Theoretical Foundations in NursingENVIRONMENTAL THEORY Florence Nightingale (1860) • “I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.” Florence Nightingale defined Nursing as “the act of utilizing the environment of the patient to assist him in his recovery” (1860/1969), that it involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development. Environmental Factors Affecting Health Defined in her environmental theory are the following factors present in the patient’s environment: •pure or fresh air •pure water •sufficient food supplies •efficient drainage •cleanliness •light (especially direct sunlight) Adequate ventilation has also been regarded as a factor contributing to changes of the patient’s process of illness recovery. Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status. She also emphasized in her environmental theory is the provision of a Quiet or noise-free and warm environment ,attending to patient’s dietary needs by assessment, documentation of time of food intake, and evaluating it’s effects on the patient. Nightingale believed that the environment was the major component creating illness in a patient; she regarded disease as “the reactions of kindly nature against the conditions in which we have placed ourselves.” Her theory Contains three major relationships: •environment to patient •nurse to environment •nurse to patient and that the manipulation of the environment . warmth .would contribute to the process and health of the patient Did not agree with the “germ theory of disease” although she accepted the ill effects of contamination from organic materials from the patients and the environment hence found sanitation as important Also renowned for pioneering statistical analysis of healthcare . Environmental Theory Disease is a reparative process. cleanliness.ventilation. diet.Modern Nursing. and noise .light. ” .THE INTERPERSONAL RELATIONS THEORY Hildegard Peplau (1952) ( Psychodynamic Nursing: Mother of Psychiatric Nursing She defined Nursing as “ an interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to recognize. respond to the need for help. Dr. . Each phase is unique and has distinguished contributions on the outcome of the nurse-patient interaction. Peplau emphasized the nurse-client relationship As the foundation of nursing practice. At the time. her research and emphasis on the giveand-take of nurse-client relationships was seen by many as revolutionary. She described the nurse-patient relationship as a four-phase phenomenon. Resolution: Where patient’s needs have already been met by the collaborative efforts between the patient and the nurse. Identification: Where the patient begins to have feelings of belongingness and a capacity for dealing with the problem. creating an optimistic attitude from which inner strength ensues. who is expected to take advantage of all services.Phases Of Nurse-Patient Relationship 1. . Here happens the selection of appropriate professional assistance. 3. This is the problem identification phase. Orientation: Individual/family has a “felt need” and seeks professional assistance from a nurse (who is a stranger). Therapeutic relationship is terminated and the links are dissolved. Exploitation The nurse uses communication tools to offer services to the patient. 2. 4. as patient drifts away from identifying with the nurse as the helping person. Tutor5.Recorder observer11. Safety agent7.Resource Role : Answers questions.Nursing Roles In the course of the nurse-patient relationship.Stranger Role : Receives the client the same way one meets a stranger in other life situations. Socializing agent6. interdependence.Leadership Role: Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way.Surrogate Role: Helps clients clarify domains of dependence. AdditionalRoles include:1. Technical expert2.Counseling Role: Helps client understand and integrate the meaning of current life circumstances. gives information. Mediator9. 2.Researcher . provides quidance and encouragement to make changes. Manager of environment8. Administrator10. 5. the nurse assumes several roles which empower and equip her in meeting the needs of the patient. 1. 4. 6. and independence and acts on clients behalf as advocate. provides an accepting climate that builds trust. Consultant3. 3. involves analysis and synthesis of the learner’s experience. Interprets clinical treatment data.Teaching Role : Gives instructions and provides training. Health teacher4. knowledge and confidence for the mother.” .Definition of the Unique Function of Nursing Virginia Henderson (1955) “The nurse is temporarily the consciousness of the unconscious. the leg of the amputee. the eyes of the newly blind. the love of life for the suicidal. the mouthpiece for those too weak or withdrawn to speak and so on. a means of locomotion for the infant. She conceptualized the 14 Fundamental Needs . in the performance of those activities contributing to health or it’s recovery (or to peaceful death) that an individual would perform unaided if he had the necessary strength.Henderson defined Nursing as “assisting the individual. sick or well. will or knowledge”. discovering or satisfying the curiosity thatleads to normal development and health and usingavailable health facilities. .14 Fundamental Needs of humans. These needs are: •Breathing normally •Eating and drinking adequately •Eliminating body wastes •Moving and maintaining desirable position •Sleeping and resting •Selecting suitable clothes •Maintaining body temperature within normal range •Keeping the body clean and well-groomed •Avoiding dangers in the environment •Communicating with others •Worshipping according to one’s faith •Working in such a way that one feels a sense of accomplishment •Playing/participating in various forms of recreation •Learning. 