Nursing Theories & Nursing Practice

530 SECTION VI • Middle-Range Theories When providers strive to understand the
recipient’s experience (e.g., knowing), the re-
when they received the nurse caring interven- cipient has the feeling of not only being under-
tion. Men’s depression was not affected by stood but, possibly, also understanding their
receipt of three counseling sessions (there was own experiences more fully. When the provider
no significant difference from the control group) is able to be with the recipient through times
and appeared to be slowed by receipt of the com- of sorrow, frustration, suffering, and joy, the
bined caring or self-caring interventions (their recipient feels valued by the provider and
resolution of depression took longer than the perceives that they and their experiences matter
control group). Additional research needs to be to the provider. When the provider seeks to
done to identify who is most likely to experience do for the recipient what he or she would do
depression during the first year after miscarriage independently if they had the knowledge, time,
so that the right intervention may be offered. energy, capacity, or skills to do so, the recipient
feels safe and comforted. When the provider
The Connection Between Caring enables the other’s capacity to manage a situa-
and Healing tion by providing information, validation, and
support, the recipient feels capable to get
It is hard to believe that the caring model was through the challenge before them. Lastly,
first proposed almost 30 years ago. There and at the very core of caring, when the
are now scientists, practitioners, and educa- provider maintains belief in the other’s capacity
tors around the world who are applying the to come through an event or transition and
caring theory in their work. Reflecting back face a future with meaning, the recipient feels
on the work we did to understand how hopeful (as opposed to hopeless). This hope does
couples evaluated our caring interventions, not mean that sickness, sorrow, fear, or loss will
considering the lessons learned through not unfold as it must; rather, it is hope that
consulting with nurses and other providers the recipient will be able to get through the
seeking to change the culture of care, and in- situation and find meaning and purpose in
tegrating the writings and findings of others whatever comes next. In summary, when a
who have explored the caring processes and provider takes the time to know, be with, do for,
their impact, I now propose that there are enable, and maintain belief in the other, the
some logical links between the caring recipient feels a sense of wholeness - that is
processes and healing outcomes. Using the they feel understood, valued, safe and comforted,
language of provider to mean the one who is capable, and hopeful for the future. I believe
practicing caring and recipient to mean the caring and healing is possible whenever a
one who is receiving caring, I offer the provider acts with the recipient’s best interests
following model (Fig. 31-1) and thoughts
about the connections between the caring
processes and experiences of healing.

Knowing Being with

Maintaing belief Understood

Valued Fig 31 • 1 Swanson theory of
caring and healing. (Copyright ©
Hopeful
Kristen N. Swanson, 2013.)
Capable
Safe and
comforted

Doing for Enabling

CHAPTER 31 • Kristen Swanson’s Theory of Caring 531

in mind. Caring can be enacted at the bedside, determined by whether it leads to the recipient
in the community, in the boardroom, or in the feeling seen and intact (or enhanced) versus
legislature. The measure of caring’s worth is diminished and dismissed.

References

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Barnard, K. E., Magyary, D., Sumner, G., Booth, C. L., Swanson, K. M., Chen, H. T., Graham, J. C.,
Mitchell, S. K., & Spieker, S. (1988). Prevention of Wojnar, D. M., & Petras, A. (2009). Resolution
parenting alterations for women with low social of depression and grief during the first year after
support. Psychiatry, 51, 248-253. miscarriage: A randomized controlled clinical trial of
couples-focused interventions. Journal Women’s Health
Institute of Medicine of the National Academies. and Gender-based Medicine, 18(8), 1245-1257.
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27184.aspx Swanson-Kauffman, K. M. (1986a). A combined quali-
tative methodology for nursing research. Advances in
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Swanson, K. M. (1991). Empirical development of a Swanson-Kauffman, K. M. (1988). The caring needs
middle-range theory of caring. Nursing Research, of women who miscarry. In M. M. Leininger
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Swanson, K. M. (1993). Nursing as informed caring for University Press.
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Swanson-Kauffman, K. M. (1983). The unborn one: The
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Scholarship, 31, 4, 339-345.



Index

Note: Page numbers followed by f refer to figures; page numbers followed by t refer to tables; page numbers followed by
b refer to boxes.

A culture. See Theory of Culture Care Diversity and
Universality
Adaptation
Johnson Behavioral System Model, 91–92 Duffy’s model of. See Quality Caring Model
Roy model of. See Roy Adaptation Model in Hall’s model of nursing, 59f, 60
in Human-to-Human Relationship Model, 76–77
Adaptive potential, in Modeling and Role-Modeling Leininger’s theory of. See Theory of Culture Care
theory, 191–192, 192f
Diversity and Universality
Administration Locsin’s theory of. See Technological Competency as
Johnson Behavioral System Model application to,
99–100 Caring
Neuman Systems Model application to, 176 in Nightingale’s work, 49
Smith’s theory of. See Theory of Unitary Caring
Aesthetic knowing, 29, 214–215 Swanson’s theory of. See Theory of Caring
Affiliation, 190–191 Watson’s theory of. See Theory of Human Caring
Aging Caring Professional Scale, 527–528
Caring Science as Sacred Science (Watson), 322
in Theory of Accelerating Evolution, 240–241 Caritas nursing, 322, 323–324
in Theory of Goal Attainment, 142 Change, 12–13
American Holistic Nurses Association, 210 transition triggers, 364f, 365–366, 372–373
Anger, in morbid grief, 194 Choice points, in Theory of Health as Expanding
Anti-coagulants, 45
Arousal, stress-related, 192, 192f Consciousness, 288–290, 289f, 290f
Assessing and Measuring Caring in Nursing and Health Christian feminist, 47
Client, 5
Sciences (Watson), 322 Client-nurse encounter, 5. See also Dynamic Nurse-
Attending Caring Team, 334–337
Attending Nurse Caring Model, 332–334 Patient Relationship Theory; Nurse-
Awareness patient/client relationship; Nurse-Patient
Relationship Theory
in nursing theory selection, 28 Clinical Nursing: A Helping Art (Wiedenbach), 61–62
in Quality Caring Model, 398 Collaborative care, 312–313
in Theory of Health as Expanding Consciousness, 283 Collected Works of Florence Nightingale, 37, 49
Comfort Theory, 382–390
B application of, 385–389
best policy in, 385, 388–389
Barrett, Elizabeth Ann Manhart, 497–498. See also Theory best practices in, 385, 388
of Power as Knowing Participation in Change care plans in, 385
coaching in, 385
Barry, Charlotte D., 435–436. See also Community Comfort Contract in, 392
Nursing Practice Model comfort definition in, 384
comfort interventions in, 384
Basic Principles of Nursing Care (Henderson), 62 concepts of, 383–384, 384f
Bearing witness, 223 contexts in, 382
Behavioral System Model. See Johnson Behavioral ease in, 382
electronic data base in, 388–389
System Model health care needs in, 384–385
Beliefs, 6, 24. See also Values health-seeking behaviors in, 384–385
Bentov, Itzhak, 281, 282, 284 institutional advocacy in, 386–387
Boykin, Anne, 341–342. See also Nursing as Caring institutional awards in, 387
institutional integrity in, 385
Theory intention in, 386
Bureaucracy, 466–468. See also Theory of Bureaucratic intervening variables in, 384
nursing practice in, 386, 388
Caring practice exemplar of, 389–390
relief in, 382
C
533
Care, Cure, and Core Model, 59–61, 59f
practice application of, 63

