TFN-theorist-notes PREFINALS

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TFN
Betty Neuman
About the Theorist
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Birth: 1924
o Lowel, Ohio
Education:
o RN diploma- 1947 People's Hospital school of nursing in Akron, Ohio
o BSN- 1957 University of California
o MSN- 1966 ""
o PhD clinical psychology- 1985 Pacific west university
Honorable mentions:
o Honorary Doctorate- 1922 Neuman college in Aston, Pennsylvania
o Honorary Doctorate of science- 1988 Grand Valley state University in Michigan
Pioneer in the community health movement in the late 1960's
Developed her health system model while lecturing in community health nursing at university of
california, LA
Model made in response to graduate nursing students need for a course that'd expose them to
nursing problems prior to focusing on specific nursing problem areas
Model published in 1972
o A Model for Teaching Total Person Approach to Patient Problems
o Published in the 1st and 2nd edition of Conceptual Models for Nursing
The Theory
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Focus around human beings being a total person as a client system and a layered
multidimensional being
Clients have a core circle with several protective layers
Layers consist of subsystems/variables that influence the state of wellness or illness
1. Physiological-physicochemical structure and function of the body
2. Psychological- mental processes and emotions
3. Sociocultural- relationships and social/cultural expectations and activities
4. Spiritual- spiritual beliefs
5. Developmental- development over a person's lifespan
Client is exposed to internal and external stressors requiring lines of defense and reactions
Person-Open system interacting with the environment through interpersonal and extra-personal
factors
o A dynamic composite of the 5 variables
o Continuously exposed to various beneficial and noxious stressors in the environment and
are able to respond by adjusting to the environment or adjusting the environment
o Maintains system harmony and balance through interactions and adjustments
 Internal and external
o Contains:
 Central Core:
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made of normal temp range, organ strength, weakness ego structure, and
knowns or commonalities
Protective Layers:
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Flexible line of defense- outer layer
Dynamic and rapid changing buffer of stressors
Highly vulnerable to internal factors
No sleep or hunger
Normal line of defense
Evolves over time
Maintains steady state
Made of coping patterns, lifestyle, and individual ways of handling
stress
Lines of Resistance-innermost layer
internal factors attempting to stabilize individual and restore normal
line of defense when stressors break through
Health- continuum of well-being and illness
o Reflected in the harmony or balance of the individual's interaction and adjustment to the
environment
o Level of wellness- needs are met and more energy is stored than is expelled
o Evident In clients with optimal system stability
o Illness-needs are not sufficiently satisfied and more energy is used than there is
stored/available
Environment- internal and external factors or stressors
o factors considered noxious or beneficial stimuli that produce tension or disrupt system and
stability/harmony
o Stressors-vary in nature, timing, degree, change potential require energy to cope and return
to stability
 Any situation, condition, force, or potential source that's capable of creating instability
within the individuals or reduce their lines of defense/resistance
 Types:
Intrapersonal- operating within the individual
Interpersonal- forces operating between the individual and others
Extra-personal- forces outside the individual
Nursing- Maintaining the client's stability by reducing reactions or possible reactions to stressors
o Goals: attain or maintain the client's system balance and conserve energy by controlling
variables affecting the client
o Intervention happens when stressor is suspected or identified
 Based on 4 factors:
Client's degree of reaction
Resources
Goals
Anticipated outcomes
 3 levels:-useful guide for planning nursing interventions
Primary Prevention- initiated before or after an encounter with a
stressor
Includes: decreasing possibility of meeting with a stressor,
strengthening flexible lines of defense when there's stressors,
maintenance of wellness, environmental protection and sanitation,
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immunization, maintaining ideal body weight, protection from hazards,
personal hygiene, accident protection, health education/promotion
Secondary Prevention- initiated after encounter with a stressor
Includes: early case finding and treatment of symptoms and reactions
to stressor, breast self exams, and newborn screening
Tertiary Prevention- initiated after treatment
Focuses on re-adaptation, reeducation, and maintenance of stability
Model is applicable to all components of nursing and across all clinical areas
Can be used for individuals, families, and communities
o Views client as a composite of the 5 variables
Holistic approach
o Each system of subsystem on the whole must be considered
Paradigm Definitions
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Person-Open system interacting with the environment through interpersonal and extra-personal
factors
o A dynamic composite of the 5 variables
o Continuously exposed to various beneficial and noxious stressors in the environment and
are able to respond by adjusting to the environment or adjusting the environment
o Maintains system harmony and balance through interactions and adjustments
 Internal and external
o Contains:
 Central Core:
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made of normal temp range, organ strength, weakness ego structure, and
knowns or commonalities
Protective Layers:
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 Flexible line of defense- outer layer
a. Dynamic and rapid changing buffer of stressors
b. Highly vulnerable to internal factors
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No sleep or hunger
 Normal line of defense
