case study using nursing theory

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New Knowledge for the Profession: Case for Using Nursing Theory

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• 1 Purdue University Northwest, Hammond, IN, USA.
• PMID: 32605483
• DOI: 10.1177/0894318420920622

First, the authors of this column reiterate the need for using nursing theory as a foundation for nursing research and practice. A study underpinned by Johnson's behavioral model is presented as an excellent example of the use of nursing theory to guide research in the care of people with heart failure.

Keywords: borrowed theories; discipline of nursing; nursing theory.

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What Is Nursing Theory?

3 min read • July, 05 2023

Nursing theories provide a foundation for clinical decision-making. These theoretical models in nursing shape nursing research and create conceptual blueprints, ultimately determining the how and why that drive nurse-patient interactions.

Nurse researchers and scholars naturally develop these theories with the input and influence of other professionals in the field.

Why Is Nursing Theory Important?

Nursing theory concepts are essential to the present and future of the profession. The first nursing theory — Florence Nightingale's Environmental Theory — dates back to the 19th century. Nightingale identified a clear link between a patient's environment (such as clean water, sunlight, and fresh air) and their ability to recover. Her discoveries remain relevant for today's practitioners. As health care continues to develop, new types of nursing theories may evolve to reflect new medicines and technologies.

Education and training showcase the importance of nursing theory. Nurse researchers and scholars share established ideas to ensure industry-wide best practices and patient outcomes, and nurse educators shape their curricula based on this research. When nurses learn these theories, they gain the data to explain the reasoning behind their clinical decision-making. Nurses position themselves to provide the best care by familiarizing themselves with time-tested theories. Recognizing their place in the history of nursing provides a validating sense of belonging within the greater health care system. That helps patients and other health care providers better understand and appreciate nurses’ contributions.

Types of Nursing Theories

Nursing theories fall under three tiers: grand nursing, middle-range, and practical-level theories . Inherent to each is the nursing metaparadigm , which focuses on four components:

• The person (sometimes referred to as the patient or client)
• Their environment (physical and emotional)
• Their health while receiving treatment
• The nurse's approach and attributes

Each of these four elements factors into a specific nursing theory.

Grand Nursing Theories

Grand theories are the broadest of the three theory classifications. They offer wide-ranging perspectives focused on abstract concepts, often stemming from a nurse theorist’s lived experiences or nursing philosophies. Grand nursing theories help to guide research in the field, with studies aiming to explore proposed ideas further.

Hildegard Peplau's Theory of Interpersonal Relations is an excellent example of a grand nursing theory. The theory suggests that for a nurse-patient relationship to be successful, it must go through three phases: orientation, working, and termination. This grand theory is broad in scope and widely applicable to different environments.

Middle-Range Nursing Theories

As the name suggests, middle-range theories lie somewhere between the sweeping scope of grand nursing and a minute focus on practice-level theories. These theories are often phenomena-driven, attempting to explain or predict certain trends in clinical practice. They’re also testable or verifiable through research.

Nurse researchers have applied the concept of Dorothea E. Orem's Self-Care Deficit Theory to patients dealing with various conditions, ranging from hepatitis to diabetes. This grand theory suggests that patients recover most effectively if they actively and autonomously perform self-care.

Practice-Level Nursing Theories

Practice-level theories are more specific to a patient’s needs or goals. These theories guide the treatment of health conditions and situations requiring nursing intervention. Because they’re so specific, these types of nursing theories directly impact daily practices more than other theory classifications. From patient education to practicing active compassion, bedside nurses use these theories in their everyday responsibilities.

Nursing Theory in Practice

Theory and practice inform each other. Nursing theories determine research that shapes policies and procedures. Nurses constantly apply theories to patient interactions, consciously or due to training. For example, a nurse who aims to provide culturally competent care — through a commitment to ongoing education and open-mindedness — puts Madeleine Leininger's Transcultural Nursing Theory into effect. Because nursing is multifaceted, nurses can draw from multiple theories to ensure the best course of action for a patient.

Applying theory in nursing practice develops nursing knowledge and supports evidence-based practice. A nursing theoretical framework is essential to understand decision-making processes and to promote quality patient care.

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Case Studies in Nursing Theory

Winstead-Fry, Patricia

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Peplau’s Theory of Interpersonal Relations: A Case Study

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Nursing Theories & Theorists Explained

What is nursing theory.

• Nursing Theory Users
• Metaparadigms

Nursing Theorists

Nursing theory in practice.

Nursing theory is "a creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena," per the book  Integrated Theory and Knowledge Development in Nursing.

Nursing theory provides the foundational knowledge that enables nurses to care for their patients and guides their actions. Theories are in place, regardless of nursing specialization, to establish guidelines for both broad and specific nursing practices.

Nursing theory is heavily influenced by Florence Nightingale's pioneering work, which significantly influenced the modern  nursing definition . Nightingale's Environmental Theory stated that nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet – all at the least expense of vital power to the patient.” 

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By identifying potential risk factors for illness or conditions that would exacerbate an illness and potentially lead to death, Nightingale saw the importance of a patient’s environment to their overall health and well-being. As a result, healthcare professionals, including nurses, began to treat patients differently and the start of population health and public health is seen. 

In Florence Nightingale’s Environmental Theory, she identified five environmental factors: 

• Efficient drainage 
• Cleanliness or sanitation
• Light or direct sunlight

These factors were essential to decrease the spread of contagious diseases and decreasing mortality and morbidity. 

While Florence Nightingale may have introduced the first nursing theory in 1860, it is still extremely relevant today. In countries where fresh air, pure water, efficient drainage, cleanliness or sanitation, and light or direct sunlight are not present, morbidity and mortality are increased. 

What are Nursing Theories Used For?

Nursing theories provide the foundation for nursing practice and are essential to the care of patients. Academic hospitals and Magnet hospitals will consistently ensure that nursing theories are incorporated into their policies and procedures to ensure best practice is being used. 

Most nurses and institutions will employ a variety of nursing theories within their everyday practice versus just one theory. Most do it unknowingly. 

Nursing theories help bedside nurses evaluate patient care and base nursing interventions on the evaluation of the findings. 

The theories can also provide nurses with the rationale to make certain decisions. An example of a nursing theory in use is seen in the care of a Jehovah’s Witnesses patient that does not believe in blood transfusions. While the patient may need a blood transfusion, Dorothea Orem’s Self-Care theory provides nurses with a solid basis for assisting their patients and giving them the opportunity to express independence and control in caring for themselves. While the nurse may not agree with the patient’s decision to not receive a blood transfusion, Orem’s theory suggests the importance of allowing the patient to make the decision and respecting it as their own choice. 

Oftentimes, the integration of nursing theory is not as obvious as in the aforementioned example. However, it is important for nurses and nursing students to understand and respect the importance of nursing theories and their impact on modern-day nursing and healthcare. 

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Who are Nursing Theories Used By?

While all nurses, regardless of position and specialty, utilize nursing theories in their practice, not all nurses are aware of their implications. Generally speaking, most nursing theories are used by nurse educators and nurse researchers. 

Nurse educators will utilize nursing theories in designing course curriculums based on educational principles, research, and theories to provide nursing students with the knowledge and skills needed to provide care to their patients. 

Nurse researchers will conduct theory-guided research in order to create best practices and to predict potential clinical problems or explain existing knowledge. 

Nursing Metaparadigms

There have been countless nursing theories introduced since Florence Nightingale's Environmental Theory, including Imogene King‘s Theory of Goal and Dorothy Johnson’s Behavioral System Model. What they all have in common is they center around the nursing metaparadigm.

A metaparadigm is a set of theories or ideas that provide structure for how a discipline should function. Nursing metaparadigms were first classified by Fawcett into four specific categories, 

• Environment

These four concepts are fundamental to all nursing theories and without identification of them and their relevance to the theory, it is incomplete.

Furthermore, these four basic nursing metaparadigms point to the holistic care of a patient and their medical health is interconnected to the four concepts. 

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The Four Main Concepts of Nursing Theory

Fawcett’s four specific concepts help define nursing and set it apart from other disciplines and professions. These four concepts have been used to define the context and content of the nursing profession. The person is the most important concept in nursing theory, but each theorist's interpretation of the other concepts is how to differentiate between them. 

Person (also referred to as Client or Human Being) is the recipient of nursing care and may include individuals, patients, groups, families, and communities.

