Theorist
MARGARET JEAN WATSON
Focuses on the holistic approach in nursing, integrating mind, body, and spirit in patient care.
Margaret Jean Watson's metaparadigm in nursing is a comprehensive framework that guides the practice and philosophy of nursing. It encompasses four key elements: person, health, environment, and nursing. Each of these elements is interconnected and essential to understanding Watson's holistic approach to nursing care.
Margaret Jean Watson's Theory of Caring
Philosophy and Science of Caring
Watson's theory emphasizes that caring in nursing encompasses physical acts while embracing the mind-body-spirit connection. It highlights how nurses' care for patients translates into better health outcomes through a holistic health plan.
Metaparadigm in Nursing
A. Person
- Valued Human Being: A person is viewed as someone to be cared for, respected, nurtured, understood, and assisted.
- Fully Functional Integrated Self: Philosophically, a person is seen as a fully functional integrated self.
- Being-in-the-World: Describes a person as holding three spheres of being—mind, body, and spirit—each influenced by the concept of self and the freedom to make choices.
B. Health
- Unity and Harmony: Health is defined as the unity and harmony within the mind, body, and soul. It includes the degree of congruence between the perceived and experienced self.
- Three Additional Elements: Watson adds to the WHO's definition:
1. High-level physical, mental, and social functioning.
2. General adaptive-maintenance level of daily functioning.
3. Absence of illness (or efforts leading to its absence).
C. Environment
- Behavioral and Goal-Setting Values: The environment provides the values that dictate behavior and goals.
- Cultural Transmission of Caring: Caring is a cultural practice passed down through generations, not through genes.
D. Nursing
- Human Science of Care: Nursing is a human science involving professional, personal, scientific, aesthetic, and ethical care transactions related to health and illness experiences.
Major Elements of Watson’s Theory
1. The Carative Factors
- Core of Nursing: These factors guide the core of nursing from a humanistic perspective combined with scientific knowledge.
- Human Dimensions: They honor the human dimensions of nursing and the subjective experiences of those being cared for.
- Evolution to Caritas Processes: The ten carative factors evolved into ten caritas processes with a spiritual dimension, emphasizing love and caring.
The 10 Caritas Processes
1. Loving-Kindness and Equanimity: Practice toward self and others within the context of caring consciousness.
2. Authentic Presence: Being present and honoring faith, hope, and deep belief systems.
3. Spiritual Practices: Cultivating sensitivity and compassion beyond the ego self.
4. Helping-Trusting Relationships: Developing and sustaining authentic caring relationships.
5. Expression of Feelings: Supporting the expression of both positive and negative feelings.
6. Creative Problem-Solving: Engaging in artistry of caring-healing practices.
7. Teaching-Learning Experience: Promoting transpersonal teaching and learning.
8. Healing Environment: Creating supportive, protective, and corrective environments at all levels.
9. Gratification of Human Needs: Assisting with basic needs while aligning mind-body-spirit unity.
10. Spiritual-Mysterious Dimensions: Attending to existential and phenomenological forces in life and death experiences.
2. Transpersonal Caring Relationship
- Moral Commitment: The nurse’s commitment to protecting and enhancing human dignity and the higher self.
- Caring Consciousness: Communicating to preserve and honor the embodied spirit.
- Healing Potential: The nurse’s caring consciousness and connection can heal through intentional connections.
- Deeper Connections: Transpersonal caring goes beyond the ego to reach deeper spiritual connections, promoting comfort and healing.
3. Caring Occasion
- Human Caring Moment: The moment when a nurse and another person come together, creating an opportunity for human caring.
Watson's Assumptions in the Science of Caring
1. Interpersonal Demonstration: Caring can only be effectively demonstrated and practiced interpersonally.
2. Promotion of Health: Effective caring promotes health and growth for individuals or families.
3. Acceptance of Potential: Caring responses accept a person as they are and as they may become.
4. Development of Potential: A caring environment fosters potential development and allows individuals to choose the best actions for themselves.
5. Healthogenic: Caring is more healthogenic than curing, integrating biophysical knowledge with human behavior understanding.
6. Central to Nursing: The practice of caring is central to nursing.
7. Focus on Carative Factors: The focus of nursing is on the carative factors.
PATRICIA BENNER
Patricia Benner's model outlines the progression of nursing skills from novice to expert, highlighting how nurses acquire expertise through experience and situational engagement.
A. Person
Self-Interpreting Being: Benner describes a person as a self-interpreting being, defined through the course of living a life, not pre-defined.
Understanding of Self: A person has an effortless, non-reflective understanding of the self in the world, participating in common meanings.
Aspects of Understanding: The person must deal with four major aspects:
The role of the situation.
The role of the body.
The role of personal concerns.
The role of temporality (worldly affairs).
B. Health
Disease vs. Illness: Disease can be assessed physically, while illness is the human experience of loss or dysfunction.
Lived Experience: Focuses on the lived experience of being healthy and ill.
Health vs. Well-being: Health is what can be assessed; well-being is the human experience of health or wholeness.
C. Environment
Situation over Environment: Benner uses "situation" to imply a social environment with social definitions and meanings.
Phenomenological Terms: "Situated" and "situated meaning" are defined by a person's interaction, interpretation, and understanding of their situation.
D. Nursing
Lived Experience: Nursing is the care and study of the lived experience of health, illness, and disease, and their interrelationships.
Emotional Involvement: Nursing involves high emotional engagement in the nurse-client relationship, showing connection and concern.
Benner applies the Dreyfus model of skill acquisition, describing five levels of skill development in nursing:
1. Novice
No Experience: The person has no background experience in the situation they are involved in. Nursing students and nurses in new situations fall into this category.
2. Advanced Beginner
Sufficient Experience: The person can understand aspects of the situation. Newly graduated nurses typically belong to this level, managing patient care with some reliance on experienced nurses.
3. Competent
Consistency and Time Management: Performance is characterized by consistency, predictability, and time management. Competence involves active teaching and learning for advancement.
4. Proficient
Holistic View: The performer perceives the situation as a whole rather than in aspects. Performance is guided by maxims, with a qualitative leap beyond competence.
5. Expert
Intuitive Grasp: The expert no longer relies on analytical principles but has an intuitive grasp of situations, demonstrating clinical grasp, resource-based practice, and an ability to see the big picture and unexpected elements.
