Nursing Theories of Adbellah, Travelbee,

Leininger and Parse

Faye Glenn Abdellah

 Introduced “Patient-Centered Approaches in Nursing Model

 Identified 21 nursing problems which determines nursing care
 Nursing as service to individuals and families, therefore to society
 Conceptualized nursing as an art and science

 Abdellah and colleagues developed a list of 21 nursing problems,

 They identified 10 steps to identify the client’s problems and 11 nursing skills to be
used in developing a treatment typology

11 Nursing Skills:
 1. Observation of health status
 2. Skills of communication
 3. Application of knowledge
 4. Teaching of patients and families
 5. Planning and organization of works
 6. Use of resource materials
 7. use of personnel services
  8. Problem solving
 9. Direction of work of others
 10. therapeutic use of the self
 11. Nursing procedures

Classification of Nursing Problems:

 1. Basic to all patients
 To maintain good hygiene and physical comfort
 To promote optimal activity ; rest, exercise, sleep
 To promote safety
 To maintain good body mechanics
 2. Sustenal Care needs
 To facilitate the maintenance of a supply of oxygen
 To facilitate the maintenance of nutrition
 To facilitate the maintenance of elimination
 To facilitate maintenance o fluid and electrolyte
 To recognize the physiological responses of the body to disease
 To facilitate maintenance of sensory function
 3. Remedial care needs
 To identify and accept positive and negative expresions, feelings
4. Restorative care needs
 To accept the optimum possible goals in the light of limitations
 To use community resources as an aid in resolving problems
 To understand the role of social problems as influencing factors in the case of
illness
 Cultural Care Diversity and Universality Theory by Madeleine Leininger

The cultural care worldview flows into knowledge about individuals, families, groups,
communities, and institutions in diverse health care systems. This knowledge provides
culturally specific meanings and expressions in relation to care and health. The next
focus is on the generic or folk system, professional care system(s), and nursing care.
Information about these systems includes the characteristics and the specific care
features of each. This information allows for the identification of similarities and
differences or cultural care universality and cultural care diversity.
Next are nursing care decisions and actions which involve cultural care
preservation/maintenance, cultural care accommodation/negotiation and cultural
care re-patterning or restructuring. It is here that nursing care is delivered.

Major Concepts
 Transcultural nursing is defined as a learned subfield or branch of nursing which
focuses upon the comparative study and analysis of cultures with respect to
nursing and health-illness caring practices, beliefs, and values with the goal to
provide meaningful and efficacious nursing care services to people according to
their cultural values and health-illness context.
 Ethnonursing 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 is defined as a learned humanistic and scientific profession and discipline
which is focused on human care phenomena and activities in order 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) 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 in order to improve a human health
condition (or well-being), disability, lifeway, or to work with dying clients.
 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 individual, group, or institutional cultural values, beliefs, and lifeways in
order to provide or support meaningful, beneficial, and satisfying health care, or
well-being services.
 Health is a state of well-being that is culturally defined, valued, and practiced, and
which reflects the ability of individuals (or groups) to perform their daily role
activities in culturally expressed, beneficial, and patterned lifeways.
 Human beings are believed to be caring and to be capable of being concerned
about the needs, well-being, and survival of others. Leininger also indicates that
nursing as a caring science should focus beyond traditional nurse-patient
interactions and dyads to include families, groups, communities, total cultures, and
institutions.
 Society/environment are not terms that are defined by Leininger; she speaks
instead of worldview, social structure, and environmental context.
 Worldview is the way in which people look at the world, or at the universe, and
form a “picture or value stance” about the world and their lives.
 Culture is the learned, shared and transmitted values, beliefs, norms, and lifeways
of a particular group that guides their thinking, decisions, and actions in patterned
ways.
 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 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 and lifeway, or to deal with illness, handicaps or death.
 Culture care diversity indicates the variabilities and/or differences in meanings,
patterns, values, lifeways, or symbols of care within or between collectives that are
related to assistive, supportive, or enabling human care expressions.
 Culutre care universality indicates the common, similar, or dominant uniform
care meanings, pattern, values, lifeways or symbols that are manifest among
many cultures and reflect assistive, supportive, facilitative, or enabling ways to
help people. (Leininger, 1991)
 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 is generic or folk knowledge.
 Etic
Knowledge which describes the professional perspective. It is professional care
knowledge.
 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 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 to face death.

Theory of Human becoming (Man-Living-Health Theory By Parse

 Parse's Human Becoming Theory guides the practice of nurses to focus on quality
of life as it is described and lived. The human becoming theory of nursing presents
an alternative to both the conventional bio-medical approach as well as the bio-
psycho-social-spiritual approach of most other theories and models of nursing.
Parse's model rates quality of life from each person's own perspective as the goal
of the practice of nursing. Rosemarie Rizzo Parse first published the theory in
1981 as the "Man-living-health" theory, and the name was changed to the "human
becoming theory" in 1992.
  The theory is structured around three abiding themes: meaning, rhythmicity, and
transcendence.
 The model makes assumptions about man and becoming, as well as three major
assumptions about human becoming.