Care/caring, 5
Boykin and Schoenhofer’s theory of. See Nursing as
Caring Theory
bureaucratic. See Theory of Bureaucratic Caring

534 Index D

taxonomic structure of, 382–383, 383f Death
technical interventions in, 385 grieving response to, 192–194, 194t
transcendence in, 382 in Theory of Integral Nursing, 222
value-added outcomes in, 386
wow moments in, 386 Debriefing, 369
Comfort Theory and Practice (Kolcaba), 381 Developmental processes
Communication
integral, 224 in Modeling and Role-Modeling theory, 194–195,
nonverbal, 198 195t
nursing discipline, 6
Community in Theory of Integral Nursing, 211, 217–218, 220f
Community Nursing Practice Model, 437–438, Disease, origin of, 45
Dissipative structures, theory of, 288, 289f
439 Diversity of Human Field Pattern Scale, 251
Humanbecoming Paradigm, 271–273 Domain, 4–5
Self-Care Deficit Theory, 117 Dossey, Barbara, 207–208. See also Theory of Integral
Theory of Health as Expanding Consciousness,
Nursing
294–295 Dream Experience Scale, 251
Community Nursing Practice Model, 436–446 Drives, 189–190, 190t
Duffy, Joanne, 393–394. See also Quality Caring Model
application of, 441–442, 442t–445t Dying
community in, 437–438, 439
core services in, 439, 440 conscious, 222
development of, 436 in Theory of Integral Nursing, 222
in education, 441–442 Dynamic Nurse-Patient Relationship: Function, Process and
environment in, 438
evaluation and, 440 Principles, The (Orlando), 82
first circle services in, 439, 440 Dynamic Nurse-Patient Relationship Theory, 82
foundations of, 436
nursing in, 437 practice applications of, 82–84
person in, 437, 439
policy development and, 439–440 E
practice exemplar of, 445
second circle services in, 439–440 Education, 6
services in, 438–440, 439f Community Nursing Practice Model, 441–442
third circle services in, 440 of Florence Nightingale, 38–39
Compassion, 223 Humanbecoming Paradigm and, 273
Complexity theory, 468–469 Johnson Behavioral System Model and, 99
Concept development, 135–136 Neuman Systems Model and, 175–176
Conceptual models, 13 on nurse-patient relationship, 69
analysis of, 31 Nursing as Caring Theory and, 350
evaluation of, 31 theory-guided nursing practice and, 33
Conceptual structures, of nursing discipline, 5–6 Theory of Bureaucratic Caring and, 477
Conscious dying, 222 Theory of Culture Care Diversity and Universality
Consciousness. See Theory of Health as Expanding and, 313
Theory of Goal Attainment and, 140
Consciousness Theory of Human Caring and, 335
Contagionism, 45 Theory of Integral Nursing and, 225
Couple’s Miscarriage Project, 529–530 Transitions Theory and, 371
Creating a Caring Science Curriculum: Emancipatory
Emancipation, of women, 47
Pedagogies (Hills and Watson), 322 Emancipatory knowing, 29–30
Crimean War, 40–44, 41f, 43f Empathy, in Human-to-Human Relationship Model,
Critical points, 368
Cultural feminism, 47 78
Culture. See also Theory of Culture Care Diversity and Energyspirit, 244
Environment, 5
Universality
nursing theory and, 15–16 Community Nursing Practice Model, 438
organization, 466–468 Johnson Behavioral System Model, 93, 95–96
in Theory of Goal Attainment, 141 Modeling and Role-Modeling Theory, 189–191
in Theory of Health as Expanding Consciousness, Neuman Systems Model, 171–172, 171f
Nightingale model, 45–46
291 Quality Caring Model, 439
Curiosity, 20 Roy Adaptation Model, 158
Theory of Integral Nursing, 213–214, 213f, 220f, 224
Epigenesis, in Modeling and Role-Modeling theory,

