Theoretical Foundation of Nursing Nursing Theories - are organized bodies of knowledge to define what nursing is,

NCM 100 what nurses do, and why they do it.

Domain - is a view or perspective of discipline.
Introduction of TFN;

Philosophy - These are beliefs and values that define a way of thinking and are
generally known and understood by a group or discipline.
NURSING DOMAIN IN A PARADIGM
Theory - A belief, policy, or procedure proposed or followed as the basis of
action. A set of concepts, definitions, relationships, and assumptions that project a
systematic view of a phenomena. Person or client - is the
recipient of nursing care and
may include individuals,
Concept - Concepts are often called the building blocks of theories. patients, groups, families,
Nursing - and communities.
Conceptual framework - A conceptual framework is a group of related ideas,
The nurse’s Health - is
statements, or concepts. attributes, defined as the
characteristic degree of
s, and
Domain - The domain is the perspective or territory of a profession or discipline. actions
wellness or
well being that
provide care the client
on behalf of or
Models - Models are representations of the interaction among and between the in conjunction
experience
concepts showing patterns. with the client
Environment - is
defined as the internal
Proposition - Propositions are statements that describe the relationship between and external
surroundings that
the concepts. affect the client.

Process - Processes are organized steps, changes, or functions intended to bring

about the desired result.

Paradigm - A paradigm refers to a pattern of shared understanding and

assumptions about reality and the world, worldview, or widely accepted value
system.

Metaparadigm - A metaparadigm is the most general statement of discipline and
functions as a framework in which the more restricted structures of conceptual
models develop.
Phenomenon- A term given to describe an idea or response about an event, a
situation, a process, a group of events, or a group of situations.
Concepts - Interrelated concepts define a theory. Concepts are used to help
describe or label a phenomenon.
Abstract Concepts. Defined as mentally constructed independently of a specific
time or place.
Concrete Concepts. Are directly experienced and related to a particular time or
place.
Definitions - are used to convey the general meaning of the concepts of the
theory.
Theoretical Definitions - Define a particular concept based on the theorist’s
perspective.
Operational Definitions - States how concepts are measured.
More limited in scope (compared to grand theories) and present concepts
and propositions at a lower level of abstraction. They address a specific
phenomenon in nursing.
 Practice-Level Theory.
Practice nursing theories are situation- specific theories that are narrow
in scope and focuses on a specific patient population at a specific time.
 By goal-oriented
o Descriptive theories
are the first level of theory development.
are not action- oriented or attempt to produce or change a
situation.

Relational Statements - define the relationships between two or more concepts. o Perspective theory
Address the nursing interventions for a phenomenon, guide
Assumptions - are accepted as truths and are based on values and beliefs. practice change, and predict consequences.
Includes propositions that call for change.
ROLE OF NURSING THEORY
Education • Other ways of classifying nursing theory
Needs-Based Theories
• Identified major concepts
- Theories under this group are based on helping
• Improved status of the profession
individuals to fulfill their physical and
Research
mental needs.
• Identifies philosophical assumptions or conceptual frameworks
Interaction Theories.
Clinical practice - These theories emphasized nursing on the establishment
• Evidence-Based Practice involves the recognition of which knowledge is and maintenance of relationships.
appropriate for application to client care. Outcome Theories
- These theories describe the nurse as controlling and
CLASSIFICATIONS OF NURSING THEORIES directing patient care using their knowledge of the
By abstraction human physiological and behavioral systems.
 Grand Theory
Grand theories are abstract, broad in scope, and complex, therefore o Classification According to Alligood
requiring further research for clarification Nursing Philosophy:
It is the most abstract type and sets forth the meaning of
 Middle-Range Theory nursing phenomena through analysis, reasoning, and logical
presentation.
 Nursing Conceptual Models. Middle-Range Theories.
These are comprehensive nursing theories that are Are precise and answer specific nursing practice
regarded by some as pioneers in nursing. questions

Grand Nursing Theories.

Are works derived from nursing philosophies, conceptual
models, and other grand theories that are
generally not as specific as middle-range theories.
NURSES USE THEORY IN EVERYDAY COMMONLY USED NON-NURSING CURRENT TRENDS THAT INFLUENCE
PRACTICE THEORIES NURSING THEORY
• Organize patient data • Systems theory • Medical science
• Understand patient data • Basic Human Needs theory • Nursing education
• Analyze patient data • Health and Wellness Models • Professional nursing organizations
• Make decisions about nursing interventions • Stress and Adaptation • Evolving research approaches
• Plan patient care • Developmental Theories • Global concerns
• Predict outcomes of care • Psychosocial Theories • Consumer demands
• Evaluate patient outcomes • Technologies

CRIMEAN WAR (1854 – 1856)

• France, England and Turkey declared war against Russia
• Sidney Herbert, the war minister, asked Nightingale be nurses in Turkey’s
military hospitals.
• 1853, Florence Nightingale accepted the superintendent’s position at
Florence Nightingale the Institute for the Care of Sick Gentlewomen in Upper
Pioneer of Public Health and Founder of Modern Nursing Harley Street, London. She held this position until
10/1854.
• 1854, with 38 women, Florence set for Crimea at Scutari
• She arrived in Constantinople, Turkey
 Born on May 12, 1820, in
• She provided medical equipment, clean water and fruits. With this work
Florence, Italy into an upper-
the mortality rate decreased from 60% to 42% and then to
class British family
2.2%
 age 24 Nightingale defied her
• 1856 returned to England at Lea Hurst.
parents
• 1860, she established the Nightingale Training School for nurses at St
 study at Kaiser's Worth Thomas’ Hospital in London
Hospital in Dusseldorf • as of 2021, the Florence Nightingale Faculty of Nursing, Midwifery &
Germany. Palliative Care still stands with 300 staff and 4,000 students
 returned from Germany, took
a job as a nurse at a hospital
in London, and was

WORKS
• Notes on Matters Affecting the Health, Efficiency, and Hospital
Administration of the British Army, an 830-page report analyzing her
experience and proposing reforms for other military hospitals
operating under poor conditions.
• In 1860, her best-authored works were published, “Notes on Nursing,”
outlining nursing principles. It is still in print today.
• She funded St. Thomas’ Hospital’s establishment, and within it, the
Nightingale Training School for Nurses
AWARDS N HONORS
• Nightingale became known as “The Lady with the Lamp.”
• “Angel of Crimea”
• Queen rewarded Nightingale’s - engraved brooch - “Nightingale Jewel” -
a prize of $250,000 from the British government.
• In 1883, Royal Red Cross by Queen Victoria.
• In 1904, was appointed a Lady of Grace of St John’s Order
ENVIRONMENTAL THEORY
Florence Nightingale’s Environmental Theory defined Nursing as “the act of utilizing the environment of the patient to assist him in his recovery”
Patient-care theory - focuses on the alteration of the patient’s environment in order to affect change in his or her health.
• In 1907, first woman to be awarded the Order of Merit.
• In the following year, she was given the Honorary Freedom of the City of
London.
DEATH
• Florence Nightingale fell ill in August 1910.
• She died on her sleep on August 13, 1910, at her home in London.
• She was 90 years old.
MEMORY
• Florence Nightingale Museum - at Nightingale Training School for
Nurses – with 2,000 artifacts.
• 1890 audio preserved in the British Library Sound Archive.
o “When I am no longer even a memory, just a name, I hope my voice may
perpetuate the great work of my life. God bless my dear old comrades of
Balaclava and bring them safely to shore.
FLORENCE NIGHTINGALE
• founder of modern nursing or professional nursing
• Her books Notes on Hospitals’ and Notes on Nursing became the first
definitive textbook for the field
 • Variety - the need for color and form changes
METAPARADIGM CONCEPTS • Bed and Bedding
• Personal Cleanliness
Nursing • Nutrition and Taking Food - individuals desire different foods at
“What nursing has to do… is to put the patient in the best condition for nature to act different times of the day
upon him” Nightingale stated that nursing “ought to signify the proper use of fresh air, • Chattering Hopes and Advice -to falsely cheer the sick by making
light, warmth, cleanliness, quiet, and the proper selection and administration of diet – light of their illness and its danger is not helpful
all at the least expense of vital power to the patient.” • Social Considerations - Nightingale supported the importance of
looking beyond the individual to the social environment in
Human Beings which they lived.
are defined in relation to their environment and the impact of the environment upon
them. ENVIRONMENTAL FACTORS
Pure fresh air – “to keep the air he breathes as pure as the external air without
Environment chilling him.”
which all that surrounds human beings is considered in relation to their state of health Pure water – “well water of a very impure kind is used for domestic purposes.
And when the epidemic disease shows itself, persons using
Health such water are almost sure to suffer.”
Effective drainage – “all the while the sewer may be nothing but a laboratory from
which epidemic disease and ill health are being installed
into the house.”
Cleanliness – “the greater part of nursing consists in preserv ing cleanliness.”
Light (especially direct sunlight) – “the usefulness of light in treating disease is
very important.”