1. Helping Role
Healing Relationships: Establishing healing relationships, providing comfort, and inviting active patient participation and control.
2. Teaching & Coaching Function
Patient Education: Timing, readying patients for learning, motivating change, assisting with lifestyle alterations, and negotiating goals.
3. Diagnostic Client-Monitoring Function
Ongoing Assessment: Competencies in ongoing assessment and anticipation of outcomes.
4. Effective Management of Rapidly Changing Situations
Crisis Management: Matching demands with resources and managing care during crises.
5. Administering & Monitoring Therapeutic Interventions & Regimens
Preventing Complications: Competencies related to drug therapy, wound management, and hospitalization.
6. Monitoring & Ensuring Quality Health Care Practices
Safety and Improvement: Maintenance of safety, continuous quality improvement, collaboration with physicians, self-evaluation, and technology management.
7. Organizational & Work-Role Competencies
Team Coordination: Competencies in priority setting, team building, coordination, and ensuring continuity.
Patricia Benner's model provides a comprehensive framework for understanding the development of nursing expertise, emphasizing the importance of experience, situational engagement, and the holistic care of patients.
IDA JEAN ORLANDO
Born in 1926.
Known for writing about the nursing process.
Educational Background:
Nursing diploma from New York Medical College.
BS in Public Health Nursing from St. John's University, NY.
MA in Mental Health Nursing from Columbia University, NY.
Professional Positions:
Associate Professor at Yale School of Nursing.
Director of the Graduate Program in Mental Health Psychiatric Nursing.
Project investigator for the National Institute of Mental Health grant.
Board member of Harvard Community Health Plan.
Published influential books: "The Dynamic Nurse-Patient Relationship" (1961) and "The Discipline and Teaching of Nursing Processes" (1972).
Orlando developed the theory of deliberative nursing process, which focuses on the interaction between a nurse and a patient. It comprises three basic elements: the patient's behavior, the nurse's reaction, and the nurse's actions.
Three Basic Aspects:
Patient Behavior
Verbal and nonverbal communication that indicates the patient's immediate needs.
Nurse’s Reaction
The nurse observes the patient’s behavior, interprets it, and formulates a plan to meet the patient's needs.
Communicates with the patient to validate perceptions before deciding on an intervention.
Nursing Actions
An interactive process where the nurse performs actions with the patient to meet their needs.
Benefits:
More effective meeting of patients' needs.
Improved critical thinking.
Enhanced nurse-physician relationships.
Improved nursing identity.
Orlando’s deliberative nursing process theory emphasizes a reciprocal relationship between nurse and patient, highlighting the importance of patient participation.
Key Points:
Formulates effective, adaptable nursing care plans.
Distinguishes nursing from medicine, emphasizing nursing actions based on patient needs rather than physician orders.
Nurses must validate their interpretations and analyses with patients before drawing conclusions.
Assumptions:
Patients become distressed by feelings of helplessness when they cannot cope with their needs.
Nursing can add to the patient’s distress.
Patients respond uniquely to distress.
Nursing offers mothering and nurturing akin to an adult nurturing a child.
Nursing deals with people, the environment, and health.
Patients need help communicating their needs.
People may be secretive or explicit about their needs.
The nurse-patient situation is dynamic, with mutual influence.
People attach personal meanings to situations.
Patients enter nursing care through medicine.
Patients cannot articulate their distress without a helpful relationship with the nurse.
Shared observations with patients help ascertain and meet needs.
Nurses address needs patients cannot meet alone.
Person
A patient with unmet needs, viewed as a developmental being requiring care.
Environment
Not explicitly defined; implied to occur in nurse-patient contact.
Health
Defined as a sense of adequacy, well-being, fulfilled needs, and comfort.
Nursing
A dynamic relationship responsive to individuals' sense of helplessness.
Goals include increasing well-being and self-care abilities, and improving patient behavior.
Function of Professional Nursing
Focused on finding and meeting the patient's immediate needs for help.
Presenting Behavior
Recognizes problematic situations as cries for help, leading to automatic internal responses from the nurse.
Immediate Reaction
The patient’s perceptions and automatic thoughts and feelings in response to situations.
Nursing Process Discipline
Involves investigating and validating observations with the patient.
Improvement
Evaluating whether nursing actions help the patient communicate needs and how those needs are met.
Stages of the Deliberative Nursing Process:
Assessment
Holistic assessment of patient’s needs using a nursing framework.
Diagnosis
Clinical judgment about health problems confirmed through assessment.
Planning
Setting goals and outcomes for identified problems, creating a nursing care plan.
Implementation
Executing the nursing care plan.
Evaluation
Assessing patient progress toward goals, adjusting the care plan as needed, and addressing new problems.
Orlando’s theory emphasizes the importance of understanding patient behavior, validating nurse perceptions, and the dynamic, interactive nature of the nurse-patient relationship.
LYDIA E. HALL
Birth and Education: Born on September 21, 1906, in New York City.
Nursing diploma (1927).
Bachelor of Science in Public Health Nursing (1937).
Master’s degree to teach natural sciences (1942).
Career: First director of the Loeb Center for Nursing with extensive experience in clinical nursing, nursing education, research, and supervision.
Death: Passed away in 1969.
Concept: Hall’s model conceptualizes individuals into three domains:
Care: Hands-on bodily care.
Core: Using the self in relationship to the patient.
Cure: Applying medical knowledge.
Beliefs:
Patients should receive care only from professional nurses.
Nursing is a complex process of teaching and learning.
Professional nursing hastens patient recovery and is crucial as medical care decreases.
Emphasizes the autonomy of professional nursing.
Model is relevant for adult patients in the rehabilitation phase post-acute disease.
Goal: Achieve self-actualization and self-love after disease recovery.
Person
Emphasizes the individual as unique, capable of growth, learning, and requiring a holistic approach.
Healing energy and motivation come from the individual, not the healthcare provider.
Health
Defined as self-awareness and consciously chosen behaviors optimal for the individual.
Nursing helps individuals explore the meaning of their behavior to identify and overcome problems, fostering self-identity and maturity.
Environment
Related to the individual’s psychological experience during acute illness treatment in a hospital.
Nursing actions focus on assisting individuals in achieving personal goals within their environment.
Nursing
Participation in care, core, and cure aspects of patient care.
Core
Refers to the person receiving care and involves the use of therapeutic self in patient relationships.
Cure
Involves medical interventions performed on the patient, including nursing activities dependent on physician orders.
