From Novice to Expert Competent
Patricia E. Benner  Typically a nurse with 2-3 years
Introduction
 Dr Patricia Benner introduced the
concept that expert nurses develop
skills and understanding of patient care
over time through a sound educational
base as well as a multitude of
experiences.
 She proposed that one could gain
knowledge and skills ("knowing how")
without ever learning the theory
("knowing that").
 She further explains that the
development of knowledge in applied
disciplines such as medicine and nursing
is composed of the extension of
practical knowledge (know how)
through research and the
characterization and understanding of
the "know how" of clinical experience.
LEVELS OF NURSING EXPERIENCE
She described 5 levels of nursing experience as;
Novice
 Beginner with no experience
 Taught general rules to help perform
tasks
 Rules are: context-free, independent of
specific cases, and applied universally
 Rule-governed behavior is limited and
inflexible
 Ex. “Tell me what I need to do and I’ll
do it.”
Advanced Beginner
 Demonstrates acceptable performance
 Has gained prior experience in actual
situations to recognize recurring
meaningful components
 Principles, based on experiences, begin
to be formulated to guide actions
experience on the job in the same area
or in similar day-to-day situations
 More aware of long-term goals
 Gains perspective from planning own
actions based on conscious, abstract,
and analytical thinking and helps to
achieve greater efficiency and
organization
Proficient
 Perceives and understands situations
as whole parts
 More holistic understanding improves
decision-making
 Learns from experiences what to expect
in certain situations and how to modify
plans
Expert
 No longer relies on principles, rules, or
guidelines to connect situations and
determine actions
 Much more background of experience
 Has intuitive grasp of clinical situations
 Performance is now fluid, flexible, and
highly-proficient
 Different levels of skills reflect changes
in 3 aspects of skilled performance:
 Movement from relying on abstract
principles to using past concrete
experiences to guide actions
 Change in learner’s perception of
situations as whole parts rather than in
separate pieces
 Passage from a detached observer to an
involved performer, no longer outside
the situation but now actively engaged
in participation
SIGNIFICANCE OF THE THEORY
 These levels reflect movement from
reliance on past abstract principles to
the use of past concrete experience as
paradigms and change in perception of
 situation as a complete whole in which
certain parts are relevant
 Each step builds on the previous one as
abstract principles are refined and
expanded by experience and the
learner gains clinical expertise.
 This theory changed the profession's
understanding of what it means to be
an expert, placing this designation not
on the nurse with the most highly paid
or most prestigious position, but on the
nurse who provided "the most exquisite
nursing care.
 It recognized that nursing was poorly
served by the paradigm that called for
all of nursing theory to be developed by
researchers and scholars, but rather
introduced the revolutionary notion
that the practice itself could and should
inform theory.
CONCLUSION
 Nursing practice guided by the human
becoming theory live the processes of
the Parse practice methodology
illuminating meaning, synchronizing
rhythms, and mobilizing transcendence
 Research guided by the human
becoming theory sheds light on the
meaning of universal humanly lived
experiences such as hope, taking life
day-by-day, grieving, suffering, and
time passing.
Human-To-Human Relationship Model
Joyce Travelbee(1926-1973)
“The nurse is responsible for helping the
patient avoid and alleviate the distress of
unmet needs.” - Travelbee
Introduction
 Joyce Travelbee (1926-1973) developed
the Human-to-Human Relationship
Model presented in her
bookInterpersonal Aspects of Nursing
(1966, 1971).
 She dealt with the interpersonal aspects
of nursing.
 She explains “human-to-human
relationship is the means through which
the purpose of nursing if fulfilled”
Development of the Theory
 Travelbee based the assumptions of her
theory on the concepts of existentialism
by Soren Kierkegaard and logotherapy
by Viktor Frankl.
 Existential theory believes that that
humans are constantly faced choices
and conflicts and is accountable to the
choices we make in life
 Logotherapy theory was first proposed
by Viktor Frankel, a survivor of
Auschwitz, in his book Man's Search for
Meaning (1963).
 Logotherapy
Basic Concepts
Suffering
"An experience that varies in intensity, duration
and depth ... a feeling of unease, ranging from
mild, transient mental, physical or mental
discomfort to extreme pain and extreme
tortured ..."
Meaning
Meaning is the reason as oneself attributes
Nursing
 is to help man to find meaning in the
experience of illness and suffering.
 has a responsibility to help individuals
and their families to find meaning.
 The nurses' spiritual and ethical choices,
and perceptions of illness and suffering,
is crucial to helping to find meaning.
Hope
 Nurse's job is to help the patient to
maintain hope and avoid hopelessness.
  Hope is a faith that can and will be
change that would bring something
better with it.
 Hope's core lies in a fundamental trust
the outside world, and a belief that
others will help someone when you
need it.
Six important factors charecteristics of hope
are:
 It is strongly associated with
dependence on other people.
 It is future oriented.
 It is linked to elections from several
alternatives or escape routes out of its
situation.
 The desire to possess any object or
condition, to complete a task or have an
experience.
 Confidence that others will be there for
one when you need them.
 The hoping person is in possession of
courage to be able to acknowledge its
shortcomings and fears and go forward
towards its goal
Communications
"a strict necessity for good nursing care"
Using himself therapeutic
 " one is able to use itself therapeutic."
 Self-awareness and self-understanding,
understanding of human behavior, the
ability to predict one's own and others'
behavior are imporatnt in this process.
Targeted intellectual approach
Nurse must have a systematic intellectual
approach to the patient's situation.
Nursing Metaparadigms
Person
 Person is defined as a human being.
 Both the nurse and the patient are
human beings.
Health
 Health is subjective and objective.
 Subjective health is an individually
defined state of well being in accord
with self-appraisal of physical-
emotional-spiritual status.
 Objective health is an absence of
discernible disease, disability of defect
as measured by physical examination,
laboratory tests and assessment by
spiritual director or psychological
counselor.
Environment
Environment is not clearly defined.
Nursing
"an interpersonal process whereby the
professional nurse practitioner assists an
individual, family or community to prevent or
cope with experience or illness and suffering,
and if necessary to find meaning in these
experiences.”
Description of the theory
 Travelbee believed nursing is
accomplished through human-to-
human relationships that begin with the
original encounter and then progress
through stages of emerging identities,
developing feelings of empathy, and
later feelings of sympathy.
 The nurse and patient attain a rapport
in the final stage. For meeting the goals
of nursing it is a prerequisite to
achieving a genuine human-to-human
relationships.
 This relationship can only be
established by an interaction process.
It has five phases.
 The inaugural meeting or original
encounter
 Visibility of personal identities/
emerging identities.
