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Theories related to maternal and child nursing
Nursing (Central Mindanao University)
Studocu is not sponsored or endorsed by any college or university
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PERINATAL NURSING
Perinatal nursing is the care and support of women and their families before, during, and after
childbirth. Perinatal nurses provide education and resources about pregnancy and childbirth, and help
oversee the mother and child during pregnancy, childbirth, and postpartum to ensure the health of
both.
A perinatal nurse’s involvement in the patient’s care depends on the nurse’s license, as well as the
patient’s needs. For example, someone who is certiûed as a nurse-midwife may be the primary care
provider for a mother and child, while a lactation consultant works with a mother after childbirth to
help her breastfeed her infant. Some perinatal nurses work in obstetrics and gynecology oýces to
provide care for a woman during her pregnancy, while others work in labor and delivery to provide a
safe, healthy environment for childbirth, and assist other health care providers during a woman’s labor
and delivery.
Perinatal nurses must be compassionate when dealing with pregnant and postpartum women, as well
as be able to communicate with a patient’s family in order to provide a nursing care plan that ensures
the health of the mother and her baby.
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Perinatal Nursing Theories and Models
MERCER'S MATERNAL ROLE ATTAINMENT THEORY
As a head nurse in pediatrics and staff nurse in intrapartum, postpartum, and newborn nursery units,
Ramona Mercer had a great deal of experience in nursing care for mothers and infants. This gave her a
strong foundation for creating her Maternal Role Attainment Theory for nursing.
The Maternal Role Attainment Theory was developed to serve as a framework for nurses to provide
appropriate health care interventions for nontraditional mothers in order for them to develop a strong
maternal identity. This mid-range theory can be used throughout pregnancy and postnatal care, but is
also beneûcial for adoptive or foster mothers, or others who ûnd themselves in the maternal role
unexpectedly. The process used in this nursing model helps the mother develop an attachment to the
infant, which in turn helps the infant form a bond with the mother. This helps develop the mother-child
relationship as the infant grows.
The primary concept of this theory is the developmental and interactional process, which occurs over a
period of time. In the process, the mother bonds with the infant, acquires competence in general
caretaking tasks, and then comes to express joy and pleasure in her role as a mother.
The nursing process in the Maternal Role Attainment Theory follows four stages of acquisition. They
are: anticipatory, formal, informal, and personal. The anticipatory stage is the social and psychological
adaptation to the maternal role. This includes learning expectations and can involve fantasizing about
the role. The formal stage is the assumption of the maternal role at birth. In this stage, behaviors are
guided by others in the mother’s social system or network, and relying on the advice of others in
making decisions. The informal stage is when the mother develops her own methods of mothering
which are not conveyed by a social system. She ûnds what works for her and the child. The personal
stage is the joy of motherhood. In this stage, the mother ûnds harmony, conûdence, and competence
in the maternal role. In some cases, she may ûnd herself ready for or looking forward to another child
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ROY'S ADAPTATION MODEL OF NURSING
The Adaptation Model of Nursing was developed by Sister Callista Roy in 1976. After working with
Dorothy E. Johnson, Roy became convinced of the importance of describing the nature of nursing as a
service to society. This prompted her to begin developing her model with the goal of nursing being to
promote adaptation. She ûrst began organizing her theory of nursing as she developed course
curriculum for nursing students at Mount St. Mary’s College. She introduced her ideas as a basis for an
integrated nursing curriculum.
The factors that inüuenced the development of the model included: family, education, religious
background, mentors, and clinical experience. Roy’s model asks the questions:
Who is the focus of nursing care?
What is the target of nursing care?
When is nursing care indicated?
Roy explained that adaptation occurs when people respond positively to environmental changes, and it is
the process and outcome of individuals and groups who use conscious awareness, self-reüection, and
choice to create human and environmental integration.
The key concepts of Roy’s Adaptation Model are made up of four components: person, health, environment,
and nursing.
According to Roy’s model, a person is a bio-psycho-social being in constant interaction with a changing
environment. He or she uses innate and acquired mechanisms to adapt. The model includes people as
individuals, as well as in groups such as families, organizations, and communities. This also includes
society as a whole.
The Adaptation Model states that health is an inevitable dimension of a person’s life, and is represented by
a health-illness continuum. Health is also described as a state and process of being and becoming
integrated and whole.
The environment has three components: focal, which is internal or external and immediately confronts the
person; contextual, which is all stimuli present in the situation that all contribute to the effect of the focal
stimulus; and residual, whose effects in the current situation are unclear. All conditions, circumstances, and
inüuences surrounding and affecting the development and behavior of people and groups with particular
consideration of mutuality of person and earth resources, including focal, contextual, and residual stimuli.
The model includes two subsystems, as well. The cognator subsystem is a major coping process
involving four cognitive-emotive channels: perceptual and information processing, learning, judgment,
and emotion. The regulator subsystem is a basic type of adaptive process that responds automatically
through neural, chemical, and endocrine coping channels.
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The Adaptive Model makes ten explicit assumptions:
1. The person is a bio-psycho-social being.
2. The person is in constant interaction with a changing environment.
3. To cope with a changing world, a person uses coping mechanisms, both innate and acquired,
which are biological, psychological, and social in origin.
4. Health and illness are inevitable dimensions of a person’s life.
5. In order to respond positively to environmental changes, a person must adapt.
6. A person’s adaptation is a function of the stimulus he is exposed to and his adaptation level.
7. The person’s adaptation level is such that it comprises a zone indicating the range of
stimulation that will lead to a positive response.
8. The person has four modes of adaptation: physiologic needs, self-concept, role function, and
interdependence.
9. Nursing accepts the humanistic approach of valuing others’ opinions and perspectives.
Interpersonal relations are an integral part of nursing.
10. There is a dynamic objective for existence with the ultimate goal of achieving dignity and
integrity.
There are also four implicit assumptions which state:
1.
2.
3.
4.
A person can be reduced to parts for study and care.
Nursing is based on causality.
A patient’s values and opinions should be considered and respected.
A state of adaptation frees a person’s energy to respond to other stimuli.
The goal of nursing is to promote adaptation in the four adaptive modes. Nurses also promote
adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of
life, and dying with dignity by assessing behaviors and factors that inüuence adaptive abilities and by
intervening to enhance environmental interactions. The Four Adaptive Modes of Roy’s Adaptation
Model are physiologic needs, self-concept, role function, and interdependence.
The Adaptation Model includes a six-step nursing process.
1.
2.
3.
4.
5.
6.
