From Novice to Expert Competent

Patricia E. Benner  Typically a nurse with 2-3 years

experience on the job in the same area
Introduction
or in similar day-to-day situations
 Dr Patricia Benner introduced the  More aware of long-term goals
concept that expert nurses develop  Gains perspective from planning own
skills and understanding of patient care actions based on conscious, abstract,
over time through a sound educational and analytical thinking and helps to
base as well as a multitude of achieve greater efficiency and
experiences. organization
 She proposed that one could gain
knowledge and skills ("knowing how")
without ever learning the theory Proficient
("knowing that").
 She further explains that the  Perceives and understands situations
development of knowledge in applied as whole parts
disciplines such as medicine and nursing  More holistic understanding improves
is composed of the extension of decision-making
practical knowledge (know how)  Learns from experiences what to expect
through research and the in certain situations and how to modify
characterization and understanding of plans
the "know how" of clinical experience.

Expert
LEVELS OF NURSING EXPERIENCE
 No longer relies on principles, rules, or
She described 5 levels of nursing experience as; guidelines to connect situations and
determine actions
Novice  Much more background of experience
 Has intuitive grasp of clinical situations
 Beginner with no experience
 Performance is now fluid, flexible, and
 Taught general rules to help perform
highly-proficient
tasks
 Different levels of skills reflect changes
 Rules are: context-free, independent of
in 3 aspects of skilled performance:
specific cases, and applied universally
 Movement from relying on abstract
 Rule-governed behavior is limited and
principles to using past concrete
inflexible
experiences to guide actions
 Ex. “Tell me what I need to do and I’ll
 Change in learner’s perception of
do it.”
situations as whole parts rather than in
separate pieces
 Passage from a detached observer to an
Advanced Beginner involved performer, no longer outside
the situation but now actively engaged
 Demonstrates acceptable performance
in participation
 Has gained prior experience in actual
situations to recognize recurring
meaningful components
 Principles, based on experiences, begin
to be formulated to guide actions
SIGNIFICANCE OF THE THEORY

 These levels reflect movement from

reliance on past abstract principles to
the use of past concrete experience as
paradigms and change in perception of
 situation as a complete whole in which  She dealt with the interpersonal aspects
certain parts are relevant of nursing.
 Each step builds on the previous one as  She explains “human-to-human
abstract principles are refined and relationship is the means through which
expanded by experience and the the purpose of nursing if fulfilled”
learner gains clinical expertise.
 This theory changed the profession's
understanding of what it means to be Development of the Theory
an expert, placing this designation not
on the nurse with the most highly paid  Travelbee based the assumptions of her
or most prestigious position, but on the theory on the concepts of existentialism
nurse who provided "the most exquisite by Soren Kierkegaard and logotherapy
nursing care. by Viktor Frankl.
 It recognized that nursing was poorly  Existential theory believes that that
served by the paradigm that called for humans are constantly faced choices
all of nursing theory to be developed by and conflicts and is accountable to the
researchers and scholars, but rather choices we make in life
introduced the revolutionary notion  Logotherapy theory was first proposed
that the practice itself could and should by Viktor Frankel, a survivor of
inform theory. Auschwitz, in his book Man's Search for
Meaning (1963).
 Logotherapy
CONCLUSION

 Nursing practice guided by the human

Basic Concepts
becoming theory live the processes of
the Parse practice methodology Suffering
illuminating meaning, synchronizing
rhythms, and mobilizing transcendence "An experience that varies in intensity, duration
and depth ... a feeling of unease, ranging from
 Research guided by the human
mild, transient mental, physical or mental
becoming theory sheds light on the
discomfort to extreme pain and extreme
meaning of universal humanly lived
tortured ..."
experiences such as hope, taking life
day-by-day, grieving, suffering, and
time passing.
Meaning

Meaning is the reason as oneself attributes

Human-To-Human Relationship Model

Nursing
Joyce Travelbee(1926-1973)
 is to help man to find meaning in the
“The nurse is responsible for helping the experience of illness and suffering.
patient avoid and alleviate the distress of  has a responsibility to help individuals
unmet needs.” - Travelbee and their families to find meaning.
 The nurses' spiritual and ethical choices,
and perceptions of illness and suffering,
Introduction is crucial to helping to find meaning.

 Joyce Travelbee (1926-1973) developed

the Human-to-Human Relationship
Model presented in her Hope
bookInterpersonal Aspects of Nursing
 Nurse's job is to help the patient to
(1966, 1971).
maintain hope and avoid hopelessness.
  Hope is a faith that can and will be
change that would bring something
Health
better with it.
 Hope's core lies in a fundamental trust  Health is subjective and objective.
the outside world, and a belief that  Subjective health is an individually
others will help someone when you defined state of well being in accord
need it. with self-appraisal of physical-
emotional-spiritual status.
 Objective health is an absence of
Six important factors charecteristics of hope discernible disease, disability of defect
are: as measured by physical examination,
laboratory tests and assessment by
 It is strongly associated with spiritual director or psychological
dependence on other people. counselor.
 It is future oriented.
 It is linked to elections from several
alternatives or escape routes out of its
Environment
situation.
 The desire to possess any object or Environment is not clearly defined.
condition, to complete a task or have an
experience.
 Confidence that others will be there for
Nursing
one when you need them.
 The hoping person is in possession of "an interpersonal process whereby the
courage to be able to acknowledge its professional nurse practitioner assists an
shortcomings and fears and go forward individual, family or community to prevent or
towards its goal cope with experience or illness and suffering,
and if necessary to find meaning in these
experiences.”
Communications

"a strict necessity for good nursing care"

Description of the theory

 Travelbee believed nursing is

Using himself therapeutic accomplished through human-to-
human relationships that begin with the
 " one is able to use itself therapeutic." original encounter and then progress
 Self-awareness and self-understanding, through stages of emerging identities,
understanding of human behavior, the developing feelings of empathy, and
ability to predict one's own and others' later feelings of sympathy.
behavior are imporatnt in this process.  The nurse and patient attain a rapport
in the final stage. For meeting the goals
of nursing it is a prerequisite to
Targeted intellectual approach achieving a genuine human-to-human
relationships.
Nurse must have a systematic intellectual  This relationship can only be
approach to the patient's situation. established by an interaction process.