  Empathy
 Sympathy
 Establishing mutual understanding and
contact/ rapport
Travelbee's ideas have greatly influenced the
hospice movement in the west.
Conclusion
 Travelbee's theory has significantly
influenced nursing and health care.
 Travelbee's ideas have greatly
influenced the hospice movement in
the west.
Human Becoming Theory
Rosemarie Rizzo Parse
THEORY DEVELOPMENT
 The human becoming theory was
developed as a human science nursing
theory in the tradition of Dilthey,
Heidegger, Sartre, Merleau-Ponty, and
Gadamer and Science of Unitary Human
Beings
by Martha Rogers .
 The assumptions underpinning the
theory were synthesized from works by
the European philosophers, Heidegger,
Sartre, and Merleau-Ponty, along with
works by the pioneer American nurse
theorist, Martha Rogers.
 The theory is structured around three
abiding themes: meaning, rhythmicity,
and transcendence.
ASSUMPTIONS
About man
 The human is coexisting while
coconstituting rhythmical patterns with
the universe.
 The human is open, freely choosing
meaning in situation, bearing
responsibility for decisions.
 The human is unitary, continuously
coconstituting patterns of relating.
 The human is transcending
multidimensionally with the possibles
About Becoming
 Becoming is unitary human-living-
health.
 Becoming is a rhythmically
coconstituting human-universe process.
 Becoming is the human’s patterns of
relating value priorities.
 Becoming is an intersubjective process
of transcending with the possibles.
 Becoming is unitary human’s emerging
Three Major Assumptions of Human Becoming
Meaning
 Human Becoming is freely choosing
personal meaning in situations in the
intersubjective process of living value
priorities.
 Man’s reality is given meaning through
lived experiences
 Man and environment cocreate
Rhythmicity
 Human Becoming is cocreating
rhythmical patterns of relating in
mutual process with the universe.
 Man and environment cocreate (
imaging, valuing, languaging) in
rhythmical patterns
Transcendence
 Human Becoming is cotranscending
multidimensionally with emerging
possibles.
 Refers to reaching out and beyond the
limits that a person sets
 One constantly transforms
SUMMARY OF THE THEORY
 Human Becoming Theory includes
Totality Paradigm
  Man is a combination of biological,
psychological, sociological and spiritual
factors
 Simultaneity Paradigm
 Man is a unitary being in continuous,
mutual interaction with environment
 Originally Man-Living-Health Theory
NURSING PARADIGMS AND PARSE'S THEORY
Person
Open being who is more than and different
from the sum of the parts
Environment
Everything in the person and his experiences
Inseparable, complimentary to and evolving
with
Health
Open process of being and becoming. Involves
synthesis of values
Nursing
A human science and art that uses an abstract
body of knowledge to serve people
SYMBOL OF HUMAN BECOMING THEORY
Black and white = opposite paradox significant
to ontology of human becoming and green is
hope
Center joined =co created mutual human
universe process at the ontological level &
nurse-person process
Green and black swirls intertwining = human-
universe co creation as an ongoing process of
becoming
STRENGTH AND WEAKNESSES
Strengths
 Differentiates nursing from other
disciplines
 Practice - Provides guidelines of care
and useful administration
 Useful in Education
 Provides research methodologies
 Provides framework to guide inquiry of
other theories (grief, hope, laughter,
etc.)
Weaknesses
 Research considered to be in a “closed
circle”
 Rarely quantifiable results - Difficult to
compare to other research studies, no
control group, standardized questions,
etc.
 Does not utilized the nursing
process/diagnoses
 Negates the idea that each person
engages in a unique lived experience
 Not accessible to the novice nurse
 Not applicable to acute, emergent care
Ramona Mercer's Contribution to Nursing
Theory: Maternal Role Attainment Theory
 The Maternal Role Attainment Theory,
a mid-range theory, was developed to
serve as a framework for nurses to
provide appropriate health care
interventions for nontraditional
mothers in order for them to
successfully adopt a strong maternal
identity. Though this theory can be used
throughout pregnancy and after
childbirth to help mothers connect with
their babies, it can also be beneficial for
adoptive mothers, foster mothers, or
others who have had nontraditional
motherhood unexpectedly, such as
taking care of a relative or friend's child
as the result of a death. The process
helps the mother form an attachment
 to the infant, which in turn helps the
infant form an attachment with the
mother. This helps in the building of the
mother-child relationship as the infant
grows.
 The primary concept of this theory is
the developmental and interactional
process, which occurs over a period of
time. In the process, the mother bonds
with the infant, acquires competence in
general caretaking tasks, and comes to
express joy and pleasure in the
maternal role.
 The nursing process follows four stages
of acquisition in the Maternal Role
Attainment Theory. First is the
anticipatory stage, which addresses the
social and psychological adaptation to
the maternal role, and learning
expectations. Second is the formal
stage, which is the assumption of the
role at birth, and addresses behaviors
guided by others in the mother's social
system and network. For example, "My
mother always said..." Third is the
informal stage, in which the mother
develops her own ways of mothering
not conveyed by her social system.
Finally, the fourth stage is the personal
stage, in which the mother experiences
harmony, confidence, and competence
in her maternal role.
Ida Jean Orlando
Deliberative Nursing Process Theory
 Orlando developed her theory from a
study conducted at the Yale University
School of Nursing, integrating mental
health concepts into a basic nursing
curriculum. She proposed that
“patients have their own meanings and
interpretations of situations and
therefore nurses must validate their
inferences and analyses with patients
before drawing conclusions.”
 The theory was published in The
Dynamic Nurse-Patient Relationship:
Function, Process, and Principles (NLN
Classics in Nursing Theory) in 1961. Her
book purposed a contribution to
concern about the nurse-patient
relationship, the nurse’s professional
role and identity, and the knowledge
development distinct to nursing.
 Orlando’s nursing theory stresses the
reciprocal relationship between
patient and nurse. What the nurse and
the patient say and do affects them
both. She views the professional
function of nursing as finding out and
meeting the patient’s immediate need
for help.
 She also described her model as
revolving around the following five
major interrelated concepts: function
of professional nursing, presenting
behavior, immediate reaction, nursing
process discipline, and improvement.
The function of professional nursing is
the organizing principle. Presenting
behavior is the patient’s problematic
situation. The immediate reaction is
the internal response. The nursing
process discipline is the investigation
into the patient’s needs. And lastly,
improvement is the resolution to the
patient’s situation.
 The Deliberative Nursing Process has
five stages: assessment, diagnosis,
planning, implementation, and
evaluation. Nurses use the standard
nursing process in Orlando’s Nursing
Process Discipline Theory to produce
positive outcomes or patient
improvement. Orlando’s key focus was
the definition of the function of nursing.
The model provides a framework for
nursing, but the use of her theory does
not exclude nurses from using other
nursing theories while caring for
patients.
Hildegard Peplau