3. as knowledge. will.The nurse as a helper to the patient. In situations where the patient cannot meet his basic needs. Both as an advocate and as a resource person. the nurse serves as a helper to accomplish them.The Nurse-Patient Relationship Henderson stated that there are three levels comprising the nurse-patient relationship: 1. 2.The nurse as a substitute for the patient. the nurse serves as the substitute as to what the patient lacks such. when the patient cannot function fully.The nurse as a partner with the patient. . the nurse and the patient formulate the care plan together. and strength in order to make him complete. In times of illness. the nurse can empower the patient to make effective decisions regarding his care plans. whole and independent once again. As partners. Dynamic Nurse-Patient Relationship “The role of the nurse is to find out and meet the patient's immediate need for help. however. the help needed may not be what it appears to be. The patient's presenting behavior may be a plea for help.” . From these observations she formulated the deliberative nursing process. nurses need to use their perception. It then dawned on her that both the formulations for "good" and "bad" nursing were contained in the records. or the feeling engendered from their thoughts to explore with patients the meaning of their behavior. While providing the overall framework for nursing. Therefore. the use of her theory does not exclude nurses from using other theories while caring for the patient. The use of her theory keeps the nurse's focus on the patient. thoughts about the perception. Despite her efforts. and easy to use.Orlando's theory was developed in the late1950s from observations she recorded between a nurse and patient. . The strength of the theory is that it is clear. This process helps the nurse find out the nature of the distress and what help the patient needs. concise. Orlando's theory remains one the of the most effective practice theories available. she was only able to categorize the records as "good" or "bad" nursing. Nursing Process. Nurse reactions 3. Patient behaviors 2. Dynamic Nurse-Patient Relationship Focused on patient’s verbal and nonverbal expressions of need and the nurse’s reactions to the behavior 3 Elements of a Nursing Situation 1. advanced nursing beyond automatic response to disciplined and professional response . Nurse actions Used the nursing process to meet patient’s needs through deliberate action. Human.core and cure) .to.Human Relationship Model Lydia Hall ( 1961 ) Key Concepts of Three Interlocking Circles Theory ( care. Nursing is participation in care.According to Hall. whereas the CORE and CURE are shared with other members of the health team • The major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the core . where CARE is thesolefunction of nurses.core and cureaspects. he needs more professional nursing care Wholly professional nursing care will hasten recovery . involves intimate bodily care like feeding. religious ministry.The theory consists of 3 major tenets: The nurse functions differently in the 3 interlocking aspects of the patient: Cure (Disease) shared with doctors Core (Person) addressed by therapeutic use of self. shared with psychiatry/psychology. etc. Care (Body) exclusive to nurses. bathing and toileting As the patient needs less medical care. she ministers to the whole person.” Joyce Travelbee (1966) . mental or spiritual is the proper concern of the nurse.The existence of suffering. whether physical.INTERPERSONAL ASPECTS OF NURSING MODEL • “A nurse does not only seek to alleviate physical painor render physical care. the nurse and the patient undergoes the following series of interactional phases: . She felt nursing needed a " Humanistic revolution " and a renewed focus on caring as central to nursing-she warned that if this didn't happen. Travelbee's ideas have greatly influenced the hospice movement. consumers might seek a "new and different kind of health careworker" . In her human-tohuman relationship model.Travelbee's experience in initial psych nursing practice at a Catholic charity hospital led her to believe that the care given in these type of institutions lacked compassion. this phase is described by the nurse and patient perceiving each other as unique individual. 2. 5.this is described as the first impression by the nurse of the sick person and vice versa The nurse and patient see each other in stereotyped or traditional roles. 