195

Equanimity, 223 Index 535
Equilibrium, 192, 192f
Erickson, Helen, 185–186. See also Modeling and Neuman Systems Model, 172
Roy Adaptation Model, 158–159
Role-Modeling Theory Theory of Goal Attainment, 143
Ethical knowing, 29 Theory of Integral Nursing, 213, 213f, 220f, 224
Ethnonursing, 304. See also Theory of Culture Care Health Goal Attainment instrument, 139
Health patterning, 500–501
Diversity and Universality modalities, 501–503
Evidence-based practice, 144 Henderson, Virginia, 56
basic nursing care components of, 58–59, 63–64
F nursing definition of, 58–59, 62–63
Hierarchy, 92
Family Health Theory, 139 Holistic person, in Modeling and Role-Modeling
Feminism
theory, 190–191, 197
cultural, 47 Home, family, 46–48
in Nightingale’s caring, 46–48 Homeorrhesis, 91
in Transitions Theory, 363 Homo pandimensionalis, 244
Fermentation, 45 Honesty, 20
Florence Nightingale Today: Healing, Leadership, Global Hope, 77
Humanbecoming Paradigm, 264–274
Action (ANA), 37
Four-quadrants perspective, 215–220, 215f, 216f, 220f art of, 269–273
change in, 268
collective exterior (“Its”), 216f, 217, 219, 220f, 224 community settings of, 271–273
collective interior (“We”), 216f, 217, 219, 220f, eighty/twenty (80/20) model of, 272
language in, 268
222–224 in nursing education, 285
individual exterior (“It”), 216f, 217, 219, 220f, 224 nursing in, 264–265
individual interior (“I”), 216, 216f, 219, 220f, 222 nursing practice in, 270, 271–273
Functional performance mechanisms, 485–486, 486f parish nursing in, 272–273
philosophical assumptions of, 266–267
G postulates of, 267–268
principles of, 267–268
General System Theory, 134 reality construction in, 268
Generating Middle Range Theory: Evidence for Practice relating in, 268
research in, 268–269
(Roy), 154 resources on, 273
Geotranscendance change, 486f, 489–491 true presence in, 269–270
Goal attainment. See Theory of Goal Attainment Human Becoming School of Thought, The (Parse), 266
Goal Attainment Scale, 137 Human Field Image Metaphor Scale, 252
Grand theories, 13 Human Field Motion Test, 251
Human-to-Human Relationship Model, 76–79
analysis of, 31 practice applications of, 79
evaluation of, 31 Humanuniverse, 266
interactive-integrative. See Johnson Behavioral System Hygiene, Nightingale on, 47
Hypnotherapeutic techniques, 198
Model; Modeling and Role-Modeling Theory;
Neuman Systems Model; Roy Adaptation I
Model; Self-Care Deficit Theory; Theory of Goal
Attainment; Theory of Integral Nursing Imagination, 4
unitary-transformative. See Paradigm Science of Impoverishment, stress-related, 192, 192f
Unitary Human Beings; Theory of Health as Individuation, 190–191
Expanding Instincts, 189–190, 190t
Grieving response, 192–194, 193f, 194t Integral Nursing. See Theory of Integral Nursing
Growth needs, 192 Intention

H Comfort Theory, 386
Nursing as Caring Theory, 343
Hall, Lydia, 56–57. See also Care, Cure, and Core Model Technological Competency as Caring, 455–456
Healing Theory of Integral Nursing, 211, 224
Theory of Unitary Caring, 511, 515
Quality Caring Model, 399 Intentional dialogue, in Story Theory, 424
Science of Unitary Human Beings, 243 Intentionality, in Science of Unitary Human Beings, 244
Theory of Caring, 530–531, 530f
Theory of Human Caring, 328
Theory of Integral Nursing, 212, 212f, 213f, 221
Health, 5
Johnson Behavioral System Model, 96–97
Modeling and Role-Modeling theory, 191

536 Index K

Interactive-integrative paradigm, 12 King, Imogene M., 133–134. See also Theory of Goal
Interdisciplinary practice, 20 Attainment
International Caritas Consortium, 330
International Research on Caritas as Healing (Nelson and Knowing, 29
aesthetic, 29, 214–215, 214f
Watson), 322 emancipatory, 29
Interpersonal Relations in Nursing (Peplau), 67 empirical, 214, 214f
Interpretation, in Human-to-Human Relationship ethical, 29, 214f, 215
paranormal, 241–242
Model, 78 personal, 29, 214, 214f
Intervention in Psychiatric Nursing (Travelbee), 78 sociopolitical, 214f, 215
Interventions Technological Competency as Caring, 450–457,
454f
Comfort Theory, 385–386 Theory of Integral Nursing, 214–215, 214f, 220,
Johnson Behavioral System Model, 97–98 220f
Modeling and Role-Modeling theory, 186, 187t
Neuman Systems Model, 173–174 Knowledge, structure of, 11–14
Theory of Health as Expanding Consciousness, Kolcaba, Katherine, 381–382. See also Comfort Theory
Kuhn, Thomas , 12
292
Transitions Theory, 364f, 367–369, 377 L
Intrapsychic factors, 486
Intuition, 190, 224 Language, 6
grammatical persons of, 215–216
J
Legitimate nursing, 108, 114
Johnson, Dorothy, 89–90. See also Johnson Behavioral Leininger, Madeleine, 303–304. See also Theory of
System Model
Culture Care Diversity and Universality
Johnson Behavioral System Model, 90–98 Liehr, Patricia, 423. See also Story Theory
achievement subsystem in, 93t Life orientation, need satisfaction and, 194
action in, 95 Listening, deep, 223
in administration, 99–100 Literature, 6. See also Research
affiliative subsystem in, 93t
aggressive/protective subsystem in, 93t meta-analysis of, 528–529
applications of, 98–102 Living a Caring-based Program (Boykin), 341
behavioral set in, 95 Locsin, Rozzano C., 449–450. See also Technological
choice in, 95
concepts of, 92–98 Competency as Caring
conceptual set in, 95 Loeb Center for Nursing and Rehabilitation, 63
core principles of, 90–92
dependency subsystem in, 93t M
diagnostic classifications in, 97
dialectical contradiction principle of, 92 Man-Living-Health: A Theory of Nursing (Parse), 266
in education, 99 Marriage, 46
eliminative subsystem in, 93t Meaning, 222–224
environment in, 95–96
functional requirements in, 95 grasping of, 248
goal in, 95 in Nursing as Caring Theory, 344–346
health in, 96–97 philosophical, 222
hierarchic interaction principle of, 92 psychological, 222
imbalance and instability in, 96 in Quality Caring Model, 401
ingestive subsystem in, 94t spiritual, 222
nursing interventions in, 97–98 in Theory of Health as Expanding Consciousness,
nursing process in, 97–98
person in, 92, 94 286–288
practice exemplar of, 100–102 Medical model, 25
reorganization principle of, 91–92 Meeting the Realities in Clinical Teaching (Wiedenbach),
research on, 98–99, 99b
restorative system in, 94t 57
set point in, 91 Meleis, Afaf I., 50, 361–362. See also Transitions
sexual system in, 94t
stabilization principle of, 91 Theory
subsystems in, 94–95, 108t–109t Metaparadigm, 5
wholeness and order principle of, 90–91
in Theory of Integral Nursing, 213–214, 213f
Justice-making, 38 Middle-range theories, 13, 31–32, 138. See also Comfort

