Nursing Theory Seminar presentation by Rebira

.
WOLLEGA UNIVERSITY
INSTITUETE OF HEALTH SCIENCE,
SCHOOL OF NURSING AND MID WIFERY
DEPARTMENT OF NURSING
INDIVIDUAL ASSIGNMENT : NURSING THEORY
TITLE: NURSING AS CARING
23 January 2023 1

NURSING AS CARING :A MODEL FOR
TRANSFORMING PRACTICE
UNIT-1
23 January 2023 2

Outlines
Introducing the theorists
Overview of theory
Historical perspective and curriculum development
Major assumptions
Dance of caring persons
Development of dance of living persons
Strength and limitation of theory
Summary
References
23 January 2023 3

Introducing the Theorists
Dr. Anne Boykin
 Grew up in Kaukauna, Wisconsin
 Was the eldest of six children
 Began her career in nursing in 1966, graduating from
Alverno College in Milwaukee, Wisconsin
 She received her master’s degree from Emory
University in Atlanta, Georgia, and her doctorate degree
from Vanderbilt University in Nashville, Tennessee
23 January 2023 4

Introducing the Theorists …
 Dr. Anne Boykin‟s Director of the college is currently
Institute for the Advancement of Caring in Nursing
 Has a longstanding commitment to the advancement
of knowledge in the discipline, especially regarding the
phenomenon of caring.
 Positions she has held in the International Association
for Human Caring as president (1993–1996), and
member of the nominating committee (1997–1999).
 she also served as coeditor of the journal International
Association for Human Caring from 1996 to 1999.
23 January 2023 5

• Her scholarly work is centered on caring as the
grounding for nursing.
• Evidenced in her books, Nursing as Caring: A
Model for Transforming Practice (coauthored
with Schoenhofer; 1993, 2001a)
• The latter book illustrates how caring grounds
the development of a nursing program by
creating the environment for study through
evaluation.
23 January 2023 6

Savina O. Schoenhofer
Born the second child and eldest daughter in a
family of nine children and spent her formative
years on the family cattle ranch in Kansas.
Spent 3 years in the Amazon region of Brazil,
working as a volunteer in community
development
1st nursing degree was completed at Wichita State
University, where she also earned graduate degrees
in nursing, psychology, and counseling.
23 January 2023 7

Completed a PhD in educational foundations and
administration at Kansas State University in 1983.
In addition to her work on caring, coauthorized with
Boykin of Nursing as Caring: A Model for
Transforming Practice (1993, 2001a), she has written
numerous articles on nursing values, primary care,
nursing education, support, touch, and mentoring.
23 January 2023 8

Overview of Theory
 Theory of Nursing as caring, a general theory,
framework, or disciplinary view of nursing
 Provides perspective that enables a thorough ,
all-encompassing knowledge of any and all
nursing practice scenarios (Boykin and
Schoenfer, 1993).
 Provides nursing scholars in the many
practitioner, researcher, administration ,
teacher, and developer professions with an
organized framework.
23 January 2023 9

Historical Perspective and Current
Development
• The Theory of Nursing as Caring sprang out of
curriculum development work done in the
College of Nursing at Florida Atlantic
University, where both authors were part of the
faculty team that revised the curriculum based on
caring.
• The point of departure was the recognition that
nursing serves to provide care, not just as a
means, but as its intended goal and primary focus.
23 January 2023 10

Development…
The two main elements that bring the theory‟s
underlying assumptions to life and enable a
practical understanding of nursing as a
discipline and a profession are:
The emphasis that has been clarified and the
concept of the nursing scenario.
The existential phenomenological theory of
humanistic nursing developed by Paterson
and Zderad in 1988 is seen as the historical
forerunner of nursing as caring.
23 January 2023 11

Development…
The first complete exposition of the Theory of
Nursing as Caring was presented at a
conference in 1992 ( Bokin and Schoenfer, 1990,
1991; Schoenfer and Boykin, 1993).
Nursing as Caring : A model for transforming
Practice was published in 1993 (Bokin and
Schoenfer, 1993).
Republished with an epilogue in 2001 (Bokin and
Schoenfer, 2001a).
23 January 2023 12

