Human senses- Identification of six senses in the human

Six human senses

I would like to share my immense happiness on the publication of research "Identification of sixth sense" and getting attention in other countries too. 

Aristotle (390 BCE-350 BCE), the Greek philosopher has viewed that human has five senses-vision, smell, hearing, taste, and touch. In our current research project (2014-2018), we were able to draw that human has six senses. 

(How to cite this article: Jobin, P., Siva, R., Sudha, R., & Hema, V.H. (2018). Intersensory Perception Model: Integrating the sixth sense in providing Nursing care. Manipal Journal of Nursing and Health Sciences, 4(1), 8-17.)

The paper defines the sense or sensing is an ability of a human being for identifying and interpreting the stimulus from the external environment through five sensory organs includes eye, nose, ear, tongue, and skin with six senses such as vision, smell, hearing, taste, touch, and auto-thermoception. 

The sensing is categorized into three:

On sight sensing

It is an ability of a human being to see and interpret the surrounding environment in the visible light through the sensory organ called eyes and the response of the nervous system is known as ophthalmoception.

Abut sensing

The word 'abut' is the Anglo-Latin origin, which means 'touch'. It is an ability of the human being to identify and interpret the surrounding environment by making physical contact through sensory organs such as skin and tongue. The response of the nervous system through tongue is called as gustaoception (taste- for example, ability to interpret taste with the contact between tongue and food) and through the skin with the contact of items is called as thermoception (temperature- for instance, ability to differentiate the high and low temperature with the contact between skin and thermal conductor), nociception (pain - for instance, ability to respond to pain with the contact between skin and needle) and mechanoreception (vibration- for example, ability to identify the vibration with the contact between skin and vibrating material).

Remote sensing

Remote sensing is an ability of the human being to acquire and interpret the surrounding environment without making physical contact and out of sight through sensory organs such as ear, nose, and skin. The response of the nervous system through ear is known as audioception (hearing- for instance, the ability of the human ears to acquire the sound waves from the surrounding) and through nose is olfacception (smell- for instance, ability of the human nose to acquire the smell of the particles from the surrounding). The body is covered with skin, which is normally sensitive to heat and cold. The ability of the skin to identify the level of room temperature in the surrounding environment without touching called auto-thermoception.

The figure explains the three modalities of sensing and highlights five sensory organs and six senses.

Read full article

Inter-sensory perception model: Integrating the sixth sense in providing nursing care

Inter-sensory perception model: Integrating the sixth sense in providing nursing care

Published in: Manipal Journal of Nursing and Health Sciences, 4(1), 8-17.
Abstract

Introduction: In 21st century, nursing profession is enriched with many theories. However, there exists a wide gap between knowledge and implementation of nursing care. 

Aim: The paper explains causes of this gap and addresses a solution using a conceptual model titled “Intersensory perception in nursing care ‘under empirical concept’ open your  sixth sense in addition to five traditional senses.” 

Methods: A qualitative case study design was used for testing the conceptual model. 

Results: The paper classifies the different modalities of sensing, adds one more nontraditional sense (auto thermoception) to five traditional senses and depicts how general sensory perception can be upgraded to inter-sensory perception among nurses through nursing education process, which is pictured as nursing foundry lab model. It also explains that how nurses can identify homeostatic imbalance among human beings using intersensory perception and help the patient to retain homeostasis. Further, a comparative analysis is done with Florence Nightingale’s environmental theory and criterion based critique model is used to evaluate the role of inter-sensory perception in nursing care. 

Conclusion: Hopefully, these concepts pave the way to implement an effective nursing care using inter-sensory perception and reduce unintentional torts by overcoming ‘numbness’ of senses.

Key words: Conceptual model, inter-sensory perception, nursing theory, sensing, sixth sense

Read full article

Best Scientific Paper Award 2016

Best Scientific Paper Award

I have presented a scientific paper on "Longitudinal investigation of lived experience among disaster victims of South Indian floods 2015: To develop a Concatenated Disaster Crisis (CDC) model using phenomenographical framework analysis" in an International Conference on disaster risk reduction and role of nurse, conducted by College of Nursing, Christian Medical College, Vellore, Tamilnadu, India on 17.11.2016 & 18.11.2016. I have received "Best Paper Award" for my presentation. Thank you very much for your help and support.

What may be the sixth sense, which can be applicable in nursing?

Dear colleagues,

I am Mrs.Ponnambily Jobin, working as Asst.Lecturer in College of Nursing. This is to bring to your kind information that I have published a conceptual model (under mid range theory) in 2015, addressing 'child sex abuse' as a problem domain. (Please see PCSA Model &List of nursing theories). Now, I am working on a grand theory focusing on 'Inter-sensory Perception in Nursing Care'. I have attempted to develop a classification of senses based on a specific criteria, which highlights sixth sense, in addition to five traditional senses such as vision, hearing, smell, touch and taste. I would like to gather suggestions from you to accept or to refute the theory. I humbly request you to have a response on 'what may be the sixth sense, which can be applicable in nursing?'. 

Disclaimer:  

• If you are interested, please forward it and discuss among your co-workers. If not, kindly ignore the post.
• This blog does not represent any institutions and any organizations that the owner may be or may not be associated professionally and personally.The aim of this blog is informational purpose only.

Nursing research and theory

Nursing research and theory
Theory
A theory is a broad and abstract characterization of phenomena. The theories are two types; classical and descriptive theories. Classical theory refers to an abstract generalization that presents a systematic explanation about how phenomena are interrelated. The theory explains about the phenomena and their interrelationship.
Descriptive theory describes a single phenomenon which means that describing a specific characteristic of individual or events by summarizing commonalities found in discrete observation.
Theories allow the researcher to order the observations together. It guides the researcher’s understanding not only of the ‘what’ of natural phenomena but also of the ‘why’ of their occurrence. Theories are abstractions that are created or invented by humans through observations and experiments. It shows the theorist’s ingenuity in pulling those facts together, drawing conclusion and making sense of them. It represents a theorist’s efforts to describe and explain phenomena. Based on level of generality, the theories are two types; grand (macro theories) and middle range theories. Grand theories are intended to explain large segments of the human experience (foe example, stress adaptation among human being). Middle range theories are purported to explain a portion of the human experience (for example; stress adaptation among post operative patients).
Conceptual model
Conceptual models are loosely structured and concepts are assembled based on their relevance to common theme. It presents an understanding of the phenomenon of interest and reflects the assumptions and philosophical views of the model’s designer. The conceptual models are two types: Statistical models and Schematic models. Statistical models are mathematic equations that express the nature and magnitude of relationships among a set of variables. A schematic model represents a phenomenon of interest and expresses the relationships in a diagram. Concepts are represented in boxes and relationship is represented by using directional and non directional arrows and/or symbols.
Conceptual Framework
A framework is the conceptual base of all the studies. If a study based on a theory, the framework is referred to as theoretical framework and a study based on a conceptual model, a framework called as conceptual framework. The conceptual framework helps the researcher to understand how concepts are defined and operationalised. 