Theory; Community Nursing Practice Model;
Quality Caring Model; Story Theory;
Technological Competency as Caring; Theory of
Bureaucratic Caring; Theory of Caring; Theory of

Power as Knowing Participation in Change; Index 537
Theory of Self-Transcendence; Theory of
Successful Aging; Theory of Unitary Caring; concepts of, 167
Transitions Theory created environment in, 172
analysis of, 31 in education, 175–176
development of, 138 environment in, 171–172, 171f
evaluation of, 31–32 flexible line of defense in, 168f, 169, 169f, 171f
Mindfulness, 222 health in, 172
Miscarriage Caring Project, 526–528 lines of resistance in, 168f, 169–170, 169f, 171f
Modeling and Role-Modeling Theory, 186–204 normal line of defense in, 168f, 169, 169f, 171f
adaptive potential in, 191–192, 192f nursing process in, 172–174, 173f
data collection in, 187, 188t practice applications of, 174–175, 178–179
data interpretation in, 197–198 practice exemplar of, 179–181
data processing in, 197–198 prevention intervention in, 173–174
developmental processes in, 194–195, 195t spirituality in, 170–171
drives in, 189–190, 190t website for, 179
environment in, 189–191 Newman, Margaret, 279–281. See also Theory of Health
epigenesis in, 195
health in, 191 as Expanding Consciousness
human needs in, 192–194, 193f NICU study, 524–525
hypnotherapeutic techniques in, 198 Nightingale, Florence, 37–53, 38f, 44f
instincts in, 189–190, 190t
intervention aims and goals in, 186, 187t assumptions of, 50
modeling process in, 187, 188t biographies of, 37
nursing in, 191 Crimean War nursing of, 40–44, 41f, 43f
person in, 189–191, 190t, 197 early life of, 38–39
philosophical assumptions in, 188–191 education of, 38–39, 44–45
practice applications of, 198–201, 199t–201t feminist context of, 46–48
practice exemplars of, 202–204 medical milieu of, 44–46
proactive nursing care in, 198 nurse definition for, 51
role-modeling process in, 187–188 nursing definition for, 4, 51, 52f
sequential development in, 195 nursing ideas of, 48–52
social justice in, 191 nursing’s goal for, 50–51
theoretical constructs in, 191–196, 192f, 193f patient for, 51
theoretical linkages in, 195–196 spirituality of, 39–40, 43
theoretical propositions in, 187–188, 188t Theory of Integral Nursing and, 209
trusting-functional relationship in, 190, 196–197, travel by, 39
196t 21st century legacy of, 52–53
Morbid grief, 194 Non-nursing functions, 62
Notes on Nursing: What It Is and What It Is Not
N
(Nightingale), 4, 38, 46, 49
Narrative. See Story Theory Not knowing, 214f, 215
Narrative means to sober ends (Diamond), 423 Nurse-patient/client relationship. See also Nurse-Patient
Narrative Medicine: The Use of History and Story in the
Relationship Theory
Healing Process (Mehl-Madrona), 423 Nursing as Caring Theory, 344
Nature of Nursing, The (Henderson), 62 Orlando’s theory of, 82–84
Needs Quality Caring Model, 397–399, 397f
Theory of Goal Attainment, 140
Comfort Theory, 384–385 Theory of Health as Expanding Consciousness,
growth, 192
life orientation and, 194 290–292
Modeling and Role-Modeling theory, 192–194, 193f Theory of Human Caring, 326–327
Quality Caring Model, 399–400 Travelbee’s theory of, 76–79
Neuman, Betty, 165–166. See also Neuman Systems Nurse-Patient Relationship Theory, 67–74
communication skills in, 70
Model components of, 69
Neuman Systems Model, 166–181, 168f listening skills in, 69–70
orientation phase of, 70–71
in administration, 176 phases of, 70–71
archive for, 179 practice exemplar on, 73–74
client-client system in, 168f, 169–171, 169f research on, 71–72
client variables in, 169f, 170–171 resolution phase of, 71
self-awareness in, 69
supervisory education for, 69
working phase of, 71

