2578 Nursing Theories Belal

7/31/2019 2578 Nursing Theories Belal

1/27

Nursing Theories

Dr. Belal M. Hijji, RN, PhD

19.09.2010


2/27

22

Learning Outcomes

At the end of this lecture, students will be able to:

Define the working terms and theory Recognise the four metaparadigms for nursing Discuss some of the selected nursing theories


3/27

33

Defining Relevant Working Terms

Phenomenon: Is a thing, event or activity that we perceive through

our senses. The phenomenon represents the subject matter of a

discipline. When experience and sensory and intuitive data becomecoherent as a whole, we have a phenomenon. For example, when a

patient, preoperatively, is noted restless in bed, biting fingernails,

and sighing, this is a phenomenon.

Concept: Is a label used to describe a phenomenon. Therefore,

when we put a name to a phenomenon, we are identifying aconcept. In the example provided above, the phenomenon may be

labelled as anxiety.

As a mental image, a concept is a view of reality tinted [colored] with

our perceptions and experience. Therefore, a phenomenon could be

given a different conceptual label by two different nurses. Therefore, a

concept is a tool not a reality it facilitates observation of a real

phenomenon. Concepts are also the building blocks of theory.

Construct: If the phenomenon is very abstract and the resultant

concept is not directly observable or measurable, it is often referred

to as a construct (self-esteem).


4/27

44

A construct is a type of highly complex concept whose reality base can

only be inferred. Therefore, imagining a continuum of concepts from

concrete (thermometre) to abstract (caring, compassion), constructswould be placed at the abstract end. All constructs are concepts but not

all concepts are constructs.

The following example illustrates the continuum of abstraction of

concepts. A cow is a very concrete conceptualisation and we move toward

more abstract levels of conceptualisation.

Cow - Bessie - livestock - farm asset - wealth

Two things are noted as the concepts become more abstract; more of the

characteristics of the concept cow are being omitted and the ability to

directly observe and measure the concept is becoming more difficult.

Constructs could be made measurable by identifying variables. For

example, if marital status is a construct, it could be made measurable bybreaking it into the variables single, widowed, divorced, married.


5/27

55

What is a Theory?

Theory is often defined in relation to practice. For example, a

teacher describes the process of giving an injection, as opposed to

students actually giving the injection to patient. Theory in this sensemeans dealing with a topic (administration of an injection).

Theory has several definitions. At basic level, theory explains the

occurrence of phenomena. To do this, it has to explain the

relationship between variables or concepts. For example, an

expansion in a bar of metal occurs when it is heated. Thephenomenon of expansion is explained by the relationship between

the variable metal and the variable heat.

The theory must also predict that each time the variables happen to

be in the same relationship, the same results will be obtained.

Another definition of theory is that it is a set of interrelatedconstructs (concepts) definitions and propositions that present a

systematic view of phenomena by specifying relations among

variables, with the purpose of explanation and prediction.


6/27

66

From the above example on the theory of metal expansion, a

number of propositions exist:

Metals are made up of atoms The structure of atom is changed by heat

Heat causes atoms to expand


7/27

77

The Metaparadigm For Nursing

Paradigm: refers to a pattern of shared understandings and

assumptions about reality and the world. We become aware ofparadigms when realities clash. In nursing we refer to qualitative vs

quantitative research paradigms.

Person, environment, health, and nursing are collectively referred to

as metaparadigm for nursing. Meta means with, while paradigm

means pattern. These four concepts are central to nursing. Person: The recipient of nursing care.

Environment: The internal and external surroundings that affect the

person.

Health: the degree of wellness or well-being that the person

experiences.

Nursing: The attributes, characteristics, and actions of the nurse

providing care to person.

What we need to know about these four major concepts is that their

definitions vary from one theorist to another


8/27

88

Overview of Selected Nursing Theories

Nightingale Environmental Theory: Nightingale (1860) definednursing as the act of utilising the environment to assist the patient in

his recovery. She linked health with five environmental factors:fresh air, pure water, efficient drainage, cleanliness and light,especially direct sunlight. Nightingale concepts about ventilation, cleanliness, quiet, warmth, and

diet remain integral parts of nursing and health care today.