Developing and testing of theory
Research plays a vital role in theory developing and testing.  Theory guides the research and researcher to assess the theory, thus, it provides a foundation for new ones.
Developing theory using qualitative research
Through qualitative research, researcher identifies patterns, communalities and its relationship among events. During the data analysis, the researcher moves from specific pieces of data to abstractions that synthesize and give structure to the observed phenomena. The main purpose is to derive a data which is grounded in reality, to provide explanation of events as they occur in reality and it should not be conceptualized in preexisting theories. 

Testing theory using quantitative research
The researchers deduce concepts in the form of hypothesis and do test through quantitative research. Then, hypotheses are predictions about how the variables would be related, if theories were correct. The researchers cannot test the theory directly, as it’s a combination of testable and non testable concepts into the form of hypothesis and test it through quantitative research. The comparison between the observed outcomes of research and the relationship predicted by the hypothesis are the major focus of the testing process. 

Rosemarie Parse Human Becoming School Thought 1998 (USA)

Rosemarie Parse Human Becoming School Thought 1998 (USA) 

Rosemarie Parse earned her B.S. degree in nursing from Duquesne University and Master’s degree in nursing and PhD from the University of Pittsburgh, Pennsylvania. Rosemarie Parse initiated and currently chairs the nursing theory, guided to practice expert panel of the American Academy of Nursing. Recent works include Community: A Human Becoming Perspective (2003), Qualitative Inquiry: The Path of Sciencing (2001), Man-living-health: A theory of nursing (1981) and The Human Becoming School Thought; A Perspective of Nurses and other Health Care Providers (1998). 

In 1981, Rosemarie Parse presented a unique theory of nursing titled ‘Man-Living-Health’, which stated the man as Homosapiens. Her purpose was to post an idea of nursing rooted in human science as an alternative to ideas of nursing grounded in the natural sciences. Based on the purpose, she posted assumptions such as
1. Man is coexisting while co constituting rhythmical patterns with the environment.
2. Man is an open being, freely choosing meaning in situation, bearing responsibility for decisions.
3. Man is a living unity continuously co constituting patterns of relating.
4. Man is transcending multi dimensionally with the possibilities.
5. Health is an open process of becoming, experienced by man.
6. Health is rhythmically co constituting process of the man-environment relationship.
7. Health is as inter subjective process of transcending with the possibilities.
8. Health is unitary man’s negentropic unfolding.

In 1998, Rosemarie Parse revised the assumptions about the human becoming school of thought are

• The human is co existing while co constituting rhythmical patterns with the universe
• The human is open, freely choosing meaning in situation, bearing responsibility for decisions
• The human is unitary, continuously co constituting pattern of relating
• The human is transcending multi dimensionally with the possibles
• Becoming is Unitary Human-Living-Health
• Becoming is a rhythmically co constituting process of the human universe process
• Becoming is the human’s pattern of relating value priorities
• Becoming is an inter subjective process of transcending with the possibles
• Becoming is unitary human’s emergency

The original nine assumptions are further synthesized into three assumptions such as
1. Human becoming is freely choosing personal meaning in situations in inter subjective process of relating value priorities.
2. Human becoming is co creating rhythmical patterns of relating in open interchange with the universe
3. Human becoming is co transcending multi dimensionally with the unfolding possibilities

Principles
The main three themes can be identified in Parse’s (1998) assumptions: meaning, rhythmicity and transcendence. Meaning refers to the linguistic and imagined content of something and the interpretation that one gives to something. Rhythmicity refers to the paced and paradoxical patterning of the human universe mutual process. Transcendence is described as reaching beyond with possible, the hopes and dreams as seen in multidimensional experience. Each of Parse’s theme leads to principles of human becoming.
Principle 1: Structuring meaning multi dimensionally is co creating reality through the languaging of valuing and imaging. It inter relates the concept of imaging, valuing and languaging. Co creating refers to human universe participation in the creating of pattern. Languaging reflects the image and values through speaking and movement, valuing is the process of living cherished beliefs and imaging is to know the explicit and tacit knowledge.
Principle 2: Co creating rhythmical patterns of relating is living the paradoxical unity of revealing-concealing and enabling-limiting while connecting-separating. She stated that these rhythmical patterns are not opposites; they are two aspects of the same rhythm and exist simultaneously, one in foreground and other in the background.
Principle 3: Co transcending with possible is the powering and originating of transforming. Powering is an energizing force, the rhythm of which is the pushing-resisting of inter human encounters. Originating is inventing new ways of conforming- not conforming in the certainty-uncertainty of living. Transforming is defined as the changing of change and is recognized by increasing university.  

Human becoming and the four major concepts
Human universe
She stated human being as ‘lives at multidimensional realms of the universe all at once, freely choosing ways of becoming as meaning is given to situations.
Health
She described unitary human’s health as a synthesis of values, way of living. It is not the opposite of disease or a state that a human has but rather a continuously changing process that the human co creates in mutual process through the human universe experience and is incarnated as patterns of relating value priorities. 

Nursing
She defined nursing as a basic science, the practice of which is a performing art like drama, dance, in each, the artist creates something unique. The knowledge base of the discipline is the science of art and performance is the art creatively lived.
Environment
She define contextual situations of nursing practice as being nurse-person or nurse-group or nurse-community. She does not define specific practice setting related to environment. She is a successful nursing theorist to create a new paradigm of nursing. The human becoming school thought has gained recognition internationally.

Madeleine Leininger Transcultural nursing theory 1995 (USA)

Madeleine Leininger Transcultural nursing theory 1995 (USA)

 
Madeleine Leininger was born in 1925, received her basic nursing education from St. Anthony’s School of Nursing, Colorado, Master of Science in mental health nursing from the Catholic University of America and PhD in Social Anthropology from the University of Washington. She is the founder of transcultural nursing society and the journal of transcultural nursing. She has conducted many projects published extensively about transcultural nursing and human care theory worldwide.

Madeleine Leininger first used the terms such as transcultural nursing, ethno nursing and cross cultural nursing. In 2006, Madeleine Leininger defined trans cultural nursing (rather than cross cultural) as “a discipline of study and practice focuses on comparative culture care differences and similarities among and between cultures in order to assist human beings to attain and maintain meaningful and therapeutic health care practices that are culturally based”. The ethno nursing is a rigorous, systematic and in-depth method for studying multiple cultures and care factors with in familiar environment of people and to focus on the interrelationship of care and culture to arrive at the goal of culturally congruent care services. 

