Theoretical Foundations in Nursing PDF

Theoretical Foundations In Nursing Jamie Beatrice Dizon INVO4  BACKGROUND OF THEORIST - The first completed exposition of the theory was presented in a AN...

Theoretical Foundations In Nursing Jamie Beatrice Dizon INVO4  BACKGROUND OF THEORIST - The first completed exposition of the theory was presented in a ANNE BOYKIN conference in 1992 - Boykin’s scholarly work is centered on caring as the grounding for - Gaut notes in Boykin and Schoenhofer that the theory is an excellent nursing as is evidenced in her books, Nursing as Caring: A Model for example of growth by intention, or gradual illumination characterized Transforming Practice (co authored with Schoenhofer) and Living a by “the development of an extant bibliography, categorization of caring Caring-Based Program (illustrates the evolution of a nursing program conceptualizations, and the further development of human care/caring grounded in caring) theories. SAVINA O. SCHOENHOFER 1998 - 1190: co founded Nightingale Songs USE OF EMPIRICAL EVIDENCE Poetry group something - - An early venue for communicating the beauty of nursing in poetry - Theory of Nursing as Caring qualitatively transforms practice and prose - In the theory, persons are unique and unpredictable in the moment and therefore should not be manipulated or objectified as testable, - Her career in nursing has been influenced by three colleagues: researchable variables. - Lt. Col. Ann Ashjian: her community nursing practice in Brazil - The Theory of Nursing reveals the essentiality of recognizing caring presented an inspiring model of nursing between the nurse and the one nursed as substantive knowledge that - Marilyn E. Parker, PhD: mentored her in the idea of nursing as a nurses must pursue. discipline, the academic role of higher education, and the world of - The outcomes of nursing care reflect the valuing of persons in ways theorists and theories that communicate “value added” richness of the nursing experience. - Anne Boykin, PhD: introduced her to caring as a substantive field in - Characteristics of personhood are essential to the theory such as unity, nursing wholeness, awareness, and intention - In Nursing as Caring, outcomes of nursing value experienced in the THEORETICAL SOURCES relationship are best articulated in terms that are subjective and - The Theory of Nursing as Caring wa s born out of the early curriculum descriptive; the full measure of the value experienced is not subjective development work at Florida Atlantic University College of Nursing or quantifiable. - Boykin and Schoenhofer recognized the importance of continuing to develop ideas toward a comprehensive conceptual framework that MAJOR CONCEPTS AND DEFINITIONS expressed the meaning and purpose of nursing as a discipline and as a FOCUS AND INTENTIONS OF NURSING profession - The focus of nursing as a discipline is of knowledge and professional - Boykin and Schoenhofer propose that nursing is concerned with the practice based on that knowledge and professional practice based on broad spectrum of human living with the focus of nursing that knowledge is nurturing persons living and growing in caring conceptualized as “nurturing persons living caring and growing in - The general intention of caring is to know persons as caring and to caring” support and sustain them as they live caring - Three bodies of work influenced the initial development of the theory: - This intention is expressed uniquely when the nurse enters a PATERSON AND ZDERAD relationship with the nursed - Paterson and Zderad’s existential phenomenological theory of - Caring is expressed in nursing and is the “intentional and authentic humanistic caring viewed by Boykin and Schenhofer as the historical presence of the nurse with another who is recognized as living caring antecedent of Nursing as Caring. and growing in caring - Such germinal ideas served as substantive and structural basis for their conceptualization. PERSPECTIVE OF PERSONS AS CARING ROACH’S THESIS - Persons is recognized as constantly unfolding in caring - From the perspective of of the theory, “fundamentally , potentially, and - Caring is the human mode of beings finds its natural expression and actually each person is caring” domain in the assumptions of theory - Knowing the person as living caring and growing in caring is - Her 6 C’s: Commitment, confidence conscience, competence, foundational to the theory compassion and comportment – contribute to a language of caring NURSING SITUATION MAYEROFF - The nursing situation is the locus of all that is known and done in - Mayeroff’s work, On Caring, provided rich elemental language nursing and is conceptualized as “the shared, lived experience in facilitating recognition and description of the practical meaning of which caring between nurse and nursed enhances personhood. lying caring in the ordinariness of life - It is within the nursing situation that the nurse reaches out to the one - Mayeroff’s major ingredients for caring: knowing, alternating rhythms, nursed and attends to calls for caring patience, honesty, trust, humility, hope, and courage – describe the wellspring of human life PERSONHOOD - Mayeroff’s concepts are essential for understanding living as caring - Personhood is a process of living grounded in caring persons and appreciating their unique expression in the reciprocal - Personhood implies being oneself as an authentic caring person and relationship. being open to unfolding possibilities for caring THEORETICAL SOURCES (cont.) - The lived experience of caring between enhances personhood, and both the nurse and the nursed grow in caring - Boykin and Schoenhofer's concept of nursing as a discipline was - “A profound understanding of personhood communicated the paradox influenced by Phenix (1964), King and Brownell (1976), and Orem (1979) of person-as-person and person-in communion all at once” - Boykin and Schoenhofer's concept of nursing as a profession was - In the intimacy of caring, respect for self as a person and respect for influenced by Flexner’s (1910) ideas. others are values that affirm personhood. - Nascent forms of the the Theory of Nursing as Caring were first published in = 1910 and 1911 1990 Faql  DIRECT INVITATION ENVIRONMENT - Within the nursing situation, the nurse uses direct invitation to come FIVE: PERSONHOOD IS ENHANCED THROUGH PARTICIPATING IN to know what matters most to the one nursed at the moment NURTURING RELATIONSHIPS WITH CARING OTHERS - The focus is on what is meaningful to the one being nursed - The nature of relationships is transformed through caring - The power of the direct invitation reaches deep into the humility of the - Carrying is living in the context of relational responsibilities and nursing situation, uniting and