The ûrst level of assessment, which addresses the patient’s behavior
The second level of assessment, which addresses the patient’s stimuli
Diagnosis of the patient
Setting goals for the patient’s health
Intervention to take actions in order to meet those goals
Evaluation of the result to determine if goals were met
Throughout the nursing process, the nurse and other health care professionals should make
adaptations to the nursing care plan based on the patient’s progress toward health.
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CASEY'S MODEL OF NURSING
Anne Casey is an English nurse who developed a nursing theory known as Casey’s Model of Nursing.
The model was developed in 1988 while she was working in pediatric oncology at the Great Ormond
Street Hospital in London.
Casey’s Model of Nursing focuses on the nurse working in partnership with the child and his or her
family. It was one of the earliest attempts to develop a nursing model designed speciûcally for child
health nursing.
The ûve aspects of this nursing theory are child, family, health, environment, and the nurse.
The philosophy of Casey’s model is that the best people to care for the child are the members of the
family, with health care professionals assisting. This necessitates a relationship between the parent(s)
and nurse.
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PARSE'S HUMAN BECOMING THEORY
Parse’s Human Becoming Theory guides the practice of nurses to focus on quality of life as it is
described and lived. The human becoming theory of nursing presents an alternative to both the
conventional bio-medical approach as well as the bio-psycho-social-spiritual approach of most other
theories and models of nursing. Parse’s model rates quality of life from each person’s own perspective
as the goal of the practice of nursing. Rosemarie Rizzo Parse ûrst published the theory in 1981 as the
<Man-living-health= theory, and the name was changed to the <human becoming theory= in 1992.
The assumptions underpinning the theory were synthesized from works by European philosophers.
The theory is structured around three abiding themes: meaning, rhythmicity, and transcendence.
The model makes assumptions about man and becoming, as well as three major assumptions about
human becoming.
The Human Becoming Theory makes the following assumptions about man:
● The human is coexistent while co-constituting rhythmical patterns with the universe.
● The human is open, freely choosing meaning in a situation, as well as bearing responsibility for
decisions made.
● The human is unitary, continuously co-constituting patterns of relating.
● The human is transcending multidimensionally with the possibles.
The Human Becoming Theory makes the following assumptions about becoming:
●
●
●
●
Becoming is unitary with human-living-health.
Becoming is a rhythmically co-constituting the human-universe process.
Becoming is the human’s patterns of relating value priorities.
Becoming is an intersubjective process of transcending with the possibles.
● Becoming is the unitary human’s emerging.
The three major assumptions about human becoming are: meaning, rhythmicity, and transcendence.
Under the assumption meaning, human becoming is freely choosing personal meaning in situations in
the intersubjective process of living value priorities. Man’s reality is given meaning through lived
experiences. In addition, man and environment co-create.
Rhythmicity states that human becoming is co-creating rhythmical patterns of relating in mutual
process with the universe. Man and environment co-create (imaging, valuing, languaging) in rhythmical
patterns.
Transcendence explains that human becoming is co-transcending multidimensionally with emerging
possibilities. It refers to reaching out and beyond the limits a person sets, and that one constantly
transforms.
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These three themes are permeated by four postulates: illimitability, paradox, freedom, and mystery.
Illimitability is <the indivisible unbounded knowing extended to inûnity, the all-at-once remembering and
prospecting with the moment.= Paradox is <an intricate rhythm expressed as a pattern preference.=
Paradoxes are not <opposites to be reconciled or dilemmas to be overcome but, rather, lived rhythms.=
Freedom is <contextually construed liberation.= People are free to continuously choose ways of being
with their situations. Mystery is <the unexplainable, that which cannot be completely known.=
The nursing model deûnes the person (referred to as <man= throughout the theory) as an open being
who is more than and different from the sum of the parts. The environment is everything in the person
and his or her experiences. The environment is inseparable from the person, as well as complementary
to and evolving with the person. Health is the open process of being and becoming, and involves the
synthesis of values. Nursing is described as a human science and art that uses an abstract body of
knowledge to help people.
The theory provides a transformative approach to all levels of nursing. It differs from the traditional
nursing process, particularly in that it does not seek to <ûx= problems. The model gives nurses the
ability to see the patient’s perspective. This allows the nurse to be <with= the patient, and guide him or
her toward the health goals. The nurse-patient relationship co-creates changing health patterns.
Nurses live the art of human becoming in presences with the unfolding of meaning, synchronizing
rhythms, and transcendence.
Rosemarie Rizzo Parse’s Human Becoming Theory includes the Totality Paradigm, which states that
man is a combination of biological, psychological, sociological, and spiritual factors. It also includes
the simultaneity paradigm, which states that man is a unitary being in continuous, mutual interaction
with the environment.
Parse’s theory includes a symbol with three elements:
● The black and white colors represent the opposite paradox signiûcant to ontology of human
becoming, while green represents hope.
● The joining in the center of the symbol represents the co-created mutual human universe
process at the ontological level, and the nurse-patient process.
● The green and black swirls intertwining represent the human-universe co-creation as an
ongoing process of becoming.
Like any theory, Parse’s Human Becoming Theory has strengths and weaknesses. The model
differentiates nursing from other disciplines, it provides guidance of care and useful administration,
and is useful in education. The model also provides research methodologies, and provides a
framework to guide inquiry of other theories. However, the research is considered a <closed circle.= The
results are rarely quantiûable. That is, the results are diýcult to compare to other research studies
since there is no control group or standardized questions. The theory does not utilize the nursing
process, and negates the idea that each patient engages in a unique lived experience. It is not
accessible to new nurses, and is inapplicable to acute, emergent care.
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NIGHTINGALE'S ENVIRONMENT THEORY
As the founder of modern nursing, Florence Nightingale’s Environment Theory changed the face of
nursing practice. She served as a nurse during the Crimean War, at which time she observed a
correlation between the patients who died and their environmental conditions. As a result of her
observations, the Environment Theory of nursing was born. Nightingale explained this theory in her
book, Notes on Nursing: What it is, What it is Not. The model of nursing that developed from
Nightingale, who is considered the ûrst nursing theorist, contains elements that have not changed
since the establishment of the modern nursing profession. Though this theory was pioneering at the
time it was created, the principles it applies are timeless.
There are seven assumptions made in the Environment Theory, which focuses on taking care of the
patient’s environment in order to reach health goals and cure illness. These assumptions are:
1.
2.
3.
4.
5.
6.
