NCMA110: 1. Eriksson, Watson and Benner 2. Rogers and Orem 3. Johnson, Roy and Neuman
NCMA110: 1. Eriksson, Watson and Benner 2. Rogers and Orem 3. Johnson, Roy and Neuman
NCMA110: 1. Eriksson, Watson and Benner 2. Rogers and Orem 3. Johnson, Roy and Neuman
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Suffering related to Life
Dignity - In the situation of being a patient, the entire life of
- constitutes one of the basic concepts of caritative a human being may be experienced as suffering
caring ethics. related to life.
- Human dignity is partly absolute dignity, partly
relative dignity. Suffering human being
- A human being’s absolute dignity involves the - The concept that Eriksson uses to describe the
right to be confirmed as a unique human being. patient.
- Absolute dignity – it was provided to us upon in - The patient refers to the concept of “patiens”
our creation, created by our parents, and you were (Latin) – means “suffering”
born, you have your unique identity. - The patient is a suffering human being, or a
- Relative dignity - we could acquire this through human being who suffers and patiently endures.
our environment, the way people treat us, the way
people give importance to us. They should Reconciliation
recognize your existence. - Drama of suffering
- A human being who suffers wants to be confirmed
Invitation in his/her suffering and be given time and space to
- Refers to the act that occurs when the career/nurse suffer and reach reconciliation.
welcomes the patient to the caring communion. - Hindi mo pwedeng pilitin na madiliin un patient
- Allowed to rest a place that breathes genuine na mag adjust agad. Hanggat maaccept nya yun
hospitality, and where the patients appeal for condition nya at magadjust/move on.
charity meets with a response. - “suffering is not holding you; You are holding
- Once you embrace the patient, you introduce suffering”
yourself, you start asking the patient about his
condition and doing procedure for the patient Caring culture
using the caritas – that’s already invitation. - the concept that Eriksson uses instead of
environment.
Suffering - It characterizes the total caring reality and is based
- An ontological concept described as a human on cultural elements such as traditions, rituals and
being’s struggle between good and evil in a state basic values.
of becoming. - Respect for the human being, his or her dignity
- Implies in some sense dying away from and holiness, forms the goal of communion and
something, and through reconciliation, the participation in a caring culture.
wholeness of body, soul and spirit is re-created,
when the human being’s holiness and dignity Eriksson’s Metaparadigm in Nursing
appear. Person/ The Human Being
- Reconciliation – nahold mo na un suffering mo, - Based on the belief that the human being is an entity
ikaw na nag cocontroll ng suffering mo. Nakapag of body, soul and spirit, emphasizes that the human
recreate ka na ng bagong ikaw. being is fundamentally a religious being.
Forms of Suffering: - Fundamentally holy, and this belief is related to the
Suffering related to illness idea of human dignity, which means accepting the
- Experiences in connection with illness and human obligation of serving with love and existing for
treatment. the sake of others.
Suffering related to Care - Seen as in constant becoming; he is constantly
changing and therefore never in a state of full
- When the patient is exposed to suffering caused
completion.
by care or absence of caring
- Engaged in a continued struggle and living in a tension
- Which is always a violation of the patient’s
between being and non-being.
dignity.
- The human being is fundamentally dependent on
communion.
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- Seeks a communion where he can give and receive
love, experience faith and hope, and be aware that his Caritative caring
existence here and now has meaning. - The innermost core of nursing
Environment - She distinguishes between caring nursing and
- Eriksson uses the concept of ethos nursing care.
- The ethos of caring science as well as that of caring, - Nursing care is based on the nursing care process,
consist of the idea of love and charity and respect and and it represents good care only when it is based
honor of the holiness and dignity of the human being. on the innermost core of caring.
- Ethos originally refers to home, or to the place where - Caring nursing represents a kind of caring
a human being feels at home without prejudice that emphasizes the patient and
- Alleviating a human being’s suffering implies being a his/her suffering and desires.
co-actor in the drama and confirming his/her suffering. - love – we will alleviate the pain of the patient;
- A human being who suffers wants to have the charity – we will provide the needs/desires of the
suffering confirmed and be given time and space to patient.
become reconciled to it.
- The ultimate purpose of caring is to alleviate suffering In doing
Health - The persons thoughts concerning health are
- As soundness, freshness, and well-being. focused on healthy life habits and avoiding illness.
- It implies being whole in body, soul and spirit. In being
- As a pure concept wholeness and holiness - The person strives for balance and harmony.
- To be able to consider whole (wholeness), balance - Balance of mind, body and spirit.
between mind, body and spirit. (pwedeng sabihin na, In becoming
okay ka sa physically pero mentally hindi, you are not - The human being becomes whole on a deeper
considered as healthy); holiness – religion and faith. level of integration.
- Both movement and integration. - Deeper level of wholeness and holiness.
- Movement – implies a change; a human being is being
formed or destroyed, but never completely.
- Movement in time and space THEORY OF TRANSPERSONAL NUSRING
- Movement – dependent on vital force and on vitality (JEAN WATSON)
of body, soul, and spirit; the direction of this - Theory of human caring and nursing: human science
movement is determined by the human being’s needs and human care.
and desires; the will to find meaning, life, and love, - Caring is the essence of nursing.
strives toward a realization of one’s potential - TLC – Tender Loving Care
- Health is conceived as a becoming, a movement
toward a deeper wholeness and holiness. Jean Watson
- As a human being’s inner health potential is touched, - Born on June 10, 1940 in West Virgina
a movement occurs that becomes visible in the - Received her BSN from the University of
different dimensions of health as doing, being, and Colorado in 1964
becoming with a wholeness that is unique to human - 2013 – she was awarded the American Academy
beings. of Nursing’s ‘Living Legend’ award, its highest
Nursing honor.
