1. FAYE ABDELLAH Abdellah was the first nurse officer to earn the ranking of a two-star rear admiral.

She was the first nurse and the first woman to serve as a Deputy Surgeon General. Her work changed the focus of nursing from disease-centered to patientcentered, and began to include the care of families and the elderly in nursing care. The Patient Assessment of Care Evaluation developed by Abdellah is now the standard used in the United States. Her publications include Better Nursing Care Through Nursing Research and Patient-Centered Approaches to Nursing. She also developed educational materials in many areas of public health, including AIDS, hospice care, and drug addiction. She was inducted into the National Women's Hall of Fame in 2000. Faye Glenn Abdellah's Contribution to Nursing Theory: Twenty-One Nursing Problems According to Abdellah's Twenty-One Nursing Problems theory of nursing, "Nursing is based on an art and science that moulds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs." The patient-centered approach to nursing was developed from Abdellah's practice, and the theory is considered a human needs theory. It was created to help with nursing education, so it most applicable in that area. The nursing model is intended to guide care in hospitals, but can be applied to community nursing, as well. The model has interrelated concepts of health and nursing problems, as well as problemsolving, which is an activity inherently logical in nature. Abdellah's theory identifies ten steps to identify the patient's problem and 11 nursing skills used to develop a treatment typology. The ten steps are: 1. 2. 3. 4. 5. 6. 7. Learn to know the patient. Sort out relevant and significant data. Make generalizations about available data in relation to similar nursing problems presented by other patients. Identify the therapeutic plan. Test generalizations with the patient and make additional generalizations. Validate the patient's conclusions about his nursing problems. Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his or her behavior. 8. Explore the patient and his or her family's reactions to the therapeutic plan and involve them in the plan. 9. Identify how the nurses feel about the patient's nursing problems. 10. Discuss and develop a comprehensive nursing care plan. The 11 nursing skills are: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. observation of health status skills of communication application of knowledge teaching of patients and families planning and organization of work use of resource materials use of personnel resources problem-solving direction of work of others therapeutic uses of the self nursing procedure

The model identifies nursing as a helping profession. Nursing care is doing something to or for a patient, or providing information to the patient with the intention of meeting needs, increasing self-ability, or alleviating impairment. In other

words, helping patients become more healthy. Abdellah describes health as a state mutually exclusive of illness. There is no definition of health given by her in the theory, but she speaks to "total health needs" and "a healthy state of mind and body" in her description of nursing as a comprehensive service. The nursing process in Abdellah's Twenty-One Nursing Problems theory is: assessment, nursing diagnosis, planning, implementation, and evaluation. In the assessment phase, nursing problems provide guidelines for the collection of data. A principle underlying the problem-solving approach is that for each identified problem, pertinent data is collected. The overt or covert nature of problems necessitates a direct or indirect approach, respectively. The results of the collection of data in the assessment phase determine the patient's specific problems, which can be grouped under one or more of the broader nursing problems. This creates the nursing diagnosis. The statement of nursing problems most closely resembles goal statements. Using the goals in the framework, a nursing care plan is developed and appropriate nursing interventions are determined. Putting those interventions in action is the implementation phase of the nursing process. After the interventions have been carried out, the evaluation takes place. The most appropriate evaluation would be the nurses progress or lack of progress toward the achievement of the goals established in the planning phase.

2. PATRICIA BENNER In the late 1960s, Benner worked in the nursing field. This included working as a Head Nurse of the Coronary Care Unit at the Kansas City General Hospital and an Intensive Care Staff Nurse at the Stanford University Hospital and Medical Center. From 1970 until 1975, she was a Research Associate at the University of California at San Francisco School of Nursing. Following that, she was a Research Assistant to Richard S. Lazarus at the University of California at Berkeley. From 1979 until 1981, she was the Project Director at the San Francisco Consortium/University of San Francisco for a project achieving methods of intraprofessional consensus, assessment, and evaluation. Since 1982, Benner has been working in research and teaching at the University of California at San Francisco School of Nursing. Benner has published nine books, including From Novice to Expert, Nursing Pathways for Patient Safety, and The Primacy of Caring. She has also published many articles. In 1995, she was awarded the 15th Helen Nahm Research Lecture Award from the University of California at San Francisco School of Nursing. She is currently a professor emerita in the Department of Physiological Nursing at the University of California at San Francisco School of Nursing. Patricia Benner's Contribution to Nursing Theory: From Novice to Expert Concept Patricia Benner developed a concept known as "From Novice to Expert." This concept explains that nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal

experiences. Benner proposed that a nurse could gain knowledge and skills without actually learning a theory. She describes this as a nurse "knowing how" without "knowing that." She further explains that the development of knowledge in fields such as nursing is made up of the extension of knowledge through research and understanding through clinical experience. The theory identifies five levels of nursing experience: novice, advanced beginner, competent, proficient, and expert. A novice is a beginner with no experience. They are taught general rules to help perform tasks, and their rule-governed behavior is limited and inflexible. In other words, they are told what to do and simply follow instruction. The advanced beginner shows acceptable performance, and has gained prior experience in actual nursing situations. This helps the nurse recognize recurring meaningful components so that principles, based on those experiences, begin to formulate in order to guide actions. A competent nurse generally has two or three years' experience on the job in the same field. For example, two or three years in intensive care. The experience may also be similar day-to-day situations. These nurses are more aware of longterm goals, and they gain perspective from planning their own actions, which helps them achieve greater efficiency and organization. A proficient nurse perceives and understands situations as whole parts. He or she has a more holistic understanding of nursing, which improves decision-making. These nurses learn from experiences what to expect in certain situations, as well as how to modify plans as needed. Expert nurses no longer rely on principles, rules, or guidelines to connect situations and determine actions. They have a deeper background of experience and an intuitive grasp of clinical situations. Their performances are fluid, flexible, and highly-proficient. Benner's writings explain that nursing skills through experience are a prerequisite for becoming an expert nurse. These different levels of skills show changes in the three aspects of skilled performance: movement from relying on abstract principles to using past experiences to guide actions; change in the learner's perception of situations as whole parts rather than separate pieces; and passage from a detached observer to an involved performer, engaged in the situation rather than simply outside of it. The levels reflect movement from reliance on past principles to the use of past experience and change in the perception of the situation as a complete whole with certain relevant parts. Each step builds on the previous step as principles are refined and expanded by experience and clinical expertise. Benner's theory of From Novice to Expert changed the understanding of what it means to be an expert in the nursing field. This moves the label from a nurse with the highest pay or the most prestigious title to the nurse who provided the best care to his or her patients.