guiding the intention of both the nurse possibilities and it acknowledges the importance of knowing the and the nursed person as person CALLS FOR NURSING - Personhood is enhanced through participating in nurturing - Calls for nursing are calls for nurturance discerned in the mind of the relationships with caring others nurse - Intentionality and authentic presence open tuners to hearing calls for NURSING nursing SIX: NURSING IS BOTH A DISCIPLINE AND PROFESSION - Calls for nursing are uniquely situated personal expressions; they - Nursing is an exquisitely interwoven unity of aspects of the discipline cannot be predicted, but originate within persons living caring and and profession of nursing their lives and wooden hopes and aspirations for growing and caring - As a discipline nursing is a way of knowing being being and living in - Calls for nursing are individually relevant ways of saying “know me as the world and is envisaged as a unity of knowledge within a larger caring person in the moment and be with me as i try to live fully who i community truly am” - The discipline of nursing attends to the discovery creation CARING BETWEEN development and refinement of knowledge needed for the practice of - When the nurse enters the world of the other person with the intention nursing of knowing the other as a caring person, the encountered gives rise to - The profession of nursing attends to the application of that knowledge the phenomenal of caring between in response to human needs - Without the caring between the nurse and the nurse, uni-directional - From the perspective of nursing as caring the discipline and practice activity or reciprocal exchange can occur, but nursing and its fullest or guided by the statement of focus, “nursing is measuring persons sense does not occur living caring and growing in caring” - It is in the context of caring between that personhood is nurtured, each expressing self and recognizing the other as a caring person NURSING RESPONSE THEORETICAL ASSERTIONS - Within the nursing situation, the knowing of a person clarifies the call - To be human is to caring for nursing and shapes the nursing response, enabling transformation - The purpose of the discipline and profession is to come to know of the knowledge brought by the nerves to the situation from general to persons and nurture them as living, caring, and growing in caring. particular and unique - The theory asks nurses to embrace caring not simply as a task or - Nursing responses to calls for carrying evolved as nurses clarify their professional obligation, but as the focus of their own being and understanding for calls through presence and dialogue nursing identity - This identity can only be created in concert with developing a relationship with the nursed. The nurse endeavors to know the other as IN VIEW OF THE METAPARADIGMS a caring person and seeks understand how that person might be PERSON sustained supported and strengthened in the unique process of living ONE: PERSONS ARE CARING BY VIRTUE OF THEIR HUMANNESS caring and growing caring - Being a person means living caring through which being and - The nurses relationship with self is critical to the implementation and possibilities are known to the fullest S practicality of the theory - Caring is an element of being human, that all humans are caring by - The nurse needs to recognise and demonstrate carrying at each nature, and caring is a growth process moment - From the perspective of nursing as caring, the understanding of person - The nurse must take a commitment to recognizing and actualizing as caring “centers on valuing and celebrating human wholeness the carry. The nurse must believe that caring has real meaning and value to human person is living and growing and caring and active personal each individual and relationship engagement with others” - Nurses need to put differences aside and work in harmony with each TWO: PERSONS ARE WHOLE AND COMPLETE IN THE MOMENT other, providing every patient with individualized care, listening to the - Wholeness or the fullness of being is forever present Is dapat you for them care needs of the patient holistically - There are three concepts strongly utilize in the theory which should be - From the perspective of nursing as caring, to encounter a person as less than whole fails to truly encounter to fail the person incorporated in practice, such as concern, participation, and keeping an open mind THREE: PERSONS LIVE CARING, MOMENT TO MOMENT - The most important task is to first know yourself as a game person - Carrying is a lifetime process that is lived moment-to-moment and is then learn to care for your patients constantly unfolding - In order to show your caring spirit, it is important that simple gestures - The awareness of self as a caring person brings to consciousness the such as, always maintaining eye contact with your patients, and valuing of caring and becomes the moral imperative directing oughts listening to their stories and sharing with them of action with the persistent question “how ought i act as caring person?” ROLES OF A NURSE HEALTH - To respect your patient’s values and desires FOUR: PERSONHOOD IS LIVING LIFE GROUNDED IN CARING - Make sure not to be judgemental - Personhood is a process of living caring and growing in caring - If a person is judgemental, they give off the impression that they are - It is being authentic demonstrating congruence between beliefs and better than others, and that is not a good way to start a caring behaviors and living out the meaning of one's life relationship. - The fullness of being human is expressed in living care uniquely day-to-day and his and has through participation and caring - In practice, the nurse should consider going the extra mile to relationships demonstrate their love, respect, and mutual interaction - Do not talk about patients as if they were not there. Always try to include what is important to them - A nurse must listen to their patient as well as the rest of the healthcare team - Work together as a team, everyone must aim towards one goal, excellent care, providing patients with the highest level possible of satisfactory nursng care. - Goal: excellent care, providing patients with the highest level of care DANCE OF CARING PERSONS - The dance of caring persons is a visual representation of the theoretical assertion that live carried between the nurse and the nurse expresses underlying relationships - It is also a model to guide of all of an organization and which each person in the healthcare system lives caring meaningfully and has a place of value in this system - Dancers enter the nursing situation visualized as a circle of caring that provides organizing purpose and integrated functioning - Each dancer gives special gifts as