Care
The exclusive domain of nursing, involving independent roles and functions based on the nurse’s knowledge and skills.
Core
Ensuring the patient receives the highest level of care possible from all healthcare professionals.
Cure
Nursing functions dependent on medical professionals, such as medication administration and diagnostic procedures.
Care
Independent nursing responsibilities based on the nurse's expertise and the patient’s condition.
Lydia Hall's model integrates the domains of care, core, and cure to provide comprehensive, patient-centered nursing care, emphasizing professional autonomy and the holistic development of patients during rehabilitation.
NOLA J. PENDER
Educational Background:
Completed master’s-level work in community health nursing at Rush University.
Worked in medical-surgical and pediatric units in Michigan hospitals from 1962.
Served at Michigan State University for 40 years, training undergraduate and graduate students and mentoring postdoctoral candidates.
Professional Roles:
President of the Midwest Nursing Research Society (1985-1987).
President of the American Academy of Nursing (1991-1993).
Member of Research America’s Board of Directors (1991-1993).
Member of the US Preventative Services Task Force (1998-2002).
Associate Dean for Research at the University of Michigan School of Nursing (1990-2001).
Co-founder and trustee of the Midwest Nursing Research Society’s foundation since 2009.
Currently Professor Emeritus at Michigan State University and Distinguished Professor of Nursing at Loyola University School of Nursing in Chicago, Illinois.
The HPM encourages a comprehensive look at variables impacting health behavior, synthesizing research from nursing, psychology, and public health into an explanatory model that still requires further testing.
Person
Individuals seek to create living conditions that allow them to express their unique health potential.
They possess reflective self-awareness, valuing growth, and attempting to balance change and stability.
Actively regulate their own behavior.
Health
Defined as a positive dynamic state, not merely the absence of disease.
Health promotion aims to increase a client's level of well-being.
It highlights the multi-dimensional nature of individuals as they interact within the environment to pursue health.
Environment
Continuous interaction and transformation between individuals and their environment.
Nursing
A helping profession empowering patients towards self-attribution, self-evaluation, and self-efficacy.
Health Promotion
Behavior motivated by the desire to increase well-being and actualize human health potential.
Health Protection
Behavior motivated by the desire to avoid illness, detect it early, or maintain functioning within the constraints of illness.
Personal Factors
Biological: Age, gender, BMI, pubertal status, aerobic capacity, strength, agility.
Psychological: Self-esteem, self-motivation, personal competence, perceived health status.
Socio-cultural: Race, ethnicity, acculturation, education, socioeconomic status.
Perceived Benefits of Action
Anticipated positive outcomes from health behavior.
Perceived Barriers to Action
Anticipated, imagined, or real obstacles and personal costs of undertaking a behavior.
Perceived Self-Efficacy
Judgment of personal capability to organize and execute health-promoting behavior, influencing perceived barriers.
Activity-Related Affect
Subjective positive or negative feelings occurring before, during, and after behavior, influencing self-efficacy.
Interpersonal Influences
Cognition about behaviors, beliefs, or attitudes of others, including norms, social support, and modeling. Primary sources are families, peers, and healthcare providers.
Situational Influences
Personal perceptions and cognitions of situations or contexts that facilitate or impede behavior. Includes perceptions of available options, demand characteristics, and aesthetic features of the environment.
Immediate Competing Demands & Preferences
Competing Demands: Alternative behaviors with low control due to environmental contingencies.
Competing Preferences: Alternative behaviors with high control, like choosing between different snacks.
Commitment to Plan of Action
Concept of intention and planned strategy leading to the implementation of health behavior.
Health-Promoting Behavior
Endpoint or action outcome directed toward attaining positive health outcomes like optimal well-being, personal fulfillment, and productive living.
Nola Pender’s Health Promotion Model emphasizes the proactive pursuit of health through understanding the interplay of individual characteristics, experiences, and behaviors, aiming to foster optimal well-being and personal fulfillment.
MYRA ESTRIN LEVINE
Levine is known for developing the Conservation Model, which she described as a profession and academic discipline integrated with health sciences.
Published key concepts in "The Conservation Principles: A Model for Health".
Conservation
Central to Levine's model, conservation aims to promote adaptation and maintain wholeness through the principles of conservation.
Conservation is achieved through adaptive changes, leading to the preservation of wholeness.
Adaptation
Defined as the "frugal, economic, contained, and controlled use of environmental resources".
Adaptation allows individuals to fit into their environments, facilitating conservation of health and integrity.
Characteristics include historicity (genetically passed responses), specificity (unique responses to specific challenges), and redundancy (multiple adaptive responses).
Wholeness
Exists when ongoing interactions and adaptations assure the individual's integrity.
Conservation of Energy
Balance of energy input and output to avoid fatigue.
Involves adequate rest, nutrition, and exercise.
Conservation of Structural Integrity
Maintaining and restoring bodily structure to prevent breakdown and promote healing.
Examples: range of motion exercises, turning unconscious patients regularly, and providing personal hygiene.
Conservation of Personal Integrity
Recognizes individuals as striving for recognition, respect, self-awareness, and self-determination.
Examples: protecting patient privacy, assisting with body image post-surgery, and providing procedural information.
Conservation of Social Integrity
Recognizes individuals within their social contexts, including family, community, and cultural heritage.
Examples: allowing family visits during hospitalization, supporting spiritual needs, and preserving social roles.
Person
Viewed as holistic beings striving to preserve wholeness and integrity.
Individuals are sentient, thinking, future-oriented, and past-aware.
Each life has meaning within the context of social life, maintaining unity and integrity.
Health
Implies unity and integrity through patterns of adaptive change.
The goal of nursing is to promote health by supporting adaptive changes.
Environment
Completes the wholeness of the individual, consisting of internal and external aspects.
Internal Environment: Physiological and pathophysiological aspects challenged by the external environment.
External Environment:
Perceptual: Responded to by sense organs.
Operational: Interacts with living tissue but not recorded by sensory organs.
Conceptual: Includes language, ideas, symbols, concepts, and cultural traditions.
Nursing
Involves human interactions, aiming to promote adaptation and maintain wholeness.
Nursing decisions are based on the unique behavior of individual patients, requiring personalized care.
Responses that help patients protect and maintain integrity while adapting to the environment:
Fight or Flight: Immediate response to threats.
Inflammatory: Promotes structural integrity and healing.
