Unit Exam 2 Reviewer

(November 18, 2022)

Dr. Madeleine Leininger PhD, LHD, DS, CTN, Culture Care Theory of Diversity and
RN, FAAN, FRCNA Universality
(Culture Care Theory of Diversity and
Universality) ❖ Is the outcome of original thinking, an
awareness of an ever- changing world, and
Background more than 6 decades of using, building,
and refining the theory.
❖ Born on July 13, 1925 in Sutton Nebraska, ❖ It is not a borrowed theory but has been
United States. developed as a nursing theory highly
❖ She was blended in terms of awareness relevant to discover the care and health
culture. needs for persons, families, groups, and
❖ Lived on a farm with two brothers and institutions from similar and diverse
sisters. cultures.
❖ Credits aunt who suffered congenital heart
disease when encouraging her become a Leininger's Nursing Theory
nurse.
❖ Providing care that is culturally congruent
Education ❖ Described her theory as "creative and
systematic way of discovering new
❖ 1948 - Diploma at St. Anthony's School of knowledge
Nursing ❖ Increasingly relevant due to migration and
❖ 1950 - BS in Biologic Science at diversity grows
Benedictine College, Atchinson, Kansas ❖ Broad theory: impact of culture on all
❖ 1954 - MSN from Catholic University, aspects of human life
Washington, D.C ❖ Respecting the culture, accommodations,
❖ 1965 - PhD in Anthropology from or re-pattering
University of Seattle
Assumptive Premises of the Theory
Experiences
❖ Human care and Caring - refers to the
❖ Joined U.S Army Nursing Corps at 18 and abstract and manifest phenomena with
then the Cadet Nurse Corps at 20 expression of assistive, supportive,
❖ Opened a psychiatric nursing service and enabling, and facilitating ways to help self
educational program at Creighton or others with evident or anticipated needs
University in Omaha Nebraska (1951-1954) to improve health.
❖ Worked at a child guidance home in ❖ Culture - refers to patterned lifeways,
1950's values, beliefs, norms, symbols, and the
❖ Appointed professor in Nursing and practices of individual, group or institutions.
Anthropolgy at the University of Colorado ❖ Culture Care - refers to synthesized and
❖ Dean of the University of Washington culturally constituted assistive, supportive,
School of Nursing in 1969-1974 enabling or facilitative caring acts toward
❖ Served as Dean, professor in nursing, self or others focused on evident or
Adjunct professor for Anthropolgy, and anticipated needs for the client's health or
then Director of the Center for Nursing well-being
Research Program at the University of ❖ Culture Care Diversity - refers to cultural
Utah College of Nursing (1974-1980) variability or differences in care beliefs,
meanings, patterns, values, symbols, and
lifeways within and between cultures and
human-beings.
❖ Culture Care Universality - refers to ❖ Culture Shock - may result when an
commonalities or similar culturally based outsider attempts to comprehend or adapt
meaning, patterns, values, symbols, and effectively to a different cultural group, it
lifeways reflecting care as a universal may lead to anger and can be reduced by
humanity. seeking knowledge of the culture before
❖ Cultural and Social Structure encountering that culture.
Dimensions - refers to dynamic, holistic, ❖ Cultural impositions - refers to the
and interrelated patterns of structured outsider's efforts, both subtle, and not to so
features of culture (subcultures), including subtle, to impose their own cultural values,
religion (spiritual), kinship (social), political beliefs, behavior upon an individual, family,
characteristics (legal), economics, or group from another culture.
education, technology, cultural values,
philosophy, history, and language Comparison of Traditional Metaparadigm

Transcultural Nursing refers to a formal area ❖ Nursing is a humanistic and scientific