a. Evolves over time
b. Maintains steady state
c. Made of coping patterns, lifestyle, and individual ways of handling stress
 Lines of Resistance-innermost layer
a. internal factors attempting to stabilize individual and restore normal line
of defense when stressors break through
Health- continuum of well-being and illness
o Reflected in the harmony or balance of the individual's interaction and adjustment to the
environment
o Level of wellness- needs are met and more energy is stored than is expelled
o Evident In clients with optimal system stability
o Illness-needs are not sufficiently satisfied and more energy is used than there is
stored/available
Environment- internal and external factors or stressors
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factors considered noxious or beneficial stimuli that produce tension or disrupt system and
stability/harmony
o Stressors-vary in nature, timing, degree, change potential require energy to cope and return
to stability
 Any situation, condition, force, or potential source that's capable of creating instability
within the individuals or reduce their lines of defense/resistance
 Types:
 Intrapersonal- operating within the individual
 Interpersonal- forces operating between the individual and others
 Extra-personal- forces outside the individual
Nursing- Maintaining the client's stability by reducing reactions or possible reactions to stressors
o Goals: attain or maintain the client's system balance and conserve energy by controlling
variables affecting the client
o Intervention happens when stressor is suspected or identified
 Based on 4 factors:
 Client's degree of reaction
 Resources
 Goals
 Anticipated outcomes
3 levels:-useful guide for planning nursing interventions
 Primary Prevention- initiated before or after an encounter with a stressor
a. Includes: decreasing possibility of meeting with a stressor, strengthening
flexible lines of defense when there's stressors, maintenance of wellness,
environmental protection and sanitation, immunization, maintaining ideal
body weight, protection from hazards, personal hygiene, accident
protection, health education/promotion
 Secondary Prevention- initiated after encounter with a stressor
a. Includes: early case finding and treatment of symptoms and reactions to
stressor, breast self exams, and newborn screening
 Tertiary Prevention- initiated after treatment
a. Focuses on re-adaptation, reeducation, and maintenance of stability
Lydia Hall
About the Theorist
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Birth: Sept 21, 1906
o New York City
Education:
o Basic nursing- 1927 York hospital school of nursing York, Pennsylvania
o BS Public Health- 1937 Teachers college Columbia University New York
o MA in teaching Natural Science- 1942 ""
First director of Loeb center for nursing and rehabilitation until death
Death: 1969
Nursing experiences: clinical, educational, research and supervisory components
Articulated her basic philosophy of nursing which the nurse may base patient care
The Theory
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Contains 3 independent but interconnected circles
o Can’t function independently but interrelated
 Hall said individuals could be conceptualized in 3 separate domains:
1. The Core (the person)
o Based on social sciences
o Involves therapeutic use of self and is shared among members of the health care team
o Developing interpersonal relationships with the patients allows for them to express verbally
how they are feeling about their disease and recovery
2. The Care (the body)
o Represents nurturing component
o Exclusive to nurses
o Nurses provides patient bodily care and help to complete basic daily biological functions
o Nursing Goal- comfort the patient
o Nurse and Patient can get close when nurse provides care (basic needs)
o Nurses apply knowledge of natural and biological sciences providing a strong theoretical
base for nursing implementations
o Patient views nurse as potential comforter
3. The Cure (the illness)
o Nurse helps patient and their family through medical, surgical, and rehabilitative
prescriptions made by a physician
o Nurse is active advocate for the patient
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The 3 aspects interact and change depending on the patient's progress
Hall believed patients should only receive care from PROFESSIONAL nurses only
o Nursing is interacting with the patient in a complex process of teaching and learning
o Doesn't like "team-nursing"
 Careers described as work that has to be done and how it should be divided is a trade
not a profession
Paradigm Definitions
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Nursing- functions in all 3 circles but shares them with other disciplines to varying degrees
o Care circle is exclusive to nurses
o Core circle can be shared with social workers and psychologists and clergy
Health- the state of self-awareness with conscious selection of behaviors that are optimal for the
individual
o Nurses need to help the person explore the meaning of their behavior
 Identify and overcome problems through developing self identity and maturity
Environment (Society)- deals with the relation to the individual
o Hall is credited with the concept of Loeb Center
 Assumes that the hospital environment during the treatment of acute illness makes a
difficult psychological experience for the patient
 Loeb Center is an environment that is conducive to the individual
Ida Jean Orlando
About the Theorist
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Birth-1926
First-generation American of Italian descent
Education:
o Nursing diploma- New York Medical College
o BS in Public Health Nursing- St. John's University NY
o MA in Mental Health Nursing- Columbia University, NY
Career:
o Associate professor at Yale School of Nursing
 Director of the Graduate Program in Mental Health Psychiatric Nursing
 Project investigator of national institute of Mental Health grant
 Grant called: Integration of Mental Health Concepts in a Basic Nursing
Curriculum
 Continued her theory work at Belmont, MA
 Director of research project- Two Systems of Nursing in a Psychiatric Hospital
Published works:
o The Dynamic Nurse-Patient Relationship (1961)
o The Discipline and Teaching of Nursing Processes (1972)
Positions in Boston Area:
o Board member of Harvard Community Health Plan
o National and international consultant
o Frequent lecturer
o Conducted seminars on her theory
The Theory
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Her theory developed in the late 1950's
o Observations she recorded between a nurse and a patient
Categorized nursing as good or bad but realized that her records contained both good and bad
o Formulated her nursing process
Nurse Role: to find and meet the patient's immediate need for help
A patient's plea is for help but may not be for what they need
o Nurse needs to use their perception, their thoughts about their perceptions, and the
feelings about their thoughts in order to find meaning about the patient's behavior with
them
o Helps the nurse discover the nature of the patient's distress
The Nursing Process is Set in Motion by the Patient Behavior
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All verbal or non-verbal patient behavior should always be considered an expression of their need
for help that should be validated
o Verbal- use of language
o Non-verbal- physiological symptoms, motor activity, non-verbal communication
If the nurse can't validate the behavior properly then the nurse-patient relationship fails
Communication is vital to get the patient's cooperation to achieve health
The Patient Behavior Stimulates a Nurse Reaction
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The beginning of the nurse-patient relationship
Important to evaluate the patient's behavior with nurse reaction steps to achieve positive
feedback
Nursing Steps:
o Nurse perceives behavior through any of the sense
 Perception leads to automatic thought
 The thought produces an automatic feeling
 Nurse shares reactions with the patient to see if their perceptions are
accurate or not
 Nurse consciously deliberates about personal reactions and patient
input in order to produce professional deliberative actions based on
mindful assessments not automatic reactions
Nurse Action
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Takes place when nurses are providing care
Automatic Reactions
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Created from nursing behaviors performed to satisfy a directive order instead of the
patient's need for help
Actions don't evolve talking with the patient's immediate expressed need for help
Non-deliberative behavior
Following medical orders
Deliberative Reactions
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Disciplined professional response
Actions are from the nurse's assessment determined to achieve mutual help between the
nurse and the patient's health
Criteria is as follows:
1. Correct Identification and Validation
 Actions result from identification of patient needs by validating the nurse's
reaction to patient behavior
2. Nurses explore meanings of actions with the patient and its relevance to meeting their
need
3. Nurse validates action's effectiveness after compelling it
4. Nurse is free from stimuli non-related to the patient's need during process of actions
Paradigm Definitions
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Human/Person- an individual in need
o Unique individual that behaves verbally or nonverbally
o Assumed that individuals can satisfy their needs by themselves sometimes or need help
from others
Health- being without emotional or physical discomfort and having a sense of well-being
contributing to healthy state
o Experiences of being helped culminate over periods of time in greater degrees of
improvement
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Environment- nursing situation occurring when a nurse and patient make contact and perceive,
think, feel, and act in immediate situation
o Any environmental aspect can cause the patient to become distressed
o Environment is meant to be therapeutic
Nursing- distinct profession providing direct assistance to individuals to help them avoid, diminish,
or cure their sense of helplessness
o Professional nursing- finding out and meeting the client's immediate need for help
Sister Callista Roy
About the Theorist
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Birth: Oct. 24, 1939
o Los Angeles
o 2nd child
Began working at age 14 at a large general hospital
o Pantry girl, mad, and nurse's aide
Education:
o Bachelor of Arts with a nursing major- 1963: Mount St. Mary's College LA.
o Master's degree in pediatric nursing-1966: University of California, LA.
o Master's and PhD in Sociology-1973 & 1977: " "
Published works:
o Nursing Outlook (1970)
The Theory
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Ideas first showed up in graduate papers written at UCLA (1964)
Her theory framework crystallized during the 1970's, 80's, and 90's
o Identified her theory's central questions:
1. Who is the focus of nursing care?
2. What is the target of nursing care?
3. When is nursing care indicated?
Focus of model: A set of processes by which a person adapts to environmental stressors
o People are unified bio-psychosocial system constantly reacting with the environment
When environmental stimuli demands too much or the person's adaptive mechanisms are too low
o =behavioral responses are ineffective for coping
Person- adaptive system consisting of input, control processes, output, and feedback
o Input- stimuli from the external environment and internal self
 Includes info from cognator and regulator mechanisms
o Control Processes- a person's biological and psychological coping mechanisms and their
cognator and regulator responses
o Output- adaptive and ineffective behavioral response of the person
o Feedback- info regarding the behavioral responses that's conveyed as input in the system
Each person gets affected by stressors=stimuli
o Focal- change immediately confronting the person
 Require adaptive responses
o Contextual- all other stimuli present in the person or environment
o Residual- beliefs attitudes/traits that affect the person's present situation
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Contextual and residual stimuli contribute to the effect of the focal stimuli
