the flu

Peplau's theory focuses on the interpersonal processes and

The interpersonal focus of Peplau's theory requires that

Peplau defines nursing as a therapeutic relationship

She believed that through the devise of the therapeutic

Peplau theorized that nurse-patient relationships must pass

1. Orientation Phase – A trusting relationship is

2. Working Phase – This is where most of the “work” of the

The patient recognizes the nurse as helping,

3. Termination Phase – The nurse and patient

Peplau explains that nursing is therapeutic because it is a healing

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

2. Teacher – The nurse provides detailed instructions

3. Resource Person – Using expert professional

4. Leader – Nurse collaborates with patient to work

6. Counselor – The nurse seeks to explore the

Nurses employ to provide care like physical assessment, use of IV

Man as an organism strives in its own way to reduce tension by

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

Mild anxiety is a positive state of heightened awareness and

If left unaddressed, mild anxiety can lead to maladaptive coping

Moderate anxiety involves a decreased perceptual field (focus on

Symptoms are disruptive and may succeed in managing their

Severe anxiety involves feelings of dread and terror as manifested

Individuals with severe anxiety may turn to alcohol and drugs as a

Panic anxiety can involve loss of rational thought, delusions,

An Irish American born in 1926 and passed away

Received her nursing diploma from New York Medical

Earned her Bachelor of Science in Public Health from St.

Was an associate professor at Yale School of Nursing, and

Worked as the director of a research project at McLean

This research led to the publication of “The Discipline and

Orlando has served as a board member of Harvard

The General Concepts of Ida Jean Orlando’s Theory

Presenting behavior is the patient's problematic situation. The

The nursing process discipline is the investigation into the patient's

The patient’s behavior stimulated a

Nurses use the standard nursing process in

Patient is able to recover

The major dimensions is the “Dynamic Nurse-Patient

All patient behavior (verbal or non-verbal) must be

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

In this part, the beginning of the nurse-patient

It is important to correctly evaluate the behavior of the patient

The nurse perceives behavior of the patient through any of the

The perception of possible actions leads to automatic thought

The nurse shares reactions with the patient to ascertain whether

The nurse consciously deliberates about personal reactions and

There are two ways in implementing nurse actions:

2. Deliberative reaction/actions – nursing behavior or

Improvement is the resolution to the patient’s problems. The