of humanistic and specific knowledge and mode of helping a client through specific
practices focused on holistic Culture Care cultural caring processes (cultural values,
(caring) phenomena and competencies to beliefs and practices) to improve or
assist individuals and groups to maintain or maintain a health condition.
regain their health and to deal with disabilities, ❖ Person may not be used and may not be
dying, or other human conditions in culturally the central, meaningful, or dominant term
congruent and beneficial ways. in some cultures, instead the linguistic
terms of human beings, families, clans,
SUBCONCEPTS and collective groups are frequently used
transculturally because these terms have
❖ Generic Care Systems - are culturally cultural meanings and are often used by
learned and transmitted, indigenous (or the people.
traditional), folk (home-based), knowledge ❖ Health is a state of well being that is
and skills used to provide assistive, culturally defined and constituted ,and
supportive, enabling, or facilitative acts maintain to the ability to help individuals or
toward or for another individual, group, or groups to perform their daily role activities
institution with evident or anticipated needs in culturally expressed beneficial care and
to ameliorate or improve a human life way patterned lifeways.
or to deal with handicaps and death ❖ Environment refers to the totally of
situations. geophysical situations or the lived-in
❖ Professional Care Systems - are defined geographic and ecological settings and
as formally taught, learned, and cultures.
transmitted professional care, health,
illness, wellness and related knowledge Sunrise Model of Madeleine Leininger's
and practice skills that prevail in Theory
professional institutions usually with
multidisciplinary personnel to serve The Sunrise Model is relevant because it
consumers. enables nurses to develop critical and complex
❖ Ethnohistory - includes those past facts, thoughts about nursing practice. These
events, instances, experiences of thoughts should consider and integrate cultural
individuals, groups, cultures, and and social structure dimensions in each
instructions that are primarily people- specific context, besides nursing care’s
centered (ethno) and describe explain and biological and psychological aspects
interpret human lifeways within particular
cultural contexts over short or long periods
of time.
Three modes of nursing care decisions and ❖ Care is the distinct, dominant, unifying, and
actions central focus of nursing, and while curing
and healing cannot occur effectively
❖ Culture Care Prevention or Maintenance without care, care may occur without a
- refers to those assistive, supportive, cure.
facilitative, or enabling professional actions ❖ Care and caring are essential for humans’
and decisions that help people of a survival and their growth, health, well-
designated culture to adapt to or to being, healing, and ability to deal with
negotiate with others for meaningful, handicaps and death
beneficial, and congruent health outcomes. ❖ Nursing care will be culturally congruent or
❖ Culture Care Repatterning or beneficial only when the nurse knows the
Reconstructing - refers to assistive, clients. The clients’ patterns, expressions,
supportive, facilitative, or enabling and cultural values are used in appropriate
professional actions and decisions that and meaningful ways by the nurse with the
help client reorder, change, or modify their clients.
lifeways for new different and beneficial ❖ If clients receive nursing care that is not at
health outcomes. least reasonably culturally congruent (that
❖ Culture Care Accommodation or is, compatible with and respectful of the
Negotiation - refers to those assistive, clients’ lifeways, beliefs, and values), the
supportive, facilitative, or enabling client will demonstrate signs of stress,
professional actions and decisions that noncompliance, cultural conflicts, and/or
help people of a designated culture (or ethical or moral concerns.
subculture) to adapt to or to negotiate with
others for meaningful , beneficial, and Application to Nursing Theory
congruent health outcomes
Cultural Care Theory of Diversity and
Assumptions of Madeleine Leininger’s Universality can be applied:
Theory
Different cultures perceive, know, and practice ❖ Encouraging patients to discuss their
care differently, yet there are some background and experience with health
commonalities about care among all world care system
cultures ❖ Demonstrate open mindedness
❖ Teaching nurse how to approach patients
❖ Values, beliefs, and practices for culturally of different culture
related care are shaped by, and often ❖ The Applications are numerous but are
embedded in, “the worldview, language, based on what is known and how much a
religious (or spiritual), kinship (social), nurse is willing to learn about the patients
political (or legal), educational, economic, culture. However, it is an important theory
technological, ethnohistorical, and aimed at improving health care.
environmental context of the culture.
❖ While human care is universal across
cultures, caring may be demonstrated
through diverse expressions, actions,
patterns, lifestyles, and meanings.
❖ Cultural care is the broadest holistic means
to know, explain, interpret, and predict
nursing care phenomena to guide nursing
care practices.
❖ All cultures have generic or folk health care
practices, that professional practices vary
across cultures, and that there will be
cultural similarities and differences
between the care-receivers (generic) and
the professional caregivers in any culture.
Rosemarie Rizzo Parse
(Human Becoming Theory)

Background: Contributions of the Theorist:

❖ She graduated at Duquesne University, ❖ Published 9 books and more then 150
Pittsburgh. articles and editorial about Nursing Field.
❖ Received her master’s and doctorate ❖ Created the Human Becoming Theory of
degrees at University of Pittsburgh. Nursing
❖ She served as a faculty member at the ❖ Published her theory, “Man-Living-Health”
University of Pittsburgh. in 1981 and on 1992 she renamed it as
❖ She became the Dean of Nursing School “Human Becoming Theory”.
at Duquesne University on 1977 to1982.
❖ She was a Professor and Coordinator of The Metaparadigm of human becoming
the Center for Nursing Research at Hunter theory
College in the University of New York in
1983 to 1993. Person
❖ Professor and Niehoff Chair at Loyola ❖ an open beings that is unpredictable and
University Chicago in 1993 to 2006. everchanging individuals
❖ Professor Emeritus at Loyola University Environment
Chicago in 2006 to present. ❖ evolving with the person’s experiences
❖ She worked as a Consultant and Visiting Health
Scholar at the New York College of ❖ open process of being and becoming,
Nursing. involves synthesis of values.
❖ She is the founder and editor of Nursing ❖ health is ever-changing as humans choose
Science Quarterly. ways of living.
❖ President of Discovery and International, Nurse
Inc. ❖ a basic science and art that requires
❖ Active Fellow in the American Academy of knowledge to fulfill their commitment to
Nursing. humankind.