Major Assumptions
Boykin and Schoenhofer address six major
assumptions that reflect a set of values to understand
and explicate the meaning of nursing.
1. Persons are caring by virtue of their humanness
2. Persons are whole and complete in the moment
3. Persons live caring, moment to moment
4. Personhood is living life grounded in caring
5. Personhood is enhanced through participating in
nurturing relationships with caring others
6. Nursing is both a discipline and a profession
(practiced discipline)
23 January 2023 13

Major Assumptions…
Person: Persons are caring by virtue of their
humanness
The belief that persons are caring by virtue of
their humanness sets forth the ontological and
ethical bases on which the theory is grounded.
Being a person means living, through which
being and possibilities are known to the fullest.
Each person throughout his or her life grows in
the capacity to express caring.
23 January 2023 14

The assumption that all persons are caring does not
require that each act of a person be caring, but it does
require the acceptance that “fundamentally, potentially,
and actually, each person is caring” (Boykin &
Schoenhofer).
Through entering, experiencing, and appreciating the life-
world of other, the nature of being human is more fully
understood.
From the perspective of Nursing as Caring, the
understanding of person as caring “centers on valuing
and celebrating human wholeness, the human person as
living and growing in caring, and active personal
engagement with others” (Boykin & Schoenhofer).
23 January 2023 15

Persons Are Whole and Complete in the
Moment
Respect for the person is communicated by the
notion of a person as whole or complete in the
moment.
Being complete in the moment signifies that
there is no insufficiency, no brokenness, and no
absence of something.
Wholeness, or the fullness of being, is forever
present.
23 January 2023 16

 The view of the person as caring and complete is
intentional, offering a unifying lens for being present
with the other that prevents segmenting into parts such as
mind, body, and spirit.
 Through this lens, the person is at all times whole, with
no insufficiency, brokenness, or absence of something.
 The idea of wholeness does not preclude the idea of
complexity of being.
 Instead, from the perspective of Nursing as Caring, to
encounter a person as less than whole fails to truly
encounter the person.
23 January 2023 17

Persons Live Caring, Moment to Moment
 Caring is a lifetime process that is lived moment
to moment and is constantly unfolding.
 In the rhythm of life experiences, we continually
develop expressions of ourselves as caring
persons.
 Actualization of the potential to express caring
varies in the moment.
23 January 2023 18

As competency in caring is developed through life, we
come to understand what it means to be a caring person,
to live caring, and to nurture each other as caring.
This awareness of self as a caring person brings to
consciousness the valuing of caring and becomes the
moral imperative, directing the “oughts” of actions with
the persistent question, “How ought I act as caring
person?” (Boykin & Schoenhofer ).
23 January 2023 19

Health: Personhood Is Living Life Grounded in
Caring
 Personhood is a process of living caring and
growing in caring
 It is being authentic, demonstrating congruence
between beliefs and behaviors, and living out the
meaning of one‟s life.
 Personhood acknowledges the potential for
unfolding caring possibilities moment to moment.
23 January 2023 20

 From the perspective of nursing as caring,
personhood is the universal human call.
 This implies that the fullness of being human
is expressed in living caring uniquely day to
day and is enhanced through participation in
caring relationships (Boykin & Schoenhofer).
23 January 2023 21

Environment: Personhood is enhanced through
participating in nurturing relationships with caring
others
o As a process, personhood acknowledges the potential of
persons to live caring and is enhanced through
participation in nurturing relationships with caring
others.
o The nature of relationships is transformed through
caring.
o Caring is living in the context of relational
responsibilities and possibilities, and it acknowledges
the importance of knowing the person as person.
23 January 2023 22

Nursing: Nursing is both a discipline and a profession
 Nursing is an “exquisitely interwoven” ( Dr. Boykin &
Schoenfoer) unity of aspects of the discipline and
profession of nursing.
 As a discipline, nursing is a way of knowing, being,
valuing, and living in the world and is envisaged as a
unity of knowledge within a larger unity.
 The discipline of nursing attends to the discovery,
creation, development, and refinement of knowledge
needed for the practice of nursing.
 The profession of nursing attends to the application of
that knowledge in response to human needs.
23 January 2023 23

 Nursing as caring focuses on the knowledge
needed for plenary understanding of what it
means to be human and the distinctive
methods needed to verify this knowledge.
 As a human science, knowing nursing means
knowing in the realms of personal, empirical,
ethical, and aesthetic all at once
 These patterns of knowing provide an
organizing framework for asking
epistemological questions of caring in nursing.
23 January 2023 24