Parse synthesized the original nine assumptions about humans and becoming into
three assumptions about human becoming, as follows:
 1. Human becoming is freely choosing personal meaning with situation,
intersubjectively living value priorities.
 2. Human becoming is configuring rhythmical patterns of relating with human
universe.
 3. Humanbecoming is cotranscending illimitably with emerging possibles.

 three major assumptions about human becoming are: meaning, rhythmicity, and
transcendence.
 Under the assumption meaning, human becoming is freely choosing personal
meaning in situations in the intersubjective process of living value priorities. Man's
reality is given meaning through lived experiences. In addition, man and
environment co-create. has three concepts: (1) imaging, (2) valuing, and (3)
languaging
 Imaging is a process of knowing and of coming to know as persons accept and
reject ideas, values, beliefs and practices consistent with their worldview
 Imaging is the creating of reality, and one’s reality reflects who one is as a
unitary person
 Valuing –is the process of choosing and embracing what is important. ersons are
continuously confirming-not confirming beliefs as they are making choices about
how to think, act, and feel, and these choices may be consistent with prior
choices, or they may be radically different and require a shifting of value
priorities.
Languaging – it is about the way persons are with the world and in relationships

with others and self
 Rhythmicity states that human becoming is co-creating rhythmical patterns of
relating in mutual process with the universe. Man and environment co-create
(revealing-concealing, (2) enabling-limiting, and (3) connecting-separating.) in
rhythmical patterns.
 Transcendence explains that human becoming is co-transcending
multidimensionally with emerging possibilities. It refers to reaching out and
beyond the limits a person sets, and that one constantly transforms.
 Three related concepts: powering , originating, transforming
Powering is the pushing-resisting process that propels people in life. It involves the
way persons consider the possibilities that lie ahead and how they choose to go on
and find a way to be with situations
 Originating –people strive to be like others while simultaneously striving to be
unique and different from others.. It is the unique choices people mske when
facing alternatives, and the consequences of those choices
 Illimitability is "the indivisible unbounded knowing extended to infinity, the all-at-
once remembering and prospecting with the moment.“
 Paradox is "an intricate rhythm expressed as a pattern preference." Paradoxes
are not "opposites to be reconciled or dilemmas to be overcome but, rather, lived
rhythms."
 Freedom is "contextually construed liberation." People are free to continuously
choose ways of being with their situations.
 Mystery is "the unexplainable, that which cannot be completely known."
 person (referred to as "man" throughout the theory) as an open being who is
more than and different from the sum of the parts.
 The environment is everything in the person and his or her experiences. The
environment is inseparable from the person, as well as complementary to and
evolving with the person.
 Health is the open process of being and becoming, and involves the synthesis of
values.
 Nursing is described as a human science and art that uses an abstract body of
knowledge to help people.

Parse's theory includes a symbol with three elements:

 The black and white colors represent the opposite paradox significant to ontology
of human becoming, while green represents hope.
 The joining in the center of the symbol represents the co-created mutual human
universe process at the ontological level, and the nurse-patient process.
 The green and black swirls intertwining represent the human-universe co-
creation as an ongoing process of becoming.
Nursing Metaparadigm Travelbee
Person
- Person is defined as a human being.
- Both the nurse and the patient are human beings.
- A human being is a unique, irreplaceable individual who is in continuous process of
becoming, evolving and changing.

Health
- Health is subjective and objective.
- Subjective health—is an individually defined state of well being in accord with self-
appraisal of physical-emotional-spiritual status.
- Objective health—is an absence of discernible disease, disability of defect as
measured by physical examination, laboratory tests and assessment by spiritual director
or psychological counselor.

Environment
- Environment is not clearly defined.
- She defined human conditions and life experiences encountered by all men as
sufferings, hope, pain and illness.
Illness – being unhealthy, but rather explored the human experience of illness

Suffering – is a feeling of displeasure which ranges from simple transitory mental,

physical or spiritual discomfort to extreme anguish and to those phases beyond
anguish—the malignant phase of dispairful “not caring” and apathetic indifference
Pain – is not observable. A unique experience. Pain is a lonely experience that is
difficult to communicate fully to another individual.

Hope – the desire to gain an end or accomplish a goal combined with some degree of
expectation that what is desired or sought is attainable
Hopelessness – being devoid of hope
Nursing - Nursing is an interpersonal process whereby the professional nurse
practitioner assists an individual, family or community to prevent or cope with
experience or illness and suffering, and if necessary to find meaning in these
experiences.”

Interactional Phases of Human-to-Human Relationship Model:

 1.Original Encounter
- First impression by the nurse of the sick person and vice-versa.
- Stereotyped or traditional roles
2. Emerging Identities
- the time when relationship begins
- the nurse and patient perceives each others uniqueness
3. Empathy
- the ability to share in the person’s experience

 4. Sympathy
- when the nurse wants to lessen the cause of patient’s suffering.
- it goes beyond empathy—“When one sympathizes, one is involved but not
incapacitated by the involvement.”
- therapeutic use of self
5. Rapport
- Rapport is described as nursing interventions that lessens the patient’s suffering.
- Relation as human being to human being
- “A nurse is able to establish rapport because she possesses the necessary
knowledge and skills required to assist ill persons and because she is able to
perceive, respond to and appreciate the uniqueness of the ill human being.”