o Determine the level of stress of adaptation
Person's ability to adapt to changing stimuli determined by their Adaptation Level
o point is constantly changing based on collective effect of the stimuli that can be tolerated at
given time points
Basic internal Processes used in Adaptation
Regulator Subsystem- receives/processes changing stimuli from external environment
and internal self through neural-chemical-endocrine channels
1. Produces automatic, unconscious reactions targeting organs/tissues that create body
responses as feedback systems
2. Cognator Subsystem- receives varying internal and external stimuli involving psychological and
social factors
 Includes physical and physiological factors
Changing stimuli are controlled through cognitive/emotive pathways
o Include perception/info processing, learning, judgement, and emotion
The subsystems produce behavioral responses in 4 effector modes:
o Physiological: includes…
1. Oxygenation
2. nutrition
3. elimination
4. activity/rest
5. skin integrity
6. senses
7. fluids/electrolytes
8. neurological and endocrine function
Psychosocial- includes
o Self-concept
o Role function
o Interdependence
o Self-Concept- includes individual's feelings/beliefs given at given points of time that
influence behavior. Includes…
1. Psychic integrity
2. Physical self
3. Personal self
4. Self-consistency
5. Self-ideal/self-expectancy
6. Moral-ethnical-spiritual self
7. learning
8. inner self-concept
9. Self esteem
o Role Function: includes…
1. Role
2. Position
3. Role performance
4. Role mastery
5. Social integrity
6. Primary role
7. Secondary role
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8. Tertiary role
9. Instrumental and expressive behaviors
Interdependence- addresses ability to love, respect, value others, and respond to others on
this manner. Includes…
1. Affectional adequacy
2. Nurturing
3. Significant others
4. Support systems
5. Receptive behaviors
6. Contributing behaviors
Paradigm Definitions
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Environment- internal and external stimuli
o Including focal, contextual, and residual stimuli= person's adaptation level/ zone of coping
ability
o Includes all conditions, circumstances, and influences surrounding the development, family,
and culture
Person- adaptive system that responds to internal and external environment stimuli in the 4
adaptive modes
o Adaptation levels are determined by the intensity of focal, contextual, and residual stimuli
o Nursing promotes the patient's adaptation level by manipulating the environmental stimuli
 Reduces ineffective responses or reinforce adaptive behaviors
Health- a state or a process of being and becoming an integrated and whole person
o Through adaptation a person is freed of trapped energy from ineffective coping attempts
 When free the energy can be used for promoting integrity, healing, and enhancing
health
Nursing- science and practice of promoting adaptation for holistic functioning of a person though
application of nursing processes to effect healthy in a positive way
o Aim- increase the person's adaptive responses by decreasing the energy needed to cope in
situations that would normally require more energy than they have
o Promotes adaptation of all 4 modes
 Contribute to health, life quality, and dying with dignity
Myra Estrine Levine
About the Theorist
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Birth: Chicago, Illinois
o The oldest kid
 1 sister and brother
Became interested in nursing because her father had gastrointestinal problems and received a lot
of nursing care
Education:
o 1994-graduated from Cook County Nursing School
o 1949- BSN: University of Chicago
o 1962- MSN: Wayne State University
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Career:
o US Army- private duty nurse, civilian nurse
o Surgical nursing supervisor
o Nursing administration
o Lectured about nursing- George (2002), UIC, and Tel Aviv University in Isreal
Publications: 77 total works
o "An Introduction to Clinical Nursing" - 1969, 1973, 1989
Honorary Mentions:
o Loyola Univ. - 1992
o Names:
 Renaissance women-highly principled, remarkable, and committed to patient's quality
of care
Death: 1996 at age 75
o "eventually everyone's life comes to an end"
The Theory
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Based model on Nightingale's idea- nurses should create an environment where the patient can
heal
Used works from Tiilich- unity principle of life
4 Conservation Principles
1. Adaptation
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Def: ongoing process of change in which patient maintains his integrity within the realities of
environment
o Individuals have a range of adaptive responses
 Responses vary by heredity, age, gender, or challenges from the illness
 Responses are the same
o Timing and manifestation of responses are unique to each individual
o Achieved though "frugal, economic, contained and controlled" use of environmental
resources by individuals
2. Wholeness
o Exist when interactions/constant adaptations to the environment permits the assurance of
integrity
o Gets promoted by conservation principle use
3. Conservation
o The outcome of the adaptation principle
o "Keeping the life system together"
o Getting a balance of energy and demand that's within the biological realities of the person
4. Conservation Principle
o Conservation of Energy:
 Basic to the natural/universal law of conservation
 Energy- identifiable, measurable, and manageable
 Patients can be encouraged to conserve energy by limiting themselves from activities
o Conservation of Structural Integrity
 Focus is on the healing process
 The patient's ability to be whole physically after illness
 The body's ability to renew itself
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Ex. Nurses ensure proper positioning and range of motion of the patient to prevent
deformities
Conservation of Personal Integrity
 Focus- to give patient's a sense of self
 An intensely private, unique and secret knowledge that the patient uses to
describe themselves
 People have a public and private self
 Some part of the private is not known to anyone else
