THEORETICAL FOUNDATIONS IN NURSING

“NEW NURSING THEORIES”

Prepared By:HANNAH MARIE M. BAGU, RN1ST Year – MSN 2ND Semester

OBJECTIVES:After 30-45 minutes of discussion

about the New Nursing Theories, the participants would be able to:◦Identify the 2 new nursing theories

discussed.◦State at least 3/4 major assumptions

underlying Rozzano Locsin’s theory.◦Utilize the Nursing as Caring Theory to

the Nursing practice, administration, education & research.

ANNE BOYKIN & SAVANA SCHOENHOFER

Nursing as Caring

ANNE BOYKIN1944 - Kaukauna,

Wisconsin1966 – Nursing Career

◦Alverno College in Milwaukee, Wisconsin

Master’s Degree◦Emory University Atlanta,

GeorgiaDoctorate

◦Vanderbilt University in Nashville, Tennessee

1981 – South Florida◦Steve Staudenmeyer

DEAN & PROFESSOR◦Christine E. Lynn College of Nursing,

Florida Atlantic University

DIRECTOR◦Christine E. Lynn Center for Caring

Awards2009 - Visionary Caring Science Award

by the Watson Caring Science Institute

Book PublicationsNursing as Caring: A Model for Transforming

Practice (1993, 2001a)

Living a Caring-Based Program (1994b).

Politics and Public Policy: A Matter of Caring (1995)

Caring as Healing: Renewal Through Hope (1994)

SAVANA SCHOENHOFER1940 – Kansas

1960 – Volunteer◦Amazon, Brazil

1983 – PhD◦Kansas State

University

PROFESSOR◦Cora S. Balmat School of Nursing, Alcorn

State University, Natchez, Mississippi

1990 - Co-FOUNDER◦Nursing Aesthetics Publication,

Nightingale Songs

Book PublicationsNursing as Caring: A Model for

Transforming Practice (1993, 2001a)

ASSUMPTIONS OF CARING AS NURSING :

Persons are caring by virtue of their humanness.

Persons are whole and complete in the moment.

Persons live caring from moment to moment.

Personhood is a way of living grounded in caring.

Personhood is enhanced through participation in nurturing relationships with caring others.

Nursing is both a discipline and a profession.

CARINGAltruistic, active expression of

love

Intentional and embodied recognition of value and connectedness

Nursing uniquely focuses on caring as its central value

Illuminated in the experience of caring and in reflection on that experience

FOCUS & INTENTION OF NURSING

Focus of Nursing

◦Persons living in caring and growing in caring

Intention of Nursing

◦Nurturing persons living and growing in caring

NURSING SITUATIONA shared lived experience in which caring

between the nurse and nursed enhances personhood

◦Involves values, intentions and actions of two or more persons choosing to live a nursing relationship

Nursing is created in the “caring between”

All knowledge of nursing is understood within the nursing situation

PERSONHOODPersonhood is living grounded in

caring.

Personhood is the universal human call.

Understanding communicates the paradox of person-as-person and person-in-communion all at once.

CALL FOR NURSINGCall for acknowledgement and

affirmation of the person living and caring in specific ways in the immediate situation

(Boykin & Schoenhofer, 1993, 2009)

Calls for nurturance through personal expressions of caring

Originates within persons

Intentionality and authentic presence open the nurse to hear calls for nursing

CALL FOR NURSING (continued)

There are relevant ways of saying “know me as a caring person in the moment and be with me as I try to live fully who I truly am.”

Calls are unique and cannot be predicted as in a diagnosis.

Nurses develop sensitivity and expertise in hearing calls through intention, experience, study, and reflection.

NURSING RESPONSESpecific expression of caring

nurturance to sustain and enhance the “other” as he or she lives caring and grows in caring in the situation of concern

Uniquely created for the moment

Cannot be predicted or applied as preplanned protocols

THE CARING BETWEENSource and ground of nursing

Loving relation into which the nurse and nursed enter and co-create by living intention to care.

Personhood is enhanced in the context of the caring between

Without the caring between, unidirectional activity or reciprocal exchange can occur but nursing in the fullest sense does not

LIVED MEANING OF CARING AS NURSINGMeaning of nursing is best

understood by the study of a nursing situation.

Nurse and nursed live caring uniquely.

