Intro to Nursing

1. Florence Nightingale's definition of Nursing:

o "The act of utilizing the environment; pure air, pure water,
efficient drainage, cleanliness, and light, of the patient
to assist him or her in his or her recovery"
2. Common themes in nursing definitions: *Nursing is…
o Caring
o An art
o A science
o Client centered
o Holistic
o Adaptive
o Concerned with health promotion, health maintenance, and
health restoration
o A helping profession
3. Roles of Professional Nurses
o Care giver-"Mothering role" provides care and comfort while
preserving the patient's dignity
o Communicator-Communicating with the client and colleagues
about nursing actions to establish rapport and
cooperation.
o Teacher- Providing health teaching, knowledge, or technical
skills to effect behavior change.
o Counselor- Providing emotional, intellectual, and
psychological support to help the patient cope with
stressful problems to improve personal relationships and
promote personal growth.
o Change agent- Initiating change by recognizing problems and
solutions to assist the client in making a health
promoting lifestyle.
o Leader-Using interpersonal influences to help the client
make life improving decisions.
o Manager- A nurse plans, gives directions, develops staff,
and represents the staff.
o Researcher- Participating in scientific investigation and
use their research in nursing practices.
o Client Advocate- Defends the client and ensures their needs
are met.

 Fourfold function nursing

Promote health
Prevent illness
Restore health
 Alleviate suffering

Historical and Societal Influences on Nursing

1. To perform efficient nursing care the nurse should have a
balance of evidence based practice, the science, and on hands
experience caring for a patient to know how to be
compassionate, the art.
2. Civilizations:
a. Primitive Man- health=spirits
 Methods: Pummeling, incantations, drums, and using lots
of smoke and strong odors.
b. East- Health=hygiene
 Men were nurses
 Qualifications:
1. Knowledge of drug preparation
2. Cleverness
3. Devotions to patients
4. Purity of body and mind
b. China- Health=balance of energy
 Ying: passive, negative feminine
 Yang: active, positive masculine
 Methods: acupuncture, dissection, herbal remedies,
bloodletting, physical exams
b. Egypt
 Methods: pills, decorations, tablets, injections, and
infusions
 Left people on the street to get advice
 Branches:
1. Theurgic- magic
2. Practitioners- natural
b. Babylonia- Health= Gods
 Astrology based
 Hammurabi Code:
1. Sliding scale to pay for treatment
2. Malpractice can result in cutting off the doctor's
hands
b. Assyria- Health=spirits
 Methods: sacred rituals and punishments
b. Persia-
 Types of physicians
1. Surgical
2. Incantations/Exorcisms
3. Plants
b. Palestine- Health= Sanitation
  Methods: food inspection, tree preservation, vital
stats documentation, fumigation, and infection
quarantine.
 Visiting sick=charity
b. Greece- Health= Gods
 Visiting sick= sacred obligation
 Institutions:
1. Xendochion- inn for poor and strangers
2. Iotrions- surgery
3. Abaton- for sick inside temples
 Left ill on streets= death pollutes the healthy
b. Rome- Health= Gods (Apollo)
 Public Health Infrastructures
1. Sewage systems
2. Cementaries
 Slaves provided health care
 Soldiers=PRIORITY
b. Northern Europe
 Magic:
1. White- medicines and nature
2. Black- evil spirits
b. Germany
 Highly regarded women because they believed they could
talk to Gods and they knew how to treat wounds, treat
animals, and do obstetrical care

3. Father of Medicine= Hippocrates

a. Outlined the role of a physician, created standards for
bandaging and bathing, and saw the importance of nurses.
2. Periods:
a. Intuitive Period:
i. Christian era
ii. Morality of helping others
iii. Shaman and witch doctors
1. Methods:
a. White magic
b. Hypnosis
c. Charms
d. Dances
e. Trephining
f. Animals
g. Fire
h. Incantation
i. Purgative
j. Massage
b. Apprentice Period:
 i. On the job training
ii. Care performed by: prisoners, crusaders, and religious
orders
1. Crusaders:
a. Knights of st. John of Jerusalem
b. Teutonic Knights
c. Knights of Templars
d. Knights of st. Lazarus
ii. Renaissance (1400-1600)
1. Lack of sanitation + poverty = health problems
ii. Reformation
1. No religious orders led to hospital deterioration=
no good health
ii. Dark Period
1. Poor nursing standards and qualifications
2. Last-resort occupation
3. Care done by prisoners and prostitutes
ii. Reform leaders:
1. John Howard-prisoner reformer
2. Mother Mary Aikenhand- established "Irish Sisters
of Charity" school
3. Pastor Theodore & Federica Munster Fliedner-
established "Deaconesses @ Kaisenworth" training
institute
4. Madame Jeanne Mance- established "Hotel Dieu of
Montreal" a log cabin hospital
b. Period of Educated Nursing
i. Nursing schools in England
1. St. Thomas Hospital School of Nursing
ii. Influence of Florence Nightingale
iii. Important people:
1. Linda Richards- 1st graduate nurse in the U.S.
2. Dr. William Holstead- designed rubber gloves
3. Clara Bartom = founded the American Red Cross
4. Dorothea Lynde Dix=established the Nurse Corpse of
the US
5. Caroline Hampton Robb
6. Clara Louise Maas- medical researcher on Yellow
fever
7. Edith Cavall- Matahari
b. Contemporary
i. Factors influencing contemporary nursing:
1. Economics
2. Consumer demand
3. Changing family structure
4. Nursing shortage
5. Science and technology
 6. Legislation
7. Demography
8. Nursing association
9. Feminist influence

 Marcella = converted her palace into a monastery

 Fabiola = matron of nursing ; establish first public hospital in
Rome
 Paula = built hospitals and hospice for the pilgrims who followed
the road to Bethlehem

History of Nursing in the Philippines

1. Health= spirits, superstitions, and special Gods
2. Spanish Regime Hospitals
a. Hospital Real de Manila- spanish soldiers
b. San Lazaro Hospital- Brother Juan Clemente; leprosy
c. Hospital de Indios- Fransciscan order; supported by
charities
d. San Juan de Dios Hospital- Brotherhood of Misericordia;
public health services
e. Hospital de Aguas Santas- founded by Brother J. Bautista
2. Prominent people: Philippine Revolution
a. Josephine Bracken- Tejeros field hospital
b. Rose Sevilla de Alvaro- created soldier quarters
c. Hilaria de Aguinaldo- organized Red Cross
d. Melchora Aquino
e. Agueda Kahabagan- leader in Nueva Ecija
f. Captain Salome
g. Trinidad Tecson
2. Prominent people: Nursing Leaders
a. Cesaria Tan
b. Socorro Sirilan
c. Magdalena- 1st filipino industrial nurse
d. Annie Sand- National League of Phil. Government nurses
founder
e. Coronal Elvegia Mendoza
f. Loreta Tupaz- Florence Nightingale of Iloilo
g. Socorro Diaz
h. Conchita Ruiz
i. Dr. Julita Sotejo- Florence Nightingale of the Philippines
j. Anastasia Giron
k. Rosario Montemayor
2. Schools of Nursing:
a. Iloilo Mission Hospital
 b. St. Paul's Hospital School of Nursing
c. Philippine General Hospital School of Nursing
d. St. Luke's Hospital school of nursing
e. Mary Johnston Hospital and School of nursing
f. Philippine Christian Mission Institute schools of nursing
g. San Juan de Dios Hospital School of Nursing
h. Emmanuel Hospital School of Nursing
i. Southern Island school of nursing
j. Colleges of Nursing in the Philippines
i. U of Santo Tomas College of Nursing
ii. Manila Central University College of Nursing
iii. University of Philippines College of Nursing
iv. FEU
1958 UE

