Theoretical Foundations in Nursing

Theoretical Foundations in Nursing

ENVIRONMENTAL THEORYFlorence Nightingale (1860)

I think ones feelings waste themselves in words; they ought all to be distilled into actions which bring results.

Florence Nightingale defined Nursing asthe act ofutilizing the environment of the patient to assist him in his recovery(1860/1969),that itinvolves the nurse's initiative to configureenvironmental 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 hisdevelopment.Environmental Factors Affecting HealthDefined in herenvironmental theory are thefollowing factors present in thepatients environment:pureor freshairpure watersufficient foodsuppliesefficient drainagecleanlinesslight (especially direct sunlight) Adequate ventilation has also been regarded as a factor contributing to changes of the patients process ofillness 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 inher environmental theory is the provision of aQuiet or noise-free andwarm environment,attending to patients dietary needs byassessment, documentation of time of food intake, and evaluating its effects on the patient. Nightingale believed that the environment was the major component creating illness in a patient; sheregarded disease as the reactions ofkindly nature against the conditions in which we haveplaced ourselves. Her theory Contains three majorrelationships:environment topatientnurse to environmentnurse to patientModern Nursing; Environmental Theory

Disease is a reparative process, and that themanipulation of theenvironment -ventilation, warmth ,light, diet, cleanliness, and noise - would contribute to the process andhealth 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 healthcareTHE INTERPERSONAL RELATIONS THEORY

Hildegard Peplau (1952) ( Psychodynamic Nursing: Mother of Psychiatric Nursing Shedefined Nursing as an interpersonal process oftherapeutic interactions between an individual who is sickor in need of health services and a nurse especiallyeducated to recognize, respond to the need for help.Dr. Peplau emphasized thenurse-client relationshipAs the foundation of nursing practice. At the time, her research andemphasis on thegive-and-take of nurse-client relationships was seen by many as revolutionary. She described the nurse-patient relationship asa four-phase phenomenon. Each phase is unique and hasdistinguished contributions on the outcome of the nurse-patient interaction.Phases OfNurse-Patient RelationshipOrientation: Individual/family has a felt need and seeks professional assistance from a nurse (who is a stranger). This is the problem identification phase. 2. Identification: Where the patient begins to have feelings of belongingness and a capacity for dealing with theproblem, creating an optimistic attitude from which inner strength ensues. Here happens the selection of appropriate professional assistance.3. ExploitationThe nurse uses communication tools to offer services to the patient, who is expected to take advantage of all services.4. Resolution: Where patients needs havealready been met by the collaborative efforts between the patient and the nurse.Therapeutic relationship isterminated and the links are dissolved, as patient drifts away from identifying with the nurse as the helping person.

Nursing RolesIn the course ofthe nurse-patient relationship, the nurse assumes several roles which empower and equip her in meeting the needs of the patient.1.Stranger Role:Receivesthe clientthe samewayone meets a stranger in otherlife situations; provides an accepting climate that builds trust.2.Resource Role:Answers questions.Interprets clinical treatment data, gives information.3.Teaching Role:Gives instructions andprovides training; involves analysis and synthesis of the learners experience.4.Counseling Role:Helps clientunderstand and integrate the meaning ofcurrent life circumstances; provides quidance and encouragement to make changes.5.Surrogate Role:Helps clients clarify domainsofdependence, interdependence, and independence and acts on clients behalf as advocate.6.Leadership Role:Helps clientassumemaximum responsibility for meeting treatment goals ina mutually satisfying way.AdditionalRolesinclude:1. Technicalexpert2. Consultant3. Health teacher4. Tutor5. Socializing agent6. Safety agent7. Manager of environment8. Mediator9. Administrator10.Recorder observer11.Researcher

