Compiled by:Daniel, L., Leslie, D., & Sanders, J.Table 2: Selected Conceptual Frameworks: Basic Assumptions and Concepts DefinedConceptual Framework: Johnson’s Behavioral System Model Basic Assumption: This is a holistic view that is based on Florence Nightingale’s idea that the problem with illness is not the illness itself but how the person who is ill interacts with his or her environment. The patient is a behavioral system linked to his or her environment and prior learning and stimuli influence behavior (Alligood, 2018). A behavioral system is a structure that functions as a whole system made of parts and human beings strive to achieve balance within it. Behavior represents a wide continuum of tolerance but cultural norms are only found in the middle section. The nursing profession is obliged to set standards for the outer limits of acceptable behavior (Fawcett, 2005). Person: The person is a behavioral system composed of patterns that link the person with the environment. Past experiences and stimuli influence a person’s current interactions and behavior. A person is always adjusting and adapting his or her behavior to maintain or restore balance within the system and this balance is important for optimal functioning (Alligood, 2018). Environment: The internal environment refers to the individual person and his or her body composition (Fawcett, 2005). The external environment is separate from the behavioral system of an individual but influences the system. The environment can include but is not limited to the objects, events, and situations that affect a person. The environment can be manipulated by the nurse to help the person achieve balance within his or her system (Alligood, 2018). Health: Health is reflected by the balance within the behavioral system. When the behavior system is not balanced, there is a struggle with the ability to function and the person would be viewed as unhealthy. When an individual is able to achieve balance within the system and is fully functional in the way he or she relates to the environment, the person would be considered healthy (Alligood, 2018). Nursing: Nursing is both an art and a science that does not rely on the science of medicine but complements it. When a patient is experiencing stress within his or her behavioral system, there is an imbalance and nursing can be applied to return balance for the patient. Nursing is an external energy whose goal is to maintain, restore, or achieve optimal balance. The goal is equilibrium, a stable and harmonious state (Alligood, 2018). Conceptual Framework: Watson’s Theory of Human Caring Basic Assumption: Humans are not to be objectified; they are one with the universe and others. Humans are spiritual in nature and caring for one other is of highest respect. The relationship between the patient and nurse is vital (Fawcett, 2005). The field of humanities cannot be separated from nursing and must be as important as medical science. Nurses must understand how their own cultures, beliefs, values, and relationships influence how they interact with others and the world (Alligood, 2018). Person: A person is more than just a body and encompasses mind, spirit, and nature as well. Human beings are spiritually connected and are not bound by time or space (Alligood, 2018). Environment: Humans are connected to everything around them and in the infinite universe (Fawcett, 2005). Within her framework, Watson advocates for the use of healing spaces where the nurse is also a spiritual force of healing (Alligood, 2018). Health: Health is not necessarily the absence of disease but is found in the unity and harmony of the physical and spiritual parts of a person including body, mind, and soul. Illness and disease are not the same concept. Illness is subjective, represents disharmony, and can come from disease or become disease. Disease is a physical process that disrupts the balance at the intersection of the body, mind, and soul (Alligood, 2018). Nursing: The word nurse refers to both a person and a process. While nurses need to understand the physical well-being of a person, they also need to address the whole human experience. Watson developed a list of caritas which are processes to form an intentional foundation of nursing in a caring model. The goal of nursing is not to cure a patient but to be fully present with the patient (Alligood, 2018). Watson’s theory does not deny empirical science but relies heavily on aesthetic knowing. She emphasizes transpersonal caring which is a way of caring based on emotion that touches one’s soul. Nursing should involve forming a special relationship that connects the nurse and the patient and creates a healing environment (Fawcett, 2005). Table 2: Selected Conceptual Frameworks: Basic Assumptions and Concepts DefinedConceptual Framework: Newman’s Theory of Health as Expanding Consciousness Basic Assumption: Newman’s basic assumptions include being a unitary, open system that is in continuous interconnectedness with the universe, all while remaining engaged in an evolving pattern of the whole (Alligood, 2018). It is thought that the meaning of life and health are evolving processes that expand upon human consciousness. The theory states that every person, no matter their situation, is part of a universal process of consciousness expansion (Fawcett, 2005). This theory is based on patterns, including patterns of disease, that constantly evolve through the individual’s interaction with their environment (Endo, 2017). Person: Persons can be identified by their individual style of consciousness and therefore are considered centers of expanding consciousness. Each person is viewed as a “participant in the transformative process” (Alligood, 2018). Environment: The environment and everything in it are thought to have differing levels of consciousness. The interaction between people and the environment are key to consciousness evolution. The environment is thought of as “the larger whole, which contains the consciousness of the individual” (Alligood, 2018). Health: Health is an intertwining of disease and nondisease, which reflects a pattern of the whole. Wholeness is neither lost nor gained, but rather takes on different forms during different stages of health. Health is defined by Newman as “a transformative process to more inclusive consciousness” (Alligood, 2018). Nursing: Nurses create relationships with their patients during times of disorganization in hopes of arriving at a higher, more organized state. This is a rhythmic process in which nurse and patient come together and then move apart. Both patient and nurse undergo a transformation and expansion of consciousness (Alligood, 