2. Environment

Environment or situation is defined as the internal and external surroundings that affect the patient. It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, and significant others, and the setting for where they go for their healthcare.

Health is defined as the degree of wellness or well-being that the client experiences. It may have different meanings for each patient, the clinical setting, and the health care provider.

The attributes, characteristics, and actions of the nurse providing care on behalf of or in conjunction with, the client. 

Levels of Nursing Theory

Nursing theories are categorized into three levels including, 

• Grand Nursing Theories
• Mid-range Nursing Theories
• Nursing Practice Theories

Grand Nursing Theories 

These are theories based on broad, abstract, and complex concepts. They provide the general framework for nursing ideas pertaining to components such as people and health. These theories typically stem from a nurse theorist’s own experience.

Mid-Range Nursing Theories 

These are theories that drill down into specific areas of nursing rather than deal with sweeping concepts. They can emerge from nursing practice, research, or from the theories of similar disciplines.

Nursing Practice Theories 

These are theories that narrow their focus even further, specifically focusing on concepts concerning a defined patient population. These theories tend to directly affect patients more than the other two types of theories. Bedside nurses will often use these theories in their everyday practice. 

We talked about Nightingale and Orems' role as nursing theorists and reviewed their respective theories. Let's explore the work of some other notable nursing theorists and how their work helps nurses and other healthcare providers give better patient care.

Virginia Henderson: Nursing Need Theory

Virginia Henderson's Nursing Need Theory centers around the concept of basic human needs. Henderson believed that the role of a nurse is to assist individuals in meeting their fundamental needs and help them increase their independence. 

Her theory emphasizes the nurse's role in supporting patients in activities such as:

Maintaining desired postures

Dress and undress

Cleanliness

Communicating fears, opinions, and needs, and

Worshiping according to their faith

Jean Watson:  Theory of Human Caring

Jean Watson is a contemporary nursing theorist renowned for her Theory of Human Caring . Watson emphasizes the importance of creating a caring and compassionate relationship between the nurse and the patient. 

Her theory focuses on  ten factors:

Upholding humanistic-altruistic values by practicing kindness and compassion

Being genuinely present and fostering faith, hope, and belief systems while respecting the subjective experiences of oneself and others

Cultivating self-awareness and spiritual practices, transcending ego-centeredness to achieve a transpersonal presence.

Developing and nurturing loving, trusting, and caring relationships

Encouraging the expression of both positive and negative emotions, actively listening to others' stories without judgment

Applying creative problem-solving through the caring-healing process

Engaging in transpersonal teaching and learning within a caring relationship, adapting to the individual's perspective and transitioning towards a coaching approach for enhanced health

Creating a healing environment on various levels, fostering an atmosphere of authentic caring presence at an energetic and subtle level.

Acknowledging the interconnectedness of mind, body, and spirit while upholding human dignity

Embracing the spiritual, mysterious, and unknown aspects of life

Madeleine Leininger: Transcultural Nursing Theory

Leininger's Transcultural Nursing Theory , also called Culture Care Theory, focuses on providing culturally congruent care by understanding and respecting the values, beliefs, and practices of diverse individuals and groups.

Hildegard Peplau: Interpersonal Relations Theory

Peplau's Interpersonal Theory of Interpersonal Relations emphasizes that the journey of nurse-patient relationships involves three pivotal stages that are essential for their success: 

The initial orientation

A dynamic working phase, and

A  thoughtful termination process

According to Peplau, the nurse's role is to facilitate the patient's growth and development by utilizing therapeutic communication, empathy, and understanding.

Betty Neuman: Neuman Systems Model

The Neuman Systems Model focuses on identifying stressors that have the potential to negatively impact an individual's health and overall well-being. It incorporates various factors such as physiological, psychological, sociocultural, and developmental aspects. 

The theory also provides a flexible structure for assessment, intervention, and evaluation in nursing practice. 

Sister Callista Roy: Adaptation Model

The Roy Adaptation Model is based on the belief that individuals are adaptive systems, constantly interacting with their environment to maintain their physiological and psychosocial integrity. It views the person as a holistic being, consisting of four interconnected adaptive modes:

Physiological Mode: Deals with physical and biological aspects of adaptation, including the body's response to stressors, maintaining homeostasis, and meeting basic physiological needs.

Self-Concept Mode: Focuses on individuals' perception of themselves, including self-esteem and self-image.

Role Function Mode: Considers the roles people have in their lives, such as spouse, parent, employee, or student. 

Interdependence Mode: Emphasizes the importance of social relationships and how individuals interact with others, such as support from social networks.

Martha Rogers: Science of Unitary Human Being

Rogers' Science of Unitary Human Beings believed that nursing should focus on promoting harmony and balance within the individual and their environment. 

Her theory emphasizes the interconnectedness of human beings with their surroundings and the importance of energy fields in health and healing. Spoken another way, patients cannot be considered as “separate” from their environment.

Patricia Benner: Novice to Expert Theory

Benner's Novice to Expert Theory describes the stages of nursing skill from novice to advanced beginner, and finally, to competent. 

She emphasizes the importance of practical experience and clinical judgment in nursing practice and highlights that expertise develops over time through practice and reflection.

Imogene King: Theory of Goal Attainment

King's Theory of Goal Attainment focuses on the nurse-patient relationship and the mutual goal-setting process. Her theory emphasizes that nurses and patients should collaborate to establish goals that promote the patient's well-being and health.

Katharine Kolcaba: Comfort Theory

Kolcaba's Comfort Theory highlights the significance of providing comfort to patients as a central goal of nursing care. 

Her theory defines comfort as the immediate experience of being strengthened in physical, psychospiritual, environmental, and sociocultural dimensions.

Kolcalba’s framework proposes that healthcare providers:

Assess if patient’s comfort needs are not being met

Create interventions to meet those needs

Measure comfort prior to and after the interventions

Nursing theories are used every day in practice even if nurses aren’t aware of their use. Theories help guide evidence-based research which then leads to best practices and policies. These policies and procedures keep patients safe, while providing the best care possible. 

Nursing theories also allow nurses to positively influence the health and well-being of their patients beyond taking care of them at the bedside. Nursing theory-guided practice helps improve the quality of care delivered and helps continue to move the nursing profession forward into the 21st century. 

Most bedside nurses will not necessarily know the theories behind their practice so their usefulness is often dismissed. Advanced practice nurses, nurse scholars, nurse educators, and nurse researchers are most likely going to be up to date on current nursing theories and their impact on the nursing profession. 

Nursing theories should continue to guide nursing practice both in academia and at the bedside. It allows nurses to provide current best-practice care to their patients while also impacting them beyond the bedside. Florence Nightingale’s Environmental Theory was groundbreaking during the 1860s and helped change the course of nursing and healthcare while changing the outcomes of patients through the identification of environmental factors that may hinder their health and well-being. 

Nursing Theory FAQs

What are the major nursing theories .

• All nursing theories encompass person, environment, health, and the nurse and are categorized into three hierarchies: grand nursing theories, middle-range nursing theories, and practice level nursing theories.  

What are examples of nursing theory? 

• Some examples of nursing theories include the Environmental Theory, the Casey Model of Nursing, the Martha Rogers Theory, the Tidal Model, and the Cultural Care Theory. 

What is the Casey model of nursing?

• The Casey Model of Nursing is a model of nursing designed to encompass the child-health relationship with five focuses: child, family, health, environment, and the nurse. 

What is Martha Roger's Theory?

• The Martha Rogers Theory of nursing looks at people as “unitary” human beings that can’t be divided into parts and nursing as a blend of both art and science. 

What is a partnership model in nursing?

• It’s a patient and family-centered care system that focuses on partnership between the two, along with education, support, communication, and collaborative practice.

What are the principles of the tidal model? 

• The tidal model of nursing has 6 principles: curiosity, virtue, mystery investigation, respect of the person, crisis as an opportunity, possessing goals, and pursuit of elegance.

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Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis

This study aimed to assess the application of the Betty Neuman systems model to the care of patient/clients with multiple sclerosis.

This clinical study resulted from the application of the nursing process to a patient/client admitted with multiple sclerosis in the neurological ward of a hospital in an urban area of Iran.