Conservation of Social Integrity
 A definition of the person that goes beyond the individual and includes the holiness of
the person
 Ex. Relationships
 Social Identity is connected to:
 Family
 Friends
 Community
 Workplace
 School
 Culture
 Ethnicity
 Religion
 vacation
 Vocation
 Education
 Socio-economic status
Paradigm Definitions
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Person:
o Holistic being constantly striving to preserve wholeness and integrity
o Continually adapting and interacting with the environment
 Adaptation leads to conservation
o Need nurses when suffering occurs and independence can be set aside to accept the
services of another
Health: -Includes disease
o Patterns of adaptive changes
o Adaptations seek to fit within the environment
o Successful adaptations are those that achieve fitting the environment the best and do so in
a conserving manner
o The goal of conservation
Environment:
o There are 3 types:
 Operational: undetected natural forces effecting an individual
 Perceptual: info that's recorded by the sensory organs
 Conceptual: influenced by language, culture, ideas and cognition
o It is difficult to measure
Nursing:
o The purpose- take care of other when they need to be taken care of
 Therefore nursing will exist when someone needs care to any extent
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The created dependency is temporary
Jean Watson
About the Theorist
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Birth:
o Southern West Virginia
Education:
o Lewis Gale School of Nursing-Roanoke, Virginia
o BSN, Master of Science (psychiatric mental), Doctorate in education psychology- University
of Colorado
Distinguished Professor of Nursing
Has a chair in Caring Science at the Univ. of Colorado Health Sciences Center
Founded Center for Human Caring in Colorado
Fellow of the American Academy of Nursing
Career:
o Dean of Nursing- Univ. of Health Sciences Center
o President of National League for Nursing
Awards:
o International Kellogg Fellowship- Australia
o Fulbright Research- Sweden
o 6 Honorary Doctoral Degrees
 3 International Honorary Doctorates- Sweden, UK, Quebec
Research is in human caring and loss area
Publications:
o "The Philosophy and Science of Caring"
The Theory
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Transpersonal Human Caring- moral ideal of nursing and a caring process
o Moral idea-transpersonal and inter-subjective interactions with people
o Caring Process- commitment to protect, enhance, and preserve humanity by restoring
dignity, inner harmony, and facilitating healing
o Nurses help others get self-knowledge, self-control, and readiness for healing
 Helping them regain a sense of inner harmony
The nurse responds to patient's subjective world through dynamic interpersonal caring
transactions
o Assists clients to find meaning in their existence by exploring the meaning of their
disharmony, suffering, and turmoil
o Transactions shine light on the mystery of life and able the self-healing process
Theory- consists of Watson's values and her respect for the mysteries of the healing and caring
process; combined with 10 carative factors
o Formation of Humanistic-altruistic system of values
o Installation of faith-hope
o Cultivation of sensitivity to one's self and to others
o Development of a helping-trust relationship
o Promotion and Acceptance of expressing positive and negative feelings
o Systemic use of scientific problem solving methods for decision making
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Promotion of interpersonal teaching-learning
Provision for a supportive, protective and/or corrective mental, physical, socio-cultural and
spiritual environment
Assistance with gratifying human needs
Allowance for existential-phenomenological forces
Transpersonal Caring- moral idea
o A way of communication and inter-subjective contact through the co-participation of
oneself with another
 Individuals move toward a higher sense of self and harmony within the 3 spheres of
being
 Inter-subjectivity happens when the nurse or patient enter the experience of each
other
Caring Transactions- nurse and client are in a process of being and becoming
o Maintaining the client's dignity
o Nurse's unique self is shown through movement, sense, touch, sound, words, colors, and
forms transmitting/reflecting the client's condition back to him or her
o Inter-subjective feelings are released to promote congruence between the person's
experience and perception
 Helps release inner power and strength, restore inner harmony, develop selfknowledge and self-control
Paradigm Definitions
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Nursing:
o A human science of health-illness-healing experiences that are mediated by professional,
personal, scientific, aesthetic, and ethical human care transactions
o An art and science based with knowledge of clinical and technical competencies
o Directed toward protection, enhancement, and preservation of human dignity, health,
healing, and transcendence
o GOAL- enhance mental-spiritual growth and discover one's inner power and self-control
 "help people gain a higher degree of harmony within the mind, body, and soul, which
generates self-knowledge, self-reverence, self-healing, and self-care processes while
allowing increased diversity"
o Nurses use intuition, aesthetic skills, geist, and behaviors to relate to others
Person:
o A living, growing, gestalt, possessing 3 spheres of being-mind, body, and soul which get
influenced by the concept of self
o Client-person or group needing assistance with health-illness decisions that promote
harmony, self-control, choice, and self-determination
o People can be their own change agents that can heal themselves through their own mentalspiritual powers
o People progress to higher levels of consciousness when they find meaning and harmony in
their existence from using their mind
Health:
o The unity and harmony within the mind, body, and soul
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Harmony between self and others and between self and nature
Illness-disharmony within a person's inner self
 Incongruence between self and other/nature/experience