3. At this time. 4. the link of relationship begins to form.this phase is described as the ability to share in the person’s experience.Emerging Identities . The nurse at this time should use a disciplined intellectual approach together with therapeutic use of self to make helpful nursing actions.Original Encounter .Rapport . It goes beyond empathy. .this is described as nursing interventions that lessens the patient’s suffering.Empathy . The nurse and the sick person are relating as human being to human being.Sympathy .Series of interactional phases: 1. The sick person shows trust and confidence in the nurse.It happens when the nurse wants to lessen the cause of the patient’s suffering. System Model in Nursing Practice Betty Neuman (1972) “Health is a condition in which all parts and subparts are in harmony with the whole of the client” . Betty Neuman (1972) Her theory incorporated the concept of a whole person and an open system approach. The main role of the nurse in her theory is to help a person to adapt with environmental stimuli causing illnesses back to a state of wellness. The concept is aimed towards the development of a person in a state of wellness having the capacity to function optimally. . It is the baseline in determining the level of client within the continuum of health. the Normal Line of Defense must act in coordination with the normal wellness state.Client Variables The clients’ variables can be one or combination of the following: physiological. Lines of Resistance Lines of Resistance act when the Normal Line of Defense is invaded by too much stressor. Terms Related to Neuman’s System Theory . sociocultural. producing alterations in the client’s health. developmental and spiritual. These variables function to achieve stability in relation to the environmental stressors experienced by the client. Normal Line of Defense To achieve the stability of the system. It must reflect the actual range of responses that is normally acted by clients in response to any stressors. Stressors These are forces that produce tensions. . alterations or potential problems causing instability within the client’s system.Flexible Line of Disease It serves as a boundary for the Normal Line of Defense to adjust to situations that threaten the imbalance with in the client’s stability. . Neuman specified these reactions as Negentropy is set towards stability or wellness while Egentropy is set towards disorganization of the system producing illness. It can be positive or negative depending on the degree of reaction the client produces to adjust and adapt with the situation.Reaction These are the outcomes or produced results of certain stressors and actions of the lines resistance of a client. with reference to the goal.Behavioral System Model Dorothy Johnson (1971) “Each individual has a predisposition to act. in certain ways rather than in other ways” . . These behaviors are logical.Johnson believes that each individual has a focusing and repeating ways of acting which covers a behavioral system distinct to that individual. predictable and adequately secure and persistent to be satisfying to depiction and clarification. fixed. The product of dependency behavior is consent.The Ingestive Subsystem relates to the behaviors surrounding the ingestion of food. and physical support. The most favorable functioning of this subsystem allows social inclusion. interest or appreciation.Seven Behavioral Subsystems 1.The Dependency Subsystem are actions that trigger nurturing behaviors from other individuals in the environment. 3. closeness. 2. and the pattern and continuance of a strong public bond. . Behaviors related to the ingestion of food may relate more to what is socially satisfactory in a specified culture.The Attachment or Affiliative Subsystem Is well known as the earliest response system to expand in the individual. than to the biological necessities of the human being. and communal skills are some of the areas that Johnson distinguishes. 5.The Sexual Subsystem imitates behaviors related to procreation or reproduction.4. mechanical. 7. but the continuation of such an outline remains from culture to culture.The Aggressive Subsystem relates to behaviors concerned with the defense and selfpreservation.The Eliminative Subsystem relates to behaviors surrounding the secretion of waste products from the body. Intellectual.The Achievement Subsystem contains behaviors that attempt to control the environment. 