Definition of theUnique Function of Nursing

Virginia Henderson (1955)The nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg ofthe amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidencefor the mother, the mouthpiece for those too weak orwithdrawn to speak and so on.Henderson defined Nursing as assisting the individual, sick or well, in the performance of those activities contributing to health or itsrecovery (or topeaceful death) that an individual would perform unaided ifhe had the necessary strength,will or knowledge.She conceptualized the14 Fundamental Needs14 Fundamental Needs ofhumans.These needs are:Breathing normallyEating anddrinkingadequatelyEliminating bodywastesMoving andmaintaining desirable positionSleepingandrestingSelectingsuitable clothesMaintaining bodytemperature within normal rangeKeeping the bodyclean and well-groomedAvoiding dangers inthe environmentCommunicating withothersWorshippingaccordingto onesfaithWorking insucha waythatone feelsa sense ofaccomplishmentPlaying/participating in various formsofrecreationLearning,discoveringor satisfyingthecuriosity thatleads to normal development and health and usingavailable health facilities.The Nurse-Patient RelationshipHenderson stated thatthere are three levels comprising the nurse-patient relationship:1.The nurse as a substitute for the patient.Intimes of illness, when the patient cannot function fully, the nurse serves as the substitute as to what the patient lacks such, as knowledge, will, and strength in order to make him complete, whole and independent once again.2.The nurse as a helper to thepatient.In situations where the patient cannot meet his basic needs,the nurse serves as ahelper to accomplish them.3.The nurse as a partner with the patient.As partners, the nurse and thepatient formulate the care plan together. Both asan advocate and asa resource person, the nurse canempower the patient to make effective decisions regarding his care plans.

Dynamic Nurse-Patient Relationship

The role of the nurse is to findout and meet thepatient's immediate need for help. Thepatient's presenting behavior may be a plea for help, however, the help needed may not be whatit appears to be.Orlando's theory wasdevelopedinthe late1950sfrom observations she recorded between a nurse and patient. Despite her efforts, she was only able to categorize the records as "good" or "bad" nursing. It then dawned on her that both the formulations for "good" and "bad" nursing were contained in the records. From these observations she formulated the deliberative nursing process.Therefore, nurses needto use theirperception, thoughts about theperception, or the feeling engendered from their thoughts to explore with patients the meaning oftheir behavior. This process helps the nursefind outthe nature of the distress and what helpthe patient needs. Orlando's theory remains one the ofthe most effective practice theories available. The use ofher theory keeps the nurse's focus on the patient. The strength of the theory is that it is clear, concise, and easy to use. While providing the overall framework for nursing, the use ofher theory does not exclude nurses from using other theories while caring for the patient. Nursing Process; Dynamic Nurse-Patient Relationship

Focused on patients verbal and nonverbal expressions of need and the nurses reactions to the behavior

3 Elements of aNursing Situation

1. Patient behaviors

2. Nurse reactions

3. Nurse actionsUsed the nursing process to meet patients needs through deliberate action; advanced nursing beyond automatic response to disciplined and professional responseKey Concepts of Three Interlocking Circles Theory ( care,core and cure)

Human- to- Human Relationship Model Lydia Hall ( 1961 ) According to Hall,Nursing is participation incare,core and cureaspects, where

CAREis thesolefunction of nurses, whereas the

COREandCUREare shared with other members of the health teamThe major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate thedevelopment of the coreThe 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, religious ministry, etc.

Care (Body) exclusive to nurses; involves intimate bodily care like feeding, bathing and toileting

As the patient needs lessmedical care, he needs more professional nursing care

Wholly professional nursing care will hasten recoveryINTERPERSONAL ASPECTS OF NURSING MODEL A nurse does notonly seek to alleviate physical painor render physical care- she ministers tothe whole person.The existence of suffering, whether physical, mental orspiritual is the proper concern of the nurse.Joyce Travelbee (1966)