Environment:
o Occurrences or occasions involving caring interactions and choices by the nurse and
individual
o If caring occasion is transpersonal= client and nurse expand leading to personal growth,
maturations, and development of the self
Madeline Leininger
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Birth:
o Nebraska
Education:
o Basic Nursing 1948: St. Anthony's School of Nursing- Denver, Colorado
o B of Science 1950: Mount St. Scholastica College- Atchison, KS
o Master of Science 1954: Catholic Univ. of America- Washington DC
o PhD 1965: Unv. Of Washington Seattle
Fellow in:
o American Academy of Nursing
Honorary Doctorates:
o Benedictine college
o Univ. of Indianapolis
o Univ. Kuopoio, Finland
1998 earned the name "Living Legend" by American Academy of Nursing
The Theory
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Transcultural nursing addresses the cultural dynamics present that influence the nurse-client
relationship
Developed with a goal to provide culturally congruent wholistic care
Culture= Major concept
o Humans are cultural beings and nurses provide care to various cultures
o Nursing should be based on transcultural knowledge to be effective
 A critical factor when promoting health or aiding recovery from illness
o Nurses should use the client's culture to grow closer to client and develop a relationship
Believes that caring is the central focus
Ethnocaring- The systematic study and classification of nursing care beliefs, values, and practices
as cognitively perceived by a designated culture through their local language, experiences, beliefs,
and value system
o Ethnonursing- use of knowledge of the culture during health practices and nursing
Classified 28 ethnocaring constructs
o Comfort
o Compassion
o Coping behaviors
o Empathy
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Involvement
Love
Protective and restorative behaviors
Support
Trust
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There are 2 kinds of caring that are required to provide culturally congruent care:
o Generic- basic expression of human caring
 Includes home remedies and folk care
o Professional- involves learning, practice, and transmitting knowledge of formal and informal
education
 Includes psychomotor skills, communication, and psychosocial skills
Factors influencing well-being:- if not considered then the nurse will have fragmented knowledge
about culture care
o World view
o Religion
o Kinship
o Cultural views
o Economics
o Technology
o Language
o Ethnohistory
o Education
o Political
o Environment context
Modes to Guide Nursing in Culture Congruent Care
1. Culture Care preservation or maintenance
o
Nursing care activities focused on helping people from specific cultures to retain and use
core cultural care values relating to healthcare conditions of conditions
2. Culture Care accommodation or negotiation
o Nursing activities concerned with helping people from specific cultures to adapt or negotiate
with others so that in the end they all achieve the health goals for clients of a specific
culture
3. Culture Care repatterning or restructuring
o Therapeutic actions that a culturally competent nurse or family takes
o Enable or assist client's to modify personal health behaviors towards beneficial outcomes
o Actions done while respecting the client's culture
Assumptions of Theory
1.
2.
3.
4.
5.
Care is the essence and central focus of nursing
Caring is essential for health and well-being, healing, growth, survival, and facing illness/death
Culture care is broad and wholistic perspective to guide nursing care practices
Nursing central purpose= serve human beings in health, illness and dying
No cure is possible without giving and receiving care
6. Culture care concepts have different and similar aspects among all cultures
7. Every culture has folk remedies, professional knowledge, and professional care
o Nurses must identify and address factors in every action to provide culturally congruent care
8. Cultural care values, beliefs, and practices are influenced by world views and language
(ethnohistorical and environmental factors)
9. Beneficial, healthy, satisfying culturally based nursing enhances the client's well-being
10. Culturally beneficial nursing care occurs when cultural care values, expressions, or patterns are
known and used correctly by the nurse
11. Nurses who can't be reasonably culturally congruent with their client will experience stress,
cultural conflict, noncompliance, and ethical moral concerns
A culturally Competent Nurse…
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Consciously addressing the fact that culture affects nurse-client exchanges
Has compassion and clarity when asking each client what their cultural practices and preferences
are
Incorporates the client's personal, social, environmental, and cultural needs/beliefs into the care
plan
Respects/appreciates cultural diversity in order to increase knowledge and sensitivity with nursing
concerns
Paradigm Definitions
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Nursing:
o The same as "caring", which is the central focus
o Humanistic and scientific application of knowledge in caring for individuals, families, and
communities emphasizing their cultural and health practices
o Assist people and groups so they improve or maintain human conditions by applying
knowledge of culturally sanctioned caring modes of intervention
o Transcultural Nursing- integrating cultural views, knowledge, and experiences when
providing care for a patient
Humans/Person:
o Caring beings capable of being concerned about the needs, well-being, and survival of
others
o Families, groups, communities, total cultures, and institutions
o Human care is universal
Health:
o State of well-being; culturally defined, valued, and practiced
o An individual's ability to perform daily roles
o Includes health systems, care practices, and patterns with health promotion and
maintenance
o Universal across cultures but defined differently by individuals based on their values and
beliefs
Environment/Society:
o Not specifically defined
o Worldview, social structure, and environmental context
o Represented in culture
Patricia Benner