6. CON history
1930. 3-year diploma
1930-1942 & 1949-1950- operated by Manila Sanitarium &
Hospital
1949. Government recognition
1957. Full government recognition to offer BSN
1963. Supplemental program replaced the post basic course
1967. Full transfer of admin of the School of nursing from
the hospital
7. Nursing Laws
1. 1919

History and Evolution of Nursing Theory

1. Theory- systematic organized perspective serve as a guide for

nursing actions, in administration, education, research,
practice, and mental activity
2. Concept- mental formulation of an object, event, or phenomena
3. Construct- A group of words forming a phrase.
4. Model- Representation of the interaction among and between the
concepts showing patterns
5. Phenomena- designated of an aspect of reality
6. Philosophy- a statement of belief and values about human
beings and their world
7. Nursing Theory- articulated and communicated to others

Characteristics of Theories
Theories are…
1. Interrelating concepts
 2. Logical in nature
3. Generalizable
4. Basis for hypothesis
5. Increasing the general body of knowledge
6. Used by the practitioners
7. Consistent with other validated theories

Florence Nightingale
1. Birthday- May 12, 1820 & Death- August 13, 1910
2. Environmental Theory
3. The soldiers weren't dying because of war wounds but because of
the dirty environment. The cleanliness of one's surroundings
affect their health
4. Lady with a lamp, Mother of Nursing, First Nurse Researcher
5. 12 canons:
1. Health of Houses
2. Ventilation and Warming
3. Petty Management
4. Noise
5. Variety
6. Taking food
7. Bed and bedding
8. Light
9. Cleanliness of room and walls
10. Personal cleanliness
11. Chattering hopes and advices
12. Observation of the sick

Hildegard E. Peplau
6. Theory of Interpersonal Relationships
7. Birthday: September 1, 1909 & Death: March 17, 1999
8. Known as the "Mother of Psychiatric Nursing"
9. Overlapping phases in Nurse-Patient relationship
1. Orientation
2. Identification
3. Exploitation
4. Resolution
2. Roles of a nurse:
1. Stranger
2. Teacher
3. Resource person
4. Counselors
5. Surrogate
6. Leader
 7. Technical expert

METAPARADIGM

 Person = an individual with vital reparative processes to deal

with disease
 Environment = external condition that affect life the development
of the individual. Focus is on ventilation warmth, odors and
light
 Heath = the focus is on the reparative process of getting well
 Nursing = to place the individual in the best condition for
nature to act by manipulating the environment

Virginia Henderson
11. Need Theory
12. Birthday: November 30, 1897 & Death: March 19, 1996
13. Known by: Nightingale of Modern Nursing, Modern-Day Nursing, and
20th century Florence Nightingale
14. 14 basic needs
a. Physiological:
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes and undress
7. Maintain body temp within normal range by adjusting
clothing and modifying environment
8. Keep the body clean and well-groomed and protect the
integument
9. Avoid dangers in the environment and avoid injuring others
b. Psychological
10. Communicate with others in expressing emotions, needs,
fears, or opinions
14. Learn, discover, or satisfy the needs leading to normal
development and health
b. Spiritual
11. Worship according to one's faith
b. Social
12. Work to feel accomplishment
13. Play/participate in recreation activities

METAPARADIGM
 Person = individual requiring assistance to achieve health and
independence or a peaceful death. Mind and body are inseparable
  Environment = all external conditions and influences that affect
life and development
 Health = health is equated with independence.
 Nursing = assist and supports the individual in life activities
and the attainment of independence

Joyce Travelbee
 Human – to- human relationship model
 1946= basic nursing preparations in charity hospital school
of nursing, New Orleans
 1956= BSN ; Louisiana State University
 Books : 1966-1971- Interpersonal Aspects of Nursing
 1969- Intervention in Psychiatric Nursing Process in the one
–to-one relationship
THE Theory

 Original encounter= 1st impression

 Emerging identities= patient and nurse perceive each other as
unique individuals
 Empathy = relating to their condition
 Sympathy = goes beyond empathy ; nurse desires to alleviate the
cause of the patients illness
 Rapport = patent gains trust and confidence in the nurse ; met
needs of the patient
4 aspects of human environment

 Suffering
 Hope
 Pain
 Illness
Paradigm Theory

 Person = a unique irreplaceable individual who is in continuous

process of becoming evolving and charging
 Environment = = health included the individual’s perceptions of
health and the absence of disease
 Health = subjective and objective
 Nursing = an interpersonal process whereby the professional nurse
practitioner assist an individual , family , or community to
 prevent or cope with the experience of illness and suffering and
if necessary , to find meaning in these experiences

Faye Glenn Abdellah

 21 nursing Problems
 Born : March 13, 1919 New York City
 Served as the chief nurse officer and deputy US surgeon general
 1993= retired with a rank of rear admiral
 Theory based on Problem solving
 Focused on disease and cure
3 parts

 Basic to all patients

 Sustenal care needs
 Restorative care
11 Nursing Skills

 Observation of health and status

 Skill in communication
 Application of knowledge
 Teaching of patients and family
 Planning and organization of work
 Use of resource materials
 Use of personal resources
 Problem- solving
 Direction of work of others
 Therapeutic use of self
 Nursing diagnoses

PARADIGM THEORY

 Person = the recipient of nursing care having physical,

emotional, and sociologic needs that may be overt or covert
 Environment = not clearly defined ; clients interact with their
environment
 Health = state when the individual has no unmet needs and no
anticipated or actual impairment
 Nursing = doing something for an individual
 Dorothea E. Orem
 Self-Care Deficit Theory

 Paradigm Theory
Person = bio psychosocial being capable of self-care
Environment = internal and external stimuli. Requisites for
self-care have their origins in human beings and the
environment
Health = state of wholeness and integrity of human beings,
including, physical, mental and social well being
Nursing = a creative effort of one human being to help
another human being. Consist of 3 nursing system; wholly,
compensatory, and supportive /educative

Imogene King
 Goal Attainment Theory
Paradigm Theory

 Person =bio psychosocial being ; open system that exchange energy

and information with the environment
 Environment= internal and external environment continually
interacting to assist in the adjustment to change
 Health = a dynamic life experiences with continued goal at
attainment and adjustment to stressors
 Nursing = perceiving, thinking, relating, judging and acting with
an individual who comes to a nursing situation.

