NURSING THEORIES

1. Hildegard Peplau - Theory of Interpersonal

Relationship
2. Ida Jean Orlando - Theory of Deliberative
Nursing Process
3. Joyce Travelbee - Human to Human Relationship
4. Lydia Hall - CORE,CARE,CURE
5. Faye Abdellah - 21 Nursing Problems
6. Rosemarie Parse - Theory of Human Becoming
7. Nola Pender - Health Promotion Model
8. Madeleine Leininger - Theory of Culture Care
Diversity and Universality
9. Margaret Newman - Theory of Health as Expanding
Consciousness
10. Virginia Henderson - Need Theory

Hildegard Peplau - Theory of Interpersonal

Relationship

is a psychiatric nurse, Introduced her interpersonal

concept in 1952.
Defined Nursing: “An interpersonal process of
therapeutic interactions between an Individual who is
sick or in need of health services and a nurse
especially educated to recognize, respond to the need
for help. Nursing is a “maturing force and an
educative instrument”

Identified 4 phases of the Nurse – Patient
relationship:

Orientation – individual/family has a “felt need” and

seeks professional assistance from a nurse (who is a
stranger). This is the problem identification phase.
Identification – where the patient begins to have
feelings of belongingness and a capacity for dealing
with the problem, creating an optimistic attitude from
which inner strength ensues. Here happens the
selection of appropriate professional assistance.

Exploitation – the nurse uses communication tools to

offer services to the patient, who is expected to take
advantage of all services.

Resolution – where patient’s needs have already

been met by the collaborative efforts between the
patient and the nurse. Therapeutic relationship is
terminated and the links are dissolved, as patient drifts
away from identifying with the nurse as the helping
person.

Ida Jean Orlando - Theory of Deliberative Nursing

Process

MAJOR CONCEPTS AND DEFINITIONS:

NURSES RESPONSIBILITY
-Whatever help the patient may require for his needs
to be met. It is the nurse’s responsibility to see that
“the patient’s needs for help are met, either directly by
her own activity or indirectly by calling in the help of
others.”

NEED
-Situationally defined as a requirement of the patient
which, if supplied, relieves or diminishes his
immediate distressor and improve his immediate
sense of adequacy or well-being.

PRESENTING BEHAVIOR OF A PATIENT

-Any observable verbal or nonverbal behavior.
IMMEDIATE REACTIONS
-Include both the nurse and patient’s individual
perceptions, thoughts and feelings.

NURSING PROCESS DISCIPLINE

-Includes the nurse communicating to the patient his
or her own immediate reaction, clearly identifying that
the item expressed belongs to the nurse, and then
asking for validation or correction.

Nursing process discipline was called deliberative

nursing process in Orlando’s first book, The
Dynamic Nurse-Patient Relationship: Function,
Process and Principles of Professional Nursing
Practice, and also called nursing process and process
discipline.

IMPROVEMENT
-“Means to grow better, to turn to profit, to use
advantage”

PURPOSE OF NURSING
-Supply the help a patient requires in order for his
needs to be met.

AUTOMATIC NURSING ACTION

-Those nursing actions decided upon for reasons
other than the patient’s immediate need.

DELIBERATIVE NURSING ACTION

-Those actions decided upon after ascertaining a need
and then meeting this need.
MAJOR ASSUMPTIONS:
(NURSING)
-“Nursing is a distinct profession separate from other
discipline”
-“Professional nursing has a distinct function and
product/outcome”
-“There is difference between lay and professional
nursing”
-“Nursing is aligned with medicine”

(PATIENTS)
-“Patients’ needs for help are unique”
-“Patients have an initial ability to communicate their
needs for help”
-“When patients cannot meet their own needs they
become distressed”
-“The patient’s behavior is meaningful”
-“Patients are able and willing to communicate
verbally (and non-verbally when unable to
communicate verbally)

(NURSE)
-“The nurse’s reaction to each patient is unique”
-“Nurses should not add to the patient’s distress”
-“The nurse’s mind is the major toll for helping
patients”
-“The nurse’s use of automatic responses prevents
the responsibility of nursing from being fulfilled”
-“Nurses practice is improved through self-reflection”

(NURSE-PATIENT SITUATION)
-“The nurse-patient situation is a dynamic whole”
-“The phenomenon of the nurse-patient encounter
represents a major source of nursing knowledge”
METAPARADIGM:

PERSON
-persons behave verbally and non-verbally.