Courage is required to enter into the unknown of a nursing situation.

I CARE FOR HIMMy hands are

moist,My heart is quick,My nerves are

taut,He’s in the next

room,I care for him.

The room is tense,It’s anger-filled,The air seems

thick,I’m with him now,I care for him.

Time goes slowly by,

As our fears subside,

I can sense his calm,

He softens now,I care for him.

His eyes meet mine,

Unable to speak,I feel his trust,

I open my heart,I care for him.

It’s time to leave.Our bond is made,Unspoken thoughts,But understood,I care for him!

— J. M. Collins (1993)

NURSING PRACTICEThe nurse practicing nursing as

caring comes to know the other as a caring person in the moment. The challenge is not to discover what is missing, weakened, or needed but to come to know the other and to nurture that person in situation-specific, creative ways and to acknowledge, support, and celebrate the caring that is.

NURSING ADMINISTRATIONThe practice of nursing

administration is grounded in a concern for creating, maintaining, and supporting an environment in which calls for nursing are heard and nurturing responses are created. Nursing administrators inspire a culture that evolves from the values of nursing as caring.

NURSING EDUCATIONThe curriculum asserts the focus

and domain of nursing as nurturing persons living caring and growing in caring. Faculty assist and mentor students as co-learners; create caring learning environments, that inspire the appreciation and celebration both self and other as caring persons.

NURSING RESEARCH & DEVELOPMENTResearch and development efforts

are focused on expanding the language of caring; re-conceptualizing nursing outcomes as “value experienced in nursing situations”; and evaluating this theory based model of caring in acute and long-term health-care agencies.

FREQUENTLY ASKED QUESTIONS:

How does the nurse come to know self?

Must I like my patients to nurse them?

What about nursing a person for whom it is difficult to care?

Is it possible to nurse someone who is in an unconscious or altered state of awareness?

How does the nurse come to know self?

How does the nurse come to know self?

Trust in self

Learning to let go, to transcend

Being open and humble

Continuously calling into consciousness that each person is living caring in the moment

Taking time to experience humanness fully

Finding hope in the moment

Must I like my patients to nurse them?

Must I like my patients to nurse them?

To nurture persons as living and growing in caring, it is necessary to know the other as caring person living his/her own caring in the moment.

What about nursing a person for whom it is difficult to care?

What about nursing a person for whom it is difficult to care?

All persons are caring.

Nursing ethic to care supersedes all other values.

Is it possible to nurse someone who is in an unconscious or altered

state of awareness?

Is it possible to nurse someone who is in an unconscious or altered state of awareness?

Nurse makes self as caring person available

Nurse recognizes the vulnerability of other.

Other living caring in humility, hope, and trust.

How Does this Theory Differ From Nursing Process?

Nursing is viewed as an ongoing process that is guided by intentionality.

Value of nursing is that which is perceived as valuable to the other.

There is no predictable outcome.

USEFULNESS OF IN NURSING IN PRACTICE

Nursing practice intentionally focused on coming to know a person as caring and nurturing and supporting those nursed as they live caring leads to:

◦ Increased patient and nurse satisfaction

◦ Increased retention of nurses

◦ Environment of care becoming grounded in values of and respect for person

ROZZANO LOCSIN

Technological Competency as Caring and the Practice

of Knowing Persons in Nursing

“The practice of knowing persons as whole,

frequently with the use of varying technologies”

(Locsin, 2001) .

ROZZANO LOCSIN1976 – BSN &1978 - MAN

◦ Silliman University of the Philippines

1988 - PhD◦ University of the Philippines

1991 - PROFESSOR◦ Christine E. Lynn College of

Nursing, Florida Atlantic University

Program of Research: “Life transitions n the health-illness experience”

Awards2000 - Fullbright Scholar to Uganda

2004–2006 - Fullbright Alumni Initiative Award to Uganda

Fullbright Senior Specialist in Global and Public Health and International Development

Edith Moore Copeland Excellence in Creativity Award: Sigma Theta International

Lifetime Achievement Awards from Schools of Nursing in the Philippines

Book PublicationsAdvancing Technology, Caring and

Nursing (2001)

Technological Caring in Nursing: A Model for Practice (2005)

A Contemporary Process of Knowing: The (Unbearable) Weight of Knowing in Nursing (2009)

ROZZANO LOCSIN’S ASSUMPTIONS:

◦Persons are whole or complete in the moment (Boykin and Schoenhofer, 2001)

◦Knowing persons is a process of nursing that allows for continuous appreciation of persons moment to moment (Locsin, 2005).