Dorothy E Johnson
 Behavioral System Model
Paradigm Theory

 Person = a system of interdependent parts with patterned,

repetitive, and purposeful ways of behaving
 Environment = all forces that impact on the person and that
influence the behavioral system
  Health = focus on person, not on illness. Health is a dynamic
state influence by biologic, psychological and social factors.
 Nursing = promotion of behavioral system balance and stability

Betty Neuman
About the Theorist
 Birth: 1924
o Lowel, Ohio
 Education:
o RN diploma- 1947 People's Hospital school of nursing in
Akron, Ohio
o BSN- 1957 University of California
o MSN- 1966 ""
o PhD clinical psychology- 1985 Pacific west university
 Honorable mentions:
o Honorary Doctorate- 1922 Neuman college in Aston,
Pennsylvania
o Honorary Doctorate of science- 1988 Grand Valley state
University in Michigan
 Pioneer in the community health movement in the late 1960's
 Developed her health system model while lecturing in community
health nursing at university of california, LA
 Model made in response to graduate nursing students need for a
course that'd expose them to nursing problems prior to focusing on
specific nursing problem areas
 Model published in 1972
o A Model for Teaching Total Person Approach to Patient
Problems
o Published in the 1st and 2nd edition of Conceptual Models
for Nursing

The Theory
 Focus around human beings being a total person as a client system
and a layered multidimensional being
 Clients have a core circle with several protective layers
 Layers consist of subsystems/variables that influence the state
of wellness or illness
1. Physiological-physicochemical structure and function of the
body
2. Psychological- mental processes and emotions
3. Sociocultural- relationships and social/cultural
expectations and activities
4. Spiritual- spiritual beliefs
 5. Developmental- development over a person's lifespan
 Client is exposed to internal and external stressors requiring
lines of defense and reactions
 Person-Open system interacting with the environment through
interpersonal and extra-personal factors
1. A dynamic composite of the 5 variables
2. Continuously exposed to various beneficial and noxious
stressors in the environment and are able to respond by
adjusting to the environment or adjusting the environment
3. Maintains system harmony and balance through interactions
and adjustments
 Internal and external
4. Contains:
 Central Core:
 made of normal temp range, organ strength,
weakness ego structure, and knowns or commonalities
 Protective Layers:
 Flexible line of defense- outer layer
a. Dynamic and rapid changing buffer of
stressors
b. Highly vulnerable to internal factors
i. No sleep or hunger
 Normal line of defense
a. Evolves over time
b. Maintains steady state
c. Made of coping patterns, lifestyle, and
individual ways of handling stress
 Lines of Resistance-innermost layer
a. internal factors attempting to stabilize
individual and restore normal line of defense when
stressors break through
o Health- continuum of well-being and illness
. Reflected in the harmony or balance of the individual's
interaction and adjustment to the environment
. Level of wellness- needs are met and more energy is stored
than is expelled
. Evident In clients with optimal system stability
. Illness-needs are not sufficiently satisfied and more energy
is used than there is stored/available
o Environment- internal and external factors or stressors
. factors considered noxious or beneficial stimuli that produce
tension or disrupt system and stability/harmony
. Stressors-vary in nature, timing, degree, change potential
require energy to cope and return to stability
  Any situation, condition, force, or potential source
that's capable of creating instability within the
individuals or reduce their lines of defense/resistance
 Types:
 Intrapersonal- operating within the individual
 Interpersonal- forces operating between the individual
and others
 Extra-personal- forces outside the individual
o Nursing- Maintaining the client's stability by reducing
reactions or possible reactions to stressors
. Goals: attain or maintain the client's system balance and
conserve energy by controlling variables affecting the client
. Intervention happens when stressor is suspected or identified
 Based on 4 factors:
 Client's degree of reaction
 Resources
 Goals
 Anticipated outcomes
 3 levels:-useful guide for planning nursing interventions
 Primary Prevention- initiated before or after an
encounter with a stressor
a. Includes: decreasing possibility of meeting
with a stressor, strengthening flexible lines of
defense when there's stressors, maintenance of
wellness, environmental protection and sanitation,
immunization, maintaining ideal body weight,
protection from hazards, personal hygiene, accident
protection, health education/promotion
 Secondary Prevention- initiated after encounter with a
stressor
a. Includes: early case finding and treatment of
symptoms and reactions to stressor, breast self
exams, and newborn screening
 Tertiary Prevention- initiated after treatment
a. Focuses on re-adaptation, reeducation, and
maintenance of stability
o Model is applicable to all components of nursing and across
all clinical areas
o Can be used for individuals, families, and communities
. Views client as a composite of the 5 variables
o Holistic approach
. Each system of subsystem on the whole must be considered

Paradigm Definitions
 Person-Open system interacting with the environment through
interpersonal and extra-personal factors
 o A dynamic composite of the 5 variables
o Continuously exposed to various beneficial and noxious
stressors in the environment and are able to respond by
adjusting to the environment or adjusting the environment
o Maintains system harmony and balance through interactions
and adjustments
 Internal and external
o Contains:
 Central Core:
 made of normal temp range, organ strength,
weakness ego structure, and knowns or commonalities
 Protective Layers:
 Flexible line of defense- outer layer
a. Dynamic and rapid changing buffer of
stressors
b. Highly vulnerable to internal factors
i. No sleep or hunger
 Normal line of defense
a. Evolves over time
b. Maintains steady state
c. Made of coping patterns, lifestyle, and
individual ways of handling stress
 Lines of Resistance-innermost layer
a. internal factors attempting to stabilize
individual and restore normal line of defense when
stressors break through
 Health- continuum of well-being and illness
o Reflected in the harmony or balance of the individual's
interaction and adjustment to the environment
o Level of wellness- needs are met and more energy is stored
than is expelled
o Evident In clients with optimal system stability
o Illness-needs are not sufficiently satisfied and more energy
is used than there is stored/available
 Environment- internal and external factors or stressors
o factors considered noxious or beneficial stimuli that produce
tension or disrupt system and stability/harmony
o Stressors-vary in nature, timing, degree, change potential
require energy to cope and return to stability
 Any situation, condition, force, or potential source
that's capable of creating instability within the
individuals or reduce their lines of defense/resistance
 Types:
 Intrapersonal- operating within the individual
 Interpersonal- forces operating between the
individual and others
  Extra-personal- forces outside the individual
 Nursing- Maintaining the client's stability by reducing reactions
or possible reactions to stressors
o Goals: attain or maintain the client's system balance and
conserve energy by controlling variables affecting the client
o Intervention happens when stressor is suspected or identified
 Based on 4 factors:
 Client's degree of reaction
 Resources
 Goals
 Anticipated outcomes
 3 levels:-useful guide for planning nursing interventions
 Primary Prevention- initiated before or after an
encounter with a stressor
a. Includes: decreasing possibility of meeting
with a stressor, strengthening flexible lines of
defense when there's stressors, maintenance of
wellness, environmental protection and sanitation,
immunization, maintaining ideal body weight,
protection from hazards, personal hygiene, accident
protection, health education/promotion
 Secondary Prevention- initiated after encounter
with a stressor
a. Includes: early case finding and treatment of
symptoms and reactions to stressor, breast self
exams, and newborn screening
 Tertiary Prevention- initiated after treatment
a. Focuses on re-adaptation, reeducation, and
maintenance of stability

Lydia Hall
About the Theorist
 Birth: Sept 21, 1906
o New York City
 Education:
o Basic nursing- 1927 York hospital school of nursing York,
Pennsylvania
o BS Public Health- 1937 Teachers college Columbia University
New York
o MA in teaching Natural Science- 1942 ""
 First director of Loeb center for nursing and rehabilitation
until death
 Death: 1969
  Nursing experiences: clinical, educational, research and
supervisory components
 Articulated her basic philosophy of nursing which the nurse may
base patient care

