Chapter 2Frameworks for Professional Nursing Pract.docx

Chapter 2
Frameworks for
Professional
Nursing Practice
Definitions
• Concept
• Conceptual model
• Propositions
• Assumptions
• Theory
• Metaparadigm
Central Concepts in Nursing
• Person receiving the nursing
• Environment within which the person exits

• Health-illness continuum within which the
person falls at the time of the interaction
with the nurse
• Nursing actions
Nightingale’s Environmental Theory
• Person: Recipient of nursing care
• Environment: External (temperature,
bedding, ventilation) and internal (food,
water, and medications)
• Health: Not only to be well, but to be able
to use well every power we have to use
• Nursing: Alter or manage the environment
to implement the natural laws of health
Nightingale’s 13 Canons
• Ventilation and warmth
• Health of houses

• Petty management
• Noise
• Variety
• Food intake
• What food?
• Bed and bedding
• Light
• Cleanliness of rooms
and walls
• Personal cleanliness
• Chattering hopes and
advises
• Observation of the sick
Virginia Henderson: Definition of
Nursing and 14 Components of Care
• Person: Recipient of nursing care who is
composed of biological, psychological,

sociological, and spiritual components
• Environment: External environment
• Health: Based upon the patient’s ability to
function independently
• Nursing: Assist the person, sick or well, in
performance of activities
The Nurse−Theorists Virginia
Henderson Promo Video
https://youtu.be/c3mnNPozt_w
https://youtu.be/c3mnNPozt_w
Henderson’s 14 Basic Care Needs
(1 of 2)
• Breathe normally
• Eat and drink adequately
• Eliminate bodily wastes
• Move and maintain postures
• Sleep and rest

• Dress and undress
• Maintain body temperature within normal range
Henderson’s 14 Basic Care Needs
(2 of 2)
• Keep body clean and protect integument
• Avoid dangers
• Communicate with others
• Worship according to one’s faith
• Work (sense of accomplishment)
• Recreation
• Learn and discover, leading to normal
development and health, and use health facilities
Jean Watson: Philosophy and
Science of Caring (1 of 2)
• Goal is to help persons attain a higher level
of harmony within the mind-body-spirit
• Goal pursued through transpersonal caring

guided by 10 caritas processes
Jean Watson: Philosophy and
Science of Caring (2 of 2)
• Person (human): A unity of mind-body-spirit/nature;
embodied spirit
• Healing space and environment: A nonphysical
energetic environment; a vibrational field integral
with the person where the nurse is not only in the
environment but “the nurse IS the environment”
• Health (healing): Harmony, wholeness, and comfort
• Nursing: Reciprocal transpersonal relationship in
caring moments guided by caritas processes
The Nurse Theorists−Jean Watson
Promo Video
https://youtu.be/qX1fxKfZifo
https://youtu.be/qX1fxKfZifo

Benner’s Clinical Wisdom in Nursing
Practice: 9 Domains of Critical Care
Nursing
• Diagnosing and managing life-
sustaining physiological
functions in unstable patient
• Using skilled know-how to
manage a crisis
• Providing comfort measures
for the critically ill
• Caring for patients’ families
• Preventing hazards in a
technological environment
• Facing death: End-of-life care
and decision making
• Communicating and negotiating
multiple perspectives

• Monitoring quality and
managing breakdown
• Using the skilled know-how of
clinical leadership and the
coaching and mentoring of
others
Practice: 6 Aspects of Clinical Judgment
and Skilled Comportment (1 of 2)
• Reasoning-in-transition: Practical reasoning in an
ongoing clinical situation
• Skilled know-how: Also known as embodied
intelligent performance; knowing what to do, when to
do it, and how to do it
• Response-based practice: Adapting interventions to
meet the changing needs and expectations of patients
• Agency: One’s sense of and ability to act upon or
influence a situation

Practice: 6 Aspects of Clinical Judgment
and Skilled Comportment (2 of 2)
• Perceptual acuity and the skill of involvement: The
ability to tune into a situation and hone in on the
salient issues by engaging with the problem and the
person
• Links between clinical and ethical reasoning: The
understanding that good clinical practice cannot be
separated from ethical notions of good outcomes for
patients and families
Benner’s Clinical Wisdom in
Nursing Practice
• Person: Embodied person living in the world who is a
“self-interpreting being, that is, the person does not
come into the world pre-defined but gets defined in the

course of living a life”
• Environment: A social environment with social
definition and meaningfulness
• Health: The human experience of health or wholeness
• Nursing: A caring relationship that includes the care
and study of the lived experience of health, illness, and
disease
The Nurse Theorists V2−Patricia
Benner Promo Video
https://youtu.be/ZM315_5Jqss
https://youtu.be/ZM315_5Jqss
Martha Rogers’ Science of
Unitary Human Beings (1of 2)
• Person (human being): An irreducible,
irreversible, pandimensional, negentropic
energy field identified by pattern