SUBCONCEPTS OF THE ENVIRONMENTAL THEORY
• Health of Houses - Badly constructed houses do for the healthy
what badly constructed hospitals do for the sick. Once
ensure that the air is stagnant, and sickness is certain to
follow
• Ventilation and Warming - believed that the person who repeatedly
breathed his or her own air would become sick or remain
sick
• Light - second to fresh air, the sick needed light. She noted that
direct sunlight was what patients wanted
• Noise - never be “waked intentionally
THE ASSUMPTIONS
Florence Nightingale believed that five points were essential in achieving a
healthful house:
• pure air, pure water, efficient drainage, cleanliness & light
A healthy environment is essential for healing. She stated that “nature alone
cures.”
Nursing is an art, whereas medicine is a science. Nurses are to be loyal to the
medical plan but not servile
Strengths
- Florence Nightingale’s language to write her books was cultured and flowing,
logical in format, and elegant in style.
- Nightingale’s Environmental Theory has broad applicability to the practitioner.
- Her model can be applied
- Raises consciousness in the nurse about how the environment influences client
outcomes.
Weaknesses
- In Nightingale’s Environmental Theory, there is scant information on the
psychosocial environment compared to the physical environment.
- The application of her concepts in the twentieth century is in question.
Jean Watson
is a nurse theorist who developed “Philosophy and Theory of Transpersonal
Care” or “Caring Science”
 Born as Jean Watson Harmon
 Grew up in Welch, West Virginia
 Youngest of 8 children – was surrounded by an
extended family community environment
 1961 she graduated - attended high school in
West Virginia and in the Lewis Gale School of
Nursing in Roanoke, Virginia
 1964 she progress the nursing education and
earned her bachelor degree in nursing
 1966 she was a Master of Science and
Psychiatric and Mental Health Nursing
 1973 a PhD in educational psychology and counseling from the University of
Colorado at Boulder
 1978 - 1981 coordinator and director of the nursing page the program
 1983 - 1990 Dean of UC School of Nursing and associate director of nursing
practice
In 1997, she experienced an accidental injury that resulted in the loss of her
lefteye, and soon after, in 1998, her husband, whom she considers as her physical
and spiritual partner, and her best friend passed away and left Watson and their
two grown daughters, Jennifer and Julie, and five grandchildren
Career
she received six honorary doctoral degrees and three honorary doctorates
1993 received the National League for nursing Martha E Rogers award
1993 - 1996 served as a member of the executive committee and the governing
board and as an officer for the NLN
1995 - 1996 elected as president of NLN
1998 recognized as distinguished nurse scholar by the NYU university.
1999 assume the nation’s first Murchison Scoville Chair of Caring Science
WORKS
He authored 11 books, shared in the authorship of six books, and has written
countless nursing journals articles
1. Nursing: The Philosophy And Science Of Caring (1979)
2. Human Science And Human Care - I Think Theory Of Nursing (1985)
3. Both Modern Nursing And Beyond (1999)
4. Instruments for Assessing and Measuring Caring in Nursing and Health
Sciences (2002)
5. Caring Science as Sacred Science (2005)
Theory Of Human Caring By Jean Watson
There are many reasons to consider becoming a professional nurse, but
compassion is often a trait required of nurses.
Philosophy and Science of Caring - is concerned on how nurses express care to
their patients
Watson's Theory of Transpersonal Caring?
According to Watson's theory: “Nursing is concerned with promoting health,
preventing illness, caring for the sick, and restoring health. “It focuses on health
promotion, as well as the treatment of diseases.
According to Watson, caring is central to nursing practice and promotes health
better than a simple medical cure. She believes that a holistic approach to health
care is central to the practice of caring in nursing.
According to her Theory of Human Caring, caring can be demonstrated and
practiced by nurses. Caring for patients promotes growth; a caring environment
accepts a person as they are and looks to what they may become.
TRANSPERSONAL CARING REALTIONSHIP
Watson (1999)describes a “Transpersonal Caring Relationship” as foundation all
to her theory; it is a “special kind of human care relationship—a union with
another person— high regard for the whole person and their being-in-the-world”

7 ASSUMPTIONS OF WATSON'S MODEL

1. Caring can be effectively demonstrated and practiced only
interpersonally.
2. Caring consists of Carative Factors that result in the satisfaction of
certain human needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept the patient as he or she is now, as well as what
he or she may become.
5. A caring environment is one that offers the development of potential while
allowing the patient to choose the best action for him or herself at a given
point in time.
6. A science of caring is complementary to the science of curing.
7. The practice of caring is central to nursing.

FOUR MAJOR CONCEPTS/METAPARADIGM

Other MaJor Concept

WATSON’S THEORY AND NURSING PROCESS


WATSON’ HIERARCHY OF NEEDS
• She obtained a Bachelor of Arts degree in Nursing
from Pasadena College in 1964.
• She married Richard Benner in 1967 and they had
two children
• In 1970 she earned a master’s degree in nursing,
with a major emphasis in Medical-Surgical Nursing,
from the University of California, San Francisco
(UCSF) School of Nursing.
• In 1982 she completed doctorate, Ph.D. in stress,
coping, and health in at the University of California, Berkeley.
• In 1970 she began her career as a postgraduate nurse researcher in the School
on Nursing at UCSF
• In 1982, Benner joined the nursing faculty as an associate professor in the
Department of Physiological Nursing at UCSF and a tenured professor in 1989.
• Benner retired from full-time teaching on 2008 as professor emerita from UCSF
• She is currently the Chief Development Officer for educatingnurses.com with Dr.
Pat Hopper-Kyriakidis on an online simulation program NovEx (During COVID-
19 Pandemic)

Works
Dr Benner has published nine books, including
o From Novice to Expert
o Nursing Pathways for Patient Safety, and
o The Primacy of Caring. Interpretive Phenomenology: embodied caring
and Ethics in Health and illness
o The crisis of care
o Expertise in nursing Practice: Caring, Clinical Judgment. And Ethics
o Caregiving
o Clinic Wisdom and interventions in critical care: A thinking in Action
Approach

