FINAL – Chapter 1: Anne Boykin & Salvina O.

Schoenhofer

The Theory of Nursing as Caring: A model for transforming practice

o Major Concept:  Because calls for nursing are uniquely situated personal expressions, they cannot be predicted, but originate within persons who are
1. FOCUS AND INTENTION OF NURSING living caring in their lives and who hold hopes and aspirations for growing in caring.
 The focus of nursing is that knowledge and professional practice is nurturing persons living and growing in caring.  “Calls for nursing are individually relevant ways of saying ‘Know me as caring person in the moment and be with me as I try to live
 The intention of nursing is to know persons as caring and to support and sustain them as they live caring. fully who I truly am”’

 This intention is expressed uniquely when the nurse enters the relationship with the patient with the intention of knowing the other as 7. CARING BETWEEN

a caring person, and affirming and celebrating the person as caring.  When the nurse enters the world of the other person with the intention of knowing the other as a caring person, the encountering of

 Caring is expressed in nursing and is “the intentional and authentic presence of the nurse with another who is recognized as living in the nurse and the patient gives rise to the phenomenon of caring between.

caring and growing in caring”  The nurse comes to know the other, living and growing in caring.

 Sensitivity and skill in creating unique and effective ways of communicating caring are developed through the nurse’s intention to  Constant and mutual unfolding enhances this loving relation.
care.  Without the caring between the nurse and the patient, unidirectional activity can occur, but nursing in its fullest sense does not occur.
2. PERSPECTIVE OF PERSONS AS CARING  It is in the context of caring between that personhood is nurtured, each expressing self and recognizing the other as caring person.
 The fundamental assumption is that all persons are caring. 8. NURSING RESPONSE
 Caring is lived by each person moment to moment and is an essential characteristic of being human.  In responding to the nursing call, the nurse enters the nursing situation with the intention of knowing the other person as caring.
 Caring is a process, and throughout life, each person grows in the capacity to express caring.   This knowing of person clarifies the call for nursing and shapes the nursing response, transforming the knowledge brought by the
 Each person is caring, even though every act of the person might not be understood as caring. Knowing the person as living caring nurse to the situation from general, to particular and unique.
and growing in caring is foundational to the theory.  The nursing response is co-created in the immediacy of what truly matters and is a specific expression of caring nurturance to sustain
3. NURSING SITUATION and enhance the other living and growing in caring.
 Caring is service that nursing offers and lives in the context of the nursing situation.  Nursing responses to calls for caring evolve as nurses clarify their understanding of calls through presence and dialogue.
 The nursing situation is the locus of all that is known and done in nursing and the shared, lived experience in which caring between 9. STORY AS METHOD FOR KNOWING NURSING
nurse and patient enhances personhood  Story is a method for knowing nursing and a medium for all forms of nursing inquiry.
 The nursing situation is what is present in the mind of the nurse whenever the intent of the nurse is “to nurse”  Nursing stories embody the lived experience of nursing situations involving the nurse and the patient.
 It is within the nursing situation that the nurse attends to calls for caring or reaching out of the one nursed.  Any single nursing situation has the potential to illuminate the depth and complexity of the experience as lived, that is, the caring
 The nursing situation involves an expression of values, intentions, and actions of two or more persons choosing to live a nursing that takes place between the nurse and the patient.
relationship. In this lived relationship, all knowledge of nursing is created and understood  The nursing situation as a unit of knowledge and practice is re-created in narrative or story.
4. PERSONHOOD  Nursing situations are best communicated through aesthetic media such as storytelling, poetry, graphic arts, and dance to preserve
 Personhood is a process of living that is grounded in caring. the lived meaning of the situation and the openness of the situation through text.
 Personhood implies being who we are as authentic caring persons and being open to unfolding possibilities for caring. o MAJOR ASSUMPTIONS BOYKIN AND SCHOENHOFER address SIX MAJOR ASSUMPTIONS that reflect a set of values to provide a
 We are constantly living out the meaning of our caring from moment to moment. basis for understanding and explicating the meaning of nursing.
 Within the nursing situation, the shared lived experience of caring within enhances personhood, and both the nurse and the nursed 1. Persons are caring by virtue of their humanness

grow in caring.  The assumption that all persons are caring does not require that each act of a person be caring, but it does require the acceptance that

 In the intimacy of caring, respect for self as person and respect for other are values that affirm personhood. “fundamentally, potentially, and actually, each person is caring”

 Understanding of personhood communicates a person-as-person and person-in-communion all at once.  Through entering, experiencing, and appreciating the life-world of other, the nature of being human is more fully understood.