the nursing situation evolves - Some dancers may hear different notes and a different rhythm but all harmonized in the unity of the dance and the one of the circle  11 ESSENCES OF NURSING - Persons are to be valued, to be respected, nurtured, and understood - Awareness with the right to make informed choices regarding their health and - Openness may include families and communities - Empathy AUFTURTASD HEALTH - Caring - “Health” is valued as necessary for survival and is often proposed as - Touching the goal of nursing - Understanding - There are many instances of nursing that could be described as - Responsibility “health restoring”, “health sustaining”, “health promoting”, and - Trust “health supervision:” - Acceptance - There are instances in which health, taken in its narrowest meaning as - Self-recognition freedom from disease, is not seen as an attainable goal, as evidenced, - Dialogue for example, in labels given to patients such as “terminal”, “hopeless”, and “chronic”. Yet in actual practice these human conditions call forth MAJOR CONCEPTS AND DEFINITIONS some of the most complete, expert, total, beautiful nursing care. NURSING DIALOGUE ENVIRONMENT - When a nurse and patient come together - Environment can be understood as the time and space in which the - The nurse presents themselves as a helper ready to assist the patient nursing experience takes place. From the existential perspective, it is - The nurse is open to understanding how the patient feels with the the time and space as lived by the nurse and/or patient during the intention of improvement experience - Openness is an essential quality for humanistic nursing dialogue - Space is the lived perception of the world around the nurse and the 5 PHASES OF NURSING PROCESS patient - Preparation of the nurse knower for coming to know (assessment) - The physical environment can enhance or impede the nursing - The nurse acts as an investigator who willingly takes risks and has dialogue based on how comfortable the participants feel and how an open mind well the space encourages communication. - “Accepting the decision to approach the unknown openly” - Place is another component of space, but it is more personalized; it - The nurse knowing of the other intuitively belongs to the patient or nurse and is highly subjective - The nurse tries to understand the other, as in the “i-thou” - Space and time coincide within the nursing experience relationship, where the nurse as the “I” does not superimpose - The nursing dialogue is reinforced when the nurse understands how themselves on the “thou” of the patient the patient relates to their space. - Nurse knowing the other scientifically NURSING - The nurse as the observer must observe and analyze from the - Lived experience between human beings outside - Evolving, affecting, and helping relationship in which the patient - The nurse goes from intuition to analysis and nurse engage in a dialogue - The analysis is the sorting, comparing, contrasting, relating, - Reciprocal call and response interpreting, and categorizing - Achieved through awareness of the nurse’s own worldview - Nurse complementarity synthesizing known others - Nursing is an interhuman, transactional, interconnected dialogue in a - The ability of the nurse to develop or see themselves as a source of way that recognizes and expresses one;s own genuine humanness and knowledge, to continually develop the nursing community through responds to a unique humanness of the patient education, and increased understanding of their owned learned experiences - Succession within the nurse from many to the paradoxical one - In this stage, the nurse takes the information gleaned and applies it in the practical clinical setting - Here, the nurse takes brings the dilemma towards resolution IN VIEW OF THE METAPARADIGMS PERSONS - Humans are viewed as open energy fields with special life experiences - As energy fields, they are greater than and different from the sum of their parts and cannot be predicted from knowledge of their parts - Human beings, are viewed as being holistic in nature, are special, dynamic, aware, and multidimensional, capable of abstract thought creativity, capable of taking responsibility - Language, empathy, caring, and other abstract patterns of communication are aspects of an individually high level of complexity and diversity and enable one to increase knowledge of - self and environment  THEORETICAL SOURCES - If becoming l is the only way an individual spartan can manifest itself - The theory of health as expanding consciousness emanated from then that is health for that person Newman's early personal family experience - While caring for her mother who was experiencing restricted body DESCRIPTION OF THE THEORY movement because of amyotrophic lateral sclerosis - The theory of health as expanding consciousness (HEC) was - Roger's science of unitary human beings and her assumptions - stimulated by concern for those for whom health as the absence of regarding fullness pattern and unidirectionality are foundational to disease or disability is not possible. newman's theory - Nurses often relate to such people: people facing the uncertainty, - Hegel's fusion of opposite helped Newman conceptualize health and - debilitation, loss and eventual death associated with chronic illness. illness into a new concept of health - The theory has progressed to include the health of all persons - Bentov’s explication of life as the process of expanding consciousness - regardless of the presence or absence of disease. prompted Newman to assert her concept of health as the process of - The theory asserts that every person in every situation, no matter how expanding consciousness disordered and hopeless it may seem, is part of the universal process - Newman's postulate of disease is supported by Bohm’s theory of - of expanding consciousness – a process of becoming more of oneself, implicate order of finding greater meaning in life, and of reaching new dimensions of - Young's theory of human evolution pinpointed the role of - connectedness with other people and the world” (Newman, 2010). pattern-recognition for newman - Humans are open to the whole energy system of the universe and - Young's ideas provided the impetus for integration of the basic constantly interacting with the energy. With this process of interaction concepts of her new theory movement space time and humans are evolving their individual pattern as a whole. consciousness into a dynamic portrayal of life and health - According to Newman, understanding the pattern is essential. The expanding consciousness is the pattern recognition. - The manifestation of disease depends on the pattern of the individual MAJOR CONCEPTS AND DEFINITIONS so the pathology of the disease exists