Accomplishments: The Four Postulates

Dr. Parse attained several awards including: Illimitability

❖ indivisible, unpredictable, everchanging
❖ Two Lifetime Achievement Awards from nature of humanbecoming
the Midwest Nursing Research Society and ❖ unbounded knowing extended to infinity,
Asian American Pacific Islander Nurses the all at once remembering and
❖ Association Scholarship created in her prospecting with the moment
name at Henderson State University Paradox
School of Nursing ❖ these are individual’s choices in day to day
❖ Martha E. Rogers Golden Slinky Award living
❖ Her books was named “best picks” by Freedom
Sigma Theta Tau International ❖ people have freedom with their situations
❖ New York Times Nurse Educator of the to choose ways of being
Year Award Mystery
❖ Medal of Honor at the University of Lisbon ❖ unmeasurable and unknowable that
in Portugal always accompanies the "indivisible,
unpredictable,everchanging
humanuniverse"
Principles of human Becoming Theory others. The interactions between nurses
and patients are co-created.
Principle 1: Structuring Meaning

The three principles of Structuring meaning Enabling-Limiting

Paradox: Potentiating-Restricting
Imaging
Paradoxes: Explicit-Tacit and Reflective-Pre- ❖ involves making a decision from the
reflective possible choices and accepting the results
of that decision. Nurses support patients
❖ Is an individual’s view of reality as they consider their options and the
❖ Imaging is a personal interpretation of possible outcomes of decisions.
meaning, possibility, and consequence.
Nurses cannot completely know another's Connecting-Separating
imaging, but they explore, respect, and Paradox: Attending-Distancing
bear witness as people struggle with
shaping, exploring, integrating, rejecting, ❖ It clarifies how two people can be so close
and interpreting. but apart. Sometimes connections are
made when individuals are separating
Valuing because people can have intense
Paradox: Confirming-Not Confirming connection with an absent presence,
especially when they are mourning for
❖ According to Parse, living one's value someone else. By asking about a person's
priorities is how an individual expresses significant relationships and interests,
health and human becoming. Nurses learn nurses can learn about their connecting-
about persons' values by asking them what separating behaviors.
is most important to them. People make
choices about how to think, act, and feel Principle 3: Cotrascending with Possibles
that may be consistent with prior choices
or completely different. The three principles of Cotrascending with
Possibles
Languaging
Paradoxes: Speaking-Being Silent and Powering
Moving-Being Still Paradoxes: Pushing-Resisting, Affirming-Not
Affirming, Being-Nonbeing
❖ Language is a visible concept that relates
to how people express their chosen ❖ Powering is the pushing to act and live with
realities and priority goals . Nurses purpose amid possibilities for affirming and
discover the meaning behind a person's holding what is cherished while
words, actions, and gestures. simultaneously living with loss and the
threat of nonbeing. There is resistance with
Principle2:Configuring Rhythmical Patterns the pushing force of powering, because
persons live with others who are powering
The three principles of Configuring with different possibilities in the visible-
Rhythmical Patterns invisible becoming of the emerging now.

Revealing-Concealing Originating
Paradox: Disclosing-Not Disclosing Paradoxes:Certainty-Uncertainty, Conforming-
Not Conforming
❖ Revealing-concealing is the way persons
disclose and keep hidden the persons they ❖ Originating, the second concept of the third
are becoming. People disclose–not principle, is about human uniqueness and
disclose in different situations and with holds the following two paradoxes: (1)
different people. There is always more to conforming–not-conforming and (2)
tell and more to know about self as well as certainty-uncertainty. For some, there is
 danger in being too much like others; for
others, the danger is in being different.
Each person defines and lives originating
in light of their worldview and values.

Transforming
Paradox: Familiar-Unfamiliar

❖ Transforming is about the continuously

changing and shifting views that people
have about their lives. People are always
struggling to integrate the unfamiliar with
the familiar in living everydayness. Nurses,
in the way they are present with others,
help or hinder a person's efforts to clarify
their hopes, dreams, and desired
directions.

The Three Basic Concepts of Human

Becoming

Meaning
❖ in the intersubjective process of living
value priorities, human becoming is the
free choice of one's own particular
meaning in circumstances. Living
experiences give human existence
meaning. Man and the environment also
co-create.
Rhythmicity
❖ refers to human beings co-create
rhythmical patterns of relating to the
universe in a cooperative process. Man
and the environment co-create in rhythmic
patterns (imaging, valuing, and language).
Transcendence
❖ is the process of human becoming is
multidimensionally co-transcending with
new possibilities. It means going beyond
and beyond the boundaries that one sets
and that one is ever-evolving.