6. Human cultures have defined different socially acceptable behaviors for excretion of waste. . imaginative. physical. how can they use advanced knowledge.Goal Attainment Theory Imogene King (1971) “If the students can’t do the fundamentals.” . .Imogene King (1971) King stated that Nursing is a process of action reaction and interaction whereby nurse and client share information about their perception in the nursing situation. Interaction Interaction. reaction is not specified but somehow relates reaction as part of action. as defined by King. Reaction In King’s theory.Action Action is a means of behavior or activities that are towards the accomplishment of certain act. reaction is a response to a stimuli. . According to her. is any situation wherein the nurse relates and deals with a clientele or patient. It is both physical and mental. These levels are independent and at the same time co-exist to influence over-all nursing practice. . where a dynamic interaction between the internal and external environment can exchange information without barriers or hindrances.Open System It is the absence of boundary existence. King proposed that the nurse interacts in the system simultaneously at three different levels. how the nurse interrelates with a coworker or patient.Personal . subordinates and the client environment in general .how the nurse interacts with co-workers. superiors.how the nurse views and integrates self based from personal goals and beliefs • Interpersonal . particularly in a nurse-patient relationship • Social . communication.organization. self. body image. explore means of attaining goals. power-authority status. growth and development Interpersonal System . and stress Social System .perception. interaction. decision making . interaction and transaction • Interacting systems: Personal System .role.Nursing is a process of human interaction between nurses and patients who communicate to set goals. judgment and actions of nurse and patient lead to reaction. and agree on what means to use • Perceptions. transaction. ” . families.Self-Care Theory Dorothea Orem (1971) “Individuals. groups and communities need to be taught self-care. health and well-being. .Orem defined Nursing as “The act of assisting others in the provision and management of self-care to maintain/improve human functioning at home level of effectiveness.” The theory focuses on activities that adult individuals perform on their own behalf to maintain life. It has a strong health promotion and maintenance focus. She identified 3 related concepts: 1.Self-care - activities an Individual performs independently throughout life to promote and maintain personal well-being. 2.Self-care deficit - results when self-care agency(Individual’s ability) is not adequate to meet the known selfcare needs. 3.Nursing System - nursing interventions needed when Individual is unable to perform the necessary self-care activities: 1.Wholly compensatory - nurse provides entire self-care for the client. Example: care of a new born, care of client recovering from surgery in a post-anesthesia care unit 2.Partial compensatory - nurse and client perform care, client can perform selected self-care activities, but also accepts care done by the nurse for needs the client cannot meet independently. Example: Nurse can assist postoperative client to ambulate, Nurse can bring a meal tray for client who can feed himself 3.Supportive-educative - nurse’s actions are to help the client develop/learn their own self-care abilities through knowledge, support and encouragement. Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies. Twenty-One Nursing Problems Faye Glen Abdellah (1960) “I never wanted to be a medical doctor because I could do all I wanted to do in nursing. which is a caring profession.” . Faye Glen Abdellah (1960) The concept of Nursing in this theory is generally grouped into twenty-one problem areas for nurses to workout their judgment and appropriate care. sick or well with their health needs. . Abdellah considers nursing to be an all-inclusive service that is based on the disciplines of art and science that serves individuals. exercise.To facilitate maintenance of nutrition 7. 3. 5.To maintain good hygiene.To maintain good body mechanics. 4. To promote optimal activity.To facilitate the maintenance of a supply of oxygen 6.Typology of Twenty-one Nursing Problems 1.To promote safety.To facilitate maintenance of elimination . rest and sleep.2. To recognize the physiologic response of the body to disease conditions 10.To promote the development of productive interpersonal relationship .8.To identify and accept positive and negative expressions.To facilitate the maintenance of sensory functions 12.To facilitate the maintenance of effective verbal and nonverbal communication 15. feelings and reactions 13. 14.To facilitate the maintenance of regulatory mechanisms and functions. 11.To identify and accept the interrelatedness of emotions and illness.To facilitate the maintenance of fluid and electrolyte balance 9. To create and maintain a therapeutic environment 18.16. 19 To accept the optimum possible goals 20. To understand the role of social problems as influencing factors . 