7.
natural laws
mankind can achieve perfection
nursing is a calling
nursing is an art and a science
nursing is achieved through environmental alteration
nursing requires a speciûc educational base
nursing is distinct and separate from medicine
The focus of nursing in this model is to alter the patient’s environment in order to affect change in his
or her health. The environmental factors that affect health, as identiûed in the theory, are: fresh air, pure
water, suýcient food supplies, eýcient drainage, cleanliness of the patient and environment, and light
(particularly direct sunlight). If any of these areas is lacking, the patient may experience diminished
health. A nurse’s role in a patient’s recovery is to alter the environment in order to gradually create the
optimal conditions for the patient’s body to heal itself. In some cases, this would mean minimal noise
and in other cases could mean a speciûc diet. All of these areas can be manipulated to help the patient
meet his or her health goals and get healthy.
The Environment Theory of nursing is a patient-care theory. That is, it focuses on the care of the
patient rather than the nursing process, the relationship between patient and nurse, or the individual
nurse. In this way, the model must be adapted to ût the needs of individual patients. The environmental
factors affect different patients unique to their situations and illnesses, and the nurse must address
these factors on a case-by-case basis in order to make sure the factors are altered in a way that best
cares for an individual patient and his or her needs.
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The ten major concepts of the Environment Theory, also identiûed as Nightingale’s Canons, are:
1. Ventilation and warming
2. Light and noise
3. Cleanliness of the area
4. Health of houses
5. Bed and bedding
6. Personal cleanliness
7. Variety
8. Offering hope and advice
9. Food
10. Observation
According to Nightingale, nursing is separate from medicine. The goal of nursing is to put the patient in
the best possible condition in order for nature to act. Nursing is <the activities that promote health
which occur in any caregiving situation.= Health is <not only to be well, but to be able to use well every
power we have.= Nightingale’s theory addresses disease on a literal level, explaining it as the absence
of comfort.
The environment paradigm in Nightingale’s model is understandably the most important aspect. Her
observations taught her that unsanitary environments contribute greatly to ill health, and that the
environment can be altered in order to improve conditions for a patient and allow healing to occur.
Nightingale’s Modern Nursing Theory also impacted nursing education. She was the ûrst to suggest
that nurses be speciûcally educated and trained for their positions in healthcare. This allowed there to
be standards of care in the ûeld of nursing, which helped improve overall care of patients.
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NEUMAN'S SYSTEMS MODEL
Betty Neuman’s Systems Model provides a comprehensive holistic and system-based approach to
nursing that contains an element of üexibility. The theory focuses on the response of the patient
system to actual or potential environmental stressors and the use of primary, secondary, and tertiary
nursing prevention intervention for retention, attainment, and maintenance of patient system wellness.
The basic assumptions of the model are:
● Each patient system is a unique composite of factors and characteristics within a range of
responses contained in a basic structure.
● Many known, unknown, and universal stressors exist. Each differ in their potential for upsetting
a client’s usual stability level.
● Each patient has evolved a normal range of responses to the environment referred to as the
normal line of defense. It can be used as a standard by which to measure health deviation.
● The particular inter-relationships of patient variables can, at any point in time, affect the degree
to which a client is protected by the üexible line of defense against possible reaction to
stressors.
● When the üexible line of defense is incapable of protecting the patient against an environmental
stressor, that stressor breaks through the line of defense.
● The client is a dynamic composite of the inter-relationships of the variables, whether in a state
of illness or wellness. Wellness is on a continuum of available energy to support the system in a
state of stability.
● Each patient has implicit internal resistance factors known as LOR, which function to stabilize
and realign the patient to the usual state of wellness.
● Primary prevention is applied in patient assessment and intervention, in identiûcation and
reduction of possible or actual risk factors.
● Secondary prevention relates to symptomatology following a reaction to stressors, appropriate
ranking of intervention priorities, and treatment to reduce their noxious effects.
● Tertiary prevention relates to adjustive processes taking place as reconstitution begins, and
maintenance factors move them back in a cycle toward primary prevention.
● The patient is in dynamic, constant energy exchange with the environment.
The major concepts of Neuman’s theory are content, which is the variables of the person in interaction
with the environment; basic structure or central core; degree to reaction; entropy, which is a process of
energy depletion and disorganization moving the client toward illness; üexible line of defense; normal
line of defense; line of resistance; input-output; negentropy, which is a process of energy conservation
that increases organization and complexity, moving the system toward stability or a higher degree of
wellness; open system; prevention as intervention; reconstitution; stability; stressors; wellness/illness;
and prevention.
In the Systems Model, prevention is the primary intervention. It focuses on keeping stressors and the
stress response from having a detrimental effect on the body. Primary prevention occurs before the
patient reacts to a stressor. It includes health promotion and maintaining wellness. Secondary
prevention occurs after the patient reacts to a stressor and is provided in terms of the existing system.
It focuses on preventing damage to the central core by strengthening the internal lines of resistance
and removing the stressor. Tertiary prevention occurs after the patient has been treated through
secondary prevention strategies. It offers support to the patient and tries to add energy to the patient
or reduce energy needed to facilitate reconstitution.
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In the Neuman’s theory, a human being is a total person as a client system and the person is a layered,
multidimensional being. Each layer consists of a ûve-person variable or subsystem. The subsystems
are physiological, which refers to the physiochemical structure and function of the body; psychological,
which refers to mental processes and emotions; socio-cultural, which refers to relationships, and
social/cultural expectations and activities; spiritual, which refers to the inüuence of spiritual beliefs;
and developmental, which refers to those processes related to development over the lifespan.
Neuman explains environment as the totality of the internal and external forces which surround a
person, and with which they interact at any given time. These forces include the intrapersonal,
interpersonal, and extra-personal stressors, which can affect the person’s normal line of defense and
so can affect the stability of the system. The environment has three components: the internal, which
exists within the client system; the external, which exists outside the client system; and the created,
which is an environment that is created and developed unconsciously by the client, and is symbolic of
system wholeness.
The Systems Model of health is equated with wellness, and deûned as <the condition in which all parts
and subparts, or variables, are in harmony with the whole of the client.= The client system moves
toward illness and death when more energy is needed than what’s available. The client system moves
toward wellness when more energy is available than is needed.
Neuman views nursing as a unique profession concerned with the variables that inüuence the
response the patient might have to a stressor. Nursing also addresses the whole person, giving the
theory a holistic perspective. The model deûnes nursing as <actions which assists individuals, families
and groups to maintain a maximum level of wellness, and the primary aim is stability of the
patient-client system, through nursing interventions to reduce stressors.= Neuman also says the nurse’s
perception must be assessed in addition to the patient’s, since the nurse’s perception will inüuence the
care plan he or she sets up for the patient. The Systems Model views the role of nursing in terms of the
degree of reaction to stressors, as well as the use of primary, secondary, and tertiary interventions.
In Neuman’s Systems Model nursing process, there are six steps, each with speciûc categories of data
about the patient.