In 1985, Madeleine Leininger published her work on a theory. She defined ‘culture’ is the learned, shared and transmitted value, beliefs, norms and life ways of a particular group that guides thinking, decisions and actions in patterned ways. A subculture is a group with in the culture that differs from main culture. Culture care is the synthesized and culturally constituted assistive, supportive, facilitative caring acts towards self and others focused on evident or anticipated needs for the client’s health or well being or to face disabilities, death or other human condition. She viewed the care into two types: emic (general) and etic (professional) care. Emic care is a folk care, culturally learned and transmitted based on folk knowledge and skills. Etic care is professional care, formally learned through institutions include nursing. 

Cultural and socio structural factors include religion, kinship, politics, legal issues, education, economics, technology, philosophy of life and cultural beliefs. Culturally congruent care is defined as culturally based care knowledge, acts and decisions used in sensitive and knowledgeable ways to appropriately and meaningfully fit the cultural values, beliefs, life ways of clients for their health and well being or to prevent illness, disabilities or death. Cultural care diversity indicates the difference among human beings with respect to cultural care meanings, patterns, values, life ways and symbols related to providing beneficial care to clients of a designated culture. Cultural care universality indicates commonly shared cultural care phenomena features of human beings or a group with recurrent meaning, pattern, life ways that serve as a guide for care givers to provide assistive, supportive, facilitative or enabling people care for healthy outcome. 

She defined nursing as a learned, humanistic and scientific profession and discipline focused on human care phenomena and caring activities in order to assist, support and facilitate or enable individuals or groups to maintain their health or well being is culturally meaningful and beneficial ways or to help individual face handicaps or death.
Professional nursing care is defined as the formal and cognitively learned professional care knowledge and practice skills, obtained through educational institutions that are expected to provide assistive, supportive, enabling or facilitative acts to or for another individual or groups in order to improve human health well being. 

Madeleine Leininger (2002) discusses the concepts related to cultural care.

• Culture specific care- very specific to client’s needs
• Generalized culture care- commonly shared professional nursing care techniques that are beneficial to all
• Culture care conflict- signs of distress that fail to meet a client’s cultural expectations
• Culture care clashes- situation that arises problem
• Culture exports- sending of ideas to another culture
• Cultural imports- receiving of ideas from another culture
• Cultural space- the variation of cultures in the use of interpersonal distance to others
• Culture time- the dominant orientation of an individual to different parts, present and future periods that guides one’s thinking actions
• Culture care therapy- qualified transcultural nurses who offer assistive, supportive and facilitative healing reflections and practices to individuals who have experienced cultural pain, offenses and other concerns.

Madeleine Leininger’s short culturalogical assessment guide

• Phase 1- Record observation of what you see, hear or experience with clients.
• Phase 2- Listen to and learn from the client about cultural values.
• Phase 3- Identify and document recurrent client patterns and narrative stories with client meaning of what has been seen, heard and experienced.
• Phase 4- Synthesize themes and patterns of care derived from the phase 1, 2 and 3.
• Phase 5- Develop a culturally based client nurse care plan for decisions and actions for culturally congruent care.

To conclude, the theory of cultural care diversity and universality is of significance in a society that is becoming more and more aware of the cultural diversity with in the boundaries. It provides guidelines for the gathering of knowledge and a framework for making decisions about what care is needed or would he of the greatest benefit to the client.

Patricia Sawyer Benner’s from Novice to Expert Theory 1984 (USA)

Patricia Sawyer Benner’s from Novice to Expert Theory 1984 (USA)

 
Patricia Benner was born in Virginia, received her bachelor’s degree in nursing from Pasadena College, master’s degree in medical surgical nursing and PhD from University of California in 1970 and 1982 respectively. She has nursing practice experience as staff nurse and in management, in medical surgical, emergency care unit, coronary care unit, intensive care and home care nursing. Benner is currently director of the National Nursing Education study for the Carnegie foundation for the advancement of teaching. In addition, she is a professor in the department of social and behavioral sciences at university of California.
The Dreyfus model of skill acquisition serves as the theoretical basis of Benner’s work in identifying the professional development of nurses. This model identifies ‘five stages of qualitatively different perceptions of their task as skill improves. These stages have been labeled as novice, advanced beginner, competent, proficient and expert. Benner states that the five levels reflect changes occurring in three aspects of skilled performance. They are;

• A movement from reliance on rules and abstract principles to the use of concrete past experiences as the basis of decision making
• Increasing ability to see the situation as a whole or the big picture
• Increasing involvement within the situation

Novice

• A complete beginner with no experience in the specialty area
• Practices using theoretical knowledge acquire through formal learning
• Relies on use of context free rules for drawing conclusions based on objective features of the situation

Advanced beginner

• The newly graduated nurse who has transferred to another specialty
• Begins to notice situational elements and structure in the clinical setting
• Begins constructing more and more complex rules developed from actual practice to help guide actions
• Begins to recognize changes in clinical state but lacks the experience to identify how to manage those changes

Competent

• The nurse who has about one to two years of experience on a specific unit and improves in clinical understanding, routines, technical skills, organized ability and ability to anticipate the likely course of events.
• Exemplifies standard of care
• Establish new rules and facilitates the choice of plan

Proficient
It is a transition stage that leads to expertise and experience results in development of synaptic pathways in the brain that alter the rules and principles based responses to a more situationally associated response set of behaviors referred to as intuition. The actions of a proficient nurse demonstrate a smooth based approach and are situationally appropriate. The communication and negotiation skill of proficient nurse increases in order to meet the situational needs of the patient and family.
Expert
They are vigilant monitors. Expert nurses situate themselves with in an observational distance of the patient in order to stay attained to the changing needs and condition of the patient. She attunes to changes and awareness of salient aspects of the situation is accomplished without conscious deliberation. She uses the ‘deliberative rationality’ to reflect on goals and actions to achieve those goals rather than former rules. They can take high positions based on their experience and are confident.
Domains of nursing practice and related competencies;

• The helping role

The healing relationship;
Creates a climate and establishes a commitment to healing
Provides comfort measures
Being with the patient
Provide and communicates through therapeutic touch
Guides the patient through physical and psychological change

• The teaching and coaching role

Timing captures a patient’s readiness to learn to;
Elicit and understand the patient’s interpretation of illness
Provides an interpretation of the patient’s condition and giving a rationale for procedure

• The diagnostic and patient monitoring function

Detection and documentation of significant changes in patient’s condition
Providing an early warning signal through diagnostic signs
Anticipates patient care needs
Assess the patient’s potential for wellness and for responding to various treatment strategies

• Effective management of rapidly changing situations

Skilled performance in extreme life threatening situation
Rapid matching of demands and resources in emerging situations
Identify and mange the patient crisis until physician is available

• Administering and monitoring therapeutic interventions

Starts and maintains intravenous therapy
Administer medications accurately and safely

• Monitoring and ensuring the quality of health care practices

Provide a back up system to ensure safe medical and nursing care
Supervise the patient care

• Organizational and work role competencies

Coordinates, orders and meets multiple patient needs
Sets priorities
Builds and maintains a therapeutic team
Copes with staff shortage and high turn over

Benner’s work can be understood in a simple form such as skill levels of novice to expert or can be applied in more expanded forms in terms of understanding critical thinking and caring practices. Her work has been influential in nursing to practice, especially in caring.