Travelbee's experience in initial psych nursing practice at a Catholiccharity hospital led her to believe that the care given in these type of institutions lacked compassion.She feltnursing needed a "Humanistic revolution"anda renewedfocus oncaring as centralto nursing--she warned that if this didn't happen, consumers might seeka "new and different kind of health careworker".Travelbee'sideas havegreatly influencedthe hospice movement. In her human-to-humanrelationship model, the nurse and the patient undergoes the following series ofinteractional phases:Series ofinteractional phases:1.Original Encounter-this isdescribedasthefirst impression by the nurse of thesick person andvice versaThe nurse and patient see each other in stereotyped or traditional roles.2.Emerging Identities-thisphaseisdescribedbythe nurse and patient perceiving each other asunique individual. At this time, the link ofrelationship begins to form.3.Empathy-thisphaseisdescribedastheabilityto share in thepersons experience.4.Sympathy-Ithappens whenthe nurse wantsto lessen the cause of the patients suffering. It goes beyond empathy. The nurse at this time should use a disciplined intellectual approach together with therapeutic use of self tomake helpful nursing actions.5.Rapport-thisisdescribedasnursing interventions that lessens the patients suffering. The nurse and the sick person are relating as human being to human being. The sick person shows trust and confidence in the nurse.System Model inNursing Practice

Betty Neuman (1972)Health is a condition in which all parts and subparts are in harmonywith the whole of the clientBetty Neuman (1972)Her theory incorporated the concept ofa whole person and an open system approach. The concept is aimed towards the development of a person in a state of wellness having the capacity tofunction optimally. Themain role ofthe nurse in her theory is to help a person to adaptwith environmental stimuli causing illnesses backto a state ofwellness.Terms Related to Neumans System TheoryClient VariablesThe clients variables can be one or combination ofthe following: physiological, sociocultural,developmental and spiritual. These variables function to achieve stability in relation tothe environmental stressors experienced bythe client.Lines of ResistanceLines of Resistance act when the Normal Line ofDefense is invaded bytoo much stressor, producing alterations in the clients health.Normal Line of DefenseTo achieve the stability of the system, the Normal Line of Defense must actin coordination with the normal wellness state. It must reflect the actual rangeofresponses that is normally acted by clients inresponse to any stressors. It is thebaseline in determining the level of client within the continuum of health.Flexible Line of DiseaseIt serves as a boundary for the Normal Line of Defense to adjust tosituations that threaten the imbalance with in the clients stability.StressorsThese are forces that produce tensions, alterations or potential problems causing instability within the clients system.ReactionThese are the outcomes or produced results of certain stressors and actions ofthe lines resistance of a client. It can be positive or negative depending on the degree ofreaction the client produces to adjust andadapt with the situation.Neumanspecified thesereactions as

Negentropyis set towards stability or wellness while

Egentropyis set towards disorganization of the system producing illness.Behavioral System Model

Each individual has a predisposition to act, with reference to the goal, in certain ways rather than inother ways

Dorothy Johnson (1971)Johnson believes that each individual has a focusing and repeating ways of actingwhich covers a behavioral system distinct to that individual. These behaviors are logical, fixed, predictable and adequately secure and persistent to be satisfying to depiction and clarification.Seven Behavioral Subsystems

1.The Attachment or Affiliative SubsystemIs well known as the earliest response system to expand in the individual. The most favorable functioning ofthis subsystem allows social inclusion, closeness, and the pattern and continuance of a strong public bond.2.The Dependency Subsystemare actions thattrigger nurturing behaviors from other individuals in the environment. The product ofdependency behavior is consent, interest or appreciation, and physical support.3.The Ingestive Subsystemrelates to the behaviors surrounding the ingestion of food.Behaviors related to the ingestion offood may relate more to what is socially satisfactory in a specified culture, than to the biological necessities of the human being.4.The Eliminative Subsystemrelates tobehaviors surrounding the secretion of waste products from the body. Human cultures have defined different socially acceptable behaviors for excretion of waste, butthe continuation of suchan outline remains from culture to culture.5.The Sexual Subsystemimitates behaviors related to procreation or reproduction.6.The Aggressive Subsystemrelates tobehaviors concerned with thedefense andself-preservation.7.The Achievement Subsystemcontainsbehaviorsthat attempt tocontrol the environment. Intellectual, physical, imaginative, mechanical, and communal skills are some of the areas that Johnson distinguishes.

Goal Attainment Theory

Imogene King (1971)

If the students cant do the fundamentals, howcan they use advanced knowledge.Imogene King (1971)King stated that Nursing is a process ofactionreaction andinteractionwhereby nurse and clientshare information about their perception in the nursingsituation.ActionAction is a means ofbehavior or activities that are towards the accomplishment of certain act. Itis both physical and mental.

