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HISTORY OF NURSING THEORY GRADUATE EDUCATION ERA - The history of professional nursing began with Florence Nightingale - Coincided with the research era. - Nightingale envisioned nurses as a body of educated women at a...

HISTORY OF NURSING THEORY GRADUATE EDUCATION ERA - The history of professional nursing began with Florence Nightingale - Coincided with the research era. - Nightingale envisioned nurses as a body of educated women at a time - A Master's degree in nursing emerged. when women were neither educated nor employed. - Nursing master’s programs began to include courses in concept - After her time serving the wounded in Scutari during the Crimean War, development and nursing models, introducing students to early Nightingale’s vision and establishment of a School of Nursing at St. nursing theorists and knowledge development processes. Thomas’ Hospital in London marked the birth of modern nursing. - The baccalaureate degree began to gain wider acceptance as the - Her pioneering activities in nursing practice and education and her education level for professional nursing and nursing attained subsequent writings became a guide for nursing schools and hospitals recognition as an academic discipline at the beginning of the 20th Century. - In the 1970s, nursing continued to make the transition from vocation to profession. DURING THE MID-1800S, - Nightingale recognized the unique focus of nursing and clarified a THEORY ERA distinction between nursing knowledge and medical knowledge. - Natural outgrowth of research and graduate education. - Nightingale described that a nurse’s proper function as putting - Important precursor: general acceptance of nursing as a profession patients in the best condition for nature (God) to act upon them and and an academic discipline. set forth the following: - Doctoral education in nursing began to develop with a strong - Care of the sick is based on knowledge of people and their emphasis on theory development and testing surroundings — a different knowledge used by physicians in their - Accelerated as early work developed as frameworks for curricula and practices. advanced practice began to be recognized as theory. DURING THE 1950s - 1980s: a time of major developments in nursing theory that have been - Nursing leaders began serious discussions of the need to develop characterized as a transition from a pre-paradigm to the paradigm nursing knowledge apart from medical knowledge. period of nursing. - Until the proposal of nursing as a science, nursing practice was based - Fawcett’s seminal proposal of a nursing metaparadigm of four mainly on principles and traditions handed down through an global nursing concepts as an organizing structure of existing apprenticeship model of education and hospital procedure manuals. frameworks - Nursing practice reflected its vocational heritage more than its - Classifying nursing models as paradigms bordered by the professional vision. metaparadigm concepts of person, environment, health, and nursing systematically united nursing theoretical works for the discipline. CURRICULUM ERA - In the last decades of the 20th century, the emphasis shifted from - Addressed what content nurses should study to learn how to be a learning about the theorists to using the theoretical works to generate nurse. research questions, guide practice, and organize curricula. - Emphasized what courses nursing students should take, with the goal - Theory development emerged as a process and product of professional of arriving at a standardized curriculum. scholarship and growth among nurse leaders, administrators, - By the mid-1930s, a standardized curriculum had been published and educators, and practitioners who sought higher education. adopted by many diploma nursing programs where nursing was taught - Fitzpatrick and Whall (1983), “Nursing is on the brink of an exciting at the time. new era” - When the idea of moving nursing education from hospital-based diploma programs to colleges and universities began emerging. THEORY UTILIZATION ERA - In the second half of the 20th century, diploma programs began - Gave way to new levels of development and use of nursing theory for closing and nursing education programs opened in colleges and evidence-based professional practice. universities. - Middle-range theory and the value of a nursing framework for thought - The curriculum era emphasized course selection and content for and action in nursing practices was realized nursing programs. - Shift in emphasis to the application of nursing theory was extremely important for theory-based nursing, evidence-based practice, and RESEARCH EMPHASIS ERA future theory development. - This began during the mid-20th century. - The use of nursing philosophies, models, theories, and middle-range - Nurses began to participate in research, and research courses were theories for the thought and action of nursing practice contributes included in nursing curricula in early graduate nursing programs. important evidence for quality care - 1970s: Evaluation of the first 25 years of the journal Nursing Research - Pickler (2018) stresses the importance of using theory and being revealed that nursing studies lacked conceptual connections and explicit about the theory one is using theoretical frameworks. - Theory is relevant in the history of nursing’s progress toward - Milestones in the evolution of nursing theory: specialized nursing knowledge. That knowledge contributes to the recognition and appreciation of the significance of nursing as a - Awareness of the need for conceptual framework and theory profession and a discipline. development, - The standardization of curricula for nursing master’s education by the National League for Nursing accreditation for baccalaureate SUMMARY OF HISTORICAL ERAS and higher-degree education Historical Major Emphasis Outcomes Emerging - Decision that doctoral education for nurses should be in nursing. Era Question Goal Curriculum What Courses Standardized Develop  SIGNIFICANCE FOR THE PROFESSION Era curriculum included curricula for specialized (1900-1940) should in the diploma knowledge - Profession: refers to a specialized field of practice, founded on the student nursing programs and higher theoretical structure of a science or knowledge of that discipline and nurses program. education accompanying practice abilities. study? - Bixler and Bixler set a criteria for a profession tailored to nursing in the American Journal of Nursing Research What is the Role of Problem Isolated Era focus of nurses studies and studies to Criteria for Development of Professional Status of Nursing (1950s-1970 nursing and what studies of not yield s) research? to nurses unified 1. Utilizes in its practice a well-defined and well-organized body of research knowledge specialized knowledge that is on the intellectual level 2. Constantly enlarges the body of knowledge it uses and improves its Graduate What Carving Nurses have Focus techniques of education and service through use of the scientific Education knowledge out an an important graduate method (1950s-1970 is needed advanced role in health education on 3. Entrusts the education of its practitioners to institutions of higher s) for the role and care knowledge education practice of basis for development 4. Applies its body of knowledge in practical services vital to human nursing? nursing and social welfare practice 5. Functions autonomously in the formulation of professional policy and thereby in the control of professional activity ] Theory Era How do There are Nursing Theories 6. Attracts individuals with intellectual and personal qualities of (1980-1990s these many ways theoretical guide exalting service above their chosen occupation as a life work ) frameworks to think works shift nursing 7. Strives to compensate its practitioners by providing freedom of guide about the focus of research and action, opportunity for continuous professional growth, and research nursing the patient practice. economic security. and practice? - Professional nursing requires a systematic approach that is focused on Theory What new Nursing Middle-range Nursing the patient, and the theoretical works provide perspectives for the Utilization theories are theory theory may frameworks patient. Era needed to guide be from produce - Contributions of global theorists present nursing as a discipline and (21st produce research, quantitative knowledge provide a knowledge structure for further development Century) evidence practice, or qualitative (evidence) for quality education, approaches. for quality care? and care. 14 NURSING THEORISTS: administr NIGHTINGALE ation WATSON BENNET LEVINE SIGNIFICANCE OF NURSING THEORY OREM - At the beginning of the 20th century, nursing was not recognized as an KING academic discipline or a profession NEUMAN - Discipline and Profession are interrelated ROY - Discipline: a branch of knowledge or field of study taught and WIEDENBACH researched as a branch of higher learning; specific to academia HENDERSON and refers to a branch of education ORLANDO - Profession: refers to occupation with preparation in specific ABDELLAH knowledge in higher learning and the performance of a practice; a JOHNSON specialized field of practice, founded on the theoretical structure of PEPLAU the science or knowledge of that discipline and accompanying practice abilities. - Discipline and profession are inextricably linked, but failure to separate them from each other anchors nursing in a vocational rather than a professional view SIGNIFICANCE FOR THE DISCIPLINE - Discipline: is specific to academia and refers to a branch of education, a department of learning, or a domain of knowledge - Conceptualization of a nursing paradigm (person, environment, health, and nursing) as a structure of knowledge clarified the relationships of the collective works of major nursing theorists as conceptual frameworks and nursing paradigms - The significance of theory for nursing is that the discipline is dependent on theory for its continued - The theoretical works have taken nursing to higher levels of education and practice as nurses move from a functional focus to a patient focus - Functional Focus: emphasis on what nurses do - Patient Focus: emphasis on what nurses know about human beings and their health - Every field of knowledge or discipline includes theoretical knowledge, therefore nursing as an academic discipline depends on the existence on nursing knowledge  THEORY RELATIONAL STATEMENTS - A belief, policy, or procedure proposed or followed as the basis of action - Define the relationship between two or more concepts. - Theoria (gk) - to speculate - The chains that link concepts to one another - Organized information about a set of related concepts that may be established or speculative in nature CONCEPTUAL FRAMEWORK - will guide us toward the proper path - An analytical tool that is used to get a comprehensive understanding of a phenomenon COMPONENTS OF A THEORY - It can be used in different fields of work and is commonly used to visually explain the key concepts or variables and the relationships CONCEPT between them that need to be studied - Concipere (lt) - “to conceive” - Consists of concepts that are placed within the logical and sequential - Building blocks of thoughts design - Description of an event, situation, or experience - Represents less formal structure and used for studies in which - words/phrases that identify and establish structure and boundaries existing theory is inapplicable or insufficient for the phenomena and ideas generated by phenomena - Based on specific concepts and propositions derived from empirical - ABSTRACT CONCEPTS: abstract concepts are mentally constructed observation and intuition independent of a specific time or place - May deduce theories from a conceptual framework - Indirectly observed or intangible - Ex: love, care, freedom THEORETICAL FRAMEWORK - CONCRETE CONCEPTS: directly experienced and relate to a particular - It is the structure that can hold or support a theory of a research study time or place - The theoretical framework introduces and describes the theory which - Directly observed or tangible explains why the research problem under study exists - Ex: nurse, mother, fever - The theory provides a point of focus for attacking the unknown in a specific area IDEA - Idein (gk) - “to see” - Product of intellectual thought about the origin of a phenomenon NURSING THEORIES - Anything that describes a concept - Organized frameworks of concepts and purposes designed to guide the - the thinking process before the conceptualization of a phenomenon. practice of nursing PHENOMENON - Developed to explain and describe the nursing care, guide nursing practice and provide a foundation for clinical decision-making - Phainomen (gk) - “a thing appearing” - Provide a way to define nursing as a unique discipline that is separate - Fact or event of scientific interest susceptible to scientific description from other disciplines and explanation - Nursing theories affect everyday nursing practice, by: - Observable fact or event between objects, events, or ideas - An event regarding the idea - Helping nurses use critical thinking skills, analytical skills, and - should be able to be explained scientifically improve concept comprehension - Improving patient care, patient outcomes, and nurse-patient PROPOSITION communication - Proponere (lt.) - “to put forth” - Nursing theories have made a strong and lasting impact on the - idea that us the starting point for making a case or investigation education, training and development of professional nurses - identifies the direction of a relationship between concepts - As the nursing profession continues to evolve and define itself, new - may affirm or deny a predicate of a sentence nursing theories will be needed to guide nurses practicing at bedside - a statement that proposes a relationship between concepts. PRINCIPLE PURPOSES OF NURSING THEORY IN EDUCATION - Principium (lt) - “a beginning” - Defined as a comprehensive and fundamental law, doctrine, or - Provides a general focus for curriculum design assumption - Determines curriculum content and order of subjects - A truth, built on facts, which is foundational to other truths - Develop specialized knowledge and higher education ASSUMPTION PURPOSES OF NURSING THEORY IN RESEARCH - Sumere (lt) - “to take” - Offers framework and approach in the development of nursing - Defined as something taken as being true or factual and use as a knowledge starting point for a course of action or reasoning - Provided research focus and design - Factors that may or may not be constant in a hypothesis PURPOSES OF NURSING THEORY IN PRACTICE HYPOTHESIS - Assists nurses to describe, explain, and predict everyday experiences - A tentative explanation for an observation, phenomenon, or scientific - Establishes common terminologies problem that can be tested by further investigation - Provides knowledge in nursing practice - NULL HYPOTHESIS: testing the likelihood of a statement being true in - Carving out an advanced role for nursing practice order to decide whether to accept or reject our alternative hypothesis - ALTERNATIVE HYPOTHESIS: determine whether or not to accept or reject the statement based on the likelihood of the null hypothesis being true  ANALYSIS FOR NURSING THEORIES - The attributes, characteristics, and actions of the nurse providing are on behalf of or in conjunction with, the client CLARITY - The goal of nursing theories is to improve patient care - “How clear is this theory?” - A word should be defined carefully and specifically according to the PHILOSOPHY framework (philosophy, conceptual model, or theory) within it is - Sets forth the meaning of nursing phenomena through analysis, developed reasoning, and logical presentation of concepts and ideas SIMPLICITY CONCEPTUAL MODELS - “How simple is this theory?” - Sets of concepts that address the phenomena central to nursing - A theory should be sufficiently comprehensive, presented at a level of propositions that explain the relationship among them abstraction to provide guidance, and have as few concepts as possible with simplistic relations to aid clarity GRAND THEORY - Concepts that derive from a conceptual model and propose a testable GENERALITY proposition that tests the major premise of the model - “How general is this theory?” - Speaks of the scope of application and the purpose within the theory NURSING THEORY - Testable propositions from philosophies, conceptual models, grand ACCESSIBILITY theories, abstract nursing theories or theories from other disciplines. - “How accessible is this theory?” Theories are less abstract than grand theory and less specific than - Addresses the extent to which empiric indicators for the concepts can middle-range theory be identified and to what extent the purposes of the theory can be attained MIDDLE-RANGE THEORY - Theory’s capacity to “generate hypotheses and be subjected to - Concepts most specific to practice that propose precise testable empirical research” nursing