1. Chapter 8 Grand Nursing Theories Based on Interactive Process

2. Myra Levine
“Nursing is a humanitarian enterprise.”
Conservation Model

3. Myra Levine—(cont.) Born in Chicago in 1920
Diploma from Cook County School of Nursing (1944)
BS from University of Chicago (1949)
MS in Nursing from Wayne State University (1962)
Held a number of faculty positions including Cook County School of Nursing, Loyola University, Rush University, and the University of Illinois, Chicago
Retired in 1987 but remained active in speaking

4. The Conservation Model
The Conservation Model was developed from Nightingale’s idea of creating an environment to assist healing.
The model was developed in the late 1960s as a teaching tool for medical/surgical nursing students to de- emphasize “procedures.”
The nurses are seen as part of the environment and uses skill, knowledge, and compassion to assist each client to confront environmental challenges in resolving problems.
Effectiveness of interventions is determined by maintenance of client integrity.

5. The Conservation Model—(cont.)
Model focuses on multiple factorial interactions between the nursing and the client.
Three major concepts
Wholeness (holism)—“wholeness emphasizes a sound, organic, progressive, mutuality between diversified functions and parts within an entirety”; wholeness is integrity
Adaptation—“process of change whereby the individual retains his integrity within the realities of his internal and external environment”; conservation is the outcome
Conservation—“the way complex systems are able to continue to function even when severely challenged”

6. Question
The Conservation Model focuses on holism, conservation, and which other major concept?
Adaptation
Compensatory health
Health promotion
Nursing therapeutics

7. Answer
Adaptation
Rationale: In the Conservation Model, adaptation is the process of change whereby the individual retains his integrity within the realities of his internal and external environment. Conservation is the outcome.

8. The Conservation Model—(cont.)
Four conservation principles form the basis of the model.
Principle of the conservation of energy
Principle of the conservation of structural integrity
Principle of the conservation of personal integrity
Principle of the conservation of social integrity

9. The Conservation Model—(cont.)
Through conservation, individuals confront obstacles, adapt, and maintain their uniqueness.
The goal of conservation is health.
Focus of conservation is keeping together the wholeness of the individual.
Stresses nursing interactions and interventions are based on the conservation principles
Nursing interventions are based on conservation of the client’s integrity in each of the conservation domains.

10. The Conservation Model—(cont.)
Conservation of energy
Individuals require a constant renewal of energy to maintain life activities.
Healing and aging challenge the energy balance.
Conservation of energy is part of most basic of nursing procedures.

11. The Conservation Model—(cont.)
Conservation of structural integrity
Healing is a process of restoring structural and functional integrity.
Disabled are guided to new level of adaptation.
Nurses can limit threats to structural integrity by early recognition of functional changes and appropriate interventions.

12. The Conservation Model—(cont.)
Conservation of personal integrity
Self-worth and identity are important.
Anxiety and erosion of privacy threaten personal integrity.
Includes the sanctity of life and recognition of the holiness of each person
Nurses should give knowledge and assist in regaining and maintaining personal integrity.

13. The Conservation Model—(cont.)
Conservation of social integrity
Life gains meaning through social communities.
Health is socially determined.
Nurses provide for family members, assist with religious needs, and use interpersonal relationships to conserve social integrity.

14. The Conservation Model—(cont.)
The first edition of her book—Introduction to Clinical Nursing (1969) addressed the four conservation principles in “holistic nursing.”
In the second edition, she added detail and began presenting the principles as the Conservation Model.
Model was revised in 1989 and 1991.
Levine died in 1996 (age 75 years).

15. Sister Callista Roy
Roy Adaptation Model

16. Sister Callista Roy—(cont.)
Callista Roy was born in 1939 in Los Angeles.
Mom was an LVN.
Earned a BS in Nursing in 1963 from Mount St. Mary’s College, Los Angeles
MSN in 1966 (UCLA)
PhD in sociology 1977 (UCLA)

17. Sister Callista Roy—(cont.)
She is a member of the Sisters of St. Joseph of Carondelet.
Pediatric nurse by practice working in several Carondelet hospitals.
Currently Professor and Nurse Theorist at Boston College School of Nursing

18. Sister Callista Roy—(cont.)
Became interested in nursing theory during a seminar with theorist Dorothy Johnson
She developed basic concepts for the model while a graduate student at UCLA in the mid-1960s; it was developed as a curriculum framework for nursing programs.