ReactionIn Kings theory, reaction is not specified but somehow relates reaction as partof action. According to her, reaction is a response to astimuli.Interaction

Interaction, as defined by King, is any situation wherein the nurse relates and deals with a clientele or patient.Open System

It is the absenceof boundary existence, where a dynamic interaction between the internal andexternal environment can exchange information without barriers or hindrances. King proposed that the nurse interacts inthe system simultaneously at three different levels. These levels are independent and at the same time co-exist to influence over-allnursing practice.Personal- how the nurse views and integrates selfbased from personal goals and beliefsInterpersonal- howthe nurse interrelates with a coworker or patient, particularly in anurse-patient relationshipSocial- how the nurse interacts withco-workers, superiors, subordinates and the client environment in generalNursing is a process of human interaction between nurses and patients who communicate to set goals, explore means of attaining goals, and agree on what means to usePerceptions, judgment and actions of nurse and patient lead to reaction, interaction and transactionInteractingsystems:

Personal System -perception, self,body image, growth and development

Interpersonal System -role, interaction, communication, transaction, and stress

Social System - organization, power-authority status, decision makingSelf-Care Theory

Dorothea Orem (1971)Individuals, families, groups and communities need to be taughtself-care.Oremdefined NursingasThe act of assisting others in the provision and management of self-care to maintain/improve human functioning at home level ofeffectiveness.The theory focuses on activities that adult individuals perform on their own behalf tomaintain life, health and well-being. It has a strong health promotion and maintenance focus. She identified 3related concepts:1.Self-care-activities anIndividualperforms independently throughout life to promote and maintain personal well-being.2.Self-care deficit-resultswhenself-care agency(Individuals ability) is not adequate tomeet the known self-care needs.3.Nursing System-nursing interventions needed when Individual is unable toperform the necessary self-care activities:1.Wholly compensatory-nurseprovides entire self-care for the client.Example:care ofa newborn,care ofclient recovering from surgery in a post-anesthesia care unit2.Partial compensatory-nurseandclient perform care, client can perform selected self-care activities, butalso acceptscare done by the nurse for needs the client cannot meet independently.Example:Nurse can assistpostoperative client to ambulate, Nurse can bring a meal tray for client who can feed himself

3.Supportive-educative-nursesactions are to help the clientdevelop/learn their own self-care abilities throughknowledge, support and encouragement.Example:Nurse guidesa motherhowto 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 Iwanted to do in nursing, which is a caringprofession. 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 andappropriate care. Abdellah considers nursing to be an all-inclusive service that is based on the disciplines of art andscience that serves individuals, sick or well with their healthneeds.Typology of Twenty-one Nursing Problems

1.To maintaingoodhygiene.2. To promote optimal activity; exercise, rest and sleep.

3.Topromote safety.

4.To maintain good bodymechanics.

5.To facilitate the maintenanceofasupply of oxygen

6.To facilitate maintenance of nutrition

7.To facilitate maintenance of elimination8.To facilitate the maintenanceoffluid andelectrolyte balance9.To recognize the physiologicresponseof the bodyto disease conditions10.Tofacilitatethe maintenance ofregulatory mechanisms andfunctions.11.To facilitate the maintenanceofsensory functions12.To identifyandacceptpositive andnegative expressions, feelingsand reactions13.To identifyandaccept theinterrelatednessofemotions and illness.14.To facilitate the maintenance ofeffective verbaland non- verbal communication15.To promote the development of productive interpersonal relationship 16. To facilitate progress towardachievement of personal spiritual goals17.To create and maintain a therapeutic environment18.To facilitate awareness of self as an individual with varying needs.19Toaccepttheoptimumpossiblegoals20.To usecommunity resources as anaid inresolving problems arising from illness.21.To understand the roleofsocialproblemsas influencing factorsThe Prescriptive Theory of Nursing