Interpersonal Relations Theory
 Peplau’s theory defined Nursing as “An
interpersonal process of therapeutic
interactions between an individual
who is sick or in need of health
 services and a nurse especially
educated to recognize, respond to the
need for help.” It is a “maturing force
and an educative instrument” involving
an interaction between two or more
individuals with a common goal.
 In nursing, this common goal provides
the incentive for the therapeutic
process in which the nurse and patient
respect each other as individuals, both
of them learning and growing as a
result of the interaction. An individual
learns when she or he selects stimuli in
the environment and then reacts to
these stimuli.
Assumptions
The assumptions of Peplau’s Interpersonal
Relations Theory are:
(1) Nurse and patient can interact.
(2) Peplau emphasized that both the patient
and nurse mature as the result of the
therapeutic interaction.
(3) Communication and interviewing skills
remain fundamental nursing tools.
(4) Peplau believed that nurses must clearly
understand themselves to promote their
client’s growth and to avoid limiting client’s
choices to those that nurses value.
Major Concepts
The theory explains the purpose of nursing is to
help others identify their felt difficulties and
that nurses should apply principles of human
relations to the problems that arise at all levels
of experience.
Man
Peplau defines man as an organism that “strives
in its own way to reduce tension generated by
needs.” The client is an individual with a felt
need.
Health
Health is defined as “a word symbol that implies
forward movement of personality and other
ongoing human processes in the direction of
creative, constructive, productive, personal, and
community living.”
Society or Environment
Although Peplau does not directly address
society/environment, she does encourage the
nurse to consider the patient’s culture and
mores when the patient adjusts to hospital
routine.
Nursing
Hildegard Peplau considers nursing to be a
“significant, therapeutic, interpersonal
process.” She defines it as a “human
relationship between an individual who is sick,
or in need of health services, and a nurse
specially educated to recognize and to respond
to the need for help.”
Therapeutic nurse-client relationship
A professional and planned relationship
between client and nurse that focuses on the
client’s needs, feelings, problems, and ideas. It
involves interaction between two or more
individuals with a common goal. The attainment
of this goal, or any goal, is achieved through a
series of steps following a sequential pattern.
Four Phases of the therapeutic nurse-patient
relationship:
1. Orientation Phase
 The orientation phase is directed by the
nurse and involves engaging the client
in treatment, providing explanations
and information, and answering
questions.
 Problem defining phase
 Starts when client meets nurse as
stranger
 Defining problem and deciding type of
service needed
  Client seeks assistance ,conveys needs
,asks questions, shares preconceptions
and expectations of past experiences
 Nurse responds, explains roles to client,
helps to identify problems and to use
available resources and services
 Factors influencing orientation phase.
Click to enlarge.
 Factors influencing orientation phase.
Click to enlarge.
2. Identification Phase
 The identification phase begins when
the client works interdependently with
the nurse, expresses feelings, and
begins to feel stronger.
 Selection of appropriate professional
assistance
 Patient begins to have a feeling of
belonging and a capability of dealing
with the problem which decreases the
feeling of helplessness and
hopelessness
3. Exploitation Phase
 In the exploitation phase, the client
makes full use of the services offered.
 In the exploitation phase, the client
makes full use of the services offered.
 Use of professional assistance for
problem solving alternatives
 Advantages of services are used is
based on the needs and interests of the
patients
 Individual feels as an integral part of the
helping environment
 They may make minor requests or
attention getting techniques
 The principles of interview techniques
must be used in order to explore,
understand and adequately deal with
the underlying problem
 Patient may fluctuates on
independence
 Nurse must be aware about the various
phases of communication
 Nurse aids the patient in exploiting all
avenues of help and progress is made
towards the final step
4. Resolution Phase
 In the resolution phase, the client no
longer needs professional services and
gives up dependent behavior. The
relationship ends.
 In the resolution phase, the client no
longer needs professional services and
gives up dependent behavior. The
relationship ends.
 Termination of professional relationship
 The patients needs have already been
met by the collaborative effect of
patient and nurse
 Now they need to terminate their
therapeutic relationship and dissolve
the links between them.
 Sometimes may be difficult for both as
psychological dependence persists
 Patient drifts away and breaks bond
with nurse and healthier emotional
balance is demonstrated and both
becomes mature individuals
Subconcepts
Peplau’s model has proved of great use to later
nurse theorists and clinicians in developing
more sophisticated and therapeutic nursing
interventions.
The following are the roles of the Nurse in the
Therapeutic relationship identified by Peplau:
Stranger: offering the client the same
acceptance and courtesy that the nurse would
to any stranger
Resource person: providing specific answers to
questions within a larger context
Teacher: helping the client to learn formally or
informally
Leader: offering direction to the client or group
Surrogate: serving as a substitute for another
such as a parent or a sibling
Counselor: promoting experiences leading to
health for the client such as expression of
feelings
Technical Expert: providing physical care for the
patient and operates equipment
Peplau also believed that the nurse could take Interpersonal Theory and Nursing Process
on many other roles but these were not defined
in detail. However, they were “left to the Both Peplau’s Interpersonal Relations Theory
intelligence and imagination of the readers.” and the Nursing Process are sequential and
focus on therapeutic relationship by using
(Peplau, 1952)
problem solving techniques for the nurse and
patient to collaborate on, with the end purpose
of meeting the patients needs. Both use
Additional roles include: observation communication and recording as
 Technical expert basic tools utilized by nursing.
 Consultant
 Health teacher
 Tutor Assessment
 Socializing agent
 Continuous data collection and analysis
 Safety agent
 May not be a felt need
 Manager of environment
 Mediator
 Administrator
 Recorder observer Orientation
 Researcher  Non-continuous data collection
 Felt need
 Definite needs
Anxiety was defined as the initial response to a
psychic threat. There are four levels of anxiety
described below. Nursing Diagnosis & Planning
Four Levels of Anxiety Mutually set goals
Mild anxiety is a positive state of heightened
awareness and sharpened senses, allowing the
person to learn new behaviors and solve Identification
problems. The person can take in all available
stimuli (perceptual field).  Interdependent goal setting
 Implementation
 Plans initiated towards achievement of
mutually set goals
Moderate anxiety involves a decreased
 May be accomplished by patient, nurse,
perceptual field (focus on immediate task only);
or significant other.
the person can learn new behavior or solve
problems only with assistance. Another person
can redirect the person to the task.
Exploitation