Nursing Metaparadigms It has five phases.

Person  The inaugural meeting or original

encounter
 Person is defined as a human being.
 Visibility of personal identities/
 Both the nurse and the patient are
emerging identities.
human beings.
  Empathy  The human is unitary, continuously
 Sympathy coconstituting patterns of relating.
 Establishing mutual understanding and  The human is transcending
contact/ rapport multidimensionally with the possibles

Travelbee's ideas have greatly influenced the About Becoming

hospice movement in the west.
 Becoming is unitary human-living-
health.
 Becoming is a rhythmically
Conclusion
coconstituting human-universe process.
 Travelbee's theory has significantly  Becoming is the human’s patterns of
influenced nursing and health care. relating value priorities.
 Travelbee's ideas have greatly  Becoming is an intersubjective process
influenced the hospice movement in of transcending with the possibles.
the west.  Becoming is unitary human’s emerging

Three Major Assumptions of Human Becoming

Human Becoming Theory Meaning

Rosemarie Rizzo Parse  Human Becoming is freely choosing

personal meaning in situations in the
intersubjective process of living value
priorities.
THEORY DEVELOPMENT
 Man’s reality is given meaning through
 The human becoming theory was lived experiences
developed as a human science nursing  Man and environment cocreate
theory in the tradition of Dilthey,
Heidegger, Sartre, Merleau-Ponty, and
Gadamer and Science of Unitary Human Rhythmicity
Beings
by Martha Rogers .  Human Becoming is cocreating
 The assumptions underpinning the rhythmical patterns of relating in
theory were synthesized from works by mutual process with the universe.
the European philosophers, Heidegger,  Man and environment cocreate (
Sartre, and Merleau-Ponty, along with imaging, valuing, languaging) in
works by the pioneer American nurse rhythmical patterns
theorist, Martha Rogers.
 The theory is structured around three
abiding themes: meaning, rhythmicity, Transcendence
and transcendence.
 Human Becoming is cotranscending
multidimensionally with emerging
possibles.
ASSUMPTIONS
 Refers to reaching out and beyond the
About man limits that a person sets
 One constantly transforms
 The human is coexisting while
coconstituting rhythmical patterns with
the universe.
SUMMARY OF THE THEORY
 The human is open, freely choosing
meaning in situation, bearing  Human Becoming Theory includes
responsibility for decisions. Totality Paradigm
  Man is a combination of biological,
psychological, sociological and spiritual
STRENGTH AND WEAKNESSES
factors
 Simultaneity Paradigm Strengths
 Man is a unitary being in continuous,
mutual interaction with environment  Differentiates nursing from other
 Originally Man-Living-Health Theory disciplines
 Practice - Provides guidelines of care
and useful administration
 Useful in Education
NURSING PARADIGMS AND PARSE'S THEORY
 Provides research methodologies
Person  Provides framework to guide inquiry of
other theories (grief, hope, laughter,
Open being who is more than and different
etc.)
from the sum of the parts

Weaknesses
Environment
 Research considered to be in a “closed
Everything in the person and his experiences
circle”
Inseparable, complimentary to and evolving  Rarely quantifiable results - Difficult to
with compare to other research studies, no
control group, standardized questions,
etc.
 Does not utilized the nursing
Health
process/diagnoses
Open process of being and becoming. Involves  Negates the idea that each person
synthesis of values engages in a unique lived experience
 Not accessible to the novice nurse
 Not applicable to acute, emergent care
Nursing