Ernestine Wiedenbach (1964)"My thesis is that nursing art is not comprised of rational norreactionary actions but rather ofdeliberative action.Ernestine Wiedenbach (1964)

Wiedenbach conceptualizes nursing as the practice identification of a patients need for help through observation of presenting behaviors and symptoms, exploration of themeaningofthose symptoms with the patient, determining the cause(s) of discomfort, and determining the patients ability toresolve the discomfort or if the patient has a need for help from the nurse or other healthcare professionals. Nursing primarily consists of identifying a patients need for help. Ifthe need for helprequires intervention, the nurse facilitates the medical plan of care and also creates and implements a nursing plan ofcare based on needs and desires of thepatient. In providing care, a nurse exercises soundjudgment through deliberative, practiced, and educated recognition of symptoms. Thepatients perception of the situation is animportant consideration to the nurse when providing competent care.According to Wiedenbach there are four elements to clinical nursing: philosophy, purpose, practice, and art.Thenursesphilosophywastheirattitudeand belief about life andhow that effected reality for them. Philosophy is whatmotivates the nurse to act in a certain way. Wiedenbach also believed that there were 3essential components associated with a nursing philosophy: Reverence for life Respect for the dignity, worth, autonomy and individuality of each human being

Resolution toacton personallyand professionally held beliefsNursespurposeisthatwhich the nurse wantsto accomplish through what she does. It is all ofthe activities directed towards the overall good of the patient.Practicesare thoseobservable nursing actions that are affected by beliefs and feelings about meeting the patients need for help.TheArtofnursing includes understanding patients needs andconcerns, developing goals and actions intended to enhance patients ability and directing the activities related to the medical plan to improve the patients condition .The nurses also focuses on prevention ofcomplications related to reoccurrence or development of new concerns.

- Helping Art of Clinical Nursing

nursing is nurturing or caring for someone in a motherly fashion.

Proposed that nursesidentify patients 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 helpThe Conservation Model

Myra Estrin Levine (1977)

"Ethical behaviour is not the display of one's moral rectitude in times of crisis. Itis the day-to-dayexpression of one's commitment to other persons and the ways in which human beings relate to one another in theirdaily interactions.

She defined nursing as supportive & therapeutic interventions based on scientific or therapeutic knowledge. Nursing actions based on four principles:

conservation ofenergy

structural integrity

personal integrity

social integrityMajor Concepts:

Wholism (Holism)

Adaptation - process whereby patients retain integrity; establish body economy to safeguardstability:

Environment

Organismic Response -(1)Fight or flight,(2)inflammatory response, (3)response tostress, (4)perceptualawareness

Trophicogenesis - alternative to nursing diagnosisConservation - 4 principles of conservation - Nursing intervention is based on the conservation of the patients:

Energy

Structural Integrity

Personal Integrity

Social IntegrityComposed of 3 Theories conservation redundancy therapeutic intentionAdaptation Model

Sister Callista Roy (1979)The model provides a way of thinking about people andtheir environment that is useful in any setting. It helps oneprioritize care and challenges the nurse to move the patient fromsurvival to transformation.Sister Callista Roy (1979)

She viewed humans as biopsychosocial beings constantly interacting with a changing environment and whocope with their environment through Biopsychosocial adaptation mechanisms. There are two categories of coping mechanisms according to Roy namely the regulator and the cognator subsystems:Regulator Subsystemtranspires throughneutral, chemical and endocrineprocesses like the increase in vital signs-sympathetic response to stress.Cognator Subsystem,onthe otherhand,occurs through cognitive-emotive processes. For instance, are the effects ofprolonged hospitalization for afour-year old child.The degree ofinternal or external environmental change and the persons ability to cope with that change is likely to determine the persons healthstatus. Nursing interventions are aimed at promoting physiologic, psychologic, and social functioning or adaptation.Proposed that humans are biophychosocial beings who exist within an environmentEnvironment and self provides 3 types of stimuli: (1) focal (2) residual (3) contextualHuman stimuli create needs in adaptation modes, such as physiological self-concept, role function, and interdependenceThrough adaptive mechanisms, regulator and cognator, a person shows adaptive or ineffective response that need nursing interventionTranscultural Theory