9/27

99

Orems General Theory of Nursing

Consists of three related theories collectively referred to asOrems General Theory of Nursing:

1. Self-care Theory: 3 types of self-care requisites (needs)

2. Self-care Deficit Theory: 5 Methods of Assistance

3. Nursing Systems Theory: 3 types


10/27

10

Orems Self-care Theory

Based on the concepts of: SELF-CARE

SELF-CARE AGENCY

SELF-CARE REQUISITES

THERAPEUTIC SELF-CARE DEMAND

10


11/27

11

Self-care Definition

Self-care comprises those activities performed independently by anindividual to promote and maintain personal well-being throughout life.

Self-care Agency

Definition: the individuals ability to perform self-care activities

Consists of TWO agents:

Self-care Agent - person who provides the self-care

Dependent Care Agent - person other than the individual who

provides the care (such as a parent)

11


12/27

12

Self-care Requisites (Needs)

Definition: the actions or measures used to provide self-care. A need isalso a requirement within an individual or group which stimulates a

response to maintain integrity.

Consists of THREE categories:

Universal - requisites/needs that are common to all individuals.

These include maintaining intake and elimination of air, water, andfood.

Developmental - needs resulting from maturation or develop due to

a condition or event, such as adjusting to a change in body image or

to loss of spouse.

Health Deviation - needs resulting from illness, injury & disease orits treatment. These include actions such as seeking health care

assistance and taking prescribed medications


13/27

13

Orems Self-care Deficit Theory

Is the central focus of Orems Grand Theory of Nursing Explains when nursing is needed

Describes and explains how people can be helped through nursing

Results when the Self-care Agency (patient) cant meet her/his self-care

needs or administer self-care

Nursing meets these self-care needs through five methods of helping.

These are:

- Acting or doing for

- Guiding

- Teaching

- Supporting

- Providing an environment to promote the patients ability to meet

current or future demands


14/27

14

Orems Nursing Systems Theory Describes...

Nursing responsibilities

Roles of the nurse and patient

Rationales for the nurse-patient relationship

Types of actions needed to meet the patients demands

Orems Nursing Systems Theory

Refers to a series of actions a nurse takes to meet a patients self-care

needs Is determined by the patients self-care needs

Is composed of THREE types of nursing systems:

Wholly compensatory: a patients self-care agency is so limited that

s/he depends on others for well-being.

Partly compensatory: a patient can meet some self-care requisites

but needs a nurse to help meet others

Supportive-educative: a patient can meet self-care requisites but

needs help in decision-making, behavior control, or knowledge

acquisition


15/27

Henderson Definition of Nursing

The unique function of the nurse is to assist the individual, sick orwell, 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, and to do this in

such a way as to help him gain independence as rapidly as

possible.

It is my contention that the nurse is, and should be legally, an

independent practitioner [as long as she is not performing the doctors

duties.] But the nurse is the authority on basic nursing care. Perhaps I

should explain that by basic nursing care I mean helping the patient

with the following activities


16/27

14 Fundamental Needs

1. Breathing normally

2. Eating and drinking adequately

3. Eliminating body wastes4. Moving and maintaining a desirable position

5. Sleeping and resting

6. Selecting suitable clothes

7. Maintaining body temperature by adjusting cothing and

modifying the environment8. Keeping the body clean and well-groomed

9. Avoiding dangers in the environment and avoiding injuring others

10. Communicating with others in expressing emotions, needs, fears,or opinions

11. Worshipping according to ones faith

12. Working in such a way that one feels a sense of accomplishment13. Playing or participating in various forms of recreation

14. Learning, discovering, or satisfying the curiosity that leads tonormal development and health, and using available healthfacilities


17/27

17

Nurses Role

Substitutive : acting for a person Supplementary : assisting a person

Complementary : working with the person

with the goal of helping the person become as independent as

possible.

Today I see the role of nurses as givers of primary health care, as

those who diagnose and treat when a doctor is unavailable Nurses

may be the general (medical) practitioners of tomorrow


18/27

18

Neumans Systems Model

Neumans model is based on the individuals relationship to stress,

reaction to it, and reconstitution factors. Reconstitution is the state

of adaptation to stressors. In this model, the client is an open system composed of a central

core of energy sources (physiologic, psychologic, sociocultural,

developmental, and spiritual) surrounded by two rings referred to as

lines of resistance. These lines represent internal factors that help

the client defend against a stressor; for example an increase in thebody white cells count to fight an infection.

