Nadulpit, Lalaine G.
BS Nursing-1
Nursing as Caring: A Model of Transforming Practice
Anne Boykin and Savina Schoenhofer
Theorists
Anne Boykin
grew up in Kaukauna, Wisconsin
began her career in nursing in 1966, graduating from Alverno
College in Milwaukee, Wisconsin
Became president in the International Association for Human
Caring
Her work is centered on caring as the grounding for nursing. This is evidenced in her
book Nursing as Caring: A Model for Transforming Practice(1993, 2001a), and her book,
Living a Caring-Based Program (1994b)
Savina Schoenhofer
born in Kansas
worked as a volunteer in community development
aside from having a nursing degree, she also earned a graduate
degree in Psychology and Counseling in Wichita University
Together with Marilyn Parker, she co-founded Nightingale Songs.
The Nightingale Songs shows the beauty of nursing by means of
prose or poetry. Nurses share their reflection about their nursing
experiences and stories. By means of the Nightingale Songs, nurses
receive encouragement and support.
her career in nursing was influenced by three colleagues, one of those was Anne
Boykin who introduced her to caring as a substantive field of study in Nursing.
Created and manages the website and discussion forum on the Theory of Nursing as
Caring (http://www.nursingascaring.com)
currently a professor of graduate nursing at the Cora S. Balmat School of Nursing
Theory Description
Nursing as Caring: A Model of Transforming Practice
is a general or grand nursing theory that can be used as a framework to guide nursing
practice.
most basic concept of the theory is that each person is a caring person, and that to me
human is to be called to live one's innate caring nature.
Major Assumptions
The theory is grounded in these major assumptions/ concepts:
Persons are caring by virtue of their humanness.
Persons are caring moment to moment.
Persons are whole or complete in the moment.
Personhood is living grounded in caring.
Personhood is enhanced through participating in nurturing relationships with caring
others
Nursing is both a discipline and a profession
Dance for Caring Persons
Represents lived caring between the nurse and the
nursed.
The contributions of each dancer including the nursed
are honored.
Dancers enter the nursing situation, visualized a circle of
caring that provides purpose and integrated function.
The dance symbolizes the valuing and appreciation of each person in a way that is
person- centered and caring-focused.
The dance includes a circle of many different dancers. Each person is understood to
be caring and living their commitment to the mission of the organization in unique and
special ways.
There are no positions of power, but rather awareness that everyone brings their own
valuable and unique contribution to the whole.
There is recognition of the importance of exquisite teamwork in health care.
Related Concepts
Three bodies of work significantly influenced the initial development of the theory.
1. Humanistic Nursing Theory- viewed by Boykin and Schoenhofer as historical antecedent of
Nursing as Caring, was the source of such germinal ideas as “the between”, “call for nursing”,
“nursing response”, “personhood,” and served as substantive and structural bases for their
conceptualization of Nursing as Caring.
2. Mayeroff's Major Ingredients of Caring- provided a rich elemental language that facilitated
the recognition and description of the practical meaning of living caring in the ordinariness of
life. Mayeroff’s major ingredients of caring-- knowing, alternating rhythms, patience, honesty,
trust, humility, hope and courage describe the wellspring of human living.
3. Caring: The Human Mode of Being- thesis that caring is the human mode of being finds its
natural expression and domain in the assumptions of the theory. Roach’s 6 C's :
Commitment, ,confidence, conscience, competence, compassion, and comportment--
contribute to providing a language of caring.
Theory Application
Scenario:
A 48-year-old female complains of abdominal pain for the past 5 days. She localizes the
pain to her epigastric area and radiates to her right upper quadrant. She said that it became
worse every after eating. She experiences nausea and vomiting and cannot find a
comfortable position. She was admitted to the hospital and done several laboratory test and
abdominal ultrasound scan. She was diagnosed of cholelithiasis and needs surgery. She
underwent laparoscopic cholecystectomy under general anesthesia.
Application:
As a caring nurse for patients who underwent gallbladder removal, the first thing to do is to
provide her the best care by monitoring her vital signs, patency of airway and circulation,
keep her safe by using side rails, administer medications on time. Check surgery site for
infections. After 24 hours, I will encourage her to slowly exercise by walking in low pace and
increase the duration of pace every day for faster recovery period. Communicate with the
patient and so with the doctor. Educate her as well as her family members before discharge
and give her home instructions. Remind her to avoid strenuous activity. On her diet, encourage
her to eat high fiber food and avoid fatty foods. A caring nurse always plans and implements
what is best for her patient before, during and after hospitalization. Always treat them as a
family member and be a compassionate health care provider.
Metaparadigm
Person- “illuminated as living grounded in caring”
Nursing- “nurturing persons living caring and growing in caring”
Health- “a well-being state of a person”
Environment- “defines situationaly to any context that is influenced by the client”
References
Boykin, A. & Schoenhofer, S. (2001). Nursing as Caring: A Model for Transforming Practice.