Birth:
o
o
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
Hampton, Virginia
Spent childhood in California
Education:
o Bachelor of Arts 1964- Pasadena College
o Master degree (medical-surgical) 1970- Univ. of California, San Francisco S.O.N.
o PhD 1982
Career:
o Research assistant to Lazarus- Univ. California, Berkeley
o Critical care
o Home health care
The Theory


Introduced the idea that expert nurses develop skills and understand patient care over time
through sound educational base and experiences
Expert nurses need experience along with book knowledge to be actual professionals
Levels of Nursing Experience
1. Novice
o Has no experience
o Gets taught rules so they can help in tasks; general follower of orders
o Context-free, independent of specific cases, and applied universally
o Behavior is limited and inflexible
2. Advanced Beginner
o Shows acceptable performance
o Has some prior experience in situations so they can recall the meaningful components
o Follows principles, experienced based, and starts to be formulated to guide actions
3. Competent
o Nurse with 2-3 years of experience
o Aware of long term goals
o Gains perspective by planning own actions that help achieve greater efficiency and
organization
 Actions based on conscious, abstract, and analytical thinking
4. Proficient
o Perceives and understands situations as whole parts
o Gained holistic understanding leaders to improved decision-making
o Learns from experiences
 What to expect and how to modify plans
5. Expert
o Doesn't rely on principle, rules, or guidelines to determine situations or make actions
o More background experience
o Intuition about clinical situations
o Has fluid, flexible, and highly-proficient performance
What Levels Reflect