5. DIRECT MOTIVATION  From the perspective of Nursing as Caring, the understanding of person as caring “centers on valuing and celebrating human

 Direct invitation opens the relationship to true caring between the nurse and the patient wholeness, the human person as living and growing in caring, and active personal engagement with others”.

 The direct invitation of the nurse offers the opportunity to the patient to share what truly matters in the moment.
 With the intention of truly coming to know the patient, the nurse risks entering the other’s world and comes to know what is
meaningful to the patient.
 Invitations to share what matters, such as “How might I nurse you in ways that are meaningful to you?” or “What truly matters most
to you at this moment?” are communicated in the personal language of the nurse.
2. Persons are whole and complete in the moment
 Direct invitation reaches deep into the humility of the nursing situation, uniting and guiding the intention of both the nurse and
 Respect for the person is communicated by the notion of person as whole or complete in the moment.
patient.
 Being complete in the moment signifies that there is no insufficiency, no brokenness, and no absence of something.
 Wholeness, or the fullness of being, is forever present.
 From the perspective of Nursing as Caring, to encounter a person as less than whole fails to truly encounter the person.
3. Persons live caring, moment to moment
 Caring is a lifetime process that is lived moment to moment and is constantly unfolding.
 In the rhythm of life experiences, we continually develop expressions of ourselves as caring persons.
6. CALL FOR NURSING
 As competency in caring is developed through life, we come to understand what it means to be a caring person, to live caring, and to
 Are calls for nurturance perceived in the mind of the nurse
nurture each other as caring.
 The nurse responds uniquely to the patient with knowledge of what it means to be human.
4. Health: Personhood is living life grounded in caring
 Acknowledging and affirming the person living caring in unique ways in the immediate situation.
 Personhood is a process of living caring and growing in caring.
  It is being authentic, demonstrating congruence between beliefs and behaviors, and living out the meaning of one’s life.
 Personhood is the universal human call. This implies that the fullness of being human is expressed in living caring uniquely day to
day and is enhanced through participation in caring relationships
5. Environment: Personhood is enhanced through participating in nurturing relationships with caring others
 As a process, personhood acknowledges the potential of persons to live caring and is enhanced through participation in nurturing
relationships with caring others.
 The nature of relationships is transformed through caring.
 Caring is living in the context of relational responsibilities and possibilities, and it acknowledges the importance of knowing person
as person.
 “Through knowing self as caring person, I am able to be authentic to self, freeing me to truly be with others”
6. Nursing is both a discipline and a profession
 Nursing is an “exquisitely interwoven” unity of aspects of the discipline and profession of nursing.
 As a discipline, nursing is a way of knowing, being, valuing, and living in the world, and is envisaged as a unity of knowledge
within a larger unity.
 The discipline of nursing attends to the discovery, creation, development, and refinement of knowledge needed for the practice of
nursing.
 The profession of nursing attends to the application of that knowledge in response to human needs.
 Nursing as caring focuses on the knowledge needed for plenary understanding of what it means to be human and the distinctive
methods needed to verify this knowledge.
 As a human science, knowing nursing means knowing in the realms of personal, empirical, ethical, and aesthetic all at once.
o Dance of Caring Persons:
 Dancers enter the nursing situation, visualized as a circle of caring that provides organizing purpose and integrated functioning
 Dancers move freely; some dancers touch, some dance alone, but all dance in relation to each other and to the circle.
 Each dancer brings special gifts as the nursing situation evolves. Some dancers may hear different notes and a different rhythm, but all
harmonize in the unity of the dance and the oneness of the circle.
 Personal knowing of self and other is integral to the connectedness of persons in the dance, in which the nature of relating in the circle is
grounded in valuing and respecting person.
 All in the nursing situation, including the nurse and the patient, sustain the dance, being energized and resonating with the music of
caring.
FINAL – Chapter 2: Joyce Travelbee

Human to Human Relationship Theory

o 4 Major Concepts:
1. PERSON a unique, irreplaceable individual, who is in a continuous process of becoming, evolving and changing

o Health as a Multifactorial Phenomenon 2. HEALTH categorized health as subjective and objective health
3. ENVIRONMENT not clearly defined, she defined human conditions and life experiences as sufferings, hope, pain and illness
- Health, defined.
4. NURSING is a process whereby the professional nurse practitioner assists an individual, family or community to prevent or cope with
- The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
experience or illness and suffering, and if necessary, to find meaning in these experiences
 Factors Affecting Health
A. Political - this factor refers to one’s leadership, how he rules, manages and how other people concerned are followed to actively
A. Original Encounter
participate in the decision-making process.
 First impression by the nurse of the sick person and vice-versa.
1. Safety - the condition of being free from harm, injury or loss of authority or power
2. Oppression - unjust or cruel exercise of authority or power  Stereotyped or traditional roles