Modeling and Role modeling Theory 1983 (USA)

Modeling and Role modeling Theory 1983 (USA)
The modeling and role modeling theory was developed by three nursing expertise, Helen Lorraine Erickson, Evelyn. M. Tomlin and Mary Ann Swain. The initial publication of the theory was done in 1983 with the text; Modeling and Role modeling- A theory and Paradigm for Nursing. This book presents the theory in a very formal and readable style. The basis of theory is to focus on the person receiving nursing care, not on the nurse, care and the disease. Modeling and Role modeling is an interpersonal and interactive holistic theory of nursing that requires the nurse to assess (model), plan (role model) and intervene (five aims of intervention) on the basis of the client’s perspective of the world. The nurse always acknowledges the uniqueness and individuality of the client and appreciates that individuals, at some level, know what makes them ill and what makes them well (self care knowledge). The nurse assess the individual’s ability to mobilize resources needed to contend with stressors (adaptive potential) and assists individuals to recognize and obtain resources (internal and external) that are important for their health and healing (self care resources) and facilitates the use of these resources (self care action). The nurse acknowledges the individual’s need to be dependent and independent on support system (affiliated individuation). Concepts relating to the nurse who practices with a theory base of modeling and role modeling include facilitation, nurturance and unconditional acceptance.
Modeling
It is the process used by the nurse to develop an understanding of the client’s world as the client perceives it, the way an individual thinks, communicates, feels, believes and behaves. Role modeling is the facilitation of health. It involves the individualization of care based on the client’s model of the world and is the facilitation of the individual in attending, maintaining and promoting health through purposeful intervention.
Five aims of intervention
It is based on the five principles;

1. Build trust: The nursing process requires a trusting and functional relationship exists between nurse and client.
2. Promote client’s positive orientation: Affiliated individuation is dependent on the individual’s perceiving that he or she is an acceptable, respectable and worthwhile human being.
3. Promote client’s control: Human development is dependent on the individual’s perceiving that he or she has some control over his or her life, while concurrently sensing a state of affiliation.
4. Affirms and promotes client’s strengths: There is an innate drive towards holistic health that is facilitated by consistent and systematic nurturance
5. Self mutual goals that are health directed: Human growth is dependent on satisfaction of basic needs and facilitated by growth and satisfaction.

Self care
There are three aspects of self care in the modeling and role modeling theory

1. Self care knowledge
2. Self care resources
3. Self care action

Self care knowledge
This is an individual’s perception of factors associated with his or her personal health problems and individual perceptions of what is needed to help him. Nursing role is to assist the clients to resolve their problems by meeting their needs.
Self care resources
All individuals have internal and external resources that will help gain, maintain and promote an optimum level of holistic health. Primary internal self care resources for each individual result from the person having successfully negotiated developmental challenges such as autonomy, hope, control, purpose and wisdom. The external self care resources are being explored include perceptions, social support and the type of resources used when ill and well.
Self care action
It is the development and use of self care knowledge and self care resources. The basis of nursing is assisting clients in self care actions related to health. Self care is modeling and role modeling is used in planning and implementing rather than for determining the need for nursing care implementation. 

Additional concepts of Modeling and Role modeling Theory

• Affiliated Individuation

It is considered as motivation for human behavior. It occurs when a person perceives himself or herself as simultaneously close to separate from significant others.

• Adaptive potential

The adaptive potential assessment model (APAM) has three categories: equilibrium, arousal and impoverishment. Equilibrium has two possibilities: adaptive equilibrium and maladaptive equilibrium. Arousal and impoverishment has stress states. The model can assist the nurse in planning interventions for the client.
Nursing Metaparadigm
Person is a holistic being with interactive subsystems (biophysical, psychological, social and cognitive) and it implies that whole is greater than the sum of the parts. The environment in which people live in internal and external and includes both stressors and resources for adapting stressors. The model states health as a state of dynamic equilibrium among the various subsystems. They defined nursing is the holistic helping of persons with their self care activities in relation to their health. This is an interactive, interpersonal process that nurtures strengths to enable development, release and channeling of resources for coping with one’s circumstances and environment. The goal is to achieve a state of perceiving optimum health and contentment.
This theory suggests an interactive and interpersonal role for nursing. This has been applied to work with clients who are individuals, families and communities to empower them to direct care, based on self care knowledge, self care resources and self care actions, as the client’s perceived needs are addressed.

Nola.J.Pender Health Promotion Model 1982

Nola.J.Pender Health Promotion Model 1982
Nola.J.Pender was born in 1941 in Michigan. She earned diploma in nursing, B.S. in nursing, M.A. in human growth and development and PhD in Psychology and Education. She also did graduate level work in community health nursing at RUSH University, Chicago. The focus of her research was on health promotion. She did a research on ‘how people make decisions’ and based on this, initial version of Health Promotion Model (HPM) was published in 1982. She stated HPM as proposed a framework for integrating nursing and behavioral science perspectives as factors influencing health behaviors. The framework offered a guide for exploration of the complex biopsychosocial processes that motivate individuals to engage in behaviors directed towards the enhancement of health. The initial model had seven cognitive perceptual factors (importance of health, perceived control of health, definition of health, perceived health status, perceived self efficacy, perceived benefits and perceived barriers) and five modifying factors (demographic characteristics, biologic characteristics, interpersonal influences, situational influences and behavioral factors).
She identified the theoretical basis of the Health Promotion Model as drawing upon Social Cognitive Theory (Bandura, 1977). This theory emphasizes on self direction and self regulations are the abilities to direct and control one’s thinking and actions, perceptions of self efficacy involve one’s view of the personal ability to perform an identified set of actions. 

According to Pender et. al. (2006), Bandura identifies the following basic human capabilities;

• Symbolization - The ability to process and transform experience to create internal models to guide actions in the future.
• Forethought – The ability to anticipate possible consequences of potential actions and plan courses of action to achieve goals.
• Vicarious learning - The ability to obtain rules for selecting actions through observation of others without using trial and error.
• Self regulation- The ability to use internal standards and self evaluation to inspire and adjust behavior to external environment.
• Self reflection – The ability to consider one’s own thought process and change them.

Assumptions of Revised Health Promotion Model

• Persons seek to create conditions of living through which they can express their unique human health potential
• Persons have the capacity for reflective self awareness, including assessment o their own competencies
• Person’s value growth in directions viewed as positive and attempts to achieve a personally acceptable balance between change and stability
• Individuals seek to actively regulate their own behavior
• Individuals in all their bio-psychosocial complexity interact with the environment, progressively transforming the environment and being transformed overtime
• Health professionals constitute a part of the interpersonal environment, which influence on persons throughout their life span
• Self initiated reconfiguration of person environment interactive pattern is essential to behavior change

Health Promotion Model (Revised Variables) 

Individual characteristics and experiences

The Individual characteristics and experiences divided into prior related behavior and personal factors. Prior related behaviors are important, as it is best for predicting the future behavior. The direct effect of prior behavior is possibly that of habit formation, since each time a behavior is performed, the habit is strengthened. The personal factors are described as biological (age, BMI and strength), psychological (self esteem and self motivation) and socio cultural (race, education and socio economic status) factors.  