Patricia Benner
(From Novice to Expert) Career
BIOGRAPHY • 1989 she received the National League for Nursing Linda Richard’s Award for
• Patricia Sawyer was born on August 13, 1942, leadership in education and both the National League for Nursing
at Hampton, Virginia, and spent her childhood in Excellence in Leadership Award for Nursing Education and the NLN
California, where she received her early and President’s Award for Creativity and Innovation in Nursing Education in 2010
professional education.
• In 1990 he received the excellence in nursing research and excellence in nursing
education award from the California organization of nurse executives
• In, 1993 she also received the Alumnus of the Year Award from point Loma
Nazarene College
• in 1994 Benner became an honorary fellow in the Royal College of nursing
United Kingdom
• In 1995, she was awarded the 15th Helen Nahm Research Lecture Award from
the UCSF for her contribution doing nursing science and research
• In 2002, The Institute for Nursing Healthcare Leadership commemorated the
impact of the landmark book “From Novice to Expert” with an award
acknowledging 20 years of collecting and extending clinical wisdom,
experimental learning and caring practice
• in May 2004, Benner received the American Association of critical care nurses
pioneering spirit award for her work on skill acquisitions and
articulating nursing knowledge and critical care
• In 2007 she was selected for the UCSF School of Nursing Centennial wall of
fame, and she received the American Organization of Nurse Executives'
excellence in research award
• In 2008 Benner was ranked as the fourth most influential owners in the past 60
years by the readership of the journal Nursing Standard in the United
Kingdom.
• in 2011 the American Academy of nursing honored Patricia Benner as a Living
Legend.
• Known for Excellence and Power in Clinical Nursing Practice
Dr. Benner’s Philosophy
Dr. Benner “proposed that a nurse could gain knowledge and skills without
actually learning a theory” Described as “knowing how” without “knowing that”
Development of knowledge in nursing is “a combination of knowledge through
research and understanding through clinical experience” (Nursing Theory, 2011).
Dr. Benner describes her works interpretive phenomenology which means
observing and interpreting actual nursing practice to find the meaning of the
experiences
Dr. Patricia Benner contribution to Nursing Theory;
“From Novice to Expert
Patricia Benner developed a concept known as “From Novice to Expert.” This
concept explains that nurses develop skills and an understanding of patient care
over time from a combination of a strong educational foundation and personal
experiences.
Dr. Benner’s Motivation for Novice to Expert
• Nursing practice has been studied primarily from a sociological perspective as
opposed to the study of nursing practice itself
• Nursing knowledge is accrued over time; it is embedded in expertise. Thoughts
are based on the Dreyfus model.
• Knowledge has gone uncharted and unstudied because differences between
practical and theoretical knowledge have been misunderstood
• Well charted nursing practice and observation are essential for theory
development (Benner, 2001).
Patient needs increasing
• Lengths of stays decreasing
• Advancement in Medical technology
• Increased Learning for nurses
• Need for more experienced nurses
With all that is required in the nursing field, wanted to provide an understanding
for nurses, as they develop their skills of what makes a novice nurse become an
expert nurse (Benner,1982).
Dr. Benner’s Influences
Virginia Henderson
• Dr. Benner has acknowledged that her “thinking has been influenced greatly by
Virginia Henderson.”
Dreyfus model of Skill acquisition
• Developed in 1980
• Describes five levels of skill acquisition and development
• Model showed advancement through the stages by changes in
performance
• Developed by studying chess players and pilots
• Benner adapted the Dreyfus model for clinical nursing practice, basis for
her work: Novice to Expert.

Dr. Benner’s Stages of Nursing Proficiency
Novice
is a beginner with no experience. They are taught general rules to help perform
tasks, and their rule-governed behavior is limited and inflexible. Can also apply
to experienced nurse in a area or situation of unfamiliarity
Advanced beginner
shows acceptable performance and has gained prior experience in actual nursing
situations. This helps the nurse recognize recurring meaningful components so
that principles, based on those experiences, begin to formulate in order to guide
actions.
Competent nurse stage generally, has two- or three-years’ experience on the job
in the same field. These nurses are more aware of long-term goals, and they gain
perspective from planning their own actions, which helps them achieve greater
efficiency and organization.
Proficient nurse stage
perceives and understands situations as whole parts. He or she has a more
holistic understanding of nursing, which improves decision-making. These nurses
learn from experiences what to expect in certain situations, as well as how to
modify plans as needed
Expert nurses’ stage
is the last stage no longer relying on principles, rules, or guidelines to connect
situations and determine actions. They have a deeper background of experience
and an intuitive grasp of clinical situations. Their performances are fluid,
flexible, and highly-proficient. Benner’s writings explain that nursing skills
through experience are a prerequisite for becoming an expert nurse
Metaparadigms in Nursing
as defined by Patricia Benner
Nursing
Benner viewed nursing as the care and study of the lived experience and the
relationship of these three elements:
• Health
• Illness
• Disease
Person
“…the person does not come into the world predefined but gets defined in the
course of living a life” Benner believed that there are significant aspects that
make the being. She conceptualized these as the roles of:
• The role of the situation
• The role of the body
• The role of the personal concerns
• The role of the temporality
Health
Benner focused “on the lived experience of being healthy and being ill”
• Health is defined as what can be assessed
• Well- being is the human experience of health or wholeness
• A person may have a disease and not experience illness
• Illness is the human experience of loss or dysfunction
• Disease is what can be assessed at physical level
Environment
Dr. Benner uses the term situation rather than environment. “Personal
interpretation of the situation is bounded by the way the individual is in it”
(Tomey & Alligood, 2006). Each person’s past, present and future which include
their own personal meaning, habits and perspectives influence the current
situation (Alligood & Tomy, 2011).
• Preceptors for student nurses
• Mentors for newly graduated / pass out nurses
• Development of Clinical Simulation Protocol
• Application of theory in nursing research
Implications and Consequences
• School of nursing have adopted Benner’s model to use as a base for the
education of nurses.
• Hospitals and other nurse work places use the model as a foundation for
preceptor-based guidance of nursing students and new graduate nurses
• Social agencies and nursing continuing education program developers also use
Benner’ s model.
• Nursing administrators utilize the model to help “develop career ladders, staff
development and recognition and rewards programs”

Relationship of Paradigms to Benner’s Clinical Ladder Programs

Model The conclusion of the four paradigms of nursing creates experiences that
nurses utilize to advance through the stages of Benner’s model From Novice to • Most are based on stages of clinical
Expert. Using Dr. Benner’s Model in Practice competence of Benner’s
Examples of use in practice:
• Nursing School curriculum • Intention of the ladder is to retain
• Orientation processes experienced nurses
• Nursing educational programs
• Professional advancement ladders • Greater rewards at the expert levels
• Interdepartmental job changes than the novice level
• Developing mentorship programs
STRENGHT AND WEAKNESSES
STRENGHT
The theory has the potential to be used universally as a framework and is not
restricted by age, illness, health, or location of nursing practice. The model was
empirically tested using qualitative methodologies. “The strength of the Benner
model is that it is data-based research that contributes to the science of nursing”
One of the greatest strengths of Benner’s theory is that it focuses on the behaviour
of nurses depending on their level of understanding with nursing practice –
novice, advanced beginner, competent, proficient, expert. Her theory highlights
the importance of clinical experience in developing expertise. As observed today,
her theory is widely used as it provides a foundation to use for assigning clinical
competence.

