MYRA ESTRINE LEVINE
set out. By proposing to address the conservation
TOPIC OUTLINE
o Who is Myra Estrin Levine?
o Levine's Nursing theory: Conservational
model
o Major concepts of Levine's
conservational model
o Aims of her theory
o Four conservational model
WHO IS MYRA ESTRIN LEVINE?
• Myra Estrin Levine was born in Chicago
in 1920.
• She worked as a consultant to different
hospitals and schools of nursing.
• In 1944, Myra Estrin Levine received her
diploma in nursing from the Cook County
School of Nursing, then continued to
finish her Bachelor of Science in Nursing
from the University of Chicago in 1949.
Her Master’s of Science in Nursing was
granted to her from Wayne State
University in Detroit in 1962.
• Myra Estrin Levine died on March 20,
1996, at the age of 75.
• Levine received an honorary
membership in the American Mental
Health Aid to Israel in 1976.
• She was also the first recipient of the
Elizabeth Russel Belford Award for
excellence in teaching Sigma Theta Tau
in 1977.
WHAT IS HER NURSING THEORY?
Levine’s conservation model believes
nursing intervention is a conservation activity,
with energy conservation as a fundamental
concern, four conservation principles of nursing.
It guides nurses to concentrate on the importance
and responses at the level of the person. Nurses
fulfill the theory’s purpose by conserving energy,
structure, and personal and social integrity.
The fundamental concept of Myra Estrin
Levine’s theory is "conservation". When an
individual is in a phase of conservation, it means
that the person can adapt to the health challenges
with the slightest amount of effort. The core of
Levine’s Conservation Model is to improve a
person’s physical and emotional well-being by
considering the four domains of conservation she
of energy, structure, and personal and social
integrity, this nursing theory helps guide nurses in
providing care that will help maintain and promote
the health of the patient.
MAJOR CONCEPTS OF LEVINE'S
CONVERSATION MODEL
❖ ENVIRONMENT
The environment includes both the internal and
external environment. Three Aspects of
Environment Drawn upon Bates’ (1967)
Classification:
The operational environment consists of the
undetected natural forces and that impinge on the
individual.
The perceptual environment consists of
information that is recorded by the sensory
organs.
The conceptual environment is influenced by
language, culture, ideas, and cognition.
❖ PERSON
The person is a unique individual in unity,
integrity, feeling, belief, thinking, and whole.
❖ HEALTH
Nursing is the human interaction relying on
communication, rooted in the individual human
being’s organic dependency in his relationships
with other human beings.
❖ NURSING
Nursing is the human interaction relying on
communication, rooted in the individual human
being’s organic dependency in his relationships
with other human beings.
❖ CONSERVATION
Conservation includes joining together and is the
product of adaptation, including nursing
intervention and patient participation to maintain
a safe balance.
 ❖ PERSONAL INTEGRITY
Personal integrity is a person’s sense of identity
and self-definition. Nursing intervention is based
on the conservation of the individual’s personal
integrity.
❖ ADAPTATION
Integration of the organism in which the individual
retains integrity or wholeness. It is possible to
have degrees of adaptation.
❖ SOCIAL INTEGRITY
Social integrity is life’s meaning gained through
interactions with others. Nurses intervene to
maintain relationships.
❖ STRUCTURAL INTEGRITY
Structural integrity: Healing is the process of
restoring structural integrity through nursing
interventions that promote healing and maintain
structural integrity.
AIMS OF LEVINE'S THEORY
The conversation model aims to promote
adaptation and maintain wholeness using the four
principles of conservation.
FOUR CONSERVATIONAL MODEL
1. The conservation of energy of the
individual.
2. The conservation of the structural
integrity of the individual.
3. The conservation of the personal integrity
of the individual.
4. The conservation of the social integrity of
the individual.
MARTHA ROGERS
TOPIC OUTLINE
o Who is Martha Rogers?
o Rogers Theory of Unitary Human Beings
o Nursing metaparadigm of Martha
Rogers: Person, Nursing, Environment,
and Health
o Importance of the theory Martha Rogers
proposed and her Sub concepts
MARTHA ROGERS
• Martha Rogers was born on May 12,
1914, sharing a birthday with Florence
Nightingale. She was the eldest of four
children of Bruce Taylor Rogers and Lucy
Mulholland Keener Rogers.
• She had a thirst for knowledge at an early
age. She found Kindergarten to be
"terribly exciting and had a love and
passion for books that her parents
fostered.
• Rogers received her nursing diploma
from the Knoxville General Hospital
School of Nursing in 1936, then earned
her Public Health Nursing degree from
George Peabody College in Tennessee
in 1937.
• Rogers worked as a professor at New
York University’s School of Nursing. She
was also a Fellow for the American
Academy of Nursing.
• Her publications include: Theoretical
Basis of Nursing (1970), Nursing Science
and Art: A Prospective (1988), Nursing:
Science of Unitary, Irreducible, Human
Beings Update (1990), and Vision of
Space Based Nursing (1990).
• Rogers died on March 13, 1994.
ROGERS THEORY OF UNITARY HUMAN
BEINGS
The belief of the coexistence of the
human and the environment has greatly
influenced the process of change toward better
health. In short, a patient can’t be separated from
his or her environment when addressing health
and treatment. This view leads and opened
Martha E. Rogers’ theory, known as the “Science
of Unitary Human Beings,” which allowed nursing
to be considered one of the scientific disciplines.
Rogers’ theory defined Nursing as “an art
and science that is humanistic and humanitarian.
It is directed toward the unitary human and is
concerned with the nature and direction of human
development. The goal of nurses is to participate
in the process of change.”
NURSING METAPARADIGM OF MARTA
ROGERS: NURSING, PERSON, HEALTH, AND
ENVIRONMENT
❖ NURSING
Nursing is a learned profession and is both a
science and an art. It is an empirical science and,
like other sciences, it lies in the phenomenon
central to its focus. Rogerian nursing focuses on
concern with people and the world in which they
live—a natural fit for nursing care, as it
encompasses people and their environments.
The integrality of people and their environments,
operating from a pan dimensional universe of
open systems, points to a new paradigm and
initiates the identity of nursing as a science.
❖ PERSON
Rogers defines person as an open system in
continuous process with the open system that is
the environment (integrality). She defines unitary
human being as an “irreducible, indivisible,
pandimensional energy field identified by pattern
and manifesting characteristics that are specific
to the whole” (Rogers, 1992, p. 29).
❖ HEALTH
Rogers uses the term health in many of her earlier
writings without clearly defining the term. She
uses the term passive health to symbolize
wellness and the absence of disease and major
illness (Rogers, 1970). Her promotion of positive
health connotes direction in helping people with
opportunities for rhythmic consistency (Rogers,
1970). Later, she wrote that wellness “is a much
better term because the term health is very
ambiguous”
❖ ENVIRONMENT
Rogers (1994a) defines environment as “an
irreducible, pandimensional energy field identified
by pattern and manifesting characteristics
different from those of the parts. Each
environmental field is specific to its given human
field. Both changes continuously and creatively”.
IMPORTANCE OF THE THEORY MARTHA
ROGERS PROPOSED AND HER SUB
CONCEPTS
• Martha Rogers’ theory is known as the
Science of Unitary Human Beings or
SUHB.
• The theory views nursing as both a
science and an art as it provides a way to
view the unitary human being, who is
integral with the universe.
• The unitary human being and his or her
environment are one. Nursing focuses on
people and the manifestations that
emerge from the mutual human-
environmental field process.
• Her model addresses the importance of
the environment as an integral part of the
patient and uses that knowledge to help
nurses blend the science and art of
nursing to ensure patients have a smooth
recovery and get back to the best health
possible.
SUB CONCEPTS
❖ OPENNESS
There are no boundaries that stop energy flow
between the human and environmental fields,
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 a “non-linear
domain without spatial or temporal attributes.”
Humans’ parameters 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 the 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 RECIPROCITY
Postulates the inseparability of man and
environment and predicts that sequential
changes in the 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 environmental field’s actual state at any
given point in space-time.
❖ PRINCIPLE OF INTEGRALITY
(SYNCHRONY + RECIPROCITY)
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 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 identifies the human field and the environmental
field by wave patterns manifesting continuous
change from longer waves of a 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
the same at any two moments; rather, it is
continually new or different.
DOROTHY JOHNSON (1919-1999)
• Dorothy E. Johnson was born on August
21,1919 in Savannah, Georgia.
• In 1938, She finished her associate's
degree at Armstrong Junior College in
Savannah, Georgia.
• Due to depression, she took a year off
from school to be a governess, or
teacher, for two children in Miami,
Florida.
• Her professional nursing career began in
1942, when she graduated from
Vanderbilt University School of Nursing
in Nashville, Tennessee.
• In 1948, she received her master's in
public health from Harvard University in
Boston, Massachusetts.
• Her career mostly involved teaching such
as being an instructor and an assistant
professor in Pediatric Nursing at
Vanderbilt University School of Nursing.
Also, Johnson was an assistant
professor of Pediatric Nursing, an
associate professor of nursing, and a
nursing professor at University of
California, Los Angeles.
• From 1965 to 1967, she served as
chairperson on the California Nurses
Association Committee that developed a
position statement on specifications for
the clinical specialist.
• Dorothy Johnson received awards such
as the 1975 Faculty Award from
Graduate students, 1977 Lulu
Hassenplug Distinguished Achievement
Award from the California Nurses
Association, and the 1981 Vanderbilt
University School of Nursing Award for
excellence in Nursing.
• Dorothy Johnson died in February 1999
at the age of 80.
MAJOR CONCEPTS NURSING
❖ NURSING
Is an external regulatory force that acts to prevent
the organization and integrate the patient's
behavior at an optimal level under those
conditions in which the behavior constitutes a
threat to physical or social health or in which
illness is found.
❖ PERSON
Human being is such a behavioral system that
strives to make continual adjustments to achieve,
maintain, or regain balance to the steady-state
adaptation.
❖ HEALTH
Health is seen as the opposite of illness, and
Johnson defines it as "some degree of regularity
and constancy in behavior.
❖ ENVIRONMENT
The environment is not directly defined, but it is
simply amplified to include all elements of the
human system's surroundings and includes
interior stressors.
BEHAVIORAL SYSTEM
1. There is organization, interaction,
interdependency and integration of the
parts and elements of behaviors that go
to make up the system.
2. A system tends to achieve a balance
among the various forces operating
within and upon it, and that man strives
continually to maintain a behavioral
system balance and steady-state by
more or less automatic adjustments and
adaptations to the natural forces
occurring on him.
3. A behavioral system, which requires and
results in regularity and constancy in
behavior, is essential to man. It is
functionally significant because it serves
a useful purpose in social life and the
individual.
4. System balance reflects adjustments and
adaptations that are successful in some
wat and to some degree.
DOROTHY JOHNSON'S BEHAVIORAL
SYSTEM MODEL
- Johnson is known for her Behavior
System Model of Nursing, which was first
proposed in 1968. Her model was greatly
influenced by Florence Nightingale' s
book, Notes on Nursing.
- It advocates the fostering of efficient and
effective behavioral functioning in the
patient to prevent illness.
- The patient is defined as a behavioral
system composed of seven behavioral
subsystems. Each subsystem is
comprised of four-structural
characteristics. An imbalance in each
system results in disequilibrium. The
nurse's role is to help the patient maintain
his or her equilibrium.
SUBSYSTEMS
1. Attachment or affiliative subsystem—
serves the need for security through
social inclusion or intimacy.
2. Dependency subsystem— behaviors
designed to get attention, recognition,
and physical assistance.
3. Ingestive subsystem— fulfill the needs to
supply the biologic requirements for food
and fluids.
4. Eliminative subsystem— functions to
excrete wastes.
5. Sexual subsystem— serves the biologic
requirements of procreation and
reproduction.
6. Aggressive subsystem— functions in self
and social protection and preservation.
7. Achievement system— functions to
master and control the self or the
environment.
JOHNSON'S THEORY STRUCTURE
1. Drives serve as focal points around
which behaviors are organized to
achieve specific goals.
2. Behavior is differentiated and organized
within the prevailing dimensions of set
and choice.
3. The specialized parts or subsystems of
the system are structured by dimensions
of goal, set, choice, and actions; each
has observable behaviors.
 4. Interactive and interdependent complete a Doctoral degree in Sociology
subsystems tend to achieve and maintain in 1977.
balance between and among • 1976 The Roy’s Adaptation Model of
subsystems through control and Nursing was developed.
regulatory mechanisms. • 198 3 - 198 5 - She was a clinical nurse
scholar in neuroscience at the University
FUNCTIONAL REQUIREMENTS
of California, San Francisco.
1. The system must be protected from toxic • 198 7 - Present Time - Roy began the
influences which the system cannot newly created resident nurse theorist
cope. position at Boston College School of
2. Each system has to be nurtured through Nursing, where she teaches doctoral,
the input of appropriate supplies from the master’s, and undergraduate students.
environment. • 1991 - She founded the Boston Based
3. The system must be stimulated for use to Adaptation Research in Nursing Society
enhance growth and prevent stagnation. (BBARNS), which would later be
renamed the Roy Adaptation
Association.
CALLISTA ROY THE ADAPTATION MODEL OF NURSING
o BIOGRAPHY OF SISTER CALLISTA • The Adaptation Model of Nursing is a
ROY prominent nursing theory aiming to
o THE ADAPTATION MODEL OF explain or define the provision of nursing
NURSING science. In her theory, Sister Callista
o MAJOR CONCEPTS OF THE Roy’s model sees the individual as a set
ADAPTATIONAL MODEL of interrelated systems that maintain a
o FOUR ADAPTIVE MODES balance between various stimuli.
o LEVELS OF ADAPTATION • The factors that influenced the
o SIX-STEP NURSING PROCESS development of the model included:
SISTER CALLISTA ROY family, education, religious background,
mentors, and clinical experience.
• Born at Los Angeles on October 14, • First, consider the concept of a system as
1939. applied to an individual. Roy
• A nurse theorist, writer, lecturer, conceptualizes the person in a holistic
researcher, teacher and member of the perspective. Individual aspects of parts
religious community. act together to form a unified being.
• 1963 - She earned a Bachelor of Arts • Adaptation occurs when people respond
Degree in Nursing from Mount St. Mary’s positively to environmental changes, and
College in Los Angeles. And worked with it is the process and outcome of
Dorothy E. Johnson. individuals and groups who use
• 1966 - She earned a Master’s Degree in conscious awareness, self-reflection,
Pediatric Nursing from the University of and choice to create human and
California-Los Angeles. environmental integration.
• 1968 - She began operationalizing her
THEORETICAL SOURCES OF RAM
model when Mount Saint Mary’s College
adopted the adaptation framework as the • Roy’s Adaptation model for Nursing was
nursing curriculum’s philosophical derived in 1964 from Harry Helson’s
foundation. • Adaptation Theory - adaptive responses
• 1971 – 1982 - She was made chair of the are a function of the incoming stimulus
nursing department at the college. and the adaptive level.
• 1973 - 1977 - She also earned a Master’s • After the development of her theory, Roy
Degree in Sociology and went on to developed the model as a framework for
 nursing practice, research and
education.
• The model uses concepts from AH
Maslow to explore beliefs and values of
persons. Roy’s holistic approach to
nursing is based in Humanism.
MAJOR CONCEPTS OF THE ADAPTATIONAL
MODEL
❖ PERSON (ADAPTIVE SYSTEM)
“Human systems have thinking and feeling
capacities, rooted in consciousness and
meaning, by which they adjust effectively to
changes in the environment and, in turn, affect
the environment.”
❖ ENVIRONMENT (STIMULI)
“The conditions, circumstances and influences
surrounding and affecting the development and
behavior of persons or groups, with particular
consideration of the mutuality of person and
health resources that includes focal, contextual
and residual stimuli.”
❖ HEALTH (OUTCOME OF
ADAPTATION)
“Health is not freedom from the inevitability of
death, disease, unhappiness, and stress, but the
ability to cope with them in a competent way.”
❖ NURSING (PROMOTING ADAPTATION
AND HEALTH)
“The goal of nursing is] the promotion of
adaptation for individuals and groups in each of
the four adaptive modes, thus contributing to
health, quality of life, and dying with dignity.”
❖ ADAPTATION (GOAL OF NURSING)
“Process and outcome whereby thinking and
feeling persons as individuals or in groups use
conscious awareness and choice to create
human and environmental integration.”
INTERNAL PROCESSES
• Regulator
- The regulator subsystem is a person’s
physiological coping mechanism.
• Cognator
- The cognator subsystem is a person’s
mental coping mechanism.
FOUR ADAPTIVE MODES
• Physiological- Physical Mode
- Physical and chemical processes are
involved in the function and activities of
living organisms. These are the actual
processes put in motion by the regulator
subsystem.
• Self-Concept Group Identity Mode
- In this mode, the goal of coping is to have
a sense of unity, meaning the
purposefulness in the universe, and a
sense of identity integrity.
• Interdependence Mode
- This mode focuses on attaining relational
integrity through the giving and receiving
of love, respect and value.
• Role Function Mode
- This mode focuses on the primary,
secondary, and tertiary roles that a
person occupies in society and knowing
where they stand as a member of society.
LEVELS OF ADAPTATION
• Integrated Process
- The various modes and subsystems
meet the needs of the environment. (e.g.,
breathing, spiritual realization, successful
relationship)
• Compensatory Process
- The cognator and regulator are
challenged by the environment’s needs
but are working to meet the needs. (e.g.,
grief, starting with a new job,
compensatory breathing)
• Compromised Process
- The modes and subsystems are not
adequately meeting the environmental
challenge (e.g., hypoxia, unresolved
loss, abusive relationships)
SIX-STEP NURSING PROCESS
1. Assess the behaviors manifested from
the four adaptive modes.
2. Assess the stimuli, categorize them as
focal, contextual, or residual.
3. Make a statement or nursing diagnosis of
the person’s adaptive state.
4. Set a goal to promote adaptation.
 5. Implement interventions aimed at
managing the stimuli.
6. Evaluate whether the adaptive goal has
been met.
STRENGTHS
• The Adaptation Model of Callista Roy
suggests the influence of multiple causes
in a situation, which is a strength when
dealing with multi-faceted human beings.
• The sequence of concepts in
• Roy’s model follows logically.
• The concepts of Roy’s model are
• stated in relatively simple terms.
• A major strength of the model is that it
guides nurses to use observation and
interviewing skills in doing an
individualized assessment of each
person.
WEAKNESSES
• Painstaking application of the model
requires a significant input of time and
effort.
• Roy’s model has many elements,
systems, structures, and multiple
concepts.
ANALYSIS
• As one of the weaknesses of the theory
that applying it is time-consuming,
applying the model to emergencies
requiring quick action is difficult to
complete, the individual might have
completed the whole adaptation process
without the benefit of having a complete
assessment for thorough nursing
interventions.
• The main point of the concept was to
promote adaptation, but none were
stated on preventing and resolving
maladaptation.
BETTY NEUMAN
BETTY NEUMAN NEUMAN SYSTEM MODEL
OUTLINES
o Betty Neuman personal background
o Betty Neuman theory
o Assumption
o Major concept
o Sub concepts
o Conclusion
BETTY NEUMAN'S PERSONAL
BACKGROUND
• born in 1924 near Lowell, Ohio.
• grew up on a farm which later
encouraged her to help people who are
in need.
• Her father was a farmer who became sick
and died at the age of 36.
• Her mother was a self-educated midwife.
• She had one older brother and a younger
brother, which makes her the middle
child among her siblings. Her love for
nursing started when she took care of her
father.
• She was always engaged and fascinated
with the study of human behavior.
• During World War II, she had her first job
as an aircraft instrument technician.
1947 - Received her RN Diploma from Peoples
Hospital School of Nursing, Akron, Ohio.
- Worked as hospital nurse and head
nurse at Los Angeles County General
Hospital.
- Worked as a school nurse, industrial
nurse and clinical instructor at the
University of Southern California Medical
Center, Los Angeles.
1957 - She received a baccalaureate degree in
public health and psychology with honors.
- She got married, supported her
husband’s medical practice, and had
their daughter in 1959.
1966 - She also earned a master’s degree in
mental health, public health consultation at the
University of California, Los Angeles (UCLA).
- After her graduation, she was hired as a
department chair in the UCLA School of
Nursing graduate program.
1967- 1973 - She developed the first community
mental health program for graduate students in
Los Angeles area.
1972 - She published a draft of her model. BETTY NEUMAN'S NEUMAN SYSTEM MODEL