21. To facilitate progress toward achievement of personal spiritual goals 17.To use community resources as an aid in resolving problems arising from illness.To facilitate awareness of self as an individual with varying needs. The Prescriptive Theory of Nursing Ernestine Wiedenbach (1964) "My thesis is that nursing art is not comprised of rational nor reactionary actions but rather of deliberative action.” . exploration of the meaning of those symptoms with the patient. Nursing primarily consists of identifying a patient’s need for help. and determining the patient’s ability to resolve the discomfort or if the patient has a need for help from the nurse or other healthcare professionals. . determining the cause(s) of discomfort.Ernestine Wiedenbach (1964) Wiedenbach conceptualizes nursing as the practice identification of a patient’s need for help through observation of presenting behaviors and symptoms. In providing care.If the need for help requires intervention. the nurse facilitates the medical plan of care and also creates and implements a nursing plan of care based on needs and desires of the patient. The patient’s perception of the situation is an important consideration to the nurse when providing competent care. a nurse exercises sound judgment through deliberative. practiced. and educated recognition of symptoms. . and (4) art. . (2) purpose. (3) practice.According to Wiedenbach there are four elements to clinical nursing: (1) philosophy. Philosophy is what motivates the nurse to act in a certain way. worth. Wiedenbach also believed that there were 3essential components associated with a nursing philosophy:○ Reverence for life○ Respect for the dignity. autonomy and individuality of each human being .The nurses’ philosophy was their attitude and belief about life and how that effected reality for them. • Practices are those observable nursing actions that are affected by beliefs and feelings about meeting the patient’s need for help.Resolution to act on personally and professionally held beliefs • Nurses’ purpose is that which the nurse wants to accomplish through what she does. . It is all of the activities directed towards the overall good of the patient. The nurses also focuses on prevention of complications related to reoccurrence or development of new concerns. developing goals and actions intended to enhance patient’s ability and directing the activities related to the medical plan to improve the patient’s condition . .The Art of nursing includes understanding patient’s needs and concerns. Helping Art of Clinical Nursing “…nursing is nurturing or caring for someone in a motherly fashion..” Proposed that nurses identify patient’s need-for-help by: Observing behaviors regarding comfort Exploring meanings of the behavior Knowing the cause of discomfort Knowing if they can solve on their own or need help . ” . It is the dayto-day expression of one's commitment to other persons and the ways in which human beings relate to one another in their daily interactions.The Conservation Model Myra Estrin Levine (1977) "Ethical behaviour is not the display of one's moral rectitude in times of crisis. Nursing actions based on four principles: conservation of energy structural integrity personal integrity social integrity .She defined nursing as supportive & therapeutic interventions based on scientific or therapeutic knowledge. process whereby patients retain integrity.(1)Fight or flight. (2)inflammatory response.alternative to nursing diagnosis . (4)perceptual awareness Trophicogenesis .Major Concepts: Wholism (Holism) Adaptation . establish body economy to safeguardstability: Environment Organismic Response . (3)response tostress. Nursing intervention is based on the conservation of the patients: Energy Structural Integrity Personal Integrity Social Integrity .Conservation .4 principles of conservation . Composed of 3 Theories – (1)conservation (2)redundancy (3)therapeutic intention . Adaptation Model Sister Callista Roy (1979) “The model provides a way of thinking about people and their environment that is useful in any setting. It helps one prioritize care and challenges the nurse to move the patient from survival to transformation.” . Sister Callista Roy (1979) She viewed humans as biopsychosocial beings constantly interacting with a changing environment and who cope with their environment through Biopsychosocial adaptation mechanisms. There are two categories of coping mechanisms according to Roy namely the regulator and the cognator subsystems: . • Cognator Subsystem . The degree of internal or external environmental change and the person’s ability to cope with that change is likely to determine the person’s health status. and social functioning or adaptation. chemical and endocrine processes like the increase in vital signssympathetic response to stress. are the effects of prolonged hospitalization for a four-year old child. For instance.Regulator Subsystem transpires through neutral. occurs through cognitive-emotive processes. . Nursing interventions are aimed at promoting physiologic. psychologic. on the other hand. Proposed that humans are biophychosocial beings who exist within an environment • Environment and self provides 3 types of stimuli: (1) focal (2) residual (3) contextual • Human stimuli create needs in adaptation modes. role function. such as physiological self-concept. regulator and cognator. a person shows adaptive or ineffective response that need nursing intervention . and interdependence • Through adaptive mechanisms. Transcultural Theory Madeleine Leininger (1985) “Care is the heart of nursing.Care is curing. Care is essential