before the symptoms appear so HEALTH removal of disease symptoms does not change the individual - Is the pattern of the whole of a person and includes disease as a structure. manifestation of the pattern of the whole based on the premise that - Newman redefines Nursing the process of recognizing the individual in life is an ongoing process of expanding consciousness relation to the environment and it is the process of understanding - Health is a transformative process to more inclusive consciousness consciousness. - Using Hegel’s dialectical fusion of opposites newman explain - The nurse helps to understand people to use the power within to conceptually how disease fuses with its opposite non disease or develop the higher level of consciousness, to realize the disease absence of disease to create a new concept of health that is relational process, its recovery and prevention. and is patterned emergent at predictable unitary intuitive and - Newman also explains the interrelatedness of time,space and innovative, rather than the traditional interview that is casual a movement. Time and space are the temporal pattern of the individual, predictive dichotomous rational and controlling both have complementary relationships. PATTERN - Humans are constantly changing through time and space and it shows - Pattern is information that depicts the full and understanding of the a unique pattern of reality. meaning of all the relationships at once - It is conceptualized as a fundamental attribute of all there is giving IN VIEW OF THE METAPARADIGM unity in diversity NURSING - Pattern is what identifies an individual as a particular person - Emphasized the primacy of relationships as a focus of nursing, both - Characteristics of pattern include movement diversity and rhythm nurse-client relationships and relationships within the client’s lives - Ex: genetic pattern, voice pattern, movement pattern - Nurses facilitates pattern recognition in clients by forming CONSCIOUSNESS relationships with them and connecting with them in authentic ways - Is both the informational capacity of the system and the ability of the - Nursing process is just one pattern of recognition system to interact with its environment - Nurse in nurse-client interaction is seen as a caring presence. - In 1978, Newman identified 3 correlates of consciousness (time PERSON movement and space) as manifestations of the pattern of the whole - The human is unitary, that is cannot be divided into parts, and is MOVEMENT-SPACE-TIME inseparable from the larger unitary field - Newman emphasizes the importance of examining movement space - Persons as individuals, and human beings as species are identified by time together as dimensions of emerging patterns of consciousness their patterns of consciousness added and separate concepts of the theory - The person does not possess consciousness, the person is consciousness MAJOR ASSUMPTIONS - Persons are centers of consciousness within a overall pattern of - Health encompasses conditions heretofore described as illness or in expanding consciousness medical terms pathology - Persons include family and community - These pathological conditions can be considered a manifestation of ENVIRONMENT the total pattern of the individual - Environment is described as a “universe of open systems - The pattern of the individual that eventually manifest itself as - Described as a larger whole, which contains the consciousness of the pathology is primary and exists before structural or functional changes individual - Removal of the pathology in itself will not change the pattern of the - Not explicitly defined individual  HEALTH - Pattern of the whole of a person - Health and illness are synthesized as health-fusion of one state of being THEORETICAL ASSERTIONS - There is an inverse relationship between space and time, so when a person’s life and space is decreased, by physical and social immobility, that person's time is increased - Movement is a “means whereby space and time becomes reality. It is ls a reflection of consciousness - Time is seen as a function of movement, a measure of consciousness STRENGTHS - Can be applied in any setting - generates caring interventions WEAKNESSES - Abstract - Multidimensional - Qualitative - Little discussion on environment CONCLUSION - A grand theory of nursing - Humans cannot be divided into parts - Health is central to the theory and is seen as a process of developing awareness of self and the environment - Consciousness is a manifestation of an evolving pattern of person-environment interaction  ↳ Middle-Range Theory specific than grand thena funideas are more & Her goal : help people care BACKGROUND OF THEORIST - Behavior-specific cognitions and affect (perceived benefits of action, NOLA J. PENDER perceived barriers to action, perceived self-efficacy, activity-related - A Living Legend of the American Academy of Nursing in 2012. The affect, interpersonal influences, and situational influences). president of the academy from 1991 to 1993. - Behavioral outcomes (commitment to a plan of action, immediate - As regards health promotion, Nola Pender has written and issued competing demands and preferences, and health-promoting behavior). various articles on exercise, behavior change, and relaxation training. She also has served on editorial boards and as an editor for journals PERSONAL FACTORS and books. - Personal biological factors. Include variables such as age, gender, - Pender is also known as a scholar, presenter, and consultant in health body mass index, pubertal status, aerobic capacity, strength, agility, or promotion. She has collaborated with nurse scientists in Japan, Korea, balance. Mexico, Thailand, the Dominican Republic, Jamaica, England, New - Personal psychological factors. Include variables such as self-esteem, Zealand, And Chile. self-motivation, personal competence, perceived health status, and - By contributing leadership as a consultant to research centers and definition of health. giving scholar consultations, Pender resumes influencing nursing. She - Personal socio-cultural factors. Include variables such as race, also collaborates with the American Journal of Health Promotion editor, ethnicity, acculturation, education, and socioeconomic status. promoting legislation to support health promotion research. - First encounter in nursing was when she was f year old and witnessed the care given to her hospitalized aunt by muse (CONT.) THEORETICAL SOURCES - Perceived Benefits of Action - Anticipated positive outcomes that will I - Pender’s background in nursing, human development, experimental occur from health behavior. psychology and education led her to use a holistic nursing perspective, - Perceived Barriers to Action - Anticipated, imagined, or real blocks Financial Constraints social psychology and learning theory as foundations of HPM. EX : and personal costs of understanding a given behavior. Health Family Responsibilities , - Albert Bandura’s (1977) Social Learning Theory - Perceived Self-Efficacy - the judgment of personal capability to - Feather’s (1982) Expectancy value model of human motivation - Becker’s (1974) Health belief model, but does not include fear or threat ↑ organize and execute a health-promoting behavior. Perceived self-efficacy influences perceived barriers to action, so higher efficacy as motivation for health behavior · results in lowered perceptions of barriers to the behavior’s performance. 