Behavior specific cognition and affect

This includes perceived benefits of action, perceived barriers to action, perceived self efficacy, activity related affect, interpersonal influences and situational influences, all of which leads to a commitment to a plan of action and consideration of immediately competing demands and preferences. 

Perceived plan of action may be intrinsic benefits (feeling better) and extrinsic benefits (time to socialize while practicing the target behavior). Perceived barriers to action mean the barriers which influence action directly by blocking that action or indirectly by decreasing any commitment to act. The perceived ability to achieve a behavior is perceived self efficacy of; Can I do it?, What will happen if I do it?.

Activity related effect- There are three components to this affect; the act related emotional arousal, the self related self acting and the context related environment in which behavior occurs. Interpersonal influences are the person’s thoughts or beliefs about the behavior, attitudes and beliefs of others and may or may not accurately reflect those behavior, attitudes and beliefs. Situational influences include the options that are perceived as being available, demand characteristics and environmental features. For example, ‘no smoking’ sign is intended to discourage smoking. Commitment to plan of action initiates the behavior, to carry out a specific plan of action at a given time and place. Immediate competing demands and preferences are alternative behaviors that intrude into consciousness as possible courses of action immediately prior to the intended occurrences of a planned health promoting behavior. 

The variables of Health Promtion Model have strengths and limitations. It is strength for use in practice because looking at all of the variables provides a more complete picture of the client. The limitation of the model is lacking of the spiritual factors.

Jean Watson Theory of Everything-The Ten Primary Carative Factors 1979 (USA)

Jean Watson Theory of Everything-The Ten Primary Carative Factors 1979 (USA)
Jean Watson was born in 1940, earned a baccalaureate degree in nursing, a master’s degree in psychiatric nursing and Ph.D. from the University of Colorado. Dr. Watson was named as distinguished professor, widely published author and recipient of numerous awards including six honorary doctoral degrees. Theoretical construction from Dr. Watson theory is used as a guide to many nursing academic programs.
The purpose of Watson’s theory is caring, promotion of health, preserving dignity, respecting the wholeness and interconnectedness of humanity. The theory pictures the nursing as a healing art and science with sacred relationships. It is the need of hour for nurses to identify the healing traditions for caring relationships at the societal and planetary level. There are fundamental differences in ways of being (ontology), knowing (epistemology) and doing (praxis) within the traditional versus human science paradigm. The purpose of traditional science is identification and prediction. Human science is concerned with the meaning of the lived experience. Professional nursing within a traditional science and biomedical model is focused on ‘doing’ by controlling and manipulating physical and behavioral parameters through specific actions and environments that maintain physiological and behavioral homeostasis.
Contents of the theory
Current dimensions of the theory are;

1. Expanded views of self and person; embodied spirit
2. Having caring healing consciousness
3. Forgiveness and surrender as highest level of consciousness
4. Unitary consciousness
5. Advanced caring and healing modalities
6. Nurse as sacred healing environment
7. Trans personal caring relationships
8. The specifications of trans personal caring relationships depends upon
9. Moral commitment and consciousness needed to protect human dignity
10. Ability of a nurse to identify other’s inner condition
11. Feel a union with the others
12. Ability to realize another’s condition of being in the world
13. Nurse’s own life history and previous experience
14. The caring and healing modalities potentiate harmony, wholeness, comfort and promote inner healing by releasing disharmony.
15. Caring occasion or caring moment occurs whenever nurse and others come together with their unique life histories in a human to human transaction and has the potential for collectively expanding the field of interconnectedness consciousness of the universe in a way that expands the universal field of harmony and wholeness.

Ten carative factors
It was identified by Watson in 1979 at the age of 39 years, as characterizing a caring relationship based upon the nurse’s conscious, moral commitment to each person in such a way that facilitates healing. The carative factors are;

1. Forming a humanistic altruistic system of values
2. Enabling and sustaining faith and hope
3. Being sensitive to self and others
4. Developing a helping-trusting and caring relationships
5. Promoting and accepting the expression of positive and negative feeling
6. Engaging in problem solving caring process
7. Promoting trans personal teaching and learning
8. Attending to supportive, protective, physical, mental, societal and spiritual environments
9. Assisting with gratification of basic human needs while preserving human dignity and wholeness
10. Allowing for and being open to existential phenomenological and spiritual dimensions of caring and healing that can not be fully explained successfully.

Jean Watson has played a major role in reorienting nursing from a bio-medical, mechanistic model to one of caring as a trans personal interactive process. Dr. Watson believes that the caring occasion or caring moment opens up a higher energy field with potential for healing beyond body and self, with potential movement toward greater harmony, wholeness, health and spiritual evolution.

Sister Callista Roy’s Adaptation Model 1979 (USA)

Sister Callista Roy’s Adaptation Model 1979 (USA)
Sister Callista Roy was born on 1939, earned her B.S. in nursing from Los Angeles, M.S. in nursing and her doctorate in Sociology in 1977 from the University of California. She is the author, co author, professor and nurse theorist and known world wide for Roy Adaptation Model.  Her contributions to nursing are an Adaptation Model, Essentials of the Roy Adaptation Model, Theory Construction in Nursing, The Roy Adaptation Model: The Definitive Statement, Roy Adaptation Model Based Research, Twenty Five Years of Contributions to Nursing Science and Nursing Knowledge Development and Clinical Practice.
The Roy Adaptation Model has captured interest and respect since 1964 and she published her work in 1970 at the age of 31 years. She defined adaptation as ‘the process and outcome where by thinking and feeling persons, as individuals or in groups, use conscious awareness and choice to create human and environmental integration.’

The four major concepts of the RAM include:

1. Human as adaptive systems
2. The environment
3. Health
4. The goal of nursing

Human adaptive system
Roy conceptualizes the human system in a holistic perspective, which means the aspect of unified meaningfulness of human behavior in which the human system is greater the sum of individual parts.
Adaptation
The human adaptive system has input coming from the external environment as well as with in the system. Roy identifies inputs as stimuli and adaptation level. Stimuli are classified into three: focal, contextual and residual. The stimulus most immediately confronting the human system is the focal stimulus. Contextual stimuli are from the human systems internal and external world. Residual stimuli are those internal and external factors are unclear.
Adaptation level is the combining of stimuli that represents the condition of life process for the human adaptation system. The three levels defined by Roy are integrated, compensatory and compromised. Integrated process is present when the adaptation level is working as a whole to meet the needs of the human system. The compensatory process occur when the human’s response system have been activated and compromised process occur when the compensatory and integrated process are not providing for adaptation. 