538 Index middle-range theories in, 13, 31–32, 138
paradigms of, 11–13
Nurse Performance Goal Attainment, 139 practice-level theories in, 13–14
Nurse presence relationship in, 5
structure of knowledge in, 11–14
Humanbecoming Paradigm, 269–270 symbols of, 6
Nursing as Caring Theory, 344 syntactical structures of, 6
Theory of Health as Expanding Consciousness, tradition of, 6
values and beliefs of, 6
285–286 Nursing education. See Education
Theory of Integral Nursing, 222 Nursing Knowledge Development and Clinical Practice
Nursing, 5. See also Nursing discipline; Nursing theory
(Roy), 154
and specific nursing theories Nursing practice. See also Practice applications; Practice
caring in, 5
in Community Nursing Practice Model, 437 exemplar
genderization of, 47–48 Humanbecoming School of Thought, 270, 271–273
Hall’s conceptualization of, 59–61, 59f Johnson Behavioral System Model, 99–100
Henderson’s definition of, 58–59, 62–63 Nursing as Caring Theory, 347–349
in Humanbecoming Paradigm, 264–265 Science of Unitary Human Beings, 244–249
legitimate, 108, 114 scope of, 20
in Modeling and Role-Modeling theory, 191 theory-guided, 7–9, 14, 23–25, 32–33
Nightingale’s definition of, 4, 51
Peplau’s definition of, 69 administrative support for, 32
relationship in, 5 education for, 33
in Self-Care Deficit Theory, 115–116 feedback for, 33
task-based, 3–4 practice evaluation for, 33
Wiedenbach’s conceptualization of, 57–58 practice implementation for, 32
Nursing: Concepts of Practice (Orem), 107 theory selection for, 32
Nursing: Human Science and Human Care (Watson), 321 Theory of Bureaucratic Caring, 464–468, 473–475
Nursing: The Philosophy and Science of Caring, Revised Theory of Integral Nursing, 221–224
Theory of Power as Knowing Participation in Change,
New Edition (Watson), 322
Nursing agency, 108, 116–117 500–503
Nursing and Anthropology (Leininger), 304 Transitions Theory, 370–371
Nursing as Caring: A Model for Transforming Practice Nursing process
Johnson Behavioral System Model, 97–98
(Boykin and Schoenhofer), 341, 343 Neuman Systems Model, 172–174, 173f
Nursing as Caring Theory, 342–355 Roy Adaptation Model, 160
Self-Care Deficit Theory, 114–116, 116f
in administration, 349–350 Technological Competency as Caring, 453–454
applications of, 347–351 Theory of Goal Attainment, 139–140
assumptions of, 343–347 Nursing science, evolution of, 9–11
call for nursing in, 344, 346 Nursing theory, 3–16. See also specific theories and models
caring in, 343 communication of, 6
in education, 350 complexity and, 472–474
historical perspective on, 342–343 conceptual structure and, 6
intention in, 343 contextual development of, 21
lived meaning in, 344–346 culture and, 15–16
nurse-client relationship in, 344 definitions of, 6–7
nursing focus in, 343 domain of, 4–5
nursing practice in, 347–349 education and, 6
nursing response in, 344 evaluation of, 19–22, 25–27, 30–32
nursing situation in, 343–344
person in, 344, 346 criteria for, 30
practice exemplar of, 351–355 frameworks for, 31–32
research in, 351 guidelines for, 31
Nursing discipline, 4–6. See also Nursing theory and questions for, 21–22, 25–27, 31–32
functional components of, 31
specific nursing theories future development of, 14–16
communication networks of, 6 grand. See Grand Theories
conceptual models in, 13 imagination and, 4
conceptual structures of, 6 implementation of, 32–33
domain of, 4–5 language and symbols of, 6
education of, 6 middle-range. See Middle-Range theories
grand theories in, 13. See also Grand Theories
imagination in, 4
language of, 6
literature of, 6

nursing conceptualization in, 21 Index 539
practice and, 7–9, 14, 23–24. See also Nursing practice;
Power as Knowing Participation in Change Tool, 251,
Practice applications; Practice exemplar 495, 498–499. See also Theory of Power as
practice-level, 13–14 Knowing Participation in Change
purpose of, 7–9
questions for, 21–22 Power-imaginary process, 503
research and, 8. See also Research Power Prescriptions, 503
selection of, 23–33 Practice, 5. See also Nursing practice; Practice

evaluation and, 30–32 applications; Practice exemplar
implementation and, 32–33 Practice applications. See also Practice exemplar;
practice and, 24–25
questions about, 25–27 Research
reflective exercise for, 28–30 Care, Cure, and Core Model, 63
significance of, 22, 24–25 Comfort Theory, 385–389
sources for, 21–22 Community Nursing Practice Model, 441–442
structural components of, 31 Dynamic Nurse-Patient Relationship Theory, 82–84
study guide for, 19–22 Henderson’s conceptualization of nursing, 62–63
syntactical structure and, 6 Human-to-Human Relationship Model, 79
tradition and, 6 Modeling and Role-Modeling Theory, 198–201,
values and beliefs and, 6
199t–201t
O Neuman Systems Model, 174–175, 178–179
Nurse-Patient Relationship Model, 71–73
Object attachment, 192–194, 193f Prescriptive Theory, 61–62, 61f
Observation, in Human-to-Human Relationship Roy Adaptation Model, 160
Science of Unitary Human Beings, 242–255
Model, 78 Self-Care Deficit Theory, 118–125, 119t–122t
Occupations, for women, 47, 48 Technological Competency as Caring, 458
Ordered to Care: The Dilemma of American Nursing Theory of Bureaucratic Caring, 472–475
Theory of Caring, 526–528
(Reverby), 46 Theory of Culture Care Diversity and Universality,
Orem, Dorothea E., 105–106. See also Self-Care Deficit
313–315
Theory Theory of Goal Attainment, 138–144
Organization-disorganization paradigm, 12 Theory of Health as Expanding Consciousness,
Orlando, Ida Jean, 82. See also Dynamic Nurse-Patient
292–295
Relationship Theory Theory of Human Caring, 329–332
Theory of Integral Nursing, 225
P Theory of Power as Knowing Participation in Change,

Paradigm, 11–13 499–503
Paranormal phenomena, 241–242 Theory of Self-transcendence, 414–415
Parker, Marilyn E., 437. See also Community Nursing Theory of Successful Aging, 491
Theory of Unitary Caring, 515–516
Practice Model Transitions Theory, 369–371
Parse, Rosemarie Rizzo, 263–264. See also Wiedenbach’s conception of nursing, 61–62, 61f
Practice exemplar
Humanbecoming Paradigm Care, Cure, and Core Model, 64–65
Particulate-deterministic paradigm, 12 Comfort Theory, 389–390
Peplau, Hildegard, 67–69. See also Nurse-Patient Community Nursing Practice Model, 445
Dynamic Nurse-Patient Relationship Theory, 84–85
Relationship Theory Henderson’s conceptualization of nursing, 63–64
Person, 5 Human-to-Human Relationship Model Theory,

Community Nursing Practice Model, 437, 439 80–81
Humanbecoming Paradigm, 270–271 Johnson Behavioral System Model, 100–102
Johnson Behavioral System Model, 92, 94 Modeling and Role-Modeling theory, 202–204
Modeling and Role-Modeling theory, 189–191, 190t, Neuman Systems Model, 179–181
Nurse-Patient Relationship Theory, 73–74
197 Nursing as Caring Theory, 351–355
Nursing as Caring Theory, 344, 346 Quality Caring Model, 403–407
Self-Care Deficit Theory, 108 Roy Adaptation Model, 160–163
Technological Competency as Caring, 450–451, Science of Unitary Human Beings, 270–271
Self-Care Deficit Theory, 126–129
454f Story Theory, 427–431, 430t
Theory of Integral Nursing, 213, 213f, 220f, Technological Competency as Caring, 459
Theory of Bureaucratic Caring, 475–477
222–224
Personal control, 487–488
Personal knowing, 29
Postmodern Nursing and Beyond (Watson), 321–322