3. FLORENCE NIGHTANGLE Florence Nightingale is the most recognized name in the field of nursing. Her work was instrumental for developing modern nursing practice, and from her first shift, she worked to ensure patients in her care had what they needed to get healthy. Her Environmental Theory changed the face of nursing to create sanitary conditions for patients to get care. Career of Florence Nightingale Nightingale is best known for her pioneering work in the field of nursing. She tended to wounded soldiers during the Crimean War. She became known as the "Lady with the Lamp" because of her night rounds. While nursing soldiers during the war, Nightingale worked to improve nutrition and conditions in the wards. Many injured soldiers were dying from illnesses separate from their injuries, such as typhoid, cholera, and dysentery. Nightingale made changes on the wards or started the process by calling the Sanitary Commission. Her work led to a reduction in the death rates of injured soldiers from 42% to 2%. Nightingale believed the deaths were the result of poor nutrition, inadequate supplies, and the soldiers being dramatically overworked. After collecting evidence that pointed to unsanitary conditions as a major cause of death, Nightingale worked to improve sanitation in army and civilian hospitals during peacetime. After the Crimean War, she established a nursing school at St. Thomas' Hospital in London in 1860. The first nurses trained at this school began working in 1865 at the Liverpool Workhouse Infirmary. It was the first secular nursing school in the world, and is now part of King's College London. Her work laid the foundation for modern nursing, and the pledge all new nurses take was named after her. Nightingale wrote Notes on Nursing (1859), which was the foundation of the curriculum for her nursing school and other nursing schools. This short text was considered the foundation of nursing education, and even sold well to the public. She also wrote Notes on Hospitals, Notes on Matters Affecting the Health, and Efficiency and Hospital Administration of the British Army. Nightingale spent the rest of her career working toward the establishment and development of nursing as a profession, paving the way for nursing in its current form. In 1883, Nightingale was given the Royal Red Cross by Queen Victoria. In 1907, she was the first woman to receive the Order of Merit. In 1908, she was given the Honorary Freedom of the City of London. International Nurses Day is celebrated on her birthday. Florence Nightingale's Contribution to Nursing Theory: Environmental Theory Florence Nightingale is attributed with establishing the modern practice of nursing. She also contributed to the field with nursing theories still used today. One of her nursing theories is the Environmental Theory, which incorporates the patients' surrounding environment in his or her nursing care plan. In this theory, the role of the nurse is to use the patient's environment to help him or her recover and get back to the usual environment. The reason the patient's environment is important is because it can affect his or her health in a positive or negative way. Some environmental factors affecting health according to Nightingale's theory are fresh air, pure water, sufficient food and appropriate nutrition, efficient drainage, cleanliness, and light or direct sunlight. If any of these factors is lacking, it can delay the patient's recovery. Nightingale also emphasized providing a quiet, warm environment for patients to recover in. The theory also calls for nurses to assess a patient's dietary needs, document food intake times, and evaluate how the patient's diet affects his or her health and recovery. Determining a patient's environment for recovery based on his or her condition or disease is still practiced today, such as in patients suffering from tetanus, who need minimal noise to keep them calm and prevent seizures.

4. HILDEGARD PEPLAU Many people enter the healthcare field because they want to work with people. For these nurses, it is the nurse-patient relationship that is one of the most important things. By understanding the nurse-patient relationship, nurses can be better quipped to work with their patients and, ultimately, provide better care for them. Hildegard Peplau's model of nursing focuses on that nurse-patient relationship and identifies the different roles nurses take on when working with patients. Career of Hildegard Peplau After earning her Bachelor's Degree, Peplau studied psychological issues at Chestnut Lodge, a private psychiatric facility, with Erich Fromm, Frieda Fromm-Reichmann, and Harry Stack Sullivan. This led to Peplau's life long work, which extended Sullivan's interpersonal theory to be used in the nursing field. From 1943 to 1945 Peplau served as an Army Corps Nurse. Being stationed at the 312th Field Station Hospital in England allowed her the opportunity to work with leading figures in American and British psychiatry. In the early 1950s, she created and taught the first classes for graduate nursing students at Teachers College. She was a member of the faculty of the College of Nursing at Rutgers University between 1954 and 1974, where she created the first graduate program for clinical specialists in psychiatric nursing. In the 1950s and 1960s, she offered summer workshops for nurses across the United States where she taught interpersonal concepts and interviewing techniques, as well as individual, family, and group therapy. Peplau worked with the World Health Organization by serving as an advisor, and was a visiting professor at universities throughout the United States and around the world. She served as a consultant to the United States Surgeon General, the United States Air Force, and the National Institutes of Mental Health. She also participated in policy-making groups for the United States government. After retiring from her position at Rutgers, Peplau helped create the first European graduate nursing program at the University of Leuven in Belgium, where she was a visiting professor in 1975 and 1976. Hildegard Peplau's Contribution to Nursing Theory: The Theory of Interpersonal Relations Peplau's model for nursing, which helped later nursing theorists and clinicians develop more therapeutic interventions, includes seven nursing roles, which show the dynamic character roles typical in clinical nursing. The Seven Nursing Roles are: the stranger role, in which the nurse receives the patient the way a stranger is met in other situations, and provides an atmosphere to build trust; the resource role, in which the nurse answers questions, interprets data, and gives information; the teaching role, in which the nurse gives instructions and provides training; the counseling role, in which the nurse helps the patient understand the meaning of current circumstances, as well as provides guidance and encouragement in order for change to occur; the surrogate role, in which the nurse acts as an advocate on behalf of the patient; the active leadership role, in which the nurse helps the patient take responsibility for meeting treatment goals; and the technical expert role, in which the nurse provides physical care for the patient and operates equipment. For those who become nurses to work with people, studying Hildegard Peplau's model of nursing can be very useful. By better understanding the seven roles of nursing, they can apply different roles in different situations, which will ensure that their patients receive the best care possible, and will ultimately speed along treatment and recovery.

5. VIRGINIA HENDERSON As a patient receives treatment and is on the road to recovery, it's important that the patient is able to take care of him or herself after being released from medical care. To that end, nurses should be caring for the patient while, at the same time, be helping the patient become more independent and reach goals and milestones on the road to health. Virginia Henderson's Need Theory addresses this issue and helps nurses help patients so that they can care for themselves when they leave the healthcare facility Career of Virginia Henderson After graduating from the Army School of Nursing, Henderson worked at the Henry Street Visiting Nurse Service for two years. In 1923, she started teaching nursing at the Norfolk Protestant Hospital in Norfolk, Virginia. After earning her Master's Degree, she stayed on at Teachers College as a faculty member, where she remained until 1948. After 1953, Henderson served as a research associate at the Yale University School of Nursing. Henderson received Honorary Doctoral degrees from the Catholic University of America, Pace University, the University of Rochester, the University of Western Ontario, and Yale University. In 1985, Henderson was presented with the first Christianne Reimann Prize from the International Council of Nurses. She was also an honorary fellow of the United Kingdom's Royal College of Nursing. The same year, she was also honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association. Henderson is well known for her definition of nursing, which says, "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge." Virginia Henderson's Contribution to Nursing Theory: Nursing Need Theory Henderson's Need Theory emphasizes the importance of patient independence so that the patient will continue to progress after being released from the hospital. Henderson described the role of the nurse as one of the following: substitutive, which is doing something for the patient; supplementary, which is helping the patient do something; or complementary, which is working with the patient to do something. All of these roles are to help the patient become as independent as possible. She categorized nursing activities into fourteen components based on human needs. The fourteen components of Henderson's concept are as follows: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Breathe normally. Eat and drink adequately. Eliminate body wastes. Move and maintain desirable postures. Sleep and rest. Select suitable clothes-dress and undress. Maintain body temperature within normal range by adjusting clothing and modifying environment. Keep the body clean and well groomed and protect the integument. Avoid dangers in the environment and avoid injuring others. Communicate with others in expressing emotions, needs, fears, or opinions. Worship according to one's faith. Work in such a way that there is a sense of accomplishment. Play or participate in various forms of recreation.

14. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities. While a nurse's job is to care for patients, it is also to help patients be able to care for themselves when they leave the healthcare facility. This will help ensure that the patient has fewer setbacks during recovery from the illness or injury, and will help the transition into self-care be smoother since a nurse will be helping and supervising along the way until the patient goes home. For those nurses who work in rehabilitation, Henderson's theory is one that can be easily used every day, and it will be the patients who benefit from it.

6. JOYCE TRAVELBEE In 1956, Travelbee earned her Bachelor of Science in Nursing degree from Louisiana State University. She was given a Master of Science in Nursing degree in 1959 from Yale University. Her career dealt predominantly with psychiatric nursing and education. She worked as a psychiatric nursing instructor at the DePaul Hospital Affiliate School in New Orleans, Louisiana, and worked later in the Charity Hospital School of Nursing in Louisiana State University, New York University, and the University of Mississippi. Joyce Travelbee's Contribution to Nursing Theory: Human-to-Human Relationship Model Travelbee developed the Human-to-Human Relationship Model of Nursing. The theory was presented in her book, Interpersonal Aspects of Nursing, which was published in 1961. The assumptions of the model are based on Soren Kierkegaard's philosophy of existentialism and Viktor Frankl's logotherapy. Existentialism places the accountability for people's choices in life on the people who make those choices. Logotherapy, which was first proposed in Frankl's Man's Searching for Meaning (1963), is a form of psychotherapy that makes the assumption that fulfillment is the best protection against emotional instability. The main concepts of the nursing theory are suffering, meaning, nursing, hope, communications, self-therapy, and a targeted intellectual approach. Each of these concepts is defined by Travelbee to help nurses understand the model. Suffering ranges from a feeling of unease to extreme torture, and varies in intensity, duration, and depth. The role of nursing in Travelbee's theory is to help the patient find meaning in the experience of suffering, as well as help the patient maintain hope. Hope is defined as a faith that can and will bring change that will bring something better with it. It has six characteristics: 1. 2. 3. 4. 5. 6. It is strongly associated with dependence on other people. It is oriented with the future. It is linked to elections from several alternatives or escape routes out of its situation. The desire to possess any object or condition, to complete a task or have an experience. Confidence that others will be there for one when you need them. The hoping person is in possession of courage to be able to acknowledge its shortcomings and fears and go forward toward its goal.

Travelbee believed nursing should be accomplished through human relationships that begin with the original encounter, progress through the stages of emerging identities, and lead to the development of empathy and sympathy. The nursepatient relationship is essential to successful patient care, and this relationship is established by an interaction process. Building the patient-nurse relationship takes place in five phases: the original encounter, the visibility of personal or

emerging identities, empathy, sympathy, and the establishment of mutual understanding and a rapport. In this theory, health is both subjective and objective. Subjective health is an individually-defined state of well being in accordance with self-appraisal of the physical-emotional-spiritual status. Objective health, on the other hand, is the absence of any discernible disease, disability, or defect as measured by physical examination, lab tests, and assessment by a spiritual director or psychological counselor. This theory has greatly influenced hospice nursing in that hospice nurses focus on the relationships with their patients to improve quality of life.

7. BETTY NEUMAN It's important to look at a patient from a holistic perspective. A patient is not simply the illness or injury being treated, but an entire person. In fact, every aspect of a patient can contribute to how that patient deals with treatment and recovery, and it should all be considered when caring for the patient. In Betty Neuman's nursing theory, patients are cared for from a holistic perspective in order to ensure they are cared for as people and not simply ailments. Career of Betty Neuman After earning her Masters degree, Neuman began working as a nurse. Specifically, she was a pioneer in nursing involvement in community mental health. While she was developing her systems model, she was working as a lecturer at the University of California-Los Angeles in community health nursing. Due to her work in nursing, Neuman was named as an Honorary Member of the Fellowship of the American Academy of Nursing. Betty Neuman's first book, The Neuman Systems Model, was published in 1982. The book included nursing process format and care plans, and was a total approach to client care. Newer editions were published in 1989, 1995, 2002, and 2010. After the publication of her model, Neuman spent her time educating nurses and professors about it through her work as an author and speaker. Betty Neuman's Contribution to Nursing Theory: Neuman Systems Model In 1970 she began developing her Systems Model as a way to teach introductory nursing to students by giving them a holistic view of patients that included the physiological, psychological, sociological, and developmental aspects. It was first developed as a graduate course guide, and in 1972, the May/June edition of Nursing Research published "A model for teaching total person approach to patient problems." In 1974, Neuman's model was refined and published in Conceptual Models for Nursing Practice. It was classified as a systems model, and was titled "The Betty Neuman HealthCare Systems Model: A Total Person Approach to Patient Problems." In this publication, the term "patient" was replaced with the term "client." The Neuman Systems Model is based on the patient's relationship to stress, reaction to it, and reconstitution factors that are dynamic. The Neuman Systems Model is universal in nature, which allows it to be adapted to a variety of situations, and to be interpreted in many different ways. The central philosophy of Neuman's nursing theory consists of energy resources that are surrounded by three things:

several lines of resistence, which represent the internal factors helping the patient fight against a stressor; the normal line of defense, which represents the patient's equilibrium; and the flexible line of defense, which represents the dynamic nature that can rapidly change over a short time. In the Neuman Systems Model, the nurse's role is to keep the system's stability by using three levels of prevention. The first is primary prevention, which protects the normal line and strengthens the flexible line of defense. The secondary prevention is used to strengthen the internal lines of resistence, which reduces the reaction and increases resistence factors. Finally, tertiary prevention readapts, stabilizes, and protects the patient's return to wellness after treatment.