8X in HEALTH PROMOTION MODEL - Activity-Related Affect - Subjective positive or negative feeling occurs - The Health Promotion Model notes that each person has unique before, during, and following behavior based on the stimulus M n personal characteristics and experiences that affect subsequent properties of the behavior itself. Activity-related affect influences actions. perceived self-efficacy, which means the more positive the subjective - The set of variables for behavioral specific knowledge and effect have feeling, the greater its efficacy. In turn, increased feelings of efficacy important motivational significance. These variables can be modified G can generate a further positive affect. - Interpersonal Influences - Cognition concerning behaviors, beliefs, or · through nursing actions. - Health-promoting behavior is the desired behavioral outcome and is attitudes of others. Interpersonal influences include norms the endpoint in the Health Promotion Model. (expectations of significant others), social support - (instrumental and - The final behavioral demand is also influenced by the immediate emotional encouragement), and modeling (vicarious learning through competing demand and preferences, which can derail intended observing others engaged in a particular behavior). Primary sources of health-promoting actions. interpersonal influences are families, peers, and healthcare providers. - To enable people to improve their well-being with self-care and positive - Situational Influences - Personal perceptions and cognitions of any health behaviors. given situation or context can facilitate or impede behavior. Include - Designed to be a “complementary counterpart to models of health perceptions of options available, demand characteristics, and protection. To help nurses know and understand the major aesthetic features of the environment in which given health-promoting determinants of health behaviors as a foundation for behavioral is proposed to take place. Situational influences may have direct or counseling to promote well-being and healthy lifestyles. indirect influences on health behavior ↳ concerns on environment more - The model defines health as “a positive dynamic state not merely the - Commitment to Plan of Action - The concept of intention and I identification of a planned strategy leads to the implementation of one absence of disease.” - The model focuses on the following three areas: individual health behavior. characteristics and experiences, behavior-specific cognitions and - Immediate Competing Demands and Preferences - Competing demands are those alternative behaviors over which individuals have - affect, and behavioral outcomes. low control because of environmental contingencies such as work or The HMP allows healthcare professionals to help patients overcome barriers that prevent them from leading a healthy lifestyle family care responsibilities. MAJOR CONCEPTS AND DEFINITIONS - Competing preferences are alternative behaviors over which C - Prior Related Behavior – refers to the frequency of the same or similar individuals exert relatively high control, such as choice of ice cream or behavior in the past. This has direct and indirect effects on the · apple for a snack. likelihood of engaging in health-promoting behaviors. C - Health-Promoting Behavior - is an endpoint or action-outcome Lond - Health promotion- behavior motivated by the desire to increase directed toward attaining positive health outcomes such as optimal well-being and actualize human health potential. wellbeing, personal fulfillment, and productive living. - Health protection or illness prevention is described as behavior : motivated desire to actively avoid illness, detect it early, or maintain functioning within illness constraints. - Individual characteristics and experiences (prior related behavior and - personal factors). - ↳ past experience that make you behave that ↳ entirety lage , gender etc). , way  - Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and the behavior’s actual performance. - Greater perceived self-efficacy results in fewer perceived barriers to - specific health behavior. - Positive affect toward a behavior results in greater perceived self-efficacy, which can, in turn, result in increased positive affect. - When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased. - Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior, expect the - behavior to occur, and provide assistance and support to enable the behavior. - Families, peers, and health care providers are important sources of - interpersonal influence that can increase or decrease commitment to and engagement in health-promoting behavior. - Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior. - The greater the commitments to a specific plan of action, the more old model likely health-promoting behaviors will be maintained over time - Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention. ↳ Influences health-promoting behavior - Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and preferred over the target behavior. - Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for healthy actions. STRENGTHS - The Health Promotion Model is simple to understand, yet diving deeper shows its complexity in its structure. - Nola Pender’s nursing theory focused on health promotion and disease prevention, making it stand out from other nursing theories. - It is highly applicable in the community health setting. - It promotes the nursing profession’s independent practice, being the primary source of health-promoting interventions and education. WEAKNESSES - The Health Promotion Model of Pender could not define the nursing metaparadigm or the concepts that a nursing theory should have, man, nursing, environment, and health. - The conceptual framework contains multiple concepts, which may MAJOR ASSUMPTIONS (PERSONS, ENVIRONMENT, HEALTH) invite confusion to the reader. - Persons seek to create conditions of living through which they can - Its applicability to an individual currently experiencing a disease state I express their unique human health potential. was not given emphasis. - Persons have the capacity for reflective self-awareness, including - perior - assessment of their own competencies. - Persons value growth in directions viewed as positive and attempt to achieve a personally acceptable balance between change and stability. - Individuals seek to regulate their own behavior actively. - Individuals in all their biopsychosocial complexity interact with the air environment, progressively transforming the environment and being transformed over time. - Health professionals constitute a part of the interpersonal environment, which influences persons throughout their life span. - Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change. THEORETICAL ASSERTIONS - Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enhancement of health-promoting behavior - Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits. - Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior.  