19. Sister Callista Roy—(cont.)
Roy focused on the concept of adaptation because of her interest in resiliency of children and their ability to adapt to major physical and psychological changes.
RAM is based on the work of Dorothy Johnson, Helson’s adaptation theory, Selye’s stress and adaptation works, von Bertalanffy’s systems theory, and Lazarus’s coping model.

20. Question
Tell whether the following statement is true or false: Roy’s observations of the resiliency of children with regard to their health led her to focus her theory on the concept of adaptation.

21. Answer
True Rationale: Roy’s background work in pediatrics led her to focus on the concept of adaptation. She included the works of several other theorists while focusing on stress, coping, and adaptation.

22. Sister Callista Roy—(cont.)
The Roy Adaptation Model (RAM) was first published in Nursing Outlook in 1970.
Books and book chapters describing and updating the model were published in 1976, 1980, 1984, 1989, 1999, and 2009.

23. Roy Adaptation Model Major concepts Adaptation Focal stimuli
Contextual stimuli
Residual stimuli
Cognator subsystem
Regulator subsystem
Coping mechanisms
Adaptive and ineffective responses

24. Roy Adaptation Model—(cont.)
Major concepts
Four adaptive modes
Physiologic–physical mode
Self-concept–group identity mode
Role function mode
Interdependence mode

25. Diagrammatic representation of human adaptive systems. (Source: Roy, C
Diagrammatic representation of human adaptive systems. (Source: Roy, C., & Andrews, H. A. [1998]. The Roy adaptation model [2nd ed., p. 114). Stamford, CT: Appleton & Lange [Reprinted with permission of Pearson Education, Inc, Upper Saddle River, NJ].)

26. Roy Adaptation Model—(cont.)
Nurses assess behaviors and stimuli that influence adaptation.
Goal of nursing is promotion of adaptation in each of the four adaptive modes; this contributes to health, quality of life, and dying with dignity.

27. Roy Adaptation Model—(cont.)
The person is an open system that receives input or stimuli from both the environment and the self.
Adaptation level is determined by the combined effect of the focal, contextual, and residual stimuli.
Adaptation occurs when the person responds positively to environmental change; this promotes integrity leading to health.

28. Roy Adaptation Model—(cont.)
Two interrelated subsystems
Functional or control process subsystem
Regulator and cognator
Effector subsystem (four adaptive modes)
Physiologic functions
Self-concept
Role function
Interdependence

29. Roy Adaptation Model—(cont.)
Functional or control process subsystem
Regulator—influences the physiologic mode responds automatically through neural, chemical, and endocrine coping processes
Cognator—influences the self-concept, role function, and interdependence modes through perceptual information processing, learning, judgment, and emotion

30. Roy Adaptation Model—(cont.)
Six-step nursing process
Assess behaviors in four adaptive modes.
Assess focal, contextual, and residual stimuli.
Make statement of diagnosis of person’s adaptive state.
Set goals to promote adaptation.
Implement interventions to manage stimuli to promote adaptation.
Evaluate whether goals have been met.

31. Roy Adaptation Model—(cont.)
Among the most widely used models in nursing education—curricular framework for all levels of nursing programs
Among the most widely used models in nursing research (more than 170 studies)

32. Roy Adaptation Model—Resources
/Roy_Adaptation_Model.html
n_model.html

33. Erickson, Tomlin, and Swain
Modeling and
Role-Modeling
Theory

34. Erickson, Tomlin, and Swain—(cont.)
Helen Erickson
Diploma from Saginaw General Hospital in Saginaw, MI (1957)
BSN (1974) and MSN (1976) in psychiatric and medical surgical nursing, PhD in educational psychology (1984) from the University of Michigan
ER nurse in Midland, TX
Worked in Puerto Rico
Independent practitioner
Faculty at several schools, including University of Michigan and University of South Carolina, and is professor emeritus from University of Texas at Austin