Roy presents a unique nursing concept of control mechanisms:  the regulator and cognator.
The regulator subsystem has the components of input, internal process and output. Target organs and tissues under endocrine control produce regulator output response. Cognator control process is related to higher brain functions of perception, learning, judgment and emotion.

Roy categorizes family, group and collective system control mechanisms as the stabilizer and the innovator system. It suggests two goals: stabilization and change. Stabilizer process is those of established structure, values and daily activity where the work of the group is done and the group contributes to the general well being of society. The innovator subsystem identifies structure and processes that promotes change and growth. 

Four adaptive models
The coping processes, cognator-regulator and stabilizer-innovator promote adaptation in human adaptive system. Roy has identified four adaptive modes as categories for assessment of behavior resulting from cognator-regulator coping mechanisms in persons or stabilizer-innovator coping process in groups. These adaptive modes are

1. Physiological –physical
2. Self concept- group identity
3. Role function
4. Interdependence

Physiological –physical mode
The physiological mode represents the human system is physical responses and interaction with the environment. This is associated with fluid, electrolyte, elimination, nutrition, rest, neurologic function and endocrine function. The physical mode related to basic operating resources such as participants, physical facilities and fiscal resources.
Self concept- group identity mode
Self concept consists of a person’s beliefs about himself or herself at any given time. It has two components: physical self and personal self. Physical self includes body sensation and body image. Personal self includes self ideal, moral, ethical and spiritual belief. The group identity mode consists of interpersonal relationship, group self image, social milieu and culture.
Role function mode
It consists of a set of expectations of how a person in a particular position will behave in relation to a person who hold another position. It includes functions of the staff, decision making, initiative and delegation of the work to maintain in order to fulfill the expected responsibilities.
Interdependence mode
The mode focuses on the giving and receiving of love, respect and value with significant others and support systems. The underlying need of the mode is to nurture relationships.
Environment
She defined environment as all conditions that surround and affect the development and behavior of humans as adaptive systems, with particular consideration of person and earth resources.

The Roy Adaptation Model identifies the essential concepts relevant to nursing as the human adaptive system, the environment, health and nursing. The model suggests that nurses alter, increase, decrease, remove or maintain focal stimulus or if that is not possible, change the contextual stimuli so that the purposeful adaptation and transformation between the person and environment is promoted.

Betty Newman’s system model 1972 (USA)

                                           

Betty Newman’s system model 1972 (USA)
Betty Newman’s was born in 1924, received B.S. in Public Health Nursing and M.S. in public health from the University of California. She has practiced as bed side nurse and head of the department in various hospitals. Her contributions are lecturer, author, teacher and consultant in nursing.
The Newman’s system model was developed in 1970 with an overview of the physiological, psychological, socio cultural and developmental aspects of human beings. The model was published in 1972 in nursing research at the age of 48 years. The Newman’s system model diagram presents the major aspects such as basic structure, energy resources (physiological, psychological, socio cultural, developmental and spiritual variables), line of resistance, normal line of defense, flexible line of defense, stressors, reaction, primary, secondary and tertiary prevention, intra, inter and extra personal factors and reconstitution. The environment, health and nursing are inherent parts of the model. The client is represented in the diagram as a basic structure, surrounded by a series of concentric circles and is a living and open system. 

Basic structure and energy resources
It is made up of basic survival factors common to all. It includes physiological, psychological, socio cultural, developmental, genetic etc. Newman identifies system stability as occurring when the energy exchanges with the environment occur with out disrupting the characteristics of the system.
Client variables
She views the individual client considers the variables. The physiological (structure and function of the body), psychological (mental process and relationships), socio cultural (social and cultural expectations), developmental (growth and developmental) and spiritual (spiritual beliefs) variable.
Line of resistance
It protects the basic structure and become activated when the normal line of defense is invaded by environmental stressors.
Normal line of defense
It represents stability over time. When it is invaded, the client system reacts.
Flexible line of defense
It serves as a cushion and absorbs shock. It can be altered over a short period of factors such as inadequate nutrition, lack of sleep or in a danger situation.
Environment
It defines the environment as all the internal or external factors or influence that surrounds the client. The internal environment exists with in the client system and external environment exits in the outside the client system. She developed a third environment called created environment, which is intra, inter and extra personal environment.
Stressors
She classified stressors as intra, inter and extra personal in nature. Intra personal stressors are occurred with in the client system boundary, extra personal stressors occur outside the system boundary. Inter personal stressors occur outside the client system boundary but are proximal to the system.
Health
She identifies health as optimal system stability, harmony among the five variables or the optimal state of wellness at a given time.
Reaction
She discusses the reaction as negentropy and entropy.
Prevention as intervention
Primary prevention occurs before the system reacts to a stressor, includes health promotion strategies such as immunization, health education and life style changes. Secondary intervention occurs after the system reacts to a stressor. It includes appropriate treatment of symptoms. For example, use of analgesics to decrease pain. Tertiary prevention may begin at any point after system stability has begun to be reestablished. An example of tertiary prevention is participation in cardiac rehabilitation program after a cardio vascular surgery.
Reconstitution
It defined the return to and maintenance of system stability. It depends on successful mobilization of client resources to prevent further reaction to the stressors and represents a dynamic state of adjustment.
Newman also supports nursing as part of the model. The aim of nursing to help the client system attains, maintain or retain system stability. It can be achieved through assessment of actual and potential effects of stressor invasion and assist the client for optimal wellness through primary, secondary and tertiary modes of prevention.

Dorothea Orem Self Care Deficit Theory 1971 (USA)

Dorothea Orem Self Care Deficit Theory 1971 (USA)
Dorothea Elizabeth Orem born on 1971 received her diploma in nursing from Providence Hospital School of Nursing, her Bachelor of Science and Master of Science in nursing education from Catholic University of America. She received several honorary degrees and national awards including Catholic University of America’s Alumni Association Award for nursing theory.
Orem (2001) states her general theory as follows: “Nursing has as its special concern man’s need for self care action and provision and maintenance of it on a continuous basis in order to sustain life and health, recover from disease and injury and cope with their effects. The condition that validates the existence of a requirement for nursing in an adult is the health associated absence of the ability to maintain continuously that amount and quality of self care that is therapeutic in sustaining life and health, in recovery from diseases or injury or in coping with their effects. With children, the condition is the inability of the parent or guardian as associated with the child’s health state to maintain continuously for the child the amount and quality of care that is therapeutic”.
Orem developed self care deficit nursing theory, which is composed of three interrelated theory:

1. Theory of self care
2. Theory of self care deficit
3. Theory of nursing system

Under these three theories, there are six central concepts and one peripheral concept:

1. Self care and dependent care
2. Self care agency and dependent care agency
3. Therapeutic self care demand
4. Self care deficit
5. Nursing agency
6. Nursing system