Theoretical Assertions
 As a general theory, Nursing as Caring is
appropriate for various nursing roles, such as
individual practice, group or institutional practice,
and a variety of practice venues such as acute
care, long-term care, nursing administration, and
nursing education.
 The fundamental assumptions of Nursing as
Caring underpin the assertions and concepts of the
theory. They are (1) to be human is to be caring,
and (2) the purpose of the discipline and profession
is to come to know persons and nurture them as
persons living caring and growing in caring.
23 January 2023 25

Dance of Caring Persons
Is the image of dancer in a circle, moving freely as
individuals while engaging in a rhythm that connects
all.
Creating a culture where each person is respected,
valued, and celebrated shapes an environment that
can transform an organization.
The Dance of Caring Persons builds on the
assumptions of the theory of Nursing as Caring.
These assumptions offer a broad philosophical
framework that has implications for transforming not
only the nursing dimension of care, but also an entire
healthcare organization.
23 January 2023 26

Dance of Caring Persons…
 A Person-Centered, Caring-Focused Relational Model
 Acknowledgement that all persons have the capacity
to care by virtue of their humanness
 Commitment to respect for person in all institutional
structures and processes
 Recognition that each participant in the enterprise has
a unique valuable contribution to make to the whole and
is present in the whole
 Appreciation for the dynamic though rhythmic nature
of the Dance of Caring Persons, enabling opportunities
for human creativity
23 January 2023 27

Dance of Caring Persons…
Figure 1.1 Boykin, A., & Schoenhofer, S. O. (2001). Nursing As Caring: A
Model for Transforming Practice, p. 37
23 January 2023 28

Development of Dance of Living
Caring
 Advances in the literature and in healthcare
environments
 Led to consideration of incorporation of healthcare
robots and even humanoid nurse robots into Boykin &
Schoenhofer‟s theory of Nursing as Caring
 Dialogue at the 2018 Summer Academy of the Anne
Boykin Institute illuminated the value of van
Wynsberghe’s Caring-Centered Value-Sensitive
Design (CCVSD) approach to a consideration of robots
as “partners-in-caring” in the context of Nursing as
Caring (NAC)
23 January 2023 29

Caring…
Values of CCVSD and NAC were examined for
congruence, with dissonances addressed
Dance of Living Caring was conceptualized as an
antecedent to an innovative middle range theory of
robots as Nursing partners-in-caring in the context
of Nursing As Caring (NAC)
Dance of Living Caring is a modification of
Dance of Caring Persons to accommodate
healthcare robots and future Super AI technologies
in Nursing.
23 January 2023 30

Caring…
 Medical robots assist surgeries, streamline
clinical workflow and enhanced patient care
and workplace safety.
 A humanoid robot is a robot resembling the
human body in shape, the design may be for
functional purpose such as interacting with
human tools and environment for experimental
purpose such as the study of bipedal
locomotion or the purpose.
23 January 2023 31

Strengths & Limitations of the Theory
Strengths
As nurses we know there are various ways of
expressing caring.
The theory of Nursing as Caring had been tested
in various nursing practice settings and those
nursed had voice the „experience of being truly
cared for‟.
Patient and nurse satisfaction in those units had
reportedly increased, retention increased, and the
environment for care became grounded in the value
of respect for persons.
23 January 2023 32

Strengths & Limitations of the
Theory…
Limitations
 As nurses we frequently find that we do not have
enough time to practice caring, given the
demands of our role.
 The nursing environment, either in clinical
practice, administration, education and
research, has encountered challenges
23 January 2023 33

Strengths & Limitations of the
Theory…
These challenges depersonalizes and
routinizes the care we deliver for the clients
Like technological advances, demands for
immediate and measurable outcomes that
focus on simple and superficial quick care,
economic focus and profit motive (time is
money).
23 January 2023 34

Summary
The Theory of Nursing as Caring is a general or
grand nursing theory that offers a broad
philosophical framework with practical implications
for transforming practice (Boykin et al., 2003).
From the perspective of Nursing as Caring, the focus
and aim of nursing as a discipline of knowledge and a
professional service is “nurturing persons living
caring and growing in caring” (Boykin &
Schoenhofer, 2001a, p. 12).
23 January 2023 35