1982 - She developed and improved the concepts
and published her book, The Neuman System
Model: Application to Nursing education and
Practice.
- As a speaker and author, she spent
countless hours teaching and explaining
the model’s many concepts and aspects
to students and professors.
- She also been involved in numerous
publications, paper presentation,
consultations, lectures and conferences
on applying and using the model.
- She worked as a consultant nationally
and internationally concerning
implementing the nursing education
programs and clinical practice facilities
model.
"The Neuman systems model is a
unique, open-systems-based perspective that
provides a unifying focus for approaching a wide
range of concerns. A system act as a boundary
for a single client, a group, or even a number of
groups; it can also be defined as a social issue. A
client system in interaction with the environment
delineates the domain of nursing concern"
Viewed client as an open systems model
that respond to a stressor in the environment. The
client variable is physiological, psychological,
sociocultural, developmental and spiritual
First Edition of Neuman System Model:
The application to nursing Education and Practice
was Published in 1982

1985 - She concluded a doctoral degree in clinical

psychology at Pacific Western University.

- She was a pioneer of nursing

involvement in mental health.
THEORETICAL INFLUENCE
- She and Donna Aquilina were the first
two nurses to develop the nurse • Gestalt theory " Adjustments, Needs,
counselor role within community crisis Dynamic and Continuous, Balance and
centers in Los Angeles. Imbalance.
- She persisted in starting a private • Philosophical view of de Chardin & Marx
practice as a marriage and family • The concept of levels of prevention from
therapist, specializing in Christian Caplan's Conceptual model (1964)
counseling
• Selye's Definition of Stress.
- She is a Fellow of the American
Association of Marriage and Family
Therapy and the American Academy of
Nursing

1988 - She established The Neuman Systems

Model Trustees Group, Inc.

