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Nursing Theories and Its Theorists

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´NURSING THEORIES ´NURSING THEORIES AND AND ITS THEORISTSµ ITS THEORISTSµ PREPARED BY: PREPARED BY: VESA LARA MALAINE P. RAGA, RN VESA LARA MALAINE P. RAGA, RN
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´NURSING THEORIES´NURSING THEORIESANDAND

ITS THEORISTSµITS THEORISTSµ

PREPARED BY:PREPARED BY:

VESA LARA MALAINE P. RAGA, RNVESA LARA MALAINE P. RAGA, RN

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FLORENCE NIGHTINGALEFLORENCE NIGHTINGALE

(ENVIRONMENTAL THEORY)(ENVIRONMENTAL THEORY)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT The First Nurse TheoristThe First Nurse Theorist

Developed and described the first theory of nursing.Developed and described the first theory of nursing.

She focused the on changing and manipulating theShe focused the on changing and manipulating theenvironment in order to put the patient in best environment in order to put the patient in best 

possible conditions for nature to act.possible conditions for nature to act.

She believed that in the nurturing environment, theShe believed that in the nurturing environment, the

body could repair itself. Client·s environment is body could repair itself. Client·s environment is 

manipulated to include appropriate noise , nutrition , manipulated to include appropriate noise , nutrition , 

hygiene , light, comfort, socialization and hope.hygiene , light, comfort, socialization and hope.

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She defined NURSING as ´the act of utilizing theShe defined NURSING as ´the act of utilizing the

environment of the patient to assist him in his environment of the patient to assist him in his 

recoveryµ.recoveryµ. She linked health withShe linked health with FIVE ENVIRONMENTAL FIVE ENVIRONMENTAL 

FACTORS:FACTORS:

1.1. PURE OR FRESH AIRPURE OR FRESH AIR

2.2. PURE WATERPURE WATER

3.3. EFFICIENT DRAINAGEEFFICIENT DRAINAGE

4.4. CLEANLINESSCLEANLINESS

5.5. LIGHT esp. DIRECT SUNLIGHTLIGHT esp. DIRECT SUNLIGHT

Deficiencies in these five factors produced lack ofDeficiencies in these five factors produced lack of

health or illness.health or illness.

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In addition , Nightingale also stressed theIn addition , Nightingale also stressed the

importance of keeping the client warn , importance of keeping the client warn , maintaining a noisemaintaining a noise--free environment, andfree environment, and

attending to client·s diet in terms of assessingattending to client·s diet in terms of assessing

intake , timeliness of the food , and its effect intake , timeliness of the food , and its effect on the person.on the person.

Her general concepts about ventilation , Her general concepts about ventilation , 

cleanliness, quiet, warmth , and diet remaincleanliness, quiet, warmth , and diet remain

integral parts of nursing and health careintegral parts of nursing and health care

today.today.

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METAPARADIGMMETAPARADIGM PERSONPERSON: An individual with vital reparative: An individual with vital reparative

processes to deal with disease.processes to deal with disease.

ENVIRONMENTENVIRONMENT: External conditions that affect : External conditions that affect 

life and individuals development.life and individuals development.

HEALTHHEALTH: Focus is on the reparative process of: Focus is on the reparative process of

getting well.getting well. NURSINGNURSING: Goal is to place the individual in the: Goal is to place the individual in the

best condition for good healthcare.best condition for good healthcare.

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HILDEGARD PEPLAUHILDEGARD PEPLAU(INTERPERSONAL RELATIONS MODEL)(INTERPERSONAL RELATIONS MODEL)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT CenterCenter ofof Peplau·sPeplau·s Theory is the use of a therapeutic Theory is the use of a therapeutic 

relationship between the nurse and the client.relationship between the nurse and the client.

Nurs

es

ente

r in

to a pe

rsonal

rela

tion

sh

ip w

ith anNu

rse

sen

te

r in

to a pe

rsonal

rela

tion

sh

ip w

ith anindividual when a need is present.individual when a need is present.

To help clients To help clients fulfillfulfill their needs, nurses assume many their needs, nurses assume many 

roles: stranger, teacher, resource person , surrogate , roles: stranger, teacher, resource person , surrogate , 

leader, andleader, and counselorcounselor.. Her model continues to be used by clinicians whenHer model continues to be used by clinicians when

working with individuals who haveworking with individuals who have psychlogicpsychlogic

problems.problems.

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She identifies She identifies FOUR PHASES OF THEFOUR PHASES OF THE

NURSENURSE--CLIENT RELATIONSHIPCLIENT RELATIONSHIP namely:namely:1.1. ORIENTATIONORIENTATION--During this phase , the client During this phase , the client 

seeks help , and the nurse assists the client toseeks help , and the nurse assists the client to

underst

andthe p

ro

blem and

the ex

ten

tof

the needunde

rstand

the p

ro

blem and

the ex

ten

tof

the needfor help.for help.

2.2. IDENTIFICATIONIDENTIFICATION--During this phase , the client During this phase , the client 

assumes a posture of dependence , assumes a posture of dependence , 

interdependence , or independence in relation tointerdependence , or independence in relation tothe nurse. The nurse·s focus is to assure the personthe nurse. The nurse·s focus is to assure the person

that the nurse understands the interpersonalthat the nurse understands the interpersonal

meaning of the client·s situation.meaning of the client·s situation.

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3.3. EXPLOITATIONEXPLOITATION--In this phase , the client In this phase , the client 

derives full value from what the nurse offers derives full value from what the nurse offers through the relationship. The client uses through the relationship. The client uses 

available services based on selfavailable services based on self--interest andinterest and

needs. Power shifts from the nurse to the client.needs. Power shifts from the nurse to the client.

4.4. RESOLUTIONRESOLUTION--In this final phase , old needs In this final phase , old needs 

and goals are put aside and new ones adopted.and goals are put aside and new ones adopted.Once older needs are resolved , newer and moreOnce older needs are resolved , newer and more

mature ones emerge.mature ones emerge.

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VIEWS OF COMPONENTSVIEWS OF COMPONENTS PERSONPERSON: An organism striving to reduce tension generated by : An organism striving to reduce tension generated by needs.needs.

ENVIRONMENTENVIRONMENT: The interpersonal process is always included , and: The interpersonal process is always included , andpsychodynamic milieu receives attention , with emphasis on thepsychodynamic milieu receives attention , with emphasis on the

client·s culture and mores.client·s culture and mores. HEALTHHEALTH: Ongoing human process that implies forward movement : Ongoing human process that implies forward movement 

of personality and other ongoing human processes in the directionof personality and other ongoing human processes in the directionof creative , constructive , productive , personal , and community of creative , constructive , productive , personal , and community living.living.

NURSINGNURSING: Interpersonal therapeutic process that ´functions : Interpersonal therapeutic process that ´functions cooperatively with others human processes that make healthcooperatively with others human processes that make healthpossible for individuals in communities. Nursing is an educativepossible for individuals in communities. Nursing is an educativeinstrument, a maturing force that aims to promote forwardinstrument, a maturing force that aims to promote forwardmovement of personality.movement of personality.

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VIRGINIA HENDERSONVIRGINIA HENDERSON

(DEFINITION OF NURSING)(DEFINITION OF NURSING)

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Unlike Nightingale , she saw the nurse as Unlike Nightingale , she saw the nurse as 

concerned with both healthy and illconcerned with both healthy and illindividuals, acknowledged that nurses individuals, acknowledged that nurses 

interact with clients even when recovery interact with clients even when recovery 

may not be feasible , and mentioned themay not be feasible , and mentioned theteaching and advocacy roles of the nurse.teaching and advocacy roles of the nurse.