Madeleine Leininger (1985)Care is the heart of nursing; Careis power; Care is essential to healing;Care is curing; and Care is the centraland dominant focus of nursing andtranscultural nursing decisions andactions.Madeleine Leininger (1985)

She stated that Nursing is a learned humanistic and scientific profession and discipline which is focusedon human care phenomena and activities in order to assist, support, facilitate, or enable individuals orgroups to maintain or regain their well being (or health) in culturally meaningful and beneficial ways, or tohelppeople face handicaps or death.Transcultural nursingasalearnedsubfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health illness caring practices, beliefs and values with the goal t o provide meaningful and efficacious nursingcare services t o people according to their cultural values and health illness context. It focuses on thefact that different cultures have different caring behaviors anddifferent health and illness values, beliefs, and patterns ofbehaviors. Awareness ofthe differences allows the nurseto design culture-specific nursing interventions.

Transcultural Care Theory; EthnonursingSome of the major concepts are care, caring, culture, cultural values, and cultural variationsCaring is seen as the central theme in nursing care, knowledge and practice.Caring includes assistive, supportive, facilitative acts towards people with actual or anticipated needs3 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 outcomePhilosophy and Science of Caring

Margaret JeanWatson (1979)Caring in nursing conveys physicalActs butembraces the mind-body-spiritas it reclaims the embodied spirit as its focus attention.Margaret JeanWatson (1979)Watson proposesseven assumptionsabout thescience ofcaring andten primary carative factorsto form the framework of her theory. The basic assumptions are:Caring can beeffectivelydemonstratedand practicedonly interpersonally;Effective caringpromotes health andindividualor family growth;Caring responses accepta personnot onlyas heor she is now but as what he or she may become;Acaring environment isonethat offersthe development of potential while allowing the person to choose the best action for himself or herself at a given point in timeCaringismorehealthogenic thaniscuring.The practice of caring integrates biophysical knowledge of human behavior to generate or promote health and toprovide care to those who are ill. A science of caring is therefore complementary to the science of curing.Thepractice ofcaringiscentralto nursing

Ten CarativeFactors

1.The promotion ofa humanistic- altruisticsystemofvalues

2.Instillationof faith-hope

3.Thecultivationof sensitivity to onesselfandothers

4. The development of a helping-trusting, human caring relationship5.Promotion andacceptanceof the expression ofpositive and negative feelings.

6.Thesystemic useofthescientificproblem-solving method for decision making

7.The promotion ofinterpersonalteaching-learning

8Theprovision forsupportive,protective And corrective mental, physical, socio-cultural and spiritualenvironment

9.Assistancewith the gratification ofhumanneeds

10.Theallowancefor existentialphenomenologicalforcesThe Science of Unitary Human Beings,and Principles ofHomeodynamics

Martha Rogers (1970)Nursing is an art and science that is humanistic andhumanitarian. It is directed toward the unitary human and is concerned with the nature and direction ofhuman development.Martha Rogers (1970)

Nursing interventions seek to promote harmonious interaction between persons and their environment, strengthen thewholeness of the individual and redirect human andenvironmental patterns or organizationto achieve maximum health. 5 BasicAssumptions:1.The humanbeing isa unified whole,possessing individual integrity and manifesting characteristics that are more than and different from the sum ofparts.

2.The individualand the environmentare continuously exchanging matter and energy witheach3.Thelife processesof humanbeingsevolveirreversibly and unidirectionally along a space-time continuum

4.Patterns identifyhumanbeing andreflecttheir innovative wholeness

5.Theindividualischaracterized bythecapacity for abstraction and imagery, language and thought, sensation and emotionUnitary Human Beings

Principles of HomeodynamicsoHelicy - spiral development in continuous, non-repeating, and innovative patterning

Resonancy - patterning changes with development from lower to higher frequency(intensity)

Integrality - continuous mutual process of person and environmentTheoretical Assertions