The Theory
 Contains 3 independent but interconnected circles
o Can’t function independently but interrelated
 Hall said individuals could be conceptualized in 3 separate
domains:
1. The Core (the person)
o Based on social sciences
o Involves therapeutic use of self and is shared among members
of the health care team
o Developing interpersonal relationships with the patients
allows for them to express verbally how they are feeling about
their disease and recovery
2. The Care (the body)
o Represents nurturing component
o Exclusive to nurses
o Nurses provides patient bodily care and help to complete
basic daily biological functions
o Nursing Goal- comfort the patient
o Nurse and Patient can get close when nurse provides care
(basic needs)
o Nurses apply knowledge of natural and biological sciences
providing a strong theoretical base for nursing
implementations
o Patient views nurse as potential comforter
3. The Cure (the illness)
o Nurse helps patient and their family through medical,
surgical, and rehabilitative prescriptions made by a physician
o Nurse is active advocate for the patient

 The 3 aspects interact and change depending on the patient's

progress
 Hall believed patients should only receive care from PROFESSIONAL
nurses only
o Nursing is interacting with the patient in a complex process
of teaching and learning
o Doesn't like "team-nursing"
 Careers described as work that has to be done and how
it should be divided is a trade not a profession
Paradigm Definitions
 Nursing- functions in all 3 circles but shares them with other
disciplines to varying degrees
 o Care circle is exclusive to nurses
o Core circle can be shared with social workers and
psychologists and clergy
 Health- the state of self-awareness with conscious selection of
behaviors that are optimal for the individual
o Nurses need to help the person explore the meaning of their
behavior
 Identify and overcome problems through developing self
identity and maturity
 Environment (Society)- deals with the relation to the individual
o Hall is credited with the concept of Loeb Center
 Assumes that the hospital environment during the
treatment of acute illness makes a difficult psychological
experience for the patient
 Loeb Center is an environment that is conducive to the
individual

Ida Jean Orlando

About the Theorist
 Birth-1926
 First-generation American of Italian descent
 Education:
o Nursing diploma- New York Medical College
o BS in Public Health Nursing- St. John's University NY
o MA in Mental Health Nursing- Columbia University, NY
 Career:
o Associate professor at Yale School of Nursing
 Director of the Graduate Program in Mental Health
Psychiatric Nursing
 Project investigator of national institute of Mental
Health grant
 Grant called: Integration of Mental Health
Concepts in a Basic Nursing Curriculum
 Continued her theory work at Belmont, MA
 Director of research project- Two Systems of
Nursing in a Psychiatric Hospital
 Published works:
o The Dynamic Nurse-Patient Relationship (1961)
o The Discipline and Teaching of Nursing Processes (1972)
 Positions in Boston Area:
o Board member of Harvard Community Health Plan
o National and international consultant
o Frequent lecturer
o Conducted seminars on her theory
The Theory
 Her theory developed in the late 1950's
o Observations she recorded between a nurse and a patient
 Categorized nursing as good or bad but realized that her records
contained both good and bad
o Formulated her nursing process
 Nurse Role: to find and meet the patient's immediate need for
help
 A patient's plea is for help but may not be for what they need
o Nurse needs to use their perception, their thoughts about
their perceptions, and the feelings about their thoughts in
order to find meaning about the patient's behavior with them
o Helps the nurse discover the nature of the patient's
distress

The Nursing Process is Set in Motion by the Patient Behavior

 All verbal or non-verbal patient behavior should always be

considered an expression of their need for help that should be
validated
o Verbal- use of language
o Non-verbal- physiological symptoms, motor activity, non-
verbal communication
 If the nurse can't validate the behavior properly then the nurse-
patient relationship fails
 Communication is vital to get the patient's cooperation to
achieve health

The Patient Behavior Stimulates a Nurse Reaction

 The beginning of the nurse-patient relationship

 Important to evaluate the patient's behavior with nurse reaction
steps to achieve positive feedback
 Nursing Steps:
o Nurse perceives behavior through any of the sense
 Perception leads to automatic thought
 The thought produces an automatic feeling
 Nurse shares reactions with the patient to
see if their perceptions are accurate or not
 Nurse consciously deliberates about
personal reactions and patient input in order
to produce professional deliberative actions
based on mindful assessments not automatic
reactions
Nurse Action

 Takes place when nurses are providing care

Automatic Reactions
o Created from nursing behaviors performed to satisfy a
directive order instead of the patient's need for help
o Actions don't evolve talking with the patient's immediate
expressed need for help
o Non-deliberative behavior
o Following medical orders

Deliberative Reactions
o Disciplined professional response
o Actions are from the nurse's assessment determined to achieve
mutual help between the nurse and the patient's health
o Criteria is as follows:
1. Correct Identification and Validation
 Actions result from identification of patient needs by
validating the nurse's reaction to patient behavior
2. Nurses explore meanings of actions with the patient and
its relevance to meeting their need
3. Nurse validates action's effectiveness after compelling it
4. Nurse is free from stimuli non-related to the patient's
need during process of actions

Paradigm Definitions
 Human/Person- an individual in need
o Unique individual that behaves verbally or nonverbally
o Assumed that individuals can satisfy their needs by
themselves sometimes or need help from others
 Health- being without emotional or physical discomfort and having
a sense of well-being contributing to healthy state
o Experiences of being helped culminate over periods of time
in greater degrees of improvement
 Environment- nursing situation occurring when a nurse and patient
make contact and perceive, think, feel, and act in immediate
situation
o Any environmental aspect can cause the patient to become
distressed
o Environment is meant to be therapeutic
 Nursing- distinct profession providing direct assistance to
individuals to help them avoid, diminish, or cure their sense of
helplessness
 o Professional nursing- finding out and meeting the client's
immediate need for help

Sister Callista Roy

About the Theorist
 Birth: Oct. 24, 1939
o Los Angeles
o 2nd child
 Began working at age 14 at a large general hospital
o Pantry girl, mad, and nurse's aide
 Education:
o Bachelor of Arts with a nursing major- 1963: Mount St.
Mary's College LA.
o Master's degree in pediatric nursing-1966: University of
California, LA.
o Master's and PhD in Sociology-1973 & 1977: " "
 Published works:
o Nursing Outlook (1970)

The Theory
 Ideas first showed up in graduate papers written at UCLA (1964)
 Her theory framework crystallized during the 1970's, 80's, and
90's
o Identified her theory's central questions:
1. Who is the focus of nursing care?
2. What is the target of nursing care?
3. When is nursing care indicated?
 Focus of model: A set of processes by which a person adapts to
environmental stressors
o People are unified bio-psychosocial system constantly
reacting with the environment
 When environmental stimuli demands too much or the person's
adaptive mechanisms are too low
o =behavioral responses are ineffective for coping
 Person- adaptive system consisting of input, control processes,
output, and feedback
o Input- stimuli from the external environment and internal
self
1. Includes info from cognator and regulator mechanisms
o Control Processes- a person's biological and psychological
coping mechanisms and their cognator and regulator responses
o Output- adaptive and ineffective behavioral response of the
person
 o Feedback- info regarding the behavioral responses that's
conveyed as input in the system
 Each person gets affected by stressors=stimuli
o Focal- change immediately confronting the person
1. Require adaptive responses
o Contextual- all other stimuli present in the person or
environment
o Residual- beliefs attitudes/traits that affect the person's
present situation
 Contextual and residual stimuli contribute to the
effect of the focal stimuli
o Determine the level of stress of adaptation
 Person's ability to adapt to changing stimuli
determined by their Adaptation Level
o point is constantly changing based on collective effect of
the stimuli that can be tolerated at given time points
 Basic internal Processes used in Adaptation
 Regulator Subsystem- receives/processes changing
stimuli from external environment and internal self through
neural-chemical-endocrine channels
1. Produces automatic, unconscious reactions targeting
organs/tissues that create body responses as feedback
systems
2. Cognator Subsystem- receives varying internal and external
stimuli involving psychological and social factors
 Includes physical and physiological factors
 Changing stimuli are controlled through cognitive/emotive
pathways
o Include perception/info processing, learning, judgement, and
emotion
 The subsystems produce behavioral responses in 4 effector modes:
o Physiological: includes…
1. Oxygenation
2. nutrition
3. elimination
4. activity/rest
5. skin integrity
6. senses
7. fluids/electrolytes
8. neurological and endocrine function
 Psychosocial- includes
o Self-concept
o Role function
o Interdependence
o Self-Concept- includes individual's feelings/beliefs given at
given points of time that influence behavior. Includes…
 1. Psychic integrity
2. Physical self
3. Personal self
4. Self-consistency
5. Self-ideal/self-expectancy
6. Moral-ethnical-spiritual self
7. learning
8. inner self-concept
9. Self esteem
o Role Function: includes…
1. Role
2. Position
3. Role performance
4. Role mastery
5. Social integrity
6. Primary role
7. Secondary role
8. Tertiary role
9. Instrumental and expressive behaviors
o Interdependence- addresses ability to love, respect, value
others, and respond to others on this manner. Includes…
1. Affectional adequacy
2. Nurturing
3. Significant others
4. Support systems
5. Receptive behaviors
6. Contributing behaviors