 Patient actively seeking and drawing

Severe anxiety involves feelings of dread and help
terror. The person cannot be redirected to a  Patient initiated
task; he or she focuses only on scattered details  Evaluation
and has physiologic symptoms of tachycardia,  Based on mutually expected behaviors
diaphoresis, and chest pain.  May led to termination and initiation of
new plans

Panic anxiety can involve loss of rational

thought, delusions, hallucinations, and Resolution
complete physical immobility and muteness.
The person may bolt and run aimlessly, often  Occurs after other phases are
exposing himself or herself to injury. completed successfully
 Leads to termination
Strengths
Peplau’s theory helped later nursing theorists
and clinicians develop more therapeutic
interventions regarding the roles that show the
dynamic character typical in clinical nursing.
Its phases provide simplicity regarding the
natural progression of the nurse-patient
relationship, which leads to adaptability in any
nurse-patient interaction, thus providing
generalizability.
Weaknesses
 Though Peplau stressed the nurse-client
relationship as the foundation of
nursing practice, health promotion, and
maintenance were less emphasized.
 Also, the theory cannot be used in a
patient who doesn’t have a felt need
such as with withdrawn patients.
Conclusion
 Peplau’s theory has proved of great use
to later nurse theorists and clinicians in
developing more sophisticated and
therapeutic nursing interventions
including the seven nursing roles, which
show the dynamic character roles
typical in clinical nursing. It entails that
a nurse’s duty is not just to care but the
profession also incorporates every
activity that may affect the client’s
health.
 However, the idea of a nurse-client
cooperation is found narrow with those
individuals who are unfit and powerless
in conversing, specifically those who are
unconscious and paralyzed.
 Studying Peplau’s Interpersonal
Relations Theory of Nursing can be very
substantial especially to those who are
aspiring to be part of the profession.
Having the knowledge of the seven
roles of nursing, future nurses can apply
different roles in different situations,
which will guarantee their patients to
acquire the best care possible, and will
ultimately speed along treatment and
recovery.
Imogene King
Goal Attainment Theory
 The Theory of Goal Attainment states
that “Nursing is a process of action,
reaction, and interaction whereby nurse
and client share information about their
perception in the nursing situation.”
 King’s Theory of Goal Attainment was
first introduced in the 1960s. From the
title itself, the model focuses on the
attainment of certain life goals. It
explains that the nurse and patient go
hand-in-hand in communicating
information, set goals together, and
then take actions to achieve those
goals. The factors that affect the
attainment of goals are roles, stress,
space, and time. On the other hand, the
goal of the nurse is to help patients
maintain health so they can function in
their individual roles. The nurse’s
function is to interpret information in
the nursing process, to plan,
implement, and evaluate nursing care.
 To help nurses understand her work,
she defined several terms which include
the
Patient
social being who has three fundamental needs:
the need for health information, the need for
care that seeks to prevent illness, and the need
for care when the patient is unable to help him
or herself.
Health
involving life experiences of the patient, which
includes adjusting to stressors in the internal
and external environment by using resources
available.
Environment
the background for human interaction. It
involves the internal environment, which
transforms energy to enable people to adjust to
external environmental changes, and it involves
the external environment, which is formal and
informal organizations.
Nurse
considered part of the patient’s environment.
Three interacting systems
 concepts for the personal system are:
perception, self, growth and
development, body image, space, and
time.
 concepts for the interpersonal system
are: interaction, communication,
transaction, role, and stress.
 concepts for the social system are:
organization, authority, power, status,
and decision making.
Martha Rogers
Unitary Human Being
The assumptions
(1) Man is a unified whole possessing his own
integrity and manifesting characteristics that
are more than and different from the sum of his
parts.
(2) Man and environment are continuously
exchanging matter and energy with one
another.
(3) The life process evolves irreversibly and
unidirectionally along the space-time
continuum.
(4) Pattern and organization identify man and
reflect his innovative wholeness.
(5) Man is characterized by the capacity for
abstraction and imagery, language and thought,
sensation and emotion.
Major Concepts
Human-unitary human beings
 A person is defined as an indivisible,
pan-dimensional energy field identified
by pattern, and manifesting
characteristics specific to the whole,
and that can’t be predicted from
knowledge of the parts. A person is also
a unified whole, having its own distinct
characteristics that can’t be viewed by
looking at, describing, or summarizing
the parts.
Health
 Rogers defines health as an expression
of the life process. It is the
characteristics and behavior coming
from the mutual, simultaneous
interaction of the human and
environmental fields, and health and
illness are part of the same continuum.
The multiple events occurring during
the life process show the extent to
which a person is achieving his or her
maximum health potential. The events
vary in their expressions from greatest
health to those conditions that are
incompatible with the maintaining life
process.
Nursing
 It is the study of unitary, irreducible,
indivisible human and environmental
fields: people and their world. Rogers
claims that nursing exists to serve
people, and the safe practice of nursing
depends on the nature and amount of
scientific nursing knowledge the nurse
brings to his or her practice
Scope of Nursing
 Nursing aims to assist people in
achieving their maximum health
potential. Maintenance and promotion
of health, prevention of disease,
nursing diagnosis, intervention, and
rehabilitation encompass the scope of
nursing’s goals.
 Nursing is concerned with people-all
people-well and sick, rich and poor,
young and old. The arenas of nursing’s
services extend into all areas where
there are people: at home, at school, at
work, at play; in hospital, nursing home,
and clinic; on this planet and now
moving into outer space.
Environmental Field
“An irreducible, indivisible, pandimensional
energy field identified by pattern and integral
with the human field.”
Energy Field
 The energy field is the fundamental unit