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
Movement away from reliance on past abstract principles and more usage of past concrete
experience as paradigms
Changes in perception of certain situations; becomes a complete whole where certain parts are
relevant
Each step is built off of the previous one
o Principles become more refined and expand through experience
Theory changes what it means to be an expert nurse
o Nurses who provide the most exquisite nursing care instead of highest wages
Paradigm Definitions

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Person:
o Individual is a whole
o A self-interpreting being that doesn't enter the world predefined but becomes defined as
life happens
Health/ Well-being
Congruence between one's possibilities and one's actual practices and lived meanings as is
based on caring and feeling cared for
Environment/ Situation:
o A situation implying a social definition and meaningfulness
o Individual experiences with situations affect how that person perceives the world
Nursing:
o A caring practice whose science is guided by the moral art and ethics of care and
responsibility
Nola Pender

Birth:
o
o
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
1941- Lansing, Michigan
Only child of parents who were advocates of women's education
Education:
o Nursing Diploma 1962: S.O.N. West Suburban Hospital-Oak Park, Illinois
o BSN 1964: Michigan State University- East Lansing
o MA (human growth and development) 1965: Michigan State Univ.
o PhD (psychology) 1969: Northwestern Univ.- Evanston, Illinois
Publications:
o 1975-" A Conceptual Model for Preventive Health Behavior"
 How individuals make decisions about their own health care in a cursing context
o 1982-"Health Promotion in Nursing Practice"
Honorary Doctorates:
o 1992-Widener Univ.
o 1988-Distinguished Research Award- Midwest Nursing Research Society
o 1997-American Psychology Association Award
 Outstanding contributions to nursing and health psychology
The Theory


Presents that each person has unique personal characteristics and experiences that affect
subsequent actions
Desired result= Health promoting behavior resulting in improved health, enhanced functional
ability, and better quality of life
Personal Factors- Individual Characteristics and Experiences


Categorized as biological, psychological, and socio-cultural
Predictive about certain behaviors and get shaped by the nature of the targeted behavior
Personal Biological

Include age, gender, body mass index, pubertal status, aerobic capacity, strength, agility, and
balance
Personal Psychological

Includes self-esteem, self-motivation, personal competence, perceived health status, and health
definitions
Personal Socio-cultural

Includes race, ethnicity, acculturation, education, and socioeconomic status
Behavior-Specific Cognitions and Affect
Perceived Benefits of Action

Anticipated perceived outcomes that will occur form health behavior
Perceived Barriers to Action


Anticipated, imagined, or real blocks
Personal costs of understanding a given behavior
Perceived Self-Efficacy


A person's judgement of their personal capability to organize and execute a health promoting
behavior
Perceived self-efficacy influences perceived barriers to action
o Higher efficacy=lowered perceptions of barriers to behavior performance
Activity Related Affect

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Subjective positive or negative feelings occurring before, after, or during
Following behavior based on the stimulus properties of the behavior itself
Influences self-efficacy
o More positive the feeling= greater feeling of efficacy
Interpersonal Influences

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Def: Cognition concerning behaviors, beliefs, or attitudes of others
Include:
1. Norms (expectations)
2. Social support (instrumental and emotional encouragement)
3. Modeling (learning through observation)
The primary sources are families, peers, and healthcare providers
Situational Influences

Def: personal perceptions and cognitions of situations/contexts that can facilitate of impede
behavior
Includes:
1. Perceptions of available options
2. Demand characteristics
3. Aesthetic features of environment where care is taking place
Can have direct or indirect influences on health behavior
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
Behavioral Outcome
Commitment to Plan of Action

Concept of intention and identification of planned strategies leading to the implementation of
health behavior
Immediate Competing Demands and Preferences

Competing demands- alternative behaviors the individuals have low control over
o Usually environmental contingencies
o Ex. Family care or work
Competing preferences- alternative behaviors that individuals have a high control over
o Ex. Choice of ice cream of snack

Health Promoting Behavior

Endpoint/Action outcome directed toward attaining positive health outcomes
o Outcomes: well-being, personal fulfillment, productive living
Theory of Caring
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Theorist: Kristin Swanson
The Theory: offers explanation of what it means to practice nursing in a caring manner
 Caring: a nurturing way of relating to a valued other toward when one feels a personal
sense of commitment and responsibility
Basic Concepts/processes
 Concept of maintaining belief
 Concept of knowing
 Concept of being with
 Concept of doing for
 Concept of enabling
Metaparadigm
 Health: to live the subjective, meaning-filled experience of wholeness
 Nursing: informed caring for the well-being of others where the goal is to promote wellbeing
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