First is the assessment of the patient, which looks at: actual and potential stressors; condition and
strength of basic factors and energy sources; characteristics of üexible and normal lines of defense,
lines of resistance, degree of reaction and potential for reconstitution; interaction between the patient
and his or her environment; life process and coping factors for optimal wellness; and the perceptual
difference between the care giver and the patient.
Second, the nurse makes a diagnosis by interpreting the data collected. The data includes
health-seeking behaviors, activity intolerance, ineffective coping, and ineffective thermoregulation. The
third step in the nursing process is to set goals. The ultimate goal is to keep the client system stable.
From the goals, a plan is created, which focuses on strengthening lines of defense and resistance.
That plan is implemented using primary, secondary, and tertiary preventions. Finally, the nursing
process is evaluated to determine whether or not balance was restored, and a stable state maintained.
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ROGERS' THEORY OF UNITARY HUMAN BEINGS
Martha E. Rogers’ Theory of Unitary Human Beings views nursing as both a science and an art. The
uniqueness of nursing, like any other science, is in the phenomenon central to its focus. The purpose
of nurses is to promote health and well-being for all persons wherever they are. The development of
Rogers’ abstract system was strongly inüuenced by an early grounding in arts, as well as a background
in science and interest in space. The science of unitary human beings began as a synthesis of ideas
and facts.
The nursing theory provides a way to view the unitary human being, who is integral with the universe.
The unitary human being and his or her environment are one. Nursing focuses on people and the
manifestations that emerge from the mutual human-environmental ûeld process. A change of pattern
and organization of the human and environmental ûelds is transmitted by waves. The manifestations
of the ûeld patterning that emerge are observable events. By identifying the pattern, there can be a
better understanding of human experience.
There are eight concepts in Rogers’ nursing theory: energy ûeld, openness, pattern, pan-dimensionality,
homeodynamic principles, resonance, helicy, and integrality.
The energy ûeld is the fundamental unit of both the living and the non-living. It provides a way to view
people and the environment as irreducible wholes. The energy ûelds continuously vary in intensity,
density, and extent. There are no boundaries that stop energy üow between the human and
environmental ûelds, which is the openness in Rogers’ theory.
Rogers deûnes pattern as the distinguishing characteristic of an energy ûeld seen as a single wave. It
is an abstraction, and gives identity to the ûeld. Pan-dimensionality is deûned as <non-linear domain
without spatial or temporal attributes.= The parameters that humans use in language to describe
events are arbitrary, and the present is relative; there is no temporal ordering of lives.
Homeodynamic principles postulate a way of viewing unitary human beings. The three principles of
homeodynamics are resonancy, helicy, and integrality. Resonancy is an ordered arrangement of rhythm
characterizing both the human and environmental ûelds that undergo continuous dynamic
metamorphosis in the human environmental process. Helicy describes the unpredictable, nonlinear
evolution of energy ûelds as seen in non-repeating rhythmicities, and postulates an ordering of the
human evolutionary emergency. Integrality covers the mutual, continuous relationship of the human
and environmental ûelds. Changes occur by the continuous repatterning of the human and
environmental ûelds by resonance waves. The ûelds are integrated into each other, but are also unique.
In Rogers’ Theory of Unitary Human Beings, a person is deûned as an indivisible, pan-dimensional
energy ûeld identiûed by pattern, and manifesting characteristics speciûc to the whole, and that can’t
be predicted from knowledge of the parts. A person is also a uniûed whole, having its own distinct
characteristics that can’t be viewed by looking at, describing, or summarizing the parts. Rogers also
explains that people have the capacity to participate in the process of change. The environment is an
<irreducible, pan-dimensional energy ûeld identiûed by pattern and integral with the human ûeld.= The
two ûelds coexist and are integral to each other.
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Rogers deûnes health as an expression of the life process. It is the characteristics and behavior
coming from the mutual, simultaneous interaction of the human and environmental ûelds, and health
and illness are part of the same continuum. The multiple events occurring during the life process show
the extent to which a person is achieving his or her maximum health potential. The events vary in their
expressions from greatest health to those conditions that are incompatible with the maintaining life
process.
The nursing theory states that nursing encompasses two dimensions: nursing as art and nursing as
science. From the science perspective, nursing is an organized body of knowledge speciûc to nursing,
and arrived at by scientiûc research and logical analysis. The art of nursing is the creative use of
science to better people, and the creative use of its knowledge is the art of its practice. Rogers claims
that nursing exists to serve people, and the safe practice of nursing depends on the nature and amount
of scientiûc nursing knowledge the nurse brings to his or her practice.
The nursing process has three steps in Rogers’ Theory of Unitary Human Beings: assessment,
voluntary mutual patterning, and evaluation.
The areas of assessment are: the total pattern of events at any given point in space-time, simultaneous
states of the patient and his or her environment, rhythms of the life process, supplementary data,
categorical disease entities, subsystem pathology, and pattern appraisal. The assessment should be a
comprehensive assessment of the human and environmental ûelds.
Mutual patterning of the human and environmental ûelds includes:
sharing knowledge
offering choices
empowering the patient
fostering patterning
evaluation
repeat pattern appraisal, which includes nutrition, work/leisure activities, wake/sleep cycles,
relationships, pain, and fear/hopes
● identify dissonance and harmony
● validate appraisal with the patient
●
●
●
●
●
●
● self-reüection for the patient
To prepare nurses to practice Rogers’ model, the focus of nursing curriculum should be the
transmission of the body of knowledge, teaching and practicing therapeutic touch, and conducting
regular in-service education. Emphasis should be on developing self-awareness as a part of the
patient’s environmental energy ûeld, as well as the dynamic role of the nurse pattern manifestation on
the patient. There should also be an emphasis on laboratory study in a variety of settings, and the
importance of the use of media in education.
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MODELING AND ROLE MODELING THEORY
The Modeling and Role Modeling Theory was developed by Helen Erickson, Evelyn M. Tomlin, and Mary
Anne P. Swain. It was ûrst published in 1983 in their book Modeling and Role Modeling: A Theory and
Paradigm for Nursing. The theory enables nurses to care for and nurture each patient with an
awareness of and respect for the individual patient’s uniqueness. This exempliûes theory-based
clinical practice that focuses on the patient’s needs.
The theory draws concepts from a variety of sources. Included in the sources are Maslow’s Theory of
Hierarchy of Needs, Erikson’s Theory of Psychosocial Stages, Piaget’s Theory of Cognitive
Development, and Seyle and Lazarus’s General Adaptation Syndrome.
The Modeling and Role Modeling Theory explains some commonalities and differences among people.
