NURSING MIDDLE RANGE THEORIES

Psychodynamic Nursing
Core, Care, Cure Model
Human Becoming
Human-to-Human Relationship Model
Maternal Role Attainment
Model of Living
Model of Health
Modeling and Role-Modeling
Culture Care Diversity and
 The Psychodynamic Nursing
By: Hildegard Peplau
(Mother of Psychiatric Nursing)
Major Points:
- This theory focused on the relationship
between the nurse and the patient
([Link]. Interpersonal Relations Theory)
- Involves the use of nurse knowledge and
understanding of one’s own behavior to help
patients identify felt difficulties, and the
application of human relations to problems
that arise at all levels of expertise
Phases of Nurse-Patient Relationshi
Orientation – “getting to know each other” stage
The relationship begins as the patient and/or family
experiences a “felt need” which prompts them to seek
the help of a professional individual
Working Phase –
About both parties learning how to work together
with what they have in order to find solutions to the
health problems
Termination Phase –
Relationship between the nurse and the patient has
ended because patient’s needs have already been met
Within the nurse-patient relationship, the nurse assumed
several different roles during various phases:

Stranger Provides an accepting climate that builds

trust and confidence
Resource Person Answers questions, interprets clinical
treatment data, and provides
Teacher Gives instructions
information and provides health
care training to the patient and caregivers
CounselorHelps the patient understands current life
circumstances; provide guidance and
Surrogateencourangement
Acts to make
on the patient’s changes
behalf as an advocate
Helps patient assume maximum responsibility for
Leader meeting treatment goals
CASE STUDY

Ethel is a frail 18 year old who has just

given birth to her child prematurely. She
keeps talking about her anxieties in taking
care of her newborn.
Using Peplau’s theory, what can a nurse do
to apply theory of interpersonal
relations/psychodynamic nursing?
 Core, Care, Cure Model
By: Lydia Eloise Hall
Major
Points:
Is the person or patient to whom nursing
CORE- care is directed and need
Explains the role of nurses, and focused on
performing that noble task of nurturing the
CARE- patients, in concept of wholistic care approach

Collaborative effort of medical professionals

CURE- base on pathological and therapeutic nursing
interventions given to patient geared on
treating or curing the disease
CASE STUDY

Mr. Fox is a 47 year old litigation lawyer. He leads a

sedentary lifestyle. He smokes non-stop consuming 2-3
packs of cigarettes a day. He has mild hypertension. He
experience chest pains, tightness in the area. He was
thinking of his wife and children while he was driving and
the mortgage on the house that needs to be paid. His
chest pain persisted. He broke into cold sweat. His vision
got blurry and he felt nauseated until he vomited. He
was brought to the emergency room by his compassion
after he suddenly stepped on the brakers.
Based on Hall’s theory, what can a nurse do for Mr. Fox?
ROSEMARIE
PARSE
HUMAN BECOMING THEORY
 Human Becoming
By: Rosemarie Parse
Major Points:
- Focuses on quality of life and human dignity from
the perspective of each person or group as to the goal
of nursing
3 Structural Themes:
1. Meaning- imaging and valuing of languaging

2. Rhythmicity- revealing-concealing; enabling-limiting

3. Transcendence- powering and originating of transformin

3 Structural Themes:

1. Meaning- means people co-participate in creating

what is real for them through self-expression

2. Rhythmicity- means unity of life encompasses

apparent opposites; one shows self as opportunities
that emerge in

3. Transcendence- it means that moving beyond the

“now” moment is forging a unique personal path
4 Postulates (postulate means basis for belief)

• Illimitability – knowing the reality extended beyond

but still focusing with what is felt at the moment

• Paradox – not opposites of dilemma to be overcome

but rather lived rhythms

• Freedom – “contextually construed liberation”,

means Humans are free to choose ways

• Mystery – unexplainable, and cannot be completely

JOYCE
TRAVELBEE
Human-to-Human Relationship
Model
 Human-to-Human Relationship
Model
Major Points: Nurse-patient
By Joycehas 5 Series of Interactional
Travelbee
Phases:
• Original Encounter – first impression of the nurse to
patient and vice versa
• Emerging Identities – the link of relationship begind
• Empathy – ability to share in the person’s experience or
emotion
• Sympathy – goes beyond empathy; when the nurse
wants to lessen the cause of patient’s suffering
• Rapport – patient and nurse have a close and
RAMONA
MERCER
MATERNAL ROLE
ATTAINMENT
 Maternal Role Attainment
Theory
By: Ramona Mercer
Major Points:

- MRA is a framework for nurses to provide

appropriate healthcare interventions for non-
traditional mothers so they could successfully
attain a strong maternal identity