Stress: Developed over time, influenced by past experiences.
Perceptual: Gathers and interprets environmental information.
About Individuals
Individuals actively interact with their environment, constantly seeking information.
They are sentient beings whose sensory organs are crucial for interaction.
Change is an inherent characteristic of life.
About Nursing
Nursing interventions are based on the unique behavior of individual patients.
Patient-centered care is individualized, reflecting the unique needs of each person.
Levine's Conservation Model emphasizes maintaining wholeness and promoting health through conservation principles, adaptive changes, and individualized nursing care.
Developed by Von Bertalanffy.
Systems are composed of interrelated parts that work together toward a common goal.
Key assumptions include goal direction, the interdependence of parts, and dynamic boundaries.
Influences nursing models such as Imogene King’s Systems Interaction Model and Betty Neuman’s Health Care Systems Model.
Developed by Kurt Lewin.
Change is a dynamic process essential for growth, involving unfreezing, movement, and refreezing stages.
Focuses on recognizing the need for change, analyzing forces, and implementing strategies for change.
Human development is an orderly process from conception to death.
Key areas:
Biophysical Development: Example - Geselle’s Theory.
Psychoanalytic/Psychosocial Development: Example - Freud’s Psychosexual Stages and Erikson’s Psychosocial Stages.
Cognitive Development: Example - Piaget’s Theory of Cognitive Development.
Moral Development: Example - Kohlberg’s Theory of Moral Development.
Adaptation involves the adjustment of living beings to environmental conditions.
Continuously occurring process affecting change through interaction and response.
Related nursing model: Sister Callista Roy’s Adaptation Model.
Developed by Henry Stack Sullivan.
Emphasizes interpersonal relationships and social experiences in shaping personality.
Identifies three types of self: good me, bad me, and not me.
Developmental stages from infancy to late adolescence focus on interpersonal needs and social interactions.
Developed by Abraham Maslow.
Five-tier model of human needs: physiological, safety, love/belonging, esteem, and self-actualization.
Lower needs must be met before higher needs can be addressed.
Expanded hierarchy includes cognitive, aesthetic, and transcendence needs.
These non-nursing theories provide a foundational understanding of various human behaviors and processes, influencing nursing practice and models.
Model: Retirement and Roles Discontinuities
Person: Focuses on the elderly, defining aging as a gradual growth toward maturity of mind, body, and spirit.
Health: Views aging as a process towards self-fulfillment and maintaining positive attitudes.
Nursing: Aims to prepare individuals for retirement and assist them in leaving a legacy.
Key Concepts: Physiological age, role, role discontinuity, coping approaches, and determinants of positive retirement perception.
Model: PREPARE ME (Holistic Nursing Interventions)
Person: Pertains to patients in advanced stages of cancer, focusing on their holistic being.
Health: Emphasizes quality of life despite terminal illness, integrating physical, psychological, and spiritual aspects.
Nursing: Aims to improve quality of life through holistic care.
Key Concepts: Presence, reminisce therapy, prayer, relaxation-breathing, meditation, and values clarification.
Model: CASAGRA Transformative Leadership
Person: Focuses on nursing faculty and their continuous formation of leadership behavior.
Nursing: Encourages transformative teaching centered on values.
Key Concepts: Servant leader spirituality, self-mastery, special nursing practice, and scaffoldings of teaching (creative, caring, critical, contemplative, collegial).
Model: Technological Competency as Caring in Nursing
Person: Sees patients as active participants in their care.
Environment: Defined as the technological world we live in.
Health: Humanity is preserved by technology.
Nursing: Values technological competency as an expression of caring.
Key Concepts: Knowing, designing, participation in appreciation, and verifying knowledge.
These models highlight the unique contributions of Filipino nursing theorists to holistic care, leadership, and the integration of technology in nursing practice.
Model: COMPOSURE Behavior
Person: Individuals need humane, spiritually-oriented care.
Environment: Nurse interventions impact patient wellness.
Health: Comprehensive knowledge of patient conditions to prevent complications and measure wellness outcomes.
Nursing: Focus on delivering quality care through the COMPOSURE behavior model.
COMPOSURE Behaviors: Competence, Presence & Prayer, Open-mindedness, Stimulation, Understanding, Respect & Relaxation, Empathy.
Patient Wellness Outcome: Measured in terms of physiologic and biobehavioral outcomes.
Model: Theory of Nursing Practice and Career
Background: Based on research on nursing activities and patient anxiety in medical-surgical wards.
Concepts: Emphasizes the importance of nurse-patient-family communication to reduce patient anxiety and enhance care.
Key Factors: Nurse’s presence, concern, and stimulation affect patient anxiety and recovery.
Enhancing Factors: Experience, beliefs, attitude, feeling good about work, learning care in school, coping mechanisms, and effective communication.
Predisposing Factors: Age, sex, civil status, educational background, and work experience.
These models emphasize the importance of comprehensive, empathetic, and effective communication in nursing practice to enhance patient outcomes and reduce anxiety.
Read about Watson's holistic approach in nursing.
Study Watson's Theory of Caring and the major elements.
Focus on the Metaparadigm in Nursing: Person, Health, Environment, and Nursing.
Learn about Benner's Nursing Expertise Model.
Understand the Metaparadigm in Nursing according to Benner.
Study the five levels of skill development in nursing from Novice to Expert.
Dive into Orlando's Nursing Process Theory.
Explore the key aspects of the Deliberative Nursing Process Theory.
Understand the Metaparadigms in Orlando's Theory: Person, Environment, Health, and Nursing.
Study Hall's Core, Care, Cure Model.
Learn about the Metaparadigms in Hall's model: Person, Health, Environment, and Nursing.
Understand the concepts of Core, Care, and Cure in nursing.
Explore Nola J. Pender's Health Promotion Model.
Study Myra Estrin Levine's Conservation Model.
Compare and contrast the key concepts and Metaparadigms in both models.
Review General Systems Theory, Change Theory, Developmental Theory, Adaptation Theory, Transactional Analysis, and Maslow's Hierarchy of Needs.
Explore local conceptual models in nursing by Sr. Letty G. Kuan, Carmencita M. Abaquin, Sr. Carolina S. Agravante, Rozzano C. Locsin, Carmelita Divinagracia, and Cecilia Laurente.