The commonalities among people include:
● Holism, which is the belief that people are more than the sum of their parts. Instead, mind, body,
emotion, and spirit function as one unit, affecting and controlling the parts in dynamic
interaction with one another. This means conscious and unconscious processes are equally
important.
● Basic needs, which drive behavior. Basic needs are only met when the patient perceives they are
met. According to Maslow, whose hierarchical ordering of basic and growth needs is the basis
for basic needs in the Modeling and Role Modeling Theory, when a need is met, it no longer
exists, and growth can occur. When needs are left unmet, a situation may be perceived as a
threat, leading to distress and illness. Lack of growth-need satisfaction usually provides
challenging anxiety and stimulates growth. Need to know and fear of knowing are associated
with meeting safety and security needs.
● Aýliated Individuation is a concept unique to the Modeling and Role Modeling Theory, based on
the belief that all people have an instinctual drive to be accepted and dependent on support
systems throughout life, while also maintaining a sense of independence and freedom. This
differs from the concept of interdependence.
● Attachment and Loss addresses the idea that people have an innate drive to attach to objects
that meet their needs repeatedly. They also grieve the loss of any of these objects. The loss can
be real, as well as perceived or threatened. Unresolved loss leads to a lack of resources to cope
with daily stressors, which results in morbid grief and chronic need deûcits.
● Psychosocial Stages, based on Erikson’s theory, say that task resolution depends on the degree
of need satisfaction. Resolution of stage-critical tasks lead to growth-promoting or
growth-impeding residual attributes that affect one’s ability to be fully functional and able to
respond in a healthy way to daily stressors. As each age-speciûc task is negotiated, the person
gains enduring character-building strengths and virtues.
● Cognitive Stages are based on Piaget’s theory, and are the thinking abilities that develop in a
sequential order. It is useful to understand the stages to determine what developmental stage
the patient may have had diýculty with.
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The differences among people include:
● Inherent Endowment, which is genetic as well as prenatal and perinatal inüuences that affect
health status.
● Model of the World is the patient’s perspective of his or her own environment
based on past experiences, knowledge, state in life, etc.
● Adaptation is the way a patient responds to stressors that are health- and growth-directed.
● Adaptation Potential is the individual patient’s ability to cope with a stressor.This can be
predicted with an assessment model that delineates three categories of coping: arousal,
equilibrium, and impoverishment.
● Stress is a general response to stressful stimuli in a pattern of changes
involving the endocrine, GI, and lymphatic systems.
● Self-Care is the process of managing responses to stressors. It includes
what the patient knows about him or herself, his or her resources, and his or
her behaviors.
● Self-Care Knowledge is the information about the self that a person has
concerning what promotes or interferes with his or her own health, growth,
and development. This includes mind-body data.
● Self-Care Resources are internal and external sources of help for coping
with stressors. They develop over time as basic needs are met and developmental
tasks are achieved.
● Self-Care Action is the development and utilization of self-care knowledge
and resources to promote optimum health. This includes all conscious and unconscious
behaviors directed toward health, growth, development, and adaptation.
In the theory, modeling is the process by which the nurse seeks to know and understand the patient’s
personal model of his or her own world, as well as learns to appreciate its value and signiûcance.
Modeling recognizes that each patient has a unique perspective of his or her own world. These
perspectives are called models. The nurse uses the process to develop an image and understanding of
the patient’s world from that patient’s unique perspective.
Role modeling is the process by which the nurse facilitates and nurtures the individual in attaining,
maintaining, and promoting health. It accepts the patient as he or she is unconditionally, and allows the
planning of unique interventions. According to this concept, the patient is the expert in his or her own
care, and knows best how he or she needs to be helped.
This model gives the nurse three main roles. They are facilitation, nurturance, and unconditional
acceptance. As a facilitator, the nurse helps the patient take steps toward health, including providing
necessary resources and information. As a nurturer, the nurse provides care and comfort to the
patient. In unconditional acceptance, the nurse accepts each patient just as he or she is without any
conditions.
The basic theoretical linkages used in nursing practice for this model are: developmental task
resolution (residual) and need satisfaction are related; basic need status, object attachment and loss,
growth and development are all interrelated; and adaptive potential and need status are related.
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According to the theory, the ûve goals of nursing intervention are to build trust, promote the patient’s
positive orientation, promote the patient’s control, aýrm and promote the patient’s strengths, and set
mutual, health-directed goals.
Modeling refers to the development of an understanding of the patient’s world, while role modeling is
the nursing intervention, or nurturance, that requires unconditional acceptance. This model considers
nursing as a self-care model based on the patient’s perception of the world, as well as his or her
adaptation to stressors.
When it comes to research, the following are some theoretical propositions presented by the model:
● The individual’s ability to contend with new stressors is directly related
to the ability to mobilize resources needed.
● The individual’s ability to mobilize resources is directly related to their need deûcits and assets.
● Distressors are unmet basic needs; stressors are unmet growth.
● Objects that repeatedly facilitate the individual patient in need take on
signiûcance for that individual patient. When this occurs, attachment to the signiûcant object
occurs.
● Secure attachment produces feelings of worthiness.
● Feelings of worthiness result in a sense of futurity.
● Real, threatened, or perceived loss of the attachment object results in morbid grief.
● Basic need deûcits co-exist with the grief process.
● An adequate alternative object must be perceived as available in order for the patient to resolve
his or her grief process.
● Prolonged grief due to an unavailable or inadequate object results in morbid grief.
● Unmet basic and growth needs interfere with growth processes for the patient.
● Repeated satisfaction of basic needs is a prerequisite to working through developmental tasks
and resolution of related developmental crises.
● Morbid grief is always related to need deûcits.
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ORLANDO'S NURSING PROCESS DISCIPLINE THEORY
The Dynamic Nurse-Patient Relationship , published in 1961 and written by Ida Jean Orlando,
described Orlando’s Nursing Process Discipline Theory. The major dimensions of the model explain
that the role of the nurse is to ûnd out and meet the patient’s immediate needs for help. The patient’s
presenting behavior might be a cry for help. However, the help the patient needs may not be what it
appears to be. Because of this, nurses have to use their own perception, thoughts about perception, or
the feeling engendered from their thoughts to explore the meaning of the patient’s behavior. This
process helps nurses ûnd out the nature of the patient’s distress and provide the help he or she needs.
The concepts of the theory are: function of professional nursing, presenting behavior, immediate
reaction, nursing process discipline, and improvement.