Application of Parse’s human becoming

theory in the nursing practice:

The theory guides practice for nurses who

work with families and with persons in hospital
settings, clinics, and community settings. A
community-based health action model, for
instance, has been developed and received
support from the local community. The theory
has generated controversy and scholarly
dialogue about nursing as an evolving
discipline and distinct human science.
Ernestine Wiedenbach Ernestine Wiedenbach’s Contribution to
(The Helping art of clinical nursing) Nursing: The Helping Art of Clinical
Nursing
Biography and Career of Ernestine
Wiedenbach ❖ Ernestine Wiedenbach's theory has
contributed to the development of the
❖ Born on August 18, 1900, in Hamburg, clinical nursing practice by influencing core
Germany concepts in practice, such as the nursing
❖ Earned a Bachelor of Arts from Wellesley process, and by contributing to the goal of
College in 1922 nursing, which is to attend to a patient's
❖ R.N from Johns Hopkins School of needs by assessing their need for help in
Nursing in 1925 the clinical setting. The nursing process is
❖ Got her Masters of Arts from Teachers a systematic problem-solving approach
College, Columbia University in 1934 first applied by Orlando in 1961 and
❖ Wiedenbach earned a certificate in nurse- involved four key steps which include;
midwifery from the Maternity Center ➢ Assessment
Association School for Nurse-Midwives in ➢ Planning
New York and taught there until 1951. ➢ Intervention
❖ Wiedenbach died on March 8, 1998 ➢ Evaluation

➢ She first published “The family-centered MAJOR CONCEPTS AND DEFINITIONS

maternity nursing” in 1958.
➢ She recommended in this book that babies In her model of nursing, she explains that
should be in hospital rooms with their nursing is the practice of identification of a
mothers rather than in a central nursery. patient’ s need for help through:
➢ This book is designed primarily to answer ❖ the observation of presenting behaviors
the question of what the nurse needs to and symptoms
know and do incline with the experience of ❖ exploration of the meaning of those
childbearing. Patricia James, James symptoms with the patient
Dickoff, and Ida Orlando Pelletier are the ❖ determining the cause of the discomfort
influencers of Wiedenbach but Ida Orlando ❖ determining the patient’ s ability to resolve
influenced her theory the most. the discomfort or if the patient has a need
for help from the nurse or other health care
Wiedenbach's prescriptive theory is based professionals.
on three factors : The goal of nursing consists primarily of
identifying a patient’ s need for help.
❖ The prescription for the fulfillment of the A need-for-help
central purpose. ❖ defined as “ any measure desired by the
❖ The central purpose that the practitioner patient that has the potential to restore or
recognizes as essential to the particular extend the ability to cope with various life
discipline. situations that affect health and wellness. ”
❖ The realities in the immediate situation that ❖ Need-for-help must be based on the
influence the central purpose. individual patient’ s perception of his or her
own situation.

Patient
❖ any person who has entered the
healthcare system and is receiving help,
which means he or she does not need to
be ill.
❖ A person receiving health-related
education would qualify as a patient.
Nurse ❖ May be classified as to :
❖ A functioning human being who not only ➢ procedural skills
acts, but thinks and feels. ➢ communication skills
❖ A nurse uses his/her knowledge in his/her
role. Components of Practice Indirectly Related
❖ Nurses whose action is directed toward to Patient' s Care
achievement of a specific purpose,
thoughts and feelings have a disciplined ❖ Coordination of resources;
role to play Nurse ➢ Reporting, Consulting and Conferring
Person
❖ Each person, whether a nurse or patient, Wiedenbach asserted that there are four
has a unique potential to develop self- elements to clinical nursing:
sustaining resources. Self-awareness and 1. Philosophy: An attitude toward life and
self-acceptance are essential to personal reality that evolves from each nurse ’ s beliefs
integrity and self-worth. and code of conduct. Philosophy motivates the
nurse to act, guides thinking about what to do,
THE PRACTICE and influences decision-making According to
❖ Knowledge, Judgement, and Skills are Wiedenbach, a nursing philosophy has three
three aspects necessary for effective essential components:
practice. a. Reverence for the gift of life
❖ Identification, ministration, and validation b. Respect for the dignity, worth, autonomy,
are three components and individuality of each human being
c. A resolution to act on personally and
PRACTICE : KNOWLEDGE professionally held beliefs
2. Purpose: That which the nurse wants to
❖ Knowledge encompasses all that has been accomplish through her actions. It
perceived and grasped by the human mind, encompasses all of the activities directed
it' s scope and range are infinite. toward the overall good of the patient.
❖ Knowledge may be : 3. Practice: Observable actions that are
➢ Factual influenced by discipline thoughts and feeling
➢ Speculative toward meeting the patient’ s need for help.
➢ Practical These actions are directed and patient
centered.
PRACTICE : JUDGEMENT 4. Art: The art of clinical nursing consist of:
a. The nurse ’ s understanding of the patient’ s
❖ Clinical Judgement- represents the condition, situation, and need.
nurse ’ s likeliness to make sound b. The nurse ’ s internal goals and external
decisions, which are based on actions that are meant to enhance patient
differentiating fact from assumption, and capability through appropriate nursing care.
relating them to cause and effect. c. The nurse ’ s activities directed toward
❖ Sound Judgement- It is the result of improvement of the patient’ s condition through
disciplined functioning of mind and artful utilization of the medical plan of care.
emotions, and improves with expanded d. The nurse ’ s intervention aimed at
knowledge, as well as increased clarity of prevention of recurrence of the current concern
professional purpose. or development of a new concern.