Summary
The theory is grounded in fundamental
assumptions (1)To be human is to be caring &
(2) The activities of the discipline and the
profession of nursing coalesce in coming to
know persons as caring and nurturing them as
persons living and growing in caring.
The understanding of nursing as a discipline
and as a profession uniquely focuses on caring
as its central value, its primary interest, and the
direct intention of its practice.
23 January 2023 36

Summary
• Nursing as Caring is being used as a conceptual
basis for developing middle range theories.
• From the perspective of Nursing as Caring, the
nursing situation is the unit of knowledge for study
for a focus on personhood as a process of living that
is grounded in caring (Boykin & Schoenhofer,
1991).
• The mutual relationship shared by the nurse and the
nursed is one of reciprocity and subjectivity.
23 January 2023 37

References
1. Boykin, A. & Schoenhofer, S. (2001). Nursing as
Caring: A Model for Transforming Practice.
Boston: Jones and Bartlett.
2. Boykin, A. & Schoenhofer, S. (2000). "Nursing as
Caring". In Parker, M., Nursing Theories and
Nursing Practice. Pp. 371-385
3. http://www.nursingascaring.com/
4. Locsin, R., Development of an Instrument to
measure Technological Caring in Nursing. Nursing
and Health Sciences.(1999) Vol. 1, Issue 1, pp27-34
5. Parker, M., Smith, M., Nursing Theories and
Nursing Practice 3rd Edition. 2010, Davis,
Philadelphia, Pa.
6. Martha Raile Alligood, nursing theorists and
their work, 9th edition
23 January 2023 38

References
6. Schoenhofer, S. O., Van Wynsberghe, A., & Boykin, A.
(2018). Engaging robots as nursing partners-in-caring: Nursing
As Caring meets Care-Centered Value Sensitive Design.
International Journal for Human Caring, 23, 157-167. DOI:
10.20467/1091-5710.23.2.157
7. Schoenhofer, S. O., Van Wynsberghe, A., & Boykin, A.
(2018). Engaging robots as nursing partners-in-caring: Nursing
As Caring meets Care-Centered Value Sensitive Design.
International Journal for Human Caring, 23, 157-167. DOI:
10.20467/1091-5710.23.2.157
8. Boykin, A., & Schoenhofer, S. O. (2001). Nursing As Caring:
A model for transforming practice. Sudbury, MA: Jones &
Bartlett. (download free from Gutenberg.org)
savibus@gmail.com
23 January 2023 39

.
WOLLEGA UNIVERSITY
INSTITUETE OF HEALTH SCIENCE,
SCHOOL OF NURSING AND MID WIFERY
DEPARTMENT OF NURSING
INDIVIDUALASSIGNMENT : NURSING THEORY
TITLE: MODEL OF NURSING BASED ON ACTIVITIES OF
LIVING
23 January 2023 41

MODEL OF NURSING BASED ON
ACTIVITIES OF LIVING
UNIT-2
23 January 2023 42

Outlines/ Contents
Introduction
Major concepts
12 activities if daily living
5 potential or actual problems
The lifespan
Dependence/Independence continuum
Individuality in living
Evaluation of the theory
References
23 January 2023 43

Introduction
 Theorists: Nancy Roper, Winifred W. Logan
and Alison J. Tierney
 One of the widely used nursing model
 Also referred as a Human Needs Model
 A Model of nursing care based on activities
of daily living (ADLs).
 The activities of Livings (ALs) are what
constitute “everyday living activities” (Roper,
Logan, & Tierney, 2000).
23 January 2023 44

Introduction…
Model of Nursing based on Activities of
Living “is an attempt to identify only the main
features of the nature of living taking into
account knowledge from the natural sciences,
the social sciences and the humanities” (Roper,
Logan, & Tierney, 2000).
Roper et al. (2000) indicated that the activities
of Livings (ALs) are more commonly referred to
as the Activities of Daily Living (ADLs).
They identified 12 activities of Livings (ALs).
23 January 2023 45

Introduction…
• The purpose of the Roper Logan & Tierney theory is as
an assessment used throughout the patient‟s care.
 As a nurse you should use the model to assess the
patient‟s relative independence and potential for
independence in the activities of daily living.
 The patient’s independence is looked at on a continuum
that ranges from complete dependence to complete
independence.
 This helps to determine what interventions will lead to
increased independence as well as what ongoing support
is needed to offset any dependency that still exists.
23 January 2023 46