-people are sometimes able to meet their own needs

for help in some situations; however they become
distressed when they are unable to do so.

-each patient is unique and individual in his or her

response

ENVIRONMENT
-she assumes that a nursing situation occurs when
there is a nurse-patient contact and that both nurse
and patient perceive, think, feel and act in the
immediate situation.

-any aspect of the environment, even though it is

designed for therapeutic and helpful purposes, can
cause the patient to become distressed.

HEALTH
-Orlando, does not define health, but she assumes
that freedom from mental or physical discomfort and
feelings of adequacy and well-being (fulfilled needs)
contribute to health.

NURSING
-it is a distinct profession that functions autonomously.
-nurses should help relieve physical or mental
discomfort and should not add to the patient’s
distress.
-providing direct assistance to individuals in whatever
setting for the purpose of avoiding, relieving,
diminishing, or curing the person’s sense of
helplessness.
NURSING PROCESS

CHARACTERISTICS OF THE THEORY:

-Orlando's theory interrelate concepts
-Orlando's theory has a logical nature
-Orlando's theory is simple and applicable in the daily
practice.
-Orlando's theory contribute to the professional
knowledge.
-Orlando's theory is applicable in clinical practice
 Joyce Travelbee - Human to Human Relationship
1926-1973

-The need for a “Humanistic Revolution” in nursing,

with a renewed devotion on caring and compassion
for patients.

-Assist the person, family, or community to avert or

palliate the experiences of sickness and
suffering—instilling hope as a maximum goal.

-Hope being a mental state with a yearning to finalize

or reach a purpose, with an expectation of gaining that
which is desired.

-Concept of hope would evolve from psychiatric

nursing to patients with chronic illnesses, requiring
long-term care.

-To understand the ill patient, is to recognize the

person’s uniqueness.

-The nurse’s spiritual values and philosophical beliefs,

toward suffering, would be a driving force in helping
people to find meaning in their illnesses.

-The therapeutic use of self in communicating and

establishing relationships.

-Finding meaning, during interactions, is essential to

the nurse and patient relationship.

-Human-to-Human relationships serve to define and

make proficient the practice of nursing.

-Recognizing the importance of sympathy, as well as

empathy, in order to develop human-to-human
relationships.
-A nurse exhibiting sympathy is an act of courage
because the nurse is risking pain, and one should
recognize the dangers involved in sympathy, such as
over-identification, a distorted sense of pity, causing
harm to the patient, becoming too soft hearted, or
being will paralyzer to the patient.

-Involves working through the phases of initial

encounter, emerging identity, empathy, sympathy, and
rapport.

 PHASES OF THE NURSE-PATIENT

RELATIONSHIP:

-Original Encounter: The need to perceive the

human being in the patient, and vice versa, with the
task of breaking the bond of sequence.

-Emerging Identities: Patient and nurse begin to

recognize the differing qualities that each possess,
transcending roles by separating self and experiences
from one and another—not using oneself to judge
others.

-Developing Feelings of Empathy: Not sharing

another’s feelings, but sharing a psychological state of
another—exhibiting the ability to predict the behavior
of others.

-Developing Feelings of Sympathy: Experiencing,

sharing, and feeling what others are
experiencing—emotional involvement involving the
nurse transforming sympathy into concrete nursing
actions.

-Rapport: The phase of rapport is the end result of all

phases. An accumulation of thoughts, experiences,
feelings, and attitudes, involving both nurse and
patient, that they can share, perceive, and
communicate, resulting in a therapeutic relationship.

-Travelbee defined her place in history as a pioneer of

nursing theory, because she used a different
approach, the human-to-human relationship between
nurse and patient, as she synthesized her unique
ideas that differentiated her work from that of other
theorists.

Lydia Hall - CORE,CARE,CURE

METAPARADIGM CONCEPT OF HALL:

PERSON
-The individual human who is 16 year of age or older
and pass the acute stage of a long term illness is the
focus of the nursing care in the Hall’s work.