WEAKNESSES
Dr. Benner’s theory is too simple to account for the complex pattern of
phenomena linked to expert intuition in nursing
Benner and her colleagues, based on previous work by the Dreyfus brothers
(Dreyfus & Dreyfus, 1986), strongly argue that, intuition and holistic perception
are necessary for performing at expert level. However, by doing so, they
underestimate the role played by analytic and conscious problem solving at the
expert level
 Katie Eriksson
BIOGRAPHY:
 Katie Eriksson was born in Jakobstad, Finland,
 the 18th of November, 1943.
 She graduated in Helsinki School of Nursing in
1965.
 A professor of Health Sciences at Abo Akademi
University, Vaasa.
 She emphasizes that the caritative caring relates
to the innermost core of nursing.
 She is a Finland(Finnish)-Swedish nurse.
 Created the “Theory of Caritative Caring” for
40 years in Abo Akademi University, Finland.
 Professor Eriksson was an early pioneer of the idea
that “we, as caregivers, can promote
“To maintain that health was more than the absence of illness was to go against
the
established wisdom in healthcare at the time, that is to say the medical paradigm.”
-Health as soundness, freshness and well-being; health is relative; health is
integration; the health premise.
ACHIEVEMENTS:
-First a practicing nurse, then a public health nurse, then a nursing educator.
-she continued her academic studies at the University of Helsinki where she
obtained an MA (Master of Arts) degree in philosophy in 1974,
a Licentiate in philosophy in 1976, and a doctorate in Education in 1982. The
nursing process was the subject of her doctoral dissertation.
-One can describe Professor Eriksson’s career as consisting of two phases.
1. During the first of these, from 1970 to 1986, she became an outstanding
educator in caring science and, as such, was promoted to principal at the Helsinki
Swedish School of Nursing.
2. During the second phase, from 1986 to 2011, she was promoted to Professor of
Caring Science at the Department for Caring Science at Abo Akademi University.
-1986, she was called on to develop and lead an education and research
programme in the subject
of caring science for Abo Akademi University. A generous donation from the
Swedish-language
Society of Nursing in Finland enabled the creation of a four-year professorship,
from
1987 to 1992.
-1987, she introduced the expression ‘optimal health’, which became an important
concept when the Caring Science Department started in Vaasa.
-1992, she was appointed Professor of Caring Science at Abo Akademi University
in Vaasa.
-From 1996 to 2011, Professor Eriksson was also employed part-time as the
Director of Nursing at Helsinki University Hospital, where she was
responsible for research and development in the field of caring science.
-1998, she was awarded an honorary doctorate from the Nordic School of Public
Health in Gothenburg, in recognition of her promotion of interNordic
cooperation.
-2011, she was a key figure in the Nordic College of Caring Sciences and was
named an honorary member of the society.
-2012, she retired from her position at Abo Akademi University, at the age of 68.
-2013, she was awarded an honorary doctorate from Karlstad University.
Professor Eriksson’s strategy for obtaining deep understanding of central
phenomena in caring was to ask ‘what’, not ‘how’. What is health, what is
suffering, what is the basic motive of caring? Through ‘what’, she sought answers
to the big, ontological questions. It was a matter of seeking and understanding the
ontological substance. Love and charity, or caritas, as the basic motive of caring,
became a lodestar in all instruction.
CONTRIBUTIONS AND WORKS:
Professor Eriksson’s scientific contributions have been comprehensive. As of
2011
approximately 400 scientific titles in various publications have been attributed to
her. She was also an active book writer.
1. The nursing care process was published in 1981
2. The idea of health (1984)
3. The pause (1987)
4. The idea of caring (1987)
5. The suffering human being (1994).
Many of her books have been translated into Finnish, Norwegian and Danish. As
late as
2018, Professor Eriksson published one of her most important books, a
compilation entitled, Caring science: The science of caring and the timeless in
time.
THEORY OF CARITATIVE CARING
● Caring science is considered a human science in the Nordic tradition, as it is
deeply
rooted in basic issues of human life and existence
● The theory of caritative caring was developed by Katie Eriksson (1943-2019)
since the mid-1970s.
○ Was inspired by the works of f.eg. Plato and Aristotle
○ identified the fundamental aspects of the caritative theory as caritas, love and
mercy
○ The ultimate goal of caring is to alleviate suffering in a spirit of faith, hope and
love and thereby enhance dignity.
● caring ethics, the practical relationship between the patient and the nurse, and
nursing ethics
○ Nursing ethics are the ethical principles that guide a nurse’s decision-making
abilities.
○ Caritative caring consists of love and charity, which is also known as caritas,
and
respect and reverence for human holiness and dignity. According to the theory,
suffering that occurs as a result of a lack of caritative care is a violation of human
dignity.
● the concept of environment is replaced with a term caring culture, which
implies to
cultural elements of the caring reality with its traditions, rituals and basic values.
○ Respect for human being´s dignity and holiness forms the base of caring culture
○ refers to the patient’s external environment as “living space”, (i.e. external
factors and actual boundaries (physical, psychosocial and spiritual) for the
potential of a person and her health.)
● philosophical in nature.
○ Eriksson had her goal in defining the philosophical and theoretical foundation
of
care, without which the good patient care (to ensure the integrity, independence
and development of the individual) is impossible.
MAJOR CONCEPTS AND DEFINITIONS
● Caritas – means love and charity, unconditional love. Means that caring is an
endeavor to mediate faith, hope, and love through tending, playing, and learning.
● Caring Communion – Caring communion is characterized by intensity and
vitality, and by warmth, closeness, rest, respect, honesty, and tolerance. It cannot
be taken for granted but pre-supposes a conscious effort to be with the other.
● The Act of Caring – Contains the caring elements (faith, hope, love, tending,
playing, and learning), involves the categories of infinity and eternity, and invites
deep communion. The act of caring is the art of making something very special
out of
something less special.
● Caritative Caring Ethics – Caring ethics deals with the basic relation between
the
patient and the nurse.
● Dignity – Absolute dignity is granted the human being through creation, while
relative dignity is influenced and formed through culture and external contexts.
● Invitation – refers to the act that occurs when the carer welcomes the patient to
the caring communion.
● Suffering – An ontological concept described as human beings struggle between
good and evil in a state of becoming. Suffering that occurs as a result of
lack of caritative care is a violation of human dignity.
● Suffering related to illness, to care, and to life –
When the patient is exposed to suffering caused by care or absence of caring, the
patient experiences suffering related to care, which is always a violation of the
patient’s dignity.
● The suffering human being - The patient is a suffering human being, or a human
being who suffers and patiently
endures.
● Reconciliation – refers to the drama of suffering.
● Caring Culture – Eriksson (1987a) defines caring culture as a concept based on
cultural elements like traditions, rituals, and values.
MAJOR ASSUMPTIONS
1. Axioms - as fundamental truths in relation to the conception of the world. - Seek love, faith, hope, and meaning.
✔The human being is fundamentally an entity of body, soul, and spirit. IV. Human Being in Caring Context
✔The human being is fundamentally a religious being. - Becomes a suffering patient.
- Creative, imaginative, with desires.
✔The human being is fundamentally holy.
- More than just needs
✔Communion is the basis for all humanity.
Nursing
✔Caring is something human by nature, a call to serve in love. I. Caritas as a Motive in Caring
✔Suffering is an inseparable part of life. - Deepest Form of Caring
✔Health is more than the absence of illness. - Ethical Attitude
✔The human being lives in a reality that is characterized by mystery, infinity, and - Rooted in Unconditional Love
eternity. II. Natural Basic Caring
2. Theses - are fundamental statements concerning the general nature of caring - Origin and Characteristics
science. -Presence with Love, Faith, and Hope
✔Ethos confers ultimate meaning on the caring context. III. Caring Through History
- Historical Perspective
✔The basic motive of caring is the caritas motive.
- Expanding to Truth, Goodness, Beauty, and the Eternal
✔The basic category of caring is suffering. IV. Caring in Nursing
✔Caring communion forms the context of meaning of caring and derives its - Patient-Centered Care
origin from the ethos of love, responsibility, and sacrifice, namely, caritative - Affirming Dignity
ethics. V. Ultimate Goal of Caring
✔Health means a movement in becoming, being, and doing while striving for - Beyond Health
wholeness and holiness, which is compatible with endurable suffering. - Serving Others
✔Caring implies alleviation of suffering in charity, love, faith, and hope. Health
I. Erikson's Health Perspective
METAPARADIGM - Early definition: Soundness, freshness, well-being
Human Being: - Emphasis on subjective well-being
I. Human Being II. Health as Wholeness and Holiness
- Composed of body, soul, and spirit. - Current definition: Wholeness of body, soul,
- Emphasizes religiosity and human dignity. and spirit
- Views humans as in constant change, with dual tendencies. - Health as a pure concept of wholeness and holiness
II. Freedom in Eriksson's Theory III. Ontological Health Model
- Conditional freedom linked to becoming. - Eriksson's view of health in this model
- Parallels with Kierkegaard's ideas. - Health as both movement and integration
- Transcendency foundation of real freedom. IV. Health as Movement
- Balance of uniqueness and belonging. - Various facets of health as movement
III. Dependence on Communion - Dependent on vital force and vitality
- Fundamental need for communion. - Driven by the search for meaning, life, and love
- Human constitution in relationship with God and others. Environment
I. Ethos in Caring Science
- Based on Aristotle's concept Education and Professional Background
- Embodies love, charity, respect, and dignity A. Academic Achievements
II. Ethos as Ontological Concept • In 1936, received her nursing diploma from KNOXVILLE GENERAL
- Represents an "inner ought to" HOSPITAL SCHOOL of NURSING.
- Key to understanding caring • In 1937, she received an undergraduate degree in public health nursing (at
III. Ethos as Home George Peabody College in Nashville Tennessee).
- Symbolizes one's true self • In 1945, received an M.A (Master's Degree) in public health nursing from
- Integral to ethics and the caring culture Teacher College, Columbia University.
IV. Ethos as Core of Caring Culture • In 1952 as an M.P.H (Master of Philosophy in Public Health), from Johns
- Shapes ethical principles Hopkins School of Public Health. (Baltimore)
- Charity's role in alleviating suffering • In 1954 as a Sc. D (Doctor of Science), from Johns Hopkins School of Public
V. Suffering in Caring Health. (Baltimore)
- Eriksson's shift towards recognizing suffering
- Charity as a basis for relief Professional Career
VI. Understanding Suffering • In 1940, She worked at the Association for five years, first as an Assistant
- Inherent in human life Supervisor, then as the Assistant Education Director, and lastly as the acting
- Gain meaning through reconciliation Director of Education.
VII. Role in Alleviating Suffering • 1954 to 1975, Martha Rogers was a professor and head of the Division of
- Co-acting in the drama of suffering Nursing at New York University.
- Confirming, providing time, and space • 1979 she became professor emeritus and was an active member of the nursing
VIII. Forms of Suffering profession until her death on March 13, 1994.
- Illness-related, care-related, life-related • 1996, after her death, she was inducted into the American, Nurses Association
- Addressing different facets of human suffering Hall of Fame, an organization created to recognize the most outstanding women
and men in the nursing field