- Caritas as the basic motive of caring
- The 2 basic forms of love – eros and agape are The Theory of Human caring and 10 Caritas Processes
combined. The motive of caritas becomes visible - Which serve as a blueprint for professional
in a special ethical attitude in caring, or what calls nursing practice.
a caritative outlook. - You could be able to provide human caring to a
- Caritas constitutes the inner force that is patient if the type of caring you provide involves
connected with the mission to care. the 3 elements. - 10 carative factors,
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transpersonal caring relationship and caring - Goal is to protect, enhance and preserve the
occasion/moment person’s dignity, humanity, wholeness, inner
- Theory of caring focuses on the interpersonal and harmony and overall wellbeing.
transpersonal relationship between nurse and - Can be nurtured by movements, gestures, facial
other (self, patient, family, society, universe) and bodily expressions, the sharing of information,
- “Human Caring is the moral idea of nursing” touch, sound, etc.
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6. The systematic use of the scientific method for - “caritas” comes from the Greek word meaning to
problem-solving and decision-making cherish, to appreciate, to give special attention; it
- Which allows for control and prediction and connotes something very fine, that indeed is
permits self-correction. precious. (Medscape Nurses, 2005)
- Scientific method – it involves a process - Watson’s theory calls upon nurses to go beyond
7. The promotion of interpersonal teaching-learning procedures and task, but instead focuses on the
- Since the nurse should focus on the learning nurse-patient relationship resulting in therapeutic
process as much as the teaching process. outcome and transpersonal caring process
- Understanding the person’s perception of the (Alligood et al., 2010)
situation assists the nurse to prepare a cognitive
plan. Caring Occasion/ Caring Moment
8. The provision for a supportive, protective and/or - The moment (focal point in space and time) when
corrective mental, physical, socio-cultural and the nurse and another person come together in
spiritual environment such a way that an occasion for human caring is
- Watsons divides into interdependent internal and created.
external variables, manipulated by the nurse in - Both persons, with their unique phenomenal fields
order to provide support and protection for the have the possibility to come together in a human-
patient’s mental and physical health. to-human transaction.
9. Assistance with satisfying human needs
- based on a hierarchy of needs similar to Maslow's. • Watson (1999) insists that the nurse, i.e., the caregiver,
Each need is equally important for quality nursing also needs to be aware of her own consciousness and
care and the promotion of the patient's health. authentic presence of being in a caring moment with
- In addition, all needs deserve to be valued and her patient.
attended to by the nurse and patient. • Both the one care for and the one caring can be
influenced by the caring moment through the choices
and actions decided within the relationship, thereby,
influencing and becoming part of their own life history.
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and the implementation of skilled responses to the - Providing comfort measures and preserving
situation as it evolves personhood in the face of pain and extreme
Expert breakdown
- Has intuitive grasp of the situation and zeros in on - Presence (being w/ the patient)
the accurate region of the problem - Maximizing the patient's participation and control
- This stage occurs after 5 years or greater in the in his or her own recovery
same area of nursing - Interpreting kinds of pain and selecting
- The expert performer no longer relies on an appropriate strategies for pain management and
analytic principle (rule, guideline, maxim) to control
connect her or his understanding of the situation - Providing comfort and communication through
to an appropriate action touch
- Operates from a deep understanding of the total - Providing emotional and informational support to
situation patient's families
- Guiding a patient through emotional and
Benner’s Metaparadigm in Nursing developmental change
Client/Person 2. The teaching - coaching function
- "The person is a self-interpreting being, that is the - Capturing the patient's readiness to learn (timing)
person does not come into the world predefined - Assisting patients to integrate the implications of
but gets defined in the course of living a life." -Dr. illness and recovery into their lifestyles
Benner - Eliciting and understanding the patient's
Health interpretation of his/her illness
- Dr. Benner focuses on the lived experience of - Providing an interpretation of the patient's
being healthy and being ill condition and giving a rationale for procedures
- Health is defined as what can be assessed whereas - Making culturally avoided aspects of an illness
well-being is the human experience of health or approachable and understandable
wholeness 3. The diagnostic and patient-monitoring function
- Well-being and being ill are understood as distinct - Detecting and documenting significant changes in
ways of being the world. patient's condition
Environment/Situation - Anticipating breakdown and deterioration prior to
- Benner uses situation rather than environment explicit confirming diagnostic signs
because situation conveys a social environment - Anticipating problems
with social definition - Understanding particular demands and
- "To be situated implies that one has a past, experiences of an illness
present, and future and that all of these aspects… - Assessing the patient's potential for wellness and
influence the current situation." -Dr. Benner for responding for various treatment strategies
Nursing 4. Effective management of rapidly changing
- Described as caring relationship situations
- "Caring is primary because caring sets up the - Skilled performing in extreme life-threatening
possibility of giving and receiving help." emergencies
- Nursing is viewed as a caring practice whose - Rapid matching of demands and resources in
science is guided by the moral art and ethics of emergency situations
care and responsibility - Identifying and managing a patient crisis until a
- Dr. Benner understands that nursing practice as physician assistance is available
the care and study of the lived experience of 5. Administering and monitoring therapeutic
health, illness, and disease and the relationships interventions and regimens
among the three elements - Starting and maintaining intravenous therapy with
- Dependent on the first 3 paradigms minimal risks and complications
- Administering medications accurately and safety,
Domains of Nursing Practice including monitoring untoward effects, reactions,
1. The helping role therapeutic responses, toxicity, and
- Creating climate for and establishing a incompatibilities
commitment to healing - Combating hazards of immobility, including
preventing and intervening with skin breakdown,
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ambulating, exercising patients to maximize Rogers and Orem
mobility and rehabilitation, and preventing UNITARY HUMAN BEINGS THOERY
respiratory complications (Martha Rogers)
- Creating a wound management strategy that - she describes this in 1961 which became controversial
fosters healing, comfort, and appropriate drainage and a topic of numerous debates.
6. Monitoring and ensuring the quality of health care - During that time, it was rare that anyone in a medical
practices profession viewed human beings as anything other
- Providing a back-up system to ensure safe
than the receiver of care from as nurses and doctors.
medical and nursing care
- Assessing what can safely be omitted from or - During that time, health care providers focus on a
added to medical orders rendering treatment.
- Getting appropriate and timely responses from - Rogers insisted that a person is a unitary energy
physicians system in continuous mutual interaction with the
7. Organizational work-role universal energy system.
- Coordinating, ordering, and meeting multiple - Her theory, dramatically influence nursing by
patients’ needs and request - in other words, encouraging nursing to consider each person as a
setting priorities whole being when planning and delivering care.