8. IMOGENE KING Many people decide to pursue a career in nursing because they want to be instrumental in helping patients get healthy. In order to do that, it's necessary to set health goals with the patient, then take steps to achieve those goals. Imogene King's Theory of Goal Attainment focuses on this process to aid nurses in the nurse-patient relationship, helping their patients meet the goals they set for their health. Career of Imogene King Between 1966 and 1968, King worked as Assistant Chief of the Research Grants Branch of the Division of Nursing in Washington, D.C. under Dr. Jessie Scott. She was the director of the Ohio State University School of Nursing from 1968 until 1972. She was an Associate Professor from 1961 until 1966 and a Professor from 1971 until 1980 at Loyola University in Chicago. After serving as a professor at the University of South Florida's College of Nursing in Tampa, Florida from 1980 until 1990, King retired with the title Professor Emeritus. During her career, King was an active member of the District IV Florida Nurses Association, the American Nurses Association, and Sigma Theta Tau International. She was also a Fellow in the American Academy of Nursing. Imogene King's Contribution to Nursing Theory: Theory of Goal Attainment Imogene King's Theory of Goal Attainment was first introduced in the 1960s. The basic concept of the theory is that the nurse and patient communicate information, set goals together, and then take actions to achieve those goals. It describes an interpersonal relationship that allows a person to grow and develop in order to attain certain life goals. The factors that affect the attainment of goals are roles, stress, space, and time. According to King, the patient is a social being who has three fundamental needs: the need for health information, the need for care that seeks to prevent illness, and the need for care when the patient is unable to help him or herself. She explains health as involving life experiences of the patient, which includes adjusting to stressors in the internal and external environment by using resources available. The environment is the background for human interaction. It involves the internal environment, which transforms energy to enable people to adjust to external environmental changes, and it involves the external environment, which is formal and informal organizations. A nurse is considered part of the patient's environment. The three interacting systems in her Theory of Goal Attainment are the personal system, the interpersonal system, and the social system. Each system is given different concepts. The concepts for the personal system are: perception, self, growth and development, body image, space, and time. The concepts for the interpersonal system are: interaction, communication, transaction, role, and stress. The concepts for the social system are: organization, authority, power,

status, and decision making. King's Theory of Goal Attainment defines nursing as "process of action, reaction and interaction by which nurse and patient share information about their perception in nursing situation." According to King, nursing's focus is on the care of the patient, and its goal is the health care of patients and groups of patients. According to King, the goal of the nurse is to help patients maintain health so they can function in their individual roles. The nurse's function is to interpret information in the nursing process, to plan, implement, and evaluate nursing care. In the nurse-patient relationship, the nurse first uses his or her knowledge base to assess the patient and make a diagnosis. After the diagnosis, the nurse creates a plan for interventions to solve problems that were identified in the assessment and diagnosis. Once a care plan is created, actions are implemented to achieve the patient's health goals. Finally, the nurse evaluates the patient to determine whether or not the goals were achieved. In the healthcare field, the ultimate goal in the nurse-patient relationship is to help the patient achieve his or her goals for getting healthy. By using the nursing process described in Imogene King's Theory of Goal Attainment, a nurse can be more effective in working with a patient to achieve those goals, and can truly help patients.

9. DOROTHEA OREM n some situations, patients are encouraged to be more independent. This can be especially true in rehabilitation settings, in which patients are transitioning out of being cared for by physicians and nurses and back home to exclusive self-care. In these cases, the Self-Care Deficit Nursing Theory can be applied to help patients be more independent and prepare to be released from the healthcare facility where they are being cared for. Career of Dorothea E. Orem Dorothea Orem had a distinguished career in nursing. She earned several Honorary Doctorate degrees. She was given Honorary Doctorates of Science from both Georgetown University in 1976 and Incarnate Word College in 1980. She was given an Honorary Doctorate of Humane Letters from Illinois Wesleyan University in 1988, and a Doctorate Honoris Causae from the University of Missouri in Columbia in 1998. She was also given many awards during her career: the Catholic University of America Alumni Achievement Award for Nursing Theory in 1980, the Linda Richards Award from the National League for Nursing in 1991, and was named an honorary Fellow of the American Academy of Nursing in 1992.

Dorothea E. Orem's Contribution to Nursing Theory: Self-Care Deficit Nursing Theory (SCDNT) The Self-Care Deficit Nursing Theory, also known as the Orem Model of Nursing, was developed by Dorothea Orem between 1959 and 2001. It is considered a grand nursing theory, which means the theory covers a broad scope with general concepts that can be applied to all instances of nursing. The central philosophy of the Self-Care Deficit Nursing Theory is that all patients want to care for themselves, and they are able to recover more quickly and holistically by performing their own self-care as much as they're able. This theory is particularly used in rehabilitation and primary care or other settings in which patients are encouraged to be independent.

The self-care requisites identified by Dorothea Orem fall into one of three categories. The first is universal self-care requisites, which are needs that all people have. These include things like air, water, food, activity and rest, and hazard prevention. The second is developmental self-care requisites, which has two sub-categories: maturational, which progress the patient to a higher level of maturation, or situational, which prevent against harmful effects in development. The third category is health deviation requisites, which are needs that come up based on the patient's condition. If a patient is unable to meet their self-care requisites, a "self-care deficit" occurs. In this case, the patient's nurse steps in with a support modality which can be total compensation, partial compensation, or education and support. One of the benefits of Dorothea Orem's Self-Care Deficit Nursing Theory is that it can easily be applied to a variety of nursing situations and patients. The generality of its principles and concepts make it easily adaptable to different settings, and nurses and patients can work together to ensure that the patients receive the best care possible, but are also able to care for themselves. Thanks to Dorothea Orem's dedication to nursing, as well as her hard work in the field, nurses can use her theory today to care for patients and make their transition from the hospital or full-time care facility to their own home much smoother.

10. SISTER CALLISTA ROY Though there are hard and fast answers in the healthcare field, it is also adaptive and nurses need to be flexible in order to provide the best care for their patients. After all, each patient is different and should be cared for based on the individual needs of that particular patient. To better understand the adaptive nature of nursing, it would help to study Sister Callista Roy's Adaptive Model of Nursing. Career of Sister Callista Roy After working as a staff nurse and in administrative positions at St. Mary's Hospital in Tucson, Arizona, and St. Joseph's Hospital in Lewiston, Idaho, Roy joined the faculty of Mount St. Mary's College in 1996. She also served as Department Chair between 1971 and 1982. While working at the University of Portland, Roy helped create a Master's program in Nursing. And at the Connell School of Nursing, she was involved in developing a Ph.D. program in Nursing. She also served as a visiting professor to colleges around the world, including La Sabana University in Colombia, the University of Lund in Sweden, and the University of Conception in Chile. Between 2003 and 2006, Roy served on the Board of the International Network for Doctoral Education. She is also Faculty Senior Nurse Scientist at the Yvonne L. Munn Center for Nursing Research at Massachusetts General Hospital. Since developing her Adaptation Model of Nursing, Roy has had over 100 publications, which includes 11 books with translations in 12 languages. She has been awarded four Honorary Doctoral degrees, has several teaching awards, and won national awards from STTI, NANDA, and NLN. In 1995, Mount St. Mary's College awarded Roy the Carondelet Medal for her contributions to the nursing field. In 1978, she was elected to the American Academy of Nursing, and is still an active Fellow. Sister Callista Roy's Contribution to Nursing Theory: Adaptation Model of Nursing Developed by Roy in 1976, the Adaptation Model of Nursing asks three central questions: Who is the focus of nursing care? What is the target of nursing care? and When is nursing care indicated? This model looks at the patient from a