Martha Elizabeth Rogers

She is an American nurse, researcher, theorist, and author.
The Science of Nursing
Birth and Early Life A. Rogers' Contributions to Nursing Theory
• born on May 12, 1914 – died on March 13, 1994 • Science of Unitary Human Beings (SUHB)
• Born in Dallas, Texas • Energy Field
• They moved to Knoxville, Tennessee in 1931. • Openness
• The oldest of four children of Bruce Taylor Rogers and • Pattern
Lucy Mulholland Keener Rogers. • Pan dimensionality
• Her early experiences and education likely provided her • Hemodynamics Principles
with the foundation and motivation to pursue a career in nursing. • Rogers Metaparadigm
• Practice Methodology: The Health Patterning Practice Method - The constant change in flow from a lower to higher frequency. It is a flow of
energy between people and everything around them.
Key Concepts and Ideas 2. Helicy
i. Science of Unitary Human Beings (SUHB) - Any small change in any of the environmental fields causes a ripple effect,
- This theory revolutionized nursing by proposing that individuals are not just which creates larger changes in other fields. It is basically continuous evolution or
physical bodies with distinct parts, but rather unified energy fields inseparable change that results from the interaction of human-environment field. Change is
from their environment. constant and unpredictable. Explains the fact that many forces are mutually
interacting and constantly evolving.
ii. Energy Field 3. Integrality
- The energy field is the fundamental unit of both the living and nonliving. - This is the principle on which meditation and humor works to produce a positive
• Human Energy Field environment.
- An irreducible, pan-dimensional energy field identifiable by pattern and
manifesting characteristics that are specific to the whole and that cannot be Rogers Metaparadigm
predicted from the knowledge of the parts. PERSON (UNITARY HUMAN BEING)
• Environmental Energy Field - A unitary human being is open systems which continuously interact with
- An irreducible, pan-dimensional energy field identified by pattern and integral environment. A person cannot be viewed as parts, it should be considered as a
with the human field. whole.
ENVIRONMENT
iii. Openness - The environment is an "irreducible, pan dimensional energy field identified by
- This concept states that energy fields have no beginning and no end but that they pattern and integral with the human field"
integrate with each other. HEALTH
- Not clearly defined by Roger. It is determined by the interaction between energy
iv. Pattern fields i.e human and environment (Bad interaction or misplacing of the energy
- Pattern is defined as the distinguishing characteristic of an energy field leads to illness.)
perceived as a single waves NURSING
-It constantly maintains the energy field which is conductive for patient.
v. Pan dimensionality - Nursing action directs the interaction of person and environment to maximize
- Martha defines this concept as a domain without limits that lacks spatial or health potential.
temporal attributes, this being the best way to define the idea of a unitary whole.
viii. Practice Methodology: The Health Patterning Practice Method (Nursing
vi. Homeodynamics Principles Process)
1) Assessment
2) Voluntary mutual patterning
3) Evaluation.

Three principles of homeodynamics: Career and Achievements

1. Resonancy A. Notable Publications and Works
• Educational Revolution in Nursing (1961),
• Reveille in Nursing (1964).
• An Introduction to the Theoretical Basis of Nursing (1970)
• Nursing Science and Art: A Prospective (1988)
• Nursing: Science of Unitary, Irreducible, Human Beings Update (1990)
• Vision of Space Based Nursing (1990)
- Evaluation is an ongoing and dynamic process. Nurses continually assess the
patient's response to interventions, considering changes in energy field patterns
and overall well-being.
-Is done by repeating the pattern appraisal after the mutual patterning to determine
the extents of dissonance and harmony.

Influence on Nursing Practice

• Assessment/Pattern Appraisal
-An inclusive assessment of human and environment energy fields, its
organization of energy field, and identification of areas of dissonance.
- Holistic Perspective: Rogers emphasizes understanding individuals as unified
energy fields, rather than isolated physical entities. Nurses assess the patient's Legacy
physical, emotional, spiritual, and environmental dimensions. A. Influence on Modern Nursing Theory and Practice
-Pattern Recognition: Nurses are trained to recognize meaningful patterns within • Rogers developed the SUHB theory, which revolutionized nursing by proposing
the patient's behavior, experiences, and interactions. This involves discerning the that individuals are unified energy fields inseparable from their environment. This
unique energy field of each individual. holistic approach emphasized the interconnectedness of individuals with their
surroundings.
• Voluntary Mutual Patterning • Holistic Perspective: She advocated for a holistic understanding of individuals,
-The proper patterning of the energy fields between humans and the environment. considering physical, emotional, spiritual, and environmental dimensions. This
-The mutual interaction between the client and nurse. perspective became a cornerstone of modern nursing practice.
• Energy Fields: Rogers introduced the concept of energy fields as the
MUTUAL PATTERNING OF THE HUMAN AND fundamental unit of her theory. These fields are dynamic and extend beyond the
individual, influencing and being influenced by the broader environment.
ENVIRONMENTAL FIELDS INCLUDES:
• Influence on Nursing Education: Rogers' theories have influenced nursing
i. -Sharing knowledge
education globally, emphasizing the importance of holistic care and understanding
ii. -Offering choices
patients as unique energy fields.
iii. -Empowering the patient
iv. -Fostering patterning
Awards and Recognitions
v. -Evaluation
• Honorary Doctorates: Rogers received honorary doctorates from various
vi. -Repeat pattern appraisal, which includes nutrition, work/leisure
institutions in recognition of her significant contributions to the field of nursing
activities, wake/sleep cycles, relationships, pain, and fear/hopes
and nursing theory.
vii. -Identify dissonance and harmony
• American Academy of Nursing Living Legend: In 1986, Rogers was named a
viii. -Validate appraisal with the patient
Living Legend by the American Academy of Nursing, an honor bestowed upon
ix. -Self-reflection for the patient
individuals who have made exceptional contributions to nursing.
• Fellow of the American Academy of Nursing: She was recognized as a Fellow of
• Evaluation
the American Academy of Nursing, a prestigious acknowledgment of her
outstanding contributions to the nursing profession.
• Distinguished Alumna Award: Rogers received the Distinguished Alumna Award
from both the University of Tennessee and George Peabody College for Teachers,
in recognition of her exemplary achievements in nursing.
• Nightingale Award: Martha Rogers was a recipient of the Nightingale Award for
Excellence in Nursing, an honor that celebrates individuals who have
demonstrated exceptional dedication and innovation in the field of nursing.
• International Recognition: Rogers' work gained international recognition, and
she was invited to speak and present her theories at conferences and events around
the world.
• Named Lectureships and Scholarships: In her honor, several universities and
nursing organizations have established named lectureships, scholarships, and
awards that bear her name, ensuring her legacy continues to inspire future
generations of nurses.
VI
 Dorothea E. Orem
(1914-2007)