- Building and maintaining a therapeutic team to
provide optimal therapy Martha E. Rogers
- Coping w/ staff shortage - May 12, 1914 – March 13, 1994 (80 years old)
- American Nurse, Researcher, Theorist
Key aspects of expert nurse's practice are as follows:
- Her landmark book, “Introduction to the
1. Demonstrating a clinical grasp and resource-
based practice Theoretical Basis of Nursing”
2. Possessing the embodied know-how - She began her college education to studying
3. Seeing the big picture science at the University of Tennessee
4. Seeing the unexpected - Receiving her nursing diploma from Knoxville
General Hospital School of Nursing in 1936.
Shaping our Future Nurse Leaders - She obtain her Bachelor’s degree from George
• New graduate nurses are the future employee pool Peabody College in Nashville, Tennessee, then
• Job satisfaction & retention are greatly influenced she pursued her various Master’s and Doctoral
by the quality of orientation and support received degrees.
by the new graduate nurse - She was appointed professor and Head of the
• A positive experience will encourage the now division of Nursing at New York University, right
proficient nurse to mentor novice nurses
after graduating from John Hopkins School of
• "The mediocre teacher tells. The good teacher
explains. The superior teacher demonstrates. The Public Health were, she serves 21 years until the
great teacher inspires." -William Arthur time that she retired in 1975.
- Following her retirement, she continued to teach
"The utility of the concept of skill acquisition lies in at New York University and was a frequent
helping the teacher understand how to assist the learner presenter at scientific conferences throughout the
in advancing to the next level" (McClure, 2005) world.
- She was also actively involved in professional
Summary nursing organizations and associations concerned
- Each step builds on the previous one as abstract with an educations and scholarship.
principle are refined and expanded by experience - 1979, she became professor Emerita and
and the learner gains clinical expertise. continued to have active role in the development
- This theory changed the profession's of a nursing and the science of Unitary Human
understanding of what it means to be an expert,
beings.
placing this designation not on the nurse with the
most highly paid or most prestigious position, but
on the nurse, who provided the most exquisite
nursing care.
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• Human beings have the ability to adapt according to
the new changes in the environment.
Concepts:
- abstract ideas that occur in the mind, in speech or
thoughts; fundamental of building blocks of
thoughts and beliefs; it contains 2 dimensions
• All the human being is viewed as an integral part of
universe. (integral part - there is continuous mutual
or simultaneous interaction between human and the
environmental fields)
• Human beings and the environment have energy field,
nursing action is directed towards patterning and
maintaining these energy fields.
- In 1970, Rogers conceptual model of nursing
rested on 5 basic assumptions that describes the Energy fields
life process in human beings. - It is the inevitable part of life. Human and
- In her 1993 paradigm, Rogers postulated 4 environment both have energy field which is open
building blocks for her model: Energy Fields, i.e. energy can freely flow between human and
Universe of Openness, Pattern and environment.
Pandimensionality. - It’s the fundamental unit of both the living and
- Rogers consistently updated this conceptual non-living things.
model through revision of the homeodynamics - It provides a way to view people and environment
principle. It was that time, also that she decided to as irreducible wholes.
change the wordings. - Continuously vary in intensity, density and extent.
- Originally her theory called “Science of Unitary
Man”, she removed the word Man and change it Openness
to Human Beings because she wanted to remove - There is no boundary or barrier that can inhibit the
the concept of gender. flow of energy between human and environment
- She was the first to promote gender equality. which leads to the continuous movement or matter
- She emphasizes that our care for clients should be of energy.
Humanistic and Humanitarian in nature. Nursing - It refers to the fact that human and environmental
should be directed towards the unitary human and fields are constantly exchanging their energies.
its concerned with the nature and direction of the - In nursing, anything and everything can affect our
human development. clients’ condition.
Pattern
Assumptions: - The distinguishing character of the energy fields.
- beliefs and values that use to describe the - Single wave, it is an abstraction and gives identity
foundation of nursing theory. to field.
• Human being is considered as whole which cannot be - The nature of the pattern changes continuously
viewed as subparts. and innovatively, and these changes give identity
• The life process of human is irreparable and one way to energy field. Each human field pattern is unique.
i.e. from birth to death. - There have pragmatic and imaginative patients.
• Health and illness are the continuous expression of the Pragmatic – realistic patients; Imaginative – they
life process. think out of the box
• The energy flows freely between the individual and
environment.
• Human being possesses the ability to think, imagine,
sense, feel, and can use language for expression.
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- The human environment field is dynamic, its an
Pandimensional open system in which change continuous due to
- Undeviating field which is not constricted by the constant interchange between the human and
space or time, it is and infinite domain without environment.
boundary.
- Spaceless and timeless reality. Rogers’ Metaparadigm in Nursing
- Parameters that human used in language to Person
describe events are arbitrary and the present are - A unitary human being is open system which
relatives. There is no temporal ordering of lives. continuously interact with environment
- A person cannot be viewed as parts, it should be
Principle of Homeodynamics considered as a whole.
- The balance between the dynamic life process and Environment
environment. - It includes the entire energy field other than a person.
- These principles help to view human as unitary - These energy fields are irreducible, not limited by
human being space and time, identified by it pattern and
- The three separate principles are integrality, organization.
resonancy and heliecy. - It is interconnected with everything that happens to us.
Health
Principles of Integrality - It is determined by the interaction between energy
- Energy fields are dynamic and constantly interact fields i.e. human and environment.
with the human and environment, which affects - Bad interaction or misplacing of the energy leads to
our environment and vice versa. illness.
- Which meditation and humor works to produce a - As an expression of life process, it is the
positive environment. characteristics and behaviors coming from the mutual
- In this model, the role of the nurse is to serve simultaneous interaction of the human and
people. environment.
- Rogers also proposes noninvasive modalities for Nursing
nursing. Such as Therapeutic touch. Being a nurse - Both science and art.
doesn’t mean that we just need to carry out - It constantly maintains the energy fields which is
doctors’ order, we have our own treatment conducive for patient.
modalities and those are noninvasive. - Nursing actions directs the interaction of person and
environment to maximize health potential.