to healing. and Care is the centraland dominant focus of nursing and transcultural nursing decisions and actions.” . Careis power. support. or enable individuals or groups to maintain or regain their well being (or health) in culturally meaningful and beneficial ways. facilitate. or to helppeople face handicaps or death. .Madeleine Leininger (1985) She stated that Nursing is a learned humanistic and scientific profession and discipline which is focused on human care phenomena and activities in order to assist. It focuses on the fact that different cultures have different caring behaviors and different health and illness values. . beliefs.Transcultural nursing as a learned subfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health illness caring practices. Awareness of the differences allows the nurse to design culture-specific nursing interventions. and patterns of behaviors. beliefs and values with the goal t o provide meaningful and efficacious nursing care services t o people according to their cultural values and health illness context. facilitative acts towards people with actual or anticipated needs . Ethnonursing • Some of the major concepts are care. culture. and cultural variations • Caring is seen as the central theme in nursing care. caring. knowledge and practice. • Caring includes assistive. supportive.Transcultural Care Theory. cultural values. 3 types of Nursing Actions Cultural Care Preservation or Maintenance .retention of relevant care values unique to culture Cultural Care Accommodation or Negotiation adapting culture with professional care providers Cultural Care Repatterning or Restructuring changing life-ways while still respecting culture for a healthier outcome . ” .Philosophy and Science of Caring Margaret Jean Watson (1979) “Caring in nursing conveys physical Acts but embraces the mind-body-spirit as it reclaims the embodied spirit as its focus attention. The basic assumptions are: • Caring can be effectively demonstrated and practicedonly interpersonally.Margaret Jean Watson (1979) Watson proposes seven assumptions about thescience of caring and ten primary carative factors to form the framework of her theory. . • Caring responses accept a person not only as he or she is now but as what he or she may become. • Effective caring promotes health and individual or family growth. A science of caring is therefore complementary to the science of curing.A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at a given point in time • Caring is more “healthogenic” than is curing. • The practice of caring is central to nursing . The practice of caring integrates biophysical knowledge of human behavior to generate or promote health and to provide care to those who are ill. The development of a helping-trusting. The cultivation of sensitivity to one’s self and others 4.Instillation of faith-hope 3.The promotion of a humanisticaltruistic system of values 2.Ten Carative Factors 1. human caring relationship . Promotion and acceptance of the expression of positive and negative feelings.Assistance with the gratification of human needs 10. physical. 6.The systemic use of the scientific problem-solving method for decision making 7. protective And corrective mental.The allowance for existential phenomenological forces . socio-cultural and spiritual environment 9.5.The promotion of interpersonal teaching-learning 8 The provision for supportive. ” . It is directed toward the unitary human and is concerned with the nature and direction of human development.The Science of Unitary Human Beings. and Principles of Homeodynamics Martha Rogers (1970) “Nursing is an art and science that is humanistic and humanitarian. strengthen the wholeness of the individual and redirect human and environmental patterns or organizationto achieve maximum health. .Martha Rogers (1970) Nursing interventions seek to promote harmonious interaction between persons and their environment. 2.5 BasicAssumptions : 1.The individual and the environment are continuously exchanging matter and energy with each . possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts.The human being is a unified whole. The individual is characterized by the capacity for abstraction and imagery. language and thought. sensation and emotion .Patterns identify human being and reflect their innovative wholeness 5.The life processes of human beings evolve irreversibly and unidirectionally along a space-time continuum 4.3. spiral development in continuous.patterning changes with development from lower to higher frequency(intensity) Integrality . and innovative patterning Resonancy .continuous mutual process of person and environment . nonrepeating.Unitary Human Beings Principles of Homeodynamics o Helicy . Theoretical Assertions Energy .Man as a whole is more than the sum of his parts Openness .Man and environment continuously exchange matter and energy Helicy . sensation and emotion . thinking being . language andthought.man has capacity for abstraction and imagery.Life evolves irreversibly and unidirectionally along space and time Pattern and organization identify man and reflect