practice questions and include details such as patient age group, family situation, health condition, location of patient, and action IMPORTANCE of the nurse - “How important is this theory?” - Nursing theories lend itself to research testing, and research testing THE FUTURE OF NURSING THEORY leads to knowledge for practice - Nursing theoretical systems give direction and create understanding - Nursing theory guides research and practice, generated new ideas, and in practice, research, administration, and education. differentiates the focus of nursing from that of other professions CHARACTERISTICS OF A NURSING THEORY - Nursing knowledge is developed - Understands nursing actions through frameworks - Research follow theory for direction - Serves as a validation for nursing practice - Evaluate practice outcome and client response METAPARADIGMS OF NURSING THEORIES - A.K.A conceptual framework or conceptual model - provides different views of nursing according to the characteristics of models PERSON - A.K.A the client or human beings - The recipient of nursing care and may include individuals, patients, groups, families, and communities - Bio-psycho-social being who presents as an integrated whole HEALTH - Defined as the degree of wellness or wellbeing that the client experiences - State of wholeness or integrity of the individual, his parts and his modes of functioning - The ability to function independently regarding activities of daily living (ADL) ENVIRONMENT - A.K.A situation - Internal and external surrounds that affect the client - Sub-component of man and may act in a positive or negative way upon the client NURSING - A profession focused in helping clients to prevent, solve, alleviate or cope with problems associated with ADL  BACKGROUND - The British Royal Sanitary Commission was founded in reaction to - Nightingale came from a well-educated, wealthy, victorian family that Nightingale’s report lives in Derbyshire - Nightingale used a polar diagram to show the number of unnecessary - Her father taught her math, languages, religion, and philosophy which deaths in Crimean British military hospitals influenced her future - Nightingale could record, communicate, order, code, conceptualize, - (1837) Florence, at age 17, quoted “God spoke to me and called me to His infer, analyze, and synthesize research service) - She realized that she wanted to be a nurse, later on MAJOR ASSUMPTIONS - She completed her nursing training in 1851 at the age of 31, in NURSING Kaiserwerth Germany - Nursing is being responsible for someone else’s health - Notes on Nursing (1859) provided women with guidelines and advice in CREDENTIALS “how to think like a nurse” - She was employed to examine hospital facilities, reformatories, and - Trained nurses need additional scientific principles and observation charitable institutions skills to report to patient’s health status - She then became the superintendent of the Hospital for Invalid Gentlewomen in London HEALTH - During the Crimean War, she deployed to Scutari, Turkey along with a - Being well and living life to the fullest extent group of 34 women - Disease and illness is a reparative process - She was nicknamed, “Lady of the Lamp” - Environmental control and social awareness - Addressed the unsafe treatment environments - Using their education to spread awareness of various diseases and - Soldiers recovered but faced diseases how the mass can prevent its infection - Florence Nightingale also got critically ill with Crimean Fever - Florence was commended by Queen Victoria herself and the soldiers PERSON - She started schools and hospitals worldwide from funds she received. - Person as a patient - While critically ill, she wrote 15,000 to 20,000 letters to people - Believed persons as individual meaninf to care for them with the - Brief observations, and plans for change in healthcare patient’s unique preferences - Nightingale worked until her 80s until she lost her vision - The nurse was in control of and responsible for the patient’s - Died: August 13, 1910, at 90 years old environment NOTABLE WRITINGS ENVIRONMENT - Notes on Matter Affecting the Health. Efficiency, and Hospital - Nursing was to assist nature in healing the patient Administration Notes on Hospitals - The patient should create a therapeuic environment that enhances - Notes on Nursing comfort and recorvery - Report on Measures Adopted for Sanitary Improvements in ndia - Poor environment = poor health - What it is and What is not - Nightingale hoped that nurses become an instrument in changing the social status of the poor by improving their physical conditions THEORETICAL SOURCES FOR THEORY DEVELOPMENT - Nightingale’s parents were initially against her learning mathematics, THEORETICAL ASSERTIONS but her parents eventually allowed her to take classes from recognized mathematicians. - Integral factors in the development of Nightingale’s theory: Nightingale believed that disease was a reparative process - Personal Values - Diseases were nature’s effort to remedy a process of poisoning or - Societal Values decay, or it was a reaction aginst the conditions in which the person is - Professional Values placed - With her family’s social status, she had access to powerful people like - The word “Nature” to suggesst that it was synonymous with God family friends - Her friendship with Dickens gave her a platform to discuss social and Nightingale was totally committed to nursing education (training) healthcare issues and influenced her nursing philosophy and concepts - Nurses needed to be excellent observers of patients and the - Nightingale’s nursing philosophy was influenced by the following: environment - John Stuart Mill - In addition, she believed that nurses should use common sense in - Benjamin Jowett practice, coupled with observation, perseverance, and ingenuity - Edwin Chadwick - Harriet Marineau Nightingale didn’t embrace the Germ Theory - Her religious affiliation shared her nursing perspective - Nightingale didn’t beliebe the Germ Theory. However, she clearly - The Catholic-Anglican conflicts in the British Empire may have understood the concept of contagion and contamination impacted her belief that nursing should be a secular profession - For her, the Germ Theory opposes her belief that sanittion, goodhygiene, and approporate manipulation of the environment could prevent USE OF EMPIRICAL EVIDENCE infection. - Nightingale published her studies on social reform, nursing, and healthcare, demonstrating her statistical skills. Nightingale did not explicitly discuss the caring behavior of nurses but - Environment to patient it is clearly shown in her experiences/examples - Environment is the main factor that created illness to a patient - Nightingale wrote little information about her interpersonal - She emphasized the positive aspects of having a comfortable relationships but she did explain how it can influence the patient’s environment as well as its potential of harming a patient reparative processes - According to Nightingal, manipulation of such is needed: - However, her experience in Crimea became a piece of evidence of caring - Elimination of possible contamination and contagion behaviors. These behaviors are considered a blueprint for - Exposure to fresh air transpersonal meanings and models of caring - Proper lighting and warmth - Warner and White (2010) explore and analyze “caring relationships” in - Quietness Nightingale’s own writing. This historical study contributes to our - Nightingale discussed the concept of observation extensively, for understanding of how Nightingale described our modern concept of guidance and evaluation of the caring. - Studies also showed that in today's time, anecdotal evidence of the SIMPLICITY caring and compassionate behaviors of modern nurses was - The Nightingale Theory is descriptive and explanatory highlighted in the media during the COVID-19 pandemic of 2020. GENERALITY Nightingale believed that nurses should be moral agents - Nightingale’s belief have guided nurses worldwide - Nightingale emphasized the importance of nurses as moral agents - Nurse, patient, and environment remain important in modern nursing - She also emphasized the need for clear and concise-decision making between nurses and physicians, stating that indecision or changing the mind is more harmful to patients than making a decision ACCESSIBILITY - Researchers analyzed how Nightingale defined nursing as an ethical - Nightingale’s concepts are still usable to both qualitative and profession and the ethical practices embedded in