PRACTICE : SKILLS Metaparadigms

❖ Skills represent the nurse ' s potentiality for Person/Individual

achieving desired results ❖ possesses unique potential strives toward
❖ Skills compromise numerous and varied self–direction, and needs stimulation.
acts, characterized by harmony of ❖ self-awareness and self-acceptance are
movement, expression and intent, by essential to the individual’ s sense of
precision and by adroit use of self integrity and self-worth
Environment
❖ she incorporates the environment within
the realities
❖ a major component of her theory.
Health
❖ does not define the concept of health.
❖ However, she supports the World Health
Organization ’ s definition of health as a
state of complete physical, mental and
social well-being and not merely the
absence of disease and infirmity.
Nursing
❖ is a clinical discipline, a practice discipline
designed to produce explicit desired result
MARGARET NEWMAN The Four Metaparadigms
(Health as Expanding Consciousness) ❖ Health: "Health and illness are synthesized
as health - the fusion on one state of being
Background (disease) with its opposite (non-disease)
❖ Born on October 10, 1933. results in what can be regarded as health".
❖ Earned her Bachelor’s Degree at the ❖ Nursing: Nursing is "caring in the human
University of Tennessee in 1962. health experience". Nursing is seen as a
❖ Earned her Master’s Degree at the partnership between the nurse and client,
University of California in 1964. with both grow in the "sense of higher
❖ Earned her Doctorate at New York levels of consciousness"
University in 1971. ❖ Environment: Environment is described as
❖ Worked at the University of Tennessee, a "universe of open systems".
New York University, Pennsylvania State ❖ Person: Perceived as human. The human
University, and the University of Minnesota. is unitary, that is cannot be divided into
Health as Expanding Consciousness parts, and is inseparable from the larger
❖ A middle-ranged nursing theory. unitary field. Persons as individuals, and
❖ Theoretically sourced from Martha Roger’s human beings as a species are identifies
Theory of Humanitary Human Being, by their patterns of consciousness''. The
Arthur Young’s Theory of Process, Itzhak person does not possess consciousness"
Bentov’s Concept of Evolution of within an overall pattern of expanding
Consciousness, David Bohm’s Theory of consciousness. Persons are "centers of
Implicate, and Prigogine’s Theory of consciousness" within an overall pattern of
Dissipative Structure. expanding consciousness".
❖ The theory asserts that every person in Major Concepts and Definitions
every situation, no matter how disordered ❖ Health: Roger's insistence that health and
and hopeless it may seem, is part of the illness are simply manifestations of the
universal process of expanding rhythmic fluctuations of the life process is
consciousness – a process of becoming the foundation for viewing health and
more of oneself, of finding greater meaning illness as a unitary process moving
in life, and of reaching new dimensions of through variations in order - disorder.
connectedness with other people and the ❖ Pattern: A person identified by her or his
world. pattern, which reflects the pattern of the
❖ According to Newman, “the theory of person within the larger pattern of the
health as expanding consciousness was environment. The pattern is evolving
stimulated by concern for those for whom through various permutation of order and
health as the absence of disease or disorder, including what in everyday
disability is not possible. Nurses often language is called health and disease.
relate to such people: people facing the Pattern recognition emerges from a
uncertainty, debilitation, loss and eventual process of uncovering meaning in a
death associated with chronic illness. The person's life. Meaning is inherited in
theory has progressed to include the pattern, and vice versa.
health of all persons regardless of the ❖ Consciousness: Defines as the information
presence or absence of disease. capacity of the system that is, the ability of
❖ Evidence for the theory of health emanated the system interacts with the environment.
from Newman's early personal family Consciousness includes not only the
experience. Her mother's struggle with a cognitive and affective awareness normally
chronic illness and her dependency on associated with consciousness, but also
Newman sparked an interest in nursing. the interconnectedness of the entire living
From that experience evolved the idea that system, which includes physiochemical
"illness reflected the life patterns of the maintenance and growth processes as well
person and that what was needed was the as the immune system. This pattern of
recognition of that pattern and acceptance information, which is the consciousness of
of it for what is meant to that person". the system, is a part of a larger undivided
pattern of an expanding universe.
 "The expanding consciousness is the pattern
Three Correlates of Consciousness recognition." The manifestation of disease
➢ Movement depends on the patterns of individuals so the
➢ Time pathology of the disease exists before the
➢ Space symptoms appear so removal of disease
The relevance of movement, time and symptoms does not change the individual
space was part of the original explication and structure.
has re-emerged in the evolving patterning of According to her nursing is the process