35. Erickson, Tomlin, and Swain—(cont.)
Evelyn Tomlin
Diploma from Los Angeles General Hospital and BSN from University of Southern California
Masters in Psychiatric Nursing from University of Michigan (1976)
Clinical practice in Afghanistan
Areas of practice include critical care, home health, and nursing education
Retired and lives in Illinois

36. Erickson, Tomlin, and Swain—(cont.)
Mary Ann Swain
Education in psychology (BA, MS, and doctorate) (not a nurse) from University of Michigan
Taught research methods and statistics to graduate nursing students at DePauw University and University of Michigan
Currently an administrator (Provost) at SUNY— Binghamton

37. Modeling and Role-Modeling
Based on works of Maslow, Erickson, Piaget, Selye, and Lazarus among others
Nursing is a process between the nurse and client.
Nursing requires an interpersonal and interactive nurse– client relationship.
The focus of the model is the ability of the individual to mobilize resources when confronted with stressors.
Initially published in 1983; revised in 1990.

38. Modeling and Role-Modeling—(cont.)
Nurses assess (model), plan (role-model), and intervene (five aims of intervention) based on the client’s perspective of the world.
The nurse always acknowledges the uniqueness and individuality of the client and appreciates that all individuals have self-care knowledge (what works for them).

39. Modeling and Role-Modeling—(cont.)
Important concepts
Holism—Humans have multiple interacting subsystems (genetics, spiritual drive, body, mind, emotion) that act together, affecting and controlling one another.
Affiliated individuation—dependence on support systems while maintaining independence

40. Modeling and Role-Modeling—(cont.)
Important concepts
Adaptation—individual’s responses to external and internal stressors
Maladaptation—taxing of the system in which the individual is unable to engage constructive coping methods or mobilize appropriate resources to contend with the stressor

41. Modeling and Role-Modeling—(cont.)
Important concepts
Self-care—knowledge, resources, and actions of the client
Nursing is the holistic helping of persons with their self-care activities in relation to health; it is an interactive, interpersonal processes to achieve perceived holistic health.

42. Modeling and Role-Modeling—(cont.)
Important concepts
Modeling—the process by which the nurse seeks to understand the client’s unique model of the world
Role-modeling—the process by which the nurse understand the client’s unique model within the context of scientific theories and uses the model to plan interventions that promote health for the client

43. Question
In the Modeling and Role-Modeling Theory, which of the following is considered the interactive, interpersonal processes to holistically assist persons with their self-care activities in relation to health?
Affiliated individuation
Modeling
Nursing
Role-modeling

44. Answer
C. Nursing Rationale: Nursing is seen as an interactive, interpersonal process that nurtures strengths to achieve a state of holistic health.

45. Modeling and Role-Modeling—(cont.)
Five aims of intervention
Build trust—Nursing requires a trusting relationship.
Promote positive orientation—Affiliated nursing care should promote the client’s self-worth and hope for the future.
Promote perceived control—Nurses should assist clients have control over what happens to them.
Promote strengths—Nurses should identify and promote strengths to mobilize resources.
Set mutual goals—Nurses should use the individual’s innate drive to be as healthy as he/she can be; goals are to meet basic needs.

46. Modeling and Role-Modeling—(cont.)
Nurses promote self-care by helping clients with
Self-care knowledge—knowledge of what will improve health
Self-care resources—recognition of internal and external resources that will hope promote holistic health
Self-care action—development and use of self-care knowledge and self-care resources

47. Modeling and Role-Modeling—(cont.)
Adaptive potential—ability to mobilize resources to cope with stressors
Equilibrium
Adaptive equilibrium
Maladaptive equilibrium
Arousal
Impoverishment

48. Modeling and Role-Modeling—(cont.)
Human beings are holistic with interacting subsystems (biophysical, psychological, social and cognitive) and inherent genetic bases and spiritual drive.

49. Modeling and Role-Modeling—(cont.)
Through an interactive and interpersonal relationship, nurses use three activities:
Facilitation
Nurturance
Unconditional acceptance

50. Modeling and Role-Modeling—(cont.)
MRM is newer and not as well known as other nursing theories.
MRM has been used as the basis for curricula at a number of schools in the United States.
A series of conferences discussing the models use in research and practice were conducted in the 1990s.