NEUMAN’S AWARDS & HONORS

• Honorary doctorate of letters, Neuman

college, Aston, pa (1992)
• Honorary member of the fellowship of the
American academy of nursing (1993)
• Honorary doctorate of science, Grand
Valley State University, Michigan (1998)
• The Walsh university distinguished
service medal first annual Neuman
award - named in her honor.
BETTY NEUMAN'S MAJOR ASSUMPTIONS
❖ NURSING
Neuman (1982) believes that nursing is
concerned with whole person. View Nursing as a
"unique profession in that it is concerned with all
the variables affecting an individual's response to
stress"
❖ HEALTH
Neuman views health as a continuum of wellness
to illness that is dynamic in nature and is
constantly changing."
❖ HUMAN BEINGS
Neuman presents the concept of human beings
as an open client system in reciprocal interaction
with the environment. The client may be and
individual, family, group, community, or social
issue."
❖ ENVIRONMENT
Neuman defines environment as all the internal
and external factor that surround and influence
the client system.
→ Stressor - Significant to the concept of
environment and described as
environmental forced
3 RELEVANT ENVIRONMENTS
INTERNAL: EXTERNAL: is intrapersonal, with all
interaction contained within the client.
CREATED: is interpersonal or extra personal,
with all factors arising from outside the client.
CREATED: unconsciously developed and is used
by the client to support protective client. It is
dynamic in nature
BETTY NEUMAN'S MAJOR CONCEPTS OF
NUEMAN SYSTEM MODEL
❖ OPEN SYSTEM
A system in which there is a continuous flow of
input and process, output and feedback. It is a
system of organized complexity, where all
elements are in interaction.
❖ BASIC STRUCTURE AND ENERGY
RESOURCES
The basic structure, or central core, comprises
those basic survival factors common to the
species. These factors include the system
variables, genetic features, and strengths and
weaknesses of the system parts.
BETTY NEUMAN'S MAJOR CONCEPTS OF
NUEMAN SYSTEM MODEL
❖ CLIENT VARIABLES
→ Neuman views the individual client
holistically and considers the variables
simultaneously and comprehensively.
→ The physiological variable refers to the
structure and functions of the body.
→ The psychological variable refers to
mental processes and relationships.
→ The sociocultural variable refers to
system functions that relate to social and
cultural expectations and activities.
→ The developmental variable refers to
those processes related to development
over the lifespan.
→ The spiritual variable refers to the
influence of spiritual beliefs.
❖ FLEXIBLE LINE OF DEFENSE
A protective accordion-like mechanism that
surrounds and protects the normal line of defense
from invasion by stressors.
❖ NORMAL LINE OF DEFENSE
An adaptational level of health developed over
time and is considered normal for a particular
individual client or system; it becomes a standard
for wellness-deviance determination.
❖ LINES OF RESISTANCE
Protection factors are activated when stressors
have penetrated the normal line of defense,
causing reaction symptomatology.
BETTY NEUMAN'S SUBCONCEPTS OF
NUEMAN SYSTEM MODEL
❖ STRESSORS
A stressor is any phenomenon that might
penetrate both the flexible and normal lines of
defense, resulting in either a positive or negative
outcome.
→ INTRAPERSONAL stressors are those
that occur within the client system
boundary and correlate with the internal
environment.
→ INTERPERSONAL stressors occur
outside the client system boundary, are
proximal to the system, and impact the
system.
→ EXTRA PERSONAL stressors also occur
outside the client system boundaries but
are at a greater distance from the system
than are interpersonal stressors. An
example is a social policy.
❖ STABILITY
A state of balance or harmony requiring energy
exchanges as the client adequately copes with
stressors to retain, attain, or maintain an optimal
health level, thus preserving system integrity.
❖ DEGREE OF REACTION
The amount of system instability resulting from
stressor invasion of the normal line of defense.
❖ ENTROPY
A process of energy depletion and
disorganization moving the system toward illness
or possible death.
❖ NEGENTROPY
An energy conservation process that increases
organization and complexity, moving the system
toward stability or a higher degree of wellness.
❖ INPUT/OUTPUT
The matter, energy, and information exchanged
between the client and environment entering or
leaving the system at any point in time.
❖ RECONSTITUTION
Following treatment of stressor reaction, the
return and maintenance of system stability may
result in a higher or lower wellness level.
❖ PREVENTION AS INTERVENTION
Intervention modes for nursing action and
determinants for both client and nurse entry
into the health care system
→ PRIMARY PREVENTION occurs before
the system reacts to a stressor; it
includes health promotion and wellness
maintenance. Primary prevention
focuses on strengthening the flexible line
of defense through preventing stress and
reducing risk factors.
→ SECONDARY PREVENTION occurs
after the system reacts to a stressor and
is provided in terms of existing
symptoms. Secondary prevention
focuses on strengthening the internal
lines of resistance and, thus, protects the
basic structure through appropriate
treatment of symptoms.
→ TERTIARY PREVENTION occurs after
the system has been treated through
secondary prevention strategies. Its
purpose is to maintain wellness or protect
the client system reconstitution by
supporting existing strengths and
preserving energy. Tertiary prevention
may begin at any point after system
stability has begun reestablished
(reconstitution has begun). Tertiary
prevention tends to lead back to primary
prevention. (Neuman, 1995)
CONCLUSION
• The Neuman system model has been
well accepted by the nursing community
and is used in administration, practice,
education and research.
• The Neuman Systems Model (NSM) is
an operating framework designed to
guide caregivers and administrators in
helping those in their charge to manage
stressors. Additionally, the theory is
recognized as a valid method to create
positive client outcomes.
• The Neuman System Model Trustees
Group is actively involving protecting the
integrity of the model and advancing its
development.
IMOGENE KING
• born in 1923. Earned a diploma in
nursing from St. John’s hospital of
nursing in St. Louis in 1945.
 • worked as office nurse, staff nurse, and
• private duty nurse to support herself
while studying for a baccalaureate
degree.
• bachelor of science in nursing from St.
Louis university in 1948.
• masters of science in nursing from St
Louis university in 1957.
• doctorate from teacher's college,
• Columbia university, New York in 1961.
• died on December 24, 2007 (suffering
from stroke
IMOGENE KING'S THEORY OF GOAL
ATTAINMENT
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.
MAJOR CONCEPTS AND SUBCONCEPTS:
KING’S THEORY OF GOAL ATTAINMENT:
❖ NURSING
Nursing is a process of action, reaction, and
interaction whereby nurse and client share
information about their perceptions in the nursing
situation. The nurse and client share specific
goals, problems, and concerns and explore how
to achieve a goal.
❖ HEALTH
Health is a dynamic life experience of a human
being, which implies continuous adjustment to
stressors in the internal and external environment
through optimum use of one’s resources to
achieve maximum daily living potential.
❖ INDIVIDUAL
Individuals are social beings who are rational and
sentient. Humans communicate their thoughts,
actions, customs, and beliefs through language.
Persons exhibit common characteristics such as
the ability to perceive, think, feel, choose between
alternative courses of action, set goals, select the
means to achieve goals, and make decisions.
❖ ENVIRONMENT
The environment is the background for human
interactions. It is both external to, and internal to,
the individual.
THE FOLLOWING PROPOSITIONS ARE MADE
IN THE THEORY OF GOAL ATTAINMENT:
1. If the perceptual interaction accuracy is
present in nurse-patient interaction,
transaction will occur
2. If the nurse and patient make
transaction, the goal or goals will be
achieved
3. If the goal or goals are achieved,
satisfaction will occur.
4. If the goal or goals are achieved, effective
nursing care will occur
5. If the transaction is made up in nurse-
patient interactions, growth and
development will be enhanced
6. If role expectations and role performance
as perceived by the nurse and patient are
congruent transaction will occur.
7. If role conflict is experienced by either the
nurse or the patient (or both?), stress in
the nurse-patient interaction will occur
8. If a nurse with special knowledge
communicates appropriate information to
the patient, mutual goal setting and goal
achievement will occur.
THE ASSUMPTIONS ARE:
1. The focus of nursing is the care of the
human being (patient).
2. The goal of nursing is the health care of
both individuals and groups.
3. Human beings are open systems
interacting with their
environments constantly.
4. The nurse and patient communicate
information, set goals mutually, and then
act to achieve those goals. This is also
the basic assumption of the nursing
process.
5. Patients perceive the world as a
complete person making transactions
with individuals and things in the
environment.
6. The transaction represents a life situation
in which the perceiver and the thing being
perceived are encountered. It also
 represents a life situation in which a
person enters the situation as an active
participant. Each is changed in the
process of these experiences.
INTERACTING SYSTEMS OF THEORY OF
GOAL ATTAINMENT ACCORDING TO KING,
THERE ARE THREE INTERACTING SYSTEMS
IN THE
❖ Theory of Goal Attainment.
• Personal system
• Interpersonal system
• Social system.
Each system is given different concepts. The
personal system concepts are perception, self,
growth and development, body image, space,
and time. The concepts for the interpersonal
system are interaction, communication,
transaction, role, and stress. The social system
concepts are organization, authority, power,
status, and decision- making.
1. PERSONAL SYSTEMS
- Each individual is a personal system.
King designated an example of a
personal system as a patient or a nurse.
King specified the concepts of body
image, growth, development, perception,
self, space, and time to comprehend
human beings as persons.
2. INTERPERSONAL SYSTEMS
- These are formed by human beings
interacting. Two interacting individuals
form a dyad; three form a triad, and four
or more form small or large groups. As
the number of interacting individuals
increases, so does the complexity of the
interactions.
- Understanding the interpersonal system
requires the concepts of communication,
interaction, role, stress, and transaction.
3. SOCIAL SYSTEMS
- A more comprehensive interacting
system consists of groups that make up
society, referred to as the social system.
- Religious, educational, and health care
systems are examples of social systems.
An extended family’s influential behavior
on an individual’s growth and
development is another social system
example. Within a social system, the
concepts of authority, decision making,
organization, power, and status guide
system understanding.
DYNAMIC CONCEPTUAL SYSTEMS
The figure below demonstrates the
conceptual system that provided
“one approach to studying systems
as a whole rather than as isolated
parts of a system” and was
“designed to explain the organized
wholes within which nurses are expected to
function.”
According to King, “The human process
of interactions formed the basis for designing a