of both the living and the non-living. It
provides a way to view people and the
environment as irreducible wholes. The
energy fields continuously vary in
intensity, density, and extent.
Subconcepts
Openness
 There are no boundaries that stop
energy flow between the human and
environmental fields, which is the
openness in Rogers’ theory. It refers to
qualities exhibited by open systems;
human beings and their environment
are open systems.
Pandimensional
 Pan-dimensionality is defined as “non-
linear domain without spatial or
temporal attributes.” The parameters
that humans use in language to
describe events are arbitrary, and the
present is relative; there is no temporal
ordering of lives.
 Synergy is defined as the unique
behavior of whole systems, unpredicted
by any behaviors of their component
functions taken separately.
 Human behavior is synergistic.
Pattern
 Rogers defined pattern as the
distinguishing characteristic of an
energy field seen as a single wave. It is
an abstraction, and gives identity to the
field.
Principles of Homeodynamics
 Homeodynamics should be understood
as a dynamic version of homeostasis (a
relatively steady state of internal
operation in the living system).
 Homeodynamic principles postulate a
way of viewing unitary human beings.
The three principles of homeodynamics
are resonance, helicy, and integrality.
Principle of Reciprocy
 Postulates the inseparability of man and
environment and predicts that
sequential changes in life process are
continuous, probabilistic revisions
occurring out of the interactions
between man and environment.
Principle of Synchrony
 This principle predicts that change in
human behavior will be determined by
the simultaneous interaction of the
actual state of the human field and the
actual state of the environmental field
at any given point in space-time.
Principle of Integrality (Synchrony + Reciprocy)
 Because of the inseparability of human
beings and their environment,
sequential changes in the life processes
are continuous revisions occurring from
the interactions between human beings
and their environment.
 Between the two entities, there is a
constant mutual interaction and mutual
change whereby simultaneous molding
is taking place in both at the same time.
Principle of Resonancy
 It speaks to the nature of the change
occurring between human and
environmental fields. The life process in
human beings is a symphony of
rhythmical vibrations oscillating at
various frequencies.
 It is the identification of the human
field and the environmental field by
 wave patterns manifesting continuous
change from longer waves of lower
frequency to shorter waves of higher
frequency.
Principle of Helicy
 The human-environment field is a
dynamic, open system in which change
is continuous due to the constant
interchange between the human and
environment.
 This change is also innovative. Because
of constant interchange, an open
system is never exactly the same at any
two moments; rather, the system is
continually new or different.
Science of Unitary Human Beings and Nursing
Process
The nursing process has three steps in Rogers’
Theory of Unitary Human Beings: assessment,
voluntary mutual patterning, and evaluation.
The areas of assessment are: the total pattern
of events at any given point in space-time,
simultaneous states of the patient and his or
her environment, rhythms of the life process,
supplementary data, categorical disease
entities, subsystem pathology, and pattern
appraisal. The assessment should be a
comprehensive assessment of the human and
environmental fields.
Mutual patterning of the human and
environmental fields includes:
 sharing knowledge
 offering choices
 empowering the patient
 fostering patterning
 evaluation
 repeat pattern appraisal, which includes
nutrition, work/leisure activities,
wake/sleep cycles, relationships, pain,
and fear/hopes
 identify dissonance and harmony
 validate appraisal with the patient
 self-reflection for the patient
Strengths
 Rogers’ concepts provide a worldview
from which nurses may derive theories
and hypotheses and propose
relationships specific to different
situations.
 Rogers’ theory is not directly testable
due to lack of concrete hypotheses, but
it is testable in principle.
Weaknesses
 Rogers’ model does not define
particular hypotheses or theories for it
is an abstract, unified, and highly
derived framework.
 Testing the concepts’ validity is
questionable because its concepts are
not directly measurable.
 The theory was believed to be
profound, and was too ambitious
because the concepts are extremely
abstract.
 Rogers claimed that nursing exists to
serve people, however, nurses’ roles
were not clearly defined.
 The purpose of nurses is to promote
health and well-being for all persons
wherever they are. However, Rogers’
model has no concrete definition of
health state.
Conclusion
 The Science of Unitary HUman Beings is
highly generalizable as the concepts
and ideas are not confined with a
specific nursing approach unlike the
usual way of other nurse theorists in
defining the major concepts of a theory.
 Rogers gave much emphasis on how a
nurse should view the patient. She
developed principles which emphasizes
that a nurse should view the client as a
whole.
 Her statements, in general, made us
believe that a person and his or her
environment are integral to each other.
That is, a patient can’t be separated
from his or her environment when
addressing health and treatment. Her
conceptual framework has greatly
influenced all aspects of nursing by
 offering an alternative to traditional
approaches of nursing.
Paterson and Zderad's Humanistic Nursing
Theory:
 Paterson and Zderad's Humanistic
Nursing Theory applies both
Humanism and Existentialism to
nursing theory.
 Humanism attempts to take a
broader perspective of the
individual's potential and tries to
understand each individual from
the context of their own personal
experiences.
 Existentialism is a philosophical
approach to understanding life. It's
the belief that thinking begins with
the human - the feeling, acting,
living individual. Existentialism
emphasizes the individual's free-
choice, self-determination and self-
responsibility.
 Nursing Dialogue is when a nurse
and patient come together. The
nurse presents themselves as a a
helper ready to assist the patient.
The nurse is open to understanding
how the patient feels with the
intention of improvement.
Openness is an essential quality for
humanistic nursing dialogue.
Paterson and Zderad developed the five
phases of the nursing process:
1) Preparation of the Nurse Knower For
Coming to Know:
In this stage the nurse acts as investigator
who willingly takes risks and has an open-
mind. The nurse must be a risk-taker and be
willing to experience anything. "Accepting
the decision to approach the unknown