holistic perspective. The three concepts of her model are the human being, adaptation, and nursing. Under the concept of adaptation are four modes: physiological, self concept, role function, and interdependence. The physiological mode deals with the maintenance of the physical body. This includes basic human needs such as air, water, food, and temperature regulation. The function of the mode of self-concept is the need for the maintenance of the mind. The person's perceptions of his or her physical and personal self are included in this mode. Social integrity is emphasized in the role function mode. This addresses people's adaptations to different role changes that occur throughout a lifetime. The interdependence mode also addresses social integrity. This mode deals with the balance between independence and interdependence in a person's relationships with other people. According to Roy's model, the goal of nursing is to promote adaptation of the patient during illness and health in all four of the modes. The nurse's actions begin with assessment on two levels. First, the nurse makes a judgment as to the presence or absence of maladaptation. Second, the nurse focuses on the stimuli influencing the patient's maladaptive behavior. The nurse then takes actions to promote adaptation by manipulating the environment, elements of the patient system, or both as part of their nursing care plan. Nursing is not rigid. And by applying Roy's Adaptive Model of Nursing to your nursing practice, you can be sure that the care you give your patients will be the highest quality you can provide for that individual patient in his or her individual situation.

11. MADELEINE LEININGER While it is important to look at a patient as a whole person from a physiological, psychological, spiritual, and social perspective, it is also important to take a patient's culture and cultural background into consideration when deciding how to care for that patient. After all, the values and beliefs passed down to that patient from generation to generation can have as much of an effect on that patient's health and reaction to treatment as the patient's environment and social life. The Transcultural Nursing theory developed by Madeleine Leininger is now a nursing discipline that is an integral part of how nurses practice in the healthcare field today. Career of Madeleine Leininger Madeleine Leininger was born on July 13, 1925 in Sutton, Nebraska. She earned several degrees, including a Doctor of Philosophy, a Doctor of Human Sciences, a Doctor of Science, and is a Registered Nurse. She is a Certified Transcultural Nurse, a Fellow of the Royal College of Nursing in Australia, and a Fellow of the American Academy of Nursing. Madeleine Leininger's Contribution to Nursing Theory: Transcultural Nursing Madeleine Leininger's theory of Transcultural Nursing, also known as Culture Care Theory, falls under both the category of a specialty, as well as a general practice area. The theory has now developed into a discipline in nursing. The Transcultural Nursing theory first appeared in Leininger's Culture Care Diversity and Universality, published in 1991, but it was developed in the 1950s. The theory was further developed in her book Transcultural Nursing, which was published in 1995. In the third edition of Transcultural Nursing, published in 2002, the theory-based research and the application of the Transcultural theory are explained.

Transcultural nursing is a study of cultures to understand both similarities and differences in patient groups. Culture is a set of beliefs held by a certain group of people, handed down from generation to generation. In transcultural nursing, nurses practice according to the patient's cultural considerations. It begins with a culturalogical assessment, which takes the patient's cultural background into consideration in assessing the patient and his or her health. Once the assessment is complete, the nurse should use the culturalogical assessment to create a nursing care plan that also takes the patient's cultural background into consideration. There are many reasons it's beneficial for nurses to use cultural knowledge of patients to treat them. First of all, it helps nurses to be aware of ways in which the patient's culture and faith system provide resources for their experiences with illness, suffering, and even death. It helps nurses to be understanding and respectful of the diversity that is often very present in a nurse's patient load. It also helps strengthen a nurse's commitment to nursing based on nurse-patient relationships and emphasizing the whole person rather than viewing the patient as simply a set of symptoms or an illness. Finally, using cultural knowledge to treat a patient also helps a nurse to be open minded to treatments that can be considered non-traditional, such as spiritually based therapies like meditation and anointing. In the Transcultural Nursing theory, nurses have a responsibility to understand the role of culture in the health of the patient. Not only can a cultural background influence a patient's health, but the patient may be taking home remedies that can affect his or her health, as well. Leininger identified three nursing decisions and actions that achieve culturally friendly care for the patient. They are: cultural preservation or maintenance, cultural care accommodation or negotiation, and cultural care re-patterning or restructuring. The nurse's assessment of the patient should include a self-assessment that addresses how the nurse is affected by his or her own cultural background, especially in regards to working with patients from culturally diverse backgrounds. The nurse's diagnosis of the patient should include any problems that may come up that involve the healthcare environment and the patient's cultural background. In addition, the nurse's care plan should involve aspects of the patient's cultural background when needed. Finally, the nurse's evaluation should include a self-evaluation of attitudes toward caring for patients from differing cultural backgrounds. In today's healthcare field, it is required for nurses to be sensitive to their patients' cultural backgrounds when creating a nursing plan. This is especially important since so many people's culture is so integral in who they are as individuals, and it is that culture that can greatly affect their health, as well as their reactions to treatments and care. Thanks to Madeleine Leininger's Transcultural Nursing theory, nurses can look at how a patient's cultural background is involved in his or her health, and use that knowledge to create a nursing plan that will help the patient get healthy quickly while still being sensitive to his or her cultural background.

12. JEAN WATSON Many men and women enter the nursing field because they see it as a career that cares about people. Compassion is often a trait required of nurses, since taking care of patients' needs is their primary purpose. Jean Watson's Philosophy and Science of Caring addresses how nurses care for their patients, and how that caring translates into better health plans to help patients get healthy. Career of Jean Watson