Her emphasis on the importance ofHer emphasis on the importance of

nursing·s independence from , thenursing·s independence from , theinterdependence with , other health careinterdependence with , other health care

disciplines is well recognized.disciplines is well recognized.

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14 FUNDAMENTAL NEEDS14 FUNDAMENTAL NEEDS1.1. Breathing NormallyBreathing Normally

2.2. Eating and Drinking AdequatelyEating and Drinking Adequately

3.3. Eliminating Body WastesEliminating Body Wastes4.4. Moving and Maintaining a Desirable PositionMoving and Maintaining a Desirable Position

5.5. Sleeping and RestingSleeping and Resting

6.6. Selecting Suitable ClothesSelecting Suitable Clothes

7.7. Maintaining Body Temperature within NormalMaintaining Body Temperature within NormalRange by Adjusting Clothing and Modifying theRange by Adjusting Clothing and Modifying the

EnvironmentEnvironment

8.8. Keeping the Body Clean and Well Groomed toKeeping the Body Clean and Well Groomed to

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protect the integumentprotect the integument

9.9. Avoiding Dangers in the Environment andAvoiding Dangers in the Environment and

avoiding injuring othersavoiding injuring others10.10. Communicating with Others in ExpressingCommunicating with Others in Expressing

Emotions, Needs, Fears or OpinionsEmotions, Needs, Fears or Opinions

11.11. Worshipping according to One·s FaithWorshipping according to One·s Faith

12.12. Working in such a Way that One Feels a SenseWorking in such a Way that One Feels a Sense

of Accomplishmentof Accomplishment

13.13. Playing or Participating in Various Forms ofPlaying or Participating in Various Forms of

RecreationRecreation14.14. Learning , Discovering , or Satisfying theLearning , Discovering , or Satisfying the CuriousityCuriousity

that Leads to Normal Development and Health ,that Leads to Normal Development and Health ,

and Using Available Health Facilities.and Using Available Health Facilities.

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METAPARADIGMMETAPARADIGM PERSONPERSON: Individual requiring assistance to achieve health and: Individual requiring assistance to achieve health andindependence or a peaceful death. Mind and body areindependence or a peaceful death. Mind and body areinseparable.inseparable.

ENVIRONMENTENVIRONMENT: All exte

rnal

cond

ition

sand

influen

ce

s tha

t : All ex

te

rnal

cond

ition

sand

influen

ce

s tha

t affect life and development.affect life and development.

HEALTHHEALTH: Equated with independence , viewed in terms of the: Equated with independence , viewed in terms of theclient·s ability to perform 14 components of nursing careclient·s ability to perform 14 components of nursing careunaided: breathing , eating , drinking , maintaining comfort, unaided: breathing , eating , drinking , maintaining comfort, sleeping , resting clothing , maintaining body temperature , sleeping , resting clothing , maintaining body temperature , ensuring safety, communicating , worshiping , working , ensuring safety, communicating , worshiping , working , recreation , and continuing development.recreation , and continuing development.

NURSINGNURSING: Assists and supports the individual in life activities : Assists and supports the individual in life activities and the attainment of independence.and the attainment of independence.

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FAYE GLENN ABDELLAHFAYE GLENN ABDELLAH((CONCEPT OF TWENTY ONE NURSING PROBLEMS)CONCEPT OF TWENTY ONE NURSING PROBLEMS)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT The language ofThe language of Abdellah·sAbdellah·s framework is readable andframework is readable and

clear.clear.

Consistent with the decade in which she was writing , sheConsistent with the decade in which she was writing , she

uses the term ¶she· for nurses, ¶he· for doctors anduses the term ¶she· for nurses, ¶he· for doctors andpatients, and refers to the ob ject of nursing as ¶patient· patients, and refers to the ob ject of nursing as ¶patient· rather than client or consumer.rather than client or consumer.

She referred to Nursing diagnosis during a time whenShe referred to Nursing diagnosis during a time whennurses were taught that diagnosis was not a nurses· nurses were taught that diagnosis was not a nurses· prerogative.prerogative.

Assumptions were related to:Assumptions were related to:

change and anticipated changes that affect nursing;change and anticipated changes that affect nursing;

The need to appreciate the interconnectedness ofThe need to appreciate the interconnectedness ofsocial enterprises and social problems ;social enterprises and social problems ;

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the impact of problems such as poverty, the impact of problems such as poverty, racism , pollution , education , and so forth onracism , pollution , education , and so forth on

health care delivery ;health care delivery ;changing nursing education.changing nursing education.

continuing education for professional nurses.continuing education for professional nurses.

development of nursing leaders from under development of nursing leaders from under 

reserved groups.reserved groups. AbdellahAbdellah and colleagues developed a list of 21and colleagues developed a list of 21

nursing problems.nursing problems.

They also identified 10 steps to identify theThey also identified 10 steps to identify the

client·s problems client·s problems  11 nursing skills to be used in developing a11 nursing skills to be used in developing a

treatment typology treatment typology 

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10 STEPS TO IDENTIFY THE10 STEPS TO IDENTIFY THE

CLIENT·S PROBLEMSCLIENT·S PROBLEMS1.1. Learn to know the patient.Learn to know the patient.

2.2. Sort out relevant and significant data.Sort out relevant and significant data.

3.3. Make generalizations about available data in relation to similar Make generalizations about available data in relation to similar nursing problems presented by other patients.nursing problems presented by other patients.

4.4. Identify the therapeutic plan.Identify the therapeutic plan.

5.5. Test generalizations with the patient and make additionalTest generalizations with the patient and make additionalgeneralizations.generalizations.

6.6. Validate the patient·s conclusions about his nursing problems Validate the patient·s conclusions about his nursing problems 

7.7. Validate the patient·s conclusions about his nursing problems.Validate the patient·s conclusions about his nursing problems.

8.8. Explore the patient·s and family·s reaction to the therapeutic planExplore the patient·s and family·s reaction to the therapeutic planand involve them in the plan.and involve them in the plan.

9.9. Identify how the nurses feels about the patient·s nursing problems.Identify how the nurses feels about the patient·s nursing problems.

10.10. Discuss and develop a comprehensive nursing care plan.Discuss and develop a comprehensive nursing care plan.

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11 NURSING SKILLS11 NURSING SKILLS1.1. Observation of health statusObservation of health status

2.2. Skills of communicationSkills of communication

3.3. Application of knowledgeApplication of knowledge

4.4. Teaching of patients and familiesTeaching of patients and families5.5. Planning and organizing of workPlanning and organizing of work

6.6. Use of resource materialsUse of resource materials

7.7. Use of personal resourcesUse of personal resources

8.8. ProblemProblem--solvingsolving9.9. Direction of work of othersDirection of work of others

10.10. Therapeutic use of the selfTherapeutic use of the self

11.11. Nursing proceduresNursing procedures

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THE TWENTY ONETHE TWENTY ONE

NURSING PROBLEMSNURSING PROBLEMSTHREE MAJOR CATEGORIESTHREE MAJOR CATEGORIES

1.1. Physical , sociological , and emotionalPhysical , sociological , and emotional

needs of clients.needs of clients.

2.2. Types of interpersonal relationships Types of interpersonal relationships 

between the nurse and patient.between the nurse and patient.