model of transactions that depicted theoretical
knowledge used by nurses to help individuals and
groups attain goals.”
THEORY OF GOAL ATTAINMENT AND THE
NURSING PROCESS
Imogene King emphasizes the nursing
process in her model of nursing. The steps of the
nursing process are assessment, nursing
diagnosis, planning, implementations, and
evaluation.
• Assessment - Takes place during the
interaction. The nurse uses his or her
special knowledge and skills while the
patient delivers knowledge of him or
herself and the perception of problems of
concern to the interaction.
• Nursing diagnosis - This phase is
developed using the data collected in the
assessment. In attaining goals, the nurse
identifies problems, concerns, and
disturbances about which the patient is
seeking help.
• Planning - arises after the diagnosis. The
nurse and other health care team
members create a care plan of
interventions to solve the problems
identified. The actual activities done to
achieve the goals make up the
implementation phase of the nursing
process. Whereas in this model of
nursing, it is the continuation of
transaction.
• Evaluation - the nurse evaluates the
patient to determine whether theg oals
 were achieved. Evaluation involves
determining whether or not goals were
achieved.
HILDEGARD PEPLAU
BRIEF BACKGROUND
• Born on September 1, 1909 and died on
March 17, 1999.
• She was named one of “50 Great
Americans” in Who’s Who in 1995 by
Marquis.
• In 1996, the American Academy of
Nursing honored Peplau as a “Living
Legend". She became the Founder and
Mother of Modern Psychiatric Nursing.
INTERPERSONAL RELATIONS THEORY
The theory emphasized the nurse-client
relationship as the foundation of nursing practice.
It emphasized the give-and-take of nurse-client
relationships that was seen by many as
revolutionary.
“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.”
MAJOR CONCEPTS HEALTH
❖ 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
“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 the hospital routine.
❖ NURSING
Hildegard Peplau considers nursing to be a
“significant, therapeutic, interpersonal process.”
“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 focuses on the client’s needs,
feelings, problems, and ideas. It involves
interaction between two or more individuals with
a common goal.
FOUR PHASES OF THERAPEUTIC NURSE-
PATIENT RELATIONSHIP
❖ ORIENTATION PHASE
The nurse’s orientation phase involves engaging
the client in treatment, providing explanations and
information, and answering questions.
❖ IDENTIFICATION PHASE
The identification phase begins when the client
works interdependently with the nurse, expresses
feelings, and begins to feel stronger.
❖ EXPLOITATION PHASE
In the exploitation phase, the client makes full use
of the services offered.
❖ RESOLUTION PHASE
In the resolution phase, the client no longer needs
professional services and gives up dependent
behavior. The relationship ends.
7 NURSING ROLES AND SUB CONCEPTS
1. STRANGER - Offering the client, the
same acceptance and courtesy that the
nurse would respond to any stranger
2. RESOURCE PERSON - Providing
specific answers to questions within a
larger context
3. Teacher - Helping the client to learn
formally or informally
4. Leader - Offering direction to the client or
group
 5. Surrogate - Serving as a substitute for
another such as a parent or a sibling.
6. Counselor - Promoting experiences
leading to health for the client such as
expression of feelings.
7. Technical expert - Providing physical
care for the patient and operates
equipment.
IMPORTANCE OF INTERPERSONAL
RELATIONS THEORY
Peplau’s theory has proved greatly used to later
nurse theorists and clinicians in developing more
sophisticated and therapeutic nursing
interventions.
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.
Studying Peplau’s Interpersonal Relations
Theory of Nursing can be very substantial,
especially to aspiring to be part of the profession
IDA JEAN ORLANDO(AUGUST 12.1926-
NOVEMBER 28 2007)
• was an internationally known psychiatric
health nurse
• theorist and researcher who developed
the "deliberative nursing process theory".
• 1926 - 1st generation Irish American
Born on August 12,1926.
• 1947 - Obtain her Nursing Diploma from
the Flower Fifth Avenue Hospital School
in New York.
• 1951 - Bachelor of Science Degree in
Public Health Nursing from the ST.
John's University in Brooklyn New York.
• 1954 - Achieve her Master of Arts in
Mental Health Consultation in Teachers
College, Columbia University.
CREDENTIALS & BACKGROUND OF THE
THEORIST.
• developed her theory from a study
conducted at the yale university school of
nursing.
• first nursing leaders to identify and
emphasize the elements of the nursing
process and the critical importance of the
patient's participation in the nursing
process.
• Orlando's theory focuses on how to
produce improvement in the patience’s
behavior.
• 2000 nurse-patient contacts and created
her theory based on analysis of these
data.
• early thinkers in nursing who proposed
that patients have their own meaning and
interpretations of the situations.
THEORY DESCRIPTION
• Orlando's nursing theory stresses
reciprocal relationship between patient
and nurse.
• Persons became patients that require
nursing care where they have needs for
help (physical limitation) 1961
• Patients experience distress or feelings
of helplessness as the result of unmet
needs for help (Orlando 1961)
• Proposed a positive correlation between
the length of time the patient experiences
unmet needs and the degree of distress.
• When individuals are able to meet their
own needs, they do not feel distress and
do not require care from a professional
nurse
• Crucial for nurses to share their
perceptions thoughts and feelings
• Abraham (2011) used Orlando's theory to
help nurses achieve more successful
patients’ outcomes such as fall reduction
NURSING PROCESS THEORY
1. The behavior of the patient.
2. The reaction of the nurse.
3. Nursing actions are designed for the
patient's benefit.
• Nursing process helps the nurse find out
the nature of the distress and what helps
the patient.
• The use of this theory keeps the nurse's
focus on the patient.
• The strength of the theory is that it is
clear, concise and easy to use.
MAJOR CONCEPTS AND DEFINITIONS
1. NEED - Defined requirement of the
patient which relieves or diminishes his
immediate distress of this is supplied.
2. PRESENTING BEHAVIOR OF PATIENT
- Any observable verbal and non-verbal
behavior of the patient.
3. IMMEDIATE REACTIONS- Individual
perceptions, thoughts and feelings.
4. NURSING PROCESS DISCIPLINE -
“Deliberative Nursing Process " 11
5. AUTOMATIC NURSING ACTIONS -
Nursing activities that are decided upon
for reasons other than the patient
immediate needs.
6. DELIBERATIVE NURSING ACTIONS -
Those decided upon after ascertaining a
need and then meeting this need.
4 METAPARADIGMS
1. NURSING - Orlando speaks of nursing
as a unique and independent in its
concern for an individual's need for help
in an immediate situation.
2. PERSON - For her humans in need are
the focus of nursing practice.
3. HEALTH - She stated that nursing deals
with individuals who require help.
4. ENVIRONMENT - The effect that the
environment could have on the patient
never mentioned in Orlando's Theory.
JOYCE TRAVELBEE
• Travelbee works as a Psychiatric Mental
Health Nurse (PMHN). Psychiatric
nurses are specially trained nurses who
care for the psychological and physical
well-being of people with mental health
conditions or behavioral problems.
• 1926 - She was born and is known for her
work as a nursing theorist.
• 1956 - Travelbee earned her Bachelor of
Science in Nursing degree from
Louisiana State University.
• 1959 - She was given a Master of
Science in Nursing degree from Yale
University.
• 1973 - Travelbee died in September, at
the age of 47.
• Her career dealt predominantly with
psychiatric nursing and education.
• She worked as a psychiatric nursing
instructor at the DePaul Hospital Affiliate
School in New Orleans, Louisiana.
• And worked later in the Charity Hospital
School of Nursing in Louisiana State
University, New York University, and the
University of Mississippi.
NURSING THEORY: HUMAN TO HUMAN
RELATONSHIP MODEL
• Travelbee developed the Human-to
Human Relationship Model of Nursing.
• The Human-to-Human Relationship
Model of Nursing deals with the
interpersonal aspects of nursing,
focusing especially on mental health.
• Joyce Travelbee, who developed the
theory, explained that "human-to human
relationship is the means through which
the purpose of nursing is fulfilled."
• The theory was presented in her book,
Interpersonal Aspects of Nursing, which
was published in 1961.
THE 7 MAIN CONCEPTS OF THE NURSING
THEORY
1. SUFFERING
• The role of nursing in Travelbee's theory
is to help the patient find meaning in the
experience of suffering, as well as help
the patient maintain hope.
• Suffering, which is "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...."
• Suffering ranges from:
→ feeling of unease to extreme torture
→ varies in intensity
→ duration
→ depth
2. MEANING
- Which is the reason attributed to a
person.
3. NURSING
- Which helps a person find meaning in the
experience of illness and suffering; has a
responsibility to help people and their
families find meaning; and the nurse's
 spiritual and ethical choices, and BUILDING THE PATIENT-NURSE
perceptions of illness and suffering, RELATIONSHIP TAKES PLACE IN 5 PHASES
which are crucial to help patients find
meaning. Travelbee believed nursing should be
4. HOPE accomplished through human relationships that
begin with:
• Hope is defined as a faith that can and
will bring change that will bring • The original encounter
something better with it. • The visibility of personal or emerging
• Which is a faith that can and will be a identities
change that would bring something better • Empathy
with it.
• Sympathy
• It has six characteristics: • The establishment of mutual
a. It is strongly associated with dependence understanding
on other people.
• Rapport
b. It is oriented with the future.
c. It is linked to elections from several TRAVELBEE'S THEORY DEFINES HEALTH IN
alternatives or escape routes out of its TWO CATEGORIES:
situation.
d. The desire to possess any object or • SUBJECTIVE HEALTH
condition, to complete a task or have an
is an individually defined state of wellbeing in
experience.
accord with self-appraisal of the physical
e. Confidence that others will be there for
emotional-spiritual status.
one when you need them.
f. The hoping person is in possession of • OBJECTIVE HEALTH
courage to be able to acknowledge its
shortcomings and fears and go forward is an absence of discernible disease, disability of
toward its goal. defect as measured by physical examination,
5. COMMUNICATION laboratory tests and assessment by spiritual
- Which is "a strict necessity for good director or psychological counselor.
nursing care."
6. SELF-THERAPY
- Which is the ability to use one's own MADELLINE LEININGER
personality consciously and in full
awareness in an attempt to establish TOPIC OUTLINE
relatedness and to structure nursing
• Biography of Madeleine Leininger
interventions. This refers to the nurse's
• Career and Honors
presence physically and psychologically.
• Major Concepts and Definition of the
7. TARGETEDINTELLECTUAL
Theory
APPROACH
• Sub concepts
- By the nurse toward the patient's
situation. • Sunrise Model of Madeleine Leininger’s
Theory
• Three modes of nursing care decisions
and actions
• Assumptions, Analysis, Strengths &
Weakness
• Biography