Watson graduated from the Lewis Gale School of Nursing in 1961, and then continued her nursing studies at the University of Colorado at Boulder. She earned her bachelor's degree in 1964, a Master's degree in psychiatric and mental health nursing in 1966, and a Ph.D. in educational psychology and counseling in 1973. She served as Dean of Nursing at the University Health Sciences Center and was the President of the National League for Nursing. She is a fellow of the American Academy of Nursing. Her books include Nursing: The Philosophy and Science of Caring, Revised Edition , which was published in 2008. She currently holds an endowed chair at the University of Colorado, and in 2008, she created the Watson Caring Science Institute to help spread her nursing theory and ideas. Watson has six honorary degrees, including an International Honorary Doctorate from the University of Montreal in Quebec, Canada in 2003, and an Honorary Doctor of Sciences in Nursing from the University of Victoria in British Columbia, Canada in 2010. Jean Watson's Contribution to Nursing Theory: Philosophy and Science of Caring Jean Watson's Philosophy and Science of Caring addresses how nurses express care to their patients. Caring is central to nursing practice, and promotes health better than a simple medical cure. She believes that a holistic approach to health care is central to the practice of caring in nursing. According to Watson, caring, which is manifested in nursing, has existed in every society. However, a caring attitude is not transmitted from generation to generation. Instead, it's transmitted by the culture of the nursing profession as a unique way of coping with its environment. According to her theory, caring can be demonstrated and practiced by nurses. Caring for patients promotes growth; a caring environment accepts a person as he or she is, and looks to what he or she may become. Caring consists of curative factors. Watson's 10 curative factors are: forming humanistic-altruistic value systems, instilling faith-hope, cultivating a sensitivity to self and others, developing a helping-trust relationship, promoting an expression of feelings, using problem-solving for decision-making, promoting teaching-learning, promoting a supportive environment, assisting with gratification of human needs, and allowing for existential-phenomenological forces. The first three factors form the "philosophical foundation" for the science of caring, and the remaining seven come from that foundation. Within assisting with the gratification of human needs, Watson orders the needs. Lower-order biophysical needs include food and fluid, elimination, and ventilation. Lower-order psychophysical needs include activity-inactivity and sexuality. Higher-order psychosocial needs include achievement, affiliation, intrapersonal-interpersonal need, and selfactualization. Watson's theory has four major concepts: human being, health, environment/society, and nursing. The human being is defined as "...a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. He, human is viewed as greater than and different from, the sum of his or her parts." A human's health includes a high level of overall physical, mental, and social function; a general adaptive-maintenance level of daily function; and the absence of illness or the process of efforts that will lead to an absence of illness. Watson's nursing process parallels the scientific research process. The first step is assessment. This involves observation, identification and review of the problem, and the formulation of a hypothesis. Next, the nurse creates a care plan to determine how variables will be examined, as well as what data should be collected and how. Step three is intervention. This is the implementation of the developed plan and includes the collection of the data. Finally, the nurse conducts an

evaluation. This is the examination of the data and results of the intervention, and the interpretation of the results. This may lead to an additional hypothesis. One advantage to Watson's Philosophy and Science of Caring theory is that it creates a generalized framework for nursing that can be applied to a variety of situations and patients. It also places the patient in the context of the family, community, and culture. The patient is the focus of practice rather than the technology. However, the "looseness" of Watson's framework can also be a drawback in instances when something more structured is needed for the care of a patient.

13. LYDIA HALL Biography and Career of Lydia E. Hall Lydia E. Hall was born on September 21, 1906 in New York City. In 1927, she earned her nursing diploma and went on to complete a Bachelor of Science in Public Health Nursing in 1937. She earned a Master's degree to teach natural sciences in 1942. Hall worked as the first director of the Loeb Center for Nursing. Her nursing experience was in clinical nursing, nursing education, research, and in a supervisory role. Hall died in 1969. Lydia E. Hall's Contribution to Nursing Theory: Care, Cure, Core Theory of Nursing Lydia E. Hall developed the Care, Cure, Core Theory of Nursing in the late 1960s as a result of her work in psychiatry, as well as her experiences at the Loeb Center. In her career, she promoted involvement of community members in healthcare issues, as well. Also known as "the Three Cs of Lydia Hall," Hall's theory contains three independent but interconnected circles. The three circles are: the core, the care, and the cure. e core is the patient to whom nursing care is directed. The core has set goals by him or herself rather than by a healthcare provider or family and friends. The core makes decisions and behaves according to his or her feelings and values. The cure is the attention given to the patient by the nurse and other medical professionals. In this model, the focus of care is not only on the nurse, but on all healthcare professionals involved in the care of the patient. The cure includes interventions or actions geared toward treating the patient of whatever illness, disease, or disability he or she may be suffering from. The care circle is Hall's explanation of the role of nurses in her model. According to the theory, nurses are focused on performing the noble task of nurturing patients. This specifically speaks to the "motherly" nature of nursing, which may include a nurse addressing a patient's comfort issues. The role of nursing also includes educating patients, and helping a patient meet any needs he or she is unable to meet alone. The theory puts emphasis on the importance of the total patient rather than looking at one part or aspect. There is also emphasis put on all three aspects of the theory (care, cure, and core circles) functioning together.

14. MARTHA ROGERS There are many people who believe that a person and his or her environment are integral to each other. That is, a patient can't be separated from his or her environment when addressing health and treatment. By practicing nursing with this view of the coexistence of the human and his or her environment, a nurse can apply Martha E. Rogers's Science of Unitary Human Beings to treat patients and help them in the process of change toward better health. Career of Martha E. Rogers Rogers worked as a professor at New York University's School of Nursing. She was also a Fellow for the American Academy of Nursing. Her publications include: Theoretical Basis of Nursing (1970), Nursing Science and Art: A Prospective (1988), Nursing: Science of Unitary, Irreducible, Human Beings Update (1990), and Vision of Space Based Nursing (1990). Martha E. Rogers' Contribution to Nursing Theory: Science of Unitary Human Beings Patients are considered "unitary human beings," who cannot be divided into parts, but have to be looked at as a whole. According to Rogers's model, patients have the capacity to participate knowingly in the process of change. The environment is also irreducible, and coexists with unitary human beings. In this model, humans are viewed as integral with the universe. That is, the patient and his or her environment are one. Rogers defined health as an expression of the life process. To that end, illness and health are part of the same continuum, and the events occurring throughout the patient's life show how the patient is achieving his or her health potential. The basic characteristics that describe the life process of the patient are: energy field, openness, pattern, and pan dimensionality. The energy field is the fundamental unit of all, both the living and unliving. It provides a way to view the patient and his or her environment as wholes, and it continuously changes in intensity, density, and extent. Openness refers to the fact that the human and environmental fields are constantly exchanging their energies. That is, there are no boundaries that block the flow of energy between fields. Pattern is the distinguishing characteristic of an energy field that is seen as a single wave. It's an abstraction, and simply serves to give identiy to the field. Pan dimensionality is a domain that has no spatial or temporal attributes. Nursing in the Science of Unitary Human Beings contains two dimensions: the science of nursing, which is the knowledge specific to the field of nursing that comes from scientific research; and the art of nursing, which involves using the science of nursing creatively to help better the life of the patient. In this model, the role of the nurse is to serve people. Rogers also proposes noninvasive modalities for nursing, such as therapeutic touch, humor, music, meditation and guided imagery, and even the use of color. The interventions of nurses are meant to coordinate the rhythm between the human and environmental fields, help the patient in the process of change, and to help patients move toward better health. The practice of nursing, according to Rogers, should be focused on pain management, and supportive psychotherapy for rehabilitation. It is often important to look at both the patient as a whole person, and the patient's environment when treating the patient for an injury or illness. Martha E. Rogers's Science of Unitary Human Beings addresses the importance of the environment as an integral part of the patient, and uses that knowledge to help nurses blend the science and art of nursing to ensure patients have a smooth recovery and can get back to the best health possible.