-Hall emphasizes the importance of the individual as

unique, capable of growth and learning and requiring
a total person approach.

ENVIRONMENT
-Hall is credited with developing the concept of lobe
center because she assumed that the hospital
environment during treatment of acute illness creates
experience for the ill individual.

HEALTH
-Can be inferred to be a state of self -awareness with
conscious selection of behaviors that are optimal for
that individual.

-Hall stresses the need to help the person explore the

meaning of his or her behavior to identify and
overcome problems through developing self-identity
and maturity.
NURSING
-identified as consisting of participation in the care,
core, and cure aspects of the patients care.

CONCEPTUAL MODEL

CARE, CORE, AND CURE

-Hall enumerated three aspects of the person as

patient: the person, the body, and the disease. These
aspects were envisioned as overlapping circles of
care, core, and cure that influence each other.

-Hall clearly stated that the focus of nursing is the

provision of intimate bodily care. She reflected that the
public has long recognized this as belonging
exclusively to nursing (Hall, 1958, 1964,1965).
THE CARE CIRCLE

-Hall suggested that the part of nursing that is

concerned with intimate bodily care

-Explains the role of nurses and focused on

performing that noble task of the nurturing patients.

-Component of this model is the “motherly care”

provided by the nurses (George, J.B 2000).

-Which may include: Comfort measures, Patient

instructions and Helping patients meet their needs
where help is needed.

-Major purpose of care is to achieve an interpersonal

relationship with the individual that will facilitate the
development of the core ( Texas Woman’s University)

-The part of nursing that is concerned with intimate

bodily care (e.g., bathing, feeding, toileting,
positioning, moving, dressing, undressing, and
maintaining a healthful environment).

-Nursing is required when people are not able to

undertake these activities for themselves

THE CORE CIRCLE

-The person or patient to whom nursing care is

directed and needed.
-Core involves the therapeutic use of self, and
empathizes the social, emotional, spiritual, and
intellectual needs of the patient in relation to family,
institution, community, and the world (Hall, 1955, 1958,
1965).
-The core has goals set by himself and not by any
other person.

-Behaves according to his or hers feelings and values

(George, J. B 200).

-Through the professional nursing process, the patient

has the opportunity of making the illness a learning
experience from which he may emerge even healthier
than before his illness (Hall, 1965).

THE CURE CIRCLE

-Focus on nursing related to the physician’s orders.

-Attention given to patients by medical professionals.

-Shared by the nurse with other health professionals,

such as physicians or physical therapist.

-Interventions or actions geared toward treating the

patient for whatever illness or disease he or she is
suffering from (George, J.B 200).

-The other view of this aspect of nursing is to see the

nurse helping the patient through his or her medical,
surgical, and rehabilitative care in the role of comforter
and nurturer.

 ASSUMPTIONS:

-The motivation and energy necessary for the cure

exist with in the patient, rather than in the health care
team .

-The three aspects of nursing should not be viewed

as functioning independently but as interrelated.
-The three aspects interact ,and the circles
representing them change size, depending on the
patient’s total course of progress.

STRENGTHS WEAKNESS
 The use of the care,  Acute stage patients
core, and cure is unique are not included
to Hall
 only applicable to adult
 Hall’s work appear to patient
be completely and simply
logical.  only tool of therapeutic
communication is
reflection

 family mentioned only

in cure circle

 only related to those

who are ill

 Individuals must pass

an acute stage of illness
for you to successfully
apply her theory.

 Therefor theory relates

to only those who are ill.

 No nursing contact with

healthy individuals,
families or communities
and it negates the
concept of health
maintenance and
prevention (Gonzalo
2011).
  Lacks application to
pediatric care she impose
age requirement.
 The only tool of
therapeutic
communication Hall
discussed is reflection. It
is not always the most
effective techniques to be
used

 APPLICATION IN NURSING PROCESS:

-This theory will be applicable in assessment, planning

and implementation of patient care .

HOW DO NURSES RELATE?

-Hall proposed many ideas of professional practice,

such as the nursing process.
-Improvement of nurses to meet the needs of the
patient with better professional nursing care.
-Establishment of nurse patient relationship.
-Collaboration with other health professionals.
-Deliverance of care to ill patients

Assessment phase:
-involves the collection of data about the health status
of individual according to hall, the process of data
collection is directed for the benefit of the patient
rather than for the benefit of the nurse
Nursing diagnosis:
- statement of the patients need or problem area.