A human science and art that uses an abstract

body of knowledge to serve people

Ramona Mercer's Contribution to Nursing

SYMBOL OF HUMAN BECOMING THEORY
Theory: Maternal Role Attainment Theory

 The Maternal Role Attainment Theory,

a mid-range theory, was developed to
serve as a framework for nurses to
provide appropriate health care
interventions for nontraditional
mothers in order for them to
Black and white = opposite paradox significant successfully adopt a strong maternal
to ontology of human becoming and green is identity. Though this theory can be used
hope throughout pregnancy and after
childbirth to help mothers connect with
Center joined =co created mutual human their babies, it can also be beneficial for
universe process at the ontological level & adoptive mothers, foster mothers, or
nurse-person process others who have had nontraditional
motherhood unexpectedly, such as
Green and black swirls intertwining = human-
taking care of a relative or friend's child
universe co creation as an ongoing process of
as the result of a death. The process
becoming
helps the mother form an attachment
 to the infant, which in turn helps the Classics in Nursing Theory) in 1961. Her
infant form an attachment with the book purposed a contribution to
mother. This helps in the building of the concern about the nurse-patient
mother-child relationship as the infant relationship, the nurse’s professional
grows. role and identity, and the knowledge
development distinct to nursing.
 The primary concept of this theory is
the developmental and interactional  Orlando’s nursing theory stresses the
process, which occurs over a period of reciprocal relationship between
time. In the process, the mother bonds patient and nurse. What the nurse and
with the infant, acquires competence in the patient say and do affects them
general caretaking tasks, and comes to both. She views the professional
express joy and pleasure in the function of nursing as finding out and
maternal role. meeting the patient’s immediate need
for help.
 The nursing process follows four stages
of acquisition in the Maternal Role  She also described her model as
Attainment Theory. First is the revolving around the following five
anticipatory stage, which addresses the major interrelated concepts: function
social and psychological adaptation to of professional nursing, presenting
the maternal role, and learning behavior, immediate reaction, nursing
expectations. Second is the formal process discipline, and improvement.
stage, which is the assumption of the The function of professional nursing is
role at birth, and addresses behaviors the organizing principle. Presenting
guided by others in the mother's social behavior is the patient’s problematic
system and network. For example, "My situation. The immediate reaction is
mother always said..." Third is the the internal response. The nursing
informal stage, in which the mother process discipline is the investigation
develops her own ways of mothering into the patient’s needs. And lastly,
not conveyed by her social system. improvement is the resolution to the
Finally, the fourth stage is the personal patient’s situation.
stage, in which the mother experiences
harmony, confidence, and competence  The Deliberative Nursing Process has
in her maternal role. five stages: assessment, diagnosis,
planning, implementation, and
evaluation. Nurses use the standard
nursing process in Orlando’s Nursing
Process Discipline Theory to produce
Ida Jean Orlando positive outcomes or patient
improvement. Orlando’s key focus was
Deliberative Nursing Process Theory
the definition of the function of nursing.
 Orlando developed her theory from a The model provides a framework for
study conducted at the Yale University nursing, but the use of her theory does
School of Nursing, integrating mental not exclude nurses from using other
health concepts into a basic nursing nursing theories while caring for
curriculum. She proposed that patients.
“patients have their own meanings and
interpretations of situations and
therefore nurses must validate their Hildegard Peplau
inferences and analyses with patients
before drawing conclusions.” Interpersonal Relations Theory

 Peplau’s theory defined Nursing as “An

 The theory was published in The interpersonal process of therapeutic
Dynamic Nurse-Patient Relationship: interactions between an individual
Function, Process, and Principles (NLN who is sick or in need of health
 services and a nurse especially Health
educated to recognize, respond to the
need for help.” It is a “maturing force Health is defined as “a word symbol that implies
and an educative instrument” involving forward movement of personality and other
ongoing human processes in the direction of
an interaction between two or more
individuals with a common goal. creative, constructive, productive, personal, and
community living.”
 In nursing, this common goal provides
the incentive for the therapeutic
process in which the nurse and patient
respect each other as individuals, both Society or Environment
of them learning and growing as a
Although Peplau does not directly address
result of the interaction. An individual
society/environment, she does encourage the
learns when she or he selects stimuli in
nurse to consider the patient’s culture and
the environment and then reacts to
mores when the patient adjusts to hospital
these stimuli.
routine.

Assumptions
Nursing
The assumptions of Peplau’s Interpersonal
Hildegard Peplau considers nursing to be a
Relations Theory are:
“significant, therapeutic, interpersonal
(1) Nurse and patient can interact. process.” She defines it as a “human
relationship between an individual who is sick,
(2) Peplau emphasized that both the patient or in need of health services, and a nurse
and nurse mature as the result of the specially educated to recognize and to respond
therapeutic interaction. to the need for help.”
(3) Communication and interviewing skills
remain fundamental nursing tools.
Therapeutic nurse-client relationship
(4) Peplau believed that nurses must clearly
understand themselves to promote their A professional and planned relationship
client’s growth and to avoid limiting client’s between client and nurse that focuses on the
choices to those that nurses value. client’s needs, feelings, problems, and ideas. It
involves interaction between two or more
individuals with a common goal. The attainment
of this goal, or any goal, is achieved through a
Major Concepts
series of steps following a sequential pattern.
The theory explains the purpose of nursing is to
help others identify their felt difficulties and
that nurses should apply principles of human Four Phases of the therapeutic nurse-patient
relations to the problems that arise at all levels relationship:
of experience.
1. Orientation Phase

 The orientation phase is directed by the

Man nurse and involves engaging the client
Peplau defines man as an organism that “strives in treatment, providing explanations
in its own way to reduce tension generated by and information, and answering
needs.” The client is an individual with a felt questions.
need.  Problem defining phase
 Starts when client meets nurse as
stranger
 Defining problem and deciding type of
service needed
  Client seeks assistance ,conveys needs 4. Resolution Phase
,asks questions, shares preconceptions
and expectations of past experiences  In the resolution phase, the client no
longer needs professional services and
 Nurse responds, explains roles to client,
gives up dependent behavior. The
helps to identify problems and to use
relationship ends.
available resources and services
 In the resolution phase, the client no
 Factors influencing orientation phase.
longer needs professional services and
Click to enlarge.
gives up dependent behavior. The
 Factors influencing orientation phase.
relationship ends.
Click to enlarge.
 Termination of professional relationship
 The patients needs have already been
met by the collaborative effect of
2. Identification Phase patient and nurse
 The identification phase begins when  Now they need to terminate their
the client works interdependently with therapeutic relationship and dissolve
the nurse, expresses feelings, and the links between them.
begins to feel stronger.  Sometimes may be difficult for both as
 Selection of appropriate professional psychological dependence persists
assistance  Patient drifts away and breaks bond
 Patient begins to have a feeling of with nurse and healthier emotional
belonging and a capability of dealing balance is demonstrated and both
with the problem which decreases the becomes mature individuals
feeling of helplessness and
hopelessness
Subconcepts