- There are maternal/paternal/infant variables

(means factors that can affect) the acceptance
and impact in mothering role of a woman
 MATERNAL INFANT VARIABLES PATERNAL
VARIABLES VARIABLES
Age at first birth Temperament Age
Birth Experience Appearance First experience with
infant
Early separation Responsiveness Social Stress
from infant
Social Stress Health status Social Support
Social Support Ability to give cues Personality traits
Personality traits Self-concept
Self-concept Child-rearing
attitudes
Child-rearing Health
attitudes
4 Stages of Acquisition (acquisition means act of
attainment)

[Link] - a woman sets up her own

expectations about pregnancy and childbirth(Physical
Recovery Phase; birth-1month)

[Link] – when the baby is out mothering

role/behavior is guided by others in the social
system/network. Example when the woman looks up
to her mother’s way of child care (Achievement
Phase; 2-5months)
3. Informal – mother develops her own ways of
mothering (Disruptions Phase; 6-8months)

4. Personal – Maternal Identity a personal state of

harmony, confidence and competence in her role
and begins to experience joy of motherhood and
attachment to the child. Example when the woman
says “I’m ready to have another one”.
(Reorganization phase; 8mos-1year)
3 Levels at which adaptation to the maternal role occurs:

[Link] – Physical or bodily changes. (Ex. Hair

loss)

[Link] – mental or condition of the mind

(Ex. Forgetfulness)

[Link] – interpersonal relations with family and

friends (Ex. Less partying)
 Model of Living
By: Roper, Logan, Tierney

Major Points:

- This model answered the dilemma of finding out

what people need by understanding the patient’s
deficits and strengths. (Human Needs Model)

- Is a framework that helps nurses assess and care for

patients by identifying their abilities to perform
activities of daily living (ADLs) that includes:
ACTIVITIES OF DAILY LIVING (ADLs)
[Link] a safe environment
[Link]
[Link]
[Link]
[Link] and Drinking
[Link] (urination and defacation)
[Link] cleansing and dressing (hygiene)
[Link] body temperature
[Link] and playing
[Link]
[Link] sexuality
[Link]
 The Modeling and Role-Modeling Theory
By: Erikson, Tomlin, Swain
Major Points:

Modeling - refers to the development of an

understanding of the client’s world

Role Modeling – is the nursing intervention, or

nurturance that requires unconditional acceptance

This model considers nursing as self-care model based

on the client’s perception of the world and adaptations
to stressors; the basis of nursing is assisting patients
 3 Aspects of Self-Care in MRM
SELF-CARE
KNOWLEDG
E

SELF-CARE HEALT
ACTIONS
H

SELF-CARE
RESOURCE
S
3 Aspects of Self-Care in MRM:

[Link]-care Knowledge – is the personal awareness of

one’s needs and goals, strength, capabilities,
characteristics, values and liabilities

[Link]-care Resources – refers to the internal

(strength) and external (support) resources that will
help, gain, maintain and promote optimum level of
holistic health

[Link]-care Actions – it is the development and use of

self-care knowledge and resources towards health
 Culture Care Diversity and Universality
By: Madeleine Leininger

Major Points:

The central thesis of this theory is the properly

studying how various cultures take care of their sick
and wounded; how they articulate pain and
satisfaction; express their beliefs on illness and health
and analyze patterns of behavior relating to nursing
care with the goal of providing culture-specific nursing
diagnosis and interventions. (Transcultural Nursing)
Concepts in understanding Culture Care Diversity and
Universality Theory

Culture – set of shared attitudes, values, goals, and practices that

describes or characterizes an institution or organization
Emic Knowledge – from the perspective of the people who live
within that culture
Etic Knowledge – from the perspective of an outside observer or
researcher
Culture Care Diversity – indicates variables or differences in
meanings, patterns, or values that are related to human care
expressions
Culture Care Universality – indicates common, similar or
dominant uniform care meanings, patterns, values that reflect ways
to help people
Culture Shock – feeling of uncertainty, confusion, or anxiety that
 SHORT ASSESSMENT GUIDE

PHASE II PHASE IV

Record what you Listen to Identify Synthesize Develop

 See  Values  Patterns  Themes  Culturally-

 Hear  Beliefs  Narratives  Patterns based client-
 experience  Practices  Meanings of Care nurse plancare

PHASE I PHASE III PHASE V

MARGARET
NEWMAN
HEALTH AS EXPANDING
CONSCIOUSNESS
 Model of Health
By: Margaret Newman
Major Points:

- Health and Disease are not separate but are each

reflections of the larger whole.

- The theory asserts that every person in every situation,

no matter how disordered and hopeless it may seem, is
part of the universal process of Health as Expanding
Consciousness – a process of becoming more of oneself,
of finding greater meaning in life, and of reaching new
dimensions of connectedness with other people and the
 Concepts of HEC

MOVEMEN
T

TIME SPACE

HEALTH
DISEASE