A patient/client was evaluated according to the Neuman model. Intrapersonal stressors (physiological, psychological, socio-cultural, and spiritual), interpersonal stressors (being away from family and children) and extra-personal stressors (aggression and psychological pressure from the spouse) were found. Based on the examination, 12 nursing diagnoses based on the taxonomy of the North American Nursing Diagnosis Association International, and nursing care based on three levels of prevention that are important in the view of Neuman, are presented. The results were used in the classification of nursing interventions and the classification and nursing outcomes respectively.

Conclusions

The results suggest the desirability of care and patient/client satisfaction in the evaluation of nursing care based on the Neuman model. The model can be used as a framework to help nurses care for patients/clients. Thus, the application of this model and other models is recommended in the nursing care of patients/clients.

Introduction

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) characterized by brain inflammation, demyelination, and axonal loss, which occurs primarily between the ages of 20–40 years. 1 MS is the most prevalent inflammatory 2 and the second most common cause of neurological disability in working-age adults. Since it usually strikes in the prime of life, frequently progresses to disability, and has no cure, MS can have a strong emotional impact not only on those who suffer from it, but also on the healthcare team. 3 The range of symptoms that occur in MS can have disabling functional consequences for patients and lead to significant reductions in their quality of life and the ability of individuals to carry out their roles and job tasks. 4

The goal of early disease management is to intervene before irreversible neuronal destruction happens, to delay the progression of disability, and to improve the quality of life. 5 Currently, there is no known cure for MS, and the treatment goal of MS is the prevention of permanent neurological damage. 6 Thus, the nature of the disease poses an obvious need for interdisciplinary services. Nurses have to play a key role in the interaction with patients/clients and their families to improve the patient/client’s health. 7 The purpose of nursing care is to improve the quality of life of patients/clients. 8 An effective way to promote nursing care is by applying nursing theories. 9

The clinical use of nursing models and theories helps develop nursing knowledge. 10 It is an important step to achieve the goals that guide the practical application of clinical and educational research. 11 A wide variety of situations and phenomena make a certain degree of flexibility necessary in the selection of the models and nursing theories according to the circumstances. 12 The Betty Neuman systems model is one theory that provides guidance at three levels of prevention. 13

Neuman systems model

The Neuman systems model is based on a general system theory and reflects the nature of living organisms as open systems in interaction with each other and with the environment. Within the Neuman model, the client may be an individual, a family, a group, a community, or a social entity. An important assumption of the Newman theory is: “each client system is unique, a composite of factors and characteristics within a given range of responses.” 13 [p. 285]

The human being is a total person, characterized by five variables: these include physiological, psychological, socio-cultural, spiritual, and developmental variables. 14 The physiological variable refers to body structure and function. The psychological variable refers to mental processes in interaction with the environment. The socio-cultural variable refers to the effects and influences of social and cultural conditions. The spiritual variable refers to spiritual beliefs and influences. The developmental variable refers to age-related processes and activities. 13

An individual organism is said to have a central “core” of basic survival mechanisms, such as temperature control, ego, and organ function. 12 The core is protected by lines of defence. The outer layer is the flexible line of defence, and is variable, responding to the particular stressor. The inner or “normal” line of defence represents the state of wellness and adaptation of the individual. It is generally stable. The lines of resistance represent the internal factors that determine an organism’s response to a stressor. Stressors (intrapersonal, interpersonal, and extra-personal) are significant to the concept of environment and are described as environmental forces that interact with, and potentially alter, system stability. 15 Intrapersonal factors include interactions contained within the client, such as conditioned responses. Interpersonal factors arise from interaction between two or more individuals, such as role expectation. Extra-personal factors comprise all interactions occurring outside the client, such as financial circumstances. 16

Neuman defines the environment as all the internal and external forces surrounding the client, influencing and being influenced by the client at any point in time. She identifies three relevant environments: internal, external, and created. 12 The internal influences are contained within the boundaries of the client’s system in other words, they are intrapersonal in nature. The external influences exist outside the client; and the created environment is unconsciously developed and is used by the client to support protective coping. 17 She views health as a continuum of wellness to illness that is dynamic in nature and is constantly changing. Optimal wellness exists when the total system needs are completely met and illness exists at the opposite end of the continuum from wellness and represents a state of instability and energy depletion. 12

Neuman believes that nursing is concerned with the whole person. She views nursing as a unique profession and believes that it is concerned with all the variables affecting an individual’s response to stress. The primary aim of nursing is the stability of the client system. This is achieved through nursing intervention to reduce the stressors. Neuman’s process contains three basic parts: nursing diagnosis, nursing goals, and nursing outcomes. Neuman stresses the importance of identifying the client’s and the caregiver’s perceptions and collaboration between the client and the caregiver in all stages of the process. She identifies three levels of intervention: primary, secondary, and tertiary ( Table 1 ). Primary prevention takes place even before the client system can respond to a stressor that the purpose is to reduce the possibility of encounter with the stressor. Secondary prevention takes place after the client system responds to a stressor. Tertiary prevention occurs after the active treatment or secondary prevention stage that it focuses on readjustment toward optimal client system stability. 13 This paper demonstrates the application of the Betty Neuman systems model to the care of patients/clients with MS.

Summary of Betty Neuman’s nursing process steps.

This clinical study resulted from the application of the nursing process mediated by the nursing theory of Betty Neuman to the care of patients/clients with MS in a neurological ward of a hospital in an urban area of Iran. One patient was studied in this study.

In the first stage of the nursing process, an interview was drawn up with the purpose of guiding the research and determining the stressors. This clinical study was about single patient.

After the assessment and data collection, 12 nursing diagnoses were established according to the taxonomy of the North American Nursing Diagnosis Association International (NANDAI), and nursing care based on three levels of prevention that are important in view of Neuman, was presented. The diagnoses were:

• Disruption of the concept of “self” associated with the disease, decreased muscle strength, power and weakness,
• Not tolerating any activity associated with weakness, fatigue and irritability,
• Stress and anxiety associated with being away from children and family, disease and aggression of the spouse,
• Eating disorder, eating less than what the body needs, anorexia and nausea,
• Risk of trauma and falls in association with visual and movement disorders, weakness, and dizziness,
• Disturbance in bowel habits associated with illness, weakness, and disability,
• Changes in sexual pattern associated with fatigue and depression,
• Disorders in sleep pattern associated with an urge for urination, headache, and flushing,
• Disorder in reading and writing associated with visual disturbances and vertigo,
• Impaired skin integrity in association with drugs and associated complications,
• Urinary dysfunction associated with the disease and bladder nerve damage,
• Avoiding loneliness associated with being away from children and family.

Experience reports

Evaluation of patients/clients to classify types of stress is posed by Neuman.

Intrapersonal stressors

Intrapersonal stressors include the following needs: physiological, developmental, psychological, socio-cultural, and spiritual.

Physiological

• Neurological: dysfunctions of this system include severe headache and vertigo that worsens in light, weakness and walking disorders due to muscle weakness, blurred vision and double vision, seizures, heaviness in the head, and sometimes inability in gripping objects with hands and as a result, dropping the object, minor burning and tingling sensation in hands and feet, which worsens during an attack.
• Gastrointestinal: dysfunctions of this system include loss of appetite, early satiety, weight loss in recent months, and impairment of bowel movements in the form of constipation, and occasional nausea and vomiting.
• Respiratory: the respiratory rate was normal and lung auscultation was clear.
• Genitourinary: difficulty in urination, dripping urination.
• Dermatological: dry and red skin with spots on the face, and sometimes severe scalp irritation, especially during anxiety and under psychological pressure.
• Musculoskeletal: weakness in arms and legs, radiating pain in the shoulder and chest, imbalance and dizziness during attacks.
• Hearing: stuffiness in the ear.
• Sight: blurred vision, double vision, fluttering objects in the visual field, reduced visual field, inability to see beyond a distance of about 7–8 m.

Psychological

The patient/client cannot express any feelings about the disease, but is depressed and anxious, looks tired and bored. In the case study, irritability and mental pressure by the patient/client’s husband were considered as intrapersonal factors that caused stress. Following stress and family dissociation, she was constantly agitated and anxious. She needed intense mental family support.

Socio-cultural

The patient/client participates in artistic activities and believes that she will be mentally calm. But the patient/client cannot participate in sports classes, held by the MS center, due to problems of transportation and distance.

Developmental

She has been successfully engaged in meeting developmental needs appropriate to a middle-aged adult, for example: preparing for menopause.

Considers herself a religious person. She believes in God and prays. She participates in religious ceremony.

Interpersonal stressors

These include (a) being away from family due to long distance; (b) being away from children due to remote education place; and (c) extra-personal stressors.