Peplau’s model has proved of great use to later

3. Exploitation Phase nurse theorists and clinicians in developing
 In the exploitation phase, the client more sophisticated and therapeutic nursing
makes full use of the services offered. interventions.
 In the exploitation phase, the client
makes full use of the services offered.
 Use of professional assistance for The following are the roles of the Nurse in the
problem solving alternatives Therapeutic relationship identified by Peplau:
 Advantages of services are used is
Stranger: offering the client the same
based on the needs and interests of the
acceptance and courtesy that the nurse would
patients
to any stranger
 Individual feels as an integral part of the
helping environment Resource person: providing specific answers to
 They may make minor requests or questions within a larger context
attention getting techniques
 The principles of interview techniques Teacher: helping the client to learn formally or
must be used in order to explore, informally
understand and adequately deal with Leader: offering direction to the client or group
the underlying problem
 Patient may fluctuates on Surrogate: serving as a substitute for another
independence such as a parent or a sibling
 Nurse must be aware about the various
Counselor: promoting experiences leading to
phases of communication
health for the client such as expression of
 Nurse aids the patient in exploiting all
feelings
avenues of help and progress is made
towards the final step Technical Expert: providing physical care for the
patient and operates equipment
Peplau also believed that the nurse could take Interpersonal Theory and Nursing Process
on many other roles but these were not defined
in detail. However, they were “left to the Both Peplau’s Interpersonal Relations Theory
intelligence and imagination of the readers.” and the Nursing Process are sequential and
focus on therapeutic relationship by using
(Peplau, 1952)
problem solving techniques for the nurse and
patient to collaborate on, with the end purpose
of meeting the patients needs. Both use
Additional roles include: observation communication and recording as
 Technical expert basic tools utilized by nursing.
 Consultant
 Health teacher
 Tutor Assessment
 Socializing agent
 Continuous data collection and analysis
 Safety agent
 May not be a felt need
 Manager of environment
 Mediator
 Administrator
 Recorder observer Orientation
 Researcher  Non-continuous data collection
 Felt need
 Definite needs
Anxiety was defined as the initial response to a
psychic threat. There are four levels of anxiety
described below. Nursing Diagnosis & Planning
Four Levels of Anxiety Mutually set goals
Mild anxiety is a positive state of heightened
awareness and sharpened senses, allowing the
person to learn new behaviors and solve Identification
problems. The person can take in all available
stimuli (perceptual field).  Interdependent goal setting
 Implementation
 Plans initiated towards achievement of
mutually set goals
Moderate anxiety involves a decreased
 May be accomplished by patient, nurse,
perceptual field (focus on immediate task only);
or significant other.
the person can learn new behavior or solve
problems only with assistance. Another person
can redirect the person to the task.
Exploitation

 Patient actively seeking and drawing

Severe anxiety involves feelings of dread and help
terror. The person cannot be redirected to a  Patient initiated
task; he or she focuses only on scattered details  Evaluation
and has physiologic symptoms of tachycardia,  Based on mutually expected behaviors
diaphoresis, and chest pain.  May led to termination and initiation of
new plans

Panic anxiety can involve loss of rational

thought, delusions, hallucinations, and Resolution
complete physical immobility and muteness.
The person may bolt and run aimlessly, often  Occurs after other phases are
exposing himself or herself to injury. completed successfully
 Leads to termination
Strengths Imogene King

Peplau’s theory helped later nursing theorists Goal Attainment Theory

and clinicians develop more therapeutic
interventions regarding the roles that show the  The Theory of Goal Attainment states
dynamic character typical in clinical nursing. that “Nursing is a process of action,
reaction, and interaction whereby nurse
Its phases provide simplicity regarding the and client share information about their
natural progression of the nurse-patient perception in the nursing situation.”
relationship, which leads to adaptability in any
nurse-patient interaction, thus providing  King’s Theory of Goal Attainment was
generalizability. first introduced in the 1960s. From the
title itself, the model focuses on the
attainment of certain life goals. It
Weaknesses explains that the nurse and patient go
hand-in-hand in communicating
 Though Peplau stressed the nurse-client information, set goals together, and
relationship as the foundation of then take actions to achieve those
nursing practice, health promotion, and goals. The factors that affect the
maintenance were less emphasized. attainment of goals are roles, stress,
 Also, the theory cannot be used in a space, and time. On the other hand, the
patient who doesn’t have a felt need goal of the nurse is to help patients
such as with withdrawn patients. maintain health so they can function in
their individual roles. The nurse’s
function is to interpret information in
Conclusion the nursing process, to plan,
implement, and evaluate nursing care.
 Peplau’s theory has proved of great use
to later nurse theorists and clinicians in  To help nurses understand her work,
developing more sophisticated and she defined several terms which include
therapeutic nursing interventions the
including the seven nursing roles, which
show the dynamic character roles Patient
typical in clinical nursing. It entails that
social being who has three fundamental needs:
a nurse’s duty is not just to care but the
the need for health information, the need for
profession also incorporates every
care that seeks to prevent illness, and the need
activity that may affect the client’s
for care when the patient is unable to help him
health.
or herself.
 However, the idea of a nurse-client
cooperation is found narrow with those Health
individuals who are unfit and powerless
in conversing, specifically those who are involving life experiences of the patient, which
unconscious and paralyzed. includes adjusting to stressors in the internal
and external environment by using resources
 Studying Peplau’s Interpersonal
available.
Relations Theory of Nursing can be very
substantial especially to those who are
aspiring to be part of the profession.
Having the knowledge of the seven Environment
roles of nursing, future nurses can apply
the background for human interaction. It
different roles in different situations,
involves the internal environment, which
which will guarantee their patients to
transforms energy to enable people to adjust to
acquire the best care possible, and will
external environmental changes, and it involves
ultimately speed along treatment and
the external environment, which is formal and
recovery.
informal organizations.
Nurse knowledge of the parts. A person is also
a unified whole, having its own distinct
considered part of the patient’s environment. characteristics that can’t be viewed by
looking at, describing, or summarizing
the parts.
Three interacting systems