The peripheral concept is basic conditioning factors
Theory of self care
The concepts are self care, self care agency, self care requisites and therapeutic self care demand. Self care is the activities that individuals do it for themselves. Self care agency is the human’s acquired power and capabilities to engage in self care and is affected by basic conditioning factors such as age, gender, health state and pattern of living etc. The therapeutic self care demand is the total of activities needed over a period of time to meet the person’s known requirements for self care. Self care requisites are the reasons self care activities occur and are an expression of the hoped for results. It is categorized into three: universal, developmental and health deviation. Universal requisites means activities of daily living such as intake of air, water, food, rest etc. Developmental self care requisites are specific to the process of growth and development during life cycle changes. Health deviation self care requisites are related to change in human structure due to genetic variation or other defects. In the theory of self care, Orem explains what is meant by self care and list the various factors affect it.
The theory of self care deficit
When therapeutic self care demand exceeds self care agency, a self care deficit exists and nursing is required. Nursing may be necessary when individuals need to carry out complex self care or during illness or injury. Orem identifies the following five methods of helping that nurses may use:

1. Acting for or doing for another
2. Guiding and directing
3. Providing psychological support
4. Providing an environment to support personal development
5. Teaching

In clinical nursing practice, Orem (2001) has identified work operations include:

• Entering into and maintaining interpersonal relationships
• Design, plan and implement nursing care
• Respond to patient requests
• Coordinate nursing care
• Continue the patient care
• Use multisectoral approach
• Discharge the patient from nursing care

The theory of nursing systems
It includes nursing agency and nursing system. Nursing agency is a complex attribute of mature or maturing people educated and trained as nurses that enables them to act, to know and to help others meet their therapeutic self care demands. It is a power that nurse has to engage in effective nursing practice. Orem has identified three classification of nursing system to meet the self care requisites of the patient. The design and elements of the nursing system make four elements: the extent of the responsibility of the nurse in the health care situation, the various roles of the people in the situation, the reason for these being a nurse patient relationship and the actions to be carried out by the nurse and patient to meet therapeutic self care demand. These nursing systems are wholly compensatory, partly compensatory system and supportive-educative system.
Wholly compensatory system includes:

• Accomplishes patient’s self therapeutic care
• Compensates for patient’s inability to engage in self care
• Supports and protects the patient

Partly compensatory system includes:

• Performs some self care measures for patient
• Compensates for self care limitation of patient
• Assist the patient as required
• Performs some self care measures
• Regulates self care agency
• Accepts care and assistance from nurse

Supportive- educative system includes:

• Accomplishes self care
• Regulates the exercise and development of self care agency

To conclude, Orem indicates that nursing service to families and patients generally require some combination of aspects of two nursing systems, namely, the partly compensatory and supportive and educative nursing systems. It is applicable in nursing care with individuals in clinical side and community health practice.

Imogene King Theory of Goal Attainment 1971 (USA)

Imogene King Theory of Goal Attainment 1971 (USA)
Imogene King was born in 1923. She received her basic nursing education from St.John’s Hospital School of Nursing, Missouri and M.S. in nursing from St.Louis University and Ed.D from Colombia University. She also did her post doctoral study in research design, statistics and computers.
King’s ‘Toward a Theory for Nursing: General concepts of Human Behavior ‘was published in 1971 at the age of 48 years and ‘Theory of Nursing: systems, concepts and process’ in 1981. In 1997, King identified her framework as a conceptual system. The conceptual system includes goal, structure, functions, resources and decision making.  Here, the health as the goal of nursing, structure is three open systems, functions are demonstrated in relations of interaction and transaction. Resources include people, money and services for items needed to carry out specific activities. Decision making occurs when choices are made in resources allocation to support attaining system goals. The conceptual system is composed of three interacting system: the personal, interpersonal and social systems.
Personal system
The sub concepts are perception, information, energy, self growth and development, body image, apace, time and learning. King discusses perception as a process in which data obtained through the senses and from memory are organized, interpreted and transformed. The characteristics of self are the dynamic person, who is an open system and whose actions are oriented. The growth and development is the process in people lives through which they move from potential for achievement to actualization of self. Body image is characterized as very personal and subjective. The space is a physical area known as territory and by the behaviors of those who occupy it. She defines time as interval between the4 two events that is experienced differently by each person. She stated that when personal systems come in contact with one another, they form interpersonal systems.
Interpersonal system
The sub concepts are interpersonal relations, communication, interaction, transaction, role and stress. King included interpersonal relations as a concept of interpersonal system. Interaction is defined as the observable behavior of two or more persons in mutual presence. Communication involves the exchange of information between persons. Transaction is a series of exchanges between human being and environment. The role has three elements such as a set of expected behaviors in the social system, a set of rules with a position and relationship of two or more persons who are interacting in a particular situation. King defines stress as an ever changing condition in which as individual, through environmental interaction, seeks to keep equilibrium to support growth and development and activity. These interpersonal systems join together to form layer systems known as social system.
Social system
The sub concepts are social organization, role, status, authority, power, decision making and control. An organization is characterized by a structure that orders positions and activities and ruled by individuals who make use of resources to meet organizational goals. King defines authority as an active, reciprocal process of transaction in which the actor’s experience, understanding and values influence the meaning, legitimacy and acceptance of those in organizational positions associated with authority. Power includes organizational capacity, to use resources to meet goals. Decision making is defined as the orderly process through which choices related goals are made among identified possible activities. From the above mentioned conceptual model, she derived the theory of goal attainment.
King’s theory of goal attainment
The original concepts of theory are interaction, perception, communication, transaction, self, role, stress, growth and development, time and personal space. Interaction is the observable verbal and non verbal goal directed behaviors of two or more people in mutual presence and includes perception and communication. Interaction brings different ideas, attitudes and perceptions to the exchange called transaction. Perception is the reality as seen and experience by the individual. The elements of perception are the importing of energy from the environment and organizing it by information, transforming energy, processing, storing and exporting information.
Role is defined as set of behaviors, decision making is the process of making choices from the many available choices and health is goal of nursing. King indicates the outcome is an individual’s state of health or ability to function in social roles. From the theory of goal attainment, she has developed predictive propositions that a) perceptual accuracy, role congruence and communication leads to transaction 2) transaction leads to goal attainment 3) goal attainment leads to satisfaction and effective nursing care.
The theory is useful, testable and applicable to nursing practice. It is widely generalized and not situation specific. It is based on the review of literature and provides the reader with a set of resources for further study. Her work provides nursing with an excellent example of profession.

Nursing and theory development

(By Utente:Jollyroger (Own work) [CC BY-SA 2.5 (http://creativecommons.org/licenses/by-sa/2.5)], via Wikimedia Commons)

Nursing and theory development

 
“Nursing is a profession with unique body of knowledge and well principled skills, emphasis on care of human being during ill health to health continuum by meeting the needs physically, psychologically, socially and medically with modification of environment of individual, family and community through nursing practice, education and research”.