The nursing results were used for the classification of nursing interventions and the classification of nursing outcomes respectively ( Table 2 ).

Nursing process adapted according to the Neuman theory for the multiple sclerosis (MS) patient/client.

Some variables including socio-cultural, psychological, and physiological variables may interact, and therefore are not repeated in the table under the related variable.

MS is a chronic disorder with no definite cure. So, the goal of treatment is to control the signs and symptoms, prevent further progress, and ensure better compliance from the patient/client.

• Communication with nurses, spouse, and family, and getting the opportunity to express her feelings about her situation somewhat reduced the patient/client’s concerns, which stemmed from her desire to get attention. She stated that the hope for a bright future for her children was the incentive for the rest of her life.
• The patient/client mentioned techniques that she was taught to maintain her energy levels. She became aware of the importance of resting between activities to avoid boredom and stated that she would try to consider resting in between work.
• When the patient/client became aware of the impact of stress on the progress of her disease, she was determined to reduce the amount of stress in her life. Her family was also consulted and asked to put family tensions aside to help her.
• The patient/client named several types of foods that she should avoid, like fatty and spicy food, and decided to avoid situations that decreased her appetite, and thus, improved her nutritional status.
• The patient/client’s awareness of the measures to avoid trauma caused her to avoid walking during vertigo attacks and sit down until she felt better.
• The patient/client named several foods containing fiber that helped improve the defecation pattern. She stated that she used soaked figs to improve her situation.
• With regard to training to prevent fatigue, the patient/client could do it over time, and also understood that this could be a reason for her spouse’s aggression. So, she decided to pay more attention to the needs of her husband.
• The patient/client uses proper coverage and cooling equipment during sleep. Regarding consumption of tea before bedtime, she decided to cut the use of caffeine.
• The patient/client used to go for visual examination, but the visit intervals were long. Considering the importance of this issue, she decided to shorten the intervals of visit and used protective clothing for her eyes, such as sunglasses, when she went out into the sun.
• She stated that she could not use gloves while using detergents. She decided to bathe in warm water instead of cold water.
• The patient/client stated that she followed all the necessary hygienic measures to prevent urinary tract infections. She also decided to limit the consumption of beverages containing caffeine.
• According to the patient/client’s statement, she had the enthusiasm and interest to continue participating in training classes, and she felt lonely if she did not do so.

Conflicts of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Human Becoming Theory with a Case Study

Rachel andel rn, bsn.

• February 6, 2023
• Nursing Theories

Rosemarie Rizzo Parse is a well-known nursing theorist and researcher who has made significant contributions to nursing. Her Human Becoming Theory, also known as the Theory of Human Becoming, is a holistic and person-centered approach to nursing that emphasizes each patient’s unique experiences and the importance of empowering patients to participate in their own care. This article will provide an overview of the Human Becoming Theory , its key components, and its practical applications in nursing practice.

Table of Contents

The key components of human becoming theory.

Human Becoming Theory is a holistic and person-centered approach to nursing that emphasizes the importance of understanding and respecting each patient’s unique experiences. The theory is based on four key components:

• Phenomenology
• Subject-subject interaction
• Spirit, caritas, and transcendence
• Pattern, process, and rhythm.

Phenomenology is the study of human experiences and the subjective meaning that individuals give to those experiences. In nursing, this component of the Human Becoming Theory emphasizes the importance of understanding each patient’s unique experiences and the meaning they give to those experiences.

Subject-subject interaction refers to the dynamic relationship between the nurse and the patient, in which both individuals are active participants in the care process. This theory component emphasizes the importance of fostering a collaborative relationship between the nurse and the patient to promote patient autonomy and empower patients to participate in their care.

Spirit, caritas, and transcendence refer to the spiritual dimension of nursing care. This component recognizes that patients have a spiritual dimension to their lives and acknowledges the importance of incorporating spirituality into nursing care.

Pattern, process, and rhythm refer to human existence’s cyclical and dynamic nature. This theory component emphasizes the importance of understanding human life’s patterns, processes, and rhythms to provide holistic and patient-centered care.

Human Becoming Theory in Nursing Practice

Human Becoming Theory is applied in nursing practice in several ways, including; emphasizing the person-center approach, encouraging holistic and patient-centered care, incorporating spirituality into nursing care, and promoting patient autonomy , and empowering patients to participate in their care.(Human Becoming Theory)

A. Emphasizing the person-centered approach involves focusing on each patient’s unique experiences and needs rather than treating patients as a homogeneous group. This approach is based on the belief that each patient has unique experiences , needs, and goals and that nursing care should be tailored to meet those needs.

B. Encouraging holistic and patient-center care involves taking into account the physical, emotional, social, and spiritual aspects of a patient’s life to provide comprehensive and integrated care. This approach recognizes that patients are complex individuals and that nursing care should address all aspects of their lives to promote healing and well-being.

C. Incorporating spirituality into nursing care involves recognizing the spiritual dimension of human existence and incorporating spiritual practices and beliefs into the care process. This can include activities such as prayer, meditation, or rituals, as well as more general approaches to care that take into account the spiritual needs of patients.

D. Promoting patient autonomy and empowering patients to participate in their care involves encouraging them to take an active role in their care and make decisions about their health and well-being. This approach is based on the belief that patients are experts in their own lives and that they should be involved in the decision-making process regarding their care.

Case Study on Human Becoming Theory

 The hospice nurse sat with Ann\’s husband, Ben. Ann was resting quietly as the increased dosage of IV pain medication gradually reached its therapeutic level. Ben turned his head and slowly turned, looking out the room\’s only window. As he glanced up, a small flicker of light caught his breath. It was a shooting star. A tear fell from the corner of his eye, and he turned to Ann. The nurse sensed that something significant to Ann and Ben was unfolding. Shuffling to Ann\’s bedside, he took her small, fragile hand in his. These hands had rocked cradles, burped babies, and groomed the horses she loved to ride. Gently holding her hand, he turned to the nurse. \”She would ride like the wind was chasing her.\” Looking back to Ann his voice broke; choking back tears \”Ann, Ann I saw Jessie…Jessie is calling.\” Ben turned \”Jessie was our daughter. She died having a baby that was too big. When she died, it was a pitch-black night. Cold, so cold, the baby died too, a little boy named him Abe, Jr. after Jessie\’s husband. I took Ann outside so she could cry to God above, and there in this dark sky, we saw two falling stars…together…just falling. We knew it had to be Jessie and Abe…two angels to light up the night.\” Ben turned back as a deep sigh escaped from Ann\’s lips. A soft smile remained as she joined Jessie and Abe.(Human Becoming Theory)

• Based on this case study, how would the nurse actualize Parse\’s theory of Human Becoming?
• What are the characteristics of a human becoming nurse?  What are the strengths and weaknesses of this theory of nursing?
• From the nursing theories we have discussed, what additional theory would you apply to this case study? Develop a plan of care to include both nursing theories (be specific and provide reasons)

Actualization of Parse’s Theory of Human Becoming Based on this Case

Parse’s theory emphasizes freedom of expression, choice, and human dignity. In this case, the nurse should provide psychological support to Ben. Death is distressing, and as part of patient care, the nurse should guide Ben through that difficult moment. This is an example of End of Life care, where the nurses are supportive tools to make the last moments as comfortable as possible for the patient and the family.

The theory requires nurses to respect patients’ and families’ preferences and wishes. The patient is an individual with personal preferences about how they want to spend their End of Life. Some considerations include a preferred dying place, how the patients want the nurse to control pain and symptoms, life support preferences, psychological support for patients and families, and what relieving equipment the patient would prefer.(Human Becoming Theory)

Nurses should consider themselves an integral part of patient care and offer emotional encouragement. The theory considers a person’s biological, psychological, and spiritual elements. Therefore, the nurse understands that different patients have varying needs and recommends an approach that suits their individuality.

The End of Life is challenging for the family, who has to come to terms with reality. The nurse should listen to Ben’s words, offer encouragement, and grant their final wishes. Parse advises that nurses should do things with patients and not for patients. The nurse and the patient’s relationship considers that the patient has control over their life and has set goals that nurses should help in realization. Parse’s theory is vital in Hospice Nursing, guiding nurses on how they should relate to dying people and their families.