3.3. Common elements of client care.Common elements of client care.

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TYPOLOGY OF THETYPOLOGY OF THE

21 NURSING21 NURSINGPROBLEMSPROBLEMS

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BASIC TO ALL PATIENTSBASIC TO ALL PATIENTS1.1. To maintain good hygiene and physicalTo maintain good hygiene and physical

comfort.comfort.

2.2. To promote optimal activity: exercise , To promote optimal activity: exercise , restrest and sleep.and sleep.

3.3. To promote safety through the prevention ofTo promote safety through the prevention of

accidents, injury, or other trauma andaccidents, injury, or other trauma and

through the prevention of the spread ofthrough the prevention of the spread ofinfection.infection.

4.4. To maintain good body mechanics andTo maintain good body mechanics and

prevent and correct deformities prevent and correct deformities 

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SUSTENAL CARE NEEDSSUSTENAL CARE NEEDS5.5. To facilitate the maintenance of a supply of oxygen toTo facilitate the maintenance of a supply of oxygen toall body cells.all body cells.

6.6. To facilitate the maintenance of nutritionTo facilitate the maintenance of nutrition of all body of all body 

cells.cells.7.7. To facilitate the maintenance of elimination.To facilitate the maintenance of elimination.

8.8. To facilitate the maintenance of fluid and electrolyteTo facilitate the maintenance of fluid and electrolytebalance.balance.

9.9. To recognize the physiological responses of the body toTo recognize the physiological responses of the body to

disease conditions.disease conditions.10.10. To facilitate the maintenance of regulatory To facilitate the maintenance of regulatory 

mechanisms and functions.mechanisms and functions.

11.11. To facilitate the maintenance of sensory functionTo facilitate the maintenance of sensory function

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REMEDIAL CARE NEEDS12.12. To identify and accept positive and negativeTo identify and accept positive and negativeexpressions, feelings, and reactions.expressions, feelings, and reactions.

13.13. To identify and accept the interrelatedness of emotions To identify and accept the interrelatedness of emotions and organic illness.and organic illness.

14.14. To facilitate the maintenance of effective verbal andTo facilitate the maintenance of effective verbal andnon verbal communication.non verbal communication.

15.15. To promote the development of productiveTo promote the development of productiveinterpersonal relationships.interpersonal relationships.

16.16. To facilitate progress toward achievement of personalTo facilitate progress toward achievement of personal

spiritual goals.spiritual goals.17.17. To create and or maintain a therapeutic environment.To create and or maintain a therapeutic environment.

18.18. To facilitate awareness of self as an individualTo facilitate awareness of self as an individual withwithvarying physical  , emotional , and developmentalvarying physical  , emotional , and developmentalneeds.needs.

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RESTORATIVE CARE NEEDSRESTORATIVE CARE NEEDS19.19. To accept the optimum possible goals inTo accept the optimum possible goals in

the light of limitations, physical andthe light of limitations, physical and

emotional.emotional.20.20. To use community resources as an aid inTo use community resources as an aid in

resolving problems arising from illness.resolving problems arising from illness.

21.21. To understand the role of social problems To understand the role of social problems as influencing factors in the case of illness.as influencing factors in the case of illness.

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METAPARADIGMMETAPARADIGM PERSONPERSON: The recipients of nursing care having physical , : The recipients of nursing care having physical , emotional , and sociologic needs that may be overt or covert.emotional , and sociologic needs that may be overt or covert.

ENVIRONMENTENVIRONMENT: Not clearly defined. Some discussion: Not clearly defined. Some discussion

indicates that clients interact with their environment, ofindicates that clients interact with their environment, ofwhich nurse is a part.which nurse is a part.

HEALTHHEALTH: A state when the individual has no unmet needs : A state when the individual has no unmet needs and no anticipated or actual impairment.and no anticipated or actual impairment.

NURSINGNURSING: Broadly grouped in ´21 nursing problems,µ which: Broadly grouped in ´21 nursing problems,µ which

center around needs for hygiene , comfort, activity, rest, center around needs for hygiene , comfort, activity, rest, safety, oxygen , nutrition , elimination , hydration , physicalsafety, oxygen , nutrition , elimination , hydration , physicaland emotional health promotion , interpersonal relationships, and emotional health promotion , interpersonal relationships, and development of selfand development of self--awareness. Nursing care is doingawareness. Nursing care is doingsomething for an individualsomething for an individual..

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IDA JEAN ORLANDOIDA JEAN ORLANDO

(NURSING PROCESS THEORY)(NURSING PROCESS THEORY)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT In the late 1950s, In the late 1950s, OrlandoOrlando developed her theory inductively developed her theory inductively 

through an empirical study of nursing practice.through an empirical study of nursing practice.

For 3 years, she recorded 2000 observations between a nurse andFor 3 years, she recorded 2000 observations between a nurse and

patient interactions.patient interactions. She was only able to categorize the records as "good" or "bad"She was only able to categorize the records as "good" or "bad"

nursing.nursing.

According to records:  According to records:  

*Good Nursing*Good Nursing ² ² nurse· s focus was on the patient· s immediatenurse· s focus was on the patient· s immediate

verbal and nonverbalverbal and nonverbal behaviorbehavior from thefrom the beginning throughbeginning throughthe end of the contactthe end of the contact

*Bad Nursing*Bad Nursing ² ² nurse· s focus was on a prescribed activity or nurse· s focus was on a prescribed activity or 

something that had nothing to dosomething that had nothing to do with thewith the patient· s patient· s 

behaviorbehavior

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Based on this research , her formulations Based on this research , her formulations 

were validated , thus she extended her were validated , thus she extended her theory to include the entire nursingtheory to include the entire nursing

practice system which then evolved as practice system which then evolved as 

´Nursing Process Disciplineµ´Nursing Process Disciplineµ

Orlando'sOrlando's theory remains one the of thetheory remains one the of the

most effective practice theories available.most effective practice theories available.

Many theory scholars utilized her concept Many theory scholars utilized her concept 

as basis for their further studies.as basis for their further studies.

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ASSUMPTIONS Assumptions about Nurses:Assumptions about Nurses:

´The nurse·s reaction to each patient ´The nurse·s reaction to each patient  is uniqueµis uniqueµ

´Nurses should not add to the´Nurses should not add to the patient·s distressµpatient·s distressµ ´The nurse·s mind is the major tool´The nurse·s mind is the major tool for helpingfor helping

patientsµpatientsµ

´The nurse·s use of automatic ´The nurse·s use of automatic  responses responses 

prevents theprevents the responsibility of nursing fromresponsibility of nursing from beingbeingfulfilledµfulfilledµ

´Nurse·s practice is improved´Nurse·s practice is improved throughthrough selfself--reflectionµreflectionµ

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Assumptions about Patients:Assumptions about Patients: ´Patients· needs for help are uniqueµ´Patients· needs for help are uniqueµ

´Patients have an initial ability to´Patients have an initial ability tocommunicate their needs for helpµcommunicate their needs for helpµ

´When patients cannot meet their own´When patients cannot meet their ownneeds they become distressedµneeds they become distressedµ

´The patient·s behaviour is meaningfulµ´The patient·s behaviour is meaningfulµ

´Patients are able and willing to´Patients are able and willing tocommunicate verbally (and noncommunicate verbally (and non-- verbally verbally when unable towhen unable to communicate verbally)µcommunicate verbally)µ

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Assumptions about the nurseAssumptions about the nurse--patient patient 

situation:situation:

´The nurse´The nurse--patient situation is apatient situation is adynamic wholeµdynamic wholeµ

´The phenomenon of the nurse´The phenomenon of the nurse--patient encounter represents patient encounter represents a major a major source of nursingsource of nursing knowledgeµknowledgeµ