◦Nursing is a discipline and a professional practice (Boykin and Schoenhofer, 2001)

◦Technology is used to know persons as whole moment to moment (Locsin, 2004).

FOCUS & INTENTION OF NURSINGFocus of Nursing

◦A human being whose hopes, dreams, and aspirations are to live fully as a caring person (Boykin & Schoenhofer, 2001)

Intention of Nursing◦To know human beings fully as a whole person

By affirming, appreciating, and celebrating personhood

Through expert and competent use of nursing technologies

TECHNOLOGY OF COMPETENCY

Conceptualized as:

◦An expression of Caring Co-existence of technology and

caring in nursing

◦Providing a framework for practice

Purpose:Acknowledge wholeness of

persons as a focus of nursing

Technological means are used to know wholeness more fully

Technology used to know “who is person” rather than “what is person”

THE WHAT IS / WHO IS PERSON

What is Person?◦Empirical facts about the

compositions of the person◦Persons as objects

Who is Person?◦Understanding the unpredictable,

irreducible person who is more and different than the sum of his or her empirical self

◦Persons as unique individual

PERSON ARE COMPLETE AND WHOLE IN THE MOMENT

Persons are complete, unique and unpredictable ◦ Expressions of completeness vary from

moment to moment

Nursing interventions are not focused on “fixing” or making persons “whole again.”

Nurses come to know persons as whole.

Nursing responses are based on the persons’ uniqueness.

FOCUSING ON RECEIVED TECHNOLOGICAL DATA ALONE TO KNOW PERSON

Provides the nurse with an understanding of persons as objects who need to be fixed or made whole again

PROCESS OF KNOWING PERSON AS A WHOLE AND COMPLETE IN THE MOMENT

Persons choose whether or not to allow nurses to know them fully.

In holding the idealization of persons as “complete in the moment,” nurses must

◦Choose to enter the world of the other

◦Establish rapport, trust, confidence, commitment, and compassion

WHOLENESS PARADOXBecause persons are unique and

unpredictable

Persons can only be fully known ◦In the moment◦If the nurse chooses to enter the world of the other

◦If the person allows the nurse to know him/her

FROM THIS PERSPECTIVE

The condition in which the nurse and other allow each other to come to know one another is the nursing situation.

NURSING SITUATIONShared lived experience between

the nurse and nursed

Condition in which the nurse and the other allow each other to know one another

Nurse’s responsibility to know the person’s hopes, dreams, and aspirations

VULNERABILITY

The nurse and nursed become vulnerable as they enter each other’s world and move toward continuous knowing of one another

VULNERABILITY IN CARING SITUATIONSAllows participation

Embodiment of vulnerability enables recognition of it in others

Allows engagement of “power with” rather than “power over”

Nurses’ work is to ameliorate vulnerability (Daniels, 1998)

PROCESS OF NURSINGThe process of nursing is a dynamic unfolding

of situations encompassing knowledgeable practices (Locsin, 2005)

Knowing and appreciating uniqueness of persons

Designing participation in caring

Implementation and evaluation

Verifying knowledge of person through continuous knowing (Swanson, 1991)

KNOWING IS THE PRIMARY PROCESS OF NURSING

Knowing nursing◦“All at once” knowing of personal,

ethical, empirical, and aesthetic realms (Boykin & Schoenhofer, 2001)

Continuous knowing of person◦Occurs moment to moment◦Deters objectification◦Overpowers the motivation to

prescribe and direct the person’s life

THE ENTIRETY OF NURSING

Is to direct, focus, sustain, and maintain the person (Locsin, 2005)

Through calls and responses for nursing

CALLS FOR NURSINGCalls

◦Nurses rely on the person for calls

◦Knowing persons allows the nurse to use technologies in articulating calls

◦Illustrations of the person’s unique hopes, dreams, and aspirations

◦Individual expressions Desire to go home Wishing to die peacefully

NURSING RESPONSES

Nurses respond to calls from persons.

Nurses respond with authentic intentions to fully know persons continually in the moment.

REFERENCES:

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