3. Political will - determination to pursue something which is for the interest of the majority. B. Emerging Identities

4. Empowerment - the ability of a person to do something. Creating the circumstances where people can use their faculties  The time when relationship begins, bonds begin to form

and abilities at the maximum level in the pursuit of common goals  The nurse and patient perceive each other’s uniqueness
B. Cultural - relating to the representation of non-physical traits, such as values, beliefs, attitudes and customs shared by a group of C. Empathy
people and passed from the generation to the next.  The ability to share in the other person’s experience
1. Practices - a customary action usually done to maintain or promote health like use of anting-anting and lucky charms. D. Sympathy
2. Beliefs - a state or habit of mind in which trust or confidence is placed in some person or thing.  When the nurse wants to lessen the cause of patient’s suffering.
C. Heredity - the genetic transmission of traits from parents to offspring; genetically determined.  It goes beyond empathy— “When one sympathizes, one is involved but not incapacitated by the involvement.”
D. Environment - the sum of all the conditions and elements that make up the surroundings and influence the development of the  Therapeutic use of self
individuals. E. Rapport
E. Socio-economic - refers to the production activities, distribution of and consumption of goods of an individual.  Rapport is described as nursing interventions that lessens the patient’s suffering.
 Relation as human being to human being
  “A nurse is able to establish rapport because she possesses the necessary knowledge and skills required to assist ill persons and
because she is able to perceive, respond to and appreciate the uniqueness of the ill human being.”
o Acceptance by the Nursing Community
 Practice - hospice – self-actualizing life experience. Assumption of the sick role. Meaning of life and sickness and death.
 Education - teaches nurses to understand the meaning of illness and suffering
 Research - applied in the theory of caring cancer patients.

FINALS – Chapter 3: Margaret Newman

Theory on Health as Expanding Consciousness

o She was influenced by following theorists:

 Martha Rogers - Martha Roger’s theory of Unitary Human Beings was the main basis of the development of her theory, Health as
Expanding Consciousness

 Itzhak Bentov – The concept of evolution of consciousness

 Arthur Young – The Theory of Process

 David Bohm – The Theory of Implicate

o Theory Introduction:
- The theory of health as expanding consciousness stems from Rogers' theory of unitary human beings. 
- The theory was stimulated by concern for those whom health as the absence of disease or disability is not possible.
- The theory includes the health of all persons regardless of the presence or absence of disease.
- The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of
expanding consciousness – a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of
connectedness with other people and the world.
o Assumptions:
- Health encompasses conditions described as illness, or, in medical terms, pathology 
- These pathological conditions can be considered a manifestation of the total pattern of the individual
- The pattern of the individual that eventually manifests itself as pathology is primary and exists prior to structural or functional changes
- Removal of the pathology in itself will not change the pattern of the indivdual 
- If becoming ill is the only way an individual's pattern can manifest itself, then that is health for that person 
- Health is an expansion of consciousness. 
o Description of the Theory:
- “The theory of health as expanding 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 such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness.
- The theory has progressed to include the health of all persons regardless of the presence or absence of disease.
- The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of
expanding consciousness – a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of
connectedness with other people and the world”.
 - Humans are open to the whole energy system of the universe and constantly interacting with the energy. With this process of interaction
humans are evolving their individual pattern of whole.
- According to Newman understanding the pattern is essential. The expanding consciousness is the pattern recognition.
- The manifestation of disease depends on the pattern of individual so the pathology of the diseases exists before the symptoms appear so
removal of disease symptoms does not change the individual structure.
- Newman also redefines nursing according to her nursing is the process of recognizing the individual in relation to environment and it is the
process of understanding of consciousness.
- The nurse helps to understand people to use the power within to develop the higher level of consciousness.
- Thus, it helps to realize the disease process, its recovery and prevention.
- Newman also explains the interrelatedness of time, space and movement.
- Time and space are the temporal pattern of the individual, both have complementary relationship.
- Humans are constantly changing through time and space and it shows unique pattern of reality.

o Nursing Paradigms:
1. Health
 “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 regarded as health”.
2. Nursing
 Nursing is “caring in the human health experience”.
 Nursing is seen as a partnership between the nurse and client, with both grow in the “sense of higher levels of consciousness”
3. Human
 “The human is unitary, that is cannot be divided into parts, and is inseparable from the larger unitary field”
 “Persons as individuals, and human beings as a species are identified by their patterns of consciousness”…
 “The person does not possess consciousness-the person is consciousness”.
 Persons are  “centers of consciousness” within an overall pattern of expanding consciousness” 
4. Environment
 Environment is described as a “universe of open systems”