15. IDA JEAN ORLANDO Regardless of how well thought out a nursing care plan is for a patient, obstacles to the patient's recovery may come up at any time. This may cause problems for the original nursing care plan, and it's the nurse's job to know how to deal with those obstacles so the patient can continue to recover and stay on the path to health. Ida Jean Orlando's Deliberative Nursing Process is a nursing theory that allows nurses to create an effective nursing care plan that can also be easily adapted when and if any complications arise with the patient. Career of Ida Jean Orlando Orlando was an associate professor at Yale School of Nursing, and while there, served as the Director of the Graduate Program in Mental Health Psychiatric Nursing. It was also at Yale that she was project investigator of a National Institute of Mental Health grant. The research from this grant led to Orlando's development of the Deliberative Nursing Process published in The Dynamic Nurse-Patient Relationship: Function, Process, and Principles (NLN Classics in Nursing Theory) in 1961. She also worked as the director of a research project at McLean Hospital in Belmont, Massachusetts. This research led to the publication of The Discipline and Teaching of Nursing Process (an evaluative study) in 1972. Orlando has served as a board member of Harvard Community Health Plan. Ida Jean Orlando's Contribution to Nursing Theory: Deliberative Nursing Process Ida Jean Orlando's Deliberative Nursing Process is set in motion by the behavior of the patient. According to the theory, all patient behavior can be a cry for help, both verbal and non-verbal, and it is up to the nurse to interpret the behavior and determine the needs of the patient. The Deliberative Nursing Process has five stages: assessment, diagnosis, planning, implementation, and evaluation. In the assessment stage, the nurse completes a holistic assessment of the patient's needs. This is done without taking the reason for the encounter into consideration. The nurse uses a nursing framework to collect both subjective and objective data about the patient. The diagnosis stage uses the nurse's clinical judgment about health problems. The diagnosis can then be confirmed using links to defining characteristics, related factors, and risk factors found in the patient's assessment. The planning stage addresses each of the problems identified in the diagnosis. Each problem is given a specific goal or outcome, and each goal or outcome is given nursing interventions to help achieve the goal. By the end of this stage, the nurse will have a nursing care plan. In the implementation stage, the nurse begins using the nursing care plan. Finally, in the evaluation stage, the nurse looks at the progress of the patient toward the goals set in the nursing care plan. Changes can be made to the nursing care plan based on how well (or poorly) the patient is progressing toward the goals. If any new problems are identified in the evaluation stage, they can be addressed, and the process starts over again for those specific problems. The goal of this model is for a nurse to act deliberately rather than automatically. This way, a nurse will have a meaning behind the action which means the patient gets care geared specifically toward his or her needs at that time. This nursing process is also one that can easily be adapted to different patients with different problems, and can be stopped

at anytime, depending on the patient's progress or health. This makes Orlando's theory universal for the nursing field. Nursing care has to be flexible. Not only does a nursing care plan depend on the needs of the patient at the time of admittance, but it also needs to be able to change when and if any complications come up during the treatment and recovery process. Ida Jean Orlando's Deliberative Nursing Process directly addresses this need for flexibility, and helps nurses focus on the patient rather than simply sticking to a nursing care plan no matter what.

16. MYRA ESTRIN LEVINE While working as a nurse, Levine earned experience in oncology nursing. She was a civilian nurse at the Gardiner General Hospital, and became the Director of Nursing at Drexel Home in Chicago. She later became a clinical instructor at Bryan Memorial Hospital in Lincoln, Nebraska and administrative supervisor at the University of Chicago. She served as a chairperson of clinical nursing at her alma mater, the Cook County School of Nursing, and as a visiting professor at Tel Aviv University in Israel. She is known for her publication, Introduction to Clinical Nursing, which was first published in 1969, with additional editions printed in 1973 and 1989. Myra Estrine Levine's Contribution to Nursing Theory: Four Conservation Principles Levine developed the Four Conservation Principles. In this model, the goal of nursing is to promote adaptation and maintain wholeness using the principles of conservation. The model guides nurses to focus on the influences and responses at the level of the organism. Nurses accomplish the theory's goal through the conservation of energy, structure, and personal and social integrity. According to Levine, every individual has a unique range of adaptive responses. They vary by heredity, age, gender or the challenges that come with experiencing an illness. The responses are the same, but the timing and manifestation of the responses are unique to each individual pulse rate. Adaptation is an ongoing process of change in which the patient is able to maintain his or her integrity while staying within the realities of the environment. This is achieved through the "frugal, economic, contained and controlled use of environmental resources by the individual in his or her best interest." Wholeness exists when the patient's interaction with the environment allows integrity to be assured. Wholeness is promoted by the use of the conservation principle. Conservation is the product of adaptation. It is the achievement of a balance of energy supply and demand that is within the unique biological realities of the individual patient. The conservation principle has four aspects: conservation of energy, conservation of structural integrity, conservation of personal integrity, and conservation of social integrity. Conservation of energy refers to balancing how energy goes in and out of the body to avoid fatigue. It includes adequate rest, nutrition, and exercise. Conservation of structural integrity refers to maintaining or restoring the physical body and promoting physical healing. The conservation of personal integrity recognizes the patient's need for recognition, respect, self-awareness, and self-determination. In this area, for example, a nurse will honor a patient's need for personal space. The conservation of social integrity addresses the patient's interactions and relationships with other people, such as in a family, community, or religious group.

In this theory, nursing is a profession and an academic discipline, and should be studied and practiced in harmony with all disciplines that make up the health sciences. Nursing involves engaging in human interactions. Levine states that the goal of nursing is to promote wholeness, while realizing that every individual requires a unique cluster of activities to achieve wholeness. The patient's individual integrity is his or her concern, and it is the nurse's responsibility to assist him or her to defend and seek the realization of that individual integrity. Levine offers nine models of guided assessment in the Four Conservation Principles theory of nursing. They are: 1. 2. 3. 4. 5. 6. 7. 8. 9. vital signs body movement and positioning meeting personal hygiene needs pressure gradient system in nursing interventions nursing determination in provision of nutritional needs pressure gradient system in nursing local application of hot and cold administration of medicine establishing an aseptic environment

The nursing process used in this model is: 1. 2. 3. 4. 5. Assessment Trophicognosis Hypothesis Interventions Evaluation