Outcome and planning phase:

- involves setting priorities and mutually establishing
patient centered outcomes and goals. The patient
decides what is of highest priority and also what
outcomes and goals are desirable.

Implementation:
- involves the actual institution of plan of care

Evaluation:
-It is the process of assessing the patients progress
towards the health goals. It is directed toward deciding
whether or not the patient is successful in reaching the
established goals.

-Is the patient learning who is he? where he wants to

go?

-Is the patient learning to understand and explore the

feeling that underlie behavior?

-Is the nurse helping the patient see motivation more

clearly?

-Are the patient goal congruent with the medical

regimen? Is the patient successful in meeting the
goal?

-Is the patient physically more comfortable?





 Application(Acceptance) Lydia hall by the
nursing community :

PRACTICE EDUCATION RESEARCH

Halls theory Halls theory Implementation
closely delineates of halls theory
resembles to definite ideas in nursing units
the nursing regarding within the united
model of nursing care states was not
primary care provided by a found out side
professional the Loeb
Halls concept of nursing staff. center . Giving
nurses being the changes in
accountable Hall health care and
and responsible emphasized the current
for their own concept of Medicare and
practice are nurses Medicaid
pertinent and practicing as policies and
applicable ideas practical doctors procedures, it
concerns for “nursing may be difficult
this concept diagnosis vs. to further test
demonstrate medical halls original
support for her diagnosis assertion that
theory wholly
Focus on professional
Focused on maintaining nursing care will
personalized optimal health hasten recovery
nursing care and quality of
rather than life for the
merely routine patient and
care family
 Application of Lydia hall theory in clinical
setting:

-This theory more applicable in the following

setting:
In geriatric nursing
In operation room
In critical care unit
In dialysis unit

 Application of Lydia hall theory on nursing

process:

Case study
Jemal is 23 year old graduating football player in
Bahirdar university. Unfortunately, while on his way
to his game, he was involved in automobile accident in
which his right arm was crashed and his right leg was
injured. Their was concern about possible internal
injuries but luckily their was none. The required
surgery have been completed for his right arm and
foot, he is now in physical therapy to deal with the
effects of the accident and his recent immobility, jemal
is on his 3rd post operative day and he is
complaining being “so tired” during body strengthen
exercise and his vital sign is with in the base line.

care core cure

-Physical, the Mr. Jemal -The surgical
remarkable looking at the incision on his
finding are his floor, nurse tells right arm and
right arm is in to him , that he right leg has
an orthopedic is going home healed and he is
device to tomorrow? And beginning to
stabilize it and sure the nurse bear weight on
encourage bon observed that the foot with
healing. he is not looking some complain.
very happy
-He is right about the -There are no
handed but has prospect . Mr. problem with
learned to Jemal says “yes hydration or
compensate I am doing ok elimination, skin
with his left here but I am is intact with
hand for most scared about good turgor, all
activities daily going back to the vital sign
living. school”. How and laboratory
will take notes value are with
-He needs and tests? It normal level.
minor looks like I have
assistance with totally messed -He complaining
dressing up football tiredness on
team. I am more exercise
- He is rapidly worried with
gaining grades. I have -He is finishing
confidence in to do well in his antibiotics .
his ability to school or else I
provide for his will not be able
own physical to graduate this
care year. I am
scared that I
can not fully use
my dominant
arm I am very
worried

Nursing diagnosis:
- Impaired physical activity related to limited range of
motion as evidenced by patient reporting activity
intolerance, being “so tired” during exercise (care and
cure)

-anxiety (reluctant) to be discharged associated with

concerns about abilities to successfully meet
academic expectation (core circle )
Outcome:
-The patient will be able to ambulate with assistance
to bed side chair until discharge

-The patient will graduate in college and meet

academic expectation

Goals:
-regain use of right arm as much as possible
(care and cure)

-Successful completion of academic

expectation/performance to be able to graduate on
college(core circle)

Implementation:
-arrange physical therapy sessions around school
schedule

-Take notes with left hand, possibly use computer on it

arrange to have extra time for written test.