Nursing Theories of Hall, Newman and Levine

Levine Conservation Model:

 Model is based on three major concepts and assumptions: 1) conservation; 2)
adaptation; 3) wholeness. That is promoting adaptation and maintaining
wholeness using the principles of conservation
Conservation is about achieving a balance of energy supply and demand that is within
the unique biological realities of the individual

Four conservation principles

1. Conservation of energy
2. conservation of structural integrity
 3. Conservation of personal integrity
4. Conservation of social integrity

Adaptation is achieved through the frugal, economic, contained, and controlled use of
environmental resources by the individual on his or her best interest

3 Concepts of Adaptation:
Historicity
Adaptation is a historical process, responses are based on past experiences, both
personal and genetic
Specificity
Adaptation is also specific. Each system has very specific responses. The physiologic
responses that “defend oxygen supply to the brain are distinct from those that maintain
the appropriate blood glucose levels.”
Redundancy
Although the changes that occur are sequential, they should not be viewed as linear.
Rather, Levine describes them as occurring in “cascades” in which there is an
interacting and evolving effect in which one sequence is not yet completed when the
next begins.

Each individual “is an active participant in interactions with the environment… constantly
seeking information from it.”

The individual “is a sentient being and the ability to interact with the environment seems
ineluctably tied to his sensory organs.”

Lydia Hall’s Nursing Theory

As Hall (1965) says; “To look at and listen to self is often too difficult without the help of
a significant figure (nurturer) who has learned how to hold up a mirror and sounding
board to invite the behaver to look and listen to himself. If he accepts the invitation, he
will explore the concerns in his acts and as he listens to his exploration through the
reflection of the nurse, he may uncover in sequence his difficulties, the problem area,
his problem, and eventually the threat which is dictating his out-of-control behavior.”

Major Concepts:
Individual
Health
Society/Environment
Nursing

SubConcept:
Nursing
The Core Circle
Reflective Technique
Motivation
The Cure Circle

Johnson’s Behavioral System Model is a model of nursing care that advocates the
fostering of efficient and effective behavioral functioning in the patient to prevent illness.
The three functional requirements for each subsystem include protection from noxious
influences, provision for a nurturing environment, and stimulation for growth

Johnson (1980) views human beings as having two major systems: the biological
system and the behavioral system. It is the role of medicine to focus on the biological
system, whereas nursing’s focus is the behavioral system.

7 Subsystem ( Johnson 1980)

 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 – fulfills the need 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 subsystem – functions to master and control the self or the

environment

4 Adaptive Modes
1. Physiologic-physical mode: physical and chemical processes involved in the
function and activities of living organisms; the underlying need is physiologic integrity as
seen in the degree of wholeness achieved through adaptation to changes in needs.
2. Self-concept-group identity mode: focuses on psychological and spiritual integrity
and a sense of unity, meaning, purposefulness in the universe.
3. Role function mode: refers to the roles that individuals occupy in society fulfilling the
need for social integrity; it is knowing who one is, in relation to others.
4. Interdependence mode: the close relationships of people and their purpose,
structure and development individually and in groups and the adaptation potential of
these relationships
Health System Model
 The Neuman Systems Model views the client as an open system that responds
to stressors in the environment. The client variables are physiological,
psychological, sociocultural, developmental, and spiritual. The client system
consists of a basic or core structure that is protected by lines of resistance. The
usual level of health is identified as the normal line of defense that is protected by
a flexible line of defense.

Martha Roger’s Science of Unitary Human Beings

 Mainly focusing on the four concepts and principles of homeodynamic that are

 energy fields
 openness,
 pattern,
 pandimensionality
Self-care is the performance or practice of activities that individuals initiate and perform
on their own behalf to maintain life, health and well-being.

Self-care agency is the human’s ability or power to engage in self-care and is affected
by basic conditioning factors.
Self-care Requisites or requirements can be defined as actions directed toward the
provision of self-care. It is presented in three categories:
A. Universal self-care requisites are associated with life processes and the
maintenance of the integrity of human structure and functioning.
B. Developmental self-care requisites are “either specialized expressions of universal
self-care requisites that have been particularized for developmental processes or they
are new requisites derived from a condition or associated with an event.”
C. Health deviation self-care requisites are required in conditions of illness, injury, or
disease or may result from medical measures required to diagnose and correct the
condition.
Therapeutic Self-care Demand is the totality of “self-care actions to be performed for
some duration in order to meet known self-care requisites by using valid methods and
related sets of actions and operations.”
Basic conditioning factors are age, gender, developmental state, health state,
sociocultural orientation, health care system factors, family system factors, patterns of
living, environmental factors, and resource adequacy and availability.
Nursing System is the product of a series of relations between the persons: legitimate
nurse and legitimate client. This system is activated when the client’s therapeutic self-
care demand exceeds available self-care agency, leading to the need for nursing.