BACKGROUND OF THEORIST supportive, enabling, or facilitative acts to or for another individual or MADELEINE M. LEININGER group to improve a human health condition (or well-being), disability, - While working in a child guidance home during the 1950s, Madeleine lifeway, or to work with dying clients. Leininger experienced what she described as a cultural shock when CULTURAL CONGRUENT (NURSING) CARE she realized that children’s recurrent behavioral patterns appeared to - Cultural congruent (nursing) care is defined as those cognitively based have a cultural basis. She identified a lack of cultural and care - assistive, supportive, facilitative, or enabling acts or decisions that are knowledge as the missing link to nursing. - - tailor-made to fit with the individual, group, or institutional, cultural - Her appointment followed a trip to New Guinea in the 1960s that values, beliefs, and lifeways to provide or support meaningful, opened her eyes to the need for nurses to understand their patients’ beneficial, and satisfying health care, or well-being services. culture and background to provide care. She is considered by some to be the “Margaret Mead of nursing” and is recognized worldwide as the C HEALTH - It is a state of well-being that is culturally defined, valued, and - founder of transcultural nursing, a program that she created at the practiced. 1960s coined the concept of culturally School in 1974. : aunt with congenital heart - It reflects individuals’ (or groups) ‘ ability to perform their daily role disau congruent care activities in culturally expressed, beneficial, and patterned lifeways. - Aunt with congenital heart disease led her to The goal of the Theory of Culture care nursing - pursue a career in ↳ TRANSCULTURAL NURSING THEORY - Through her observations, while working as a nurse, Madeleine - HUMAN BEINGS - Such are believed to be caring and capable of being concerned about Leininger identified a- lack of cultural and care knowledge as the others’ needs, well-being, and survival. missing component to a nurse’s understanding of the many variations - Leininger also indicates that nursing as a caring science should focus required inpatient care to support compliance, healing, and wellness, beyond traditional nurse-patient interactions and dyads to include which led her to develop the theory of Transcultural Nursing also known families, groups, communities, total cultures, and institutions. as Culture Care Theory. - - This theory attempts to provide culturally congruent nursing care - SOCIETY AND ENVIRONMENT - Leininger did not define these terms; she speaks instead of worldview, through “cognitively based assistive, supportive, facilitative, or social structure, and environmental context. enabling acts or decisions that are mostly tailor-made to fir the WORLDVIEW individual, group’s, or institution’s cultural values, beliefs, and lifeways - Worldview is how people look at the world, or the universe, and form a - Leininger’s theory’s main focus is for nursing care to fit with or have “picture or value stance” about the world and their lives. beneficial meaning and health outcomes for people of different or similar cultural backgrounds. With these, she has developed the CULTURAL AND SOCIAL STRUCTURE DIMENSIONS Sunrise Model in a logical order to demonstrate the interrelationships - Cultural and social structure dimensions are defined as involving the of the concepts in her theory of Culture Care Diversity and Universality. dynamic patterns and features of interrelated structural and - “a substantive area of study and practiced focused on comparative organizational factors of a particular culture (subculture or society) cultural care (caring) values, beliefs, and practices of individuals or which includes religious, kinship (social), political (and legal), groups of similar or different cultures to provide culture-specific and economic, educational, technological, and cultural values, universal nursing care practices in promoting health or well-being or to ethnohistorical factors, and how these factors may be interrelated and help people to face unfavorable human conditions, illness, or death in function to influence human behavior in different environmental culturally meaningful ways.” contexts. ENVIRONMENTAL CONTEXT MAJOR CONCEPTS AND DEFINITIONS - Environmental context is the totality of an event, situation, or TRANSCULTURAL NURSING particular experience that gives meaning to human expressions, interpretations, and social interactions in particular physical, - Transcultural nursing is defined as a learned subfield or branch of - ecological, sociopolitical, and/or cultural settings. nursing that focuses upon the comparative study and analysis of - - cultures concerning nursing and health-illness caring practices, CULTURE C - beliefs, and values to provide meaningful and efficacious nursing care - Culture is learned, shared, and transmitted values, beliefs, norms, and services to their cultural values and health-illness context. lifeways of a particular group that guides their thinking, decisions, and ETHNONURSING actions in patterned ways. - This is the study of nursing care beliefs, values, and practices as CULTURE CARE cognitively perceived and known by a - designated culture through their - is defined as the subjectively and objectively learned and transmitted - direct experience, beliefs, and value system (Leininger, 1979). values, beliefs, and patterned lifeways that assist, support, facilitate, or C NURSING enable another individual or group to maintain their well-being, health, improve their human condition lifeway, or deal with illness, handicaps - Nursing is defined as a learned humanistic and scientific profession or death. You take care of their culture also and discipline which is focused on human care phenomena and CULTURE CAREO