 concepts for the personal system are:

perception, self, growth and Health
development, body image, space, and  Rogers defines health as an expression
time. of the life process. It is the
 concepts for the interpersonal system characteristics and behavior coming
are: interaction, communication, from the mutual, simultaneous
transaction, role, and stress. interaction of the human and
 concepts for the social system are: environmental fields, and health and
organization, authority, power, status, illness are part of the same continuum.
and decision making. The multiple events occurring during
the life process show the extent to
which a person is achieving his or her
maximum health potential. The events
vary in their expressions from greatest
health to those conditions that are
Martha Rogers incompatible with the maintaining life
process.
Unitary Human Being

The assumptions
Nursing
(1) Man is a unified whole possessing his own
integrity and manifesting characteristics that  It is the study of unitary, irreducible,
are more than and different from the sum of his indivisible human and environmental
parts. fields: people and their world. Rogers
claims that nursing exists to serve
(2) Man and environment are continuously people, and the safe practice of nursing
exchanging matter and energy with one depends on the nature and amount of
another. scientific nursing knowledge the nurse
brings to his or her practice
(3) The life process evolves irreversibly and
unidirectionally along the space-time
continuum.
Scope of Nursing
(4) Pattern and organization identify man and
reflect his innovative wholeness.  Nursing aims to assist people in
achieving their maximum health
(5) Man is characterized by the capacity for potential. Maintenance and promotion
abstraction and imagery, language and thought, of health, prevention of disease,
sensation and emotion. nursing diagnosis, intervention, and
rehabilitation encompass the scope of
nursing’s goals.
Major Concepts  Nursing is concerned with people-all
people-well and sick, rich and poor,
Human-unitary human beings young and old. The arenas of nursing’s
services extend into all areas where
 A person is defined as an indivisible,
there are people: at home, at school, at
pan-dimensional energy field identified
work, at play; in hospital, nursing home,
by pattern, and manifesting
and clinic; on this planet and now
characteristics specific to the whole,
moving into outer space.
and that can’t be predicted from
Environmental Field Principles of Homeodynamics

“An irreducible, indivisible, pandimensional  Homeodynamics should be understood

energy field identified by pattern and integral as a dynamic version of homeostasis (a
with the human field.” relatively steady state of internal
operation in the living system).
 Homeodynamic principles postulate a
Energy Field way of viewing unitary human beings.
The three principles of homeodynamics
 The energy field is the fundamental unit are resonance, helicy, and integrality.
of both the living and the non-living. It
provides a way to view people and the
environment as irreducible wholes. The
Principle of Reciprocy
energy fields continuously vary in
intensity, density, and extent.  Postulates the inseparability of man and
environment and predicts that
sequential changes in life process are
Subconcepts continuous, probabilistic revisions
occurring out of the interactions
Openness between man and environment.

 There are no boundaries that stop

energy flow between the human and
environmental fields, which is the Principle of Synchrony
openness in Rogers’ theory. It refers to
 This principle predicts that change in
qualities exhibited by open systems;
human behavior will be determined by
human beings and their environment
the simultaneous interaction of the
are open systems.
actual state of the human field and the
actual state of the environmental field
at any given point in space-time.
Pandimensional

 Pan-dimensionality is defined as “non-

linear domain without spatial or Principle of Integrality (Synchrony + Reciprocy)
temporal attributes.” The parameters
 Because of the inseparability of human
that humans use in language to
beings and their environment,
describe events are arbitrary, and the
sequential changes in the life processes
present is relative; there is no temporal
are continuous revisions occurring from
ordering of lives.
the interactions between human beings
 Synergy is defined as the unique
and their environment.
behavior of whole systems, unpredicted
 Between the two entities, there is a
by any behaviors of their component
constant mutual interaction and mutual
functions taken separately.
change whereby simultaneous molding
 Human behavior is synergistic.
is taking place in both at the same time.