Major Concepts
1.Person /Patient
 Is any individual who needing help to perform
activities of daily livings.
2. Health
 Can only be defined in relation to the
individual and his expectations and in relation
to his optimal level of functioning in everyday
living.
23 January 2023 47

Major Concepts…
3. Environment
 Houses, factories, and offices, sports grounds
and playgrounds.
 There is also the broader view of environment
e.g. climate and geographical location
4. Nursing
 Helping patient, solve, alleviate or cope with
problems (actual or potential) with activities
of daily livings and exists to meet the needs of
society.
23 January 2023 48

The 12 Activities of Daily Living
Roper states that the 12 activities of daily living
should be viewed “As a cognitive approach to the
assessment and care of the patient, not on paper as
a list of boxes
But in the nurse‟s approach to and organization of
her care,” and that nurses deepen their
understanding of the model and its application.
23 January 2023 49

The 12 Activities of Daily Living…
The patient should be assessed on admission,
and his or her dependence and independence
should be reviewed throughout the care plan
and evaluation.
By looking at changes in the dependence-
independence continuum, the nurse can see
whether the patient is improving or not, and
make changes to the care provided based on
the evidence presented.
23 January 2023 50

The 12 Activities of Daily Living…
The list also includes death and sexuality as
activities of daily living, but these are often
disregarded depending on the setting and
situation for the individual patient.
23 January 2023 51

1. Maintaining a safe
Environment
2. Communication
3. Breathing
4. Eating & Drinking
5. Elimination
6. Washing & Dressing
7. Controlling Temperature
8. Mobilization
9. Working & Playing
10. Expressing Sexuality
11. Sleeping
12. Death & Dying
12 Activities of Daily Living…
23 January 2023 52

ACTIVITY ASSESSMENT
Maintaining a safe environment
-Physiologic data – T, P, R, BP
-Vision and hearing
-Mobility vs. immobility
-Tissue viability assessment
-Falls assessment
Communication
-Language spoken- interpreter?
-Mental capacity
-Hearing ability
-Speech ability
-Communication aids
Breathing
-Clear airway
-Observe breathing rate, depth and effort
-Pain related to breathing
-Smoking history
Eating & Drinking
-Hydration
-Nutrition
-Swallowing and chewing
-Patterns of eating and drinking
-Dietary requirements/ religious requirements
-Weight and BMI
-Allergies
Elimination
-Elimination habits
-Continence
-Colostomy or ileostomy
23 January 2023 53

ACTIVITY ASSESSMENT
Personal Cleansing & Dressing
-Hygiene needs
-Assistance with dressing/ undressing
-Usual hygiene practices
Controlling Body Temperature -Take temperature
-Ability to maintain own temperature
Mobilizing
-Normal gait
-Aids used for mobilizing
-Moving and handling assessment
Working & Playing
-Employment
-Hobbies
-Sports
Expressing Sexuality -Problems related to sexual function
Sleeping -Normal sleep pattern
-Medication
-Activities to promote sleep
Dying -Cultural and religious beliefs
-Family/ friends
-Next of kin
23 January 2023 54

 Disability
 Pathologic & Degenerative Tissue Change
 Accident
 Infection
 Environmental Changes in the Physical,
Psychological & Social Sectors of the Client‟s
Life
5 Potential or Actual Problems
23 January 2023 55

The Lifespan
 Describes where a person is on a continuum from being
born to dying.
 Living is concerned with the whole of a person‟s life . .
from birth to death” (Roper et al. 2000).
 Roper et al (2006:55) identify five different stages
being “infancy, childhood, adolescence, adulthood,
senior citizenship.”
 However each person‟s life span is of a different length
with not everyone reaching all five stages (Healy and
Timmons, 2003).
 Depending where a person is on their lifespan will affect
each one of the twelve activities of living.
23 January 2023 56

Lifespan…
Preschooler-Child-Young adult-Middle aged-Senior
23 January 2023 57

Dependency/Independence
Continuum
 This component of the model is closely related
to the lifespan and to the ALs.
 It is included to acknowledge that there are
stages of the lifespan when a person cannot
yet (or for various reasons can no longer)
perform certain AL’S independently.
 Each person could be said to have a
dependence/ independence continuum for
each AL’s.
23 January 2023 58

