Trust in the Lord with all your

Week 11 : heart, and lean not on your own

understanding. In all your ways
acknowledge Him and He shall
GRAND & NURSING THEORY (1) direct your path. Prov. 3: 5-6
MIDDLE RANGE THEORY (2)

Instructor: Alex S. Borromeo, RN,MN

 Few Reminders

Attendance
Deadline of Final Term - Final Output
Question and Answer
Quiz this week

2
GRAND & NURSING
THEORY
Hello!

This is Sir Alex

Let’s continue with our lesson

6
INTRODUCTION

Another level of nursing knowledge is introduced to you - that is, the Nursing Theories
and Grand Theories. Again, Nursing theories describe, explain, or predict outcomes
based on the relationships of concepts from a nursing phenomenon. Grand nursing
theories, though the concepts are nearly abstract, are considered as theory as they
propose a result that tests the major premise of the grand theory. (Alligood, 2018)

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 This particular module is divided into 2 lessons:

● Lesson 1 Boykin & Schoenhofer : Theory of Nursing as Caring

● Lesson 2 Afaf Meleis : Transition Theory

SUMMARY OF LESSONS
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OBJECTIVES AND COMPETENCIES

Upon completion of this module, you are expected to:

1. identify the different nursing theories and its importance in the field of
nursing

2. name important persons with significant historical contributions in

nursing.

3. apply the nursing theory to the different clinical scenarios.

4. design your own personal scenario in relation to the application of

Nursing and Grand theories

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 QUOTE FOR THE DAY!

When I was a child, I talked like a child, I

thought like a child, I reasoned like a
“ child. When I became a man, I put the
ways of childhood behind me.

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 BOYKIN &
SCHOENHOFER
1 THEORY OF NURSING AS
CARING

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BACKGROUND AND CREDENTIALS

● Earned bachelor's from Alverno College in

Milwaukee, Wisconsin, Masters from Emory
University in Atlanta, Georgia, and Doctorate from
Vanderbilt University in Nashville, Tennessee.
● Became Dean and professor of the College of
Nursing at Florida Atlantic University
● Director for the Christine E. Lynne Center for Caring

Dr. Anne Boykin

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BACKGROUND AND CREDENTIALS

● Earned her Undergraduate and Graduate in

nursing, psychology, and counseling from
Wichita State University
● She earned her Ph.D. in education foundations
and administration from Kansas State
University

Dr. Savina Schoenhofer

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 Discussion by its
How did they came up with the theory? founders

Realization of traditionally
Holistic approach
schooled in a system Focusing on the Person
(Nursing as Caring)
approach to nursing

Little knowledge was

known until she attended born out of the revised
(Dr. Anne Boykin) curriculum development
International Association
of the faculty group
for Human Caring
Conference

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THEORETICAL SOURCES

● The theory was born out of the revised curriculum development of the faculty
group of the Florida Atlantic University of Nursing when they continue to develop
their conceptual framework of what is the unique focus of nursing.
● Adapted the concepts of Paterson and Zderad’s (1988) existential
phenomenological theory of humanistic nursing, which they view as antecedent of
nursing.
● The 6 C’s - Commitment, confidence, conscience, competence, compassion, and
comportent of Roach (1997, 2002) contributed to the language of caring.
● Mayeroff’s (1971) concepts of caring are essential in the understanding of living as
caring.
● The concept of nursing as discipline was influenced by Phenix (1964), King and
Brownell (1976), and Orem (1979) and as being a profession by Flexner (1910).

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METAPARADIGM
CONCEPTS
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PERSON

(One): Persons are Caring by Virtue of Their (Two): Persons are caring, moment to moment
Humanness
It is how the person lives their caring from moment to
An assumption that a person means ‘living caring’, with
moment. How they live caring right now informs,
the capacity to grow and express caring in his life.
changes, and helps them to grow in how a person
lives caring in the next moment.
An innate nature of a person that is to say, all persons
are caring.
Each moment is an opportunity for a person to
decide to live caring or not. A person has a choice.
The nurse sees the person as a caring person by
assisting and supporting the person in what matters to
them.

Not putting the person as an 'object' of care, but seeing

him as a caring person by knowing him and what
matters to him.

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Previous Slide

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“How i live my caring right now,
informs me, changes me, and helps
me to grow how i live my caring in
the next moment. And each
moment is an opportunity for us to
choose to live caring or not. It’s a
choice.
However, the obligation is to pay
attention, to be intentional in the
living of caring moment to
moment.” - Boykin

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PERSON METAPARADIGM CONCEPTS

(Three): Persons are whole and Complete in the Moment

Acknowledging the person as a whole or complete in the moment.