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Assumptions about Nursing:Assumptions about Nursing: ´Nursing is a distinct profession´Nursing is a distinct profession

separate from other disciplinesµseparate from other disciplinesµ

´Professional nursing has a distinct ´Professional nursing has a distinct function and product (outcome)µfunction and product (outcome)µ

´There is a difference between lay ´There is a difference between lay andandprofessional nursingµprofessional nursingµ

´Nursing is aligned with medicineµ´Nursing is aligned with medicineµ

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METAPARADIGMMETAPARADIGM PERSONPERSON: Unique individual behaving verbally : Unique individual behaving verbally nonverbally. Assumption is that individuals are at nonverbally. Assumption is that individuals are at times able to meet their own needs and at other times able to meet their own needs and at other 

times unable to do so.times unable to do so. ENVIRONMENTENVIRONMENT: Not defined: Not defined

HEALTHHEALTH: Not defined. Assumption is that being: Not defined. Assumption is that beingwithout emotional or physical discomfort and havingwithout emotional or physical discomfort and having

a sense of wella sense of well--being contribute to a healthy state.being contribute to a healthy state. NURSINGNURSING: Professional nursing is conceptualized as : Professional nursing is conceptualized as 

finding out and meeting the client·s immediate needfinding out and meeting the client·s immediate needfor help.for help.

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LYDIA HALLLYDIA HALL((THREE INTERLOCKING CIRCLES THEORY)THREE INTERLOCKING CIRCLES THEORY)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT To provide professional nursing care toTo provide professional nursing care to

people past the acute stage of illness. Shepeople past the acute stage of illness. She

conceptualized three components ofconceptualized three components of

Nursing:Nursing: CARECARE ,  , CORECORE , and , and CURECURE..

CARECARE represents nurturance and is exclusive torepresents nurturance and is exclusive to

nursing.nursing.

CORECORE involves the therapeutic use of self andinvolves the therapeutic use of self andemphasizes the use of reflection.emphasizes the use of reflection.

CURECURE focuses on nursing related to the physician·s focuses on nursing related to the physician·s 

order.order.

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VIEWS OF COMPONENTSVIEWS OF COMPONENTS PERSONPERSON: Client is composed of body, pathology, and: Client is composed of body, pathology, and

person. People set their own goals and are capable ofperson. People set their own goals and are capable oflearning and growing.learning and growing.

ENVIRONMENTENVIRONMENT: Should facilitate achievement of the: Should facilitate achievement of theclient·s personal goals.client·s personal goals.

HEALTHHEALTH: Development of a mature self: Development of a mature self--identity that identity that assists in the conscious selection of actions that assists in the conscious selection of actions that 

facilitate growth.facilitate growth. NURSINGNURSING: Caring is the nurse·s primary function.: Caring is the nurse·s primary function.

Professional nursing is most important during theProfessional nursing is most important during therecuperative period.recuperative period.

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JOYCE TRAVELBEEJOYCE TRAVELBEE(HUMAN(HUMAN--TOTO--HUMAN RELATIONSHIP MODEL)HUMAN RELATIONSHIP MODEL)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENTTo assist individuals, families, communities, To assist individuals, families, communities, 

and groups to prevent or cope with illness, and groups to prevent or cope with illness, 

regain health , finding meaning in illness, regain health , finding meaning in illness, or maintaining , maximal degree of health.or maintaining , maximal degree of health.

She further viewed that interpersonalShe further viewed that interpersonal

process is a humanprocess is a human--toto--human relationshiphuman relationshipformed during illness and ´experience offormed during illness and ´experience of

sufferingµ.sufferingµ.

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METAPARADIGMMETAPARADIGM PERSONPERSON: A unique , irreplaceable individual who is in: A unique , irreplaceable individual who is in

a continuous process of becoming , evolving , anda continuous process of becoming , evolving , andchanging.changing.

ENVIRONMENTENVIRONMENT: Not defined: Not defined

HEALTHHEALTH: Heath includes the individual·s perceptions : Heath includes the individual·s perceptions of health and the absence of disease.of health and the absence of disease.

NURSINGNURSING: An interpersonal process whereby the: An interpersonal process whereby theprofessional nurse practitioner assists an individual , professional nurse practitioner assists an individual , family, or community to prevent or cope with thefamily, or community to prevent or cope with theexperience of illness and suffering , and if necessary, experience of illness and suffering , and if necessary, to find meaning in these experiences.to find meaning in these experiences.

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MARTHA ROGERSMARTHA ROGERS

(SCIENCE OF UNITARY HUMAN BEINGS)(SCIENCE OF UNITARY HUMAN BEINGS)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT Her theory contains complex conceptualizations Her theory contains complex conceptualizations 

related to multiple scientific disciplines.related to multiple scientific disciplines.

To Rogers, unitary man is a dynamic energy To Rogers, unitary man is a dynamic energy field in constant interaction with thefield in constant interaction with the

environment, both of which are infinite.environment, both of which are infinite.

She asserted that human beings are more thanShe asserted that human beings are more than

and different from the sum if their parts ; theand different from the sum if their parts ; the

distinctive properties of the whole aredistinctive properties of the whole are

significantly different from its parts.significantly different from its parts.

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Furthermore , she believed that both human beings Furthermore , she believed that both human beings 

and environment are characterized by pattern , aand environment are characterized by pattern , a

universe of open systems, and four dimensionality.universe of open systems, and four dimensionality. According to Rogers, UNITARY MAN:According to Rogers, UNITARY MAN:

Is an Irreducible , FourIs an Irreducible , Four--Dimensional Energy FieldDimensional Energy Field

identified by Patternidentified by Pattern

Manifests Characteristics different from the Sum ofManifests Characteristics different from the Sum of

the Partsthe Parts

Interacts Continuously and Creatively with theInteracts Continuously and Creatively with the

EnvironmentEnvironment

Behaves as a TotalityBehaves as a Totality

As a Sentient Being , Participates Creatively inAs a Sentient Being , Participates Creatively in

changechange

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Nurses applying Roger·s Theory in practice:Nurses applying Roger·s Theory in practice:Focus on the Person·s WholenessFocus on the Person·s Wholeness

Seek to Promote Symphonic Interaction between theSeek to Promote Symphonic Interaction between the

Two Energy Fields (Human and Environment) toTwo Energy Fields (Human and Environment) to

Strengthen the Coherence and Integrity of theStrengthen the Coherence and Integrity of thePersonPerson

Coordinate the Human Field with theCoordinate the Human Field with the RhythmicitiesRhythmicities

of the Environmental Field and ,of the Environmental Field and ,

Direct and Redirect Patterns of Interaction betweenDirect and Redirect Patterns of Interaction betweenthe Two Energy Fields to Promote Maximum Healththe Two Energy Fields to Promote Maximum Health

Potential.Potential.

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METAPARADIGMMETAPARADIGM PERSONPERSON: Unitary man , a four: Unitary man , a four--dimensional energy field.dimensional energy field.

ENVIRONMENTENVIRONMENT: Encompasses all that is outside any : Encompasses all that is outside any 

given human field. Person exchanging matter andgiven human field. Person exchanging matter and

energy.energy.

HEALTHHEALTH: Not specifically addressed , but emerges out of: Not specifically addressed , but emerges out of

interaction between human and environment, moves interaction between human and environment, moves 

forward , and maximizes human potential.forward , and maximizes human potential.

NURSINGNURSING: A learned profession that is both science and: A learned profession that is both science and

art. The professional practice of nursing is creative andart. The professional practice of nursing is creative and

imaginative and exists to serve people.imaginative and exists to serve people.