nursing. quantitative approaches of today FORM OF LOGIC IMPORTANCE - nightingale used inductive reasoning to extract las of health, disease, - Nightingale’s writings direct the nurse to take action on behalf of the and nursing from her observations and experiences patient that encompasses the areas of - She developed her logical thinking and inductive reasoning abilities - Practice because of her education as a child particularly in the field of - Research philosophy and mathematics. - Education - Her training as a superintendent and experiences in Crimea influenced her nursing principles. ACCEPTANCE BY COMMUNITY - Nightingale’s theory is timeless and universal. - Its impact on the nursing community is still evident in today’s society. - This theory focuses on providing patients with the five essential components of environmental health: - Pure air - Pure water - Adequate lighting - Cleanliness - And efficient drainage - The foundation of many different nursing theories and practices - Transformations in society - Empowered nurses to assume a holistic role encompassing both the patient's immediate environment and administrative aspects. - Preparation of students into nurses through training; scientific and practical experiences. - Firm believer in separating practice and education - Her approaches to nursing are more philosophical, and teachings on nursing and patient care are still applied today FURTHER DEVELOPMENT - Provides guidance for nursing care while depicting what nursing is and what nursing is noe - Hardy (1987) said that Nightingale formulated a grand theory, which is an abstract heavy theory that tackles the entirety of nursing behavior - Tourville and Ingalls (2003) even described it as the living tree of all theories CRITIQUE CLARITY - Nightingale’s work addresses three major relationships - Nurse to patient relationship - Nurse to environment  PERSONAL BACKGROUND 10.“Allowance for existential-phenomenological-spiritual forces” - Born and grew up in the small town of Welch, West Virginia in the CARATIVE PROCESS 1940s. 1. “Practice of loving-kindness and equanimity within the context of - In 1997, an accidental injury resulted in the loss of her left eye. caring consciousness” - Married Douglas Watson and moved to his native state of Colorado in 2. “Being authentically present and enabling and sustaining the deep 1961. In 1998, she lost her husband. belief system and subjective life-world of self and one being cared for” EDUCATIONAL BACKGROUND 3. “Cultivation of one’s own spiritual practices and transpersonal self, - Attended high school at Lewis Gale School of Nursing in Virginia. going beyond the ego self” - Continued nursing education at the University of Colorado. 4. “Developing and sustaining a helping trusting an authentic caring - In 1964, earned a baccalaureate degree in nursing. relationship” - 1966, Master’s degree. 5. “Being present to, and supportive of, the expression of positive and - 1973, Doctorate in educational psychology and counseling. negative feelings as a connection with deeper spirit and self and the - In the 1980s, Watson, and colleagues established the Center for Human one being cared for” Caring at the University of Colorado 6. “Creative use of self and all ways of knowing as part of the caring - Watson Caring Science Institute (WCSI) was established by Watson process; to engage in the artistry of caring-healing practices” from groundwork laid by the Center for Human Caring 7. “Engaging in a genuine teaching-learning experience that attends to - Watson Endowed Chair in Caring Sciences was established at the unity of being and meaning, attempting to stay within others’ frame University of Colorado. of reference” - From 1983-1990, she was a dean of the University of Colorado School of 8. “Creating a healing environment at all levels (physical as well as Nursing and associate director of Nursing Practice at the University nonphysical, subtle environment of energy and consciousness, Hospital. whereby wholeness, beauty, comfort, dignity, and peace are AWARDS potentiated).” 9. “Assisting with basic needs, with an intentional caring - 15 honorary degrees and 12 from international universities. consciousness, administering ‘human care essentials,” which - In 1993, she received the National League for Nursing award. potentiate alignment of mind body spirit, wholeness, and unity of - 1998, recognized as a distinguished nurse scholar by New York being in all aspects of care” University. 10.“Opening and attending to spiritual-mysterious and existential - In 2013, the American Academy of Nursing inducted Watson as a dimensions of one’s own life-death; soul care for self and the “Living Legend” their highest honor. one-being-cared for” - Has been involved in international projects and has most recently presented in Jordan, Uruguay, Canada, Japan, the UK, and Greece. BOOKS 10 CARITAS PROCESSES - 1st book: Nursing: The Philosophy and Science of Caring (1979) 1. Sustaining Humanistic-Altruistic Values by Practicing - 2nd book: Nursing: Human Science and Human Care–A Theory of Loving-Kindness, Compassion, and Equanimity with Self (EMBRACE) Nursing (1985) 2. Being Authentically Present; Enabling Faith, Hope, and Belief System; - 3rd book: Postmodern Nursing and Beyond (1999) Honoring Subjective Inner, Life- World of Self/Other. (INSPIRE) - 4th book: Instruments for Assessing and Measuring Caring in Nursing 3. Being Sensitive to Self and Others by Cultivating Own Spiritual and Health Sciences (2002) Practices, Beyond Ego-Self to Transpersonal Presence (TRUST) - 5th book: Caring Science as Sacred Science (2005) 4. Development and Sustaining Loving, Trusting- Caring Relationship (NURTURE) 5. Allowing for Expression of Positive and Negative Feelings—Listening WATSON’S THEORY OF HUMAN CARING Authentically to Another Person’s Story (FORGIVE) - “Nursing is concerned with promoting health, preventing illness, caring 6. Creative Problem-Solving - ”Solution-Seeking” Through Caring for the sick, and restoring health. Process, Full Use of Self and Artistry of Caring-Healing Practices via - focuses on health promotion, as well as the treatment of diseases. Uses of All Ways of Knowing/Being/Doing/Becoming (DEEPEN) - The philosophy covers every aspect of nursing, with a focus on the 7. Engage in Transpersonal Teaching and Learning Within the Context of interaction between the caregiver and the care recipient. a Caring Relationship, Staying Within the Other’s Frame of Reference - The theory is applied through what are called carative factors or Caritas (BALANCE) processes. 8. Creating a Healing Environment at All Levels, a Subtle Environment - Curing versus Caring for Energetic, Authentic Caring Practice (CO-CREATE) 9. Reverentially Assisting With Basic Needs as Sacred Acts, Sustaining CARATIVE FACTORS Human Dignity (MINISTER) 1. “The formation of a humanistic - altruistic system of values” 10.Opening and Attending to the Spiritual, Myster, Unknowns – Allowing 2. “The instillation of faith-hope” for Miracles (OPEN) 3. “The cultivation of sensitivity to one’s self and to others” 4. “Development of a helping-trusting human caring relation” MAJOR ASSUMPTIONS 5. “The promotion and acceptance of the expression of positive and - Moral commitment, intentionality, and Caritas consciousness by the negative feelings” nurse to protect, enhance, and potentiate human dignity, wholeness, 6. “Systematic use of a creative problem-solving caring process” and healing, thereby allowing a person to create or concrete his or her 7. “The promotion of transpersonal teaching- learning” own meaning for existence. 