The function of professional nursing is the organizing principle. This means ûnding out and meeting
the patient’s immediate needs for help. According to Orlando, nursing is responsive to individuals who
suffer, or who anticipate a sense of helplessness. It is focused on the process of care in an immediate
experience, and is concerned with providing direct assistance to a patient in whatever setting they are
found in for the purpose of avoiding, relieving, diminishing, or curing the sense of helplessness in the
patient. The Nursing Process Discipline Theory labels the purpose of nursing to supply the help a
patient needs for his or her needs to be met. That is, if the patient has an immediate need for help, and
the nurse discovers and meets that need, the purpose of nursing has been achieved.
Presenting behavior is the patient’s problematic situation. Through the presenting behavior, the nurse
ûnds the patient’s immediate need for help. To do this, the nurse must ûrst recognize the situation as
problematic. Regardless of how the presenting behavior appears, it may represent a cry for help from
the patient. The presenting behavior of the patient, which is considered the stimulus, causes an
automatic internal response in the nurse, which in turn causes a response in the patient.
The immediate reaction is the internal response. The patient perceives objects with his or her ûve
senses. These perceptions stimulate automatic thought, and each thought stimulates an automatic
feeling, causing the patient to act. These three items are the patient’s immediate response. The
immediate response reüects how the nurse experiences his or her participation in the nurse-patient
relationship.
The nursing process discipline is the investigation into the patient’s needs. Any observation shared and
explored with the patient is immediately useful in ascertaining and meeting his or her need, or ûnding
out he or she has no needs at that time. The nurse cannot assume that any aspect of his or her
reaction to the patient is correct, helpful, or appropriate until he or she checks the validity of it by
exploring it with the patient. The nurse initiates this exploration to determine how the patient is
affected by what he or she says and does. Automatic reactions are ineffective because the nurse’s
action is determined for reasons other than the meaning of the patient’s behavior or the patient’s
immediate need for help. When the nurse doesn’t explore the patient’s reaction with him or her, it is
reasonably certain that effective communication between nurse and patient stops.
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Improvement is the resolution to the patient’s situation. In the resolution, the nurse’s actions are not
evaluated. Instead, the result of his or her actions are evaluated to determine whether his or her
actions served to help the patient communicate his or her need for help and how it was met. In each
contact, the nurse repeats a process of learning how he or she can help the patient. The nurse’s own
individuality, as well as that of the patient, requires going through this each time the nurse is called
upon to render service to those who need him or her.
Orlando’s model of nursing makes the following assumptions:
● When patients are unable to cope with their needs on their own, they become distressed by
feelings of helplessness.
● In its professional character, nursing adds to the distress of the patient.
● Patients are unique and individual in how they respond.
● Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child.
● The practice of nursing deals with people, environment, and health.
● Patients need help communicating their needs; they are uncomfortable and ambivalent about
their dependency needs.
● People are able to be secretive or explicit about their needs, perceptions, thoughts, and feelings.
● The nurse-patient situation is dynamic; actions and reactions are inüuenced by both the nurse
and the patient.
● People attach meanings to situations and actions that aren’t apparent to others.
● Patients enter into nursing care through medicine.
● The patient is unable to state the nature and meaning of his or her distress without the help of
the nurse, or without him or her ûrst having established a helpful relationship with the patient.
● Any observation shared and observed with the patient is immediately helpful in ascertaining
and meeting his or her need, or ûnding out that he or she is not in need at that time.
● Nurses are concerned with the needs the patient is unable to meet on his or her own.
The nurse uses the standard nursing process in Orlando’s Nursing Process Discipline Theory, which
follows: assessment, diagnosis, planning, implementation, and evaluation. The theory focuses on the
interaction between the nurse and patient, perception validation, and the use of the nursing process to
produce positive outcomes or patient improvement. Orlando’s key focus was the deûnition of the
function of nursing. The model provides a framework for nursing, but the use of her theory does not
exclude nurses from using other nursing theories while caring for patients.
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KOLCABA'S THEORY OF COMFORT
Kolcaba’s Theory of Comfort was ûrst developed in the 1990s. It is a middle-range theory for health
practice, education, and research. This theory has the potential to place comfort in the forefront of
healthcare. According to the model, comfort is an immediate desirable outcome of nursing care.
The Theory of Comfort was developed when Katharine Kolcaba conducted a concept analysis of
comfort that examined literature from several disciplines, including nursing, medicine, psychology,
psychiatry, ergonomics, and English. After the three forms of comfort and four contexts of holistic
human experience were introduced, a taxonomic structure was created to guide for the assessment,
measurement, and evaluation of patient comfort. According to Kolcaba, comfort is the product of
holistic nursing art.
Kolcaba described comfort existing in three forms: relief, ease, and transcendence. If speciûc comfort
needs of a patient are met, the patient experiences comfort in the sense of relief. For example, a
patient who receives pain medication in post-operative care is receiving relief comfort. Ease addresses
comfort in a state of contentment. For example, the patient’s anxieties are calmed. Transcendence is
described as a state of comfort in which patients are able to rise above their challenges. The four
contexts in which patient comfort can occur are: physical, psychospiritual, environmental, and
sociocultural.
The Theory of Comfort considers patients to be individuals, families, institutions, or communities in
need of health care. The environment is any aspect of the patient, family, or institutional surroundings
that can be manipulated by a nurse or loved one in order to enhance comfort. Health is considered to
be optimal functioning in the patient, as deûned by the patient, group, family, or community.
In the model, nursing is described as the process of assessing the patient’s comfort needs, developing
and implementing appropriate nursing care plans, and evaluating the patient’s comfort after the care
plans have been carried out. Nursing includes the intentional assessment of comfort needs, the design
of comfort measures to address those needs, and the reassessment of comfort levels after
implementation. Assessment can be objective, such as the observation of wound healing, or
subjective, such as asking the patient if he or she is comfortable.
Kolcaba includes deûnitions of key elements of her nursing theory, as well. Health care needs are
deûned as those needs identiûed by the patient and/or family in a particular nursing practice setting.
Intervening variables are factors that are not likely to change, and over which health care providers
have little control. These variables include prognosis, ûnancial situation, social support, and others.
Health-seeking behaviors are the behaviors of a patient in an effort to ûnd health. Institutional integrity
is the value, ûnancial stability, and wholeness of health care organizations at the local, regional, state,
and national levels. Finally, best policies are protocols and procedures developed by an institution for
overall use after the collection of evidence.
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OREM'S SELF-CARE DEFICIT NURSING THEORY
The Self-Care Deûcit Theory developed as a result of Dorothea E. Orem working toward her goal of
improving the quality of nursing in general hospitals in her state. The model interrelates concepts in
such a way as to create a different way of looking at a particular phenomenon. The theory is relatively
simple, but generalizable to apply to a wide variety of patients. It can be used by nurses to guide and
improve practice, but it must be consistent with other validated theories, laws and principles.