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IMOGENE M. KINGIMOGENE M. KING

(GOAL ATTAINMENT THEORY)(GOAL ATTAINMENT THEORY)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT TTo help the client reestablish a positive adaptation too help the client reestablish a positive adaptation to

his or her environment. She described nursing as ahis or her environment. She described nursing as a

helping profession that assists individuals and groups helping profession that assists individuals and groups 

in society to attain , maintain , and restore health. Ifin society to attain , maintain , and restore health. Ifthis is not possible , nurses help individuals die withthis is not possible , nurses help individuals die with

dignity.dignity.

In addition , King viewed nursing as an interactionIn addition , King viewed nursing as an interaction

process between client and nurse whereby duringprocess between client and nurse whereby duringperceiving , setting goals, and acting on them , perceiving , setting goals, and acting on them , 

transactions occur and goals are achievedtransactions occur and goals are achieved

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DYNAMIC INTERACTING SYSTEMSDYNAMIC INTERACTING SYSTEMSyy THREE SYSTEMSTHREE SYSTEMS in the conceptualin the conceptual

framework:framework:

yyPERSONAL SYSTEMSPERSONAL SYSTEMS (the(the

individual)individual)

yyINTERPERSONAL SYSTEMSINTERPERSONAL SYSTEMS

(individuals interacting with(individuals interacting with

one another)one another)

yySOCIAL SYSTEMSSOCIAL SYSTEMS (groups of(groups of

people in a community/society people in a community/society 

sharing common goals, sharing common goals, 

interests, and values)interests, and values)

yy Study systems as aStudy systems as a WHOLEWHOLE rather thanrather than

as isolated parts of a systemas isolated parts of a system

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DYNAMIC INTERACTING SYSTEMSDYNAMIC INTERACTING SYSTEMSElements of each SystemElements of each System

yy GOAL: HealthGOAL: Health

yy STRUCTURE: 3 open systemsSTRUCTURE: 3 open systems

yyFUNCTIONS: identified in theFUNCTIONS: identified in thereciprocal relationships as they reciprocal relationships as they 

interactinteract

yy RESOURCES: essential to keepRESOURCES: essential to keep

systems in harmonysystems in harmony

yy People & moneyPeople & money

yy DECISION MAKING: critical toDECISION MAKING: critical to

perform functions and attainperform functions and attain

goalsgoals

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PERSONAL SYSTEM CONCEPTSPERSONAL SYSTEM CONCEPTSyy PerceptionPerception

yy SelfSelf

yy awareness of being a person separate from othersawareness of being a person separate from others

yy

Grow

th and Developmen

tG

row

th and Developmen

t

yy Body ImageBody Image

yy personal & sub jective; acquired or learned; dynamic andpersonal & sub jective; acquired or learned; dynamic and

changingchanging

yy includes how person sees self & other·s reactions to one·s includes how person sees self & other·s reactions to one·s 

appearance)appearance)yy SpaceSpace

yy TimeTime

yy LearningLearning (1986 , not (1986 , not defined)defined)

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INTERPERSONAL SYSTEM CONCEPTSINTERPERSONAL SYSTEM CONCEPTS INTERACTIONINTERACTION

COMMUNICATIONCOMMUNICATION

TRANSACTIONSTRANSACTIONS

ROLEROLE

STRESSSTRESS

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METAPARADIGMMETAPARADIGM PERSONPERSON: Biopsychosocial being: Biopsychosocial being

ENVIRONMENTENVIRONMENT: Internal and external: Internal and externalenvironment continually interacts to assist inenvironment continually interacts to assist inadjustments to change.adjustments to change.

HEALTHHEALTH: A dynamic life experience with: A dynamic life experience withcontinued goal attainment and adjustment tocontinued goal attainment and adjustment to

stressors.stressors. NURSINGNURSING: Perceiving , thinking , relating , : Perceiving , thinking , relating , 

 judging , and acting with an individual who judging , and acting with an individual whocomes to a nursing situations.comes to a nursing situations.

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BETTY NEUMANBETTY NEUMAN

((HEALTH CARE SYSTEM MODEL)HEALTH CARE SYSTEM MODEL)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENTTo address the effects of stress and reactions toTo address the effects of stress and reactions toit on the development and maintenance ofit on the development and maintenance ofhealth. The concern of nursing is to prevent health. The concern of nursing is to prevent 

stress invasion , to protect the client·s basic stress invasion , to protect the client·s basic structure and to obtain or maintain astructure and to obtain or maintain amaximum level of wellness. The nurse helps themaximum level of wellness. The nurse helps theclient, through primary, secondary, andclient, through primary, secondary, and

tertiary prevention modes, to adjust totertiary prevention modes, to adjust toenvironmental stressors and maintain client environmental stressors and maintain client stability.stability.

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VIEWS OF COMPONENTSVIEWS OF COMPONENTS PERSONPERSON: A client system that is composed of: A client system that is composed of

physiologic, psychological , sociocultural , andphysiologic, psychological , sociocultural , and

environmental variables.environmental variables.

ENVIRONMENTENVIRONMENT: Internal and external forces : Internal and external forces surrounding humans at any time.surrounding humans at any time.

HEALTHHEALTH: Health or wellness exists if all parts and: Health or wellness exists if all parts and

subparts are in harmony with the whole person.subparts are in harmony with the whole person.

NURSINGNURSING: Nursing is a unique profession in that it is : Nursing is a unique profession in that it is 

concerned with all the variables affecting anconcerned with all the variables affecting an

individual·s response to stressors.individual·s response to stressors.

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MYRA ESTRINE LEVINEMYRA ESTRINE LEVINE

(CONSERVATION MODEL)(CONSERVATION MODEL)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT Using conservation activities aimed at Using conservation activities aimed at 

optimal use of client·s resources.optimal use of client·s resources.

She advocated that nursing is a humanShe advocated that nursing is a human

interaction and proposed 4 conservationinteraction and proposed 4 conservation

principles of nursing which areprinciples of nursing which are

concerned with the unity and integrity concerned with the unity and integrity 

of the individual.of the individual.

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´FOUR CONSERVATION´FOUR CONSERVATION

PRINCIPLESµPRINCIPLESµ1.1. CONSERVATION OF ENERGYCONSERVATION OF ENERGY--The human body The human body 

functions by utilizing energy. The human body functions by utilizing energy. The human body 

needs energy producing input (food , oxygen , fluids)needs energy producing input (food , oxygen , fluids)

to allow energy utilization as output.to allow energy utilization as output.

2.2. CONSERVATION OF STRUCTURAL CONSERVATION OF STRUCTURAL 

INTEGRITYINTEGRITY--The human body has physicalThe human body has physical

bounda

rie

s(Sk

in and Mu

cou

sMem

brane)

tha

tmu

st 

bounda

rie

s(Sk

in and Mu

cou

sMem

brane)

tha

tmu

st be maintained to facilitate health and prevent be maintained to facilitate health and prevent 

harmful agents from entering the body.harmful agents from entering the body.

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3.3. CONSERVATION OF PERSONAL CONSERVATION OF PERSONAL 

INTEGRITYINTEGRITY--The nursing intervention are basedThe nursing intervention are based

on the conservation of the individual client·s on the conservation of the individual client·s personality. Every individual has a sense ofpersonality. Every individual has a sense of

identity, self worth and self esteem , which must identity, self worth and self esteem , which must 

be preserved and enhanced by nurses.be preserved and enhanced by nurses.