-The nurse will help the patient to perform upper and

lower body strengthening excises every 2hr.

Evaluation:
-Using hall 5question;

Yes he wants to graduate this year and now he is not

likely for him to play again for the football team, so he
has changed his focus to academics(core)
He verbalize his feeling and concerns on what
happened on him, and at the possibility that he may
not regain full use of his dominant arm. He has also
recognized that his initial resistance to physical
therapy was based on fear(core).
The nurse at hospital helped him explore his concerns
about being discharged.
The school nurse helped him decide to ask for the
extra time for tests since he writes lower with his left
hand.

Now Jemal talks about how he needs to do whatever

he can to well scholastically he will do any thing to
graduate.

Summary:
-Hall believed patients should only receive care from
professional nurses.

-Hall defined her philosophy on the basis of the

patient.

-Hall believed that patients come to the hospital in

biological crisis (acute episode of a disease) and that
medicine does a great job at treating this crisis, but
fails to treat the chronic underlying disease. This is
where she felt nursing could make a significant
difference.

-Hall felt that taking over this sub-acute phase was the
way for nursing to legitimize itself into a true profesion.

☻☻☻☻☻☻☻☻

Halls theory of nursing involves three interlocking

circle, each representing one aspect of nursing
The care aspect represents intimate bodily care of the
patients
The core aspect deals with inner most feelings and
motivations of the patient
The cure aspect tells how the nurse helps patient
and family through the medical aspect of care
of the major concepts in nursing meta-paradigm, only
nursing is defined as the function necessary to care
out care, core and cure
Her theory can be used in nursing process. The core,
care and cure aspects are all applicable to each phase
of nursing process

Faye Abdellah - 21 Nursing Problems

-She is a pioneer in Nursing research

-She helped transform nursing theory, nursing care

and nursing education.

-She developed educational materials in many key

areas of public health, including AIDS, the mentally
handicap, violence, hospice care, smoking cessation,
alcoholism and drug addiction.

-She influenced by the desire to promote

client-centered comprehensive nursing care.

-Described nursing as a service to individuals, to

families and to society.

Identified 14 basic needs :

-Breathing normally
-Eating and drinking adequately
-Eliminating body wastes
-Moving and maintaining desirable position
-Sleeping and resting
-Selecting suitable clothes
-Maintaining body temperature within normal range
-Keeping the body clean and well-groomed
-Avoiding dangers in the environment
-Communicating with others
-Worshiping according to one’s faith
-Working in such a way that one feels a sense of
accomplishment
-Playing/participating in various forms of recreation
-Learning, discovering or satisfying the curiosity that
leads to normal development and health and using
available health facilities.

Rosemarie Parse - Theory of Human Becoming

-Nursing is a scientific discipline, the practice of which

is a performing art.

Three assumption about Human Becoming:

01 Human becoming is freely choosing personal

meaning in situation in the inter subjective process of
relating value priorities

02 becoming is co-creating rhythmic patterns or

relating in mutual process in the universe

03 Human becoming is co-transcending

multidimensionally with emerging possibilities.

These three assumptions focus on meaning,

rhythmicity, and contrascendence:

MEANING
-arises from a person’s interrelationship with the
world and refers to happenings to which the person
attaches varying degree of significance.

RHYTHMICITY
- movement toward greater diversity

CONTRASCENDENCE
-process of reaching out beyond the self.

-Model of human becoming emphasizes how

individuals choose and bear responsibility for patterns
of personal health.

-Contends that the client , not the nurse , is the

authority figure and decision maker.

-The nurse’s role involves helping individuals and

families in choosing the possibilities for changing
the health process.

Nola Pender - Health Promotion Model

-First published in 1982

-Modified in the late 1980’s
-Modified for last time in 1996

METAPARADIGM:

PERSON
-Individuals, Families, Communities

INDIVIDUALS
-Biologic, Sociocultural, Psychological

BIOLOGIC SOCIOCULTURAL PSYCHOLOGICAL

Age Race Self esteem
Body Mass Ethnicity Self motivation
Index Acculturation Perceived health
Pubertal Education status
status Socioeconomic
Menopausa status
l status
Aerobic
capacity
Strength
Agility
Balance

Self efficacy
-“Self efficacy is the judgment of personal capability to
organize and carry out a particular course of action.
Self-efficacy is not concerned with skill one has but
with judgments of what one can do with whatever
skills one possesses.” – Pender, 2006, p. 53.