Characteristics of Human Becoming Nurses

Human becoming involves the freedom of personal meaning selection in situations that relate to living values . Human Becoming nurses should have more compassion and courage to deal with patients who are terminally ill. Death is different for every person, and these nurses need to be comfortable, compassionate, and courageous in these uncertain moments. The nurses need to serve the patient’s individual needs and circumstances.

Human Becoming nurses need flexibility in developing tailored plans that serve every patient’s unique needs. In addition, the nurses should be able to provide medically oriented and emotionally based care. These interventions include checking critical signs, pain management, medication, and reporting complications. Finally, the nurses also need the flexibility to shift services from prolonged life to end-of-life care.

The nurses should have the tenacity to live in the moment with the patients, respect their preferences, and apply a holistic approach to guide them through death’s grey areas. Human Becoming nurses should be conversant with the physical, psychological, social, and spiritual factors.(Human Becoming Theory)

Parse’s theory provides a transformative approach to all nurses. It seeks to address issues and allow nurses to operate according to the patient’s perspectives. Parse pedagogy contributes to nurses’ and patients’ lives. Nurses can, therefore, guide patients towards achieving a quality life of preference. The theory shows transparent relationships between principles, practice areas, and assumptions. Parse also presents a clear distinction between nursing and other disciplines. The theory offers valuable information and guidelines on nursing practice.

The theory corresponds to individual, professional, and social attributes that help nurses perform their expected roles. The primary weakness is that Parse’s research area has no expansion room. As a result, the research methodologies involve results that are difficult to quantify. The theory is also generalized and cannot be accessed or applied in specific practice areas such as acute and emergency rooms . In this case, the theory is particularly for novice nurses.  

Similar Model to the Human Becoming Theory

Human Caring Theory affirms our respect for human dignity. The case study involves caring through intentional, authentic presence. Jean Watson’s Theory of Human Caring is applicable in this case. Nurses are responsible for putting the patient in the best position to facilitate the body and soul’s self-healing.

The theory teaches that nurses should be emotionally sensitive and have a caring attitude and energy fundamental in this case study. Nurses can make a difference in how they say and do things. Nurses should be sensitive to patients’ and families’ emotions, thoughts, and attitudes since, according to Watson, a human can only be treated as a whole. In this case, human caring in healthcare is an interpersonal process between the nurse and the care recipient.

Nursing Interventions Rationale

• Inquire about the level of anxiety and other emotional factors in the family. Emotional factors such as anxiety among family members require intervention before solving the real problem. Some members cannot respond appropriately or deal with the reality of their loved ones dying.
• Develop a rapport and acknowledgment of this challenging situation to the family.
• Identify patients’ behavioral and emotional factors that impact dependency.
• Discuss the patient’s relationship with the family.
• Determine experience and knowledge in dealing with the situation.
• Inquire about how the patient and the family want to spend their final moments.

Human Becoming Theory is a holistic and person-centered approach to nursing that emphasizes the unique experiences and needs of each patient. This theory can potentially improve patient care and nurse-patient relationships by promoting patient autonomy, incorporating spirituality into nursing care, and fostering a collaborative relationship between the nurse and the patient. However, the theory has limitations and criticisms, including a need for more empirical evidence and further development and refinement.(Human Becoming Theory)

Despite these challenges, Human Becoming Theory remains a valuable tool for nursing students and practitioners alike, as it provides a framework for understanding the complexities of patient care and promoting holistic and patient-centered care. By continuing to refine and develop the theory, nursing practitioners can improve patient care and promote healing and well-being for all patients.

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Home > ETD > Doctoral > 5909

Doctoral Dissertations and Projects

Exploring prelicensure bsn students' knowledge of mindfulness meditation using a smartphone app to manage stress and promote resilience: a qualitative single case study.

Beth A. Kelley , Liberty University Follow

School of Nursing

Doctor of Philosophy

Kara Schacke

mindfulness meditation, mindfulness meditation smartphone app, BSN student stress, BSN student resilience, meditation, stress, resilience, knowledge of mindfulness meditation, christian university

Disciplines

Education | Nursing

Recommended Citation

Kelley, Beth A., "Exploring Prelicensure BSN Students' Knowledge of Mindfulness Meditation Using A Smartphone App To Manage Stress And Promote Resilience: A Qualitative Single Case Study" (2024). Doctoral Dissertations and Projects . 5909. https://digitalcommons.liberty.edu/doctoral/5909

The purpose of this qualitative single case study was to explore pre-licensure Bachelor of Science in Nursing (BSN) students' knowledge of mindfulness meditation (MM) using a smartphone app (SMA) to manage stress and promote resilience. Guiding this study was the transactional model of stress, adaptation, and coping by Lazarus and Folkman (1984) and the zone of proximal development (ZPD) educational theory by Vygotsky. The study asked the following questions: What was pre-licensure Bachelor of Science of Nursing (BSN) students’ knowledge of mindfulness meditation (MM) using a smartphone app (SMA) to manage stress and promote resilience? What had the prelicensure BSN student experienced regarding MM with an SMA? What did prelicensure BSN students know about MM using an SMA to manage stress? What did prelicensure BSN students know about MM using an SMA to promote resilience? A sample of 91 students was obtained to answer the demographic questionnaire and three surveys. From those students, 25 volunteered for interviews and focus groups with 14 BSN students for interviews and 11 students split into two focus groups. The data were collected from surveys, interviews, and focus groups, and themes were developed. Data obtained contributes to current knowledge, and recommendations for further research are given.

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More From Forbes

Systems leadership case study: workplanning using systems thinking.

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Thomas Lim is the Vice-Dean of Centre for Systems Leadership at SIM Academy. He is an AI+Web3 practitioner & author of Think.Coach.Thrive!

Workplanning usually involves a confluence of top-down and bottom-up approaches in many organizations. Some broad annual guidance is given by the CEO, with Finance providing a budget forecast based on historical data and the strategic imperatives for the new fiscal year. The line divisions then prepare and present a list of initiatives that purportedly contribute to these imperatives and justify their budget-ask.

This generally works in stable environments where the workplanning objectives are incremental as part of a longer five-year duration, but it may be inadequate in managing transformation efforts with the need for new systemic structures due to the merging or dissolving of functional areas within the organization.

Systems thinking provides a holistic approach to understanding and managing complex systems from the current reality to a desired outcome, making it an ideal tool for recasting workplans to enhance efficiency and effectiveness.

In the case of Client X, they aimed to leverage systems leadership practices to transform internally and propagate these practices first across its internal divisions, with the goal of taking it to the ecosystem at large. This article outlines a high-level approach to recasting the workplan using systems thinking tools, which has helped Client X align its initiatives, identify gaps and overlaps and achieve strategic objectives.

What Is Systems Thinking?

Systems thinking is an approach to problem-solving that views "problems" as parts of a unified whole. It involves understanding how different parts of a system interact and influence each other within the system. Unlike traditional linear thinking, systems thinking considers the broader context and the interconnections within the system and provides a systems map wherein these interactions are perceived as system-to-system, subsystem-to-subsystem or component-to-component.

In the case of Client X, adopting systems thinking means moving away from siloed operations and toward a more integrated and cohesive approach whereby a division’s work is mapped against another for synergistic outcomes. This can help the organization address complex challenges, improve decision-making and foster innovation by removing duplication and identifying implementation gaps.

Recasting The Workplan

The workplan recasting effort begins with "taking apart" the current work streams, not along the divisions’ lines of work but from an overall organizational lens. The leaders participating in this exercise have already been trained in the fundamentals of systems thinking tools. The three-day effort is about applying the systems concepts to model Client X’s journey from its current reality to its desired outcome through its articulated theory of success. The three-day session revolves around these workpieces both at the organizational level and at each strategic level:

1. Align And Select Tools/Models: Select the appropriate systems models and frameworks to guide the recasting process.

2. Apply Systems Thinking Practices: Rework existing work streams of the workplan as layers of interaction across nested hierarchies for each strategy.

3. Identify Interconnectedness: Understand how various initiatives are interconnected and the causal loops that would guide the process.

4. Identify Gaps And Overlaps: Detect any gaps and overlaps in the initiatives to optimize efforts and budgetary choices.

The specific steps that the team undertook during the three-day process included the following.

Step 1: Articulate Vision And Current Reality

Begin by clearly defining the vision and the current reality of the organization. This involves understanding the structural gap between where Client X is and where it wants to be. This step helps in identifying the key challenges and opportunities.