Energy - Man as a whole is more than the sum of his parts

Openness - Man and environment continuously exchange matter and energy

Helicy - Life evolves irreversibly and unidirectionally along space and time

Pattern and organization identify man and reflect his innovative wholeness

Sentient, thinking being - man has capacity for abstraction and imagery, language andthought, sensation and emotion

Theory of Human Becoming

Rosemarie Rizzo Parse (1981) Nursing is a scientific discipline, the practice of which is aperforming art.Three assumptions about HumanBecoming

1. Humanbecoming isfreelychoosing personal meaning in situation inthe inter-subjective process ofrelating value priorities

2. Humanbecomingisco-creating rhythmicpatterns or relating in mutual process in the universe

3. Human becoming isco-transcending multidimensionallywith emerging possibilities.Human Becoming

A unique, 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 practiceMajor concepts include:

1. Imaging

2. Connecting-separating

3. Valuing

4. Powering

5. Languaging

6. Originating

7. Revealing-concealing

8. Transforming

9. Enabling-limitingIn capsule, Parse's three principles are:1. Meaning - mans reality is given meaning through lived experiences.Man and environment c0-create2. Rhythmicity - man and environment co-create (imaging, valuaing, langauaging) in rhythmical patterns3. Contracendence - refers to reaching out and beyond the limits that a person sets.One constantly transforms Patricia Benner- Novice to Expert

Validated the Dreyfus Model of Skill Acquisition in nursing practice with the systematic description ofthe 5stages (Novice, Advanced beginner, Competent, Proficient, and Expert)Roper, Logan, and Tierney- Model for Nursing Based on a Model of Living

Conceptual Components

12 Activities of Living (AL) -complex process of living in the view ofan amalgam of activities activities1.Maintainsafeenvironment 2.Communicate 3.Breathe4.Eatanddrink5.Eliminate6.Personalcleansinganddressing7.Temperature 8.Mobility9.Workandplay10.Expresssexuality11.Sleep12.Dying

Life span - concept of continuous change from birth to death

Dependence-independence continuum

5 factors influencing AL: Biological, Psychological, Socio-cultural, Environmental,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 factorsKatherine Kolcaba- Theory of ComfortDefined healthcare needs as those needs for comfort including physical, psycho-spiritual, social, andenvironmental needsIntervening factorsinfluenceclients perception of comfort:age, attitude,emotional support, experience,finance, prognosisTypes of comfort:1.Reliefwhenspecificneedisfulfilled2.Sense of ease, calm, and contentment3.Transcendence or risingabove the problems of painErikson, Tomlin and Swain- Modeling and Role-ModelingSynthesis ofmultiple theories related to basicneeds, developmental tasks,object attachment, and adaptivecoping potentialViews nursing as self-care based on the persons perception of the world and adaptation to stressorsPromotes growth and development while recognizing individual differences according to worldview andinherent endowmentRamona Mercer- Maternal RoleAttainmentFocused on parenting and maternal role attainment in diverse populationsDeveloped a complex theory to explain the factors impacting the maternal role over timeKathryn Barnard- Parent-Child Interaction; Child Health Assessment Interaction TheoryIndividual characteristics of each member influence the parent-infant system and that adaptive behaviormodifies those characteristics to meetthe needs of the systemThe theory is based on scales developed to measure feeding, teaching, and environmentMerle Mishel- Uncertainty in IllnessResearched into experiences with uncertainty as it relates to chronic and life-threatening illness

Later reconceptualized toaccommodate the responses to uncertainty over timein people with chronic conditions who may not resolve the uncertaintyMargaret Newman- Model of HealthMajor concepts are movement, time,space and consciousness. Movement is areflection of consciousness.Time is afunction of movement. Time is ameasure 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 NursingUsed a model from Dorothy Johnson and definition of nursing from Virginia HendersonIdentified assumptions, beliefs, and values,and major unitsIncluded goal of the profession, beneficiary of the professional service, role of the professional, source of thebeneficiarys difficulty, the intervention of the professional, and the consequenceNola Pender- Health Promotion ModelThe goal of nursing care is the optimal health of the individualDeveloped the idea that promoting optimal health supersedes disease preventionIdentifies 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.