openly".
2) Nurse Knowing of the Other Intuitively:
In this stage the nurse tries to understand
the other, as in the "I-thou" relationship,
where the nurse as the "I" does not
superimpose themselves on the "thou" of
the patient.
3) Nurse Knowing the Other Scientifically:
The nurse as the observer must observe
and analyze from the outside. At this stage,
the nurse goes from intuition to analysis.
Analysis is the sorting, comparing,
contrasting, relating, interpreting and
categorizing.
4) Nurse Complementarily Synthesizing Known
Others:
The ability of the nurse to develop or see
themselves as a source of knowledge, to
continually develop the nursing community
through education, and increased
understanding of their owned learned
experiences.
5) Succession Within the Nurse From the Many
to the Paradoxical One:
In this stage the nurse takes the
information gleaned and applies it in the
practical clinical setting. Here the nurse
takes brings the dilemma towards
resolution.
“Humanistic nursing embraces more than a
benevolent technically competent subject-
object one-way relationship guided by a nurse
in behalf of another. Rather it dictates that
nursing is a responsible searching,transactional
relationship whose meaningfulness demands
conceptualization founded on a nurse's
existential awareness of self and of the other” -
P&Z
"Uniqueness is a universal capacity of the
human species. So, "all-at-once," while each
man is unique; paradoxically, he is also like
his fellows. His very uniqueness is a
 characteristic of his commonality with all
other men." - P&Z
Life Perspective Rhythm Model
Joyce Fitzpatrick
Introduction
Life Perspective Rhythm Model is a nursing
model developedSeptember 18, 2013lized her
model from Martha Rogers' Theory of Unitary
Human beings.
Major Assumptions
 "The process of human development is
characterized by rhythms that occur
within the context of continuous
person-environment interaction."
 Nursing activity focuses on enhancing
the developmental process toward
health.
 A central concern of nursing science
and the nursing profession is the
meaning attributed to life as the basic
understanding of human existence.
 The identification and labeling of
concepts allows for recognition and
communication with others, and the
rules for combining those concepts
permits thoughts to be shared through
language.
Core Concepts
Rhythm Model includes four content concepts
and they are:
 person
 health
 wellness-illness and
 metaparadigm.
 Person
 Person includes both self and others.
 Person is seen as an open system , a
unified whole characterized by a basic
human rhythm.
 The model recognizes individuals as
having unique biological, psychological,
emotional, social, cultural, and spiritual
attitudes.
Health
 Health is a dynamic state of being that
results from the interaction of person
and the environment.
 'a human dimension under continuous
development, a heightened awareness
of the meaningfullness of life.
 Optimum health is the actualization of
both innate and obtained human
potential gathered from rewarding
relationships with others, goal directed
behavior, and expert personal care.
 Wellness-llness
 Professional nursing is rooted in the
promotion of wellness practices.
Nursing
 "A developing discipline whose central
concern is the meaning attached to life
(health)
 Primary purpose of nursing is the
promotion and maintenance of an
optimal level of wellness.
Metaparadigm
It refers to the transitions through basic
metaparadigm concepts of person,
environment, health and nursing.
Conclusion
Life Perspective Rhythm Model is a complex
nursing model which contribute to nursing
knowledge by providing taxonomy for
identifying and labeling nursing concepts to
allow for their universal recognition and
communication with others.
 Health As Expanding Consciousness
Margaret Newman
THEORY DEVELOPMENT
She was influenced by following theorists:
Martha Rogers
Martha Roger’s theory of Unitary Human Beings
was the main basis of the development of her
theory, Health as Expanding Consciousness
Itzhak Bentov – The concept of evolution of
consciousness
Arthur Young – The Theory of Process
David Bohm – The Theory of Implicate
ASSUMPTIONS
 Health encompasses conditions
heretofore described as illness, or, in
medical terms, pathology
 These pathological conditions can be
considered a manifestation of the total
pattern of the individual
 The pattern of the individual that
eventually manifests itself as pathology
is primary and exists prior to structural
or functional changes
 Removal of the pathology in itself will
not change the pattern of the indivdual
 If becoming ill is the only way an
individual's pattern can manifest itself,
then that is health for that person
 Health is an expansion of
consciousness.
DESCRIPTION OF THE THEORY
 “The theory of health as expanding
consciousness (HEC) was stimulated by
concern for those for whom health as
the absence of disease or disability is
not possible. Nurses often relate to
such people: people facing the
uncertainty, debilitation, loss and
eventual death associated with chronic
illness. The theory has progressed to
include the health of all persons
regardless of the presence or absence
of disease. The theory asserts that
every person in every situation, no
matter how disordered and hopeless it
may seem, is part of the universal
process of expanding consciousness – a
process of becoming more of oneself, of
finding greater meaning in life, and of
reaching new dimensions of
connectedness with other people and
the world” (Newman, 2010).
 Humans are open to the whole energy
system of the universe and constantly
interacting with the energy. With this
process of interaction humans are
evolving their individual pattern of
whole.
 According to Newman understanding
the pattern is essential. The expanding
consciousness is the pattern
recognition.
 The manifestation of disease depends
on the pattern of individual so the
pathology of the diseases exists before
the symptoms appear so removal of
disease symptoms does not change the
individual structure.
 Newman also redefines nursing
according to her nursing is the process
of recognizing the individual in relation
to environment and it is the process of
understanding of consciousness.
 The nurse helps to understand people
to use the power within to develop the
higher level of consciousness.
 Thus it helps to realize the disease
process, its recovery and prevention.
 Newman also explains the
interrelatedness of time, space and
movement.
  Time and space are the temporal STRENGTHS AND WEAKNESSES
pattern of the individual, both have
Strengths
complementary relationship.
 Can be applied in any setting
 “Generates caring interventions”
 Humans are constantly changing
through time and space and it shows
unique pattern of reality. Weaknesses