540 Index Quality Caring Model, 397–399, 397f
Theory of Human Caring, 326–327
Theory of Culture Care Diversity and Universality, Theory of Integral Nursing, 220–221
315–316 Religion, 223. See also Spirituality
Research. See also Practice applications
Theory of Goal Attainment, 145–147 Humanbecoming Paradigm, 268–269
Theory of Health as Expanding Consciousness, Johnson Behavioral System Model, 98–99, 99b
Neuman Systems Model, 176–178, 178–179
295–297 nurse-patient relationship, 71–72
Theory of Human Caring, 332–337 Nursing as Caring Theory, 351
Theory of Integral Nursing, 226–230 Science of Unitary Human Beings, 242–255, 249–255
Theory of Power as Knowing Participation in Change, Syrian Muslim ethnonursing, 314–315
Technological Competency as Caring, 458f
504–507 theory-based, 8
Theory of Self-transcendence, 416–417 Theory of Culture Care Diversity and Universality,
Theory of Successful Aging, 491–492
Theory of Unitary Caring, 516–518 310–313, 311f, 314
Transitions Theory, 371–378 Theory of Goal Attainment, 141–143
Unitary Pattern-Based Praxis method, 255–258 Theory of Health as Expanding Consciousness,
Wiedenbach’s conceptualization of nursing, 63
Prescriptive theory, 57–58, 61–62 291–295
practice applications of, 61–62, 61f Theory of Integral Nursing, 225
Prevention in Neuman Systems Model, 173–174, 173f Theory of Power as Knowing Participation in Change,
Prigogine, Ilya, 288, 289f
499–500
Q Theory of Self-transcendence, 414–415
traditions of, 14
Qualitative Research Methods in Nursing (Leininger), 304 Transitions Theory, 369–370
Quality Caring Model, 394–407 Rhythmical Correlates of Change, 242
Rogers, Martha E., 237–238, 281–282, 283. See also
affiliation needs in, 399–400
applications of, 400–403 Science of Unitary Human Beings
assumptions of, 396–397 Role modeling. See Modeling and Role-Modeling Theory
attentive reassurance in, 399 Roy, Sister Callista, 153–154. See also Roy Adaptation
caring factors in, 399–400
caring relationships in, 397–399, 397f Model
collaborative relationships in, 398, 400 Roy Adaptation Model, 154–163
concepts of, 396
development of, 394–3957, 395f assumptions of, 155, 156t
encouraging manner in, 399 cognator-regulator processes in, 156
feeling cared for emotion in, 397, 400 concepts of, 155–159
healing environment in, 399 environment in, 158
human needs in, 400 health in, 158–159
institutional use of, 407 historical development of, 154–155
meaning in, 399 interdependence mode in, 157, 158
mutual problem-solving in, 399 modes in, 157–158
nurse’s role in, 397 nursing process in, 160
practice exemplar of, 403–407 people in, 155–158
propositions of, 396 physiologic-physical mode in, 157
relationship-centered professional encounters in, 396 practice applications of, 160
self-caring in, 396 practice exemplar of, 160–163
Quarantine, 45 role function mode in, 157, 158
Queen Victoria, 48 self-concept-group identity mode in, 157–158
stabilizer-innovator processes in, 156
R Theory of Successful Aging and, 484–485
Roy Adaptation Model, The (Roy), 154
Rapport, in Human-to-Human Relationship Model, 78 Roy Adaptation Model-based Research: Twenty-five Years
Ray, Marilyn Anne, 461–462. See also Theory of
of Contributions to Nursing Science, 154
Bureaucratic Caring
Reaction paradigm, 12 S
Reciprocal interaction paradigm, 12
Reed, Pamela, 411–412. See also Theory of Self- Schoenhofer, Savina, 342. See also Nursing as Caring
Theory
transcendence
Relationship, 5. See also Nurse-Patient Relationship Theory Science, evolution of nursing as a, 9–11
Science of Unitary Human Beings, 238–258
Hall’s model of nursing, 60–61
Modeling and Role-Modeling Theory, 189–191, applications of, 242–255
Barrett’s practice method and, 245
196–197, 196t