unfolding consciousness. To see health as the of recognizing the individual in relation to
pattern of the whole, one needs to see disease environment and it is the process of
not as a separate entity as a manifestation of understanding of consciousness. The nurse
the evolving pattern of person-environment helps to understand people to use the e power
interaction. The paradigm shift is: From within to develop the higher level of
treatment of symptoms to a search for pattern; consciousness. Thus, it helps to realize the
From viewing disease and disrupt as negative disease process, its recovery and prevention.
to viewing them as part of the self - organizing Newman also explains the interrelatedness of
process of expanding consciousness; and from time, space and movement. Time and space
viewing the nursing role as addressing the are the temporal pattern of the individual, both
problems of disease to assisting people to get have complementary relationship. Humans are
in touch with their own pattern of expanding constantly changing through time and space, it
consciousness. shows unique pattern of reality.
Major Assumptions Strengths and Weaknesses
❖ Health encompasses conditions heretofore ❖ Strengths: It can be applied in any setting
describes as illness, or, in medical terms, and can generate caring interventions.
pathology. ❖ Weaknesses: Abstract, multi- dimensional,
❖ These pathological conditions can be qualitative, little discussion on environment.
considered manifestation of the total
pattern of the individual.
❖ The patterns of the individual that
eventually manifests itself as pathology is
primary and exits prior to structural or
functional changes.
❖ Removal of the pathology in itself will not
change the pattern of the individual.
❖ 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.
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. (Newman, 2010)
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.
Anne Boykin, Phd, RN ❖ Dr. Schoenhofer is committed to the study
Savina Schoenhofer, Phd, RN of nursing as caring.
(The Theory of Nursing as Caring: A Model ❖ She is on the board of the Anne Boykin
of Transforming Practice) Institute for the advancement of caring in
nursing, serving as a co- coordinator of its
Background of the Theorists: 2018 summer academy and co-editor of a
special issue of the international journal for
Anne Boykin human carrying on robots and caring in
nursing.
❖ The director of the Anne Boykin Institute
for the Advancement of Caring in Nursing I. Caring
of FAU College of Nursing. ❖ All people are compassionate by virtue of
❖ Positions she had held in the International being human; compassion is a
Association for Human Caring Include: fundamental aspect and manifestation of
⚫ President elect (1990-1993) being human. It is intentional to see people
⚫ President (1993-1996) as compassionate and whole beings rather
⚫ Member of the nominating committee than dividing them into distinct components
(1997-1999) like the mind, body, and spirit.
❖ She served as coeditor of the journal, ❖ Each person is caring fundamentally,
International Association for Human Caring, potentially, and actually.
from 1996 to 1999 ❖ All people are compassionate by virtue of
❖ She has written numerous book chapters being human; compassion is a
and articles and serve as a consultant fundamental aspect and manifestation of
locally, regionally, nationally, and being human. It is intentional to see people
internationally on the topic of caring. as compassionate and whole beings rather
❖ Boykin’s scholarly is centered on caring as than dividing them into distinct components
the grounding of nursing. like the mind, body, and spirit.
❖ Each person is caring fundamentally,
Savina Schoenhofer potentially, and actually.
❖ Caring is living in context of relational
❖ Schoenhofer spent three years in the responsibilities.
amazon region of brazil, working as a ❖ Caring is a responsibility to self and others.
volunteer in community development. ❖ Caring shapes relationship.
❖ Her initial nursing degree, concurrently II. Metaparadigms
with a psychology degree, was completed Person
at Wichita state university, where she also ❖ Persons are viewed as caring by virtue of
earned graduate degrees in nursing and their humanness. Persons are not viewed
counseling. as part, but rather as a whole.
❖ She completed a phd in educational Environment
foundations and administration at kansas ❖ Radiates a sense of nurturing atmosphere
state university in 1983. which help an individual to grow in caring
❖ In 1990, Schoenhofer co-founded while revealing the richness of nursing.
nightingale songs and early a venue for Health
communicating the beauty of nursing in ❖ Is believed to be achieved with the
poetry and prose. application of caring in all matters that
❖ Schoenhofer has written numerous articles deals with the patient.
on topics including nursing values, primary Nursing
care, nursing, education, support, touch, ❖ A discipline and profession. It focuses on
and mentoring. the idea of nursing as being grounded by
❖ Dr. Schoenhofer retired from active caring and that nursing revolves around
involvement in nursing education in 2014, caring people not just physically, but in
though she continues to collaborate in other aspect as well.
research and publication in nursing.
6 Major Assumptions Environment