Paradigm Definitions
 Environment- internal and external stimuli
o Including focal, contextual, and residual stimuli= person's
adaptation level/ zone of coping ability
o Includes all conditions, circumstances, and influences
surrounding the development, family, and culture
 Person- adaptive system that responds to internal and external
environment stimuli in the 4 adaptive modes
o Adaptation levels are determined by the intensity of focal,
contextual, and residual stimuli
o Nursing promotes the patient's adaptation level by
manipulating the environmental stimuli
 Reduces ineffective responses or reinforce adaptive
behaviors
 Health- a state or a process of being and becoming an integrated
and whole person
o Through adaptation a person is freed of trapped energy from
ineffective coping attempts
  When free the energy can be used for promoting
integrity, healing, and enhancing health
 Nursing- science and practice of promoting adaptation for
holistic functioning of a person though application of nursing
processes to effect healthy in a positive way
o Aim- increase the person's adaptive responses by decreasing
the energy needed to cope in situations that would normally
require more energy than they have
o Promotes adaptation of all 4 modes
 Contribute to health, life quality, and dying with
dignity

Myra Estrine Levine

About the Theorist
 Birth: Chicago, Illinois
o The oldest kid
 1 sister and brother
 Became interested in nursing because her father had
gastrointestinal problems and received a lot of nursing care
 Education:
o 1994-graduated from Cook County Nursing School
o 1949- BSN: University of Chicago
o 1962- MSN: Wayne State University
 Career:
o US Army- private duty nurse, civilian nurse
o Surgical nursing supervisor
o Nursing administration
o Lectured about nursing- George (2002), UIC, and Tel Aviv
University in Isreal
 Publications: 77 total works
o "An Introduction to Clinical Nursing" - 1969, 1973, 1989
 Honorary Mentions:
o Loyola Univ. - 1992
o Names:
 Renaissance women-highly principled, remarkable, and
committed to patient's quality of care
 Death: 1996 at age 75
o "eventually everyone's life comes to an end"

The Theory
 Based model on Nightingale's idea- nurses should create an
environment where the patient can heal
 Used works from Tiilich- unity principle of life
4 Conservation Principles
1. Adaptation
o Def: ongoing process of change in which patient maintains
his integrity within the realities of environment
o Individuals have a range of adaptive responses
 Responses vary by heredity, age, gender, or challenges
from the illness
 Responses are the same
o Timing and manifestation of responses are unique to each
individual
o Achieved though "frugal, economic, contained and controlled"
use of environmental resources by individuals
2. Wholeness
o Exist when interactions/constant adaptations to the
environment permits the assurance of integrity
o Gets promoted by conservation principle use
3. Conservation
o The outcome of the adaptation principle
o "Keeping the life system together"
o Getting a balance of energy and demand that's within the
biological realities of the person
4. Conservation Principle
o Conservation of Energy:
 Basic to the natural/universal law of conservation
 Energy- identifiable, measurable, and manageable
 Patients can be encouraged to conserve energy by
limiting themselves from activities
o Conservation of Structural Integrity
 Focus is on the healing process
 The patient's ability to be whole physically after
illness
 The body's ability to renew itself
 Ex. Nurses ensure proper positioning and range of
motion of the patient to prevent deformities
o Conservation of Personal Integrity
 Focus- to give patient's a sense of self
 An intensely private, unique and secret knowledge
that the patient uses to describe themselves
 People have a public and private self
 Some part of the private is not known to anyone
else
o Conservation of Social Integrity
 A definition of the person that goes beyond the
individual and includes the holiness of the person
  Ex. Relationships
 Social Identity is connected to:
 Family
 Friends
 Community
 Workplace
 School
 Culture
 Ethnicity
 Religion
 vacation
 Vocation
 Education
 Socio-economic status

Paradigm Definitions
 Person:
o Holistic being constantly striving to preserve wholeness and
integrity
o Continually adapting and interacting with the environment
 Adaptation leads to conservation
o Need nurses when suffering occurs and independence can be
set aside to accept the services of another
 Health: -Includes disease
o Patterns of adaptive changes
o Adaptations seek to fit within the environment
o Successful adaptations are those that achieve fitting the
environment the best and do so in a conserving manner
o The goal of conservation
 Environment:
o There are 3 types:
 Operational: undetected natural forces effecting an
individual
 Perceptual: info that's recorded by the sensory organs
 Conceptual: influenced by language, culture, ideas and
cognition
o It is difficult to measure
 Nursing:
o The purpose- take care of other when they need to be taken
care of
 Therefore nursing will exist when someone needs care to
any extent
o The created dependency is temporary
Jean Watson
About the Theorist
 Birth:
o Southern West Virginia
 Education:
o Lewis Gale School of Nursing-Roanoke, Virginia
o BSN, Master of Science (psychiatric mental), Doctorate in
education psychology- University of Colorado
 Distinguished Professor of Nursing
 Has a chair in Caring Science at the Univ. of Colorado Health
Sciences Center
 Founded Center for Human Caring in Colorado
 Fellow of the American Academy of Nursing
 Career:
o Dean of Nursing- Univ. of Health Sciences Center
o President of National League for Nursing
 Awards:
o International Kellogg Fellowship- Australia
o Fulbright Research- Sweden
o 6 Honorary Doctoral Degrees
 3 International Honorary Doctorates- Sweden, UK, Quebec
 Research is in human caring and loss area
 Publications:
o "The Philosophy and Science of Caring"