Principle of Resonancy
- an ordered arrangement of rhythm characterizing Clinical Practice:
both human field and environmental field. • Nursing action is always focused on unitary human
- Constant change in the way or pattern of the being and change the energy field between human and
energy field from a lower to higher frequency. environment.
- This movement of energy can be made by human • Nursing interventions include all the noninvasive
touch, guided imagery activities, drawing, actions such as guided imaginary, humor, therapeutic
storytelling and other active use of imagination. touch, music etc. which are used to increase the
potential of human being.
Principle of Heliecy Nursing Education:
- Any minute change in the environment which • Emphasis should be given on the understanding of the
leads to ripple effect i.e. results in a larger change patient and self, energy field and environment.
in other field. • Training should lay more focus on teaching non-
- This change is constant, unpredictable and there invasive modalities such as therapeutic touch,
are many factors which mutually interact and meditation, humor, regular in-service education
cause the change. programmer etc.
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Nursing
Orem’s Metaparadigm in Nursing - a service, an art and a technology.
Person - The giving of direct assistance to persons who are
- Humans with physical, psychological, unable to meet their own self-care needs,
interpersonal and social components, meeting developed through nursing education and
self-care needs through learned behavior. experiences.
Man as an integrated Whole - As a community service: nursing is a service of
- She further describes man as a logical organism deliberately selected and performed actions to
with rational powers. assists individuals or groups to maintain self-care,
- As a biological organism, man exists and responds including structural integrity, functioning and
both as organism and object in an environment development.
with physical and biological components. - As an interpersonal process: since it requires the
social interaction of a nurse with a patient and
involves transaction between them.
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Johnson, Roy and Neuman
7 Subsystems of the Behavior System Model:
BEHAVIORAL SYSTEM MODEL 1. Attachment or affiliative subsystem
(Dorothy Johnson) 2. Dependency subsystem
Dorothy E. Johnson 3. Ingestive subsystem
- was one of the greatest nursing theorists who 4. Eliminative subsystem
developed the “Behavioral System Model.” 5. Sexual subsystem
- Johnson has noted that her theory evolved from 6. Aggressive- protective subsystem
philosophical ideas, theory and research, her 7. Achievement subsystem
clinical background, and many years of thought,
discussions, and writing. Johnson’s Metaparadigm in Nursing
- Johnson’s Behavioral System Model (JBSM) was Person
heavily influenced by Florence Nightingale’s - Defined as behavioral system that strives to make
book, “Notes on Nursing” continual adjustments to achieve, maintain, or
Education: regain balance to the steady state that is adaptation.
• 1942, graduated BSN from Vanderbilt University Environment
School of Nursing, Nashville, Tennessee - is not directly defined, but it is implied to include all
- Top student in her class elements of the surroundings of the human system
- Received the Prestigious Vanderbilt Founder’s and includes interior stressors.
Medal Health
• 1948, graduated master’s degree in public health - is seen as the opposite of illness, and Johnson
from Harvard University in Boston defines it as “some degree of regularity and
Career and Appointments: constancy in behavior, the behavioral system
• 1943-1944 reflects adjustments and adaptations that are
- Staff nurse at the Chatham- Savannah Health successful in some way and to some degree…
Council adaptation is functionally efficient and effective.
- Instructor and an assistant professor in pediatric Nursing
nursing at Vanderbilt University School of - is seen as “an external regulatory force which acts
Nursing. to preserve the organization and integration of the
• 1949- 1978 patient’s behavior at an optimal level under those
- Assistant professor of pediatric nursing, an conditions in which the behavior constitutes a threat
associate professor of nursing, and a professor to physical or social health, or in which illness is
of nursing at the University of California, Los found.”
Angeles.
Three functional requirements of Human:
Behavioral System Model 1. To be protected from noxious influences with which
- a model of nursing care that advocates the fostering the person cannot cope
of efficient and effective behavioral functioning in 2. To be nurtured though the input of supplies from the
the patient to prevent illness. environment
- The patient is identified as a behavioral system 3. To be stimulated to enhance growth and prevent
composed of seven behavioral subsystems: stagnation.
affiliative, dependency, ingestive, eliminative,
sexual, aggressive, and achievement.
Concepts in Behavioral System Theory:
The subsystem of Behavior 1. Behavioral system
- parts of the behavioral system. - Man is a system that indicates the state of the
- It carries out specialized task/function needed to system through behaviors
maintain the integrity of the whole system 2. Boundaries
- It has a set of behavioral responses that are - The point that differentiates the interior of the
developed through motivation, experience and system from the exterior.
learning 3. Function
- Consequences or purposes of actions
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4. Functional requirements Career:
- Input that the system must receive to survive and • Worked as a Pediatric nurse
develop • Associate professor and chairperson of the
5. Homeostasis Department of Nursing at Mount Saint Mary’s
- Process of maintaining stability College until 1982
6. Instability • Professor, Mount Saint Mary’s College and the
- State in which the system output of energy depletes University of Portland in 1983
the energy needed to maintain stability. • Clinical Nurse Scholar in Neuroscience, she was a
7. Stability Robert Wood Johnson postdoctoral fellow at the
- Balance or steady state in maintaining balance University of California, San Francisco from 1983
within an acceptable range. to 1985
8. Stressor • Resident Nurse Theorist, at Boston College School
of Nursing 1987- present
- A stimulus from the internal or external world that
results in stress or instability
Adaptation Model of Nursing
9. Structure
- The RAM focuses on the inter relatedness of four
- The parts of the system that make up the whole
adaptive systems
10. System - It focuses on persons coping(adaptative)abilities in
- That which functions as a whole by virtue of response to constantly to changing environment
organized independent interaction of its parts (Lopes, Pagliuca, Araujo,2006)
11. Subsystem - Nursing can promote effective coping by asking”
- A minisystem maintained in relationship to the How can I modify this patient’s environment to
entire system when it or the environment is not facilitate his adaptation (Chitty & Black, 2011)
disturbed.
12. Tension 4 Adaptive Modes:
- The system’s adjustment to demands, change or 1. Psychological Mechanism
growth, or to actual disruptions - Physical and chemical process involved in the
13. Variables function and activities of living organism.
- Factors outside the system that influence the - The basic need of this mode is composed of the
system’s behavior, but which the system lacks needs associated with oxygenation, nutrition,
power to change elimination, activity and rest, and protection.