BIOGRAPHY OF MADELEINE LEININGER

• Madeleine Leininger was born on July

13, 1925, in Sutton, Nebraska.
 • She lived on a farm with her four brothers
and sisters and graduated from Sutton
High School.
• After her graduation from Sutton High,
she was in the U.S. Army Nursing Corps
while pursuing a basic nursing program.
• Her aunt, who had congenital heart
disease, led her to pursue a career in
nursing.
• In 1948, she earned a nursing diploma
from St. Anthony’s Hospital School of
Nursing in Denver, Colorado Leininger
opened a psychiatric nursing service and
educational program at Creighton
University in Omaha, Nebraska.
• She earned the equivalent of a BSN
through her studies in biological
sciences, nursing administration,
teaching, and curriculum during 1951-
1954.
CAREER HONORS
• In 1954, she moved on to serve as
Associate Professor of Nursing and
Director of the Graduate Program in
Psychiatric Nursing at the University of
Cincinnati.
• She also studied in this university,
pursuing further graduate studies in
curriculum, social sciences, and nursing.
• Leininger was appointed Professor of
Nursing and Anthropology at the
University of Colorado — the first joint
appointment of a nursing professor and a
second discipline in the United States.
• She was the first in the 1960s to coin the
concept of “culturally congruent care,”
which was the goal of the Theory of
Culture Care, and today the concept is
being used globally.
HONORS
• As for being a pioneer nurse
anthropologist, Leininger was appointed
Dean of the University of Washington,
School of Nursing in 1969 and remained
in that position until 1974.
• In 1973, under her leadership, the
University of Washington was recognized
as the outstanding public institutional
school of nursing in the United States.
Her appointment followed a trip to New
Guinea in the 1960s that opened her
eyes to the need for nurses to understand
their patients’ culture and background to
provide care.
• She is considered by some to be the
“Margaret Mead of nursing” and is
recognized worldwide as the founder of
transcultural nursing, a program that she
created at the school in 1974.
TRANSCULTURAL NURSING THEORY
In 1995, Madeleine Leininger defined
transcultural nursing as “a substantive area of
study and practiced focused on comparative
cultural care (caring) values, beliefs, and
practices of individuals or groups of similar or
different cultures to provide culture-specific and
universal nursing care practices in promoting
health or well-being or to help people to face
unfavorable human conditions, illness, or death in
culturally meaningful ways.”
Through her observations, while working
as a nurse, Madeleine Leininger identified a lack
of cultural and care knowledge as the missing
component to a nurse’s understanding of the
many variations required inpatient care to support
compliance, healing, and wellness, which led her
to develop the theory of Transcultural Nursing
also known as Culture Care Theory.
This theory attempts to provide culturally
congruent nursing care through “cognitively
based assistive, supportive, facilitative, or
enabling acts or decisions that are mostly tailor-
made to fit with the individual, group’s, or
institution’s cultural values, beliefs, and lifeways.”
MAJOR CONCEPTS AND DEFINITIONS
• TRANSCULTURAL NURSING
Transcultural nursing is defined as a learned
subfield or branch of nursing that focuses upon
the comparative study and analysis of cultures
concerning nursing and health-illness caring
practices, beliefs, and values to provide
meaningful and efficacious nursing care services
to their cultural values and health-illness context.
 • ETHNONURSING
This is the study of nursing care beliefs, values,
and practices as cognitively perceived and known
by a designated culture through their direct
experience, beliefs, and value system (Leininger,
1979).
• NURSING
Nursing is defined as a learned humanistic and
scientific profession and discipline which is
focused on human care phenomena and
activities to assist, support, facilitate, or enable
individuals or groups to maintain or regain their
well-being (or health) in culturally meaningful and
beneficial ways, or to help people face handicaps
or death.
• PROFESSIONAL NURSING CARE
(CARING)
Professional nursing care (caring) is defined as
formal and cognitively learned professional care
knowledge and practice skills obtained through
educational institutions that are used to provide
assistive, supportive, enabling, or facilitative acts
to or for another individual or group to improve a
human health condition (or well-being), disability,
lifeway, or to work with dying clients.
• CULTURAL CONGRUENT (NURSING)
CARE
Cultural congruent (nursing) care is defined as
those cognitively based assistive, supportive,
facilitative, or enabling acts or decisions that are
tailor-made to fit with the individual, group, or
institutional, cultural values, beliefs, and lifeways
to provide or support meaningful, beneficial, and
satisfying health care, or wellbeing services.
• HEALTH
It is a state of well-being that is culturally defined,
valued, and practiced. It reflects individuals’ (or
groups) ‘ability to perform their daily role activities
in culturally expressed, beneficial, and patterned
lifeways.
• HUMAN BEINGS
Such are believed to be caring and capable of
being concerned about others’ with more arrows
as caring science should focus beyond traditional
nurse-patient interactions and dyads to include
families, groups, communities, total cultures, and
institutions.
• SOCIETY AND ENVIRONMENT
Leininger did not define these terms; she speaks
instead of worldview, social structure, and
environmental context.
• WORLDVIEW
Worldview is how people look at the world, or the
universe, and form a “pictureor value stance”
about the world and their lives.
• CULTURAL AND SOCIAL STRUCTURE
DIMENSIONS
Cultural and social structure dimensions are
defined as involving the dynamic patterns and
features of interrelated structural and
organizational factors of a particular culture
(subculture or society) which includes religious,
kinship (social), political (and legal), economic,
educational, technological, and cultural values,
ethnohistorical factors, and how these factors
may be interrelated and function to influence
human behavior in different environmental
contexts.
• ENVIRONMENTAL CONTEXT
Environmental context is the totality of an event,
situation, or particular experience that gives
meaning to human expressions, interpretations,
and social interactions in particular physical,
ecological, sociopolitical, and/or cultural settings.
• CULTURE
Culture is learned, shared, and transmitted
values, beliefs, norms, and lifeways of a particular
group that guides their thinking, decisions, and
actions in patterned ways.
• CULTURE CARE
Culture care is defined as the subjectively and
objectively learned and transmitted values,
beliefs, and patterned lifeways that assist,
support, facilitate, or enable another individual or
group to maintain their well-being, health,
improve their human condition lifeway, or deal
with illness, handicaps or death.
 • CULTURE CARE DIVERSITY
Culture care diversity indicates the variabilities
and/or differences in meanings, patterns, values,
lifeways, or symbols of care within or between
collectives related to assistive, supportive, or
enabling human care expressions.
• CULTURE CARE UNIVERSALITY
Culture care universality indicates the common,
similar, or dominant uniform care meanings,
patterns, values, lifeways, or symbols manifest
among many cultures and reflect assistive,
SUBCONCEPTS
• GENERIC (FOLK OR LAY) CARE
SYSTEMS
Generic (folk or lay) care systems are culturally
learned and transmitted, indigenous (or
traditional), folk (home-based) knowledge and
skills used to provide assistive, supportive,
enabling, or facilitative acts toward or for another
individual, group, or institution with evident or
anticipated needs to ameliorate or improve a
human life way, health condition (or well-being),
or to deal with handicaps and death situations.
• EMIC
Knowledge gained from direct experience or
directly from those who have experienced it. It is
generic or folk knowledge.
• PROFESSIONAL CARE SYSTEMS
Professional care systems are defined as
formally taught, learned, and transmitted
professional care, health, illness, wellness, and
related knowledge and practice skills that prevail
in professional institutions, usually with
multidisciplinary personnel to serve consumers.
• ETIC
The knowledge that describes the professional
perspective. It is professional care knowledge.
• ETHNOHISTORY
Ethnohistory includes those past facts, events,
instances, experiences of individuals, groups,
cultures, and instructions that are primarily
people-centered (ethno) and describe, explain,
and interpret human lifeways within particular
cultural contexts over short or long periods of
time.
• CARE
Care as a noun is defined as those abstract and
concrete phenomena related to assisting,
supporting, or enabling experiences or behaviors
toward or for others with evident or anticipated
needs to ameliorate or improve a human
condition or lifeway.
• CARE
Care as a verb is defined as actions and activities
directed toward assisting, supporting, or enabling
another individual or group with evident or
anticipated needs to ameliorate or improve a
human condition or lifeway or face death.
• CULTURE SHOCK
Culture shock may result when an outsider
attempts to comprehend or adapt effectively to a
different cultural group. The outsider is likely to
experience feelings of discomfort and
helplessness and some degree of disorientation
because of the differences in cultural values,
beliefs, and practices.
• CULTURAL IMPOSITION
Cultural imposition refers to the outsider’s efforts,
both subtle and not so subtle, to impose their own
cultural values, beliefs, behaviors upon an
individual, family, or group from another culture.
(Leininger, 1978).
SUNRISE MODEL OF MADELEINE
LEININGER’S THEORY
The Sunrise Model is relevant because it
enables nurses to develop critical and complex
thoughts about nursing practice. These thoughts
should consider and integrate cultural and social
structure dimensions in each specific context,
besides nursing care’s biological and
psychological aspects.
THREE MODES OF NURSING CARE
DECISIONS AND ACTIONS
• CULTURAL CARE PRESERVATION OR
MAINTENANCE
Cultural care preservation is also known as
maintenance. It includes those assistive,
supporting, facilitative, or enabling professional
actions and decisions that help people of a
particular culture to retain and/or preserve
relevant care values so that they can maintain
their well-being, recover from illness, or face
handicaps and/or death.
• CULTURAL CARE ACCOMMODATION
OR NEGOTIATION
Cultural care accommodation, also known as
negotiation, includes those assistive, supportive,
facilitative, or enabling creative professional
actions and decisions that help people of a
designated culture to adapt to or negotiate with
others for a beneficial or satisfying health
outcome with professional care providers.
• CULTURE CARE REPATTERNING OR
RESTRUCTURING
Culture care repatterning or restructuring
includes those assistive, supporting, facilitative,
or enabling professional actions and decisions
that help clients reorder, change, or greatly
modify their lifeways for new, different, and
beneficial health care pattern while respecting the
clients’ cultural values and beliefs and still
providing a beneficial or healthier lifeway than
before the changes were established with the
clients. (Leininger, 1991)
ASSUMPTIONS
• Different cultures perceive, know, and
practice care differently, yet there are
some commonalities about care among
all world cultures.
• Values, beliefs, and practices for
culturally related care are shaped by, and
often embedded in, “the worldview,
language, religious (or spiritual), kinship
(social), political (or legal), educational,
economic, technological, ethnohistorical,
and environmental context of the culture.
• While human care is universal across
cultures, caring may be demonstrated
through diverse expressions, actions,
patterns, lifestyles, and meanings.
Cultural care is the broadest holistic
means to know, explain, interpret, and
predict nursing care phenomena to guide
nursing care practices. All cultures have
generic or folk health care practices, that
professional practices vary across
cultures, and that there will be cultural
similarities and differences between the
care-receivers (generic) and the
professional caregivers in any culture.
• Care is the distinct, dominant, unifying,
and central focus of nursing, and while
curing and healing cannot occur
effectively without care, care may occur
without a cure. Care and caring are
essential for humans’ survival and their
growth, health, well-being, healing, and
ability to deal with handicaps and death.
• Nursing, as a transcultural care discipline
and profession, has a central purpose of
serving human beings in all areas of the
world; that when culturally based nursing
care is beneficial and healthy, it
contributes to the well-being of the
client(s) – whether individuals, groups,
families, communities, or institutions – as
they function within the context of their
environments.
• Nursing care will be culturally congruent
or beneficial only when the nurse knows
the clients. The clients’ patterns,
expressions, and cultural values are
used in appropriate and meaningful ways
by the nurse with the clients.
• If clients receive nursing care that is not
at least reasonably culturally congruent
(that is, compatible with and respectful of
the clients’ lifeways, beliefs, and values),
the client will demonstrate signs of
stress, noncompliance, cultural conflicts,
and/or ethical or moral concerns.
ANALYSIS
• In Leininger’s nursing theory, it was
stated that the nurse would help the client
move towards amelioration or
improvement of their health practice or
condition. This statement would be of
great difficulty for the nurse because
instilling new ideas in a different culture
might present an intrusive intent for the
“insiders.” Culture is a strong set of
practices developed over generations
that would make it difficult to penetrate.
 • It is highly commendable that Leininger
formulated a theory that is specified to a
multicultural aspect of care. On the other
side, too much was given to the culture
concept per se that Leininger failed to
discuss the functions or roles of nurses
comprehensively. It was not stated how
to assist, support or enable the client to
attuning them to an improved lifeway
STRENGTHS
• Leininger has developed the Sunrise
Model in a logical order to demonstrate
the interrelationships of the concepts in
her theory of Culture Care Diversity and
Universality.
• Leininger’s theory is essentially
parsimonious in that the necessary
concepts are incorporated in such a
manner that the theory and its model can
be applied in many different settings.
• It is highly generalizable. The concepts
and relationships presented are at a level
of abstraction, which allows them to be
applied in many different situations.
Though not simple in terms, it can be
easily understood upon the first contact.
WEAKNESS
• The theory and model are not simple in
terms.
ROSEMARIE RIZZO PARSE
• Born 28 july 1938; Pittsburgh,
Pennsylvania
• TITLES: Nursing Scientist Professor
Author Founder
• Grew in a very strict catholic family that
placed high value in education, Parse