The Theory
 Transpersonal Human Caring- moral ideal of nursing and a caring
process
o Moral idea-transpersonal and inter-subjective interactions
with people
o Caring Process- commitment to protect, enhance, and preserve
humanity by restoring dignity, inner harmony, and facilitating
healing
o Nurses help others get self-knowledge, self-control, and
readiness for healing
 Helping them regain a sense of inner harmony
 The nurse responds to patient's subjective world through dynamic
interpersonal caring transactions
o Assists clients to find meaning in their existence by
exploring the meaning of their disharmony, suffering, and
turmoil
o Transactions shine light on the mystery of life and able the
self-healing process
  Theory- consists of Watson's values and her respect for the
mysteries of the healing and caring process; combined with 10
carative factors
o Formation of Humanistic-altruistic system of values
o Installation of faith-hope
o Cultivation of sensitivity to one's self and to others
o Development of a helping-trust relationship
o Promotion and Acceptance of expressing positive and negative
feelings
o Systemic use of scientific problem solving methods for
decision making
o Promotion of interpersonal teaching-learning
o Provision for a supportive, protective and/or corrective
mental, physical, socio-cultural and spiritual environment
o Assistance with gratifying human needs
o Allowance for existential-phenomenological forces

 Transpersonal Caring- moral idea

o A way of communication and inter-subjective contact through
the co-participation of oneself with another
 Individuals move toward a higher sense of self and
harmony within the 3 spheres of being
 Inter-subjectivity happens when the nurse or patient
enter the experience of each other
 Caring Transactions- nurse and client are in a process of being
and becoming
o Maintaining the client's dignity
o Nurse's unique self is shown through movement, sense, touch,
sound, words, colors, and forms transmitting/reflecting the
client's condition back to him or her
o Inter-subjective feelings are released to promote congruence
between the person's experience and perception
 Helps release inner power and strength, restore inner
harmony, develop self-knowledge and self-control

Paradigm Definitions
Nursing:
o A human science of health-illness-healing experiences that are
mediated by professional, personal, scientific, aesthetic, and
ethical human care transactions
o An art and science based with knowledge of clinical and
technical competencies
o Directed toward protection, enhancement, and preservation of
human dignity, health, healing, and transcendence
 o GOAL- enhance mental-spiritual growth and discover one's inner
power and self-control
 "help people gain a higher degree of harmony within the
mind, body, and soul, which generates self-knowledge,
self-reverence, self-healing, and self-care processes
while allowing increased diversity"
o Nurses use intuition, aesthetic skills, geist, and behaviors
to relate to others
 Person:
o A living, growing, gestalt, possessing 3 spheres of being-
mind, body, and soul which get influenced by the concept of
self
o Client-person or group needing assistance with health-illness
decisions that promote harmony, self-control, choice, and
self-determination
o People can be their own change agents that can heal themselves
through their own mental-spiritual powers
o People progress to higher levels of consciousness when they
find meaning and harmony in their existence from using their
mind
 Health:
o The unity and harmony within the mind, body, and soul
o Harmony between self and others and between self and nature
o Illness-disharmony within a person's inner self
 Incongruence between self and other/nature/experience
 Environment:
o Occurrences or occasions involving caring interactions and
choices by the nurse and individual
o If caring occasion is transpersonal= client and nurse expand
leading to personal growth, maturations, and development of
the self

Madeline Leininger
 Birth:
o Nebraska
 Education:
o Basic Nursing 1948: St. Anthony's School of Nursing- Denver,
Colorado
o B of Science 1950: Mount St. Scholastica College- Atchison,
KS
o Master of Science 1954: Catholic Univ. of America-
Washington DC
o PhD 1965: Unv. Of Washington Seattle
 Fellow in:
o American Academy of Nursing
  Honorary Doctorates:
o Benedictine college
o Univ. of Indianapolis
o Univ. Kuopoio, Finland
 1998 earned the name "Living Legend" by American Academy of
Nursing

The Theory
 Transcultural nursing addresses the cultural dynamics present
that influence the nurse-client relationship
 Developed with a goal to provide culturally congruent wholistic
care

 Culture= Major concept

o Humans are cultural beings and nurses provide care to
various cultures
o Nursing should be based on transcultural knowledge to be
effective
 A critical factor when promoting health or aiding
recovery from illness
o Nurses should use the client's culture to grow closer to
client and develop a relationship
 Believes that caring is the central focus
 Ethnocaring- The systematic study and classification of nursing
care beliefs, values, and practices as cognitively perceived by a
designated culture through their local language, experiences,
beliefs, and value system
o Ethnonursing- use of knowledge of the culture during health
practices and nursing
 Classified 28 ethnocaring constructs
o Comfort
o Compassion
o Coping behaviors
o Empathy
o Involvement
o Love
o Protective and restorative behaviors
o Support
o Trust
o ….
 There are 2 kinds of caring that are required to provide
culturally congruent care:
o Generic- basic expression of human caring
 Includes home remedies and folk care
 o Professional- involves learning, practice, and transmitting
knowledge of formal and informal education
 Includes psychomotor skills, communication, and
psychosocial skills
 Factors influencing well-being:- if not considered then the nurse
will have fragmented knowledge about culture care
o World view
o Religion
o Kinship
o Cultural views
o Economics
o Technology
o Language
o Ethnohistory
o Education
o Political
o Environment context

Modes to Guide Nursing in Culture Congruent Care

1. Culture Care preservation or maintenance
o Nursing care activities focused on helping people from
specific cultures to retain and use core cultural care values
relating to healthcare conditions of conditions
2. Culture Care accommodation or negotiation
o Nursing activities concerned with helping people from
specific cultures to adapt or negotiate with others so that in
the end they all achieve the health goals for clients of a
specific culture
3. Culture Care repatterning or restructuring
o Therapeutic actions that a culturally competent nurse or
family takes
o Enable or assist client's to modify personal health
behaviors towards beneficial outcomes
o Actions done while respecting the client's culture

Assumptions of Theory
1. Care is the essence and central focus of nursing
2. Caring is essential for health and well-being, healing, growth,
survival, and facing illness/death
3. Culture care is broad and wholistic perspective to guide nursing
care practices
4. Nursing central purpose= serve human beings in health, illness and
dying
5. No cure is possible without giving and receiving care
 6. Culture care concepts have different and similar aspects among all
cultures
7. Every culture has folk remedies, professional knowledge, and
professional care
o Nurses must identify and address factors in every action to
provide culturally congruent care
8. Cultural care values, beliefs, and practices are influenced by
world views and language (ethnohistorical and environmental
factors)
9. Beneficial, healthy, satisfying culturally based nursing enhances
the client's well-being
10. Culturally beneficial nursing care occurs when cultural care
values, expressions, or patterns are known and used correctly by
the nurse
11. Nurses who can't be reasonably culturally congruent with their
client will experience stress, cultural conflict, noncompliance,
and ethical moral concerns

A culturally Competent Nurse…

 Consciously addressing the fact that culture affects nurse-client

exchanges
 Has compassion and clarity when asking each client what their
cultural practices and preferences are
 Incorporates the client's personal, social, environmental, and
cultural needs/beliefs into the care plan
 Respects/appreciates cultural diversity in order to increase
knowledge and sensitivity with nursing concerns

Paradigm Definitions
 Nursing:
o The same as "caring", which is the central focus
o Humanistic and scientific application of knowledge in caring
for individuals, families, and communities emphasizing their
cultural and health practices
o Assist people and groups so they improve or maintain human
conditions by applying knowledge of culturally sanctioned
caring modes of intervention
o Transcultural Nursing- integrating cultural views,
knowledge, and experiences when providing care for a patient
 Humans/Person:
o Caring beings capable of being concerned about the needs,
well-being, and survival of others
o Families, groups, communities, total cultures, and
institutions
o Human care is universal
  Health:
o State of well-being; culturally defined, valued, and
practiced
o An individual's ability to perform daily roles
o Includes health systems, care practices, and patterns with
health promotion and maintenance
o Universal across cultures but defined differently by
individuals based on their values and beliefs
 Environment/Society:
o Not specifically defined
o Worldview, social structure, and environmental context
o Represented in culture