51. Modeling and Role-Modeling—Resource

52. Jean Watson
Human Science
and
Human Caring Theory

53. Jean Watson Jean Watson was born in 1940 in West Virginia.
Diploma from Lewis Gale Hospital School of Nursing in Roanoke, VA
BSN (1964) and MSN (1966) in psychiatric–mental health nursing and PhD in Educational Psychology and Counseling (1973) from the University of Colorado
Faculty at the University of Colorado since 1973
In 1992, she founded the Center for Human Caring and is still the director.

54. Theory of Human Science and Human Caring
Initially published in 1979 as the Philosophy and Science of Caring
In 1985, Nursing: Human Science and Human Care: A Theory of Nursing was published; it was revised in
Caring Science as Sacred Science (2nd ed.) (2012) is her most recent work.

55. Theory of Human Science and Human Caring—(cont.)
Describes caring as the essence of nursing
Caring is perceived to be a moral ideal rather than a task-oriented behavior.
Her work is focused on humanities with a phenomenologic, existential, and spiritual orientation.

56. Theory of Human Science and Human Caring—(cont.)
She used works of Leininger, Peplau, Rogers, Nightingale, Maslow, Heidegger, Selye, Lazarus, and Sarte among others in her work.

57. Theory of Human Science and Human Caring—(cont.)
Main concepts
Transpersonal caring relationship
Ten carative factors
Caring occasion/caring moment

58. Theory of Human Science and Human Caring—(cont.)
Ten “carative factors” for nursing practice
Formation of humanistic–altruistic system of values
Instillation of faith–hope
Cultivation of sensitivity to self and others
Development of a helping–trusting relationship
Promotion and acceptance of the expression of positive and negative feelings

59. Theory of Human Science and Human Caring—(cont.)
Ten “carative factors” for nursing practice—(cont.)
6. Systematic use of the scientific problem-solving method for decision making
7. Promotion of interpersonal teaching–learning
8. Provision for supportive, protective, and corrective mental, physical, sociocultural, and spiritual environment
9. Assistance with gratification of human needs
10. Allowance for existential-phenomenologic forces

60. Evolution of the Theory
Carative factors became clinical caritas processes.
Caritas (Greek) meaning to cherish, appreciate, and to give special attention to
Clinical caritas is an emerging model of transpersonal caring.

61. Clinical Caritas Processes
Practice of loving-kindness an equanimity within context of caring consciousness
Being authentically present sustaining the deep belief system and subjective life world of self and one being cared for
Cultivation of one’s spiritual practices and transpersonal self (going beyond self)
Developing and sustaining a helping–trusting, caring relationship
Being supportive of the expression of positive and negative feeling and connection with the spirit of self

62. Clinical Caritas Processes—(cont.)
6. Creative use of self as part of the caring process 7. Engaging in teaching learning experience that attends to unity of being and meaning Creating healing environment at all levels Assisting with basic need and intention caring consciousness tending to both embodied spirit and evolving spiritual emergence 10. Opening an attending to spiritual-mysterious and existential dimension of one’s own life death care for self

63. Theory of Human Science and Human Caring—(cont.)
Nursing consists of knowledge, thoughts, values, commitment, and action; it is related to human care transactions within the lived world of the person.
Nursing involves transpersonal human-to-human attempts to protect, enhance, and preserve humanity by helping a person find meaning in illness, suffering, pain, and existence; it involves helping others gain self- knowledge, control, and self-healing wherein a sense of inner harmony is restored.

64. Theory of Human Science and Human Caring—(cont.)
Goals of nursing
Enhance mental–spiritual growth for self and others.
Find meaning in one’s own existence and experiences.
Discover inner power and control.
Encourage transcendence and self-healing.

65. Theory of Human Science and Human Caring—(cont.)
Widely recognized, but not well understood (opinion)
Used sparingly in nursing education
Used as a framework in qualitative research studies; also elements of the study have been tested by Watson and colleagues

66. Theory of Human Science and Human Caring—Resources