was once a nursing student becomes a
nursing scientist, professor and author of
various books. A theorist whom made the
title for herself and now affects the
modern nursing world.
• Grew up in a strict catholic family. Spent
most of her young life in castle Shannon;
Pennsylvania
• Went to St. Francis academy in
Pennsylvania to finish basic education
• Bachelor degree of science in nursing
(BSN) in Duquesne University in
Pittsburgh (1960)
• Master's (1961) and doctorate (1969)
degrees from the university of Pittsburgh.
• Teaching career at the University of
Pittsburgh while finishing her Ph.D.
(1961-1966)
• She served as dean of the School of
Nursing at Duquesne from 1977-1979
and left at 1983
• Professor and coordinator of the center
for nursing research at Hunter College of
the City University of New York (1983-
1993)
• Professor and Neuhoff chair at Loyola
University Chicago (1993-2006)
• January 2007-present, consultant and
visiting scholar at the New York
University College of nursing,
• Founder and current editor of nursing
science
• Founder of the institute of human
becoming (1992)
• Founded nursing science quarterly
• President of discovery international, inc.
(2014)
THE HUMANBECOMING THEORY
Specify fundamental beliefs about
human universe, the ethos of human becoming,
and living quality. “A person is a unitary being in
continuous interaction with his or her
environment.”
Human Becoming Theory includes
Totality Paradigm “Man is a combination of
biological, psychological, sociological and
spiritual factors”
Humanuniverse (Human & Universe) is
unitary, indivisible, unpredictable, ever-changing,
and ever - evolving
Nurses living in the Humanbecoming
Paradigm beliefs hold that their primary concern
is people’s perspectives of living quality
The Humanbecoming theory posits the
quality of life from each person’s own perspective
as the goal of nursing practices.
THE THREE ABIDING THEMES
HUMANBECOMING THEORY
• Imaging - Personal interpretation of
meaning, possibilities, and
consequences (perception)
• Valuing - How the clients established
hierarchy on what’s important to them
(priorities)
• Languaging - Symbolizing and
expressing their reality (imaging) and
priorities (valuing)
• Revealing-Concealing - The way persons
disclose and keep hidden the persons
they are becoming
• Enabling-Limiting - Potentials and
opportunities that surface with the
restrictions and obstacles of everyday
living
• Connecting-Separating - Persons create
patterns of connecting and separating
with people and projects.
• Power - Conveys meaning about struggle
and life and the will to go on despite
hardship and threat.
• Originating - Human uniqueness; choices
about originating occur with the reality of
certainty-uncertainty
• Transforming - Continuously changing
and shifting views that people have about
their lives
• Enabling – Limiting of Valuing gives rise
to Originating
OF → Making a certain decision from ambiguity
to contemplate the priorities and living
with the consequences of those choice
• Revealing - Concealing of Imaging gives
rise to Powering
→ Personal perception of reality and
experience can either be concealed or
disclosed by the person that may give
sense or reason to a certain
• Connecting - Separating of Languaging
gives rise to Transforming •
→ Connecting or distinguishing of conveyed
perception may conclude to the change
in perspective.
JOYCE J. FITZPATRICK
TOPIC OUTLINE
o Know who Joyce Fitzpatrick is
o Discuss the life perspective rhythm
model
o Identify the significance of Fitzpatrick’s
theory
o Recognize the theory's conclusion
BACKGROUND
• born in 1944
• founder and head of the Bolton's World
Health Collaborating Center for Nursing
• Holds an adjunct position as Professor in
the Department of Geriatrics, Mount
Sinai School of Medicine, New York, N.Y
• a nurse educator and advocate for
nursing, psychological care, nursing and
geriatrics
EDUCATION
• began her nursing studies at Georgetown
University
• obtained a master's degree in psychiatric
mental health nursing at Ohio State
University
• PhD - New York University
• MBA - Case Western Reserve University
currently holds a position of Elizabeth
Brooks for Professor of Nursing at Case
Western Reserve University’s Frances
Payne Bolton School of Nursing
WORKS
• written approximately 65 books, including
nursing instructional manuals, and 395
papers for scholarly publications
• Some of her published books:
→ Advanced Practice Psychiatric Nursing:
→ Integrating Psychotherapy,
Psychopharmacology and
Alternative/Complementary Approaches
Theories Guiding Nursing Research
Practice: Making Nursing Knowledge
Development Explicit (2014)
→ Nursing Concepts Analysis: Application
to
→ Research and Practice (2016)
WHAT IS RHYTHM?
• "A systematic, regular, repeated pattern
of a movement or sound"
• "Movement, fluctuation or variation
marked by regular recurrence or natural
flow"
LIFE PERSPECTIVE RHYTHM THE MODEL
JOYCE FITZPATRICK
• published on 1989 in Conceptual Models
of Nursing, second edition, which is an
anthology of nursing theory a construct to
assist with the professional practice of
nursing.
• based on Martha Rogers' Theory of
Unitary Human Beings. While Rogers'
theory covered eight separate areas, Dr.
Fitzpatrick has built her nursing theory on
four major concepts involving the delivery
of nursing care (specifically on pattern)
WHAT IS LIFE PERSPECTIVE RHYTHM
MODEL ALL ABOUT?
• "Various components of completing a life
experience as rhythms"
• proposes that the process of human
development is characterized by rhythms
• the job of nursing then is to understand
and assist the client with putting their
rhythms together to support all of the
body's other rhythms and return to a state
of health
WHAT IS RHYTHM? (Theory application)
Can be described, measured and will be
repeated. Thus, the stages of life and illness can
be equated to rhythms.
FOUR MAJOR CONCEPTS
PERSON
• not only includes the client but all people
whom he or she interacts with
• is seen as an open system, a unified
whole characterized by a basic human
rhythm
• recognizes individuals as having unique
biological, physiological, emotional,
social, cultural and spiritual attitudes.
HEALTH
• dynamic state of being which is
influenced by a person's interaction with
the environment.
• optimum health is the goal of nursing
interaction which goes beyond
• professional interactions to maintain
optimum health; (1) assistance from care
providers; (2) client willing to change and
follow guidelines for a healthy life; (3)
surrounding the client with supportive
people
WELLNESS- ILLNESS
• wellness is the state of optimum health
• professional nursing has matured into its
current focus of promoting wellness
• not only do health professionals treat
illnesses, they promote lifestyle changes
and habits that will lower the chances of
experiencing illness during one's lifetime
essentially, the focus of health exams
has become preventive care
METAPARADIGM
→ PERSON - everything knows about the
client and his life
→ ENVIRONMENT - the social construct
that surrounds the client and its effect on
the client
→ HEALTH - establishes which items of
health that health care workers need to
address
→ NURSING - the nursing theory, actions
and treatments that the nurse needs to
bring to bear to return the client to the top
of wellness possible
MAJOR ASSUMPTIONS
1. "The process of human development is
characterized by rhythms that occur
within the context of continuous person -
environment interaction"
2. Nursing activity focuses on enhancing
the developmental process toward health
3. A central concern of nursing science and
the nursing profession is the meaning
attributed to life as the basic
understanding of human existence
4. The identification and labeling of
concepts allow for recognition and
communication with others, and the rules
allows for recognition and
communication with others, and the rules
combining those concepts permits
thoughts to be shared through language
SIGNIFICANCE
1. Provides taxonomy for identifying and
labelling nursing concepts to allow for
their universal recognition and
communication with others 2.
2. It is a new theory that is still being
integrated into the profession. It remains
to be seen as the effect of this theory on
moving the profession to a world-wide
model.
3. Many nursing theories do not take one of
her four areas into consideration, and
thus are difficult to translate to a new
culture, environment or a different level of
health. This model is a complex attempt
to solve this issue in nursing
CONCLUSION
The Life Perspective Rhythm Model
concludes that the process of human
development is characterized by rhythms that
occur within the context of continuous person-
environment interaction and that nursing activities
basically focuses on strengthening the
developmental process towards health.
Dr. Fitzpatrick anticipates that the
nursing profession will have standardized theory,
practice, and procedures to support the client in
every circumstance. Since the 1800s, the nursing
profession has been developing its professional
framework. A comprehensive professional action
plan for each client should be integrated using the
life perspective rhythm model. Each client needs
a customized treatment plan because they are all
in unique circumstances. Communication
between nursing and its practitioners around the
globe is also necessary. Any culture or
environment can use a philosophy that
incorporates the life cycle for wellness and
maintenance.
ANNE BOYKIN AND SAVINA
SCHOENHOFFER
TOPIC OUTLINES
o Biography
o About the Theory
o Major Concepts
o The 6Major Assumptions Theoretical
Assertions Dance of Caring Persons
o Implications for Practice and Nursing
Service Administration
 → ANNE BOYKIN
Anne Boykin grew up in Kaukauna, Wisconsin.
She began her career in nursing in 1966,
graduating from Alverno College in Milwaukee,
Wisconsin. She received her master’s degree
from Emory University in Atlanta, Georgia, and
her doctorate from Vanderbilt University in
Nashville, Tennessee.
Boykin’s scholarly work is centered on caring as
the grounding for nursing. This is evidenced in her
book (coauthored with Schoenhofer), Nursing as
Caring: A Model for Transforming Practice (1993,
2001), and her book, Living a Caring-Based
Program (1994). The latter book illustrates how
caring grounds the development of a nursing
program by creating the environment for study
through evaluation.
→ SAVINA SCHOENHOFER
Savina Schoenhofer was born the second child
and eldest daughter in a family of nine children
and spent her formative years on the family cattle
ranch in Kansas. She is named for her maternal
grandfather, who was a classical musician in
Kansas City, Missouri.
During the 1960s, Schoenhofer spent 3 years in
the Amazon region of Brazil, working as a
volunteer in community development. Her initial
nursing degree was completed at Wichita State
University, where she also earned graduate
degrees in nursing, psychology, and counseling.
She completed a PhD in educational foundations
and administration at Kansas State University in
1983. In 1990 Schoenhofer co-founded
Nightingale Songs, an early venue for
communicating the beauty of nursing in poetry
and prose.An early study made it apparent to
Schoenhofer that caring was the service that
patients overwhelmingly recognized.
Schoenhofer serves on the Ethics Advisory
Committee at the University of Mississippi
Medical Center, where she consults and advises
on questions of ethics in clinical situations that
arise in practice and health care ethics education
in clinical and education settings. She is
Professor of Nursing at University of Mississippi
Medical Center School of Nursing in Jackson and
Adjunct Professor at the Florida Atlantic
University College of Nursing, Boca Raton,
Florida.
THE THEORY OF NURSING AS CARING:
• Based on an understanding that the
focus of nursing, both as a discipline and
as a profession, involves the nurturing of
persons living, caring and growing in
caring.
• In this statement, we recognize the
unique human need to which nursing is
the response as a desire to be
recognized as a caring person and to be
supported in caring.
PERSPECTIVE OF PERSONS AS CARING
All people are caring - This is the fundamental
view that grounds the focus of nursing as a
discipline and a profession. The unique
perspective offered by the theory of Nursing as
Caring builds on that view by recognizing
personhood as a process of living grounded in
caring.
MAJOR CONCEPTS
1. FOCUS AND INTENTION OF NURSING
The focus of nursing as a discipline of knowledge
and a professional practice is nurturing persons
living and growing in caring.
The general intention of nursing is to know
persons as caring and to support and sustain
them as they live caring (Boykin & Schoenhofer,
2006).
2. PERSPECTIVE OF PERSONS AS
CARING
The fundamental assumption of the theory is that
all persons are caring.
Caring is lived by each person moment to
moment and is an essential characteristic of
being human.
3. NURSING SITUATION
The nursing situation is the locus of all that is
known and done in nursing (Boykin &
Schoenhofer, 2001a) and is conceptualized as:
“The shared, lived experience in which caring
between nurse and the patient enhances
personhood”.
4. PERSONHOOD
Personhood implies being oneself as an
authentic caring person and being open to
unfolding possibilities for caring.
Nurses are constantly living out the meaning of
their caring from moment to moment.
5. DIRECT INVITATION
Opens the relationship to true caring between the
nurse and the patient. The direct invitation of the
nurse offers the opportunity to the patient to share
what truly matters in the moment.
The power of the direct invitation reaches deep
into the humility of the nursing situation, uniting
and guiding the intention of both the nurse and
the patient.
6. CALL FOR NURSING
Are calls for nurturance perceived in the mind of
the nurse (Boykin & Schoenhofer, 2001).
Calls for nursing are uniquely situated personal
expressions; they cannot be predicted, but
originate within persons who are living caring in
their lives and who hold hopes and aspirations for
growing in caring.
7. CARING BETWEEN
The encounter between the nurse and the patient
gives rise to the phenomenon of caring between,
within which personhood is nurtured (Boykin &
Schoenhofer, 2001).
Without the caring between the nurse and the
patient, unidirectional activity or reciprocal
exchange can occur, but nursing in its fullest
sense does not occur.
8. NURSING RESPONSE
Nursing responses to calls for caring evolve as
nurses clarify their understanding of calls through
presence and dialogue.
Such responses are uniquely created for the
moment and cannot be predicted or applied as
pre planned protocols (Boykin & Schoenhofer,
1997).
9. STORY AS METHOD FOR KNOWING
NURSING
is a method for knowing nursing and a medium
for all forms of nursing inquiry. Nursing stories
embody the lived experience of nursing situations
involving the nurse and the patient.
THE MAJOR ASSUMPTIONS
PERSON
→ One: Persons Are Caring by Virtue of
Their Humanness
Being a person means living, caring, through
which being, and possibilities are known to the
fullest. Each person throughout his or her life
grows in the capacity to express caring. The
assumption that all persons are caring does not
require that each act of a person be caring, but it
does require the acceptance that “fundamentally,