Patricia Benner
 Birth:
o Hampton, Virginia
o Spent childhood in California
 Education:
o Bachelor of Arts 1964- Pasadena College
o Master degree (medical-surgical) 1970- Univ. of California,
San Francisco S.O.N.
o PhD 1982
 Career:
o Research assistant to Lazarus- Univ. California, Berkeley
o Critical care
o Home health care

The Theory
 Introduced the idea that expert nurses develop skills and
understand patient care over time through sound educational base
and experiences
 Expert nurses need experience along with book knowledge to be
actual professionals

Levels of Nursing Experience

1. Novice
o Has no experience
o Gets taught rules so they can help in tasks; general
follower of orders
o Context-free, independent of specific cases, and applied
universally
o Behavior is limited and inflexible
2. Advanced Beginner
o Shows acceptable performance
 o Has some prior experience in situations so they can recall
the meaningful components
o Follows principles, experienced based, and starts to be
formulated to guide actions
3. Competent
o Nurse with 2-3 years of experience
o Aware of long term goals
o Gains perspective by planning own actions that help achieve
greater efficiency and organization
 Actions based on conscious, abstract, and analytical
thinking
4. Proficient
o Perceives and understands situations as whole parts
o Gained holistic understanding leaders to improved decision-
making
o Learns from experiences
 What to expect and how to modify plans
5. Expert
o Doesn't rely on principle, rules, or guidelines to determine
situations or make actions
o More background experience
o Intuition about clinical situations
o Has fluid, flexible, and highly-proficient performance

What Levels Reflect

 Movement away from reliance on past abstract principles and more

usage of past concrete experience as paradigms
 Changes in perception of certain situations; becomes a complete
whole where certain parts are relevant
 Each step is built off of the previous one
o Principles become more refined and expand through experience
 Theory changes what it means to be an expert nurse
o Nurses who provide the most exquisite nursing care instead
of highest wages

Paradigm Definitions
 Person:
o Individual is a whole
o A self-interpreting being that doesn't enter the world
predefined but becomes defined as life happens
 Health/ Well-being
Congruence between one's possibilities and one's actual
practices and lived meanings as is based on caring and
feeling cared for
 Environment/ Situation:
 o A situation implying a social definition and meaningfulness
o Individual experiences with situations affect how that
person perceives the world
 Nursing:
o A caring practice whose science is guided by the moral art
and ethics of care and responsibility

Nola Pender
o 1941- Lansing, Michigan
o Only child of parents who were advocates of women's
education
 Education:
o Nursing Diploma 1962: S.O.N. West Suburban Hospital-Oak
Park, Illinois
o BSN 1964: Michigan State University- East Lansing
o MA (human growth and development) 1965: Michigan State Univ.
o PhD (psychology) 1969: Northwestern Univ.- Evanston,
Illinois
 Publications:
o 1975-" A Conceptual Model for Preventive Health Behavior"
 How individuals make decisions about their own health
care in a cursing context
o 1982-"Health Promotion in Nursing Practice"
 Honorary Doctorates:
o 1992-Widener Univ.
o 1988-Distinguished Research Award- Midwest Nursing Research
Society
o 1997-American Psychology Association Award
 Outstanding contributions to nursing and health
psychology

The Theory
 Presents that each person has unique personal characteristics and
experiences that affect subsequent actions
 Desired result= Health promoting behavior resulting in improved
health, enhanced functional ability, and better quality of life

Personal Factors- Individual Characteristics and Experiences

 Categorized as biological, psychological, and socio-cultural

 Predictive about certain behaviors and get shaped by the nature
of the targeted behavior
Personal Biological

 Include age, gender, body mass index, pubertal status, aerobic

capacity, strength, agility, and balance
Personal Psychological

 Includes self-esteem, self-motivation, personal competence,

perceived health status, and health definitions
Personal Socio-cultural

 Includes race, ethnicity, acculturation, education, and

socioeconomic status

Behavior-Specific Cognitions and Affect

Perceived Benefits of Action

 Anticipated perceived outcomes that will occur form health

behavior
Perceived Barriers to Action

 Anticipated, imagined, or real blocks

 Personal costs of understanding a given behavior
Perceived Self-Efficacy

 A person's judgement of their personal capability to organize and

execute a health promoting behavior
 Perceived self-efficacy influences perceived barriers to action
o Higher efficacy=lowered perceptions of barriers to behavior
performance
Activity Related Affect

 Subjective positive or negative feelings occurring before, after,

or during
 Following behavior based on the stimulus properties of the
behavior itself
 Influences self-efficacy
o More positive the feeling= greater feeling of efficacy
Interpersonal Influences

 Def: Cognition concerning behaviors, beliefs, or attitudes of

others
 Include:
1. Norms (expectations)
2. Social support (instrumental and emotional encouragement)
3. Modeling (learning through observation)
 The primary sources are families, peers, and healthcare providers
Situational Influences

 Def: personal perceptions and cognitions of situations/contexts

that can facilitate of impede behavior
 Includes:
1. Perceptions of available options
2. Demand characteristics
3. Aesthetic features of environment where care is taking place
 Can have direct or indirect influences on health behavior

Behavioral Outcome
Commitment to Plan of Action

 Concept of intention and identification of planned strategies

leading to the implementation of health behavior

Immediate Competing Demands and Preferences

 Competing demands- alternative behaviors the individuals have low

control over
o Usually environmental contingencies
o Ex. Family care or work
 Competing preferences- alternative behaviors that individuals
have a high control over
o Ex. Choice of ice cream of snack

Health Promoting Behavior

 Endpoint/Action outcome directed toward attaining positive health
outcomes
o Outcomes: well-being, personal fulfillment, productive
living

Ludwig von Bertalanffy

 Developed in 1936
 System: set of interrelated parts that come together to form a
whole that performs a function that is made of 4 parts
1. The System- Open and/or Closed
 Open: systems that are relatively free movement of
information, matter, and energy into and out of the system
 No restrictions and difficult identifiable
boundaries
  Control of input and output leads to dynamic
equilibrium
 Closed: a system that prevents any movement in and out.
Some may not even exist
 Static and unchanging
2. Input
 Any info, energy or material entering the system from
the environment past its boundaries
3. Output
 Any info, energy, or material leaving the system and
enters the environment through the system's boundaries
1. The GOAL of a system is an output that can't be reused as
input
1. Feedback Loop
 Allows the system to monitor its internal functioning
so it can restrict or increase its input and output to
maintain the highest functioning level
 Theory allows for the consideration of the human beings'
subsystems
 A human being can be conceptualized as the client and becomes the
target system for nursing interventions

Kurt Lewin
 It has 3 phases
1. Unfreezing: becoming motivated to change
a. Disconfirmation: present confirmations lead to dissatisfaction
i. The bigger the difference is between what is believed and
what needs to be believed means the more likely new info
will be ignored
b. Previous Beliefs: a person’s beliefs that newly become seen as
invalid creates “survival anxiety”
i. Can be beneficial or unbeneficial to change depending on
what the person’s previous beliefs were.
b. Learning Anxiety: activates defensiveness and resistance to
change because it may be hard to unlearn what has already been
accepted
 Occurs in 3 stages: Denial, Scapegoating/Passing the
Buck, and Maneuvering/Bargaining
2. Movement: changing what needs to be changed
3. Refreezing: making the changed new behavior into a new habit
 a. Includes developing a new self-concept and identity and
interpersonal relationships