• Environment: An irreducible, pandimensional,
negentropic energy field, identified by pattern
and manifesting characteristics different from
those of the parts and encompassing all that is
other than any given human field
Martha Rogers’ Science of
Unitary Human Beings (2 of 2)
• Health: Health and illness are a part of a
continuum
• Nursing: Seeks to promote symphonic
interaction between fields, to strengthen the
integrity of the human field, and to direct
patterning of the human and environmental
fields for realization of maximum health
potential
Principle of Hemeodynamics

• Helicy
• Resonancy
• Integrality
Martha Rogers Interview Part I
Video
https://youtu.be/V1XN3rPKndE
https://youtu.be/V1XN3rPKndE
Martha Rogers Interview Part II
Video
https://youtu.be/f6qWm8sGut0
https://youtu.be/f6qWm8sGut0
Dorothea Orem’s General Theory
of Nursing
• Composed of three related theories:
– Theory of self-care
– Theory of self-care deficit

– Theory of nursing systems
Types of Self-Care Requisites
• Universal self-care requisites (found in all
human beings and associated with life
processes)
• Developmental self-care requisites (related to
different stages of human life cycle)
• Health-deviation self-care requisites (related to
deviations in structure or function)
Dorothea Orem’s General
Theory of Nursing (1of 2)
• Person (patient): A person under the care of a
nurse; a total being with universal,
developmental needs and capable of self care
• Environment: Physical, chemical, biologic,
and social contexts within which human beings

exits; environmental components include
environmental factors, elements, and
conditions, as well as the developmental
environment
Dorothea Orem’s General
Theory of Nursing (2 of 2)
• Health: A state characterized by soundness
or wholeness of developed human structures
and of bodily and mental functioning
• Nursing: Therapeutic self-care designed to
supplement self-care requisites. Nursing
actions fall into one of three categories:
Wholly compensatory, partly compensatory,
or supportive educative system
The Nurse Theorists; Excellence in
Action−Dorothea Orem Promo Video

https://youtu.be/O_ie_504B7U
https://youtu.be/O_ie_504B7U
Callista Roy’s Adaptation Model
• Person (human system): A whole with parts that
function as a unity
• Environment: Internal and external stimuli; the
world within and around humans as adaptive
systems
• Health: A state and process of being and becoming
an integrated and whole human being
• Nursing: Manipulation of stimuli to foster
successful adaptation
Roy’s 6-Step Nursing Process
• Assessing behaviors manifested from the 4
adaptive modes
• Assessing and categorizing stimuli
• Making a nursing diagnosis

• Setting goals to promote adaptation
• Implementing interventions aimed at
managing stimuli to promote adaptation
• Evaluating achievement of adaptive goals
The Nurse Theorists−Callista Roy
Promo Video
https://youtu.be/fC2zMcTquaU
https://youtu.be/fC2zMcTquaU
Betty Neuman’s Systems Model
(1 of 3)
• Wellness model based on general systems
theory
• Focus of the model is on the client system in
relationship to stressors
• Client system is protected by a circular series of
buffers known as lines of defense
– Flexible line of defense

– Normal line of defense
– Lines of resistance
(2 of 3)
• Person (client system): A composite of
physiological, psychological, sociocultural,
developmental, and spiritual variables in
interaction with the internal and external
environment
(3 of 3)
• Environment: All internal and external factors
of influences surrounding the client system;
three relevant environments identified are the
internal environment, the external environment,
and the created environment
• Health: A continuum of wellness to illness;

equated with optimal system stability
• Nursing: Prevention as intervention; concerned
with all potential stressors
The Nurse Theorists−Betty Neuman
Promo Video
https://youtu.be/UilhyIGg8jA
https://youtu.be/UilhyIGg8jA
King’s Interacting Systems Framework and
Theory of Goal Attainment (1 of 3)
• Conceptualizes 3 levels of dynamic
interacting systems that include personal
systems (individuals), interpersonal systems
(groups), and social systems (society)
• Concepts important to understanding the
theory include communication, interaction,
role, stress, and transaction