4.4. CONSERVATION OF SOCIAL CONSERVATION OF SOCIAL INTEGRITYINTEGRITY--

The social integrity of the client reflects theThe social integrity of the client reflects the

family and the community in which the client family and the community in which the client 

functions. Health Care institutions may separatefunctions. Health Care institutions may separate

individuals from their family. It is important for individuals from their family. It is important for 

nurses to consider the individual in the context nurses to consider the individual in the context 

of the family.of the family.

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METAPARADIGMMETAPARADIGM PERSONPERSON: A Holistic Being: A Holistic Being

ENVIRONMENTENVIRONMENT: Broadly, includes all the: Broadly, includes all the

individual·s experiences.individual·s experiences. HEALTHHEALTH: The maintenance of the client·s : The maintenance of the client·s 

unity and integrity.unity and integrity.

NURSINGNURSING: A discipline rooted in the organic : A discipline rooted in the organic dependency of the individual human beingdependency of the individual human being

on his or her relationship with others.on his or her relationship with others.

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SISTER CALLISTA ROYSISTER CALLISTA ROY

(ADAPTATION THEORY)(ADAPTATION THEORY)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT ViewedViewed humans as humans as BiopsychosocialBiopsychosocial beings constantly beings constantly 

interacting with a changing environment and who cope withinteracting with a changing environment and who cope with

their environment throughtheir environment through BiopsychosocialBiopsychosocial adaptationadaptation

mechanisms.mechanisms. Focuses on the ability of Individuals. , families, groups, Focuses on the ability of Individuals. , families, groups, 

communities, or societies to adapt to change.communities, or societies to adapt to change.

The degree of internal or external environmental changeThe degree of internal or external environmental change

and the person·s ability to cope with that change is likely toand the person·s ability to cope with that change is likely to

determine the person·s health status.determine the person·s health status.

Nursing interventions are aimed at promoting physiologic, Nursing interventions are aimed at promoting physiologic, 

psychologicpsychologic, and social functioning or adaptation. , and social functioning or adaptation.

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4 MODES4 MODES OF ADAPTATIONOF ADAPTATION1.PHYSIOLOGIC1.PHYSIOLOGIC--PHYSICAL MODEPHYSICAL MODE

Behavior Behavior pertaining to the physicalpertaining to the physical

aspect of the human systemaspect of the human system Physical and chemical processes Physical and chemical processes 

Nurse must be knowledgeable about Nurse must be knowledgeable about normal processesnormal processes

5 needs (Oxygenation , Nutrition , 5 needs (Oxygenation , Nutrition , Elimination , Activity & Rest, andElimination , Activity & Rest, andProtectionProtection

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2. SELF CONCEPT2. SELF CONCEPT--GROUP IDENTITY MODEGROUP IDENTITY MODETheThe composite of beliefs and feelings composite of beliefs and feelings 

held about oneself at a given timeheld about oneself at a given time

Focus on the psychological and spiritualFocus on the psychological and spiritual

aspects of the human systemaspects of the human systemNeed to know who one is, so that oneNeed to know who one is, so that one

can exist with a state of unity, meaning , can exist with a state of unity, meaning , and purposefulnessand purposefulness

2 modes (physical self , and personal self)2 modes (physical self , and personal self)Goal: psychological integrityGoal: psychological integrity

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3. ROLE FUNCTION MODE3. ROLE FUNCTION MODESet Set of expectations about how aof expectations about how a

person occupying one positionperson occupying one position

behaves toward a person occupyingbehaves toward a person occupyinganother positionanother position

Basic needBasic need--social integrity, the needsocial integrity, the need

to know who one is in relation toto know who one is in relation to

othersothers

Goal: Social integrityGoal: Social integrity

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4. INTERDEPENDENCE MODEINTERDEPENDENCE MODEBehaviourBehaviour pertaining to interdependent pertaining to interdependent relationships of individuals and groupsrelationships of individuals and groups

Focus on the close relationships of people andFocus on the close relationships of people and

their purposetheir purposeEach relationship exists for some reasonEach relationship exists for some reason

Involves the willingness and ability to give toInvolves the willingness and ability to give toothers and accept from othersothers and accept from others

Balance results in feelings of being valued andBalance results in feelings of being valued andsupported by otherssupported by others

Basic needBasic need--feeling of security in relationshipsfeeling of security in relationships

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METAPARADIGMMETAPARADIGM PERSONPERSON: Biopsychological beign and the recipient of: Biopsychological beign and the recipient of

nursing care.nursing care.

ENVIRONMENTENVIRONMENT: All conditions, circumstances, and: All conditions, circumstances, and

influences surrounding and affecting theinfluences surrounding and affecting thedevelopment of an organism or groups of organisms.development of an organism or groups of organisms.

HEALTHHEALTH: The person encounters adaptation problems : The person encounters adaptation problems 

in changing the environment.in changing the environment.

NURSINGNURSING: A theoretical system of knowledge that : A theoretical system of knowledge that 

prescribes a process of analysis and action related toprescribes a process of analysis and action related to

the care of the ill or potentially ill persons.the care of the ill or potentially ill persons.

JEAN WATSONJEAN WATSON

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JEAN WATSONJEAN WATSON

(HUMAN CARING THEORY)(HUMAN CARING THEORY)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT Focus on curative factors derived from aFocus on curative factors derived from a

humanistic perspective and fromhumanistic perspective and from

scientific knowledge.scientific knowledge. Watson·s Theory of Human Caring has Watson·s Theory of Human Caring has 

received worldwide recognition and is areceived worldwide recognition and is a

major force in redefining nursing as amajor force in redefining nursing as acaringcaring--healing health model.healing health model.

WATSON·SWATSON·S

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WATSON·SWATSON·S

´CORE OF NURSINGµ´CORE OF NURSINGµForming a HumanisticForming a Humanistic--Altruistic System ofAltruistic System of

ValuesValues

Insti

lling

Fa

ith and HopeIn

still

ing

Fa

ith and HopeCultivating Sensitivity to One·s Self andCultivating Sensitivity to One·s Self and

OthersOthers

Developing a HelpingDeveloping a Helping--Trust (Human Care)Trust (Human Care)

RelationshipRelationship

Promoting and Accepting the Expression ofPromoting and Accepting the Expression of

Positive and Negative FeelingsPositive and Negative Feelings

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WATSON·SWATSON·S

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WATSON·SWATSON·S

´ASSUMPTIONS OF CARINGµ´ASSUMPTIONS OF CARINGµ Human Caring in Nursing is Not just anHuman Caring in Nursing is Not just an

Emotion , Concern , Attitude or Benevolent Emotion , Concern , Attitude or Benevolent 

Desire. Caring Connotes a Personal Response.Desire. Caring Connotes a Personal Response.

Caring is anCaring is an intersub jectintersub ject human process and is human process and is 

the Moralthe Moral IIdea of Nursing.dea of Nursing.

Caring can be Effectively Demonstrated Only Caring can be Effectively Demonstrated Only 

Interpersonally.Interpersonally. Effective Caring Promotes Health more the does Effective Caring Promotes Health more the does 

Curing.Curing.

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Caring responses accept a person not only as they Caring responses accept a person not only as they 

are now , but also for what the person may become.are now , but also for what the person may become.

A Caring Environment offers the Development ofA Caring Environment offers the Development ofPotential while Allowing the Person to Choose thePotential while Allowing the Person to Choose the

Best Action for the Self at a given point in time.Best Action for the Self at a given point in time.

