Nursing

Theorists and
their Theories,
part 4

Betty Neuman; Sister

Callista Roy; Josephine
Paterson and Loretta
Zderad; Madeleine
Leninger

BSN 1A
3:00 pm-6:00 pm

TFN Group 4

Abatol, Gerique Marathae

Alesna, Sharmaine
Capa, Rachel
Chiu, Patricia Marie
Cinco, Ion Yvan
Col, Crizia Dawn
Cortes, Marjimae Therese
Etable, Fritzie Lee
Ratcliffe, Gilbert
Roma, Christian Bekah
Yecpot, Mark Kevin
Sister Callista Roy: Adaptation Model
Roy proposed the Roy Adaptation Model while studying for her master’s degree
at UCLA, where Dorothy Johnson challenged students to develop conceptual models of
nursing. She conducted research on nursing interventions for cognitive recovery in head
injuries and on the influence of nursing models on clinical decision making

Roy Adaptation Model is based on the belief that the human being is an open
system. The system responds to environmental stimuli through the cognator and
regulator coping mechanisms for individuals and the stabilizer and innovator control
mechanisms for groups. The responses occur through at least one of four modes—
physiological-physical, self-concept-group identity, role function, and interdependence.
The responses in these modes are usually visible to others and can be identified as
adaptive or ineffective. Adaptive behaviors that need support and ineffective
behaviors are then analyzed to identify the associated stimuli. The major stimulus
leading to one of these behaviors is the focal stimulus; other stimuli that are verified as
being involved are contextual, and stimuli that might be involved but have not been
verified are residual.

The Four Modes of Adaptation

• Physiologic-Physical Mode; physical

and chemical processes involved in
the function and activities of living
organisms; the underlying need is
physiologic integrity as seen in the
degree of wholeness achieved
through adaptation to change in
needs.

• Self-concept- Group Identity Mode;

focuses on psychological and
spiritual integrity and sense of unity,
meaning, and purposefulness in the
universe.

• Role Function Mode; roles that

individuals occupy in society,
fulfilling the need for social integrity. It is ‘knowing who one is in relation to others’.

• Interdependence Mode; the close relationships of people and their purpose,

structure and development individually and in groups and the adaptation potential
of these groups.

In the Adaptation Model, assumptions are specified as scientific assumptions or

philosophical assumptions.

Scientific Assumptions
• Systems of matter and energy progress to higher levels of complex self-
organization.
 • Consciousness and meaning are constitutive of person and environment
integration
• Awareness of self and environment is rooted in thinking and feeling
• Humans by their decisions are accountable for the integration of creative
processes.
• Thinking and feeling mediate human action
• System relationships include acceptance, protection, and fostering of
interdependence
• Persons and the earth have common patterns and integral relationships
• Persons and environment transformations are created in human consciousness
• Integration of human and environment meanings results in adaptation.

Philosophical Assumptions
• Persons have mutual relationships with the world and God
• Human meaning is rooted in the omega point convergence of the universe.
• God is intimately revealed in the diversity of creation and is the common destiny of
creation.
• Persons use human creative abilities of awareness, enlightenment, and faith.
• Persons are accountable for the processes of deriving, sustaining and transforming
the universe.

Josephine Paterson and Loretta Zderad: Humanistic Nursing

Humanists believe nursing care is a two-way interaction between the nurse and
patient, with the actions of both influencing the outcomes. They acknowledge the
uniqueness of individuals and interactions between the nurse and her patient,
humanistic nursing theories help nurses blend both the art and the science of their
profession. They emphasize the importance of caring as a key component of nursing
practice.