By following this structured study plan, you will have a comprehensive understanding of various nursing theories and models for your exam. Good luck! 📚✨
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MARGARET JEAN WATSON
Focuses on the holistic approach in nursing, integrating mind, body, and spirit in patient care.
Margaret Jean Watson's metaparadigm in nursing is a comprehensive framework that guides the practice and philosophy of nursing. It encompasses four key elements: person, health, environment, and nursing. Each of these elements is interconnected and essential to understanding Watson's holistic approach to nursing care.
Margaret Jean Watson's Theory of Caring
Philosophy and Science of Caring
Watson's theory emphasizes that caring in nursing encompasses physical acts while embracing the mind-body-spirit connection. It highlights how nurses' care for patients translates into better health outcomes through a holistic health plan.
Metaparadigm in Nursing
A. Person
- Valued Human Being: A person is viewed as someone to be cared for, respected, nurtured, understood, and assisted.
- Fully Functional Integrated Self: Philosophically, a person is seen as a fully functional integrated self.
- Being-in-the-World: Describes a person as holding three spheres of being—mind, body, and spirit—each influenced by the concept of self and the freedom to make choices.
B. Health
- Unity and Harmony: Health is defined as the unity and harmony within the mind, body, and soul. It includes the degree of congruence between the perceived and experienced self.
- Three Additional Elements: Watson adds to the WHO's definition:
1. High-level physical, mental, and social functioning.
2. General adaptive-maintenance level of daily functioning.
3. Absence of illness (or efforts leading to its absence).
C. Environment
- Behavioral and Goal-Setting Values: The environment provides the values that dictate behavior and goals.
- Cultural Transmission of Caring: Caring is a cultural practice passed down through generations, not through genes.
D. Nursing
- Human Science of Care: Nursing is a human science involving professional, personal, scientific, aesthetic, and ethical care transactions related to health and illness experiences.
Major Elements of Watson’s Theory
1. The Carative Factors
- Core of Nursing: These factors guide the core of nursing from a humanistic perspective combined with scientific knowledge.
- Human Dimensions: They honor the human dimensions of nursing and the subjective experiences of those being cared for.
- Evolution to Caritas Processes: The ten carative factors evolved into ten caritas processes with a spiritual dimension, emphasizing love and caring.
The 10 Caritas Processes
1. Loving-Kindness and Equanimity: Practice toward self and others within the context of caring consciousness.
2. Authentic Presence: Being present and honoring faith, hope, and deep belief systems.
3. Spiritual Practices: Cultivating sensitivity and compassion beyond the ego self.
4. Helping-Trusting Relationships: Developing and sustaining authentic caring relationships.
5. Expression of Feelings: Supporting the expression of both positive and negative feelings.
6. Creative Problem-Solving: Engaging in artistry of caring-healing practices.
7. Teaching-Learning Experience: Promoting transpersonal teaching and learning.
8. Healing Environment: Creating supportive, protective, and corrective environments at all levels.
9. Gratification of Human Needs: Assisting with basic needs while aligning mind-body-spirit unity.
10. Spiritual-Mysterious Dimensions: Attending to existential and phenomenological forces in life and death experiences.
2. Transpersonal Caring Relationship
- Moral Commitment: The nurse’s commitment to protecting and enhancing human dignity and the higher self.
- Caring Consciousness: Communicating to preserve and honor the embodied spirit.
- Healing Potential: The nurse’s caring consciousness and connection can heal through intentional connections.
- Deeper Connections: Transpersonal caring goes beyond the ego to reach deeper spiritual connections, promoting comfort and healing.
3. Caring Occasion
- Human Caring Moment: The moment when a nurse and another person come together, creating an opportunity for human caring.
Watson's Assumptions in the Science of Caring
1. Interpersonal Demonstration: Caring can only be effectively demonstrated and practiced interpersonally.
2. Promotion of Health: Effective caring promotes health and growth for individuals or families.
3. Acceptance of Potential: Caring responses accept a person as they are and as they may become.
4. Development of Potential: A caring environment fosters potential development and allows individuals to choose the best actions for themselves.
5. Healthogenic: Caring is more healthogenic than curing, integrating biophysical knowledge with human behavior understanding.
6. Central to Nursing: The practice of caring is central to nursing.
7. Focus on Carative Factors: The focus of nursing is on the carative factors.
PATRICIA BENNER
Patricia Benner's model outlines the progression of nursing skills from novice to expert, highlighting how nurses acquire expertise through experience and situational engagement.
A. Person
Self-Interpreting Being: Benner describes a person as a self-interpreting being, defined through the course of living a life, not pre-defined.
Understanding of Self: A person has an effortless, non-reflective understanding of the self in the world, participating in common meanings.
Aspects of Understanding: The person must deal with four major aspects:
The role of the situation.
The role of the body.
The role of personal concerns.
The role of temporality (worldly affairs).
B. Health
Disease vs. Illness: Disease can be assessed physically, while illness is the human experience of loss or dysfunction.
Lived Experience: Focuses on the lived experience of being healthy and ill.
Health vs. Well-being: Health is what can be assessed; well-being is the human experience of health or wholeness.
C. Environment
Situation over Environment: Benner uses "situation" to imply a social environment with social definitions and meanings.
Phenomenological Terms: "Situated" and "situated meaning" are defined by a person's interaction, interpretation, and understanding of their situation.
D. Nursing
Lived Experience: Nursing is the care and study of the lived experience of health, illness, and disease, and their interrelationships.
Emotional Involvement: Nursing involves high emotional engagement in the nurse-client relationship, showing connection and concern.
Benner applies the Dreyfus model of skill acquisition, describing five levels of skill development in nursing:
1. Novice
No Experience: The person has no background experience in the situation they are involved in. Nursing students and nurses in new situations fall into this category.
2. Advanced Beginner
Sufficient Experience: The person can understand aspects of the situation. Newly graduated nurses typically belong to this level, managing patient care with some reliance on experienced nurses.
3. Competent
Consistency and Time Management: Performance is characterized by consistency, predictability, and time management. Competence involves active teaching and learning for advancement.
4. Proficient
Holistic View: The performer perceives the situation as a whole rather than in aspects. Performance is guided by maxims, with a qualitative leap beyond competence.
5. Expert
Intuitive Grasp: The expert no longer relies on analytical principles but has an intuitive grasp of situations, demonstrating clinical grasp, resource-based practice, and an ability to see the big picture and unexpected elements.
1. Helping Role
Healing Relationships: Establishing healing relationships, providing comfort, and inviting active patient participation and control.