Caring occasions involve action and choice by nurseCaring occasions involve action and choice by nurse

and client. If the caring occasion is transpersonal , and client. If the caring occasion is transpersonal , the limits of openness expand , as do humanthe limits of openness expand , as do human

capacities.capacities.

The most abstract characteristic of a caring person is The most abstract characteristic of a caring person is 

that the person is somehow responsive to another that the person is somehow responsive to another 

person as a unique individual , perceives the other·s person as a unique individual , perceives the other·s 

feelings, and sets one person apart from another.feelings, and sets one person apart from another.

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The Human Caring involves values, aThe Human Caring involves values, a

will and a commitment to care , will and a commitment to care , knowledge , caring actions andknowledge , caring actions and

consequences.consequences.

The Ideal and Value of Caring is aThe Ideal and Value of Caring is astarting point, a stance , and an attitudestarting point, a stance , and an attitude

that has to become a will , an intention , that has to become a will , an intention , 

a commitment, and a conscious a commitment, and a conscious  judgment that manifests itself in judgment that manifests itself in

concrete acts.concrete acts.

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METAPARADIGMMETAPARADIGM PERSONPERSON: A valued being to be cared for, : A valued being to be cared for, respected , nurtured , understood , and assisted , arespected , nurtured , understood , and assisted , afully functional , integrated self.fully functional , integrated self.

ENVIRONMENTENVIRONMENT: Social environment, caring and: Social environment, caring andthe culture of caring affect health.the culture of caring affect health.

HEALTHHEALTH: Physical , mental , and social wellness: Physical , mental , and social wellness

NURSINGNURSING: A humansci

ence of people and: A human

scien

ce of people andhuman health; illness experiences that arehuman health; illness experiences that are

mediated by professional , personal , scientific, mediated by professional , personal , scientific, aesthetic, and ethical human care transactions.aesthetic, and ethical human care transactions.

DOROTHY E JOHNSONDOROTHY E JOHNSON

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DOROTHY E. JOHNSONDOROTHY E. JOHNSON

(BEHAVIORAL SYSTEM MODEL)(BEHAVIORAL SYSTEM MODEL)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT To reduce stress so the client can recover as To reduce stress so the client can recover as 

quickly as possible. According to Johnson , quickly as possible. According to Johnson , 

each person as a behavioral system is each person as a behavioral system is composed of seven subsystems namely:composed of seven subsystems namely:

INGESTIVE , ELIMINATIVE , AFFILIATIVE , INGESTIVE , ELIMINATIVE , AFFILIATIVE , 

AGGRESSIVE , DEPENDENCE , AGGRESSIVE , DEPENDENCE , ACHIEVEMENT , and SEXUAL AND ROLEACHIEVEMENT , and SEXUAL AND ROLE

IDENTITY.IDENTITY.

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´SEVEN SUBSYTEMSµ´SEVEN SUBSYTEMSµ1.1. INGESTIVEINGESTIVE -- Taking in nourishment in socially andTaking in nourishment in socially andculturally acceptable ways.culturally acceptable ways.

2.2. ELIMINATIVEELIMINATIVE -- Riddling the body of waste inRiddling the body of waste in

socially culturally acceptable ways.socially culturally acceptable ways.3.3. AFFILIATIVEAFFILIATIVE -- Security seeking behaviorSecurity seeking behavior

4.4. AGGRESSIVEAGGRESSIVE -- SelfSelf--protective behavior.protective behavior.

5.5. DEPENDENCEDEPENDENCE -- NurturanceNurturance--seeking behaviorseeking behavior

6.6. ACHIEVEMENTACHIEVEMENT -- Master of oneself and one·s Master of oneself and one·s environment according to internalized standard ofenvironment according to internalized standard ofexcellence.excellence.

7.7. SEXUAL AND ROLE IDENTITY BEHAVIORSEXUAL AND ROLE IDENTITY BEHAVIOR

I dditi h i d th t h t i tI dditi h i d th t h t i t

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In addition , she viewed that each person strives toIn addition , she viewed that each person strives to

achieve balance and stability both internally andachieve balance and stability both internally and

externally and to function effectively by adjustingexternally and to function effectively by adjustingand adapting to environmental forces throughand adapting to environmental forces through

learned pattern of response. Furthermore , Shelearned pattern of response. Furthermore , She

believed that the patient strives to become abelieved that the patient strives to become a

person whose behavior is commensurate withperson whose behavior is commensurate withsocial demands ; who is able to modify his social demands ; who is able to modify his 

behavior in ways that support biologic behavior in ways that support biologic 

imperatives ; who is able to benefit to the fullest imperatives ; who is able to benefit to the fullest 

extent during illness from the health careextent during illness from the health careprofessional·s knowledge and skills ; and whoseprofessional·s knowledge and skills ; and whose

behavior does not give evidence of unnecessary behavior does not give evidence of unnecessary 

trauma as a consequence of illness.trauma as a consequence of illness.

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METAPARADIGMMETAPARADIGM PERSONPERSON: A system of interdependent parts with: A system of interdependent parts withpatterned , repetitive , and purposeful ways ofpatterned , repetitive , and purposeful ways ofbehaving.behaving.

ENVIRONMENTENVIRONMENT: All forces that affect the person and: All forces that affect the person andthat influence the behavioral systemthat influence the behavioral system

HEALTHHEALTH: Focus on person , not ill ness. Health is a: Focus on person , not ill ness. Health is adynamic state influenced by biologic, psychological , dynamic state influenced by biologic, psychological , and social factorsand social factors

NURSINGNURSING: Promotion of behavioral system , balance: Promotion of behavioral system , balanceand stability. An art and a science providing externaland stability. An art and a science providing externalassistance before and during balance disturbancesassistance before and during balance disturbances

ROSEMARIE RIZZO PARSEROSEMARIE RIZZO PARSE

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ROSEMARIE RIZZO PARSEROSEMARIE RIZZO PARSE

(HUMAN BECOMING THEORY)(HUMAN BECOMING THEORY)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT Parse·s Model of Human Becoming emphasizes Parse·s Model of Human Becoming emphasizes 

how individuals choose and bear responsibility how individuals choose and bear responsibility for patterns of personal health.for patterns of personal health.

She contends that the client, not the nurse is She contends that the client, not the nurse is the authority figure and decision maker.the authority figure and decision maker.

´In true presence the nurse·s whole being is ´In true presence the nurse·s whole being is 

immersed with the client as the other immersed with the client as the other illuminates the meanings of his or her situationilluminates the meanings of his or her situationand moves beyond the moment.µ(Parse , 1994)and moves beyond the moment.µ(Parse , 1994)

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She proposes She proposes THREE ASSUMPTIONSTHREE ASSUMPTIONS about about 

Human BecomingHuman Becoming::

1.1. Human Becoming is freely choosing personalHuman Becoming is freely choosing personalmeaning in situations in the intermeaning in situations in the inter--sub jectivesub jective

process relating value priorities.process relating value priorities.2.2.Human Becoming is coHuman Becoming is co--creating rhythmic creating rhythmic 

patterns or relating in mutual process withpatterns or relating in mutual process withthe universe.the universe.

3.3.Human Becoming is coHuman Becoming is co--transcendingtranscendingmultidimensionallymultidimensionally with the emergingwith the emergingpossiblespossibles..

Parse·s Three Assumptions focus onParse·s Three Assumptions focus on

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Parse·s Three Assumptions focus onParse·s Three Assumptions focus onMEANING , RHYTHMICITY andMEANING , RHYTHMICITY and

COTRANSCENDENCE.COTRANSCENDENCE.MEANINGMEANING arises from a person·s arises from a person·s 

interrelationship with the world and refers interrelationship with the world and refers 

to happenings to which the personto happenings to which the personattaches varying degrees of significance.attaches varying degrees of significance.