Ifat Ibraham Meleis

 Middle range theory ; Transitions Theory
 Main purpose- prepare individuals and families for developmental
situational and health/illness transition
 2 parts
o Intervention mode- individuals realizes they're in a
transition state
 Main goal- person to realize they are going through a
transition period
 Nurse should provide knowledge, skills, strategies
o Understanding the transition
 Developmental= events from childhood , adolescence or
from adulthood to old age
 Health and illness= events such as diagnosis of chronic
illness
 Situational= birth to death , natural disasters
 Organizational= change in leadership

o Properties of transition Experiences

 Awareness= related to the perception knowledge and
recognition of the transition experience
 Engagement= related to the involvement of the individual in
the transition
 Change & difference= are properties of transitions that are
similar but not interchangeable
 Time span= flow of movement that happens in a transition
 Critical points/events= awareness of change / difference or
increased in transition experiences
o Transition conditions= include facilities & inhibitors or the
perceptions of ands meanings attached to health and illness
situations that facilitate of hinder progress toward achieving a
healthy transition
o Ex. personal conditions , community , social condition

Metaparadigm

o Person= active being who experiences fundamentals life patterns

who perceived transition experiences
o Environment= conditions that expose persons to potential damage
o Health = consists of complex and multidimensional transitions
that are characterized by flow and movement over time
 o Nursing = being the primary caregiver for individuals and their
families during the transition process and applying nursing
therapeutics during transitions to promote healthy outcomes.

Maternal Role Attainment Theory

 Theorist: Ramona T. Mercer
 Maternal Role Attainment: an interactional developmental process
that occurs overtime in which the mother becomes attached to her
infant, acquires competence in caretaking tasks, and expresses
pleasure/gratification in the role
 Maternal identity: endpoint mother experiences a sense of
harmony, confidence, and competence in how she performs the role.
Original Theory
 Stages of Maternal Role Attainment:
1. Anticipatory:
 During pregnancy
 Includes commitment and preparation
2. Formal:
 Begins with birth of infant and up to physical
restoration (1-2 weeks)
 Maternal behavior is learned from others and mother
practices those behaviors
3. Informal:
 Occurs at 2 weeks-4 months after the child’s birth
 Approaching normalization
 Mother learns infant cues and develops own style of
mothering
4. Role identity:
 Begins at 4 months after birth of the child
 Internalization of maternal role identity occurs
 Mother views herself as competent
 Factors affecting maternal role identity:
1. Stress
2. Social support
3. Family functioning
4. Maternal age
5. Childbearing attitudes
6. Self concept
7. Infant’s health status
8. Birth experience
9. Relationship with the father
 Desired outcomes for infants
1. Cognitive development
 2. Health
3. Attachment
4. Social competence
 Ecological environment
1. Microsystem:
 Most influential
 Includes mother, infant, her partner, and close
relationships with the family
2. Mesosystem:
 Includes extended family, school, work. Church, and etc
as influencers
3. Macrosystem:
 “exosystem”
 Represents relationships between 2+ mesosystem factors
Revised Theory:
 Use of expressions/words taken from studies of women
 Stages:
1. During pregnancy
 Includes social and psychological adjustments to
pregnancy
 Experctations are explored
 Women visualize herself as a mother
2. Begins with the birth of infant:
 Includes recovery form birth process
 Mother learns from others
3. Mothers structures roles based on past experiences and
future goals
4. Integrates mothering into her self-system
 Internalizes role
 Viewed as competent mother

Parent-Child Interaction Model

 Theorist: Kathryn E. Barnard
 The Theory:
o Includes 3 overlapping circles with interaction in the
middle
1. Child
 Physical appearance
 Temperament
 Feeding/sleeping patterns
 Self-regulation
2. Caregiver
  Psychosocial assests
 Physical health
 Mental health
 Coping skills
 Life changes
 Expectations
 Concerns about child
3. Environment
 Social support
 Financial resources
 Safe housing
 Adequate food
 Community involvement
 Theory focus: the interaction between all circles in the middle
o Sensitivity to cues reflects the patient’s ability to
recognize and respond to the infant’s cues
 Theory Goal: to identify problems at a point before they develop
and when intervention would be most effective
 Corresponding characteristics to infant/child:
o Clarity of cues
o Child’s responsiveness to parents

Infant/Child Characteristics:
Parent/Caregiver characteristics:
 Clarity of cues
 Sensitivity to cues
 Child’s responsiveness to parents
 Ability to alleviate distress
 Ability to provide a growth-
fostering situation
Metaparadigm:
 Health: a dynamic state of being in which the developmental
and behavioral potential of an individual Is realized to the
fullest extent possible
o Viewed as a continuum that includes wellness and
illness
 Nursing: the process by which the patient is assisted I
maintenance and promotion of his independence

Postpartum Depression Theory

 Theorist: Cheryl Tatano Black
 They theory:
 1. Major concepts:
 Postpartum moods
1. Postpartum depression – nonpsychotic major
depressive disorder that may begin 4 weeks-1 year
after birth
2. Maternity blues- transient, self-limiting time of
melancholy and mood swings during early postpartum
period
3. Postpartum psychosis- characterized by
hallucinations, delusions, and irrational behavior
that are considered an emergency cause the mom and
child are in danger
4. Postpartum OCD-symptoms include: repetitive
intrusive thoughts of harming the baby, fear of
being alone with the baby, and hypervigilance in
protecting baby
5. Postpartum onset panic disorder- characterized by
onset of fear, anxiety, rapid breathing, heart
palpitations, and sense of impending doom
 Loss of control- a basic psychological problem with
which women attempt to cope through a 4 stage process
called “teetering on the edge”
1. Encountering terror in the form of symptoms
2. Dying of self
3. Struggling to survive
4. Regaining control of their live during transition
and guarded recovery while mourning lost time with
their infant
 Risk factors/predictors of PPD:
1. Prenatal depression
2. Childcare stress
3. Life stress
4. Prenatal anxiety
5. History of depression
6. Marital satisfaction
7. Marital status
8. Economic status
9. Unplanned/unwanted pregnancy
10. Social support
 Concepts used for screening:
1. Sleeping/eating disturbances
2. Mental confusion
3. Anxiety/insecurity
4. Emotional liability
5. Loss of self
6. Guilt/shame
7. Suicidal thoughts
Theory of Caring
 Theorist: Kristin Swanson
 The Theory: offers explanation of what it means to practice
nursing in a caring manner
 Caring: a nurturing way of relating to a valued other toward
when one feels a personal sense of commitment and
responsibility
 Basic Concepts/processes
 Concept of maintaining belief= sustaining faith in other’s
capacities to get through an event or transition
 Concept of knowing= refers to striving to understand the
meaning of an event in the life of other; avoiding
assumptions
 Concept of being with= refers to being emotionally present
to the other
 Concept of doing for= refers to doing for others what one
would do for oneself
 Concept of enabling enabling= refers to facilitating the
other’s passage through life transitions and unfamiliar
events
 Metaparadigm

 Person: unique being s who are in the most of becoming and

whose wholeness is made manifest in thoughts, feelings and
behaviors
 Environment: any context that influences or is influenced by
the designated client
 Health: to live the subjective, meaning-filled experience of
wholeness
 Nursing: informed caring for the well-being of others where
the goal is to promote well-being