Pattern
Principle of Resonancy
 Rogers defined pattern as the
 It speaks to the nature of the change
distinguishing characteristic of an
occurring between human and
energy field seen as a single wave. It is
environmental fields. The life process in
an abstraction, and gives identity to the
human beings is a symphony of
field.
rhythmical vibrations oscillating at
various frequencies.
 It is the identification of the human
field and the environmental field by
 wave patterns manifesting continuous Strengths
change from longer waves of lower
frequency to shorter waves of higher  Rogers’ concepts provide a worldview
frequency. from which nurses may derive theories
and hypotheses and propose
relationships specific to different
situations.
Principle of Helicy
 Rogers’ theory is not directly testable
 The human-environment field is a due to lack of concrete hypotheses, but
dynamic, open system in which change it is testable in principle.
is continuous due to the constant
interchange between the human and
environment. Weaknesses
 This change is also innovative. Because
of constant interchange, an open  Rogers’ model does not define
system is never exactly the same at any particular hypotheses or theories for it
two moments; rather, the system is is an abstract, unified, and highly
continually new or different. derived framework.
 Testing the concepts’ validity is
questionable because its concepts are
not directly measurable.
Science of Unitary Human Beings and Nursing
 The theory was believed to be
Process
profound, and was too ambitious
The nursing process has three steps in Rogers’ because the concepts are extremely
Theory of Unitary Human Beings: assessment, abstract.
voluntary mutual patterning, and evaluation.  Rogers claimed that nursing exists to
serve people, however, nurses’ roles
were not clearly defined.
 The purpose of nurses is to promote
The areas of assessment are: the total pattern
health and well-being for all persons
of events at any given point in space-time,
wherever they are. However, Rogers’
simultaneous states of the patient and his or
model has no concrete definition of
her environment, rhythms of the life process,
health state.
supplementary data, categorical disease
entities, subsystem pathology, and pattern
appraisal. The assessment should be a
comprehensive assessment of the human and Conclusion
environmental fields.
 The Science of Unitary HUman Beings is
highly generalizable as the concepts
and ideas are not confined with a
Mutual patterning of the human and specific nursing approach unlike the
environmental fields includes: usual way of other nurse theorists in
defining the major concepts of a theory.
 sharing knowledge
 Rogers gave much emphasis on how a
 offering choices
nurse should view the patient. She
 empowering the patient
developed principles which emphasizes
 fostering patterning
that a nurse should view the client as a
 evaluation
whole.
 repeat pattern appraisal, which includes
 Her statements, in general, made us
nutrition, work/leisure activities,
believe that a person and his or her
wake/sleep cycles, relationships, pain,
environment are integral to each other.
and fear/hopes
That is, a patient can’t be separated
 identify dissonance and harmony
from his or her environment when
 validate appraisal with the patient
addressing health and treatment. Her
 self-reflection for the patient
conceptual framework has greatly
influenced all aspects of nursing by
 offering an alternative to traditional 2) Nurse Knowing of the Other Intuitively:
approaches of nursing.
In this stage the nurse tries to understand
the other, as in the "I-thou" relationship,
where the nurse as the "I" does not
superimpose themselves on the "thou" of
Paterson and Zderad's Humanistic Nursing the patient.
Theory:

3) Nurse Knowing the Other Scientifically:

 Paterson and Zderad's Humanistic The nurse as the observer must observe
Nursing Theory applies both and analyze from the outside. At this stage,
Humanism and Existentialism to the nurse goes from intuition to analysis.
nursing theory. Analysis is the sorting, comparing,
contrasting, relating, interpreting and
 Humanism attempts to take a categorizing.
broader perspective of the
individual's potential and tries to
understand each individual from
4) Nurse Complementarily Synthesizing Known
the context of their own personal
Others:
experiences.
The ability of the nurse to develop or see
 Existentialism is a philosophical themselves as a source of knowledge, to
approach to understanding life. It's continually develop the nursing community
the belief that thinking begins with through education, and increased
the human - the feeling, acting, understanding of their owned learned
living individual. Existentialism experiences.
emphasizes the individual's free-
choice, self-determination and self-
responsibility.
5) Succession Within the Nurse From the Many
to the Paradoxical One:
 Nursing Dialogue is when a nurse
and patient come together. The In this stage the nurse takes the
nurse presents themselves as a a information gleaned and applies it in the
helper ready to assist the patient. practical clinical setting. Here the nurse
The nurse is open to understanding takes brings the dilemma towards
how the patient feels with the resolution.
intention of improvement.
Openness is an essential quality for
humanistic nursing dialogue.
“Humanistic nursing embraces more than a
benevolent technically competent subject-
object one-way relationship guided by a nurse
Paterson and Zderad developed the five in behalf of another. Rather it dictates that
phases of the nursing process: nursing is a responsible searching,transactional
relationship whose meaningfulness demands
1) Preparation of the Nurse Knower For
conceptualization founded on a nurse's
Coming to Know:
existential awareness of self and of the other” -
In this stage the nurse acts as investigator P&Z
who willingly takes risks and has an open-
mind. The nurse must be a risk-taker and be
willing to experience anything. "Accepting "Uniqueness is a universal capacity of the
the decision to approach the unknown human species. So, "all-at-once," while each
openly". man is unique; paradoxically, he is also like
his fellows. His very uniqueness is a
 characteristic of his commonality with all  The model recognizes individuals as
other men." - P&Z having unique biological, psychological,
emotional, social, cultural, and spiritual
attitudes.

Life Perspective Rhythm Model

Health
Joyce Fitzpatrick
 Health is a dynamic state of being that
Introduction results from the interaction of person
and the environment.
Life Perspective Rhythm Model is a nursing  'a human dimension under continuous
model developedSeptember 18, 2013lized her development, a heightened awareness
model from Martha Rogers' Theory of Unitary of the meaningfullness of life.
Human beings.  Optimum health is the actualization of
both innate and obtained human
potential gathered from rewarding
Major Assumptions relationships with others, goal directed
behavior, and expert personal care.
 "The process of human development is  Wellness-llness
characterized by rhythms that occur  Professional nursing is rooted in the
within the context of continuous promotion of wellness practices.
person-environment interaction."
 Nursing activity focuses on enhancing
the developmental process toward
Nursing
health.
 A central concern of nursing science  "A developing discipline whose central
and the nursing profession is the concern is the meaning attached to life
meaning attributed to life as the basic (health)
understanding of human existence.  Primary purpose of nursing is the
 The identification and labeling of promotion and maintenance of an
concepts allows for recognition and optimal level of wellness.
communication with others, and the
rules for combining those concepts
permits thoughts to be shared through
Metaparadigm
language.
It refers to the transitions through basic
metaparadigm concepts of person,
Core Concepts environment, health and nursing.

Rhythm Model includes four content concepts

and they are:
Conclusion
 person
Life Perspective Rhythm Model is a complex
 health
nursing model which contribute to nursing
 wellness-illness and
knowledge by providing taxonomy for
 metaparadigm. identifying and labeling nursing concepts to
 Person allow for their universal recognition and
communication with others.

 Person includes both self and others.