Butcher’s practice method and, 245–249 Index 541
Cowling’s practice constituents and, 245
energy fields in, 238–239 Self-care knowledge, 190
healing in, 243 Self-care resources, 190
helicy in, 240 Self-Care Theory in Nursing: Selected Papers of Dorothea
homeodynamics in, 239–240
integrality in, 240 Orem, 106
intentionality in, 244 Simultaneity paradigm, 12
nursing practice and, 243b Simultaneous action paradigm, 12
openness in, 239 Skills, 25
pandimensionality in, 239 Smith, Marlaine C., 511–512. See also Theory of Unitary
pattern in, 239
postulates of, 238–239 Caring
practice exemplar of, 270–271 Smith, Mary Jane, 421. See also Story Theory
practice methods and, 244–249 Social justice, in Modeling and Role-Modeling theory,
research applications of, 249–255
resonancy in, 240 191
spirituality in, 244 Spinsterhood, 46, 48
theories from, 240–242 Spirituality
Theory of Accelerating Evolution from, 240–241
Theory of Emergence of Paranormal Phenomena Florence Nightingale, 39–40, 43
Modeling and Role-Modeling theory, 191
from, 241–242 Neuman Systems Model, 170–171
Theory of Rhythmical Correlates of Change from, 242 Reed’s studies of, 413. See also Theory of Self-
therapeutic touch in, 243, 244
Unitary Pattern-Based Praxis method and, 245–249 transcendence
website for, 243b Science of Unitary Human Beings, 244
worldview of, 238 Theory of Integral Nursing, 223
Self-care, 190 Theory of Successful Aging, 486f, 488–489
integral, 222 Standardized nursing languages, 139–140
for nurse, 221 Story. See also Story Theory
Self-Care Deficit Theory, 107–130 in Modeling and Role-Modeling theory, 196t, 197
agent in, 109 Story path, 425–426, 425f
basic conditioning factors in, 109–110, 109f Story Theory, 421–431
caregiver in, 109 assumptions of, 423
community groups in, 117 concepts of, 423, 423f
concepts of, 109 ease in, 426
deliberate action in, 111 emergence of, 422–423
dependent-care theory in, 107–108 foundations of, 423–424, 423f
developmental self-care requisites in, 113 intentional dialogue in, 424
estimative capabilities in, 111–112 practice exemplar of, 427–431, 430t
family in, 117 self-in-relation in, 424–426, 425f
foundational capabilities and dispositions in, 111 story path in, 425–426, 425f
health deviation self-care requisites in, 113 Stress response, in Modeling and Role-Modeling
multiperson situations and units in, 117
nursing agency in, 108, 116–117 theory, 191–192, 192f
nursing system definition in, 114–116, 116f Study guide, 19–22
nursing systems theory in, 108–109 Suffering, 77
power components in, 111
practice applications of, 118–125, 119t–122t in Theory of Integral Nursing, 222–224
practice exemplar of, 126–129 Suggestions for Thought (Nightingale), 43
productive operation capabilities in, 111–112 Sunrise enabler, in Theory of Culture Care Diversity and
self-care agency in, 111, 111f
self-care deficit theory in, 107 Universality, 310–312, 311f
self-care definition in, 110–111 Swain, Mary Ann, 186. See also Modeling and Role-
self-care requisites in, 112–113
self-management in, 125 Modeling Theory
structure of, 109f Swanson, Kristen M., 521–522. See also Theory of
therapeutic self-care demand in, 112
transitional capabilities in, 111–112 Caring
universal self-care requisites in, 112–113 Sympathy, in Human-to-Human Relationship Model,

78
Syntactical structures, of nursing discipline, 5–6
Syrian Muslims, ethnonursing study of, 314–315

T

Technological Competency as Caring, 450–459
applications of, 458
calls for nursing in, 457–458
change in, 458
continuous knowing in, 455–456
definition of, 450

542 Index goal of, 309
health in, 310
future research in, 458f in nurse education, 313
intention in, 455–456 orientational definitions in, 309–310
knowing persons in, 450–457, 454f practice applications of, 313–315
nursing process in, 453–454 practice exemplar of, 315–316
nursing response in, 457–458 professional care in, 307, 309
practice exemplar of, 459 purpose of, 308
purpose of, 450 rationale for, 306
situation of care in, 452–457 research in, 310–313, 311f, 314
technological knowing in, 457, 457f sunrise enabler in, 310–312, 311f
trust in, 452, 453 Syrian Muslim ethnonursing research in, 314–315
wholeness ideal in, 453 theoretical assumptions of, 308–310
Temporal Experience Scale, 252 theoretical tenets of, 306–308
Textbook of the Principles and Practice of Nursing worldview in, 307, 310
Theory of Dependent Care, 107–108
(Henderson), 58, 62 Theory of Dissipative Structures, 288, 289f
Theoretical Nursing: Development and Progress (Meleis), Theory of Emergence of Paranormal Phenomena,

362 241–242
Theory. See Nursing theory and specific nursing theories Theory of Goal Attainment, 133–147
Theory for Nursing: Systems, Concepts, Process, A (King),
conceptual framework of, 135–136, 135f
133 documentation system in, 137
Theory of Accelerating Evolution, 240–241 Goal Attainment Scale in, 137
Theory of Bureaucratic Caring, 462–477 multicultural applications of, 141
nursing process in, 139–140
application of, 472–475 philosophical foundation of, 134
caring in, 468 practice applications of, 138–144
description of, 469–470
development of, 468–472 client perspective and, 143
generation of, 462–463, 463f in client systems, 140, 142–143
holographic emergence in, 463–464, 463f with clients across life span, 142
as holographic theory, 470–472 evidence-based, 144
leadership models in, 467–468 in multicultural settings, 141
in nursing education, 475 in multidisciplinary settings, 140–141
nursing practice in, 464–468, 473–475 recommendations for, 144
organizational cultures in, 466–468 in work settings, 143–144
organizational transformation in, 470–472 practice exemplar of, 145–147
practice exemplar of, 475–477 research applications of, 141–143
Theory of Caring, 521–531, 530f standardized nursing languages in, 139–140
at-risk mothers study and, 525–526 transaction process model in, 136–137, 136f
caring knowledge in, 528–529 Theory of Group Power within Organizations, 139
Caring Professional Scale in, 527–528 Theory of Health as Expanding Consciousness
Couple’s Miscarriage Project study and, 529–530 applications of, 284–291
evolution of, 524 assumptions underlying, 282
healing, connection to, 530–531, 530f community-level application of, 294–295
literature meta-analysis in, 528–529 consciousness stages in, 290f
Miscarriage Caring Project study and, 526–528 cross-culture relevance of, 291
NICU study and, 524–525 development of, 282–284
practice applications of, 526–528 disruption-related choice points in, 288–290, 289f,
refinements of, 524–526
Theory of Culture Care Diversity and Universality, 290f
expanding consciousness in, 284–285
304–317 focusing process in, 291–292
care modalities in, 307–308 insights in, 288–290, 289f
collaborative care in, 312–313 levels of awareness in, 283
cultural care diversities in, 306–307 meaning in, 286–288
cultural commonalities in, 306–307 nurse-client interaction in, 290–292
culture care accommodation/negotiation in, 307–308, nurse-family interaction in, 291–292
nursing practice and, 292–295
310 pattern in, 286–288, 292
culture care preservation/maintenance in, 307–308, 310 philosophical influences on, 281–282
culture care restructuring/repatterning in, 308
development of, 304–305
domain of inquiry in, 311–312
generic care in, 307, 309, 312