Step 2: Recast Workplan As A Nested Hierarchy Of Choices

Recast the workplan as a nested hierarchy of choices to ensure that decisions at every level are aligned and relevant. This helps in clarifying the strategic intent and who is responsible for what and aids in surfacing gaps and duplications, enabling better resource allocation and prioritization.

Step 3: Cluster Use Cases, And Prioritize Challenge Statements

Cluster the use cases, and prioritize the top three challenge statements that need to be addressed. This focuses the efforts on the most critical issues and ensures that resources are used effectively.

Step 4: Work On Chosen Challenge Statements

The selected challenge statements are put through using the levels of perspective "walk-up" framework to surface and test mental models for diagnosis. This helps in understanding the underlying assumptions and beliefs that drive current behaviors and outcomes.

Step 5: Create A Theory Of Success

Develop a theory of success that identifies the key levers at higher leverage for achieving the desired outcomes from key success factors. This provides a clear road map for action and helps in aligning efforts across the organization.

Step 6: Co-Create A Walk-Down Of The Levels Of Perspective

Collaborate with stakeholders to create a walk-down of the levels of perspective. This step aligns the challenge statement and diagnosis with a related growth strategy, ensuring that all efforts are coherent and strategic.

By integrating systems thinking into the recasting of its workplan, Client X was able to achieve a more cohesive, efficient and effective approach to its initiatives. The workplan was still central in execution, but it is now reinforced and streamlined for internal alignment in a way that was not possible before overlaying the systems thinking perspectives.

This approach can be extrapolated to enable other organizations to address complex challenges, optimize resource allocation and drive strategic outcomes. A coaching reinforcement can additionally be put in place to ensure that these practices are deeply embedded within the organization, leading to sustained transformation and growth.

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Harris Chooses Walz

A guide to the career, politics and sudden stardom of gov. tim walz of minnesota, now vice president kamala harris’s running mate..

This transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors. Please review the episode audio before quoting from this transcript and email [email protected] with any questions.

Hey, it’s Michael. Before we get started, I want to tell you about another show made by “The New York Times” that pairs perfectly with “The Daily.” It’s called “The Headlines.” It’s a show hosted by my colleague, Tracy Mumford, that quickly catches you up on the day’s top stories and features insights from “The Times” reporters who are covering them, all in about 10 minutes or less.

So if you like “The Daily”— and if you’re listening, I have to assume you do — I hope that means you’re going to “The Headlines” as well. You can now find “The Headlines” wherever you get your podcasts. So find it, subscribe to it, and thank you. And now, here’s today’s “Daily.”

From “The New York Times,” I’m Michael Barbaro. This is “The Daily.”

[MUSIC PLAYING]

Today, the story of how a little known Midwestern governor became Kamala Harris’s choice for a running mate. My colleague Ernesto Londoño walks us through the career, politics, and sudden stardom of Governor Tim Walz of Minnesota.

It’s Wednesday, August 7.

Ernesto, over the past few days, we watched Vice President Harris bring the final three contenders for her running mate to her house in Washington, DC, for a set of in-person interviews. And then we watched as she seemed to narrow her pool of choices down to a final two — the governor of Pennsylvania, Josh Shapiro, and the governor of Minnesota, Tim Walz. And now, of course, we know that she has made her choice. What has she told us about her campaign strategy, the way she views this race, in ultimately choosing Tim Walz?

Michael, I think what the choice tells us is that Kamala Harris was drawn to two qualities that Governor Walz brings to the table. And what’s interesting is they may seem to be in tension. For starters, here’s the ultimate everyday man, somebody who grew up in a small town in Middle America, served in the National Guard, was a high school teacher, a football coach, very plain-spoken, goes to campaign events wearing T-shirts and baseball caps, is a gun owner and very proud about it. He sort of embodies the Midwest.

And she clearly thinks that that is going to bring the kind of moderate, white, working class voters that the campaign needs in swing states to come to them, to make this feel like a balanced ticket and something that will give her enough of the crucial votes to defeat Donald Trump in the fall.

On the other hand, as governor, he passed a slew of pretty progressive legislation in the past couple of years, everything from abortion rights to gun control. So these things are likely to appeal to bread and butter Democrats.

But the question is, when voters have examined these two facets of Tim Walz, may it bring them enough enthusiasm from the base and enough undecided voters that the campaign desperately needs, or at some point, do these two aspects of him start canceling each other out?

Right. In short, you’re saying Harris is betting on a dual appeal from Walz to two essential constituencies, but the risk is that the appeal to one of them is just much, much greater than to the other.

Right. You could definitely see a scenario where voters, once they’ve examined Tim Walz’s story and legacy, may conclude that both of these candidates are quite liberal.

OK, so tell us the story of Tim Walz, a story that I think a lot of us don’t know because we really don’t know Walz all that well, and how he has come to embody these two qualities and that tension that you just described.

Michael, the origin story of Tim Walz’s political career is quite fascinating.

He and his wife were teachers in a small city south of Minneapolis. And in 2004, when George W. Bush was running for re-election, Walz took a group of his students to a political rally in his hometown. They wanted to just see the president make his case. And a strange scuffle happened when they were trying to get in.

Well, one of the kids had a John Kerry sticker on his wallet. And this is where the individual says, well, you’re not going to be allowed to enter. You’ve been deemed a threat.

Apparently, one of the students had a sticker for Bush’s rival, John Kerry, on his wallet. And security officials at the rally didn’t want to let them in.

And I said, oh, it’s OK. They’re with me. And who are you? And I said, I’m Tim Walz. I’m their teacher here, and showed them my ID. And they said, well, you two have been deemed a threat to the president. And I said, well, that’s not true. And it kind of escalated.

And this really ticked off Tim Walz. He was really upset. There was a fight and a confrontation at the rally.

At this point in time, I’m kind of nervous. I’m getting arrested. So I’m like saying, well, I’m Teacher of the Year in Mankato. And they didn’t care about that. And it was kind of a sad epiphany moment, how it felt for people to be looked right through by people. These people didn’t see me. And this is happening.

And ultimately, he sort of walks away from this moment feeling really sick of the Bush administration, the politics of the day. And he turns around and volunteers for the Kerry campaign.

And then the more interested he becomes in politics in this era, he starts looking around his congressional district, and there’s a Republican who’s held the seat for many, many years. This was a largely rural district in southern Minnesota. And there’s no reason to believe that a newcomer to politics, somebody without a donor base, could make a run for this seat and win.

But Walz signs up for this weekend boot camp, where expert campaigners train newcomers who want to run for office. And he gets really enthused by the idea that he can pull it off. So he starts raising money with the support of an army of students who become so thrilled and energized by the prospect that their nerdy and kind geography teacher is making this uphill bid for a congressional race.

So his campaign staff is basically his former students.

That’s right. And he proves to be a formidable candidate. He draws a lot of attention to his experience in the classroom and as a coach.

When I coached football, these stands held about 3,000 people. That’s a lot. It’s also the number of American soldiers who have died fighting in Iraq.

He’s a very strong advocate for pulling out of the war in Iraq.

Serving right now are kids that I taught, coached, and trained to be soldiers. They deserve a plan for Iraq to govern itself, so they can come home.

And one thing that happens in the campaign that is really surprising to people is he comes out as being in favor of same-sex marriage. Now, it’s useful to remember that this is 2006, when the vast majority of Democrats, Democrats running for most elected office, were not ready to come out in favor of same-sex marriage.

And here’s a guy who’s new to politics, who’s trying to unseat a Republican who’s held on to his seat for more than 12 years, taking what appeared to be a reckless position on something. And when he was asked about it at the time, Tim Walz told a supporter, this just happens to be what I believe in. And I’d rather lose a race that I’ve ran being true and consistent to my values than try to run as somebody I’m not.

And of course, he wins.

Yes. To everybody’s surprise, he pulled it off.

So from the get-go, he shows a kind of maverick, “politics be damned” quality, taking stands that he knows may be unpopular among the voters he’s trying to win over. But he’s got some innate political gifts that are all making it work.

Yeah, I think that first campaign showed us that Tim Walz had real political chops. He was a very effective campaigner. And people really liked him. When he was knocking on doors, when he was introducing himself to voters, they saw him as somebody who was very genuine and who was admirable.

So once he gets elected in this conservative leaning district in Minnesota, what does he actually do in Congress?