2018) Conceptual Framework: Peplau’s Theory of Interpersonal Relationships Basic Assumption: “Nursing is a significant, therapeutic, interpersonal process” and the “understanding of the meaning of the experience to the patient is required in order for nursing to function as an educative, therapeutic, maturing force” (Fawcett, 2005). Person: All people serve a purpose during their time on this earth. People seek satisfaction and accomplishment each day of their lives. People will act on their immediate interpretations of their situation or during a time of change because it is what comfortable for them. Patient’s behaviors are based on past experiences and outcomes (Fawcett, 2005). Environment: Peplau did not incorporate the environment much within her theory, although she noted the importance of culture on the formation of one’s personality. In particular, she stated that “it is the interaction of cultural forces with the characteristic expression of a particular infant’s biological constitution that determines personality” (Fawcett, 2005). Health: Health is defined by Peplau as a “word or symbol that identifies forward movement of personality and other human processes, such as creativity, constructiveness, productiveness, personal, and human processes” (Fawcett, 2005). Nursing: “Defined as an interpersonal, therapeutic process that takes place when professionals, specifically educated to be nurses, engage in therapeutic relationships with people who are in need of health services. Peplau theorized that nurse-patient relationships must pass through three phases in order to be successful: (a) orientation, (b) working, and (c) termination” (Hagerty, Samuels, Norcini-Pala & Gigliotti, 2017). Conceptual Framework: Orem’s Self-Care Framework Basic Assumption: Human beings require inputs to remain alive and must act deliberately to care for self and others. They must first be able to identify the needs and take action in meeting those needs (Alligood, 2018). Self-care must meet needs such as food, air, water, elimination, rest, socialization, prevention of hazards to human life, and promotion of functioning within the appropriate social system. If a person is in need of medical care, self-care also includes being able to secure medical help, to carry out prescribed interventions, to care for the effects of the disease and interventions, to accept help when needed, and to live productively with the effects of the disease and treatment (Sitzman, 2011). Orem’s theory boasts three correlated concepts. They are self-care, self-care deficit, and the nursing system. The theory of self-care includes the practice of activities that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being. A self-care deficit is created when an adult is incapable of the provision of effective self-care. The nursing system is the system by which the patient’s needs will be met by the nurse, the patient, or both (Fawcett, 2005). Person: People are unitary beings with biologic, symbolic, and social features and exhibit the characteristics of humans throughout their life cycles (Fawcett, 2005). The patient is referred to as a mature or maturing person who needs to initiate and perform the care required for being. However, this theory allows for dependent-care as well and includes care provided for people too young or otherwise unable to provide care for oneself (Alligood, 2018). Environment: The environment can be broken down into physical, biologic, chemical, and socioeconomic-culture features. The physical, biologic, and chemical factors include the earth and its formations, pollution, air, weather, pets, wild animals, and other objective physical components. The socioeconomic-cultural factors focus on the family and community systems. The family composition, relationships, and the dynamics within the culture come together to play a role in a person’s environment. In Orem’s framework some environmental conditions may be isolated while others regulated and controlled. She emphasizes that the environment has the ability to affect one’s development. Individuals are viewed as objects subject environmental forces (Fawcett, 2005). Health: Orem refers to health state as a state of wholeness of the human body and mental functioning and one’s presentation of his or her existence to self and others. “Health state is made up of inseparable anatomic, physiological, psychological, interpersonal, and social aspects” (Fawcett, 2005, p. 239). Nursing: The need for nursing exists when a person cannot meet his or her own needs on a continuous basis. The function of nursing is to provide assistance for a person when one is unable to provide care for oneself. Nursing systems are action-based tasks for patients who are limited (Alligood, 2018). The foundations of this human service are providing therapeutic care and also maintaining a specialized, knowledge, skill, and attitude. Dependent on the need, nursing can be either wholly compensatory, partly compensatory, or supportive-developmental (Fawcett, 2005). Conceptual Framework: Parse Human Becoming Theory Basic Assumption: Nursing practice guided by Parse will focus on how each patient rates his or her own quality of life from one’s own perspective. Three themes are found in this model’s assumptions: meaning, rhythmicity, and transcendence. In the framework of human becoming, personal meaning is freely chosen. Each person lives in his or her own reality based on one’s own experiences. Relating comes through rhythmicity, or creating patterns in the relationship between man and environment. Transcendence is the transformation of a person that occurs when he or she reaches beyond one’s limits (Petiprin, 2016). Person: Man is coexistent with the universe, open and free to choose, unitary in patterns, and multidimensional (Petiprin, 2016). Environment: People coexist with the universe (Petiprin, 2016). They have a very personal oneness with the world and are inseparable from it as they form relationships with it (Alligood, 2018). Health: Human becoming is a unique process for each individual and their group. People make choices about their own health based on the circumstances of the universe and the relationships they have formed with it. Human becoming is enhanced through the patients’ descriptions of their experiences. “Individuals and groups can describe their own experience in ways that shed light on the meaning of health” (Fawcett, 2005). Nursing: Parse categorizes nursing as a basic science. She believes patients ought to seek nurses for nursing and not medical diagnoses. The art of nursing is apparent through the relationships formed and the practice of being present (Alligood, 2018).