8. “The provision of supportive, protective, and (or) corrective mental, - The conscious will of the nurse affirms the subjective and spiritual physical, societal, and spiritual environment” significance of the patient while seeking to sustain caring in the midst 9. “The assistance with the gratification of human needs” of threat and despair - The nurse seeks to recognize, accurately detect, and connect with the - Many hospitals seeking Magnet status are meeting these challenges inner condition of the spirit of another through the genuine presence by using Watson's theory of human caring for administrative change and by being centered in the caring moment EDUCATION - The nurse’s ability to connect with another at this transpersonal - Watson's writing focus on educating graduate nursing students spirit-to-spirit level - Her theory taught in numerous baccalaureate nursing currciula - The caring-healing modalities within the context of transpersonal - Watson's Caring Science Institute (WSCI) offers numerous trainings caring/Caritas consciousness potentiate harmony, wholeness, and and educational materials unity of being by releasing some of the disharmony - "Caring Science, Mindful Practice" teaches participants both about - Ongoing personal and professional development Watson's theory and introduces principles of mindful practice - The nurse’s own life history - Watson's Caring in the Digital World provides a guide for teaching and - Other facilitators are personal growth experiences such as caring in the digital environment psychotherapy RESEARCH - Continuous growth for developing and maturing within the - Qualitative, naturalistic, and phenomenological methods have been transpersonal caring model is ongoing. identified as particularly relevant to the study of caring - Watson suggests that a combination of qualitative-quantitative THEORETICAL ASSERTIONS inquiry may be useful for futher exploration NURSING - Researchers are providing statiscal validation supporting the impact of - Nursing consists of "knowledge, thought, values, philosophy, the theory commitment, and action, with some degree of passion." - Wide topics were researched - Curing as the elimination of disease - Calls upon nurses to go beyond procedures, tasks, and techniques FURTHER DEVELOPMENT - Focused on human care process - Jean Watson is working with more than 20 different countries that are - Humans cannot be treated as objects and humans cannot be involves in caring science education separated from self, other, nature, and the larger universe. - The paradigm is a guide honoring the whole person PERSON - WSCI continues to grow with innovative national and international - Views the person as "a unity of mind/body/spirit/nature" partnerships - Her views of humanity emphasize the interconnectedness of self, other, and source of existence. - More emphasis on humans as whole spiritual beings, fully connected and evolving the Source with an infinite field of universal consciousness and Cosmic Love" HEALTH - Watson's definition of health was derived from WHO later on, she defined health as “unity and harmony within the mind, body, and soul” ENVIRONMENT - Nurse’s role in the environment as “attending to supportive, protective, and or corrective mental, physical, societal, and spiritual environments” - In broad view of environment she said, "the caring science is not only for sustaining humanity, but also for sustaining the planet." - "Healing spaces can be used to help others transcend illness, pain, and suffering" LOGICAL FORM - Theory contains broad ideas that address health-illness phenomena - Caring - body of nursing knowledge as a separate science - 1979, more on clarifying the relationship of the person of the nurse and the person of the patient - Has foundational support by Carl Rogers, Erikson, and Maslow - Incorporated of postmodern paradigm shift - Replace with postmodern approach leading it to be more holistic, humanistic, open system APPLICATION BY THE NURSING COMMUNITY PRACTICE - Watson's theory has been validated in outpatient, inpatient, and community health clinical setting - Attending Nursing Caring Model (ANCM) exemplified the application of Watson Caring Science to Practice - Continues to be applicable and transformative in hospital systems - Used both internationally and nationally Hospitals can apply for and attain a national designation as a National Caring Science Affiliate ADMINISTRATION AND LEADERSHIP - Calls for administrative practices and business models to embrace caring - Nurses follow their own professional practice model rather than short-term solutions  FACTS ABOUT BENNER NOVICE - Born in August 1942 -- Hampton, Virginia - No experience - Worked as an admitting clerk - Inflexible - Graduated from Pasadena College Batch 1964 - Have theoretical knowledge only - In 1970, Master's Degree in nursing. - Rule follower - Has a Ph.D. and a published dissertation ADVANCED BEGINNER - had a range of clinical experience - Has experience with real situations - Chief Development Officer for educatingnurses.com - Has at least 1-2 years of experience - Director of the Carnegie Foundation for the Advancement of Teaching - Past experience guide actions (ability to recognize recurrent National Nursing Education situations) - Honorary fellow of the Royal College of Nursing COMPETENT - 2008 -- Ranked 4th most influential nurse - Good time management - 2011 -- awarded as a living legend by American Academy of Nursing - 2-3 years experience - Possess the expertise and ability to manage can handle many ABOUT BENNER’S THEORY unexpected occurrences that arise in clinical nursing - Benner is a well-known researcher on health, stress coping, and skill PROFICIENT acquisition. - Guided by maxims - The theory from novice to expert was commemorated in 2002 by The - Has a holistic understanding Institute for Nursing Healthcare Leadership - Uses experience to anticipate needs - Awarded an acknowledgment for 20 years of collecting and extending EXPERT clinical wisdom, experiential learning, and caring practices - Has a broad range of experience - Flexible SOURCES TO BENNER’S THEORY - No longer relies on principle (maxims, rules, and guidelines) to connect - Influenced by Virginia Henderson his/her comprehension of the circumstance to the appropriate path of - Studied clinical nursing practice in an attempt to discover and action describe the knowledge embedded in nursing practice - Articulation Research - “describing, illustrating, and giving language to USE OF EMPIRICAL EVIDENCE taken-for-granted areas of practical wisdom, skilled knowhow and notions of good practice. 1. The helping role - Practical knowledge vs. Theoretical Knowledge 2. The teaching-coaching function - Hubert Dreyfus introduced Benner to Phenomenology. 3. The diagnostic and patient monitoring function - Used the Dreyfus Model of Skill Acquisition in her theory 4. Effective management of rapidly changing situations (flexibility) 5. Administering and monitoring therapeutic interventions and regimens 6. Monitoring and ensuring the quality of health care practices THEORY EXPLANATION 7. Organizational work role competencies. - Benners’ theory describes five levels of skill acquisition and development. (novice, advanced beginner, competent, proficient, and MAJOR ASSUMPTIONS expert) - There are no interpretation-free data - Benner novice to expert was derived from the Dreyfus Model of Skill - There are no nonreactive data Acquisition - Meanings are embedded in skills, practices, intentions, expectations, - Nurses develop skills and clinical knowledge over time through quality and outcomes education and a multitude of experiences. - Primordial understanding — Heidegger (1962). - Benner identified the Dreyfus model as the two interrelated aspects of - The meanings embedded in skills, practices, intentions, expectations, practice from advanced beginner to expert and outcomes cannot be made completely explicit - Clinicians at different levels of practice live in different worlds, - Humans are integrated, holistic beings. recognizing and responding to different situated needs for action - Clinicians develop an agency, or the sense of responsibility toward the patient, and evolve into fully participating members of the healthcare IN VIEW OF THE METAPARADIGMS team. NURSING - Described as an “enabling condition of connection and concern” FIVE LEVELS OF SKILL ACQUISITION - Viewed nursing practice as the care and study of the lived experience of health, illness, disease, and the relationships among these three elements PERSON - “self- interpreting being that is, the person does not come into the world predefined but defined in the course of living a life.” - To overcome the Cartesial Dualism - the body and mind are distinct, separate entities - A person must deal with these aspects:  - Role of the situation - Role of the body - Role of personal concerns - Role of temporality - Believes that a person is embodied HEALTH - Focused on “the lived experiences of being healthy and ill” - Defined health as what can be assessed, while well-being is the human experience of health or wholeness ENVIRONMENT - Used the term “SITUATION” instead of “ENVIRONMENT” - Also used the phenomenological terms “ being situated” and “situated meaning” - “Personal interpretation of the situation is bounded by the way the individual is in it” (Benner & Wrubel, 1989 p. 84) THEORETICAL ASSERTIONS - There is always more to any situation than theory predicts or describes. - Benner used a hermeneutical approach to