"A nurse is always with the person with the intention of knowing the
person as a whole and with the responsibility through authentic
presence to be with the person to come to know that wholeness."
(Savina Boykin)

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“I am always with you, with the
intention of knowing you as
person. You are never defined
a part. You are never a arm,
never a leg. You are always
whole. And it’s my
responsibility through
authentic presence to be with
you to come with that
wholeness.” - Boykin

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HEALTH METAPARADIGM CONCEPTS

(Four) Personhood is living Life Grounded in

Caring

Is a process of living caring and growing in caring.

The completeness of being human is communicated through

living caring and enhancing the capacity to live caring in the
world.

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“Our capacity to live caring
in the world moment to
moment. Living grounded in
caring.” - Schoenhofer

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ENVIRONMENT METAPARADIGM CONCEPTS

(Five) Personhood is Enhanced Through Participating in

Nurturing Relationships WIth Caring Others.

It is where nursing comes into the picture by enhancing the personhood

through a relationship with caring others.

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That’s where Nursing
Practice, comes in.

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NURSING METAPARADIGM CONCEPTS

(Six) Nursing is a both a discipline and a

profession

Discipline refers to the domain of knowledge that is needed to

be enhanced and refined in nursing practice. The profession
of nursing is the application of that knowledge.

Nursing as caring focuses on the knowledge and its

application.

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Nursing is a both a
discipline and a profession
MAJOR
CONCEPTS
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MAJOR CONCEPTS AND DEFINITIONS

Focus and Intention of Nursing

From the perspective of the Theory of Nursing, the focus of nursing as Caring is
emphasizing discipline and professional nursing practice as "nurturing persons living
and growing in caring.

Generally, nursing intends to know persons as caring, supporting them, and

sustaining them as they live.

The intention is shown when the nurse and the nursed are entering a relationship
intending to know, by being authentic, the other as a caring person.

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MAJOR CONCEPTS AND DEFINITIONS
NURSING SITUATION
The nursing situation is a "shared,
lived experience in which the caring
between nurse and nursed
enhances personhood."
The nursing situation generates
knowledge of nursing. In other words,
the aspects of nursing are known
throughout the nursing situation.
As the nurse enters the nursing
situation, the situation lives and grows
dynamically.
PERSONHOOD
Personhood is a process of living
where the person is being grounded
by caring. This implies a person as
being an authentic caring person and
living caring from moment to
moment. Personhood is enhanced
when the nurse and the nursed grow
in caring and lived through the shared
experience of caring.
CALL FOR NURSING
It is what the nurses perceived in their
minds and enters into the world of the
person authentically.
The nurse uses specialized knowledge
as a response to the one nursed,
knowing, and affirming the person
living to care.
Calls for nursing is a way of a person
to say to the nurse, "Know me as a
caring person at the moment and
understand what matters to me for
growing and caring."
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 MAJOR CONCEPTS AND DEFINITIONS

CARING BETWEEN NURTURING RESPONSE DIRECT INVITATION

A phenomenon that exists when the
nurse enters the world of another
person with the intention to know the
person as a caring person and
uniquely understand what truly
matters to that person.
It is a unique response of a nurse to a
person of what truly matters.
It is a response created by a general
call of nursing. The call of nursing and
the nurturing response occurs in the
caring between the nurse and the
nursed.
Related to the call and response is the
direct invitation. This opens an
opportunity of genuine caring
between the nurse and the nursed.
The nurse may tell the patient, "I am
here to care for you and what
matters to you."

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MAJOR CONCEPTS AND DEFINITIONS
Story as Method for
Knowing Nursing Story
Nursing stories include the lived experience of
the nursing situation that involves the nurse
and the nursed. It is a method for knowing to
nurse and hearing others' stories as a
medium for inquiries.
The story as a method represents the nature
of the lived experience of someone, making
knowledge for nursing practice for further
research.
Dance of Caring Persons
The interconnectedness of the health care
team contributing to the fullness of the
development of personhood. In the dance of
caring, such persons include the patient and
the nurse, the physician, dietitian, laboratory
personnel, finance officer, janitor, and others
who contribute their unique way of caring to
enhance the personhood.
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35
36
END OF LESSON 1 :
BOYKIN & SCHOENHOFER

Theory of Nursing as Caring

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 AFAF MELEIS
2 TRANSITION THEORY

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39
BACKGROUND AND CREDENTIALS

● She was born in Alexandria, Egypt

● Earned her Nursing Degree at the University of Alexandria,
Egypt
● Received her MS in Nursing at University of California in
1946, and in MA in Sociology in 1966
● Earned her P.h.D. in medical and social psychology in 1968
● Currently the Counsel General of the International on
Women’s Health Issues
● Received numerous awards, medals, and honorary
doctorates

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THEORETICAL SOURCES
● Her nursing background, sociology, symbolic interactionism, and role
theory and her educational experience led her to develop the transition
theory.
● Clinical findings from her research experiences, educational programs,
and clinical practice, and other settings contributed to her theoretical
sources.
● Influenced by Walker and Avant’s (1995,2005) literature in the
knowledge of nursing phenomena.
● The development of Meleis’ mentoring to Schumacher led to the
proposal of the first transition theory (Schumacher & Meleis, 1994).