potentially, and actually, each person is caring”
(Boykin & Schoenhofer, 2001).
→ Two: Persons Are Whole and Complete
in the Moment
Being complete in the moment signifies that there
is no insufficiency, no brokenness, and no
absence of something. Wholeness, or the
fullness of being, is forever present. The view of
the person as caring and complete is intentional,
offering a unifying lens for being present with the
other that prevents segmenting into parts such as
mind, body, and spirit.
→ Three: Persons Live Caring, Momentto
Moment
Caring is a lifetime process that is lived moment
to moment and is constantlyunfolding. In the
rhythm of life experiences, we continually develop
expressions oourselves as caring persons.
Actualization of the potential to express caring
varies athe moment.
HEALTH
→ Four: Personhood Is Living Life
Grounded in Caring
Personhood is a process of living caring and
growing in caring: It is being authentic,
demonstrating congruence between beliefs and
behaviors, and living out the meaning of one’s life.
Personhood acknowledges the potential for
unfolding caring possibilities moment to moment.
ENVIRONMENT
→ Five: Personhood Is Enhanced Through
Participating in Nurturing Relationships
with Caring Others
Caring is living in the context of relational
responsibilities and possibilities, and it
acknowledges the importance of knowing the
person as a person.“Through knowing self as
caring person, I am able to be authentic to self,
freeing me to truly be with others” (Boykin &
Schoenhofer, 2001)
NURSING
→ Six: Nursing Is Both a Discipline and a
Profession
Nursing is an “exquisitely interwoven unity of
aspects of the discipline. As a discipline, nursing
is a way of knowing, being, valuing, and living in
the world and is envisaged as a unity of
knowledge within a larger unity. The discipline of
nursing attends to the discovery, creation,
development, and refinement of knowledge
needed for the practice of nursing. The profession
of nursing attends to the application of that
knowledge in response to human needs.
THEORETICAL ASSERTIONS
As a general theory, Nursing as Caring is an
appropriate model for various nursing roles, such
as individual practice, group or institutional
practice, and a variety of practice venues such as
acute care, long-term care, nursing
administration, and nursing education.
The fundamental assumptions of Nursing as
Caring underpin all assertions and concepts of
the theory. They are as follows:
1. To be human is to be caring, and;
2. The purpose of the discipline and
profession is to come to know persons
and nurture them as persons living caring
and growing in caring.
DANCE OF CARING PERSONS
The Dance of Caring Persons is a visual
representation of the theoretical assertion that
lived caring between the nurse and the patient
expresses underlying relationships. The
egalitarian spirit of caring respect characterizes
each participant in the Dance of Caring Persons,
in which the contributions of each dancer,
including the one nursed, are honored. Dancers
move freely; some dancers touch, some dance
alone, but all dance in relation to one another and
to the circle.
OUTCOMES OF NURSING CARE
Outcomes of nursing care are
conceptualized from values experienced in the
nursing relationship, and in normative
documentation, these outcomes are
unacknowledged.
Boykin and Schoenhofer (1997) note that
it is the responsibility of the courageous
advanced practice nurse to “go beyond what is
currently accepted in delimiting and language the
value expressed by persons who participate in
nursing situations”.
IMPLICATIONS FOR PRACTICE AND
SERVICE ADMINISTRATIONPRACTICE
SERVICE ADMINISTRATION
Practicing nursing within this framework
requires the acknowledgment that knowing self
as caring matters and is integral to knowing
others as caring. This is especially important in
light of practice environments that depersonalize
and support the notion of the nurse as an
instrument and a means to an end. Rather than
nursing practice focused on activities, the lens for
practice becomes the intention to know and
nurture the person as caring.
In living Nursing as Caring, the nursing
administrator makes decisions through a lens in
which activities are infused with a concern for
shaping a transformative culture that embodies
the fundamental values expressed within nursing
as caring. All activities of the nursing
administrator must be connected to the direct
work of nursing and be “ultimately directed to the
person(s) being nursed” (Boykin & Schoenhofer,
2001).
MARGARET NEWMAN
BIOGRAPHY
• was born on October 10, 1933, in
Memphis, Tennessee.
• She is known as a American Nurse, a
University Professor and a Nursing
Theorist.
• 1954- She earned a bachelor’s degree in
home economics and English from
Baylor University in Waco, Texas.
• 1962- second bachelor’s degree in
Nursing from the University of
Tennessee in Memphis (M. Newman,
curriculum vitae,1996). Margaret
Newman
• 1964- Her master’s degree in medical
surgical
nursing and teaching is from the
University of San Francisco, California,
• 1971- She earned her doctorate in
nursing science and rehabilitation
nursing from New York University.
• Newman held academic positions at the
University of Tennessee, New York
University, Pennsylvania State
University, and the University of
Minnesota in Minneapolis (where she is
Professor Emeritus) until Ma her
retirement in 1996. rgaret Newman
• Director of Nursing for the Clinical
Research Center at the University of
Tennessee, Director of the Ph.D.
Program in the Division of Nursing at
New York University, Professor-in-
Charge in Nursing at Pennsylvania State
University.
• She published several books, including
Theory Development in Nursing (1979),
and Health as Expanding
Consciousness.
• The theory of health as expanding
consciousness emanated from
Newman’s early personal family
experiences. While caring for her mother
who was experiencing restricted body
movement because of amyotrophic
lateral sclerosis, Newman became
interested in nursing.
INFLUENCE
• Martha Rogers-Theory of unitary human
beings Itzhak Bentov-The concept of
evolution of Consciousness
• Arthur young-The Theory of Process
David Bohm-The Theory of Implicate
THEORY: HEALTH AS EXPANDING
CONSCIOUSNESS
The theory of health as expanding consciousness
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
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)
As the theory evolved, Newman developed a
synthesis of the pattern of movement, space,
time, and consciousness (M. Newman, personal
communication, 2004, 2008).time is increased
(Newman, 1979).
Movement is a “means whereby space and time
become a reality” (Newman, 1983, p.165).
Humankind is in a constant state of motion and is
constantly changing internally (at the cellular
level) and externally (through body movement
and interaction with the environment). This
movement through time and space is what gives
humankind a unique perception of reality.
Movement brings change and enables the
individual to experience the world (Newman,
1979)
The concept of time is seen as a function of
movement (Newman, 1979). This assertion was
supported by Newman’s (1972) studies of the
experience of time as related to movement and
gait tempo.
EMPHASIS ON THE EXPERIENTIAL
PROCESS
• Movement-Space-Time
 • Newman emphasizes the importance of
examining movement-space-time
together as dimensions of emerging
patterns of consciousness rather than as
separate concepts of the theory (M.
Newman, personal communication,
2004).
• In 1978 Newman identified three
correlates of consciousness (time,
movement, and space) as manifestations
of the pattern of the whole. the life
process is seen as a progression toward
higher levels of consciousness. Newman
(1979) views the expansion of
consciousness. as what life and health is
all about, and the sense of time is an
indicator in the changing level of
consciousness.
MAJOR ASSUMPTION
1. Health encompasses conditions up to
now and described as illness or, in
medical terms, pathology.
2. These “pathological” conditions can be
considered a manifestation of the total
pattern of the individual.
3. The pattern of the individual that
eventually manifests itself as pathology is
primary and exists before structural or
functional changes.
4. Removal of the pathology in itself will not
change the pattern of the individual.
5. If becoming “ill” is the only way an
individual’s pattern can manifest itself,
then that is health for that person. From
these assumptions, Newman set forth
her thesis: Health is the expansion of
consciousness (M. Newman, personal
communication, 2008)
MAJOR CONCEPT
❖ HEALTH PATTERN
• Health is the “pattern of the whole” of a
person and Includes disease as a
manifestation of the pattern of The whole,
based on the premise that life is an
ongoing Process of expanding
consciousness (Newman, 1986).
• It is regarded as the evolving pattern of
the person and environment and is
viewed as an increasing ability to
perceive alternatives and respond in a
variety of ways (Newman, 1986).
• Health is “a transformative process to
more inclusive consciousness”
(Newman, 2008, p. 16).
❖ PATTERN
• Pattern is information that depicts the
whole and understanding of the meaning
of all the relationships at once (M.
Newman, personal communication,
2004).
• Pattern is what identifies an individual as
a particular person. Examples of explicit
manifestations of the pattern of a person
are the genetic pattern that contains
Information that directs becoming, the
voice pattern, And the movement pattern
(Newman, 1986).
• In Health as Expanding Consciousness,
Newman (1986, 1994) developed pattern
as a major concept that Is used to
understand the individual as a whole
being. Newman described a paradigm
shift in the field of health Care: the shift
from treatment of disease symptoms to a
Search for patterns and the meaning of
those patterns. Newman (1994)
❖ CONSCIOUSNESS
• Consciousness is both the informational
capacity of the System and the ability of
the system to interact with Its
environment (Newman, 1994). •
Consciousness includes not only
cognitive and affective awareness, but
also the “interconnectedness of the entire
living system Which includes
physicochemical maintenance and
growth Processes as well as the immune
system” (Newman, 1990a, p. 38).
• Newman (1986) integrates Bentov’s
(1977) definition of absolute
consciousness as “a state in which
contrasting concepts become reconciled
and fused. Movement and rest fuse into
one” (p. 67).
METAPARADIGHM
• HEALTH
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
regarded as health.
• PERSON
Persons as individuals are identified by their
individual patterns of consciousness (Newman,
1986) and defined as “centers of consciousness
within an overall pattern of expanding
consciousness” (Newman, 1986, p. 31). The
definition of persons includes family and
community (Newman, 1994).
• NURSING
Nursing is caring in the human health experience
Person–environment interaction. Nursing
Newman emphasizes the primacy of
relationships as A focus of nursing, both nurse-
client relationships And relationships within
clients’ lives (Newman, 2008).
Nurse and patient coming together and moving
apart in process recognition, insight, And
transformation. (From Newman, M. A. [2008].
Transforming presence: The difference that
Nursing makes. Philadelphia: F. A. Davis.
• ENVIRONMENT
Environment Although environment is not
explicitly defined, it is Described as being the
larger whole, which contains the Consciousness
of the individual. • Client and environment are
viewed as a unitary evolving pattern (Newman,
2008)
CONCLUSION
• Newman's theory has moved forward to
include the health of people even though
they do or do not have a disease.
• Health is central to the theory and is seen
as a process that develops awareness of
the individual self and environment. It can
be conceptualized as consciousness,
being a manifestation of the person and
environment.
• This theory has a sense in one's mind
that will open to a new or larger kind of
awareness.
• The emphasis of this process is on
knowing/caring through pattern
recognition.
JOSEPHINE E. PATERSON
TOPIC OUTLINE
o Background concepts
o Theory
o Framework
• Born on September 1, 1924, in Freeport,
New York Dr. Paterson graduated with a
master's degree in Public Health Nursing
and a Doctorate in Nursing Science from
Boston University.
• In 1969, her nursing doctorate, in mental
health and psychiatric nursing, was
acquired from Boston University School
of Nursing, Boston, Massachusetts.
• John Hopkin's University, School of
Hygiene and Public Health, Baltimore,
Maryland, is where she received her
another master's degree. A St. John's
University and Lenox Hill Hospital School
of Nursing alumni.
• In 1976, she published her first book of
HUMANISTIC NURSING together with
Loretta T. Zderad.
• Dr. Paterson was assigned to work as a
psychotherapist at the Mental Hygiene
Clinic. She held a position as a faculty at
Stonybrook State University in New York.
• They shared knowledge, conceptions,
and ideas to develop the FORMAL
THEORY OF HUMANISTIC NURSING.
OVERVIEW OF THE THEORY
• Existentialism and Phenomenology.
• The theory of humanistic nursing is
interactive and multidimensional.
• The patient (which can refer to a person,
family, or community) and the nurse are
the two components described in
humanistic nursing theory as being made
of human beings.
• Along with the patient's physical and
mental health, humanistic nursing places
a strong emphasis on how the
relationship between the patient and
nurse develops.
• Their early dedication to conceptualizing
nursing as radically as possible led to the
development of NURSOLOGY, a
phenomenological method for examining
 nursing as an existential experience-- His very uniqueness is a characteristic of his
human experience. commonality with all other men." - P&Z
• 3 Concepts that provide basis of Nursing.
CONCEPTS THAT PROVIDE BASIS OF
→ Dialogue
NURSING
→ Community
→ Phenomenological Nursology 1. DIALOGUE
HUMANISTIC NURSING THEORY When a patient and a nurse interact. The nurse
approaches the patient as a helper who is
The Humanistic Nursing Theory incorporates
prepared to help. With the goal of improving, the
both Existentialism and Humanism into nursing
nurse is receptive to how the patient feels. In
theory.
order to have a humanistic nursing discussion,
Humanism makes an effort to view each person's there must be openness.
potential from a wider perspective and seeks to
→ Meeting
comprehend each person in light of their unique
→ Relating
life experiences.
→ Presence
Existentialism is a way of looking at life from a → Call and response
philosophical perspective. The idea that a human 2. COMMUNITY
being, a feeling, acting, living being, is where
Humanistic nursing emphasizes community,
thinking starts. Existentialism places a strong
takes place within communities, and is influenced
emphasis on a person's individuality, self-
by them. It is the simultaneous struggle of two or
reliance, and responsibility.
more people who are both living and dying.
The basic objective of humanistic nursing is to
3. PHENOMENOLOGICAL NURSOLOGY
help people realize their greatest potential,
regardless of their circumstances. The nurse- 5 Phases of The Nursing Process
patient relationship, which allows both parties to
have an impact on the results of nursing ELEMENTS OF FRAMEWORK FOR
interventions, is prioritized in this nursing theory. HUMANISTIC