Success Breeds Success

-According to Pender, “The most powerful input to
self-efficacy is a successful performance of a behavior”
(Pender, 2006, p. 59).

Building Healthy Communities

ENVIRONMENT
-where a person spends most of time (schools,
workplaces)
-Nursing centers
-Occupational health settings
-Community
-“Environmental wellness is manifest in harmony and
balance between human beings and their
surroundings” (Pender, 2006, p. 9).

HEALTH
-This model promotes the pursuit of health through out
the life span (Pender, 2006 p. 282).

Subscales: “health responsibility, physical activity,

nutrition, interpersonal relations, spiritual growth and
stress management” (Tomey, 2010, p. 441).

NURSING
-Health Promotion Services
-Health Promoting Interventions
-Empowerment for Self Care
-Client’s capacity for Self Care

-“Nurses make age-specific and risk-specific

recommendations for clinical preventative services”
(Tomey, 2010, p. 435).

-“Clinical interest in health behaviors represents a

philosophical shift that emphasized the quality of lives
alongside the saving of lives” (Tomey, p. 442).

-Nurses promote wellness by health promotion

education (Tomey, p. 442).

Concepts Unique To Model:

-“Unlike avoidance-oriented models that rely upon fear

or threat to health as motivation for health behavior,
the HPM has a competence or approach-oriented
focus (Pender, 1996). Health promotion is motivated
by the desire to enhance well being and to actualize
human potential (Pender, 1996).”

-The HPM is a borrowed theory. (Tomey, p. 441)

How Pender’s HPM can be used in clinical

practice:

-Applies across a lifespan

-Useful in a variety of settings
-Holistic
-Unique plans
-Educating/hands-on

HPM: Framework for patient assessment

(GOALS)
-Improved health (holistically)
-Enhanced functional ability
-Better quality of life at every stage
-Increased well-being
-Possess a positive dynamic state

NURSING EDUCATION
-“…increasingly, the HPM is incorporated in nursing
curricula as an aspect of health assessment,
community health nursing, and wellness-focused
courses” (Tomey, 2010, p. 443).

Current Research Status of Health Promotion

Theory:

-Promoting participation: Evaluation of a health

promotion program for low income seniors
-Testing the barriers to healthy eating scale
-Diet and exercise in low-income culturally diverse
middle school students
-Early detection of type 2 diabetes among older
African Americans
-A bicycle safety education program for parents of
young children
-Effectiveness of a tailored intervention to increase
factory workers’ use of hearing protection
-An explanatory model of variables influencing health
promotion behaviors in smoking and nonsmoking
college students
-Balanced analgesia after hysterectomy: The effect on
outcomes
-Promoting the mental health of elderly African
-Americans: A case illustration
-Barriers and facilitators of self-reported physical
activity in cardiac patients

STRENGTHS LIMITATIONS
Positive emotions or Commitment to a plan of
affect is the drive that action is less likely when
increases the probability competing demands over
of commitment and action which a person has little
to the desired goal. control over requires
immediate attention.
The greater the
commitment to a plan of Commitment to a plan of
action, the more likely action is less likely to
health promoting result when other actions
behaviors are maintained are more attractive and
over time. preferred over target
behavior
Persons are more likely
to commit to and engage
in health promoting
behaviors when others
model the behavior.

SUMMARY
-“guide nurses in helping clients achieve improved
health, enhanced functional ability, and better quality
of life” (Bredow, 2009, p. 301).
-Model is justified by its ability to account for lifestyle
factors and need for “improvements in society”
(Bredow, p. 301).
-Based on two other theories: expectancy value theory
and social cognitive theory.
-Model has been widely tested in many settings
-Has “exciting possibilities for the creation of
interventions that are tailored to the unique
characteristics and needs of individual clients”
(Bredow, p. 301).
 Madeleine Leininger - Theory of Culture Care
Diversity and Universality

-Founded the International Transcultural Nursing

Society
-Published Culture Care Diversity and Universality:
A theory of Nursing
-Published Transcultural Nursing, Concepts, Theories,
Research & Practice
METAPARADIGM:

PERSON
-Human are believed to be caring and capable of
being concerned about the desires, welfare and
continued existence of others.