A. Persons are Caring by Virtue D: Personhood is Enhanced through

of their Humanness Participating in Nurturing Relationships
B. Persons are Whole and Complete with Caring Others
in the Moment
C. Persons Live Caring, Moment ❖ As a process, personhood acknowledges
to Moment the potential of persons to live caring and
D. Personhood is Enhanced through is enhanced through participation in
Participating in Nurturing Relationships nurturing relationships with caring others.
with Caring Others The nature of relationships is transformed
E. Personhood is Living Life Grounded through caring.
in Caring
F. Nursing is Both a Discipline Health
and a Profession
E: Personhood is Living Life Grounded
Person in Caring

A: Persons are Caring by Virtue ❖ Personhood is a process of living caring

of their Humanness and growingin caring: It is being authentic,
demonstrating congruence between
❖ The belief that persons are caring by virtue beliefs and behaviors, and living out the
of the humanness sets forth the ontological meaning of one’s life. Personhood
and ethical bases on which the theory is acknowledges the potential for unfolding
grounded. Being a person means living caring possibilities moment to moment.
caring, through which being and
possibilities are known to the fullest. Nursing
❖ The assumption that all persons are
caring does not require that each act of a F: Nursing is Both a Discipline
person be caring, but it does require the and a Profession
acceptance that “fundamentally, potentially,
and actually, each person is caring” ❖ Nursing is an “exquisitely interwoven”
(Boykin & Schoenhofer, 2001a, p. 2). (Boykin & Schoenhofer, 2001a, p. 6) unity
of aspects of the discipline and profession
B: Persons are Whole and Complete of nursing. As a discipline, nursing is a way
in the Moment of knowing, being, valuing, and living in the
world, and is envisaged as a unity of
❖ Person as caring centers on valuing and knowledge within a larger unity. It focuses
celebrating human wholeness, that is the on the idea of nursing as being grounded
human person as living caring and growing by caring and that nursing revolves around
in caring; valuing and respecting each caring people not just physically, but in all
person’s beauty, worth, and uniqueness. aspect in life.
❖ The person is at all times whole. To
encounter a person as less than whole III. Key Concepts
fails to encounter an individual.

C: Persons Live Caring, Moment A. The Focus of Nursin g and

to Moment Intention of Nursing
( What do nurses think about while they are
❖ Caring is a lifetime process that is lived nursing?)
moment to moment and is constantly
unfolding. In the rhythm of life experiences, ❖ The focus of nursing is nurturing person’s
we continually develop expressions of living caring and growing in caring.
ourselves as caring persons.
B. Nursing Situation IV. Dance of Nursing
( What does the nurse do? )
❖ Acknowledgement that all persons have
❖ The nursing situation is the shared, lived the capacity to care by virtue of their
experience in which the caring between humanness.
nurse and nursed enhances personhood. ❖ Commitment to respect for person in all
❖ It is in the nursing situation that the nurse institutional structures and processes.
attends to calls for caring, creating ❖ Recognition that each participant in the
responses that nature personhood. enterprise has a unique valuable
contribution to make to the whole and is
C. Personhood present in the whole.
❖ Appreciation for the dynamic though
❖ Personhood is a process of living that is rhythmic nature of the Dance of Caring
grounded in caring. Personhood implies Persons, enabling opportunities for human
being who we are as authentic caring creativity.
persons and being open to unfolding
possibilities for caring.

D. Direct Invitation
( Example of Direct Invitation: Ask, in your
words, sincerely desiring to know: “ What
matters to you most, right now?”)

❖ This question is very considerate question

– wait for the patient’s in stillness.
❖ The one who is being nursed will respond
to the invitation in many different ways with
unique calls for nursing that arise from
what matters.

E. Call for nursing & Nursing Responses

❖ A call for nursing is a call from the one

nursed, perceived in the mind of the nurse.
This call for acknowledgement and
affirmation of that person living caring in
specific ways in the immediate situation.
❖ The nurse responds to these calls for
nursing with specific caring responses to
sustain and enhance the other as caring
person. Caring nurturance is what we call
nursing response.