 Abstract
NURSING PARADIGMS  Multi-dimensional
 Qualitative
Health  Little discussion on environment

“Health and illness are synthesized as health -

the fusion on one state of being (disease) with
its opposite (non-disease) results in what can be CRITIQUE
regarded as health”.
Clarity

Semantic clarity is evident in the definitions,

Nursing
 Nursing is “caring in the human health
experience”.
 Nursing is seen as a partnership
between the nurse and client, with both
grow in the “sense of higher levels of
consciousness”
Human
 “The human is unitary, that is cannot be
divided into parts, and is inseparable
from the larger unitary field”
 “Persons as individuals, and human
beings as a species are identified by
their patterns of consciousness”…
 “The person does not possess
consciousness-the person is
consciousness”.
 Persons are “centers of consciousness”
within an overall pattern of expanding
consciousness”
Environment
descriptions, and dimensions of the concepts of
the theory.
Simplicity
 The deeper meaning of the theory of
health as expending consciousness is
complex.
 The theory as a whole must be
understood, nut just the isolated
concepts.
Generality
 The theory has been applied in several
different cultures
 It is applicable across the spectrum of
nursing care situations.
Empirical Precision
Quantitative methods are inadequate in
capturing the dynamic, changing nature of this
theory.

Environment is described as a “universe of open

systems” Derivable Consequences

Newman's theory provides an evolving guide for

all health-related disciplines.
CONCLUSION  Individual characteristics and
experiences (prior related behavior and
 Newman's theory can be personal factors).
conceptualized as
 A grand theory of nursing
 Humans can not be divided into parts
 Behavior-specific cognitions and affect
 Health is central to the theory and is
(perceived benefits of action, perceived
seen “and is seen as a process of
barriers to action, perceived self-
developing awareness of self and the
efficacy, activity-related affect,
environment”
interpersonal influences, and situational
 “Consciousness is a manifestation of an
influences).
evolving pattern of person-environment
interaction”

 Behavioral outcomes (commitment to a

plan of action, immediate competing
demands and preferences, and health-
Nola Pender promoting behavior).

The Health Promotion Model

The health promotion model notes that each Subconcepts

person has unique personal characteristics and
Personal Factors
experiences that affect subsequent actions. The
set of variables for behavioral specific Personal factors categorized as biological,
knowledge and affect have important psychological and socio-cultural. These factors
motivational significance. These variables can are predictive of a given behavior and shaped
be modified through nursing actions. Health by the nature of the target behavior being
promoting behavior is the desired behavioral considered.
outcome and is the end point in the HPM.
Health promoting behaviors should result in a. Personal biological factors
improved health, enhanced functional ability
Include variable such as age gender body mass
and better quality of life at all stages of
index pubertal status, aerobic capacity,
development. The final behavioral demand is
strength, agility, or balance.
also influenced by the immediate competing
demand and preferences, which can derail an
intended health promoting actions.
b. Personal psychological factors

Include variables such as self esteem self

Major Concepts motivation personal competence perceived
health status and definition of health.
 Health promotion is defined as behavior
motivated by the desire to increase
well-being and actualize human health
potential. It is an approach to wellness. c. Personal socio-cultural factors