-Humans are universally caring beings who survive in

a diversity of cultures through their ability to provide
the universality of care in a variety of ways according
to different cultures, needs and settings.

ENVIRONMENT
-Worldwide, social structure and environmental
context
-Leininger’s description of culture centers on a
particular group(society) and the patterning of actions,
thoughts and decisions that occurs as a result of
“learned, shared and transmitted values, beliefs,
norms, and lifeways.

HEALTH
-Health is seen as being universal across cultures and
distinct within each culture in a way that represents
the beliefs, values and practices of the particular
culture.

-Components of health: Health Systems, Health Care

Practices, Changing Health Patterns, Health
Promotions and Health Maintenance.

NURSING
-Leininger gave three types of Nursing actions that are
culturally-based and thus consistent with the needs
and values of the clients. These are:

-Cultural care preservation/maintenance

-Cultural care accommodation/negotiation

-Cultural care repatterning/restructuring

Margaret Newman - Theory of Health as

Expanding Consciousness

-“The human is unitary, that is cannot be divided into

parts and is inseparable from the larger unitary field”

-Humans are open energy systems in continual

contact with the environment.

-Humans are continuously active in evolving their own

patterns of “whole” and are intuitive.

-“the person does not possess consciousness- the

person is consciousness”

Newman published the HEC theory in 1979

HEC THEORY:
- assumes that life is a process of expanding
consciousness.

Consciousness: Cognitive and affective

awareness and interconnectedness with the
environment.
Health: Outcome of interaction with the
environment

-Centers on life patterns

Health is a pattern

PATTERN RECOGNITION
-Nurses help clients get in touch with the meaning of
life by identifying their health patterns.
-Patterns that people see, hear and feel show and
describe relationships:
Relationships within the person, with other
people and with the environment.
Patterns depict relationship and connectedness.

-Pattern recognition is a form of caring.

CARING
-Nursing: “caring of the human health experience”

-Caring, a form of knowing, is transformed into more

inclusive caring at a higher level of consciousness.

-Researchers and nurses employing HEC see their

practices as a way of forming caring relationships with
clients.

 HEC AND THE NURSING ROLE

“…the goal of nursing is not to make people well or to
prevent their getting sick, but to assist people to utilize
the power that is within them as they evolve toward
higher levels of consciousness…”
–M.Newman
-Newman’s Challenge to nurses:
Examine your own process of interaction within a
relationship. This self knowledge will enhance your
ability to sense the unfolding pattern in patient’s,
families, and communities.

-Caring in the HEC perspective is nonjudgmental,

noninterventionist, and involves being with rather than
just doing for.

-By spending time with the patient, nurses are able to

take the initiative to promote health, not just treat the
problems caused by disease.
Margaret Newman : ROLE OF THE NURSE

-Discover new rules/patterns for higher consciousness

-Intervention is pattern recognition
-Equal partnership between client and nurse

METAPARADIGM:

PERSON
-Human are believed to be caring and capable of
being concerned about the desires, welfare and
continued existence of others.

-Humans are universally caring beings who survive in

a diversity of cultures through their ability to provide
the universality of care in a variety of ways according
to different cultures, needs and settings.

ENVIRONMENT
-Worldwide, social structure and environmental
context

-Leininger’s description of culture centers on a

particular group(society) and the patterning of actions,
thoughts and decisions that occurs as a result of
“learned, shared and transmitted values, beliefs,
norms, and lifeways.

HEALTH
-Health is seen as being universal across cultures and
distinct within each culture in a way that represents
the beliefs, values and practices of the particular
culture.
-Components of health: Health Systems, Health Care
Practices, Changing Health Patterns, Health
Promotions and Health Maintenance.

NURSING
-Leininger gave three types of Nursing actions that are
culturally-based and thus consistent with the needs
and values of the clients. These are:
-Cultural care preservation/maintenance
-Cultural care accommodation/negotiation
-Cultural care repatterning/restructuring