 Person is seen as an open system , a
unified whole characterized by a basic
human rhythm.
 Health As Expanding Consciousness matter how disordered and hopeless it
may seem, is part of the universal
Margaret Newman process of expanding consciousness – a
THEORY DEVELOPMENT process of becoming more of oneself, of
finding greater meaning in life, and of
She was influenced by following theorists: reaching new dimensions of
connectedness with other people and
Martha Rogers
the world” (Newman, 2010).
Martha Roger’s theory of Unitary Human Beings
was the main basis of the development of her
theory, Health as Expanding Consciousness  Humans are open to the whole energy
system of the universe and constantly
Itzhak Bentov – The concept of evolution of
interacting with the energy. With this
consciousness
process of interaction humans are
Arthur Young – The Theory of Process evolving their individual pattern of
whole.
David Bohm – The Theory of Implicate

 According to Newman understanding

ASSUMPTIONS the pattern is essential. The expanding
consciousness is the pattern
 Health encompasses conditions
recognition.
heretofore described as illness, or, in
medical terms, pathology
 These pathological conditions can be
considered a manifestation of the total  The manifestation of disease depends
pattern of the individual on the pattern of individual so the
 The pattern of the individual that pathology of the diseases exists before
eventually manifests itself as pathology the symptoms appear so removal of
is primary and exists prior to structural disease symptoms does not change the
or functional changes individual structure.
 Removal of the pathology in itself will
not change the pattern of the indivdual
 If becoming ill is the only way an  Newman also redefines nursing
individual's pattern can manifest itself, according to her nursing is the process
then that is health for that person of recognizing the individual in relation
 Health is an expansion of to environment and it is the process of
consciousness. understanding of consciousness.

DESCRIPTION OF THE THEORY  The nurse helps to understand people

to use the power within to develop the
 “The theory of health as expanding higher level of consciousness.
consciousness (HEC) was stimulated by
concern for those for whom health as
the absence of disease or disability is
not possible. Nurses often relate to  Thus it helps to realize the disease
such people: people facing the process, its recovery and prevention.
uncertainty, debilitation, loss and
eventual death associated with chronic
illness. The theory has progressed to  Newman also explains the
include the health of all persons interrelatedness of time, space and
regardless of the presence or absence movement.
of disease. The theory asserts that
every person in every situation, no
  Time and space are the temporal STRENGTHS AND WEAKNESSES
pattern of the individual, both have
Strengths
complementary relationship.
 Can be applied in any setting
 “Generates caring interventions”
 Humans are constantly changing
through time and space and it shows
unique pattern of reality. Weaknesses

 Abstract
NURSING PARADIGMS  Multi-dimensional
 Qualitative
Health  Little discussion on environment

“Health and illness are synthesized as health -

the fusion on one state of being (disease) with
its opposite (non-disease) results in what can be CRITIQUE
regarded as health”.
Clarity

Semantic clarity is evident in the definitions,

Nursing descriptions, and dimensions of the concepts of
the theory.
 Nursing is “caring in the human health
experience”.
 Nursing is seen as a partnership
Simplicity
between the nurse and client, with both
grow in the “sense of higher levels of  The deeper meaning of the theory of
consciousness” health as expending consciousness is
complex.
 The theory as a whole must be
Human understood, nut just the isolated
concepts.
 “The human is unitary, that is cannot be
divided into parts, and is inseparable
from the larger unitary field”
Generality
 “Persons as individuals, and human
beings as a species are identified by  The theory has been applied in several
their patterns of consciousness”… different cultures
 “The person does not possess  It is applicable across the spectrum of
consciousness-the person is nursing care situations.
consciousness”.
 Persons are “centers of consciousness”
within an overall pattern of expanding Empirical Precision
consciousness”
Quantitative methods are inadequate in
capturing the dynamic, changing nature of this
Environment theory.

Environment is described as a “universe of open

systems” Derivable Consequences

Newman's theory provides an evolving guide for

all health-related disciplines.
CONCLUSION  Individual characteristics and
experiences (prior related behavior and
 Newman's theory can be personal factors).
conceptualized as
 A grand theory of nursing
 Humans can not be divided into parts
 Behavior-specific cognitions and affect
 Health is central to the theory and is
(perceived benefits of action, perceived
seen “and is seen as a process of
barriers to action, perceived self-
developing awareness of self and the
efficacy, activity-related affect,
environment”
interpersonal influences, and situational
 “Consciousness is a manifestation of an
influences).
evolving pattern of person-environment
interaction”

 Behavioral outcomes (commitment to a

plan of action, immediate competing
demands and preferences, and health-
Nola Pender promoting behavior).

The Health Promotion Model

The health promotion model notes that each Subconcepts

person has unique personal characteristics and
Personal Factors
experiences that affect subsequent actions. The
set of variables for behavioral specific Personal factors categorized as biological,
knowledge and affect have important psychological and socio-cultural. These factors
motivational significance. These variables can are predictive of a given behavior and shaped
be modified through nursing actions. Health by the nature of the target behavior being
promoting behavior is the desired behavioral considered.
outcome and is the end point in the HPM.
Health promoting behaviors should result in a. Personal biological factors
improved health, enhanced functional ability
Include variable such as age gender body mass
and better quality of life at all stages of
index pubertal status, aerobic capacity,
development. The final behavioral demand is
strength, agility, or balance.
also influenced by the immediate competing
demand and preferences, which can derail an
intended health promoting actions.
b. Personal psychological factors

Include variables such as self esteem self

Major Concepts motivation personal competence perceived
health status and definition of health.
 Health promotion is defined as behavior
motivated by the desire to increase
well-being and actualize human health
potential. It is an approach to wellness. c. Personal socio-cultural factors