Include variables such as race ethnicity,

acculturation, education and socioeconomic
 On the other hand, health protection or status.
illness prevention is described as
behavior motivated desire to actively
avoid illness, detect it early, or maintain
Perceived Benefits of Action
functioning within the constraints of
illness. Anticipated positive outcomes that will occur
from health behavior.
Perceived Barriers to Action place. Situational influences may have direct or
indirect influences on health behavior.
Anticipated, imagined or real blocks and
personal costs of understanding a given
behavior.
Commitment to Plan Of Action

The concept of intention and identification of a

Perceived Self Efficacy planned strategy leads to implementation of
health behavior
Judgment of personal capability to organize and
execute a health-promoting behavior. Perceived
self efficacy influences perceived barriers to
action so higher efficacy result in lowered Immediate Competing Demands and
perceptions of barriers to the performance of Preferences
the behavior.  Competing demands are those
alternative behaviors over which
individuals have low control because
Activity Related Affect there are environmental contingencies
such as work or family care
 Subjective positive or negative feeling responsibilities.
that occur before, during and following
 Competing preferences are alternative
behavior based on the stimulus
behaviors over which individuals exert
properties of the behavior itself.
relatively high control, such as choice of
 Activity-related affect influences
ice cream or apple for a snack
perceived self-efficacy, which means
the more positive the subjective feeling,
the greater the feeling of efficacy. In
turn, increased feelings of efficacy can Assumptions
generate further positive affect.  Individuals seek to actively regulate
their own behavior.
 Individuals in all their biopsychosocial
Interpersonal Influences complexity interact with the
environment, progressively
 Cognition concerning behaviors, beliefs,
transforming the environment and
or attitudes of the others.
being transformed over time.
 Interpersonal influences include: norms
 Health professionals constitute a part of
(expectations of significant others),
the interpersonal environment, which
social support (instrumental and
exerts influence on persons throughout
emotional encouragement) and
their life span.
modeling (vicarious learning through
 Self-initiated reconfiguration of person-
observing others engaged in a particular
environment interactive patterns is
behavior).
essential to behavior change.
 Primary sources of interpersonal
influences are families, peers, and
healthcare providers.
Propositions

 Prior behavior and inherited and

Situational Influences acquired characteristics influence
beliefs, affect, and enactment of health-
Personal perceptions and cognitions of any
promoting behavior.
given situation or context that can facilitate or
 Persons commit to engaging in
impede behavior. Include perceptions of
behaviors from which they anticipate
options available, demand characteristics and
deriving personally valued benefits.
aesthetic features of the environment in which
given health promoting is proposed to take
 Perceived barriers can constrain
commitment to action, a mediator of
Strengths:
behavior as well as actual behavior.
 Perceived competence or self-efficacy
to execute a given behavior increases
the likelihood of commitment to action
and actual performance of the
behavior.
 Greater perceived self-efficacy results in
fewer perceived barriers to a specific
health behavior.
 Positive affect toward a behavior
results in greater perceived self-
efficacy, which can in turn, result in
increased positive affect.
 When positive emotions or affect are
associated with a behavior, the
probability of commitment and action is
Weaknesses:
increased.
 Persons are more likely to commit to
and engage in health-promoting
behaviors when significant others
model the behavior, expect the
behavior to occur, and provide
assistance and support to enable the
behavior.
 Families, peers, and health care
providers are important sources of
interpersonal influence that can
increase or decrease commitment to
and engagement in health-promoting
behavior.
 Situational influences in the external
Analysis
environment can increase or decrease
commitment to or participation in
health-promoting behavior.
 The greater the commitments to a
specific plan of action, the more likely
health-promoting behaviors are to be
maintained over time.
 Commitment to a plan of action is less
likely to result in the desired behavior
when competing demands over which
persons have little control require
immediate attention.
 Commitment to a plan of action is less
likely to result in the desired behavior
when other actions are more attractive
and thus preferred over the target
behavior.
 Persons can modify cognitions, affect,
and the interpersonal and physical
environment to create incentives for
health actions.
Strengths/Weaknesses
 It is simple to understand yet it is
complex in structure.
 Her theory gave much focus on health
promotion and disease prevention
making it stand out from other nursing
theories.
 It is highly applicable in the community
health setting.
 It promotes the independent practice of
the nursing profession being the
primary source of health promoting
interventions and education.
 The model of Pender was not able to
define the four most important
concepts that a nursing theory should
have, man, nursing, environment and
health.
 The conceptual framework contains
multiple concepts which may invite
confusion to the reader.
 Its applicability to an individual
currently experiencing a disease state
was not given emphasis.
 Due to its focus to health promotion
and disease prevention per se, its
relevance to nursing actions given to
individuals who are ill are obscure. But
then again, this characteristic of her
model also gives the concepts its
uniqueness.
 Pender’s principles paved a new way of
viewing nursing care but then one
should also be reminded that the
curative aspect of nursing cannot be
detached from our practice.
 Community health care setting is the
best avenue in promoting health and
preventing illnesses. Using Pender’s
Health Promotion Model, community
program may be focused on activities
that can improve the well-being of the
people. Health promotion and disease
prevention can more easily be carried
out in the community, as compared to
 programs that aim to cure disease
conditions.
 For an individual to fully adhere to a
health promoting behavior, he or she
needs to shell out financial resources.
This limits the application of Pender’s
model. An individual who economically
or financially unstable might have lesser
commitment to plan of action
decreasing the ideal outcome of a
health promoting behavior even if the
individual has the necessary will to
complete it.
 Although not stated in the model, for
example, in the Intensive Care Unit,
Health Promotion Model may still be
applied in one way or another. This is
projected towards improving health
condition and prevention of further
debilitating conditions. Diet
modifications and performing passive
and active range of motion exercises
are examples of its application.