In Congress, he develops a reputation for being somebody who can work across the aisle. And this is a period where Democrats and Republicans were deeply polarized over the Iraq War. He spends a lot of his time lobbying to expand benefits for veterans, so it’s easier for them to go to college after their service, and also becomes a leading voice in the quest to repeal Don’t Ask, Don’t Tell, the policy that prohibited openly gay servicemen from serving in uniform.

And he remained really popular. He easily won re-election five times. The last time he runs for his seat happens to be 2016, when President Trump wins his district by about 15 points.

And still, voters kept Tim Walz in office.

I think it’s important to note what you just said. Walz is distinguishing himself as a Democrat who can take some pretty progressive positions, as he did in that first campaign on gay rights, as he did with Don’t Ask, Don’t Tell, and keep winning in very Trump-friendly districts of his state.

That’s right. And as he’s serving his sixth term in office, he sets his sights on the governor’s mansion and decides to run for office in 2018. He wins that race easily. And early on, during his time as governor, the eyes of the world are on Minnesota after a police officer kills George Floyd. And what we see is massive looting and protests in Minneapolis.

Right, and remind us how Governor Walz handles that violence, those protests.

Yeah, I think that’s a crucial chapter in Tim Walz’s political career and one that will come under scrutiny in the days ahead.

After George Floyd was killed on a Monday —

People are upset, and they’re tired. And being Black in Minnesota already has a stigma and a mark on your back.

— protests took root in Minneapolis.

Y’all want to sit out here and shoot off your rubber bullets and tear gas.

And they got progressively larger and more violent.

There comes a point where the mayor and the police chief in Minneapolis plead for help. They ask the governor to send in the National Guard. And crucially, that request was not immediately heeded.

This is the third precinct here. There are fires burning to the left of it at the —

And at the height of the crisis, a police precinct building was abandoned.

There’s someone climbing up the wall right now, kicking the window in, trying to climb up the wall.

Because city officials grew concerned that protesters were about to overrun it and may attack the cops inside their own turf.

[EXPLOSIONS]

And the building is set on fire.

Right, a very memorable image. I can recall it happening in real-time.

Yeah, and in the days that followed, I think there were a lot of questions of why the governor didn’t send in troops earlier and whether a more muscular, decisive response could have averted some of the destruction that spread through the city.

And how does Walz end up explaining his decision not to send in the National Guard more quickly?

The governor and his administration have said that they were really, really dealing with an unprecedented challenge. And I think there was a concern that sending in troops into this really, really tense situation could have done more to escalate rather than pacify things on the street.

But in the weeks and months that followed, there were a lot of questions about Governor Walz’s leadership. And there were critics who said, during what may have been the most challenging week of his life, we saw a governor who was indecisive and who waited too long to send in resources that ultimately allowed the city to get to a semblance of order.

Right, and it feels like this is a moment that will almost assuredly be used against him by Donald Trump and JD Vance, the Republican ticket, which has made law and order so central to their message in this campaign.

Yeah, absolutely. And here in Minnesota, that was certainly a liability for him when he ran for re-election in 2022. But voters kept him in office, and he won that race handily. And not only did he win, but Democrats managed to flip the Senate and have full control of the legislature on his watch.

And that sets in motion one of the most productive legislative sessions in Minnesota history, where Tim Walz and his allies in the House and the Senate managed to pass a trove of really progressive legislation, oftentimes on a party vote.

Tell us about some of that legislation.

Well, Minnesota becomes the first state in the wake of the Supreme Court ending the constitutional right to abortion to actually codify this right under state statute. And they did a lot more stuff. They had a huge budget surplus, and they used that, for instance, to fund meals for all school children.

They managed to pass a couple of gun control laws that were very contentious. They gave the right to undocumented immigrants to get driver’s licenses. They legalized recreational marijuana. And finally, the governor takes a pretty bold stance on this issue of gender affirming care for transgender kids and teenagers, and says that Minnesota will be a safe haven for people who want that health care.

So, Ernesto, so how should we think about that blitz of legislation and the largely progressive tone of it, given the way that Walz had campaigned and succeeded up to that moment as somebody with such broad appeal across the political spectrum?

When the governor was asked whether this had been too much too quickly in terms of progressive legislation, his answer was that these were broadly popular policies, that these are issues Democrats had campaigned on. And here, Democrats had a window of opportunity where they were in control of the governor’s mansion and control of the House, the Senate, and that when you have political capital, you spend it.

But when you start listening to Republicans in Minnesota, they say, here’s a guy who campaigned on this mantra of “One Minnesota.” That was his campaign slogan. And he sort of came into office with this promise that he would govern in a bipartisan way, reach across the aisle.

But when they had all the votes they needed to pass their policies, Republicans felt that Walz was not bothering to bring them into the fold and to pass legislation that was going to be palatable to conservatives in the state. So I think people who once regarded him as a moderate now start seeing him as somebody who, when he had the power, acted in ways that were really progressive and liberal.

So at the height of his power, Governor Walz emerges as somebody who, when given a shot at getting done what he really wants to get done with a Democratic legislature, is a pretty progressive leader, even at the risk of being somewhat at odds with his earlier image as more moderate, because in his mind, enough people in the state are behind these policies.

Yeah, and I think he assumed that he had banked enough goodwill and that people across the state liked him enough to tolerate policies they may have disagreed with. And I think it’s safe to say, among the people who cover him here regularly, there was never any real hint that Tim Walz was eyeing a run for higher office. He’s not somebody who has written the kind of political memoir that oftentimes serves as a case of what you would bring to a national ticket or to the White House. And he seems pretty happy with a state job.

So it was a huge surprise when Tim Walz starts going viral through a string of cable news appearances right after President Biden drops out of the race, and the Democrats are scrambling to put Harris at the top of the ticket. And what becomes clear is that Walz is very forcefully auditioning for the role of vice president, and Vice President. Harris starts taking him very seriously.

We’ll be right back.

So, Ernesto, tell us about this cable news audition that Governor Walz undertakes over the past few weeks and how, ultimately, it seemed to help him land this job of being Harris’s running mate.

I think Walz does something really interesting, and that is that he says that Democrats shouldn’t be talking about Trump and Vance as existential threats. He kind of makes the case that Democrats have been in this state of fear and paralysis for too long, and that it’s not serving them well. So the word he latches onto is “weird.”

Well, it’s true. These guys are just weird.

It is. It is.

And they’re running for he-man women hater’s club or something. That’s what they go at. That’s not what people are interested in.

And I think one other thing we see in Walz is somebody who’s putting himself out there as a foil to JD Vance.

That angst that JD Vance talks about in “Hillbilly Elegy,” none of my hillbilly cousins went to Yale, and none of them went on to be venture capitalists or whatever. It’s not —

I think the case he’s making is that Tim Walz is a more authentic embodiment of small town values.

What I know is, is that people like JD Vance know nothing about small town America. My town had 400 people in it, 24 kids in my graduating class. 12 were cousins. And he gets it all wrong. It’s not about hate.

And behind the scenes, people from Tim Walz’s days on Capitol Hill start calling everybody they know in the Harris campaign and the Harris orbit and saying, here’s a guy who has executive experience as governor, but also somebody who has a really impressive record from his time on Capitol Hill and somebody who could be an asset in helping a Harris administration pass tough legislation. So you should take a hard look at this guy.

Which is, of course, exactly what Harris ends up doing. And I want to talk for a moment about how Harris announces Walz as her running mate on Tuesday morning. She did it in an Instagram message. And it felt like the way she did it very much embraced this idea that you raised earlier, Ernesto, that Walz contains these two appeals, one to the Democratic base, one to the white working class.

Harris specifically cites the work that Walz did with Republicans on infrastructure and then cites his work on gun control. She mentions that he was a football coach and the founder of the high school Gay Straight Alliance. She’s straddling these two versions of Walz.

But I want to linger on the idea for a moment of Walz’s vulnerabilities, because once he becomes Harris’s running mate, Harris and Walz are going to lose a fair amount of control over how they present him to the country, because he’s going to become the subject of very fierce attacks from the Republicans in this race. So talk about that for just a moment.

Yeah, I mean, it’s important to keep in mind that Governor Walz has never endured the scrutiny of a presidential race. So the questions he’s going to be asked and the way his record is going to be looked at is going to be different and sharper. I think the Harris campaign is billing him as, first and foremost, a fighter for the middle class. And I think that certainly will have some appeal.