F. Caring Between

❖ When the nurse enters the world of the

other person with the intention of knowing
the other as a caring person, the
encountering of the nurse and the one
nursed gives rise to the phenomenon of
caring between, within which personhood
is nurtured (Boykin & Schoenhofer, 2001).
Josephine Paterson& Loretta Zderad Theory Influence
(The Humanistic Nursing Theory)
❖ The humanistic model of nursing looks at
Background of the Theorist: the patient as an individual, and each
situation as unique. In this nursing
❖ Dr. Paterson Mastered in Public Health approach, there is no formulaic method or
Nursing, Completed Doctor of Nursing process in order to care for patients. Each
Science degree at Boston University- patient is assessed and treated on a case-
dissertation on Comfort. by-case basis.
❖ Dr. Zderad Mastered in Psychiatry, Doctor ❖ The Humanistic Model of Nursing is an
at Georgetown University in Philosophy- approach to nursing that encompasses a
dissertation on Empathy. number of individual theories, including
❖ Dr. Paterson and Dr. Zderad are both from Patricia Benner’s From Novice to Expert
the United States. Model of Nursing and Jean Watson’s
❖ Their career as nursing academics began Theory of Caring.Benner’s From Novice to
in the 1950s when they both worked at Expert Model of Nursing proposes that a
Catholic University and met each other. nurse can gain knowledge and skills
❖ They continued cooperating and remained without ever learning the theory behind it.
pals for the next 40years. Benner explains that the development of
❖ Shared experiences, ideas and insights to knowledge in applied disciplines such as
form a concept that evolved into the medicine and nursing is composed of the
Formal Theory of Humanistic Nursing. extension of practical knowledge through
❖ They first published their book: Humanistic research and the characterization and
Nursing in 1976. understanding of the “know how” of clinical
experience.Theory Influence
Brief description of the theory ❖ The theory explains the five levels of
nursing, which are: novice, advanced
❖ “Paterson and Zderad’s Humanistic beginner, competent, proficient, and expert.
Nursing Theory applies both Humanism How nurses approach patients is
and Existentialism to nursing theory. dependent on the level of expertise of the
Humanism attempts to take a broader nurse.
perspective of the individual’s potential and ❖ In Watson’s Theory of Caring, nursing is
tries to understand each individual from the “concerned with promoting
context of their own personal experiences. health,preventing illness, caring for the sick
Existentialism is a philosophical approach and restoring health.” Watson believes that
to understanding life. It’s the belief that holistic health care is central to the practice
thinking begins with the human – the of nursing, and defines nursing as“a
feeling, acting, living individual. human science of persons and human
Existentialism emphasizes the individual’s health-illness experiences that are
free-choice, self-determination and self- mediated by professional, personal,
responsibility. scientific, esthetic, and ethical human
❖ Humanistic nursing theory encompasses a transactions.” Watson’s model contains
call from a person or persons(families, seven assumptions about care and caring,
communities, humanity) for help with a as well as ten primary carative factors. It
health-related need, and a response to that places the patient in the context of the
call when recognized by a nurse or groups family, community, and culture, and the
or communities of nurses. Through focus of the practice is on the patient
dialogue, nurse(s) and person(s) work rather than the technology.
toward resolving a health-related need
(Kleiman, 2010).
Major Concepts and their definitions 2. Nurse Knowing of the Other Intuitively
➢ In this stage, the nurse tries to understand
Dialogue the other, as in the “I-thou”
❖ Nursing is a lived dialogue. It is a nurse- relationship,where the nurse as the “I”
nursed relating creatively. does not superimpose themselves on the
“thou” of thepatient.
A. )Meeting 3. Nurse Knowing the Other Scientifically
➢ is characterized by the expectation that ➢ The nurse as the observer must observe
there will be a nurse and nursedrelating. and analyze from the outside. At this
B. ) Relating stage,the nursegoes from intuition to
➢ is a process of a nurse-nursed doing with analysis. The analysis is the sorting,
each other. comparing,contrasting, relating,
⚫ Subject-Subject relating"I-Thou"-is a interpreting, and categorizing.
coming to know the other and the self 4. Nurse Complementarily Synthesizing
inrelation, intuitively. Known Others
⚫ Subject-Object relating"I-It"-is an authentic ➢ The ability of the nurse to develop or see
analyzing, synthesizing, andinterpreting of themselves as a source of knowledge, to
the "I-Thou" relation through reflection. continually develop the nursing community
C. )Presence through education, and increased
➢ is the quality of being open, receptive, understanding of their owned learned
ready, and available to another person. experiences.
5. Succession Within the Nurse from the
D. ) Call and Response Many to theParadoxical One
➢ Nurses and clients call and respond to ➢ In this stage, the nurse takes the
each other both verbally and nonverbal. information gleaned and applies it int he
practical clinical setting. Here the nurse
Community Phenomenologic Nursology takes brings the dilemma towards
❖ meaning comes from the realization that it resolution.
is through each other that we more fully
participate in and expand our lives- two or Metaparadigms
more persons struggling together towards
a center(Paterson&Zderad, 1976). Nursing
➢ is a nurturing response of one person to
Phenomenologic Nursology another in a time of need that aimstoward
❖ methodology for understanding and the development of well-being and more
describing nursing situations.- Assumes a being.
perceived health need by the individual ➢ helping to increase responsible choices
who is involved in the interaction with a ➢ is concerned with the individual’s unique
health care provider.- Concerned with the being and striving towards
nature of facts and what they mean to becoming,focusing on the whole
individuals. ➢ it is a lived dialogue that incorporates the
intersubjective in which a nurse and
apatient meet, relate, and are totally
5 Phases of Humanistic Nursing Process present in an existential way that
includesintimacy and mutuality
1.Preparation of the Nurse Knower for
Coming to Know Health
➢ In this stage, the nurse acts as an ➢ Matter of personal survival. It is a process
investigator who willingly takes risks and of experiencing one’s potentialfor well-
has anopen mind. The nurse must be a being and more
risk-taker and be willing to experience ➢ being, a quality of living and dying.
anything. “Accepting the decision to ➢ finding meaning in life
approach the unknown openly”. Well-being: steady state (maintenance of
quality) or more than absence of disease
More well-being: process of becoming all that
is humanly possible

Person
➢ Human beings are characterized as being
capable, open to options,person with
values, and the unique manifestation of
their past, present,and future.

Environment
➢ Community: The phenomenon of society or
environment
➢ Two or more persons struggling together
toward a center.
➢ It is only through our community that we
are able to reach our full potential.

Use of theory in Research

➢ The Phenomenological method is

proposed as a descriptive approach for
participants in the nursing situation to
study, interpret, and attest the nature and
meaning of the lived events.

Relevance to Nursing Practice

➢ The bounded concern for attention to
physical status gives support for
application of the theory.
➢ The difficulty of continuous “active
presence” with the whole of nurse’s being
is addressed by the theorists.
➢ Have limited applicability in situations in
which the nurse as helper interacts with a
child or a comatose patient.