- The complex processes of this mode are
ADAPTIVE MODEL OF NURSING associated with the senses, fluid and electrolytes,
(Sr. Callista Roy) neurologic function, and endocrine function.
Sister Callista L. Roy 2. Self-concept
- Born October 14, 1939 - The goal of coping is to have a sense of unity,
- She is known for her groundbreaking work in meaning the purposefulness in the universe, as
creating the Adaptation Model of Nursing. well as a sense of identity integrity
- belongs to the Sisters of St. Joseph of Carondelet. - This includes body image and self-ides.
Education: 3. Role-function mode
• 1963, Graduated Bachelor of Arts Major in Nursing - Focuses on the primary, secondary and tertiary
from Mount Saint Mary’s College in Los Angeles roles that a person occupies in society, and
• 1966, graduated Master’s degree in nursing from the knowing where he or she stands as a member of
University of California society.
• 1973, Earned her master’s degree in sociology, 4. Interdependence mode
University of California - Focuses on attaining relational integrity through
• 1977, Received her doctorate degree in sociology, the giving the receiving of love, respect and value.
University of California - This is achieved with effective communication
and relations
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Subsystem (internal process)
Regulator NEUMAN SYSTEMS MODEL
- a basic type of adaptive process that responds (Betty Neuman)
automatically through neural, chemical, and Betty Neuman
endocrine coping channels. - 1924 – present
Cognator - 1947, she received her RN Diploma from Peoples
- a major coping process involving four cognitive Hospital school of Nursing, Akron Ohio.
motive channels: perceptual and information - Hospital nurse and head nurse at Los Angeles
processing, learning, judgment, and emotion. County General Hospital, school nurse, industrial
nurse, and clinical instructor at the University of
Types of Stimuli
Southern California Medical Center, Los Angeles.
1. Focal Stimulus
- The degree of change or stimulus more - 1957, she received a baccalaureate degree in public
immediately confronting the person and the one to health and psychology with honors. Amidst her
which the person must make adaptive response. hectic life as a nurse, she also managed to work as a
2. Contextual Stimuli fashion model and learned to fly a plane.
- Present to contribute to the behavior caused or - 1966, earned master’s degree in mental health,
precipitated by the focal stimuli. public health consultation in 1966 from the
3. Residual Stimuli University of California, Los Angeles (UCLA)
- Factors that may be affecting behavior but whose
efforts are not validated. Neuman’s systems model
- Views the client as an open system that responds to
Roy’s metaparadigm in nursing stressors in the environment.
Person - The client variables are physiological, sociocultural,
- Human systems have thinking and feeling developmental, and spiritual. The client system
capacities, rooted in consciousness and meaning, consists of a basic or core structure that is protected
by which they adjust effectively to changes in the by lines of resistance.
environment and, in turn, affect the environment. - The usual level of health is identified as the normal
Environment line of defense that is protected by a flexible line of
- The conditions, circumstances and influences defense.
surrounding and affecting the development and
behavior of persons or groups, with particular
consideration of mutuality of person and health
resources that includes focal, contextual and
residual stimuli.
Health
- Health is not freedom from the inevitability of
death, disease, unhappiness and stress but the
ability to cope with them in a competent way.
Nursing
- The goal of nursing is the promotion of adaptation
for individuals and groups in each of the four
adaptive modes, thus contributing to health,
quality of life, and dying with dignity.
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c) Extrapersonal stressors also occur outside the - She focused on spousal communication and
client system boundaries but are at a greater distance interaction in effective or ineffective number of
from the system that are interpersonal stressors. An children in families.
example is social policy. - Focused on people who do not make healthy
transitions and the discovery of interventions to
Concepts of levels of prevention facilitate healthy transitions.
1. Primary prevention
- It includes health promotion and maintenance of Transition Theory
wellness. - “to help people go through healthy transitions,
2. Secondary prevention including mastery of behaviors, sentiments, cues,
- Focuses on strengthening the internal lines of and symbols associated with new roles and
resistance and, thus, protects the basic structure identities and non-problematic processes, to
through appropriate treatment of symptoms. enhance healthy outcomes”
3. Tertiary prevention - leads to development of nursing therapeutics that
- To maintain wellness or protect the client system are congruent with the unique experience of
reconstitution through supporting existing clients and their families in transition, thus
strengths and continuing to preserve energy. promoting healthy responses in transition.
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Person
- Transition involve a process of movement and
changes in fundamental life patterns.
- Transition cause changes in identities, roles,
relationships, abilities and patterns of behavior.
Health
- Transitions are complex and multidimensional.
Patterns of multiplicity and complexity.
- All transitions are characterized by flow and
movement over time.
- mastery, ability to assume new roles.
Environment
- Vulnerability is related to transition experiences,
interactions, and environmental conditions that
expose individuals to potential damage,
problematic or extended recovery or delayed or
unhealthy coping.
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Ovals: originating emerges with the enabling-limiting of Grand theories of Hall, Travelbee and Orlando
valuing.
Triangles: transforming emerges with the languaging of CORE, CARE AND CURE MODEL
connecting-separating. (Lydia Eloise Hall)
- participation in care, core and cure aspects of
Humanbecoming Theory patient care, where CARE is the sole function of
Three principles/ major assumptions nurses, whereas the CORE and CURE are shared
- Structuring meaning is the imaging and valuing of with other members of the health team.
languaging
- Meaning is borne in the messages that person give Lydia Eloise Hall
& take with others in Speaking, Moving, Silence, - September 21, 1906 – February 27, 1969
& Stillness. - graduated from York Hospital School of Nursing
- Configuring rhythmical patterns is the revealing- in 1927 with a diploma in nursing.
concealing and enabling-limiting of connecting- - earned a Bachelor of Science degree in public
separating health nursing in 1937.
- Cotranscending with possible is the powering and - received a master’s degree in the teaching of
originating of transforming natural life sciences from Columbia University in
Transcendence is: 1942.
- About change and positivity - worked as the first director of the Loeb Center for
- To believe one thing or another Nursing. Her nursing experience was in clinical
- To go in one direction or another nursing, nursing education, research, and in a
supervisory role.