“Nursing is practical endeavour, but it is practical endeavour engaged in by Self-Care Deficit Theory of Nursing
persons who have specialized theoretic nursing knowledge with developed Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The act of
capabilities to put this knowledge to work in concrete situations of nursing assisting others in the provision and management of self-care to maintain or
practice.” -Orem, 2001 improve human functioning at the home level of effectiveness.”
It focuses on each individual’s ability to perform self-care, defined as “the
CREDENTIALS AND BACKGROUND practice of activities that individuals initiate and perform on their own behalf in
• Dorothea Elizabeth Orem was born in maintaining life, health, and well-being.”
Baltimore, Mary land, in 1914.
• She began her nursing career at Providence Orem’s general theory of nursing is related into three parts:
Hospital School of Nursing in Washington, • Theory of Self-Care
DC, she received her diploma in early 1930’s. • Theory of Self-Care Deficit
• She received a Bachelor of Science degree • Theory of nursing system
in nursing education from Catholic University
of America (CUA) in 1939. The theory of self-care has 4 sub-concepts
• She received a Master of Science degree of • Self care
nursing education in CUA in 1946. • Self-care agency
• In 1970, Orem left CUA and began her consulting firm. • self-care requisites
• Orem’s first published book was Nursing: Concepts of Practice (Orem, 1971). a) universal
• Orem retired in 1984and continued developing the self-care deficit nursing b) developmental
theory (SCDNT). c) health deviation
• Georgetown University conferred the honorary degree of doctor of science on • therapeutic self-care demand
Orem in 1976.
• She received the CUA Alumni Association Award for Nursing Theory in 1980. The Theory of Self-care
• Other honors included honorary doctor of science, Incarnate Word College, Self-care is the performance or practice of activities that individuals initiate and
1980; doctor of humane letters, Illinois Wesleyan University, 1988; Linda perform on their own behalf to maintain life, health and well-being. When self-
Richards Award, National League for Nursing, 1991; and honorary fellow of the care is effectively performed, it helps to maintain structural integrity and human
American Academy of Nursing, 1992. She was awarded the doctor of nursing functioning and contributes to human development.
from the University of Missouri in 1998.
Self-Care Agency
• At age 92, Dorothea Orem’s life ended after a period of being bedridden. She Human’s acquired powers and capabilities to engage in self-care. The ability to
died Friday, June 22, 2007, at her residence on Skidaway Island, Georgia. engage in self-care is affected by basic conditioning factor. The basic conditioning
factors are age, gender, developmental state, health state, socio-cultural
orientations, health care system factors, pattern of living etc.
Orem's conceptualization of self- care agency suggests that the reason that
individuals do not act appropriately may not be because they do not know how to
perform self-care actions but, rather, because self-care agency varies with one's
physical, cognitive, and psychosocial development.
Self-Care Requisites
Actions directed towards provision of self-care.
• Universal- Associated with life processes and the maintenance of the
integrity of human structure and functioning.
A common term for these requisites is activities of daily living. Universal self-
care requisites include:
-The maintenance of enough air intake
-The maintenance of proper intake of water
-The maintenance of ample intake of food
-The provision of care linked with the eradication process and excretions
-The maintenance of a balance between a task and rest
-The maintenance of equilibrium between solitude and social interaction
-The prevention of threats to human life, functioning, and well-being
-The advancement of human functioning and development in social groups under
human potential and desire to be normal.
• Developmental- More specific to the process of growth and development
and are influenced by what is happening during the life cycle
stages, such influence may be positive or negative.
Developmental self-care requisites become apparent when the adult's
social interactions are judged. Either be specialized expressions
of universal self-care necessities. They include:
-Adjusting to a new job
-Adjusting to body changes
-Adjusting to a new social group
-Adjusting to a new environment.
• Health deviation- Are conditions that affect health status and require more
than usual self-care efforts. They are needed in situations of
disease, illness, or injury. They include:
-Seeking and securing suitable medical care Being conscious of and tending to the
effects and results of therapeutic conditions and circumstances.
-Effectively carrying out medically prescribed diagnostic, curative, and recovery
actions.
-Recognizing and attending to or controlling the discomforting or detrimental
effects of prescribed medical measure.
-Adjusting the self-concept in accepting oneself as being in a certain state of
health and in need of particular health care forms.
-Learning to live with the effects of pathologic conditions and the impact of
medical diagnostic and treatment measures in a lifestyle that promotes continued
personal development
Therapeutic self care demand
Total of care activities needed, either at an identified moment or over a period of
time, to meet a person’s known requirements for self-care.
The Theory of Self Care Deficit
When therapeutic self care demand exceeds self care agency, a self care deficit
exists and nursing is needed.
Theory of Nursing System
This theory describes how the patient’s self care needs will be met by the nurse,
the patient, or both.
If there is a self care deficit that is, If there is a difference between what the
individual can do (self-care agency) and what needs to be done to maintain
optimum functioning (therapeutic self-care demand) nursing is required.
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 the available self-care agency, leading to
nursing.
Classification of Nursing System
• Wholly compensatory system
• Partly compensatory system
• Supportive educative system
Wholly Compensatory System
The wholly compensatory system, is applied when patients are unable to engage
in self-care due to physical or cognitive limitations. In this system, nurses assume
complete responsibility for all aspects of the patient’s care, including the physical,
emotional, and psychological needs. The main points of this system is the patient
is relying on us nurses or health care providers.

Subtypes of this system are:

• Unable to engage in self care (person in coma)
• Aware but could not engage in self care (person with c3-c4 vertebral
fracture) Major Assumptions
• Include person who are severely mentally impaired (senile person, some • All patients wish to care for themselves.
forms of mental retardation • Humans are capable and willing to engage in self care and care for dependent
members of the family.
• Self care and dependent care are learned behaviors through human
communication and interaction with each other.
• Nursing is a deliberate helping actions performed by nurses for the benefits of
others over a certain period of time.
Partly Compensatory System • Humans are supposed to be self reliant and responsible for their self care needs
It is used when patients have some capacity for self care but require assistance in and care needs for dependent members of the family.
specific areas. Nurses in this system collaborate with patients, identifying their • Humans are unique individuals that are separated from each other and from their
strengths and helping them to actively participate in those areas where they have environment.
the ability to do so. The healthcare provider fills in the gaps by compensating for Four Major Concepts of Orem’s Theory
the patient’s limitations. • Person
• Health
Supportive Educative System • Environment
Emphasizes the importance of education and emotional support in helping patients • Nursing
develop and maintain their self care abilities. Nurses in this system serve as Person
educators and mentors, providing knowledge, guidance, and emotional - Person is defined by Orem as the patient (a recipient of nursing care) a being
encouragement to empower patients to take responsibility for their own health and who functions biologically, symbolically, and socially and who has the potential
well-being. for learning and development.
*Orem states that one or ore of these three types of nursing system may be used
with a signle patient over a period of time. Health
- A state characterized by soundness or wholeness of bodily structure and
functions; illness is its opposite.
- It consists of physical, psychological, interpersonal and social aspects; these
aspects are inseparable.
 Step 2: Design of a nursing system and plan for delivery of care.
Environment Step 3: Production and management of nursing systems.
- Environment consists of environmental factors, environment elements, Orem’s Theory and the Nursing Process
environmental conditions (external physical and psychological surrounding), and Collect data in six areas:
developmental environment. • The person’s health status
• The physician’s perspective of the person’s health status
Nursing • The person’s perspective of his or her health
- Orem defines the art of nursing as an intellectual quality of the individual nurse; • The health goals within the context of life history, life style, and health status.
- Orem further defines nursing as a human service. • The person’s requirements for self care
- Nursing is distinguished from the other human services by its focus on persons • The person’s capacity to perform self care
with inabilities to maintain the continuous provision of health care.
*Nurse designs a system that is wholly or partly compensatory or supportive-
Goal of Nursing educative. The two actions are:
• To render the patient or members of his family capable of meeting the patient’s 1. Bringing out a good organization of the components of patient’s therapeutic
self care needs self care demands.
• To maintain a state of health 2. Selection of combination of ways of helping that will be effective and efficient
• To regain normal or near normal state of health in the event of disease or injury in compensating for/ overcoming patients self care deficits.
• To stabilize, control, or minimize the effects of chronic poor health or disability
Priority of nursing problems according to Orem’s Theory of Self- Care Deficit
The Self care Deficit Theory focuses on assessment through the use of nursing • Air
process. Nurses asses the individual’s ability to meet self care needs and barriers • Water
to meeting self care needs. • Food
They then establish an individualized plan to facilitate successful knowledge or • Elimination
skill acquisition for self care. • Activity/Rest
Comparison of Orem’s nursing process and the nursing process • Solitude/Interaction
• Prevention of hazards
• Promotion of normalcy
• Maintain a developmental environment
Nursing Process • Prevent or manage the developmental threats
1. Assessment • Maintenance of health status
2. Nursing Diagnosis • Awareness and management of the disease process
3. Plans with Scientific Rationale • Adherence to the medical regimen
4. Implementation • Awareness of potential problem
5. Evaluation • Modify self image
• Adjust lifestyle to accommodate health status changes.
Orem’s Nursing Process
Step 1: Diagnosis and prescription, determine why nursing is needed. Analyze and Applications to Orem’s Self-Care Deficit Theory in nursing practice, education and
interpret- make judgment regarding care. research
Practice
• Many articles document the use of the self-care theory as a basis for clinical
practice
• Orem’s self-care deficit theory has been used in the context of the nursing
process to teach patients to increase their self-care agency to evaluate nursing
practice and to differentiate nursing from medical practice.
Education
• Orem’s self care deficit theory has been the focus of the curriculum in nursing
education at many school of nursing
Research
• The self care theory provided conceptual framework for many researchers.
Critiques of Orem’s Theory
Strengths
• Provides a comprehensive base to nursing practice
• It has utility for professional nursing in the areas of nursing practice, curricula,
education, administration, and research
• Specifies when nursing is needed
• Self care approach is contemporary with the concepts of health promotion and
health maintenance
• Expanded her focus of individual self-care to include multi person units
Limitations
• In general system theory, a system theory is viewed as a single whole thing
while Orem defines a system as a single whole thing
• Appears that the theory is illness oriented rather with no indication of its use in
wellness settings
Imogene King
(Jan 30,1923 – Dec 24, 2007)
BIOGRAPHY
• January 30, 1923: Born in West Point, Iowa.
Youngest of 3 children
• 1945 – Nursing Diploma from St. John’s Hospital
School, St. Louis Missouri
• 1948 – Bachelor of Science in Nursing from St.
Louis University
• 1957 – Master of Science in Nursing from St.
Louis University
• 1961 – EdD from Teacher’s College, Columbia
University, New York
• 1947-1958 – Med-Surg Nursing Instructor and Asst. Director at St. John’s
Hospital School of Nursing
• 1966-1968 - Asst. Chief, Research Grants Branch, Division of Nursing,
Washington,
• 1968-1972 – Director, School of Nursing at Ohio State University
• 1961-1966 – Associate Professor at Loyola University, Chicago
• 1971-1980 – Professor at Loyola University, Chicago
• 1990 - Retired with the title Professor Emeritus after serving as Professor at
University of South Florida, College of Nursing
• Continued to speak at conferences around the world and consulted with the
students who were using and studying her theory
• December 24, 2007 – She died, 2 days after suffering from stroke
KING’S INTERACTING SYSTEM FRAMEWORK AND THEORY OF
GOAL ATTAINMENT
CONCEPTUAL FRAMEWORK
• Imogene King’s Interacting Systems Framework emphasizes the importance of
the interaction between nurse and patients.
• It views the interaction as an open system which is in constant interaction with a
variety of environmental factors.
• 3 Systems – Personal, Interpersonal, and Social Systems
PERSONAL SYSTEM
• Perception – a process of organizing, interpreting, and transforming information defining, validating, and accepting the authority of individuals within an
from sense data and memory that give’s meaning to one’s experience, organizational.
represents one’s image of reality and represents one’s behavior. • Power – the process whereby one or more persons influence other persons in a
• Self – a composite of thoughts and feelings that constitute a person’s awareness situation.
of individual existence, of who and what he or she is. • Status – the position of an individual in a group or a group in relation to other
• Growth and Development – cellular, molecular, and behavioral changes in groups in an organization.
human beings that are function of genetic endowment, meaningful and satisfying • Decision Making – a dynamic and systematic process by which goal-directed
experiences, and an environment conducive to helping individuals move choice of perceived alternatives is made and acted upon by individuals or
towards maturity. groups to answer a question and attain a goal.
• Body Image – a person’s perception of his or her body. • Control – being in charge.
• Time – the duration between the occurrence of one event and the occurrence of Among the 3 systems, the conceptual framework of Interpersonal System
another event. had the greatest influence on the development of her theory.
• Space – the physical area called territory that exists in all directions.
• Learning – gaining knowledge. INTERACTING SYSTEMS FRAMEWORK NURSE-PATIENT
TRANSACTIONS MODEL
INTERPERSONAL SYSTEM
• Interactions – the acts of two or more persons in mutual presence; a sequence of
verbal and nonverbal behaviors that are goal directed.
• Communication – the vehicle by which human relations are developed and
maintained; encompasses intrapersonal, interpersonal, verbal and nonverbal
communication.
• Transaction – a process of interaction in which human beings communicate with
the environment to achieve goals that are valued; goal-directed human
behaviors.
• Role – a set of behaviors expected of a person occupying a position in a social
system.
• Stress – a dynamic state whereby a human being interacts with the environment
to maintain balance for growth, development, and performance, involving an
exchange of energy and information between the person and the
environment for regulation and control of stressors.
• Coping – a way of dealing with stress. MAJOR CONCEPTS AND SUBCONCEPTS NURSING PARADIGMS
• Nursing – is a process of action, reaction, and interaction whereby nurse and
SOCIAL SYSTEM client share information about their perceptions in the nursing situation.
• Organization – composed of human beings with prescribed roles and positions • Health – it is a dynamic state in the life cycle; illness interferences with that
who use resources to accomplish personal and organizational goals. process.
• Authority – a transactional process characterized by active, reciprocal, relations • Environment – it is the background for human interactions. It is both external
in which member’s values, backgrounds and perceptions play a role in to, and internal to the individual.
• Person – a person existing in an open system as a spiritual being and rational • Lack of development of applying the theory in providing nursing care to groups,
thinker who makes choices, selects alternative courses of action, and has ability families, or communities.
to record their history through their own language and symbols, unique, • King’s theory also contains some inconsistencies: (1) She indicates that nurses