uncover the knowledge in clinical nursing practice. - Dunlop (1986) had comments on this approach. - As such, the competencies within each domain are in no way intended as an exhaustive list. - Benner examined the role of narrative accounts in understanding the notion of good or ethical caring in expert clinical nursing practice. - One of the relationship statements included in Benner’s work is that clinical knowledge develops over time, and each clinician develops a personal repertoire of practice knowledge that can be shared in dialogue with other clinicians LOGICAL FORM - Benner used the Dreyfus model of skill acquisition to better understand skill acquisition in clinical nursing practice. - Benner was able to identify the performance characteristics and teaching-learning needs inherent at each skill level. - The goal of Benner’s research is to bring meanings and knowledge embedded in skilled practice into public discourse. FURTHER DEVELOPMENT - The separation of academic coursework from clinical learning developed over time. - The ever-increasing complexity of technology and clinical nursing practice coupled with the separation between education and practice sets the stage for new graduate nurses to face a major transition upon graduation. - Benner states the importance of study recommendations - Benner initiated an educational newsletter to share Educating Nurses: A Call for Radical Transformation (2010)  CREDENTIALS AND BACKGROUNDS - Organismic Response (Holistic Response): Integrated and holistic - Private duty nurse (1944) wherein it involved the entire bio-psycho-social-spiritual organism - Civilian nurse in the U.S. Army (1945) - Response to Fear (Flight or Fight): Adreonocortical-sympathetic - Preclinical instructor of Physical Sciences - Cook County School of reactions thar are most primitive biological responses, activated Nursing (1947-1950) whenever a major threat is determined to exist or actually not - Director of nursing - Drexel Home in Chicago (1950-1951) - Inflammatory-Immue Response: as a primary mechanism of - Surgical supervisor - University of Chicago Clinics (1951-1952) healing and protection against an organism’s environmental - Surgical supervisor - Henry Ford Hospital in Detroit (1956-1962) irritants and pathogens - Response to Stress: Upon Selye’s (1956) model of Adaptive Stress Received numerous honors, including: Response, the point is characterized by predictable behavioral anf biological responses to various major or nonspecific stressors - Charter fellow - American Academy of Nursing (1973) - Sensory Response: individual experience of perception - Honorary Member- American Mental Health Aid to Israel (1976) components in the external environment through rendered biologic - Honorary recognition - Illinois Nurses Association (1977) sensory stimuli - First recipient of the Elizabeth Russell Belford Award for Excellence in teaching - Sigma Theta Tau (1977) 4 MAJOR CONSERVATION PRINCIPLES - Both the 1st and 2nd edition of her book "Introduction to Clinical - Conservaton of Energy: from the concept of Energy Balance and First Nursing" (Levine, 1969a, 1973) received American Journal of Nursing Law of Thermodynamics, adaptation efforts to conserve energy are Book of the Year awards reflected and sustained in clinical manifestations of illness and - Her book "Renewal for Nursing" was translated to Hebrew (Levine, 1971c) healing. - Was listed in Who's Who in American Women (1977-1988) - Conservation of Structural Integrity: Restoring the body's structure, - Was listed in Who's Who in American Nursing (1987) preventing physical breakdown, and contributing to healing. - Was active in theory development and encouraged questions and - Conservation of Personal Integrity: Focuses on the interaction research about her theory after her retirement (Levine, 1996) between the patient and the nurse, trying to promote social - Was a frequent presenter of programs, workshops, seminars, and connectivity that nurses intervene to maintain relationships. panels and a prolific writer regarding nursing education - Conservation of Social Integrity: Focuses on the interaction between - Developed a conceptual organizational structure for teaching the patient and the nurse, trying to promote social connectivity that medical-surgical nursing nurses intervene to maintain relationships. - Addressed the goal of the four conservation principles in "Holistic Nursing" (Levine 1969) IN VIEW OF METAPARADIGMS NURSING THEORETICAL SOURCES - “Human Interaction” (Levine, 1973) - Beland (1971) - Theory of Specific Causation and Multiple Factors - Unique knowledge and scientific knowledge (Levine,1988) - Gibson’s (1966) - Definition of Perceptual Systems - Nursing promotes conservation of wholeness and integrity (Levine, - Erikson’s (1964, 1968) - Differentiation Between Total and Whole 1989) - Selye‘s (1956) - Stress Theory - Because of the uniqueness of each individual, nursing care for each - Bates’ (1967) - Model of External Environment patient must be highly individualized. (Levine,1971) - Nightingale (1992) - Contribution to distinguishing ‘guardian activity’ - Nursing interventions are based on the four conservation principles for nurses to ‘save lives and increase health and comfort’. and are both therapeutic and supportive in nature. - Other influences: - “Nursing is a profession as well as an academic discipline, always - Goldstein (1963) practiced and studied in concert with all of the disciplines that - Hall (1966) together form the health sciences.” (Levine,1965) - Sherrington (1906) PERSON - Dubos (1961, 1965) - Holistic, upon wholeness and integrity, along identity and self-worth. - System of systems, and in its wholeness expresses the organization of USE OF EMPIRICAL EVIDENCE all contributing parts. - Countless scientific principles. - Wholeness - healthy, integrated individual. - Research and widely supported evidence. - Health - from Anglo-Saxon word 'hal' , meaning, whole. - Well-researched, evidence-based scientific principles for creation of - Integrity - encompasses wholeness of the individual and the sense of activities. independence and selfhood. - Every individual has a unique range of adaptive responses, simply striving to preserve wholeness. MAJOR CONCEPTS AND DEFINITIONS - The person receiving nursing care is a patient varying from its reaction - Conservation: (lt.) conservatio, which means to “keep together” and a to the stimulus and its owntiming. natural law that describes the way many complex systems are able to HEALTH function even when purposely challenged - Health is socially determined by the ability to function in a reasonably - Adaptation: factor for conservation wholeness, health, and integrity normal manner within: - “It is important to keep in mind that health is also culturally - Historicity: patterned responses through genetics and life determined— it is not an entity on its own, but rather a definition experiences imparted by the ethos and beliefs of the groups to which individuals - Specificity: adaptive responses to specific challenges belong." (Levine, 1995) - Redundancy: availability of multiple adaptive responses - "I use the word 'integrity' to encompass the wholeness of the individual and the sense of independence and selfhood that is implied in that  term. Conserving the integrity of the individual is the hallmark of - The model has also been applied to nursing management, including nursing intervention " (Levine, 1971) outcomes management, and quality improvement. - "Healing is the defense of wholeness" (Levine, 1996) RESEARCH ENVIRONMENT - Researchers have used the conservation principles as a framework to - Environment is the context in which individuals live their lives guide research in wide-ranging clinical situations. - Consists of an internal (physiological andpathophysiological - Fawcett challenged researchers to design "studies that test processes) and the external environment (perceptual, operational, and conceptual-theoretical-empirical structures directly derived or linked conceptual components) with both in continual interaction with the conservation principles INTERNAL ENVIRONMENT EDUCATION - Used Claude Bernard's conceptualization in the 19th century of the - Introduced new material to the curricula and presented an early milleu interne discussion of death and dying. EXTERNAL ENVIRONMENT - Evidence supporting the model has been integrated successfully into - Levine (1973) used Bates’ (1967) description of the external undergraduate and graduate curricula. environment as having three components: - Perceptual - Aspects of the world that individuals intercepts and FURTHER DEVELOPMENT interpret with their sense organs - Levine and others have done work on using the conservation principles - Operational - Environment components that physically affects as the specified basis for a Nursing Diagnosis Taxonomy. individuals, although they cannot directly perceive them, such as - Mefford (2004) developed a middle-range theory of health promotion microorganisms for preterm infants based on Levine's conservation model that was - Conceptual - Characterized by cultural patterns, spirituality, and tested by both him and Alligood. aspects mediated through the symbols of language, thought and - Outcome: The consistency of nursing caregivers also served as a partial history. mediator of the effects of physiological integrity at birth on the use of clinical resources by preterm infants in the neonatal intensive care unit. - Mefford (2022) has also developed a middle-range theory of healing from childhood sorrow and loss based primarily on Levin‘s conservation model but also integrating theoretical elements from he theory of chronic sorrow and the adverse childhood experiences (ACE) pyramid. - Outcome: The findings indicate that interventions to instill hope, promote forgiveness, and reduce negative religious coping may be effective strategies to improve adult life satisfaction in survivors of childhood loss experiences. THEORETICAL ASSERTIONS - "The goal of nursing is to promote adaptation and maintain - wholeness". - "The nurse participates actively in every patient's environment and much ofwhat she does supports his adjustments as he struggles in the predicament of illness". - "When nursing intervention influences adaptation favorably, or toward renewed social well-being, then the nurse is acting in a therapeutic sense; when the the response is unfavorable, the nurse provides supportive care". - "Nursing principles are all 'conservation’ principles." The four conservation principles are the conservation of energy, structural integrity, personal integrity, and social integrity of the individual. LOGICAL FORM - DEDUCTIVE REASONING: Used in the initial development of the conservation model. It is an approach where you progress from general ideas to specific conclusions - Levine came up with the conservation model by integrating various theories and concepts from the humanities and from the sciences of nursing, physiology, psychology, and sociology. - With the assistance of many of her students and colleagues, and through her own personal health encounters (Levine, 1972), - Levine experienced the conservation model and its principles operating in practice. - INDUCTIVE REASONING: Used to further develop and inform the conservation model. It is an approach where youprogress from specific observations to form general conclusions. ACCEPTANCE BY THE NURSING COMMUNITY PRACTICE - Levine's model has been applied as a health promotion model in community settings for adults.  BACKGROUND - maintenance of sufficient intake of food - Full Name: Dorothea Elizabeth Orem - maintenance of sufficient intake of water - Place of Birth: Baltimore, Maryland in 1914 - provision of care associated with elimination processes and - Death: Junee 22, 2007 excrements - maintenance of balance between solitude and social interaction - preventions of hazards to human life, human functioning, and AWARDS AND ACHIEVEMENTS human well-being - 1976: Georgetown University conferred the honorary degree of doctor of - promotion of human-functioning and development within social science on Orem groups in accordance with human potential, known human - 1980: Received the CUA Alumni Association Award for Nursing Theory limitations, and the human desire to and Honorary Doctor of Science from Incarnate World College - be normal. - 1988: Doctor of Humane Letters from Illinois Wesleyan University DEVELOPMENTAL SELF-CARE REQUISITES - 1991: Linda Richards Award from the National League for Nursing - are associated with the development processes. These requisites are - 1998: Awarded Doctor of Nursing from the University of Missouri generally derived from a condition or associated with an event. These - 2004: Reprint of the second edition of Nursing: Concepts of Practice are more specific to a process of growth and development. - Includes the ff: THEORETICAL SOURCES - provision of conditions that promote development - The primary source for Orem’s ideas about nursing was her personal - engagement in self- development experience. She was able to identify the proper object or focus of - prevention of or overcoming effects of human conditions and life nursing through her reflections on nursing practice situations. situations that can adversely affect human development - Orem’s identification of the proper object of nursing marked the HEALTH-DEVIATION SELF-CARE REQUISITES beginning of her theoretical works. - These are requisites required in conditions of illness, injury or disease. - Orem, working independently and also along with her colleagues, - These requisites exist for persons who are ill or injured, who have resulted in the refinement of the Self-Care Deficit Nursing Theory. specific forms of pathological conditions and disorders. - Thereis no particular nursing leader who influenced Orem but she - The health deviation self-care requisites are needs that arise because cited numerous other terms in terms of their contribution to of an injury or disease. nursing. - Includes the ff: - seeking and securing appropriate medical assistance SELF-CARE DEFICIT NURSING THEORY - being aware of and attending to the effects and results of - A general theory by which Orem defined as “one that is descriptively pathologic conditions explanatory of nursing types in all types of nursing situations. - effectively carrying out medically prescribed measures - This theory was one of Orem’s goals to improve the quality of - modifying self-concepts to accept oneself as being in a particular nursing care in her state state of health and in specific forms of health care - There are originally three specific theories articulated: theory of - learning to live with the effects of pathologic conditions. self-care, theory of self-care deficits, and theory of nursing systems. The theory of dependent care was developed later on THEORY OF SELF-CARE (CONT.) - THEORETICAL ASSERTIONS THEORY OF SELF-CARE - the theory of self-care describes why and how people take care of - Self-care: Orem defined as the practice of activities maturing and themselves. Orem emphasized that self-care is a human regulatory mature persons initiate and perform on his or her behalf in action that must be learned and performed deliberately and maintaining life, health, and wellbeing. continuously. - The activities we initiate or perform unto ourselfved in order for us to sustain our health and well-being. THEORY OF SELF-CARE DEFICIT - Self-care agency: ability of mature and maturing persons to engage in - specifies when nursing is needed. According to Orem, nursing is self-care and is influenced by essential conditioning factors. required when an adult is incapable or limited in the provision of - Self-care agency is conditioned by age, experience, and health. continuous, effective self-care. - Therapeutic self-care demands: are the summation of care measles - Self-care deficit: Once a person is not capable of meeting his or her necessary at specific times over a duration of time to meet all of an self-care requisites individual’s known self-requisites. It uses appropriate methods for managing the factors identified in the requisites and fulfilling the - a term that describes the relationship between the action activity element of the requisite capabilities of individuals and their demand for care. - therapeutic self-care is the total self-care actions to be performed - The requirements of persons for nursing care are associated with the over a specific duration to meet self-care requisites subjectivity of mature and maturing persons of health-related or - Self-care requisites are the actions to be performed to regulate human health care-related action limitations. functioning and development - Orem believed that Nursing is only required when the parent, guardian, - These requisites are groups of needs that an individual must attain or dependent isn’t capable of or is limited in providing continuous as identified by Dorothea Orem for us to achieve optimum health effective self-care. - Needs of self-care UNIVERSAL SELF-CARE REQUISITES THEORY OF NURSING SYSTEMS - associated with life processes as well as the maintenance of integrity - it is all about the provision of care to individuals who are unable to of human structure and functioning provide for themselve - Orem also calls these requisites as Activities of daily living. - Determines how a nurse will meet the self-care needs of her patient - These include the ff: - Orem states that there are 3 basic systems of nursing. - maintenance of sufficient intake of air - wholly compensatory system,  - partially compensatory system, and supportive-educative system. - NURSING SYSTEMS: series and sequences of deliberate actions performed at times. - NURSING AGENCY: Capabilities of persons educated as nurses that empower them to present themselves as nurses WHOLLY COMPENSATORY SYSTEM - the nurse is WHOLLY responsible for accomplishing (1) the patient’s therapeutic self-care, (2) compensating for the patient's inability to engage in self-care, and - (3) supporting and protecting the patient. - the nurse will provide the needs the client cannot meet. - the patient becomes dependent sa nurse PARTLY COMPENSATORY SYSTEM - Nurse has the primary responsibility over the patient, however, there are also responsibilities the patient must meet with regards to his self-care - both the nurse and patient perform self-care measures - the patient regulates their own self-care - the nurse is expected to assist the patient as needed, while the patient is expected to accept the care and assistance from the nurse. - Patient and nurse will work hand-in-hand to meet self-care needs SUPPORTIVE-EDUCATIVE SYSTEM - patient is expected to fully accomplish their own self-care, while the nurse regulates or observes their development and self-care agency. - This system gives the patient the most responsibility out of all the three systems - the client or an individual needs to be taught how he/she can meet his/her self-care needs. THEORY OF DEPENDENT CARE - aimed at people who are socially dependent and require assistance for self-care, clarifies that self-care and dependent care are parallel - the person is meeting the self-care needs of another person. - dependent-care agent: the acquired ability of a person to know and meet the therapeutic demand of the dependent person - the demands of providing dependent care may influence or condition your own self-care demand and agency. - As the population grows, so does the need for dependent care. In the coming years, we can expect more and more aged, chronically ill, and debilitated people in need of dependent care. IN VIEW OF METAPARADIGMS NURSING - in orem’s theory, she viewed nursing as art through which the practitioner of nursing gives specialized assistance to persons with disabilities, making more than ordinary assistance necessary PERSON - who are people of all ages to whom nurses provide direct care. HEALTH - the state of being structurally or functionally sound. Health can include both the state of individuals and groups. A subgroup of health, namely Human Health, is the ability to reflect on oneself, symbolize experience and communicate with others. ENVIRONMENT - can have physical, chemical, and biological features. Families, cultures, and communities may be included in the environment. ACCEPTANCE BY THE NURSING COMMUNITY - The SCDNT was adapted by some German Hospitals as a basic structure for the Nursing Management Curriculum, as well as being referenced by the World Health Organization in making the WHO Conceptual Framework for Self-Care Intervention. - in contrast to scdnt acceptance in research and practice, it’s guidance in education is denied  BACKGROUND be stored in our memory for recall and use at a later time in new and - Born on January 30, 1923 - West Point, Iowa, United States different situations - Received Nursing Diploma (1945) - St. John’s Hospital School of Nursing - Received Master of Science in Nursing, and became associate director (1947-1958) - St. John’s School of Nursing - Studied with Mildred Montag [Disseration Chair] (1961) - Developed her research “A Conceptual Frame of Refernce for Nursing” 1968) - Awarded to honorary doctorate (May 1998) - Loyola University - A theory for Nursing: Systems, Concepts, Process her second book, as released (1981) - She was regarded as Professor Emeritus ar the University of South Florida; Kind retired (1990) IN VIEW OF METAPARADIGMS - Her articles were translated into Japanese, Spanish, and German - King’s Personal philosophy about human beings ad life influenced her assumptions SOURCES FOR THEORY DEVELOPMENT - “Based on an overall assumption that the focus of nursing is human - Used her first book as her reference for her theory beings interacting with their environment, leading to a state of health for individuals which is an ability to function in social roles USE OF EMPIRICAL EVIDENCE NURSING - Imogene King believed that concepts are abstract ideas that give - The goal of nursing is to help individuals maintain their health so they meaning to our sense perceptions, permit generalizations, and tend to can function in their roles be stored in our memory for recall and use at a later time in new and - Is an interpesonal process of action, reaction, interaction, and different situations. transaction HEALTH - Nurses have the capacity and the ability to learn - A dynamic process whereas illness interferes with that process the various medical performances a professional - “Implies continuous adjustments to stress in the internal and external environment through the optimum use of one’s resources to achieve nurse must have through the first hand basic the maximum potential for daily living experiences via our senses like sight, hearing, PERSON smell and touch. - Individuals are spirited beings - Individuals have the ability through their language and other symbols - King described the Theory of Goal Attainment to record their history and preserve their culture. as a model that focuses on the attainment of - Individuals are unique and holistic , of intrinsic worth, and capable of rational thinking and most decision-making in most situations certain life goals. - Individuals differ in their needs, wants, and goals ENVIRONMENT - An understanding of the ways that human beings interacts with their environment to maintain health was essential for nurses - Adjustments to life and health are influences by an individual’s interaction with environment - Each human being perceives the world aas a total person in making interactions with individuals and things in the environment THEORETICAL ASSERTIONS - Theory of Goal Attainment: interpersonal system and interactions - Each member perceives the other, makes judgements and take actions - Perceptual Congruence + Conquered Disturbance = Transactions - Open for feedback 8 PROPOSITIONS WITHIN KING’S THEORY OF GOAL ATTAINMENT - The propositions describe relationships among concepts 1. If Perceptual Congruence (PC) is present in nurse-client interaction - Individuals = Personal Systems (I), transactions occur - perception, self growth, and development, body image, space and 2. If nurse and client will make transactions (T), goals will be attained time (GA) - Groups = Interpersonal Systems 3. If goals are attained (GA), satisfaction (S) will occur - interaction , communication , transaction , role , and stress 4. If goals are attained (GA), effective nursing care (NCe) will occur - Societal = Social Systems 5. If transactions (T) are made in nurse-client interactions (I), growth - organization, authority, power, status, and decision- making. and development (GD) will be enhanced - Imogene King believed that concepts are abstract ideas that give 6. If role expectations and role performance as perceived by nurse and meaning to our sense perceptions, permit generalizations, and tend to client are congruent (RNC), transactions (T) will occur  7. If role conflict (RC) is experienced by nurse or client, stress (ST) n nurse-client interactions ((I) will occur 8. If nurses with special knowledge and skill communicate (CM) appropriate information to clients , mutual goal setting (T) and goal attainment (GA) will occur. ACCEPTANCE BY THE NURSING COMMUNITY PRACTICE - Universitites used King’s work to develop nursing curriculum - GONR or Goal-Oriented Nursing records - Collect data - Document the effectiveness of nursing care - Data base, nursing diagnosis, goal list, nursing orders, flow sheers, propress notes, anf discharge summary - Improved documentation in e-health records EDUCATION - Universities used King’s noncepts for nursing curricula - Deve