Theoretical thinking
The first unit of theory is concept. A concept is an idea or thought comes to mind through experience or observation. The concepts are divided into two; empirical and abstract. The empirical concepts (phenomena) are observed through senses, for example, heart rate and abstract concepts (intuition) are not observable, for example, caring.
The term metaparadigm indicates the boundaries of a discipline which summarizes the mission of the same discipline. There are four metaparadigm related to nursing; person, health, environment and nursing. The person represents individual, family or community. Health is a state of well being and environment is the surroundings of the person and nursing is the practice of the science based on the aspect of ‘care’, ‘cure’ and ‘prevention’. A proposition explains the relationships between the concepts. 

“A theory is a creative arrangement of concepts with definitions and its propositions in general, which describes the phenomena or intuition and its relationships, predict the actions and reactions through the research and solve problems in the reality”.

“A conceptual framework is a pictorial representation of theory or conceptual model”.

“A conceptual model is a creative arrangement of concepts related to specific event or problem in the reality with definitions and its propositions, which describes the phenomena or intuition and its relationships, predict the actions and its reactions through the research and solve the problems in the reality”. 

Barnum (1998) stated that a complete nursing theory is one that contains context, content and process. Context is an environment, content is the subject and process is the way of act to use the theory.
Smith and Liehr (2003) suggested three rungs for the model; philosophical, theoretical and empirical. The philosophical (highest) rung represents the beliefs and assumptions which are true and fundamental to a theory. The theoretical (middle) rung is abstract and consists of the symbols, ideas and concepts of the theory and empirical (lowest) rung is concrete, which is observed by senses. 

Levels of theory
Chinn and Kramer (2004) stated that theory is divided into micro, macro, midrange, atomistic or wholistic. Micro and atomistic suggests narrow range, where as, macro and wholistic implies a broad range. Middle range theories deal with a portion of nursing’s total concern but not with the totality of the discipline. Grand theory covers broad areas of concern with a discipline and meta theory is about theoretical process and theory development. Middle range theories are based on day to day research, narrow in scope, limited number of concepts and propositions, less abstract and more applicable to practice.
Im (1999) stated that situation specific theories are focused on specific nursing intervention phenomena, limited to specific population, are not intended to be universal theories and are may or may not be testable.

Dickoff and James (1968) developed theory on four levels:
Level 1: factor isolating – is descriptive in nature and naming or classifying the events.
Level 2: factor relating – associating or correlating factors
Level 3: situation relating – explains and predicts how situations are related
Level 4: situation producing – it requires sufficient knowledge about how and why situations are related. Level 4 being the most powerful, as it controls rather than description, explanation or prediction. 

Fawcett (2005) described various types of middle range theory. She stated that middle range theories describe what a phenomenon is, explain why it occurs and predict how it occurs. Middle range descriptive theories describe only one concept or classify a phenomenon. Middle range explanatory theories specify relations between two or more concepts and middle range predictive theories predict relationship between concepts. 

Johnson and Webber (2005) propose a criterion based critique model for nursing theories.
Phase 1: Intention of the theory

• Criterion I: understandable meaning
• Criterion II: consistent boundaries
• Criterion III: understandable language

Phase 2: Concepts and propositions

• Criterion IV: identify the major concepts
• Criterion V: formulation of propositions
• Criterion VI: understand and interpret the propositions

Phase 3: Usefulness in nursing practice

• Criterion VII: explains and predicts the phenomena
• Criterion VIII: influences nursing practice

Theories provide a platform to facilitate critical thinking to explain phenomena, identify the relationship between the concepts, solve the problems in the reality and predict the actions and reactions in the future. As new knowledge and discoveries emerge in nursing realms, the boundary of art and science of the discipline of nursing dissolves and fuses together.

Martha Rogers Science of Unitary Human Beings Model, 1970 (USA)

(By Unknown photographer [Public domain], via Wikimedia Commons)

Martha Rogers Science of Unitary Human Beings Model, 1970 (USA)

Martha Rogers was born on 1914 and earned a bachelor’s degree in nursing from George Peabody College, master’s degree in public health nursing from Columbia University and doctorate in nursing from the John Hopkins University. She was a teacher and mentor to an impressive list of nursing scholars and theorists. Rogers continued her work and writing until her death in 1994. 

Martha Rogers described her theory of Unitary Man in 1961 and stated that person was a ‘Unitary energy system’ in ‘continuous mutual interaction with the universal energy system’, ‘dramatically influenced nursing by encouraging nurses to consider the person as a whole entity when planning and delivering care’.

She published the book in 1970 at the age of 56 years; An introduction to the theoretical basis of nursing science, Rogers outlined the five assumptions that provide the foundation for the discipline of nursing.

1. Man is a unified whole possessing his own integrity and manifesting characteristics that are more than and different from the sum of his parts.
2. Man and environment are continuously exchanging matter and energy with one another.
3. The life process evolves irreversibly and unidirectionally along the space time continuum.
4. Pattern and organization identify man and reflect his innovative wholeness.
5. Man is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion.

Rogers condensed the assumptions to five blocks of the conceptual system (Rogers, 1992):

1. Energy fields
2. Pan dimensionality
3. Pattern
4. Unitary persons
5. Environment 

An energy field is defined as the distinguishing characteristics of an energy field perceived on a single wave. It is the unique configuration of relationships of a particular system. Areas of human field’s pattern that have been explored include pain, stress, hope, time etc.

She identified two energy fields of concern to nurses, which are integrated; human field and environmental field. The human field can be conceptualized as a person or groups, family or community. These fields can not be broken into sub systems. She interpreted the nursing care is holistic, meaning a summation of parts to arrive at the whole, where a nurse would assess the domains, subsystems identified, then synthesize the accumulated data to arrive at a picture of the total person. A change in one field causes alterations in other field. Both are integrated, can not be separated.

The fields are pan dimensional, defined as ‘a non linear domain with out spatial or temporal attributes’. Pan dimensional reality transcends traditional notions of space and time, which can be understood as perceived boundaries only.

Principles of homeodynamics

She defined the three principles of homeodynamics are reasoning, helicy and integrality. It describes the nature of change in the human environmental field process.

Principle of resonancy specifies the continuous change from lower to higher frequency wave pattern in human and environmental fields. Rogers elaborated: ‘individuals experience lesser diversity and greater diversity, time as slower, faster and unmoving’.

The principle of helicy is the continuous innovative unpredictable, increasing diversity of human and environmental field patterns. This describes the nature of change. The principle of integrality is continuous mutual human fields and the environmental field process. It specifies the context of change as the integral human environmental field process where person and environment are inseparable.

Together, postulates of Rogerian nursing science suggest that the human and environmental field change continuously, flow in lower and higher frequencies. Rogers believed that they serve as guides both to the practice of nursing and to research in the science of nursing.