holistic and have different needs, wants, and goals. are concerned about groups’ health care but concentrates her discussion on
nursing as occurring in a dyadic relationship. (2) King says that the nurse
THE STEPS OF NURSING PROCESS and client are strangers, yet she speaks of their working together for goal
• Assessment – the theory suggests that assessment occurs during interaction attainment and the importance of health maintenance.
between a nurse and patient, where the nurse collects data on the patient's
growth, self-perception, and health status, relying on communication for CONCLUSION
accuracy and effective interaction and translation. King's conceptual system and middle-range Theory of Goal Attainment, focusing
• Nursing Diagnosis - this phase is developed using the data collected in the on nurse-patient partnerships, has significantly advanced nursing knowledge. This
assessment. In attaining goals, the nurse identifies problems, concerns, approach has been widely used by nurses worldwide to enhance patient care
and disturbances about which the patient is seeking help. quality, demonstrating its usefulness in various settings
• Planning - the planning phase involves the nurse and healthcare team creating a
care plan to address identified problems, setting goals, and making decisions, BETTY NEUMAN
encouraging patient participation in achieving these goals. Neuman’s System Model
• Implementation - the actual activities done to achieve the goals make up the “Health is a condition in which all parts and subparts are in harmony with the whole of the client.”
implementation phase of the nursing process. Whereas in this model of
nursing, it is the continuation of transaction. BIOGRAPHY
• Evaluation - in this phase, evaluation involves assessing the patient's progress  September 11, 1924
towards achieving goals, focusing on the effectiveness of nursing care.  Born in Lowell, a village in Washington
County, Ohio, United States, along the
STRENGTHS Muskingum River
• A major strong point of King’s conceptual system and Theory of Goal  A nurse, educator, health counselor,
Attainment is how nurses can understand goal attainment theory and describe a therapist, author, speaker, and researcher.
logical sequence of events.
 Her love for nursing started when she took
• For most parts, concepts are concretely defined and illustrated.
care of her father, which later created her
• King’s definitions are clear and are conceptually derived from the research
compassion in her chosen career path
literature. Her Theory of Goal Attainment presents ten major concepts.
The concepts are easily understood and derived from the research literature,
EDUCATION AND CAREER
which clearly establishes King’s work as important for knowledge
1947
building in nursing.
 Registered Nurse Diploma from the Peoples Hospital School of Nursing, in
WEAKNESSES
Akron Ohio
• Theory of Goal Attainment has been criticized for having limited application in
1966
nursing areas in which patients are unable to interact competently with the
 Masters Degree in Mental Health, Public Health Consultation, at UCLA
nurse. King maintained the broad use of the theory in most
1970
nursing situations.
 Started developing The Systems Model
1985
 Completed her doctorate in Clinical Psychology from Pacific Western
University
1988
 Founded the Neuman Systems Model Trustee Group, Inc.
AWARDS AND HONORS
 She was honored by President Richard Jusseaume and Provost Dr. Laurence
Bove with the Walsh University. Distinguished Service Medal, which is
awarded to those who have contributed outstanding professional or voluntary
service to others within the national, regional or local community.
 She was an honorary member of the American Academy of Nursing.
1992 - Honorary Doctorate of Letters, Neumann College, Aston, PA
1993 - Honorary Member of the Fellowship of the American Academy of Nursing
1998 - Honorary Doctorate of Science, Grand Valley State University, Michigan
NEUMAN’S SYSTEM MODEL
 Betty Neuman describes the Neuman Systems Model as “a unique, open-
system-based perspective that provides a unifying focus for approaching a
wide range of concerns. A system acts as a boundary for a single client, a
group, or even several groups; it can also be defined as a social issue. A client
system in interaction with the environment delineates the domain of nursing
concerns.”
 The system is described as moving into illness on a wellness-illness
continuum. If adequate energy is available, the system will be reconstituted
with the normal defense line restored at, below, or above its previous level.
 Three words frequently used concerning stress are inevitable, painful, and
intensifying
 Is based on the person’s relationship to stress, response, and reconstitution
factors that are progressive in nature
MAJOR CONcEPTS AND DEFINITIONS
A. WHOLISTIC APPROACH
 Is a dynamic, open, systems approach to client care originally developed to
provide a unifying focus for defining nursing problems and for
understanding the client in interaction with the environment
Clients - are viewed as wholes whose parts are in dynamic interaction
B. ENVIRONMENT
 Consists of both internal and external forces surrounding the client,
influencing and being influenced by the client, at any point in time
○ Created Environment – is developed unconsciously by the client to express
system wholeness symbolically
C. OPEN SYSTEM
 “There is a continuous flow of input and process, output, and feedback”
 Stress and reaction to stress are basic component of an open system
○ Function or Process – the client as a system exchanges “energy, information,
and matter with the environment as well as other parts and subparts of the system”
as it uses available energy resources “to move toward stability and wholeness”
○ Input and Output - are “the matter, energy, and information that are exchanged
between the client and the environment”
○ Feedback - system output in the form of “matter, energy, and information serves
as feedback for future input “for corrective action to change, enhance, or stabilize
the system”
○ Negentropy - “A process of energy conservation that increases organization and
complexity, moving the system toward stability at a higher degree of wellness”
○ Stability - is a dynamic and “desirable state of balance in which energy
exchanges can take place without disruption of the character of the system, ”
which points toward optimal health
D. CLIENT SYSTEM
 Is “a composite of five variables (physiological, psychological, sociocultural,
developmental, and spiritual) in interaction with the environment”.
○ Physiological Variable – refers to body structure and function.
○ Psychological Variable – refers to mental processes in interaction with the
environment.
○ Sociocultural Variable – refers to the effects and influences of social and
cultural conditions.
○ Developmental Variable - refers to age-related processes and activities.
○ Spiritual Variable - refers to spiritual beliefs and influences”.
E. NORMAL LINE OF DEFENSE
 “Expansion of the normal line of defense reflects an enhanced wellness state,
and contraction indicates a diminished wellness state”
F. FLEXIBLE LINE OF DEFENSE
 It is perceived as serving as a protective buffer for preventing stressors from
breaking through the usual wellness state as represented by the normal line of
defense
G. HEALTH
 “Health is a continuum of wellness to illness that is dynamic in nature.
Optimal wellness exists when the total system needs are being completely
met”
○ Wellness - “Wellness exists when all system subparts interact in harmony with
the whole system and all system needs are being met”.
○ Illness - “Illness exists at the opposite end of the continuum from wellness and
represents a state of instability and energy depletion”.
H. STRESSORS
 Are tension-producing stimuli.
○ Intrapersonal Forces - occurring within the individual, “such as conditioned
responses”
○ Interpersonal Forces - occurring “between one or more individuals, such as role
expectations”
○ Extrapersonal Forces - occurring outside the individual, such as financial
circumstances”
I. DEGREE OF REACTION
● Represents system instability that occurs when stressors invade the normal line
of defense
J. PREVENTION AS INTERVENTION
● Are purposeful actions to help the client retain, attain, or maintain system
stability.
○ Primary Prevention - is used when a stressor is suspected or identified. “A
reaction has not yet occurred,” but the degree of risk is known.
○ Secondary Prevention - “Secondary prevention involves interventions or
treatment initiated after symptoms from stress have occurred.”
○ Tertiary Prevention - “Tertiary prevention occurs after the active treatment or
secondary prevention stage. It focuses on readjustment toward optimal client
system stability.”
K. RECONSTITUTION
 Occurs after treatment for stressor Reactions
IV. MAJOR ASSUMPTIONS
 Each client system is unique, a composite of factors and characteristics within
a given range of responses.
 Stressors exist. Each differs in its potential for disturbing a client’s usual
stability level or normal line of defense.
V. INFLUENCES OF THE NEUMAN’S SYSTEMS MODEL
A. PIERRE TIELHARD DE CHARDIN
 A philosopher-priest that believed human beings are continually evolving
towards a state of perfection – an Omega Point
B. GESTALT THEORY
 A theory of German origin which proposes that the dynamic interaction of the
individual and the situation determines experience and behavior.
C. GENERAL ADAPTATION SYNDROME
 Mainly talks about an individual’s reaction to stress on the 3 levels
○ alarm
○ resistance
○ Exhaustion
D. GENERAL SYSTEMS THEORY
 Postulates that the world is made up of systems that are interconnected and
are influenced by each other.
VI. 4 NURSING METAPARADIGM ACCORDING
TO NEUMAN
A. NURSING
 Neuman believes that nursing is concerned with the whole person. She
views nursing as a “unique profession in that it is concerned with all of the
variables affecting an individual’s response to stress”.
B. HUMAN BEING
 “Neuman presents the concept of human beings as an open client system
in reciprocal interaction with the environment. The client may be an individual,
family, group, community, or social issue.”

C. HEALTH
 She views health as a continuum of wellness to illness that is dynamic in
nature and is constantly changing.

D. ENVIRONMENT
 As all the internal and external factors that surround and influence the client
system
○ Internal Environment – exists within the client system.
○ External Environment – exists outside the client system.
○ Created Environment - is an environment that is created and developed
unconsciously by the client and is symbolic of system wholeness.

VII. STRENGTHS AND WEAKNESSES

A. STRENGTHS
 The Neuman Systems Model’s major strength is its flexibility for use in all
areas of nursing – administration, education, and practice.
 Neuman has presented a view of the client equally applicable to an individual,
a family, a group, a community, or any other aggregate.
 The Neuman Systems Model, particularly presented in the model diagram, is
logically consistent.

B. WEAKNESSES
 The major weakness of the model is the need for further clarification of the
terms used.
 Interpersonal and extrapersonal stressors need to be more clearly
differentiated