Boston: Jones and Bartlett.
Boykin, A. & Schoenhofer, S. (2000). "Nursing as Caring". In Parker, M., Nursing Theories and
Nursing Practice. Pp. 371-385 http://www.nursingascaring.com/
Boykin, A., Schoenhofer, S. & Valentine, K. (2013). Health care system transformation for nursing
and healthcare leaders: Implementing a culture of caring. New York: Springer Publishing.
http://www.nursingascaring.com
Conceptual Model of Nursing
Evelyn Adam
Evelyn Adam
Canadian nursing theorist who applied the structure of a conceptual
model for nursing in her book Être Infirmière in 1979
Work focuses on development of models and theories
Contributes to theory development and clarification of models of Johnson
and Henderson
Principal Works
1. Être Infirmière (1979) /To Be A Nurse (1980)- Explains the fundamental concepts of
nursing, as developed throughout the years and looks at where nursing may be going in
the future.
2. La personne agee et ses besoins: Interventions infirmieres. (1996)- Analyzes the nursing
care of the aged/elderly based on Henderson's model.
Adam published Être Infirmière and To Be A Nurse to help nurses understand the writings of
Virginia Henderson. She accomplished this by placing Henderson’s concept of nursing within
the structure of a conceptual model and by developing and refining the sub-concepts
identified by Henderson.
Adam’s work makes an important distinction between a conceptual model and a theory.
“A conceptual model is usually based on, or derived from, a theory… . A model, emerging
from a theory, ma become the basis for a new theory.” “ A conceptual model, for whatever
discipline, is not reality; it is a mental image of reality or a way of conceptualizing reality. A
conceptual model is therefore a conception of nursing.”
Climate of empathy, warmth, mutual respect, caring and acceptance were considered
by Adam as the most important components of being a nurse and that these components
determines the effectiveness of nursing care.
Components that Constitute Nursing Practice:
1. The Client
2. The Nurse (with his or her conceptual model as a base for the nursing process).
3. The Relationship between the client and the nurse.
Adam insists that the helping relationship and the systematic process are important to all
health professionals. Nursing fits into the whole of healthcare as an integral component of the
interdisciplinary health team. Each discipline makes a unique contribution to the prevention of
health problems. Each discipline is present because it has a distinct and specific contribution
to health.
Each petal represents a distinct health discipline; for example, nursing, medicine, physical
therapy, speech therapy, or nutrition. The center of the flower indicates the shared functions. A
part of each petal is separate and distinct from the others and the largest part of each petal
represents the unique contribution of each discipline.
Criteria used to evaluate theories by Dorothy Johnson:
1. Social Significance- Clients would be asked whether the service (nursing) was significant
to their health.
2. Social Congruence- Clients would be asked whether the service (nursing) was
congruent with their expectations.
3. Social Utility- Nurses would be asked whether the conceptual model provided useful
direction for education, practice, and research.
Theory Description
Evelyn Adam’s Conceptual Model of Nursing
broader than a theory for it is a model that helps you decide which theory to use.
a conceptual model specifies nursing's focus of inquiry and may thus lead to the
development of theories which will prove useful not only to nurses but to other health
professionals as well.
Evelyn Adam developed the concepts of Virginia Henderson within the structure of the
conceptual model of Dorothy Johnson.
In To Be A Nurse, Adam explains the essential elements of a conceptual model as
presented by Johnson. She then develops Henderson’s concepts within the structure of a
conceptual model.
Assumptions
Assumptions that form the theoretical foundation of Henderson’s vision of nursing:
1. Every individual strives for and desires independence.
2. Every individual is a complex whole, made up of fundamental needs.
3. When a need is not satisfied, it follows that the individual is not complete, whole, or
independent.
Values
Henderson’s conception of nursing is composed of three beliefs:
1. The nurse has a unique function, although he or she shares certain functions with other
professionals.
2. When the nurse takes over the physician’s role, the nurse delegates his or her primary
function ti inadequately prepared personnel.
3. Society wants and expects this service (nursing) from the nurse and no other worker is as
able, or wiling, to give it.
Major Units
The following are major units of Henderson’s model:
1. The goal of nursing is to maintain or restore the client’s independence in the satisfaction of
his or her fundamental needs.
2. The client or beneficiary of the nurse’s service is a whole being made up of 14
fundamental needs:
a. Breathe normally
b. Eat and drink adequately
c. Eliminate body wastes
d. Move and maintain desirable postures
e. Sleep and rest
f. Select suitable clothes– dress and undress.
g. Maintain body temperature within normal range by adjusting clothing and modifying
the environment.
h. Keep the body clean and well-groomed and protect the integument.
i. Avoid dangers in the environment and avoid injuring others.
j. Communicate with others in expressing emotions, needs, fears, or opinions.
k. Worship according to individual faith.
l. Work in such a way that brings a sense of accomplishment.
m. Play, or participate in various forms of recreation.
n. Learn, discover, or satisfy the curiosity that leads to normal development and health
and use the available health facilities.