2. Teaching & Coaching Function
Patient Education: Timing, readying patients for learning, motivating change, assisting with lifestyle alterations, and negotiating goals.
3. Diagnostic Client-Monitoring Function
Ongoing Assessment: Competencies in ongoing assessment and anticipation of outcomes.
4. Effective Management of Rapidly Changing Situations
Crisis Management: Matching demands with resources and managing care during crises.
5. Administering & Monitoring Therapeutic Interventions & Regimens
Preventing Complications: Competencies related to drug therapy, wound management, and hospitalization.
6. Monitoring & Ensuring Quality Health Care Practices
Safety and Improvement: Maintenance of safety, continuous quality improvement, collaboration with physicians, self-evaluation, and technology management.
7. Organizational & Work-Role Competencies
Team Coordination: Competencies in priority setting, team building, coordination, and ensuring continuity.
Patricia Benner's model provides a comprehensive framework for understanding the development of nursing expertise, emphasizing the importance of experience, situational engagement, and the holistic care of patients.
IDA JEAN ORLANDO
Born in 1926.
Known for writing about the nursing process.
Educational Background:
Nursing diploma from New York Medical College.
BS in Public Health Nursing from St. John's University, NY.
MA in Mental Health Nursing from Columbia University, NY.
Professional Positions:
Associate Professor at Yale School of Nursing.
Director of the Graduate Program in Mental Health Psychiatric Nursing.
Project investigator for the National Institute of Mental Health grant.
Board member of Harvard Community Health Plan.
Published influential books: "The Dynamic Nurse-Patient Relationship" (1961) and "The Discipline and Teaching of Nursing Processes" (1972).
Orlando developed the theory of deliberative nursing process, which focuses on the interaction between a nurse and a patient. It comprises three basic elements: the patient's behavior, the nurse's reaction, and the nurse's actions.
Three Basic Aspects:
Patient Behavior
Verbal and nonverbal communication that indicates the patient's immediate needs.
Nurse’s Reaction
The nurse observes the patient’s behavior, interprets it, and formulates a plan to meet the patient's needs.
Communicates with the patient to validate perceptions before deciding on an intervention.
Nursing Actions
An interactive process where the nurse performs actions with the patient to meet their needs.
Benefits:
More effective meeting of patients' needs.
Improved critical thinking.
Enhanced nurse-physician relationships.
Improved nursing identity.
Orlando’s deliberative nursing process theory emphasizes a reciprocal relationship between nurse and patient, highlighting the importance of patient participation.
Key Points:
Formulates effective, adaptable nursing care plans.
Distinguishes nursing from medicine, emphasizing nursing actions based on patient needs rather than physician orders.
Nurses must validate their interpretations and analyses with patients before drawing conclusions.
Assumptions:
Patients become distressed by feelings of helplessness when they cannot cope with their needs.
Nursing can add to the patient’s distress.
Patients respond uniquely to distress.
Nursing offers mothering and nurturing akin to an adult nurturing a child.
Nursing deals with people, the environment, and health.
Patients need help communicating their needs.
People may be secretive or explicit about their needs.
The nurse-patient situation is dynamic, with mutual influence.
People attach personal meanings to situations.
Patients enter nursing care through medicine.
Patients cannot articulate their distress without a helpful relationship with the nurse.
Shared observations with patients help ascertain and meet needs.
Nurses address needs patients cannot meet alone.
Person
A patient with unmet needs, viewed as a developmental being requiring care.
Environment
Not explicitly defined; implied to occur in nurse-patient contact.
Health
Defined as a sense of adequacy, well-being, fulfilled needs, and comfort.
Nursing
A dynamic relationship responsive to individuals' sense of helplessness.
Goals include increasing well-being and self-care abilities, and improving patient behavior.
Function of Professional Nursing
Focused on finding and meeting the patient's immediate needs for help.
Presenting Behavior
Recognizes problematic situations as cries for help, leading to automatic internal responses from the nurse.
Immediate Reaction
The patient’s perceptions and automatic thoughts and feelings in response to situations.
Nursing Process Discipline
Involves investigating and validating observations with the patient.
Improvement
Evaluating whether nursing actions help the patient communicate needs and how those needs are met.
Stages of the Deliberative Nursing Process:
Assessment
Holistic assessment of patient’s needs using a nursing framework.
Diagnosis
Clinical judgment about health problems confirmed through assessment.
Planning
Setting goals and outcomes for identified problems, creating a nursing care plan.
Implementation
Executing the nursing care plan.
Evaluation
Assessing patient progress toward goals, adjusting the care plan as needed, and addressing new problems.
Orlando’s theory emphasizes the importance of understanding patient behavior, validating nurse perceptions, and the dynamic, interactive nature of the nurse-patient relationship.
LYDIA E. HALL
Birth and Education: Born on September 21, 1906, in New York City.
Nursing diploma (1927).
Bachelor of Science in Public Health Nursing (1937).
Master’s degree to teach natural sciences (1942).
Career: First director of the Loeb Center for Nursing with extensive experience in clinical nursing, nursing education, research, and supervision.
Death: Passed away in 1969.
Concept: Hall’s model conceptualizes individuals into three domains:
Care: Hands-on bodily care.
Core: Using the self in relationship to the patient.
Cure: Applying medical knowledge.
Beliefs:
Patients should receive care only from professional nurses.
Nursing is a complex process of teaching and learning.
Professional nursing hastens patient recovery and is crucial as medical care decreases.
Emphasizes the autonomy of professional nursing.
Model is relevant for adult patients in the rehabilitation phase post-acute disease.
Goal: Achieve self-actualization and self-love after disease recovery.
Person
Emphasizes the individual as unique, capable of growth, learning, and requiring a holistic approach.
Healing energy and motivation come from the individual, not the healthcare provider.
Health
Defined as self-awareness and consciously chosen behaviors optimal for the individual.
Nursing helps individuals explore the meaning of their behavior to identify and overcome problems, fostering self-identity and maturity.
Environment
Related to the individual’s psychological experience during acute illness treatment in a hospital.
Nursing actions focus on assisting individuals in achieving personal goals within their environment.
Nursing
Participation in care, core, and cure aspects of patient care.
Core
Refers to the person receiving care and involves the use of therapeutic self in patient relationships.
Cure
Involves medical interventions performed on the patient, including nursing activities dependent on physician orders.