Include variables such as race ethnicity,

acculturation, education and socioeconomic
 On the other hand, health protection or status.
illness prevention is described as
behavior motivated desire to actively
avoid illness, detect it early, or maintain
Perceived Benefits of Action
functioning within the constraints of
illness. Anticipated positive outcomes that will occur
from health behavior.
Perceived Barriers to Action place. Situational influences may have direct or
indirect influences on health behavior.
Anticipated, imagined or real blocks and
personal costs of understanding a given
behavior.
Commitment to Plan Of Action

The concept of intention and identification of a

Perceived Self Efficacy planned strategy leads to implementation of
health behavior
Judgment of personal capability to organize and
execute a health-promoting behavior. Perceived
self efficacy influences perceived barriers to
action so higher efficacy result in lowered Immediate Competing Demands and
perceptions of barriers to the performance of Preferences
the behavior.  Competing demands are those
alternative behaviors over which
individuals have low control because
Activity Related Affect there are environmental contingencies
such as work or family care
 Subjective positive or negative feeling responsibilities.
that occur before, during and following
 Competing preferences are alternative
behavior based on the stimulus
behaviors over which individuals exert
properties of the behavior itself.
relatively high control, such as choice of
 Activity-related affect influences
ice cream or apple for a snack
perceived self-efficacy, which means
the more positive the subjective feeling,
the greater the feeling of efficacy. In
turn, increased feelings of efficacy can Assumptions
generate further positive affect.  Individuals seek to actively regulate
their own behavior.
 Individuals in all their biopsychosocial
Interpersonal Influences complexity interact with the
environment, progressively
 Cognition concerning behaviors, beliefs,
transforming the environment and
or attitudes of the others.
being transformed over time.
 Interpersonal influences include: norms
 Health professionals constitute a part of
(expectations of significant others),
the interpersonal environment, which
social support (instrumental and
exerts influence on persons throughout
emotional encouragement) and
their life span.
modeling (vicarious learning through
 Self-initiated reconfiguration of person-
observing others engaged in a particular
environment interactive patterns is
behavior).
essential to behavior change.
 Primary sources of interpersonal
influences are families, peers, and
healthcare providers.
Propositions

 Prior behavior and inherited and

Situational Influences acquired characteristics influence
beliefs, affect, and enactment of health-
Personal perceptions and cognitions of any
promoting behavior.
given situation or context that can facilitate or
 Persons commit to engaging in
impede behavior. Include perceptions of
behaviors from which they anticipate
options available, demand characteristics and
deriving personally valued benefits.
aesthetic features of the environment in which
given health promoting is proposed to take
 Perceived barriers can constrain Strengths/Weaknesses
commitment to action, a mediator of
Strengths:
behavior as well as actual behavior.
 Perceived competence or self-efficacy  It is simple to understand yet it is
to execute a given behavior increases complex in structure.
the likelihood of commitment to action  Her theory gave much focus on health
and actual performance of the promotion and disease prevention
behavior. making it stand out from other nursing
 Greater perceived self-efficacy results in theories.
fewer perceived barriers to a specific  It is highly applicable in the community
health behavior. health setting.
 Positive affect toward a behavior  It promotes the independent practice of
results in greater perceived self- the nursing profession being the
efficacy, which can in turn, result in primary source of health promoting
increased positive affect. interventions and education.
 When positive emotions or affect are
associated with a behavior, the
probability of commitment and action is
Weaknesses:
increased.
 Persons are more likely to commit to  The model of Pender was not able to
and engage in health-promoting define the four most important
behaviors when significant others concepts that a nursing theory should
model the behavior, expect the have, man, nursing, environment and
behavior to occur, and provide health.
assistance and support to enable the  The conceptual framework contains
behavior. multiple concepts which may invite
 Families, peers, and health care confusion to the reader.
providers are important sources of  Its applicability to an individual
interpersonal influence that can currently experiencing a disease state
increase or decrease commitment to was not given emphasis.
and engagement in health-promoting
behavior.
 Situational influences in the external
Analysis
environment can increase or decrease
commitment to or participation in  Due to its focus to health promotion
health-promoting behavior. and disease prevention per se, its
 The greater the commitments to a relevance to nursing actions given to
specific plan of action, the more likely individuals who are ill are obscure. But
health-promoting behaviors are to be then again, this characteristic of her
maintained over time. model also gives the concepts its
 Commitment to a plan of action is less uniqueness.
likely to result in the desired behavior  Pender’s principles paved a new way of
when competing demands over which viewing nursing care but then one
persons have little control require should also be reminded that the
immediate attention. curative aspect of nursing cannot be
 Commitment to a plan of action is less detached from our practice.
likely to result in the desired behavior  Community health care setting is the
when other actions are more attractive best avenue in promoting health and
and thus preferred over the target preventing illnesses. Using Pender’s
behavior. Health Promotion Model, community
 Persons can modify cognitions, affect, program may be focused on activities
and the interpersonal and physical that can improve the well-being of the
environment to create incentives for people. Health promotion and disease
health actions. prevention can more easily be carried
out in the community, as compared to
 programs that aim to cure disease
conditions.
 For an individual to fully adhere to a
health promoting behavior, he or she
needs to shell out financial resources.
This limits the application of Pender’s
model. An individual who economically
or financially unstable might have lesser
commitment to plan of action
decreasing the ideal outcome of a
health promoting behavior even if the
individual has the necessary will to
complete it.
 Although not stated in the model, for
example, in the Intensive Care Unit,
Health Promotion Model may still be
applied in one way or another. This is
projected towards improving health
condition and prevention of further
debilitating conditions. Diet
modifications and performing passive
and active range of motion exercises
are examples of its application.