But I think in coming days, there’s going to be a lot of attention drawn to parts of his record that may be unpopular with many voters. For instance, giving undocumented immigrants driver’s licenses, which Governor Walz championed. It’s likely to provide fodder for an attack ad.

The very dramatic footage of Minneapolis burning in 2020 is also something that I think people will be drawn to. And there’s going to be interest in reexamining what the governor did and what he could have done differently to avert the chaos.

And on Tuesday, we saw that the Trump campaign wasted no time in trying to define Tim Walz as soft on crime, permissive on immigration policy. And they also made clear they wanted to relitigate the era of George Floyd’s killing. And specifically, they want to try to tie him to the effort at the time to defund the police, which is a movement that Walz personally never endorsed.

So the Republican attack here will be pretty simple. Walz is liberal. Harris is liberal. So, in their efforts to speak to especially white working class and rural voters in swing states, the Trump campaign is going to say this is not the ticket for that group of voters. This is the ticket of burning police precincts and gun control. And of course, that may not be fair, but that’s very likely going to be the message over the next couple of months.

Right. I think there’s going to be effort to portray him as a radical liberal who has used his small town roots to put on this sort of veneer of being a moderate and a really sort of understanding and being part of the segments of the electorate that I think are critical in this election.

I want to speak for just a moment about the person Harris did not pick when she chose Walz because many Democrats had felt that Walz was a potentially too liberal seeming running mate for a candidate, Kamala Harris, who herself comes from a blue state and is caricatured by the Republicans as liberal herself.

And the person she didn’t choose was Governor Josh Shapiro of Pennsylvania, who was seen as having a huge appeal in that particular key swing state, but also presented risks of his own of alienating parts of the Democratic base with his well-documented support for Israel and his criticism of campus protesters. How should we think about the fact that, ultimately, Harris chose Walz over Shapiro?

Yeah, I think in the final stretch of this campaign to be the vice presidential pick, we started seeing a lot of acrimony in pockets of the Democratic base, drawing attention to the fact that Governor Shapiro could be divisive on Gaza, which has really sort of split the party in recent months.

So I think at the end of the day, they made a calculation that Tim Walz would be more of a unifying figure and would be somebody who would inspire and energize enough pockets of the electorate that they need, particularly in the Midwest, to make him the stronger and more exciting pick and somebody who wouldn’t force them to go back to defending and relitigating the Biden administration’s record on Israel and on the war in Gaza.

Right, and then, on Tuesday night, we got our first glimpse of Harris and Walz together on stage for the first time at a campaign rally. I’m curious, what struck you about their debut together.

Good evening, Philadelphia.

I think everybody was watching the opening scene of this rally to see what the chemistry between these two people was going to be like. And they both seemed giddy. They were literally, at times, bouncing with enthusiasm.

Since the day that I announced my candidacy, I set out to find a partner who can help build this brighter future.

So Pennsylvania, I’m here today because I found such a leader.

Governor Tim Walz of the great state of Minnesota.

They soon got down to business. And that business was how to define Tim Waltz for voters who don’t know him well.

To those who know him best, Tim is more than a governor.

And right off the bat, we saw that Kamala Harris really highlighted a lot of pieces of his pre-political career.

To his former high school football players, he was Coach.

She repeatedly called him Coach Walz, Mr. Walz, evoking his time in the classroom, and even used his military title from his days in the Army.

To his fellow veterans, he is Sergeant Major Walz.

And then when it came time for Tim Walz to introduce himself on this massive stage —

Welcome the next vice president of the United States, Tim Walz.

— he drew a lot of attention to his small town roots.

I was born in West Point, Nebraska. I lived in Butte, a small town of 400.

He said something that he said repeatedly recently in campaign appearances, which is —

In Minnesota, we respect our neighbors and their personal choices that they make. Even if we wouldn’t make the same choice for ourselves, there’s a golden rule — mind your own damn business.

The golden rule of small towns is you mind your own damn business, which is something he said in the context of his argument that Republicans have been limiting, rather than expanding, people’s rights. But he also drew attention to the fact that he’s a gun owner.

By the way, as you heard, I was one of the best shots in Congress. But in Minnesota, we believe in the Second Amendment, but we also believe in common sense gun violence laws.

And then when it came time to draw a sharp contrast with their opponents, Tim Walz said, these guys are phonies.

Donald Trump is not fighting for you or your family. He never sat at that kitchen table like the one I grew up at, wondering how we were going to pay the bills. He sat at his country club in Mar-a-Lago, wondering how he can cut taxes for his rich friends.

He said it’s actually people like me and Kamala Harris who come from humble origins and showed what is possible in America when you hail from a working class background, and you seize opportunities that were available to you.

Thank you, Philadelphia. Thank you, Vice President. God bless America.

So when it comes to this question of Walz’s dual identities and dual appeals, what did we learn on day one of this new Democratic ticket, do you think?

I think the campaign is trying to convey that these two facets of Tim Walz’s life are not mutually exclusive, that they don’t need to be in tension. They don’t cancel each other out. They’re both part of Tim Walz’s story. And I think that’s how they’re going to present him from now until Election Day.

Ernesto, thank you very much. We appreciate it.

It’s my pleasure, Michael.

Here’s what else you need to know today. On Tuesday, Hamas said that Yahya Sinwar, one of the masterminds behind the deadly October 7 attacks on Israel, had consolidated his power over the entire organization. Until now, Sinwar had held the title of Hamas’s leader in Gaza. But with the assassination of Hamas’s top political leader by Israel last week, Hamas said that Sinwar would take on that title as well. Sinwar remains a major target of Israel and is believed to have been hiding in tunnels underneath Gaza since October 7.

And the US Department of Justice has charged a Pakistani man with ties to Iran with trying to hire a hitman to assassinate political figures in the United States. The man recently traveled to the US and was arrested in New York last month. American authorities believe that his potential targets likely included former President Trump.

Today’s episode was produced by Alex Stern, Eric Krupke, and Olivia Natt. It was edited by Lisa Chow and Patricia Willens, contains original music by Pat McCusker and Marion Lozano, and was engineered by Alyssa Moxley. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Nick Pittman and Minnesota Public Radio.

That’s it for “The Daily.” I’m Michael Barbaro. See you tomorrow.

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Earlier this summer, few Democrats could have identified Gov. Tim Walz of Minnesota.

But, in a matter of weeks, Mr. Walz has garnered an enthusiastic following in his party, particularly among the liberals who cheer on his progressive policies. On Tuesday, Vice President Kamala Harris named him as her running mate. Ernesto Londoño, who reports for The Times from Minnesota, walks us through Mr. Walz’s career, politics and sudden stardom.

On today’s episode

Ernesto Londoño , a reporter for The Times based in Minnesota, covering news in the Midwest.

Background reading

Who is Tim Walz , Kamala Harris’s running mate?

Mr. Walz has faced criticism for his response to the George Floyd protests.

There are a lot of ways to listen to The Daily. Here’s how.

We aim to make transcripts available the next workday after an episode’s publication. You can find them at the top of the page.

The Daily is made by Rachel Quester, Lynsea Garrison, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Chris Wood, Jessica Cheung, Stella Tan, Alexandra Leigh Young, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, M.J. Davis Lin, Dan Powell, Sydney Harper, Michael Benoist, Liz O. Baylen, Asthaa Chaturvedi, Rachelle Bonja, Diana Nguyen, Marion Lozano, Corey Schreppel, Rob Szypko, Elisheba Ittoop, Mooj Zadie, Patricia Willens, Rowan Niemisto, Jody Becker, Rikki Novetsky, Nina Feldman, Will Reid, Carlos Prieto, Ben Calhoun, Susan Lee, Lexie Diao, Mary Wilson, Alex Stern, Sophia Lanman, Shannon Lin, Diane Wong, Devon Taylor, Alyssa Moxley, Olivia Natt, Daniel Ramirez and Brendan Klinkenberg.

Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Paula Szuchman, Lisa Tobin, Larissa Anderson, Julia Simon, Sofia Milan, Mahima Chablani, Elizabeth Davis-Moorer, Jeffrey Miranda, Maddy Masiello, Isabella Anderson, Nina Lassam and Nick Pitman.

An earlier version of this episode misstated the subject that Walz’s wife taught. She taught English, not Social Studies.

How we handle corrections

Ernesto Londoño is a Times reporter based in Minnesota, covering news in the Midwest and drug use and counternarcotics policy. More about Ernesto Londoño

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