DIVERSITY - activities to assist, support, facilitate, or enable individuals or groups - indicates the variabilities and/or Q - to maintain or regain their well-being (or health) in culturally - differences in meanings, patterns, meaningful and beneficial ways, or to help people face handicaps or values, lifeways, or symbols of care within or between collectives death. related to assistive, supportive, or enabling human care expressions. PROFESSIONAL NURSING CARE (CARING) CULTURE CARE O UNIVERSALITY - Professional nursing care (caring) is defined as formal and cognitively - - indicates the common, similar, or dominant- - uniform care meanings, learned professional care knowledge and practice skills obtained patterns, values, lifeways, or symbols manifest among many cultures - through educational institutions that are used to provide assistive,  Sunrise Model and reflect assistive, supportive, facilitative, or enabling ways to help people. (Leininger, 1991) GENERIC (FOLK OR LAY) CARE SYSTEMS - Are culturally learned and transmitted, indigenous (or traditional), folk (home-based) knowledge and skills used to provide assistive, supportive, enabling, or facilitative acts toward or for another individual, group, or institution with evident or anticipated needs to ameliorate or improve a human life way, health condition (or well-being), or to deal with handicaps and death situations. EMIC - Knowledge gained from direct experience or directly from those who - have experienced it. It is generic or folk knowledge. Professionally ~ taught in an institution & PROFESSIONAL CARE SYSTEMS Culturallya - Professional care systems are defined as formally taught, learned, and ~ I maintain/ cannot be Preserve imposed transmitted professional care, health, illness, wellness, and related knowledge and practice skills that prevail in professional institutions, - usually with multidisciplinary personnel to serve consumers. tailor-mades to fit ETIC - ↳ goal - The knowledge that describes the professional perspective. It is professional care knowledge. ETHNOHISTORY THREE MODES OF NURSING CARE DECISIONS AND ACTIONS - includes those past facts, events, instances, experiences of individuals, groups, cultures, and instructions that are primarily CULTURAL CARE PRESERVATION OR MAINTENANCE people-centered (ethno) and describe, explain, and interpret human - Cultural care preservation is also known as maintenance. It includes - lifeways within particular cultural contexts over short or long periods of those assistive, supporting, facilitative, or enabling professional time. ↳ History of ethnic group actions and decisions that help people of a particular culture to retain- CARE and/or preserve relevant care values so that they can maintain their - well-being, recover from illness, or face handicaps and/or death. - Care as a noun is defined as those abstract and concrete phenomena related to assisting, supporting, or enabling experiences or behaviors CULTURAL CARE ACCOMMODATION OR NEGOTIATION - toward or for others with evident or anticipated needs to ameliorate or - Cultural care accommodation, also known as negotiation, includes those assistive, supportive, facilitative, or enabling creative - improve - a human condition or lifeway. - Care as a verb is defined as actions and activities directed toward professional actions and decisions that help people of a designated - assisting, supporting, or enabling another individual or group with - culture to adapt to or negotiate with others for a beneficial or satisfying - evident or anticipated needs to ameliorate or improve a human health outcome with professional care providers. condition or lifeway or face death. CULTURE CARE REPATTERNING OR RESTRUCTURING CULTURE SHOCK - Culture care repatterning or Restructuring - Culture care repatterning - Culture shock may result when an outsider attempts to comprehend or or restructuring includes those assistive, supporting, facilitative, or adapt effectively to a different cultural group. The outsider is likely to enabling professional actions and decisions that help clients reorder, - experience feelings of discomfort and helplessness and some degree - change, or greatly modify their lifeways for new, different, and - of disorientation because of the differences in cultural values, beliefs, beneficial health care pattern while respecting the clients’ cultural and practices. values and beliefs and still providing a beneficial or healthier lifeway - Culture shock may lead to anger and can be reduced by seeking than before the changes were established with the clients. (Leininger, knowledge of the culture before encountering that culture. 1991) CULTURAL IMPOSITION - Cultural imposition refers to the outsider’s efforts, both subtle and not MAJOR ASSUMPTIONS so subtle, to impose their own cultural values, beliefs, behaviors upon - Different cultures perceive, know, and practice care differently, yet an individual, family, or group from another culture. (Leininger, 1978) there are some commonalities about care among all world cultures. - Values, beliefs, and practices for culturally related care are shaped by, SUNRISE MODEL and often embedded in, “the worldview, language, religious (or spiritual), kinship (social), political (or legal), educational, economic, - The Sunrise Model is relevant because it enables nurses to develop technological, ethnohistorical, and environmental context of the critical and complex thoughts about nursing practice. These thoughts culture. should consider and integrate cultural and social structure - While human care is universal across cultures, caring may be dimensions in each specific context, besides nursing care’s biological demonstrated through diverse expressions, actions, patterns, and psychological aspects. lifestyles, and meanings. - The cultural care worldview flows into knowledge about individuals, - Cultural care is the broadest holistic means to know, explain, interpret, families, groups, communities, and institutions in diverse health care and predict nursing care phenomena to guide nursing care practices. systems. This knowledge provides culturally specific meanings and - All cultures have generic or folk health care practices, that professional expressions concerning care and health. The next focus is on the practices vary across cultures, and that there will be cultural generic or folk system, professional care systems, and nursing care. similarities and differences between the care-receivers (generic) and Information about these systems includes the characteristics and the the professional caregivers in any culture. specific care features of each. This information allows for the - Care is the distinct, dominant, unifying, and central focus of nursing, identification of similarities and