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METAPARADIGM
CONCEPTS
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PERSON METAPARADIGM CONCEPTS

The process of movement with the

capacity to cause changes in a person's
life patterns.

The transition may cause change in

identity, roles, relationship, ability and
pattern of behaviors.

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HEALTH METAPARADIGM CONCEPTS

Transitions are “complex and

multidimensional” and characterized by
movement and flow as it gradually evolves.

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ENVIRONMENT METAPARADIGM CONCEPTS

Vulnerability has a relationship with

transition experiences, interactions and
environmental factors exposing the
person to physical or emotional harm,
recovery or unhealthy coping

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NURSING METAPARADIGM CONCEPTS

Nursing is the provision of primary care of

nurses to patients who are in the transition
stage

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Major Concepts and Definitions MELEIS TRANSITION THEORY AND FRAMEWORK

CONDITIONS PROPERTIES
TYPES OF PROPERTIES
TRANSITION
Awareness Personal

Developmental
Engagement

Situational Community
Changes and Process
Outcome
Differences
Health-Illness

Time Span Society

Organizational
Critical points and
Events

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 Return
MAJOR CONCEPTS AND DEFINITIONS

TYPES and PATTERNS of TRANSITION

Types and patterns include developmental, health and illness, situational and organizational.

Developmental transition
relates to birth, adolescence, menopause, aging (or senescence), and death.

Health and illness transitions

refer to the recovery process, and diagnosis of chronic diseases.

Situational transitions
involve the death of a loved one, relocation, hospital discharge

Organizational transitions
changing environmental conditions.

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MAJOR CONCEPTS AND DEFINITIONS

Properties of Transition Experience

● The properties of transition experiences include the five subconcepts - awareness,

engagement, changes and differences, time span and critical points and events.

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 Return
Awareness refers to a person's ability to know, perceive, and recognize a transition experience.
- A person may become unaware of the change, which means that the person has not begun a transition yet;
however, Meleis et al. emphasize that lacking awareness does not mean that the transition has not begun.

Engagement refers to the degree of a person’s involvement in the process of change or transition.

Changes and differences are also the property of transitions.

- Changes brought about to a person’s experience in his identity, role, relationship, ability and behavior are
expected to bring a movement or flow both internal and external processes.
- Differences are reflected through a person’s dissatisfaction to self expectations and feelings, or viewing self
or the world in dissimilar ways.

Time Span is characterized by a transition that moves and flows over time. That is to say, starting from the
anticipation of a change to a healthy transition or a failing one.

Critical points and events are “markers such as birth, death, diagnosis of an illness, etc.” linked to an
intensifying awareness of change during a transition.
 Return
MAJOR CONCEPTS AND DEFINITIONS

TRANSITION CONDITIONS

● These are factors that influence how a person moves through a

transition making it possible for a person or hindering the
progress toward fulfilling a positive change.
● This include personal, community or societal conditions

○ Personal condition refers to meanings, cultural beliefs and attitudes, socioeconomic

status, preparation and knowledge.
○ Community conditions include community resources, and Societal conditions include
marginalization of immigrants.

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 Return
MAJOR CONCEPTS AND DEFINITIONS

PATTERNS OF RESPONSE or PROCESS and OUTCOME INDICATORS

● Patterns of response are also known as process and outcome indicators. And these patterns are marked by
positive responses.

◦ Process indicators that handle a patient’s health or vulnerability and risk will be facilitated by the nurse through
an early assessment and provide interventions to achieve a healthy transition.

- A good process indicator would be “the need to feel and stay connected” is a good example of a positive
transition.

◦ Outcome indicators are the basis of whether the transition is a healthy one. However, Meleis et al. warned that
outcome indicators could be misinterpreted with irrelevant events in people's lives if appraised early during the
transition.

- Showing mastery of skills and behaviors signify good outcome indicators.

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MAJOR CONCEPTS AND DEFINITIONS
NURSING THERAPEUTICS
● Meleis et al. proposed the nursing
therapeutics that contain "three
measures" of intervention that nurses
can utilize during a transition -
assessment of readiness, preparation
for the transition, and role
supplementation.
Assessment of readiness relates assessment of
transition conditions and to the full understanding
of the patient.
Preparation for the transition includes
intervention and educating the patient.
Role supplementation exists when there is a role
insufficiency perceived in a patient.
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END OF LESSON 2 :
AFAF MELEIS

TRANSITION THEORY

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Thanks!
ANY QUESTIONS?
You can email me at
alex.borromeo@bulsu.edu.phedu.ph

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CREDITS

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