RHYTHMICITYRHYTHMICITY is the movement towardis the movement toward

greater diversity.greater diversity.

COTRANSCENDENCECOTRANSCENDENCE is the process ofis the process of

reaching out beyond the self.reaching out beyond the self.

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METAPARADIGMMETAPARADIGM PERSONPERSON: A major reason for nursing existence: A major reason for nursing existence

ENVIRONMENTENVIRONMENT: Man and environment interchange: Man and environment interchangeenergy to create what is in the world , and manenergy to create what is in the world , and man

chooses the meaning given to the situations he createschooses the meaning given to the situations he creates HEALTHHEALTH: A lived experience that is a process of being: A lived experience that is a process of being

and becomingand becoming

NURSINGNURSING: Nursing Practice is directed toward: Nursing Practice is directed toward

illuminating , synchronizing and mobilizing family illuminating , synchronizing and mobilizing family interrelationships in light of the meaning assigned tointerrelationships in light of the meaning assigned tohealth and its possibilities as language in thehealth and its possibilities as language in thecocreatedcocreated patterns of relating.patterns of relating.

DOROTHEA OREMDOROTHEA OREM

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DOROTHEA OREMDOROTHEA OREM

((SELFSELF--CARE THEORY)CARE THEORY)

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FOCUS/DEVELOPMENTFOCUS/DEVELOPMENT

Defined Nursing:Defined Nursing: ´́The ac t of assisting oth ers Th e ac t of assisting oth ers 

in th e provisio n and management o f selfin th e provisio n and management o f self--

care to maintain/improv e h uma nc are to maintain/improv e h uma n

func tio ning at ho me lev el o f effec tiv eness.µfunc tio ning at ho me lev el o f effec tiv eness.µ

Fo cuses o n a c tivities that a dult individua ls Fo cuses o n a c tivities that a dult individua ls 

p erform o n th eir o wn beha lf to maintain life , p erform o n th eir o wn beha lf to maintain life , 

h ea lth  a nd wellh ea lth  a nd well--being.being. Has a  stro ng h ea lth  pro motio n a ndHas a  stro ng h ea lth  pro motio n a nd

maintena nce fo cus.maintena nce fo cus.

Id tifi d l t d tId tifi d l t d t

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Identified 3 related concepts:Identified 3 related concepts:

SELFSELF--CARECARE ² ² activities an Individualactivities an Individual

performs independently throughout life toperforms independently throughout life topromote and maintain personal wellpromote and maintain personal well--

being.being.

SELFSELF--CARE DEFICITCARE DEFICIT ² ² results when selfresults when self--care agency (Individual·s ability) is not care agency (Individual·s ability) is not 

adequate to meet the known selfadequate to meet the known self--carecare

needs.needs.

NURSING SYSTEMNURSING SYSTEM ² ² nursing interventions nursing interventions needed when Individual is unable toneeded when Individual is unable to

perform the necessary selfperform the necessary self--care activities:care activities:

WHOLLY COMPENSATORYWHOLLY COMPENSATORY ²² nurse provides entire selfnurse provides entire self--

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WHOLLY COMPENSATORYWHOLLY COMPENSATORY  nurse provides entire selfnurse provides entire self

care for the client.care for the client.

Example: care of a new born , care of client recovering fromExample: care of a new born , care of client recovering from

surgery in a postsurgery in a post--anesthesiaanesthesia care unitcare unit

PARTIAL COMPENSATORYPARTIAL COMPENSATORY ² ² nurse and client performnurse and client perform

care , client can perform selected selfcare , client can perform selected self--care activities, but care activities, but 

also accepts care done by the nurse for needs the client also accepts care done by the nurse for needs the client 

cannot meet independently.cannot meet independently.

Example: Nurse can assist post operative client to ambulate , Example: Nurse can assist post operative client to ambulate , 

Nurse can bring a meal tray for client who can feed himselfNurse can bring a meal tray for client who can feed himself

SUPPORTIVESUPPORTIVE--EDUCATIVEEDUCATIVE ² ² nurse·s actions are to helpnurse·s actions are to help

the client develop/learn their own selfthe client develop/learn their own self--care abilities care abilities 

through knowledge , support and encouragementthrough knowledge , support and encouragement..Example: Nurse guides a mother how to breastfeed her baby, Example: Nurse guides a mother how to breastfeed her baby, 

CounselingCounseling a psychiatric client on more adaptive copinga psychiatric client on more adaptive coping

strategies.strategies.

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METAPARADIGMMETAPARADIGM PERSON:PERSON: An integrated whole composed of an internal physical , An integrated whole composed of an internal physical , 

psychologicpsychologic, and social nature with varying degrees of self , and social nature with varying degrees of self--carecare

ability ability 

ENVIRONMENT: Prevailing internal and external conditions inENVIRONMENT: Prevailing internal and external conditions in

some time and place frame of referencesome time and place frame of reference

HEALTH: A state of physical , mental , and social wellHEALTH: A state of physical , mental , and social well--being , andbeing , and

not merely the absence of disease or infirmitynot merely the absence of disease or infirmity

NURSING: An art through which the practitioner of nursing gives NURSING: An art through which the practitioner of nursing gives 

specialized assistance to persons with disabilities of such aspecialized assistance to persons with disabilities of such acharacter that greater than ordinary assistance is necessary tocharacter that greater than ordinary assistance is necessary to

meet daily needs for self care and to intelligently participate inmeet daily needs for self care and to intelligently participate in

the medical care they are receiving from the physicianthe medical care they are receiving from the physician

MADELEINE LEININGERMADELEINE LEININGER

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MADELEINE LEININGERMADELEINE LEININGER

(TRANSCULTURAL THEORY)(TRANSCULTURAL THEORY)

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FOCUS/DEVE

LOPMENT

FOCUS/DEVE

LOPMENT

The Culture Care Diversity and Universality theory, The Culture Care Diversity and Universality theory, 

according to Dr.according to Dr. LeiningerLeininger, focuses on describing ,  , focuses on describing , 

explaining and predicting nursing similarities andexplaining and predicting nursing similarities and

differences focused primarily on human care anddifferences focused primarily on human care andcaring in human cultures.caring in human cultures.

The Culture Care Diversity & Universality theory The Culture Care Diversity & Universality theory 

does not focus on medical symptoms, disease entities does not focus on medical symptoms, disease entities 

or treatments.or treatments.

It is instead focused on those methods of approach toIt is instead focused on those methods of approach to

care that means something to the people to whomcare that means something to the people to whom

the care is given.the care is given.

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METAPARADIGMMETAPARADIGM PERSON:PERSON: ShouldShould refer to families, groups, andrefer to families, groups, and

communitiescommunities

HEALTH:HEALTH: Not Not distinct to nursing as many distinct to nursing as many 

disciplines use this termdisciplines use this term ENVIRONMENT:ENVIRONMENT: IncludedIncluded events with meanings events with meanings 

and interpretations given to them in particular and interpretations given to them in particular 

physical , ecological , sociopolitical or culturalphysical , ecological , sociopolitical or cultural

setting.setting.

NURSING:NURSING: Care has the greatest meaning whichCare has the greatest meaning which

explains nursingexplains nursing

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 THE END THE END

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THANK YOUTHANK YOUVERY MUCH!!!VERY MUCH!!!

VLMPR2010VLMPR2010


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