Dependence/independence
Continuum
o Dependence/independence continuum is closely linked
to both the lifespan and the activities of living.
o The continuum ranges from total dependence to total
independence, exists for each activity of living
throughout the lifespan &
o Changes as the person ages as well as if some event or
health condition or other circumstance requires a
temporary or permanent change.
o Each activity needs to be assessed for how dependent
or independent the person is in performing this activity.
23 January 2023 59

Dependence/independence
Continuum…
 If these are mapped at the assessment stage of
the nursing process, they can be re-evaluated
to see if a patient is becoming more
independent in each activity or if they are
becoming more dependent as care is provided.
 The activities of living are often linked to one
another and becoming independent in one may
mean the same for other activities too.
 The same is true when a person becomes more
dependent.
23 January 2023 60

Influences of Activities of Living
 According to the model, there are five factors
that influence the activities of living.
 The incorporation of these factors into the
theory of nursing makes it a holistic model.
 If they aren’t considered, the resulting
assessment is incomplete and flawed.
 The factors are used to determine the
individual patient’s relative independence in
regards to the activities of daily living.
23 January 2023 61

Influences of Activities of Living…
 These factors affect the performance of activities of
daily living (ALs ) at any time during the lifespan.
 Each influences on one or more activities of daily
living (ALs ).
 Can be a positive influence, which is a facilitator in
supporting and enhancing the daily living , AL(s).
 Or can be a negative influence, which is a barrier
that may be a potential or actual health hazard.
 Roper et al. (2000) identified five interrelated
influences on ALs.
23 January 2023 62

These factors include biological, psychological,
sociocultural, environmental, and politico-economic.
1. Biological
The biological factor addresses the impact of the overall
health, of current injury and illness, and the scope of the
patient‟s anatomy and physiology.
2. Psychological
The psychological factor addresses the impact of emotion,
cognition, spiritual beliefs, and the ability to understand.
According to Roper, this is about “knowing, thinking,
hoping, feeling and believing.”
23 January 2023 63

3. Sociocultural
 Is the impact of society and culture as
experienced by the individual patient.
 This includes expectations and values based on
class and status
 And culture within the sociocultural factor relates
to the beliefs, expectations, and values held by
the individual patient for him or herself
 As well as by others pertaining to independence
in and ability to carry out the ADL.
23 January 2023 64

4. Environmental
The environmental factor in Roper‟s theory of
nursing makes it a “green” model.
The theory takes into consideration the impact of
the environment on the activities of daily living,
But also examines the impact of the activities of
daily living on the environment.
23 January 2023 65

5. Politico-Economic Factor
Is the impact of the government, politics, and
economy on the activities of daily living.
Addresses issues such as funding, government
policies and programs, war or conflict,
availability to benefits, political reforms, interest
rates &
Availability of public and private funding, among
others.
23 January 2023 66

Individuality in Living
 Manifested by the style in which individuals
attend to each of their activities of living
 This is according to the achieved stage on the
lifespan and place on the dependence/
independence continuum,
 Which have all been, and still are being,
influenced by the interacting five groups of
factors.
23 January 2023 68

Evaluation of the Theory
Adequacy
 Cannot be applied to all populations.
Clarity
 Is clearly presented in the literature and can be
easily read and understood by any reader.
Consistency
 Has several key concepts that are defined
throughout the literature.
23 January 2023 70

Evaluation of the Theory…
Logical Development
 Throughout the literature, the Model of Living
is clearly presented in a reasonable and valid
manner.
Level of Theory Development
 Meets the description based on an interactive
process theory because it consists of several
well-defined concepts.
Complexity
 The model is said to be self-explanatory or not
too complicated as compared to others.
23 January 2023 71

References
1. Roper N, Logan WW, Tierney AJ. The
Elements of Nursing. Churchill Livingstone,
1980.
2. Roper N, Logan W and Tierney A. The
elements of nursing 4th ed. Edinburgh:
Churchill Livingstone, 1996.
3. Wimpenny P. The meaning of models of
nursing to practicing nurses. Journal of
Advanced Nursing 40(3), 346–354, 2002.
4. Martha Raile Alligood, nursing theorists
and their work, 9th edition
23 January 2023 72

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