3. The role of the nurse is a complementary- supplementary one.
4. The source of difficulty or the probable origin of those problems known as nursing problems
is an insufficiency of either knowledge, will, and/ or strength.
5. The intervention: the focus, or center of attention, of the nurse’s action is the client’s
resources (knowledge, will, and strength).
6. The desired consequence are need satisfaction, independence in need satisfaction, or, in
some cases, peaceful death.
Adam states that she chose to work with Henderson’s concept of nursing for two reasons.
First, she felt that Henderson’s work was partly known but badly known. Second, she felt that
Henderson’s work was more immediately accessible than other works because the language
was already familiar to nurses.
Adam’s concern for the need of an explicit conceptual model for nursing was developed
when she was Johnson’s student. Through Johnson, Adam also became familiar with the
structure of a conceptual model: assumptions, values, and major units.
Major Concepts
Goal of the Profession- what the member of the profession strives to achieve at the
end.
Beneficiary- a person or a group of people who the professional directs their activities
like the client.
Role- the part that the professional plays. it is the societal function of the professional.
Source of Difficulty- the probable origin of the clients difficulty to which the professional
is prepared to cope.
Intervention- the focus of centers of the professional's attention, the moment they
intervene with a client
Consequences- the results of the professional's effort to attain the ideal and limited
goal.
Assessment Tool- instrument that the professional uses in collecting information about
the beneficiary, the nursing history tool, and the data collection tool.
Assumption- theoretical or scientific basis of a conceptual model; the important
premises that support the important units of the model.
Change- substitution of one thing for another, alteration.
Data collection- first step of the nursing process, collecting information about the
beneficiary and his nursing record.
Concept- idea, mental image, generalization formed and developed in the mind.
Conception- a way of conceptualizing reality, an invention of the mind, a mental
image. Depending on the level of abstraction, the conception can be a philosophy, a
theory or conceptual model.
Conceptual model- abstraction or way of conceptualizing reality; theoretical
framework of reference sufficiently explicit to guide a particular discipline; conception
formed with assumptions, values and main units.
Nursing conceptual model- mental representation, concept or conception of nursing
that is sufficiently complete and explicit to guide all fields of activity of this profession.
Helping relationship- interaction between the beneficiary and the professional, which
helps the former to live more fully; interpersonal exchange in which the assistant
manifests qualities of support such as: empathy, respect and others.
Intervention- fifth main unit of a conceptual model, constituted by the focus of interest
and the form of professional intervention.
Intervention focuses- part of the fifth main unit of a model; intervention center with the
patient.
Mode of intervention- part of the fifth unit of a model; they are the means or modes of
intervention available to the professional.
Major Units- the 6 essential components of a complete and explicit conception.
Need- requirement or necessity.
Fundamental need- common requirement to all human beings, healthy or sick.
Individual need- specific, particular or personal requirement that precedes a
fundamental need.
Nursing care plan- written action plan, written communication that precedes the
second and third steps of the nursing process; plan to be followed; projection to be
done.
Nursing process- methodological and systematic approach to an action; logical and
dynamic method; a process in 5 steps.
Practice- one of the 3 fields of activity of a service profession; the field of activity of the
manager and the service professional.
Problem- difficulty that has to be reduced or eliminated.
Resolution method- scientific problem solving process; systematic way to proceed
when solving the problem.
Values- the value system underlying a conceptual model.
Metaparadigm
Nursing- “assist the individual sick or well, in the performance of those activities
contributing to health or its recovery that he would perform unaided if he had the
necessary strength, will or knowledge.”
Health- “the quality of health rather than life itself. That margin of mental' physical vigor
that allows a person to work most effectively and to reach his highest potential level of
satisfaction in life”
Person- “individual who requires assistance to achieve health and independence or
peaceful death.”
Environment- “the aggregate of all the external conditions and influence affecting the
life and development of an organism”
Conclusion
Adam’s work in developing the conceptual model is unique in that she has taken
Henderson’s previously existing concept of nursing and presented it within the previously
existing structure of a model. The result is something more than the sum of the two. It is a
complete, concise, explicit conceptual model.
Theory Application
Scenario:
An Earthquake had happened and you are assigned to a evacuation site as a Nurse.
Because this was not planned, the place still messy, with inefficient supplies and hygiene. What
do you do?
Application:
We can apply Nightingale’s Theory. First is to identify the stressors or problems. Identify what
theory can be used/ applied. Next is we have to apply the theory and get the results
(effective/ineffective). After getting the results, re-evaluate. What else is the problem? What
could be improved? Repeat the model and find other problems.
References:
Roy, C. & Roberts, S.L. (1981). Theory construction in nursing: An adaptation model. Englewood
Cliffs, NJ: Prentice-Hall
Adam, E (1975, Sept.) A conceptual model for nursing. Canadian Nurse, 71(9), 40-41.