It is a practice theory because they believe that the theory of a science of nursing
develops from the lived experiences of the nurse and the person receiving care. Theory
becomes a response to the phenomenological experience; meaning, that the practice of
nursing itself is the basis for what we truly believe about nursing. Our experience is the
foundation for the understanding of nursing and what it means to be a nurse

Metaparadigm

Human Beings- Human beings are characterized as being capable, open to options,
persons with values and
the unique manifestation of their past present and future.
- It is through relationships with others that the human being becomes, which in
turn, allows for each person’s unique individuality to be actualized.
- People need information: People need options and need opportunities to make
their own decisions.
Health- a matter of personal survival; quality of living or dying.
- More than the absence of disease and well-being, but also for ‘more-being’
- Well-being- Steady state of health; More-being- process of becoming all that is
humanly possible.
- Finding meaning in life.
Nursing- nurturing response of one person to another in time of need, aiming towards
development of well-
being and more-being.
- Helping make responsible choices
- Blend of theory and methodology
Dialogue- Nurse-Nursed relationship
- Meeting, Relating, Presence, and a Call-and-Response
- Crucial in interaction and in the understanding of each other.

Meeting- the ‘coming together’

o Expectation to Nurse and/or to be Nursed’
Relating- The process of nurse-nursed ‘doing’ with each other is relating, being
with the other.
Presence- The quality of being open, receptive, ready, and available to another
person in a reciprocal manner
Call and Response- Transactional, sequential, and simultaneous
o “All-at-Once”
o Dialogue of Nursing is lived

Community- occurs within a community and is affected by community

- Opportunity to understand a person as an individual through relationships
- The experience of persons relating to others, paving way to ‘become’

Phenomenologic Nursing:

1. Preparation of the nurse knower for coming to know

• Understanding own viewpoint/angle helps to make sense and aid in acquiring
meaning of experience. Being open to new and different ideas/understandings is a
necessary position in being able to get to know the other intuitively.

2. Nurse knowing the other intuitively

• Paterson and Zderad describe this as “moving back and forth between the
impressions the nurse becomes aware of herself and the recollected real
experience of the other” (Paterson & Zderad, 1976). Dialogue back and forth
between patient and nurse allows for clearer understanding à further
generalisation in developing process.

3. Nurse knowing the other scientifically

• Implies need for objectivity in coming to know the other scientifically
• Reflective practice validates patterns and themes
• “This is the time when the nurse mulls over, analyses, sorts out, compares,
contrasts, relates, interprets, gives names to and categorises (Paterson & Zderad,
1976)”

4. Nurse complimentarily synthesising known others

• The ability of the nurse to develop or see themselves as a source of knowledge, to
continually develop the nursing community through education, and increased
understanding of their owned learned experiences.
5. Succession within the nurse from the many to paradoxical one
• “Nurse comes up with a conception or abstraction that is inclusive of and beyond
the multiplicities and contradictions (Paterson & Zderad, 1976)”.
• Process that allows for reflection, correction and expansion of own angular
interpretation
• Implies universal understanding from the simplest to most complex dialogue and
interactions between the nurse and assimilates patient experiences
• No member of this interaction or experience is the same as before coming
together of patient and nurse

Madeleine Leininger: Culture Care of Theory of Diversity and

Universality
• Developed in the mid-1950s and early 1960s.
• Developed particularly to discover the meanings and ways to give care to people
who have different values and lifeways. Designed to guide nurses to provide
nursing cares that fits with those that are being cared for.
• Culture Care theory not only focuses on nurse-client interaction but the focus also
includes care for families, groups, communities, cultures and institutions.

The Culture Care Diversity and Universality theory focuses on describing,

explaining and predicting nursing similarities and differences focused primarily on
human care and caring in human cultures.
The Culture Care Diversity & Universality theory does not focus on medical
symptoms, disease entities or treatments. It is instead focused on those methods of
approach to care that means something to the people to whom the care is given.

Application of the theory

• Key elements of a method of application in Practice Methodology have been
identified by Dr. Leininger and they are (1) goals of nursing which address
practices, clients (2) cultural assessment (using the Sunrise Enabler) and (3)
nursing judgments, decisions and actions.
• Research findings are used to develop protocols for cultural-congruent care that
blends with the particular cultural values, beliefs and life ways of the client.