Parse’s Metaparadigm in Nursing - she is an advocate for chronically ill patient.
Nursing - Writer and in 1960 – 21 publications
- Nursing as a discipline will enjoy the recognition
of having a unique knowledge base & the Assumptions:
profession will be distinct from Medicine. - The motivation and energy necessary for healing
- People / client will actually seek nurses for exist within the patient, rather than in the
nursing care, not medical diagnosis. healthcare team.
Environment, Person, Health - The three aspects of nursing should not be viewed
- viewed as Humanuniverse, Humanbecoming and as functioning independently but interrelated
Living Quality - The three aspects interact, and the circles
representing them change size, depending on the
Summary: patient’s total course of progress.
- Parse’s Theory of Humanbecoming is a vital way
to develop an effective relationship with your Halls’ Metaparadigm in Nursing
patient especially given the short period of time Person / Individual
you are with them. The humanbecoming theory - A unique irreplaceable individual who is in
develops trust and mutual understanding of care; continuous process of becoming, evolving and
relieves stress and facilities healing all of which changing
are the foundation holistic care and nursing. Environment
- The concept of society or environment is dealt
with in relation to the individual
Health
- Can be inferred to be a state of self-awareness
with a conscious selection of behaviors that are
optimal for that individual.
Nursing
- Is identified as consisting of participation in the
care, core and cure aspects of patient care.
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Sub-concepts
1. Care Circle HUMAN TO HUMAN RELATIOSHIP
- This circle solely represents the role of nurses, and (Joyce Travelbee)
is focused on performing the task of nurturing Joyce Travelbee
patients. - born in 1926
- Mothering role - In 1956, Travelbee earned her Bachelor of Science in
- The theory puts the emphasis on the important of Nursing degree from Louisiana State University.
total patient care rather than looking at one part or - She was given a Master of Science in Nursing degree
aspects. in 1959 from Yale University.
2. Core Circle - Her career dealt predominantly with psychiatric
- The patient to whom nursing care is directed. nursing and education.
- The core has goals set by him or herself rather - She worked as a psychiatric nursing instructor at the
than by any other person DePaul Hospital Affiliate School in New Orleans,
• Reflective technique Louisiana, and worked later in the Charity Hospital
- the professional nurse in a way the he or School of Nursing in Louisiana State University,
she acts as a mirror to the patient to help New York University, and the University of
the latter explore his or her own feelings Mississippi
regarding his or her current health status - Travelbee died in 1973 at the age of 47.
and related potential changes in lifestyle. Some of Joyce Travelbee’s works include:
• Motivational technique • Travelbee’s Intervention in Psychiatric Nursing: A
- discovered through the process of one-to-one relationship
bringing into awareness the feelings • Interpersonal aspects in nursing
being experienced. • Intervention in psychiatric nursing: process in the
- With this awareness, the patient is now one-to-one relationship
able to make conscious decisions based
on understood and accepted feelings and 7 basic concepts
motivation. 1. Suffering
3. Cure Circles - an experience that varies in intensity, duration and
- It is the attention given to the patient by the nurse depth, a feeling of unease, ranging from mild,
and other medical professionals. transient mental, physical or mental discomfort to
- Medical health providers extreme pain.
- During this aspect of nursing care, the nurse is an 2. Meaning
active advocate of the patient. - The reason attributed to a person
3. Nursing
- helps a person find meaning in the experience of
illness and suffering
- has a responsibility to help people and their
families find meaning
- the nurse’s spiritual and ethical choices, and
perceptions of illness and suffering, which are
crucial to help patients find meaning.
4. Hope
- which is a faith that can and will be a change that
would bring something better with it.
- Six important characteristics of hope are:
dependence on other people, future orientation,
Summary: escape routes, the desire to complete a task or
The three interlocking circles may change in size and have an experience, confidence that others will be
overlap in relation to the patient’s phase in the disease there when needed, and the acknowledgment of
process. A nurse functions in all three circles but to fears and moving forward towards its goal.
different degrees.
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5. Communication - When there is trusting relationship develop
- a strict necessity for good nursing care between Nurse and patient, there is harmony and
- convey and receive messages whether verbal or fluidity of actions, treatment and interventions,
nonverbal. there is less resistance of the part of the client.
6. Self-therapy
- the ability to use one’s own personality
consciously and in full awareness in an attempt to Travelbee’s Metaparadigm in Nursing
establish relatedness and to structure nursing Person
interventions. - Defined as human being.
- This refers to the nurse’s presence physically and - A human being is a unique, irreplaceable
psychologically. individual who is in continuous process of
7. Targeted intellectual approach becoming, evolving and changing.
- by the nurse toward the patient’s situation. Environment
- Not clearly defined; she defined human
Major Concepts conditions and life experiences encountered by
all men
Health
- The criteria of subjective and objective
- A person’s subjective health is individually
defined state of well-being.
- Objective health is an absence of discernible,
disease, disability or defect.
Nursing
- An interpersonal process whereby the
professional nurse4 practitioner assists an
individual, family or community to prevent or
cope with experience or illness and suffering, and
if necessary, to find meaning in these experiences.
Practical Application
Clinical Setting
- Helps the nurse how to build a relationship
Human-to-Human Relationship - Helps setting goals for nurses
- This diagram is interactional face of human to - Has been influential in hospicare with helping
human relationship. patients
1. Original encounter - Find meaning in their imminent death
- This is the first impression by the nurse with the Academics
ill person. - Has influenced current nursing curriculum
2. Emerging identities - Emphasized communication as a therapeutic tool
- The nurse and the patient perceive each other as - This theory focused on nursing education has
unique person. changed from sign, symptoms and intervention to
- They try to interact each other. a more holistic care approach.
3. Empathy Research
- The ability to share in the person experience, - It is used in
putting yourself in the shoes of your patient, it research to
makes your actions more caring and explore how
compassionate. patient gain
4. Sympathy meaning after a
- The nurse has the desire to alleviate the cause of recent diagnosis
patient illness or suffering. of illness
5. Rapport - Applied in the
- Nursing actions are done to relieved the patient’s theory in caring
distress. cancer for patients.