practice exemplar of, 295–297 Index 543
presence in, 285–286
research as praxis, 291–295 structure of, 220, 220f
resonance in, 285–286 transpersonal dimension in, 223
Toward a Theory of Health presentation and, 282 Theory of Integral Nursing (Dossey), 225
unitary-transformative paradigm in, 283–284 Theory of Nursing Systems, 108–109. See also Self-Care
Theory of Human Caring, 322–337
Attending Nurse Caring Model and, 332–334 Deficit Theory
carative factors in, 323–324 Theory of Power as Knowing Participation in Change,
caring (healing) consciousness in, 328
Caring Moment in, 326 495–507, 497f
caring occasion in, 328 applications of, 499–503
Caring Science orientation in, 323 concepts of, 496–499
clinical caritas processes in, 324–325 control, power as, 498
conceptual elements of, 323 freedom, power as, 498, 504–507
in customer service, 335–336 practice exemplar of, 504–507
development of, 322–323 practice methodology for, 500–503
in education, 335 research on, 499–500
in hospitals, 331 underlying basis of, 496
implications of, 328–329 Theory of Rhythmical Correlates of Change, 242
International Caritas Consortium and, 330 Theory of Self-Care, 107. See also Self-Care Deficit
practice applications of, 329–332
practice exemplar of, 332–337 Theory
reading of, 325–326 Theory of Self-transcendence, 412–418
transpersonal caring relationship in, 326–327
Watson Caring Science Institute and, 329–330 applications of, 414–415
Theory of Integral Nursing, 208–230 concepts of, 413–414, 414f
application of, 225 personal factors in, 416–417
AQAL (all quadrants, all levels) in, 217–220, 220f practice exemplar of, 416–417
communication in, 224 research in, 414–415
content components of, 212–220 self-transcendence in, 413, 414f, 417
context in, 220–221 vulnerability in, 413, 414f
development in, 211, 217–218, 220f well-being in, 413–414, 414f
development of, 210 Theory of Successful Aging, 483–492, 486f
in education, 225 applications of, 491
environment in, 213–214, 213f, 220f, 224 creativity in, 486
four-quadrants perspective in, 215–220, 215f, 216f, development of, 483–485
functional performance mechanisms in, 485–486, 486f
220f, 222–224 geotranscendance and, 486f, 489–491
in global health, 226 intrapsychic factors in, 486, 486f
healing in, 212, 212f, 213f, 221 model for, 486f
health in, 213, 213f, 220f, 224 negative affect and, 487
integral dialogues in, 208–209 personal control and, 487–488
integral process in, 208 positive affect and, 487
integral worldview in, 208 practice exemplar of, 491–492
intentions of, 211, 224 Roy Adaptation Model and, 484–485
meaning in, 222–224 spirituality in, 486f, 488–489
metaparadigm in, 213–214, 213f Theory of Unitary Caring, 510–518
nurse in, 213, 213f, 220–221, 220f, 222 applications of, 515–516
nursing practice and, 221–224 appreciating pattern in, 511–512, 514–515
patterns of knowing in, 214–215, 214f, 220, 220f assumptions of, 511
person in, 213, 213f, 220f, 222–224 caring concept in, 510
philosophical assumptions of, 211–212 concepts of, 511–513
philosophical foundation of, 208, 209 creative emergence in, 515
in policy guidance, 225–226 development of, 510–511
practice exemplar in, 226–230 dynamic flow attunement in, 512, 515
questions in, 208 empirical indicators in, 513–515
relationship-based care in, 220–221 Infinity in, 512–513, 515
relationship-centered case in, 220 manifesting intentions in, 511, 514
research on, 225 practice exemplar of, 516–518
propositions of, 513
Therapeutic touch, 244
Tomlin, Evelyn, 186
Totality paradigm, 12
Touch, therapeutic, 244

544 Index Trusting-functional relationship, 190–191
mind-set establishment for, 196, 196t
Towards a Theory for Nursing: General Concepts of Human nurturing space creation for, 196–197, 196t
Behavior (King), 133 story facilitation for, 196t, 197

Tradition, 6 Turkel, Marian C., 464
Transaction process model, 136–137, 136f
Transcultural nursing, 306. See also Theory of Culture U

Care Diversity and Universality Unitary field pattern portrait research method, 253–255,
Transcultural Nursing: Concepts, Theories, and Practices 254f

(Leininger), 304 Unitary Pattern-Based Praxis method, 245–249
Transitional objects, 193 pattern manifestation knowing and appreciation in,
Transitions Theory, 362–378 245–248
practice exemplar of, 255–258
applications of, 369–371 voluntary mutual patterning in, 248–249
assumptions of, 363
change triggers, 364f, 365–366, 372–373 Unitary-transformative paradigm, 12
concepts of, 363–367, 365t
in education, 371 V
feminist postcolonialism and, 363
intervention within, 364f, 367–369, 377 Values, 6, 24
lived experience and, 362–363 Johnson Behavioral System Model, 97
in nursing practice, 370–371
origins of, 362–363 Veritivity, 155
practice exemplar of, 371–378 Visions of Rogers’ Science-Based Nursing (Barrett),
properties of transition, 364f, 365, 373–376
propositions of, 363–367 495–496
research involving, 369–370
responses, patterns of, 364f, 366–367, 368t, W

376–377 Watson, Jean, 321–322. See also Theory of Human
role theory in, 362 Caring
situation-specific theories, development of, 371
triggers of transition, 363–366, 364f Ways of knowing, 29
Transparency, in Theory of Integral Nursing, 222 Wholeness
Transpersonal Caring Theory. See Theory of Human
Johnson Behavioral System Model, 90–91
Caring Theory of Health as Expanding Consciousness,
Travelbee, Joyce, 76. See also Human-to-Human
285–286
Relationship Model Wiedenbach, Ernestine, 55–56
Troutman-Jordan, Meredith, 485. See also Theory of
nursing conceptualizations of, 57–58
Successful Aging prescriptive theory of, 57–58, 61–62, 63
True presence, in Humanbecoming Paradigm, 269–270 Wilber, Ken, 211
Women Founders of the Social Sciences, The (McDonald), 49