Care
The exclusive domain of nursing, involving independent roles and functions based on the nurse’s knowledge and skills.
Core
Ensuring the patient receives the highest level of care possible from all healthcare professionals.
Cure
Nursing functions dependent on medical professionals, such as medication administration and diagnostic procedures.
Care
Independent nursing responsibilities based on the nurse's expertise and the patient’s condition.
Lydia Hall's model integrates the domains of care, core, and cure to provide comprehensive, patient-centered nursing care, emphasizing professional autonomy and the holistic development of patients during rehabilitation.
NOLA J. PENDER
Educational Background:
Completed master’s-level work in community health nursing at Rush University.
Worked in medical-surgical and pediatric units in Michigan hospitals from 1962.
Served at Michigan State University for 40 years, training undergraduate and graduate students and mentoring postdoctoral candidates.
Professional Roles:
President of the Midwest Nursing Research Society (1985-1987).
President of the American Academy of Nursing (1991-1993).
Member of Research America’s Board of Directors (1991-1993).
Member of the US Preventative Services Task Force (1998-2002).
Associate Dean for Research at the University of Michigan School of Nursing (1990-2001).
Co-founder and trustee of the Midwest Nursing Research Society’s foundation since 2009.
Currently Professor Emeritus at Michigan State University and Distinguished Professor of Nursing at Loyola University School of Nursing in Chicago, Illinois.
The HPM encourages a comprehensive look at variables impacting health behavior, synthesizing research from nursing, psychology, and public health into an explanatory model that still requires further testing.
Person
Individuals seek to create living conditions that allow them to express their unique health potential.
They possess reflective self-awareness, valuing growth, and attempting to balance change and stability.
Actively regulate their own behavior.
Health
Defined as a positive dynamic state, not merely the absence of disease.
Health promotion aims to increase a client's level of well-being.
It highlights the multi-dimensional nature of individuals as they interact within the environment to pursue health.
Environment
Continuous interaction and transformation between individuals and their environment.
Nursing
A helping profession empowering patients towards self-attribution, self-evaluation, and self-efficacy.
Health Promotion
Behavior motivated by the desire to increase well-being and actualize human health potential.
Health Protection
Behavior motivated by the desire to avoid illness, detect it early, or maintain functioning within the constraints of illness.
Personal Factors
Biological: Age, gender, BMI, pubertal status, aerobic capacity, strength, agility.
Psychological: Self-esteem, self-motivation, personal competence, perceived health status.
Socio-cultural: Race, ethnicity, acculturation, education, socioeconomic status.
Perceived Benefits of Action
Anticipated positive outcomes from health behavior.
Perceived Barriers to Action
Anticipated, imagined, or real obstacles and personal costs of undertaking a behavior.
Perceived Self-Efficacy
Judgment of personal capability to organize and execute health-promoting behavior, influencing perceived barriers.
Activity-Related Affect
Subjective positive or negative feelings occurring before, during, and after behavior, influencing self-efficacy.
Interpersonal Influences
Cognition about behaviors, beliefs, or attitudes of others, including norms, social support, and modeling. Primary sources are families, peers, and healthcare providers.
Situational Influences
Personal perceptions and cognitions of situations or contexts that facilitate or impede behavior. Includes perceptions of available options, demand characteristics, and aesthetic features of the environment.
Immediate Competing Demands & Preferences
Competing Demands: Alternative behaviors with low control due to environmental contingencies.
Competing Preferences: Alternative behaviors with high control, like choosing between different snacks.
Commitment to Plan of Action
Concept of intention and planned strategy leading to the implementation of health behavior.
Health-Promoting Behavior
Endpoint or action outcome directed toward attaining positive health outcomes like optimal well-being, personal fulfillment, and productive living.
Nola Pender’s Health Promotion Model emphasizes the proactive pursuit of health through understanding the interplay of individual characteristics, experiences, and behaviors, aiming to foster optimal well-being and personal fulfillment.
MYRA ESTRIN LEVINE
Levine is known for developing the Conservation Model, which she described as a profession and academic discipline integrated with health sciences.
Published key concepts in "The Conservation Principles: A Model for Health".
Conservation
Central to Levine's model, conservation aims to promote adaptation and maintain wholeness through the principles of conservation.
Conservation is achieved through adaptive changes, leading to the preservation of wholeness.
Adaptation
Defined as the "frugal, economic, contained, and controlled use of environmental resources".
Adaptation allows individuals to fit into their environments, facilitating conservation of health and integrity.
Characteristics include historicity (genetically passed responses), specificity (unique responses to specific challenges), and redundancy (multiple adaptive responses).
Wholeness
Exists when ongoing interactions and adaptations assure the individual's integrity.
Conservation of Energy
Balance of energy input and output to avoid fatigue.
Involves adequate rest, nutrition, and exercise.
Conservation of Structural Integrity
Maintaining and restoring bodily structure to prevent breakdown and promote healing.
Examples: range of motion exercises, turning unconscious patients regularly, and providing personal hygiene.
Conservation of Personal Integrity
Recognizes individuals as striving for recognition, respect, self-awareness, and self-determination.
Examples: protecting patient privacy, assisting with body image post-surgery, and providing procedural information.
Conservation of Social Integrity
Recognizes individuals within their social contexts, including family, community, and cultural heritage.
Examples: allowing family visits during hospitalization, supporting spiritual needs, and preserving social roles.
Person
Viewed as holistic beings striving to preserve wholeness and integrity.
Individuals are sentient, thinking, future-oriented, and past-aware.
Each life has meaning within the context of social life, maintaining unity and integrity.
Health
Implies unity and integrity through patterns of adaptive change.
The goal of nursing is to promote health by supporting adaptive changes.
Environment
Completes the wholeness of the individual, consisting of internal and external aspects.
Internal Environment: Physiological and pathophysiological aspects challenged by the external environment.
External Environment:
Perceptual: Responded to by sense organs.
Operational: Interacts with living tissue but not recorded by sensory organs.
Conceptual: Includes language, ideas, symbols, concepts, and cultural traditions.
Nursing
Involves human interactions, aiming to promote adaptation and maintain wholeness.
Nursing decisions are based on the unique behavior of individual patients, requiring personalized care.
Responses that help patients protect and maintain integrity while adapting to the environment:
Fight or Flight: Immediate response to threats.
Inflammatory: Promotes structural integrity and healing.