King’s Interacting Systems Framework
and Theory of Goal Attainment (2 of 3)
• Person (human being): A personal system that
interacts with interpersonal and social systems.
• Environment: Can be both external and
internal; the external environment is the context
within which human beings grow, develop, and
perform daily activities. The internal
environment of human beings transforms energy
to enable them to adjust to continuous external
environmental changes.
King’s Interacting Systems Framework
and Theory of Goal Attainment (3 of 3)
• Health: Dynamic life experiences of a human
being, which implies continuous adjustment to
stressors in the internal and external

environment through optimum use of one’s
resources to achieve maximum potential for
daily living
• Nursing: A process of human interaction; the
goal of nursing is to help patients achieve their
goals
The Nurse Theorists−Imogene King
Promo Video
https://youtu.be/1sZPaj-RioE
https://youtu.be/1sZPaj-RioE
Johnson’s Behavioral System Model:
7 Subsystems of Behavior
• Achievement
• Affiliative
• Aggressive
• Dependence
• Sexual

• Eliminative
• Ingestive
Johnson’s Behavioral System Model
(1 of 2)
• Person (human being): A biopsychosocial
being who is a behavioral system with 7
subsystems of behavior
• Environment: Includes internal and external
environment
• Health: Efficient and effective functioning of
system; behavioral system balance and
stability
Johnson’s Behavioral System Model
(2 of 2)
• Nursing: An external regulatory force that
acts to preserve the organization and
integrity of the patient’s behavior at an

optimal level under those conditions in
which the behavior constitutes a threat to
physical or social health or in which illness
is found
The Nurse Theorists−Dorothy
Johnson Promo Video
https://youtu.be/3TJ8g232PL8
https://youtu.be/3TJ8g232PL8
Parse’s Humanbecoming Theory:
Themes and Processes
• Three themes:
– Meaning
– Rhythmicity
– Transcendence
• Three processes:
– Explicating

– Dwelling
– Moving beyond
Parse’s Humanbecoming Theory
• Person: An open being, more than and different than
the sum of parts in mutual simultaneous interchange
with the environment who chooses from options and
bears responsibility for choices
• Environment: Co-exists in mutual process with the
person
• Health: Continuously changing process of becoming
• Nursing: A learned discipline; the nurse uses true
presence to facilitate the becoming of the participant
The Nurse Theorists−Rosemarie
Parse Promo Video
https://youtu.be/yezjnbA5ln0
https://youtu.be/yezjnbA5ln0

Leininger’s 3 Modalities
• Cultural care preservation and/or
maintenance
• Cultural care accommodation and/or
negotiation
• Cultural care repatterning or restructuring
Madeleine Leininger’s Cultural
Diversity and Universality Theory (1 of 2)
• Person: Human being, family, group,
community, or institution
• Environment (environmental context):
Totality of an event, situation, or experience that
gives meaning to human expressions,
interpretations, and social interactions in
physical, ecological, sociopolitical, and/or
cultural settings

Madeleine Leininger’s Cultural Diversity
and Universality Theory (2 of 2)
• Health: A state of well-being that is culturally
defined, valued, and practiced
• Nursing: Activities directed toward assisting,
supporting, or enabling with needs in ways
that are congruent with the cultural values,
beliefs, and lifeways of the recipient of care
The Nurse Theorists−Madeleine
Leininger Promo Video
https://youtu.be/uyS-VIfxagk
https://youtu.be/uyS-VIfxagk
Peplau’s Theory of
Interpersonal Relations (1 of 4)
• Six nursing roles that emerge during
the phases of relationship:

–Teacher
–Resource
–Counselor
–Leader
–Technical expert
–Surrogate
• Three phases in the nurse–patient
relationship:
– Orientation
– Working
– Resolution
• Person: Encompasses the patient (who has

problems for which expert nursing services
are needed or sought) and the nurse
• Environment: Forces outside the organism
within the context of culture
• Health: Implies forward movement of
personality and other ongoing human
processes in the direction of creative,
constructive, productive, personal, and
community living
• Nursing: The therapeutic, interpersonal
process between the nurse and the patient
The Nurse Theorists−Hildegard
Peplau Promo Video
https://youtu.be/96OsVRsebuA

https://youtu.be/96OsVRsebuA
Pender’s Health Promotion Model:
3 Major Categories to Consider
• Individual characteristics and experiences
(biological factors, psychological factors,
sociocultural factors)
• Behavior-specific cognitions and affect
(perceived benefits of action, perceived barriers
to action, perceived self-efficacy, activity-
related affect)
• Behavioral outcome
Pender’s Health Promotion Model
(1 of 2)
• Person: The individual, who is the primary
focus of the model
• Environment: The physical, interpersonal,
and economic circumstances in which

persons live
• Health: A positive high-level state
Pender’s Health Promotion Model
(2 of 2)
• Nursing: The role of the nurse includes
raising consciousness related to health-
promoting behaviors, promoting self-
efficacy, enhancing the benefits of change,
controlling the environment to support
behavior change, and managing barriers to
change
The Nurse Theorists V2−Nola
Pender Promo Video
https://youtu.be/WYiE8-U0PCg
https://youtu.be/WYiE8-U0PCg
Afaf Ibrahim Meleis:

Transitions Theory (1 of 3)
• Transition is a process triggered by a change
that represents a passage from a fairly stable
state to another fairly stable state
• Transitions can be described in terms of types
and patterns of transitions, properties of
transition experiences, transition conditions,
process indicators, outcome indicators, and
nursing therapeutics
• Person: Persons are active beings who
experience fundamental life patterns and who
have perceptions of and attach meaning to
transition experiences
• Environment: Environmental conditions
expose persons to potential damage,

problematic recovery, or delayed or unhealthy
coping contributing to vulnerability related to
transitions
• Health: Health consists of complex and
multidimensional transitions that are characterized
by flow and movement over time; healthy
outcomes are defined in terms of the transition
process
• Nursing: Nursing means being the primary
caregiver for individuals and their families during
the transition process and applying nursing
therapeutics during transitions to promote healthy
outcomes
The Nurse Theorists V2−Afaf Meleis

Promo Video
https://youtu.be/xSn2qqmcwaA
https://youtu.be/xSn2qqmcwaA
Swanson’s Theory of Caring (1 of 3)
• Five basic processes of caring:
– Maintaining belief
– Knowing
– Being with
– Doing for
– Enabling
• Person: Unique beings who are in the midst
of becoming and whose wholeness is made
manifest in thoughts, feelings, and
behaviors
• Environment: Any context that influences
or is influenced by the designated client

• Health and well-being: To live the
subjective, meaning-filled experience of
wholeness; wholeness involves a sense of
integration and becoming wherein all facets
of being are free to be expressed
• Nursing: Informed caring for the well-being
of others
Kolcaba’s Theory of Comfort (1 of 4)
• Comfort care encompasses 3 components:
– An appropriate and timely intervention to meet
the comfort needs of patients
– A mode of delivery that projects caring and
empathy
– The intent to comfort

• Comfort needs include patients’ or families’
desire for or deficit in relief, ease, or
transcendence in the physical, psychospiritual,
sociocultural, or environmental contexts of
human experience
• Comfort measures refer to interventions that are
intentionally designed to enhance patients’ or
families’ comfort
• Person: Recipients of care may be
individuals, families, institutions, or
communities in need of health care
• Environment: Includes any aspect of the
patient, family, or institutional setting that
can be manipulated by the nurse, a loved
one, or the institution to enhance comfort

• Health: Considered optimal functioning of
the patient, the family, the healthcare
provider, or the community
• Nursing: The intentional assessment of
comfort needs, design of comfort
interventions to address those needs, and
reassessment of comfort levels after
implementation compared with baseline
Reed’s Self-Transcendence Theory
(1 of 3)
• Three major concepts are central to the theory of
self-transcendence:
– Self-transcendence
– Well-being
– Vulnerability

• Additional concepts include:
– Moderating–mediating factors
– Points of intervention
(2 of 3)
• Person: Human beings who develop over
the life span through interactions with other
persons and within an environment
• Environment: Composed of family, social
networks, physical surroundings, and
community resources
(3 of 3)
• Health (well-being): A sense of feeling
whole and healthy, according to one’s own
criteria for wholeness and health
• Nursing: The role of nursing activity is to

assist persons through interpersonal
processes and therapeutic management of
their environment to promote health and
well-being
The Nurse Theorists V2−Pamela
Reed Promo Video
https://youtu.be/d0Kq9mckER4
https://youtu.be/d0Kq9mckER4
Merle Mishel:
Uncertainty in Illness Theory (1 of 4)
• Uncertainty is defined as the “inability to
determine the meaning of illness-related
events inclusive of inability to assign definite
value and/or to accurately predict outcomes”
• Second central concept, cognitive schema,
defined as a “person’s subjective
interpretation of illness-related events”