The major assumptions of Orem’s Self-Care Deûcit Theory are:
● People should be self-reliant, and responsible for their care, as well as others in their family who
need care.
● People are distinct individuals.
● Nursing is a form of action. It is an interaction between two or more people.
● Successfully meeting universal and development self-care requisites is an important
component of primary care prevention and ill health.
● A person’s knowledge of potential health problems is needed for promoting self-care behaviors.
● Self-care and dependent care are behaviors learned within a socio-cultural context.
Orem’s theory is comprised of three related parts: theory of self-care; theory of self-care deûcit; and
theory of nursing system.
The theory of self-care includes self-care, which is the practice of activities that an individual initiates
and performs on his or her own behalf to maintain life, health, and well-being; self-care agency, which is
a human ability that is <the ability for engaging in self-care,= conditioned by age, developmental state,
life experience, socio-cultural orientation, health, and available resources; therapeutic self-care
demand, which is the total self-care actions to be performed over a speciûc duration to meet self-care
requisites by using valid methods and related sets of operations and actions; and self-care requisites,
which include the categories of universal, developmental, and health deviation self-care requisites.
Universal self-care requisites are associated with life processes, as well as the maintenance of the
integrity of human structure and functioning. Orem identiûes these requisites, also called activities of
daily living, or ADLs, as:
1.
2.
3.
4.
5.
the maintenance of suýcient intake of air, food, and water
provision of care associated with the elimination process
a balance between activities and rest, as well as between solitude and social interaction
the prevention of hazards to human life and well-being
the promotion of human functioning
Developmental self-care requisites are associated with developmental processes. They are generally
derived from a condition or associated with an event.
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Health deviation self-care is required in conditions of illness, injury, or disease. These include:
1.
2.
3.
4.
Seeking and securing appropriate medical assistance
Being aware of and attending to the effects and results of pathologic conditions
Effectively carrying out medically prescribed measures
Modifying self-concepts to accept onseself as being in a particular state of health and in
speciûc forms of health care
5. Learning to live with the effects of pathologic conditions.
The second part of the theory, self-care deûcit, speciûes when nursing is needed. According to Orem,
nursing is required when an adult is incapable or limited in the provision of continuous, effective
self-care. The theory identiûes ûve methods of helping: acting for and doing for others; guiding others;
supporting another; providing an environment promoting personal development in relation to meet
future demands; and teaching another.
The theory of nursing systems describes how the patient’s self-care needs will be met by the nurse, the
patient, or by both. Orem identiûes three classiûcations of nursing system to meet the self-care
requisites of the patient: wholly compensatory system, partly compensatory system, and
supportive-educative system.
Orem recognized that specialized technologies are usually developed by members of the health care
industry. The theory identiûes two categories of technologies.
The ûrst is social or interpersonal. In this category, communication is adjusted to age and health
status. The nurse helps maintain interpersonal, intra-group, or inter-group relations for the coordination
of efforts. The nurse should also maintain a therapeutic relationship in light of pscyhosocial modes of
functioning in health and disease. In this category, human assistance adapted to human needs,
actions, abilities, and limitations is given by the nurse.
The second is regulatory technologies, which maintain and promote life processes. This category
regulates psycho- and physiological modes of functioning in health and disease. Nurses should
promote human growth and development, as well as regulating position and movement in space.
Orem’s approach to the nursing process provides a method to determine the self-care deûcits and then
to deûne the roles of patient or nurse to meet the self-care demands. The steps in the approach are
thought of uas the technical component of the nursing process. Orem emphasizes that the
technological component <must be coordinated with interpersonal and social pressures within nursing
situations.
The nursing process in this model has three parts. First is the assessment, which collects data to
determine the problem or concern that needs to be addressed. The next step is the diagnosis and
creation of a nursing care plan. The third and ûnal step of the nursing process is implementation and
evaluation. The nurse sets the health care plan into motion to meet the goals set by the patient and his
or her health care team, and, when ûnished, evaluate the nursing care by interpreting the results of the
implementation of the plan.
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KING'S THEORY OF GOAL ATTAINMENT
The Theory of Goal Attainment was developed by Imogene King in the early 1960s. It describes a
dynamic, interpersonal relationship in which a patient grows and develops to attain certain life goals.
The theory explains that factors which can affect the attainment of goals are roles, stress, space, and
time.
The model has three interacting systems: personal, interpersonal, and social. Each of these systems
has its own set of concepts. The concepts for the personal system are perception, self, growth and
development, body image, space, and time. The concepts for the interpersonal system are interaction,
communication, transaction, role, and stress. The concepts for the social system are organization,
authority, power, status, and decision-making.
The following propositions are made in the Theory of Goal Attainment:
If perceptual interaction accuracy is present in nurse-patient interactions, transaction will occur.
If the nurse and patient make transaction, the goal or goals will be achieved.
If the goal or goals are achieved, satisfaction will occur.
If transactions are made in nurse-patient interactions, growth and development will be
enhanced.
● If role expectations and role performance as perceived by the nurse and patient are congruent,
transaction will occur.
● If role conüict is experienced by either the nurse or the patient (or both), stress in the
nurse-patient interaction will occur.
●
●
●
●
● If a nurse with special knowledge communicates appropriate information to the patient, mutual
goal-setting and goal achievement will occur.
There are also assumptions made in the model. They are:
The focus of nursing is the care of the human being (patient).
The goal of nursing is the health care of both individuals and groups.
Human beings are open systems interacting with their environments constantly.
The nurse and patient communicate information, set goals mutually, and then act to achieve
those goals. This is also the basic assumption of the nursing process.
● Patients perceive the world as a complete person making transactions with individuals and
things in the environment.
●
●
●
●
● Transaction represents a life situation in which the perceiver and the thing being perceived are
encountered. It also represents a life situation in which a person enters the situation as an
active participant. Each is changed in the process of these experiences.
According to King, a human being refers to a social being who is rational and sentient. He or she has
the ability to perceive, think, feel, choose, set goals, select means to achieve goals, and make
decisions. He or she has three fundamental needs: the need for health information when it is needed
and can be used; the need for care that seeks to prevent illness; and the need for care when he or she
is unable to help him or herself.
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Health involves dynamic life experiences of a human being, which implies continuous adjustment to
stressors in the internal and external environment through optimum use of resources to achieve
maximum potential for daily living. Environment is the background for human interaction. It involves
the internal and external environments. The internal environment transforms energy to enable a person
to adjust to continuous external environment changes. The external environment involves formal and
informal organizations. In this model, the nurse is part of the patient’s environment.