17. KATHARINE KOLCABA One of the many roles of a nurse is to make sure patients are well cared for and comfortable. After all, many people decide to go into the field of nursing to help people, and what better way to help patients than to make sure they have everything they need to be comfortable during treatment and recovery? In Katharine Kolcaba's Comfort Theory of Nursing, the focus is on patient comfort. And though her theory is relatively new, it is one that will seem to be useful in a wide variety of nursing settings. Career of Katharine Kolcaba Kolcaba is currently serving as Associate Professor of nursing at the University of Akron College of Nursing. She has received many awards, including the Cushing Robb Prize from Case Western Reserve University in 1987 for outstanding work in a Master of Science in Nursing program and the Advancement of Science Award from Midwest Nursing Research Society for End of Life and Palliative Care Nursing in 2003. In 2005, she was awarded the Mary Hanna Journalism Second Place Award in the Best Practice Category by the American Society of Perianesthesia Nurses for a co-written article published in the Journal of PeriAnesthesia Nursing. She was also given the Marie Haug Student Award for Excellence in Aging Studies from Case Western Reserve Univeristy in 1997. Most recently, she was given the Researcher of the Year award with Dr. Therese Dowd from the Delta Omega Chapter of Sigma Theta Tau in 2006. Since retiring from teaching, Kolcaba has focused on volunteering with the American Nurses Association and the Honor Society of Nursing, Sigma Theta Tau. Her publications include Comfort Theory and Practice: A Vision for Holistic Health Care and Research.

Katharine Kolcaba's Contribution to Nursing Theory: Comfort Theory Kolcaba developed her nursing theory in the 1990s. It is a middle range nursing theory designed for nursing practice, research, and education. According to her theory, patient comfort exists in three forms: relief, ease, and transcendence. These comforts can occur in four contexts: physical, psychospiritual, environmental, and sociocultural. Relief comfort usually comes in the form of pain management through medications. When medications are administered, the patient has a sense of relief from the pain. Ease comfort is focused more on the environment and psychological state of the patient. For example, after issues of anxiety are addressed and dealt with, a patient feels at ease. Finally, transcendence comfort comes when a patient is able to rise above challenges that occur in care and recovery. In this theory, the role of a nurse is to assess a patient's comfort needs and create a nursing care plan to meet those needs. As a patient's comfort needs change, the nurse's interventions change, as well. Through this method, nurses are able to ensure their patients are properly cared for, and that they are comfortable. If a patient is comfortable, he or she will feel emotionally and mentally better, which will aid in recovery.

18. RAMONA MERCER The relationship between a mother and child is an important one. The foundation of this relationship is the basis for how the mother and child grow and change together, as well as how the child develops individually. Many nurses work in the perinatal field in order to help foster this relationship, and nursing theory can give them the resources and tools to do it. Nurses can help women develop their maternal roles with the help of Ramona Mercer's Maternal Role Attainment Theory. Career of Ramona Mercer Ramona Mercer has served as the head nurse in pediatrics and staff nurse in intrapartum, postpartum, and newborn nursery units. For over 30 years, she has done research into parenting in low- and high-risk situations and transition into the maternal role. She authored Perspectives on Adolescent Health Care, Transitions in a Woman's Life, and Parents at Risk. In 1990, she received the American Nurses Foundation's Distinguished Contribution to Nursing Science Award. Mercer is a professor emeritus in the department of family health care nursing at the University of California in San Francisco. She spends her time teaching and writing to educate others about perinatal and maternal nursing. Ramona Mercer's Contribution to Nursing Theory: Maternal Role Attainment Theory The Maternal Role Attainment Theory, a mid-range theory, was developed to serve as a framework for nurses to provide appropriate health care interventions for nontraditional mothers in order for them to successfully adopt a strong maternal identity. Though this theory can be used throughout pregnancy and after childbirth to help mothers connect with their babies, it can also be beneficial for adoptive mothers, foster mothers, or others who have had nontraditional motherhood unexpectedly, such as taking care of a relative or friend's child as the result of a death. The process helps the mother form an attachment to the infant, which in turn helps the infant form an attachment with the mother. This helps in the building of the mother-child relationship as the infant grows. The primary concept of this theory is the developmental and interactional process, which occurs over a period of time. In the process, the mother bonds with the infant, acquires competence in general caretaking tasks, and comes to

express joy and pleasure in the maternal role. The nursing process follows four stages of acquisition in the Maternal Role Attainment Theory. First is the anticipatory stage, which addresses the social and psychological adaptation to the maternal role, and learning expectations. Second is the formal stage, which is the assumption of the role at birth, and addresses behaviors guided by others in the mother's social system and network. For example, "My mother always said..." Third is the informal stage, in which the mother develops her own ways of mothering not conveyed by her social system. Finally, the fourth stage is the personal stage, in which the mother experiences harmony, confidence, and competence in her maternal role.

19. MARGARET NEWMAN Margaret A. Newman's Contribution to Nursing Theory: Health as Expanding Consciousness The initial idea for Newman's Health as Expanding Consciousness Theory came together as a result of an invitation to speak at a conference on nursing in 1978. It stems from Rogers' Theory of Unitary Human Beings. It was stimulated by concern for those for whom the absence of disease or disability is not possible. Newman was also influenced by Bentov's concept of the evolution of consciousness, Young's Theory of Process, and Bohm's Theory of Implicate. This grand theory of nursing claims that every person in every situation, regardless of how disordered and hopeless it may seem, is part of the universal process of expanding consciousness, which is a process of becoming more of oneself, finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world. Newman's theory makes six assumptions. They are: 1. Health encompasses conditions heretofore described as illness, or, in medical terms, pathology. 2. These pathological conditions can be considered a manifestation of the total pattern of the individual patient. 3. The pattern of the individual patient that eventually manifests itself as pathology is primary, and exists prior to structural or functional changes. 4. Removal of the pathology in itself will not change the pattern of the individual patient. 5. If becoming ill is the only way an individual patient's pattern can manifest itself, then that is health for that individual patient. 6. Health is an expansion of the consciousness. According to Newman, "The theory of health as expanding consciousness (HEC) was stimulated by concern for those for whom health as the absence of disease or disability is not possible. Nurses often relate to such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness. The theory has progressed to include the health of all persons regardless of the presence or absence of disease. 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 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 world." Humans are open to the whole energy system of the universe and constantly interacting with the energy. With the process of interaction, humans are evolving their individual patterns of whole. According to Newman, the pattern of the individual patient is essential. The expanding consciousness is pattern recognition. How a disease manifests in an individual patient depends on the pattern of that patient, so the pathology of the disease exists before the symptoms appear. By this logic, the removal of the symptoms of the disease will not change the

patient's individual structure or pattern. The model also addresses the interrelatedness of time, space, and movement. Time and space are the temporal pattern of the patient, and have a complementary relationship. People are constantly changing through time and space, which is movement, which shows a unique pattern of reality. According to Newman, nursing is the process of recognizing the patient in relation to the environment, and it is the process of the understanding of consciousness. The nurse helps patients understand how to use the power they have within in order to develop a higher level of consciousness. Therefore, it helps to realize the process of disease, its recovery, and its prevention. Nursing is seen as a partnership between the nurse and patient, and both grow in the sense of higher levels of consciousness.