·According to Paterson and Zderad, this act of

making one's underlying meanings and values
present is referred to as "phenomenological
reflection on experiences."

·In addition to a technical and medical foundation,

a nurse's training should place equal emphasis
on the nurse's interpersonal skills. ·A situation for
humanistic nursing "comes into being."·
“Humanistic nursing embraces more than a
benevolent technically competent subject-object
METAPARADIGM
one-way relationship guided by a nurse in behalf
of another. Rather it dictates that nursing is a ❖ PERSON
responsible searching, transactional relationship
whose meaningfulness demands People are seen as open energy fields with
conceptualization founded on a nurse's unique life experiences. Humans are seen as
existential awareness of self and of the other” - being unique, dynamic, conscious, and
P&Z multifaceted beings who are also capable of
abstract cognition, creativity, and accountability
·"Uniqueness is a universal capacity of the Person has the capability of self-reflection.
human species. So,"all at-once," while each man
is unique; paradoxically, he is also like his fellows.
 ❖ HEALTH
According to the humanistic nursing philosophy,
there is a call for assistance with a health-related
issue from an individual, a family, a community,
or from humanity as a whole.
❖ NURSING
Nursing is described as a "living experience
between human beings" by Paterson. The
discussion between the patient and nurse is one
that is developing, impacting, and beneficial. The
humaneness of nursing is inextricably linked to
the nursing profession. Since nursing is a "human
transaction," it involves all of the human limits,
emotions, and potentials of each patient.
Nursing is an inter-human, transactional,
interrelated dialogue that involves providing care
in a way that acknowledges and expresses one's
own true humanness and reacts to the patient's
particular humanness.
❖ ENVIRONMENT
Patterson claims that the environment is a
representation of the location where the service
is provided, the neighborhood, or the entire
planet. The time and location of the nursing
experience might be thought of as the
environment.
5 PHASES OF PHENOMENOLOGICAL
DESCRIPTION
1. Preparation of the Nurse Knower for
Coming to Know Nurse
2. Knowing of the Other Intuitively Nurse
3. Knowing the Other Scientifically Nurse
4. Complementarily Synthesizing Known
Others
5. Succession Within the Nurse from the
Many to the Paradoxical One
LORETTA ZREDAD
• Born in June 7, 1925 in Chicago, Illinois’.
• Zderad graduated at St. Beranrd's
Hospital School of Nursing and of Loyola
University.
• She received her Master of Science
degree from Catholic University, in
Washington, D.C, and a Doctor of
Philisophy from Georgetown University,
in Washington D.C, in the year 1968.
• Zderad taught in several universities and
has lead groups on humanistic nursing.
• Zderad served as a faculty of the State
University og New York at Stonybrook.
• She retired in 1985, at the age of 60, as
the associate Chief for Nursing
Education at the Northport Veterans
Administration Medical Center, in
Northport, New York.
JOSEPHINE PATERSON & LORETTA
ZDERAD HUMANISTIC NURSING THEORY
• Humanistic Nursing Theory is based on
the idea that nursing is an inter-
subjective transactional relationship
between a nurse and a patient who are
human beings existing in the world.
• The conceptual framework of the theory
is existentialism and it presents a
phenomenological method of inquiry that
can be used by nurses to examine and
understand their everyday practice
• The theory serves as a vehicle to
describe the essences of everyday
nursing experiences
• They used a phenomenological
perspective as the basis for a dialogue
about lived experiences to uncover
answers to the questions. The sum total
of all these experiences will enhance the
development of the science of nursing.
• Paterson and Zderad believed that a
simple, scientific approach to nursing
education would not be sufficient to
create truly effective and content nurses.
3 CONCEPTS THAT PROVIDE BASIS (OR
COMPONENTS) OF NURSING
1. DIALOGUE
It is a nurse-nursed relating creatively. Humans
need nursing. Nurses need to nurse. Nursing is
an intersubjective experience in which there is
real sharing.
→ Meeting - is the coming together of
human beings and is characterized by
the expectation that there will be a nurse
and a nursed.
 → Relating - the process of nurse-nursed
"doing" with each other is relating, being
with each other. It may be Subject-Object
relating which refers to how we use
objects and know theirs through
abstractions, conceptualization,
categorizing, labeling, and so on or
Subject-Subject relating when both nurse
and the client are open to each other as
fully human, beyond the role of nurse and
client, but as struggling, joyful, confused,
and hopeful individuals facing the next
moment.
• Presence - the quality of being open,
recetive, ready, and available to another
person in a reciprocal manner.
• Call and Response - are transactional,
sequential and simultaneous. Must be
done "all at once".
2. COMMUNITY
- It is two or more persons striving
together, living-dying all at once.
- Humanistic Nursing leads to community,
it occurs within a community, and is
affected by the community.
- It is through the intersubjective sharing of
meaning in community that human
becoming is comforted and nurtured.
- Community is the experience persons,
and it is through community, persons
relating to theirs, that it is possible to
become.
- Humanistic nursing proposes that the
nurse needs to be fully prepared to work
in and with a community, exploring and
valuing its reality.
3. PHENOMENOLOGIC NURSOLOGY
→ Preparation of the nurse knower for
coming to know.
→ Nurse knowing the other intuitively.
→ Nurse knowing the other scientifically.
→ Nurse complementarily synthesizing
known others.
→ Succession within the nurse from the
many to the paradoxical one.
5 PHASES OF THE NURSING PROCESS
PREPARATION OF THE NURSE KNOWER
FOR COMING TO KNOW:
- In this stage, the nurse acts as an
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”.
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.
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. The analysis is the sorting,
comparing, contrasting, relating,
interpreting, and categorizing.
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.
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.
NURSING METAPARADIGM
❖ NURSING
- Is a nurturing response of one person to another
in a time of need that aims toward the
development of well-being and more being.
-Nursing is concerned with the individual's unique
being and striving towards becoming, focusing on
the whole.
 ❖ MAN

- Human beings are characterized as being

capable, open to options, person with values, and
the unique manifestation of their past, present,
and future.

❖ HEALTH

- Matter of personal survival. It is a process of

experiencing one's potential for well-being and
more-being, a quality of living and dying

→ well-being : steady state (maintenance of

quality) or more than absence of disease
→ more well-being : process of becoming all
that is humanly possible
❖ ENVIRONMENT

- Community: The phenomenon of society or

environment

- Two or more persons struggling together toward

a center

- It is only through our community that we are able

to reach our full potential

concepts for efficacy in practice settings.

CONCLUSION

Use of core concepts from Humanistic Nursing

Theory can provide a unifying language for
planning care and description of investigations.
Future research efforts in hospice and palliative
nursing should define and evaluate these