Stress: Developed over time, influenced by past experiences.
Perceptual: Gathers and interprets environmental information.
About Individuals
Individuals actively interact with their environment, constantly seeking information.
They are sentient beings whose sensory organs are crucial for interaction.
Change is an inherent characteristic of life.
About Nursing
Nursing interventions are based on the unique behavior of individual patients.
Patient-centered care is individualized, reflecting the unique needs of each person.
Levine's Conservation Model emphasizes maintaining wholeness and promoting health through conservation principles, adaptive changes, and individualized nursing care.
Developed by Von Bertalanffy.
Systems are composed of interrelated parts that work together toward a common goal.
Key assumptions include goal direction, the interdependence of parts, and dynamic boundaries.
Influences nursing models such as Imogene King’s Systems Interaction Model and Betty Neuman’s Health Care Systems Model.
Developed by Kurt Lewin.
Change is a dynamic process essential for growth, involving unfreezing, movement, and refreezing stages.
Focuses on recognizing the need for change, analyzing forces, and implementing strategies for change.
Human development is an orderly process from conception to death.
Key areas:
Biophysical Development: Example - Geselle’s Theory.
Psychoanalytic/Psychosocial Development: Example - Freud’s Psychosexual Stages and Erikson’s Psychosocial Stages.
Cognitive Development: Example - Piaget’s Theory of Cognitive Development.
Moral Development: Example - Kohlberg’s Theory of Moral Development.
Adaptation involves the adjustment of living beings to environmental conditions.
Continuously occurring process affecting change through interaction and response.
Related nursing model: Sister Callista Roy’s Adaptation Model.
Developed by Henry Stack Sullivan.
Emphasizes interpersonal relationships and social experiences in shaping personality.
Identifies three types of self: good me, bad me, and not me.
Developmental stages from infancy to late adolescence focus on interpersonal needs and social interactions.
Developed by Abraham Maslow.
Five-tier model of human needs: physiological, safety, love/belonging, esteem, and self-actualization.
Lower needs must be met before higher needs can be addressed.
Expanded hierarchy includes cognitive, aesthetic, and transcendence needs.
These non-nursing theories provide a foundational understanding of various human behaviors and processes, influencing nursing practice and models.
Model: Retirement and Roles Discontinuities
Person: Focuses on the elderly, defining aging as a gradual growth toward maturity of mind, body, and spirit.
Health: Views aging as a process towards self-fulfillment and maintaining positive attitudes.
Nursing: Aims to prepare individuals for retirement and assist them in leaving a legacy.
Key Concepts: Physiological age, role, role discontinuity, coping approaches, and determinants of positive retirement perception.
Model: PREPARE ME (Holistic Nursing Interventions)
Person: Pertains to patients in advanced stages of cancer, focusing on their holistic being.
Health: Emphasizes quality of life despite terminal illness, integrating physical, psychological, and spiritual aspects.
Nursing: Aims to improve quality of life through holistic care.
Key Concepts: Presence, reminisce therapy, prayer, relaxation-breathing, meditation, and values clarification.
Model: CASAGRA Transformative Leadership
Person: Focuses on nursing faculty and their continuous formation of leadership behavior.
Nursing: Encourages transformative teaching centered on values.
Key Concepts: Servant leader spirituality, self-mastery, special nursing practice, and scaffoldings of teaching (creative, caring, critical, contemplative, collegial).
Model: Technological Competency as Caring in Nursing
Person: Sees patients as active participants in their care.
Environment: Defined as the technological world we live in.
Health: Humanity is preserved by technology.
Nursing: Values technological competency as an expression of caring.
Key Concepts: Knowing, designing, participation in appreciation, and verifying knowledge.
These models highlight the unique contributions of Filipino nursing theorists to holistic care, leadership, and the integration of technology in nursing practice.
Model: COMPOSURE Behavior
Person: Individuals need humane, spiritually-oriented care.
Environment: Nurse interventions impact patient wellness.
Health: Comprehensive knowledge of patient conditions to prevent complications and measure wellness outcomes.
Nursing: Focus on delivering quality care through the COMPOSURE behavior model.
COMPOSURE Behaviors: Competence, Presence & Prayer, Open-mindedness, Stimulation, Understanding, Respect & Relaxation, Empathy.
Patient Wellness Outcome: Measured in terms of physiologic and biobehavioral outcomes.
Model: Theory of Nursing Practice and Career
Background: Based on research on nursing activities and patient anxiety in medical-surgical wards.
Concepts: Emphasizes the importance of nurse-patient-family communication to reduce patient anxiety and enhance care.
Key Factors: Nurse’s presence, concern, and stimulation affect patient anxiety and recovery.
Enhancing Factors: Experience, beliefs, attitude, feeling good about work, learning care in school, coping mechanisms, and effective communication.
Predisposing Factors: Age, sex, civil status, educational background, and work experience.
These models emphasize the importance of comprehensive, empathetic, and effective communication in nursing practice to enhance patient outcomes and reduce anxiety.
Read about Watson's holistic approach in nursing.
Study Watson's Theory of Caring and the major elements.
Focus on the Metaparadigm in Nursing: Person, Health, Environment, and Nursing.
Learn about Benner's Nursing Expertise Model.
Understand the Metaparadigm in Nursing according to Benner.
Study the five levels of skill development in nursing from Novice to Expert.
Dive into Orlando's Nursing Process Theory.
Explore the key aspects of the Deliberative Nursing Process Theory.
Understand the Metaparadigms in Orlando's Theory: Person, Environment, Health, and Nursing.
Study Hall's Core, Care, Cure Model.
Learn about the Metaparadigms in Hall's model: Person, Health, Environment, and Nursing.
Understand the concepts of Core, Care, and Cure in nursing.
Explore Nola J. Pender's Health Promotion Model.
Study Myra Estrin Levine's Conservation Model.
Compare and contrast the key concepts and Metaparadigms in both models.
Review General Systems Theory, Change Theory, Developmental Theory, Adaptation Theory, Transactional Analysis, and Maslow's Hierarchy of Needs.
Explore local conceptual models in nursing by Sr. Letty G. Kuan, Carmencita M. Abaquin, Sr. Carolina S. Agravante, Rozzano C. Locsin, Carmelita Divinagracia, and Cecilia Laurente.
By following this structured study plan, you will have a comprehensive understanding of various nursing theories and models for your exam. Good luck! 📚✨
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