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2. The nurse’s reaction
“it is believed that the spiritual values a person holds will - Active thought process by the nurse which he/she
determine, to a great extent, his perception of illness. The observed the behavior, interprets them and
spiritual values of the nurse or her philosophical beliefs formulates the plan to meet the patients need.
about illness and suffering will determine the degree to 3. The nurse’s activity
which he or she will be able to help ills persons find - Interactive process wherein the patient and the
meaning, or no meaning, in these situations.” (Travelbee, nurse perform action for and with the patient to
1971) meet the patients observed needs.
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King, Barker and Reed form a foundation of excellence and through presence
in patient centered care.
GOAL ATTAINMENT THEORY - If perceptual interaction accuracy is present in nurse
(Imogene King) client relations or interaction then transaction will
- Nursing is a process of action, reaction, and occur.
interaction whereby nurse and client share - If nurse and client make transaction now, goal will be
information about their perception in the nursing attained. If the goals will be attained, the satisfaction
situation will occur.
Imogene king According to King:
- Jan 30,1923 – Dec. 24, 2007 The patient is a social being who has:
- 1945 – received her nursing diploma from St. 3 fundamental needs:
John’s Hospital School of Nursing in St. Louis, 1. The need for health information
Missouri 2. The need for care that seeks to prevent illness
- 1948 – Bachelor of Science in Nursing from St. 3. The need for care when the patient is unable to
Louis University help him or herself.
- 1957 – Masters’ of Science in Nursing, also from
St. Louis University King’s Metaparadigm in Nursing
- 1957 – doctoral degree from Teachers College, Person/ Individual
Columbia University - Are spiritual beings and have the ability through their
language and other symbols to record their history and
3 interacting systems (core concepts) preserve their culture. Individuals are unique and
1. Personal system holistic, of intrinsic worth, and capable of rational
- Consist of perception, self, growth and thinking and decision making in most situations.
development, body image, space and time. - Individuals differ in their needs, wants, and goals
2. Interpersonal system Environment
- consist of interaction communication, transaction, - is “an understanding of the ways that human beings
role and stress interact with their environment to maintain health was
3. Social system essential for nurses”.
- Organization, authority, power, status and - Open systems imply that interactions occur constantly
decision making. between the system and the system’s environment.,
“adjustments to life and health are influenced by an
Process of Interaction individual’s interaction with environment.
- Each human being perceives the world as a total person
in making transactions with individuals and things in the
environment”
Health
- dynamic state in the life cycle, while illness interferes
with that process. Health “implies continuous adjustment
to stress in the internal and external environment through
the optimum use of one’s resources to achieve the
maximum potential for daily living.
Nursing
- an observable behavior found in the health care systems
in society.
- the nurse and client communicate information, mutual - Goal of Nursing: “is to help individuals maintain their
set a goal and act to attain that goal which is central to health so they can function in their roles”
his/her goal attainment theory.
- Transactions as life situations in which perceiver Summary:
- In nursing practice, when you include patient in Imogene King’s theory of Goal Attainment focuses on the
formulating goals with face to face discussion and interacting system framework to guide and direct nurses
open listen, which will influence practice because in the nurse-patient relationship, going hand-in-hand with
you’re putting the patient at the center of your care. Its their patients to meet the goals towards good health.
important to focus on patient goals because it will
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Environment
- composed of family, social networks, physical Major Concepts:
surroundings, and community resource, all of which - The theory explains the purpose of nursing to help
make significant contributions to the health processes others identify there difficulties
that nurses influence through their management of - Nurses should apply principles of human relations to
the therapeutic interactions among people, objects their problem that arise at all level of experience
and nursing activities. - Nursing itself is therapeutic, and that healing is an
Health art, assisting an individual who is sick
- the context of well-being. - Nursing is an interpersonal process because it
- Well-being is a sense of feeling whole and healthy, involves interaction between two or more individuals
according to one’s own criteria for wholeness and with a common goal.
health. - The attainment of goal is achieved through the use of
Nursing a series of steps following a series of pattern.
- The role of nursing activity is to assist people through
interpersonal and therapeutic management of their Table of contents
environment to promote health and well-being. - Hildegard Peplau’s theory emphasized the nurse-
client relationship as the foundation of nursing
Major assumptions: practice
- humans impose conceptual boundaries upon - She forms an interpersonal model emphasizing the
themselves to define their reality and to provide a need for a partnership between nurse and client as
sense of wholeness and connectedness within passively receiving treatment and the nurse passively
themselves and their environment. acting out doctor’s orders.
- self-transcendence is a developmental imperative.
Phases in Nurse Patient Interaction
Middle-ranged Theories of Peplau, Mercer and Beck 1. Orientation Phase
- directed by the nurse and involves engaging the
THEORY OF INTERPERSONAL RELATIONS client in treatment, providing explanations and
(Hildegard E. Peplau) information, and answering questions.
- Starts when the client meets nurse as a
Hildegard E. Peplau stranger
- September 1, 1909 - March 17, 1999 2. Identification subphase (Working phase)
- An American nurse and the first published nursing - Selection of appropriate professional assistance
theorist since Florence Nightingale. - Patient begins to have a feeling of belonging and
- A primary contributor to mental health law reform, a capability of dealing with the problem which
she led the way towards humane treatment of patients decreases the feeling of helplessness
with behavior and personality disorders. and hopelessness.
- Nursing diagnosis
3. Exploitation subphase (Working phase)
- Use of professional assistance for problem-
solving alternatives
- Rendering of our nursing management
4. Termination phase (Resolution Phase)
- Termination of professional relationship
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Health
- is a word symbol that implies forward movement MATERNAL ROLE ATTAINMENT THEORY
of personality (Ramona Mercer)
Nursing - an interaction and developmental process occurring over
- is a significant therapeutic interpersonal process time in which the mother becomes attached to her infant,
that functions cooperatively with other human acquires competence in the caretaking task involved in
process that make health possible for individuals the role and expresses pleasure and gratification in the
in communities. role.