differences or cultural care and while curing and healing cannot occur effectively without care, universality and cultural care diversity. care may occur without a cure. - Next are nursing care decisions and actions which involve cultural care - Care and caring are essential for humans’ survival and their growth, preservation or maintenance, cultural care accommodation or health, well-being, healing, and ability to deal with handicaps and negotiation, and cultural care repatterning or restructuring. It is here death. that nursing care is delivered. - Nursing, as a transcultural care discipline and profession, has a central - Nowadays, nurses must be sensitive to their patients’ cultural purpose of serving human beings in all areas of the world; that when backgrounds when creating a nursing plan. This is especially culturally based nursing care is beneficial and healthy, it contributes important since so many people’s culture is so integral in who they are to the well-being of the client(s) – whether individuals, groups, as individuals, and it is that culture that can greatly affect their health families, communities, or institutions – as they function within the and their reactions to treatments and care. With these, awareness of context of their environments. the differences allows the nurse to design culture-specific nursing - Nursing care will be culturally congruent or beneficial only when the - interventions. nurse knows the clients. The clients’ patterns, expressions, and - - Through Leininger’s theory, nurses can observe how a patient’s cultural cultural values are used in appropriate and meaningful ways by the background is related to their health and use that knowledge to create nurse with the clients. a nursing plan that will help the patient get healthy quickly while still - If clients receive nursing care that is not at least reasonably culturally being sensitive to his or her cultural background. congruent (that is, compatible with and respectful of the clients’ lifeways, beliefs, and values), the client will demonstrate signs of stress, noncompliance, cultural conflicts, and/or ethical or moral Conclusion : concerns. ANALYSIS Nurel must treat patients with a care action tailor-fit to - In Leininger’s nursing theory, it was stated that the nurse would help their cultural beliefs. the client move towards amelioration or improvement of their health practice or condition. This statement would be of great difficulty for the nurse because instilling new ideas in a different culture might present an intrusive intent for the “insiders.” Culture is a strong set of practices developed over generations that would make it difficult to penetrate. - The whole activity of immersing yourself within a different culture is time-consuming to understand their beliefs and practices fully. Another is that it would be costly on the part of the nurse. - Because of its financial constraints and unclear ways of being financially compensated, it can be the reason why nurses do not engage much with this kind of nursing approach. - Because of the intrusive nature, resistance from the “insiders” might impose a risk to the nurse’s safety, especially for cultures with highly taboo practices. - It is highly commendable that Leininger formulated a theory that is specified to a multicultural aspect of care. On the other side, too much was given to the culture concept per se that Leininger failed to discuss the functions or roles of nurses comprehensively. It was not stated how to assist, support or enable the client to attuning them to an improved lifeway. STRENGTHS - Leininger has developed the Sunrise Model in a logical order to demonstrate the interrelationships of the concepts in her theory of Culture Care Diversity and Universality. - Leininger’s theory is essentially parsimonious in that the necessary concepts are incorporated in such a manner that the theory and its model can be applied in many different settings. - It is highly generalizable. The concepts and relationships presented are at a level of abstraction, which allows them to be applied in many different situations. - Though not simple in terms, it can be easily understood upon first contact. WEAKNESS - The theory and model are not simple in terms. CONCLUSION - According to transcultural nursing, nursing care aims to provide care congruent with cultural values, beliefs, and practices. - Cultural knowledge plays a vital role for nurses on how to deal with the patients. To start, it helps nurses to be aware of how the patient’s culture and faith system provide resources for their experiences with illness, suffering, and even death. It helps nurses understand and respect the diversity that is often present in a nurse’s patient load. It also helps strengthen a nurse’s commitment to nursing based on nurse-patient relationships and emphasizing the whole person rather than viewing the patient as simply a set of symptoms or illness. Finally, using cultural knowledge to treat a patient also helps a nurse be open-minded to treatments that can be considered non-traditional, such as spiritually based therapies like meditation and anointing.  BACKGROUND OF THEORIST THE FOUR CONTEXTS IN WHICH PATIENT COMFORT CAN OCCUR: KATHARINE KOLCABA - Physical Bodily sensation - - Born and educated in Cleveland, Ohio. - Psychospiritual Internal awarenes - - 1965, diploma in nursing and practiced part time for many years in - Environmental External surroundings · medical-surgical nursing, long-term care, and home care. - Sociocultural Interpersonal family societal , , relationships - 1987, she graduated in the first R.N. to M.S.N. class at the Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU), THE THEORY OF COMFORT SIX BASIC CONCEPTS (KEY ELEMENTS) with a specialty in gerontology. HEALTH CARE NEEDS - While in school, she shared a job in a head nurse position in a - Health care needs are defined as those needs identified by the patient dementia unit. It was in the context of that experience that she began and/or family in a particular nursing practice setting. theorizing about the outcome of comfort. - Health care needs are defined as the need for comfort that comes from stressful healthcare situations. ACCORDING TO KOLCABA: - The types of needs that can arise are: physical, psychospiritual, social, - Comfort is an immediate desirable outcome of nursing care. Comfort is and environmental. the product of holistic nursing. - Holistic nursing is a practice of nursing that focuses in healing the NURSING INTERVENTIONS whole person ↳> wholeness of person a - are defined as the commitment of nursing and health care institutions - This practice recognizes that a person is not simply his or her to promote comfort care and meet the comfort needs of patients - illness.