his innovative wholeness Sentient. Theory of Human Becoming Rosemarie Rizzo Parse (1981) “Nursing is a scientific discipline.” . the practice of which is a performing art. Human becoming is co-creating rhythmic patterns or relating in mutual process in the universe 3. .Three assumptions about Human Becoming 1. Human becoming is freely choosing personal meaning in situation in the inter-subjective process of relating value priorities 2. Human becoming is co-transcending multidimensionallywith emerging possibilities. humanistic approach instead of a physiological basis for nursing Nursing is a human science that is not dependent on medicine or any discipline for its practice .Human Becoming A unique. Originating 7. Connecting-separating 3. Revealing-concealing 8. Enabling-limiting .Major concepts include: 1. Languaging 6. Imaging 2. Powering 5. Valuing 4. Transforming 9. langauaging) in rhythmical patterns 3. valuaing. One constantly transforms . Man and environment c0-create 2.man’s reality is given meaning through lived experiences. Meaning . Parse's three principles are: • 1.man and environment cocreate (imaging.In capsule.refers to reaching out and beyond the limits that a person sets. Contracendence . Rhythmicity . Novice to Expert Validated the Dreyfus Model of Skill Acquisition in nursing practice with the systematic description of the 5 stages (Novice. Proficient.Patricia Benner . and Expert) . Advanced beginner. Competent. complex process of living in the view of an amalgam of activities .Roper.Model for Nursing Based on a Model of Living Conceptual Components 12 Activities of Living (AL) . and Tierney . Logan. Mobility 9. Sleep 12. Breathe 4.activities 1. Eliminate 6. Maintain safe environment 2. Personal cleansing and dressing 7. Express sexuality 11. Eat and drink 5. Dying . Communicate 3. Work and play 10. Temperature 8. concept of continuous change from birth to death Dependence-independence continuum 5 factors influencing AL: Biological.Life span .Politicoeconomic. The individuality of living is the way in which the individual attends to ALs in regard to place on lifespan and dependence-independence continuum and as influenced by the 5 factors . Socio-cultural. Environmental. Psychological. Transcendence or rising above the problems of pain .finance. andenvironmental needs • Intervening factors influence client’s perception of comfort: age. prognosis • Types of comfort:1. experience.Sense of ease. calm. attitude.Katherine Kolcaba .Theory of Comfort • Defined healthcare needs as those needs for comfort including physical. social. psycho-spiritual.Relief when specific need is fulfilled2. and contentment3. emotional support. Erikson. and adaptivecoping potential • Views nursing as self-care based on the person’s perception of the world and adaptation to stressors • Promotes growth and development while recognizing individual differences according to worldview andinherent endowment . object attachment. developmental tasks. Tomlin and Swain .Modeling and Role-Modeling • Synthesis of multiple theories related to basic needs. Maternal Role Attainment • Focused on parenting and maternal role attainment in diverse populations • Developed a complex theory to explain the factors impacting the maternal role over time .Ramona Mercer . Kathryn Barnard . and environment . teaching. Child Health Assessment Interaction Theory • Individual characteristics of each member influence the parent-infant system and that adaptive behaviormodifies those characteristics to meet the needs of the system • The theory is based on scales developed to measure feeding.Parent-Child Interaction. Uncertainty in Illness • Researched into experiences with uncertainty as it relates to chronic and life-threatening illness Later reconceptualized to accommodate the responses to uncertainty over time in people with chronic conditions who may not resolve the uncertainty .Merle Mishel . Margaret Newman - Model of Health • Major concepts are movement, time, space and consciousness. “Movement is a reflection of consciousness. Time is a function of movement. Time is a measure of consciousness.” • The goal of nursing is not to promote wellness or to prevent illness, but to help people use the power withinthem as they evolve toward a higher level of consciousness. Evelyn Adam - Conceptual Model for Nursing • Used a model from Dorothy Johnson and definition of nursing from Virginia Henderson • Identified assumptions, beliefs, and values, and major units • Included goal of the profession, beneficiary of the professional service, role of the professional, source of thebeneficiary’s difficulty, the intervention of the professional, and the consequence Nola Pender - Health Promotion Model • The goal of nursing care is the optimal health of the individual • Developed the idea that promoting optimal health supersedes disease prevention • Identifies cognitive-perceptual factors of a person, like importance of health-promotion behavior and its perceived barriers, and these factors are modified by demographics, biology, interpersonal influences, and situational and behavioral factors.