The Theory of Goal Attainment deûnes nursing as <a process of action, reaction and interaction by
which nurse and client share information about their perception in a nursing situation= and <a process
of human interactions between nurse and client whereby each perceives the other and the situation,
and through communication, they set goals, explore means, and agree on means to achieve goals.= In
this deûnition, action is a sequence of behaviors involving mental and physical action, and reaction is
included in the sequence of behaviors described in action. King states that the goal of a nurse is to
help individuals to maintain their health so they can function in their roles. The domain of the nurse
<includes promoting, maintaining, and restoring health, and caring for the sick, injured and dying.= The
function of a professional nurse is <to interpret information in the nursing process to plan, implement,
and evaluate nursing care.=
King gives detailed information about the nursing process in her model of nursing. The steps of the
nursing process are: assessment, nursing diagnosis, planning, implementations, and evaluation.
The theory explains that assessment occurs during interaction. The nurse brings special knowledge
and skills whereas the patient brings knowledge of him or her self, as well as the perception of
problems of concern to the interaction. During the assessment, the nurse collects data regarding the
patient including his or her growth and development, the perception of self, and current health status.
Perception is the base for the collection and interpretation of data. Communication is required to verify
the accuracy of the perception, as well as for interaction and translation.
The nursing diagnosis is developed using the data collected in the assessment. In the process of
attaining goals, the nurse identiûes problems, concerns, and disturbances about which the patient is
seeking help.
After the diagnosis, the nurse and other health care team members create a care plan of interventions
to solve the problems identiûed. The planning is represented by setting goals and making decisions
about the means to achieve those goals. This part of transaction and the patient’s participation is
encouraged in making decisions on the means to achieve the goals.
The implementation phase of the nursing process is the actual activities done to achieve the goals. In
this model of nursing, it is the continuation of transaction.
Evaluation involves determining whether or not goals were achieved. The explanation of evaluation in
King’s theory addresses meeting goals and the effectiveness of nursing care.
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WATSON'S PHILOSOPHY AND SCIENCE OF CARING
The Philosophy and Science of Caring has four major concepts: human being, health,
environment/society, and nursing.
Jean Watson refers to the human being as <a valued person in and of him or herself to be cared for,
respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully
functional integrated self. Human is viewed as greater than and different from the sum of his or her
parts.=
Health is deûned as a high level of overall physical, mental, and social functioning; a general
adaptive-maintenance level of daily functioning; and the absence of illness, or the presence of efforts
leading to the absence of illness.
Watson’s deûnition of environment/society addresses the idea that nurses have existed in every
society, and that a caring attitude is transmitted from generation to generation by the culture of the
nursing profession as a unique way of coping with its environment.
The nursing model states that 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.
Watson believed that holistic health care is central to the practice of caring in nursing. She deûnes
nursing as <a human science of persons and human health-illness experiences that are mediated by
professional, personal, scientiûc, esthetic and ethical human transactions.=
The nursing process outlined in the model contains the same steps as the scientiûc research process:
assessment, plan, intervention, and evaluation. The assessment includes observation, identiûcation,
and review of the problem, as well as the formation of a hypothesis. Creating a care plan helps the
nurse determine how variables would be examined or measured, and what data would be collected.
Intervention is the implementation of the care plan and data collection. Finally, the evaluation analyzes
the data, interprets the results, and may lead to an additional hypothesis.
Watson’s model makes seven assumptions:
1.
2.
3.
4.
Caring can be effectively demonstrated and practiced only interpersonally.
Caring consists of carative factors that result in the satisfaction of certain human needs.
Effective caring promotes health and individual or family growth.
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.
The ûrst three carative factors are the <philosophical foundation= for the science of caring, while the
remaining seven derive from that foundation. The ten primary carative factors are:
1. The formation of a humanistic-altruistic system of values, which begins at an early age with
the values shared by parents. The system of values is mediated by the nurse’s life
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experiences, learning gained, and exposure to the humanities. It is perceived as necessary to
the nurse’s maturation which in turn promotes altruistic behavior toward others.
2. The installation of faith-hope, which is essential to the carative and curative processes.
When modern science has nothing else to offer a patient, a nurse can continue to use
faith-hope to provide a sense of well-being through a belief system meaningful to the
individual.
3. The cultivation of sensitivity to one’s self and to others, which explores the need of nurses to
feel an emotion as it presents itself. The development of a nurse’s own feeling is needed to
interact genuinely and sensitively with patients. By striving to become more sensitive, the
nurse is more authentic. This encourages self-growth and self-actualization in both the nurse
and the patients who interact with the nurse. The nurses promote health and higher-level
functioning only when they form person-to-person relationships.
4. The development of a helping-trust relationship, which includes congruence, empathy, and
warmth. The strongest tool a nurse has is his or her mode of communication, which
establishes a rapport with the patient, as well as caring by the nurse. Communication
includes verbal and nonverbal communication, as well as listening that connotes empathetic
understanding.
5. The promotion and acceptance of the expression of both positive and negative feelings,
which need to be considered and allowed for in a caring relationship because of how
feelings alter thoughts and behavior. The awareness of the feelings helps the nurse and
patient understand the behavior it causes.
6. The systematic use of the scientiûc method for problem-solving and decision-making, which
allows for control and prediction, and permits self-correction. The science of caring should
not always be neutral and objective.
7. The promotion of interpersonal teaching-learning, since the nurse should focus on the
learning process as much as the teaching process. Understanding the person’s perception of
the situation assists the nurse to prepare a cognitive plan.
8. The provision for a supportive, protective and/or corrective mental, physical, socio-cultural,
and spiritual environment, which Watson divides into interdependent internal and external
variables, manipulated by the nurse in order to provide support and protection for the
patient’s mental and physical health. The nurse must provide comfort, privacy, and safety as
part of the carative factor.
9. Assistance with satisfying human needs based on a hierarchy of needs similar to Maslow’s.
Each need is equally important for quality nursing care and the promotion of the patient’s
health. In addition, all needs deserve to be valued and attended to by the nurse and patient.
10. The allowance for existential-phenomenological forces, which helps the nurse to reconcile
and mediate the incongruity of viewing the patient holistically while at the same time
attending to the hierarchical ordering of needs. This helps the nurse assist the patient to ûnd
strength and courage to confront life or death. Phenomenology is a way of understanding
the patient from his or her frame of reference. Existential psychology is the study of human
existence.
Watson’s hierarchy of needs begins with lower-order biophysical needs, which include the need for
food and üuid, elimination, and ventilation. Next are the lower-order psychophysical needs, which
include the need for activity, inactivity, and sexuality. Finally, are the higher order needs, which are
psychosocial. These include the need for achievement, aýliation, and self-actualization.
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