Merle Mishel:
• The revised theory incorporates two new
concepts: Self-organization and probabilistic
thinking
• Uncertainty in illness theory is organized
around 3 themes:
– Antecedents of uncertainty
– Appraisal of uncertainty
– Coping with uncertainty
Merle Mishel:
• Person: The concept of the person is the central
focus of the theory and may be an individual or
the family of ill individual; the individual is
viewed as a biopsychosocial being who is an

open system exchanging energy with the
environment
• Environment: Not explicitly defined but is
acknowledged to exchange energy with the
person system
Merle Mishel:
• Health: Defined in terms of uncertainty in the
context of the illness experience, with the
concept of health or well-being being congruent
with the formulation of a new life view and
probabilistic thinking
• Nursing: Nurses are viewed as a part of the
antecedent variable of structure providers
The Nurse Theorists V2−Merle
Mishel Promo Video

https://youtu.be/E31I9TgikKM
https://youtu.be/E31I9TgikKM
Cheryl Tatano Beck:
Postpartum Depression Theory (1 of 3)
• Two major concepts: Postpartum mood
disorders and loss of control
• Four stages in the coping process
• Postpartum Depression Screening Scale
(PDSS) used in screening
Cheryl Tatano Beck:
• Person: Described in terms of wholeness
with biological, sociological, and
psychological aspects, with personhood
understood in the context of family and
community

• Environment: Viewed broadly in terms of
individual factors and external factors
Cheryl Tatano Beck:
• Health: Not defined explicitly; traditional ideas
of physical and mental health with health are
viewed as a consequence of women’s responses
to the contexts of their lives and environments
• Nursing: A caring profession with caring
obligations; the nurse accomplishes the goals of
health and wholeness through interpersonal
interactions
Synergy Model for Patient Care (1 of 4)
• Framework for designing practice
competencies to care for critically ill patients
• Goal of optimizing outcomes for patients and

families
• Optimal outcomes realized when the
competencies of the nurse match the patient
and family needs
• 8 patient characteristics identified are resiliency,
vulnerability, stability, complexity, resource
availability, participation in care, participation
in decision making, and predictability
• 8 nurse characteristics are clinical judgment,
advocacy, caring practices, collaboration,
systems thinking, response to diversity, clinical
inquiry, and facilitation of learning
• Persons: Viewed in the context of patients
who are biological, social, and spiritual

entities who are present at a particular
developmental stage
• Environment: The concept is not explicitly
defined; however, included in the
assumptions is the idea that environment is
created by the nurses for the care of the
patient
• Health: The concept of health is not
explicitly defined; an optimal level of
wellness as defined by the patient is
mentioned as a goal of nursing care
• Nursing: The purpose of nursing is to meet
the needs of patients and families and to
provide safe passage through the healthcare
system during a time of crisis

The Nurse of the Future:
Nursing Core Competency Graphic
• Illustrates through use of broken lines, the reciprocal
and continuous relationship between each
competency and nursing knowledge, that the
competencies may overlap and are not mutually
exclusive, and that all competencies are of equal
importance
• Nursing knowledge is placed as the core in the
graphic to illustrate that nursing knowledge reflects
the overarching art and science of professional
nursing practice
NOF Core Competency Model
• Essential knowledge, attitudes, and skills (KAS),
reflecting cognitive, affective, and psycho-motor
learning domains are specified for each

competency
• The KAS identified in the model reflect the
expectations for initial nursing practice
following the completion of a pre-licensure
professional nursing education program
The NOF Core Competencies
• Patient-centered care
• Professionalism
• Leadership
• Systems-based
practice
• Informatics and
technology
• Communication
• Teamwork and
collaboration
• Safety

• Quality improvement
• Evidence-based
practice
NOF Core Competency Model (1 of 2)
• Human being/patients: Recipient of nursing
care or services; may be individuals, families,
groups, communities, or populations
• Environment: The atmosphere, milieu, or
conditions in which one lives, works, or plays
• Health: Experience often expressed in terms of
wellness and illness, that may occur in the
presence or absence of disease or injury
NOF Core Competency Model (2 of 2)
• Nursing: The protection, promotion, and
optimization of health and abilities;
prevention of illness and injury; alleviation

of suffering through the diagnosis and
treatment of human response; and advocacy
in the care of individuals, families, groups,
communities, and populations
Overview of Selected
Non-Nursing Theories
• General System Theory (von Bertalanffy)
• Social Cognitive Theory (Bandura)
• Stress and Coping Process Theory (Lazarus)
• General Adaptation Syndrome (Selye)
Guide for Selecting a Framework for
Theory-Based Practice (1 of 3)
• Consider the values and beliefs that you truly
hold in nursing
• Write a philosophy of nursing that clarifies
your beliefs related to person, environment,

health, and nursing
• Survey definitions of person, environment,
health, and nursing in nursing models
• Select 2 or 3 frameworks that best fit with your
beliefs related to the concepts of person,
environment, health, and nursing
• Review the assumptions of the frameworks
that you have selected
• Make applications of those frameworks in a
selected area of nursing practice
• Compare the frameworks on client focus,
nursing action, and client outcome

• Review the nursing literature written by
persons who have used the frameworks
• Select a framework and develop its use in your
nursing practice

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