- The primary concept of this theory is the developmental
Role of Nurse and interactional process, which occurs over a period of
Stranger time. In the process, the mother bonds with the infant,
- receives the client in the same way one meets a acquires competence in general caretaking tasks, and
then comes to express joy and pleasure in her role as a
stranger in other life situations provides an
mother.
accepting climate that builds trust.
- The Maternal Role Attainment Theory was developed
Teacher to serve as a framework for nurses to provided
- who imparts knowledge in reference to a need or appropriate health care interventions for mothers in order
interest for them to develop a strong maternal identity.
Resource Person - This middle-range theory can be used throughout
- one who provides a specific needed information pregnancy and postnatal care, but is also beneficial for
that aids in the understanding of a problem or new adoptive or foster mothers, or others who find
situation themselves in the maternal role unexpectedly.
Counselors - The process used in this nursing model helps the mother
- helps to understand and integrate the meaning of develop an attachment to the infant, which in turns helps
current life circumstances, provides guidance and the infant form a bond with the mother. This helps
encouragement to make changes develop the mother-child relationship as the infant grows.
Surrogate
- helps to clarify domains of dependence Ramona Mercer
interdependence and independence and acts on - Born October 4, 1929
client’s behalf as an advocate. - Diploma in Nursing at St. Margaret’s School of
Leader Nursing in Montgomery, Alabama.
- helps client assume maximum responsibility for - BSN - University of New Mexico
meeting treatment goals in a mutually satisfying - Master's degree in maternal child nursing from Emory
way University
- Doctoral studies in maternity nursing at the University
Summary: of Pittsburgh.
- Peplau’s work is a middle-range descriptive - She worked as head nurse in pediatrics and staff nurse
classification theory that focuses on the phases of the in intrapartum, postpartum, and newborn nursery units.
interpersonal process that occur when an ill person (10years)
and a nurse come together to resolve a health-related - She was a faculty member at Emory University for 5
difficulty. years
- This theory emphasizes the close relationship a nurse - Professor in the department of Family Health Care
and patient must make to have effective nursing care Nursing at the University of California, San Francisco
happen. - She focused on the behaviors and needs of
- Learning about this theory can only positively affect breastfeeding mothers, mothers with postpartum
how nursing students will enter into their clinical illness, mother of infants born with defects and
experience. teenaged mothers.
- With this theory in hand, students’ nurses and licensed - “the process of becoming a mother requires extensive
nurses can have the opportunity to provide the care psychological, social and physical work, a woman
and communication needed to create the best nurse- experiences heightened vulnerability and faces
patient relationship. tremendous challenges as she makes this transition,
nurses have an extraordinary opportunity to help
women learn, gain confidence and experience growth
as they assume the mother identity.”
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Middle-ranged theories of Mishel and Pender
Antepartum factors
- buntis pa siya
- manganganak palang
• Stress in pregnancy
• Antepartum social support
• Self esteem Theory Framework
• Antepartum depression - comprehensive framework within which to view
Postpartum factors the experience of acute and chronic illness and to
- Nun nanganak na siya organize nursing interventions to promote optimal
• Parenting stress adjustment.
• Postpartum family support
Uncertainty
Loss of Control - is the inability to determine the meaning of
- it was identified as the basic psychological illness-related events.
problem in the 1993 substantive theory Cognitive Schema
development phase of Beck’s work. - a person’s subjective interpretation of illness,
- an aspect woman experience in all aspects in their treatment and hospitalization.
lives. Stimuli Frame
- The process of loss of control left women - is the form, composition and structure of the
“teetering on the edge” and consisted of the stimuli that a person perceives.
following stages: Symptom Pattern
Stage 1: Encountering Terror - the degree to which symptoms occur with
Stage 2: Dying of Self sufficient consistency.
Stage 3: Struggling to Survive Cognitive Capacities
Stage 4: Regaining Control - are the information processing abilities of a
Summary: person.
- Postpartum depression (PPD) is a potentially life-
threatening condition with a substantial impact on Major Assumptions
quality of life. It has the ability to affect not only the Person
mother, but the entire family - this theory focused on person.
- Beck developed the Postpartum Depression Predictors - Uncertainty
Inventory (PDPI), which is a tool used by nurses and - adaptation –continuity of the persons usual
other health care professionals to identify women at biopsychosocial behavior to reduce uncertainty.
risk for developing PPD. - uncertainty can result in a new level of
- All nurses dealing with mothers in the postpartum organization and a new perspective on life,
period must be knowledgeable of these risk factors in incorporating the growth and change that result
order to properly identify the women most at risk. from uncertain experiences.
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Anne Boykin
- Kaukauna, Wisconsin
- AlvernoCollege in Milwaukee, Wisconsin in 1966
(Nursing)
- Emory University in Atlanta, Georgia (Masters)
- Vanderbilt University in Nashville,
Concepts of Health Promotion Model Tennesee(Doctorate)
• Health promotion - currently the Director of Nursing at Florida Atlantic
• Health protection University.
• Individual characteristics and experiences
• Behavior-specific cognitions and affect Savina O. Schoenhofer
• Behavioral outcomes - Her initial nursing degree was completed at
Wichita State University, where she also earned
Sub concept of the Health Promotion Model graduate degrees in nursing, psychology, and
• Personal Factors (biological, psychological, and counseling.
socio-cultural) - She completed a PhD in educational foundations
• Perceived benefit of action and administration at Kansas State University in
• Perceived barrier to action 1983.
• Perceived self-efficacy
• Activity related Affect
• Interpersonal Influence
• Situational Influences
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THEORY OF CARING
(Kristen M. Swanson)
Kristen M. Swanson 31 PAGES HAHAHA tas yung iba dyan, merong naka
- was born in Providence, Rhode Island.
enumerate lang, d ko na nilagyan ng meaning. Pero
- she studied psychosocial nursing with an
emphasis on the concepts of loss, stress, coping, nilagay ko naman lahat nun nasa ppt nila sir/mam. kung
interpersonal relationships, person and may gusto kayo dagdagan or bawasan, edit nyo sa docx.
personhood, environments and caring. Basta kayo bahala Hahahaha Goood luccckk!! - Aki
5 Dimensions
1. Knowing
2. Being with
3. Doing for
4. Enabling
5. Maintaining belief
• Caring is central to nursing
• Theory can be applied to clinical setting.
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