Outside the lines of resistance are two lines of defense. The normal

line of defense represents the persons state of equilibrium or the

state of adaptation developed and maintained over time and

considered normal for the person. The flexible line of defense isdynamic and can be rapidly altered over a short period of time. It

prevents stressors from penetrating the normal line of defense.


19/27

19

Stressors in Neumans model are:

Intrapersonal: Occur within an individual (infection)

Interpersonal: Occur between individuals (Unrealistic role

expectation) Extrapersonal: Occur outside the person (financial concerns)

The individuals reaction to stress depends on the strength of lines

of defense. When these lines fail, the resulting reaction depends on

the lines of resistance.

Nursing interventions focus on retaining or maintaining system

stability. The intervention are carried out on three preventive levels:

Primary prevention: Focuses on protecting the normal line of

defense and strengthening the flexible line of defense.

Secondary prevention: Focuses on strengthening internal

lines of resistance, reducing the reaction, and increases

resistance factors.

Tertiary prevention: Focuses on readaptation and stability

and protects reconstitution or return to wellness after

treatment.


20/27


21/27

21

Roy Adaptation Model

Roy sees the person as "a biopsychosocial being in constantinteraction with a changing environment.

The person is an open, adaptive system who uses coping skills todeal with stressors.

The environment is "all conditions, circumstances and influencesthat surround and affect the development and behaviour of theperson".

Stressors are stimuli that influence the person. Three types of stimuli influence an individuals ability to cope withthe environment.

Focal stimuli are those that immediately confront the individual in aparticular situation. Focal stimuli for a family include individualneeds.

Contextual stimuli are those other stimuli that influence the situation. Residual stimuli include the individuals beliefs or attitudes that mayinfluence the situation.

Contextual and residual stimuli for a family system includenurturance, socialization, and support.


22/27

22

Roy Four Modes of Adaptation

The physiologic mode. Adaptation involves the maintenance ofphysical integrity. Basic human needs such as nutrition, oxygen,fluids, and temperature regulation are identified with this mode.

The self-concept mode. A function of this mode is the need for

maintenance of psychic integrity. Perceptions of ones physical andpersonal self are included in this mode.

The role function mode. The need for social integrity is emphasizedin this mode in which human beings adapt to various role changesthat occur throughout a lifetime.

The interdependence mode. The need for social integrity is also

emphasized in the interdependence mode. Interdependenceinvolves maintaining a balance between independence anddependence in ones relationships with others.


23/27

Spiritual Caring

individuals are holistic beings = physical, mental, spiritual, emotional

Considering a light bulb analogous to a human, think of the glass,

aluminum, and other tangible materials that comprise it asrepresenting the physical dimension; think of the light and warmth the

bulb elicits as the psychological; and the electrical current that

energizes and ultimately provides the meaning and function for the

bulb as the spiritual dimension. Stallwood & Stoll 1975 as cited by

Taylor, E. F. (2002).
https://encrypted.google.com/imgres?imgurl=http://www.lightbulbmarket.com/files/1974975/uploaded/Philips%2520Incandescent%2520A-19%2520Light%2520Bulb.gif&imgrefurl=http://www.lightbulbmarket.com/product/050260_60-Watt-A-19-Philips-Light-Bulb&h=600&w=335&sz=43&tbnid=pegb9rybXJ5fGM:&tbnh=301&tbnw=168&prev=/images%3Fq%3Dlight%2Bbulb%2Bpicture&zoom=1&q=light+bulb+picture&hl=en&usg=__4YTIMiLQ2pww-Di4dHQo6CPhtAA=&sa=X&ei=r36WTJcaipbgBqThqd4E&ved=0CBQQ9QEwAAhttps://encrypted.google.com/imgres?imgurl=http://www.lightbulbmarket.com/files/1974975/uploaded/Philips%2520Incandescent%2520A-19%2520Light%2520Bulb.gif&imgrefurl=http://www.lightbulbmarket.com/product/050260_60-Watt-A-19-Philips-Light-Bulb&h=600&w=335&sz=43&tbnid=pegb9rybXJ5fGM:&tbnh=301&tbnw=168&prev=/images%3Fq%3Dlight%2Bbulb%2Bpicture&zoom=1&q=light+bulb+picture&hl=en&usg=__4YTIMiLQ2pww-Di4dHQo6CPhtAA=&sa=X&ei=r36WTJcaipbgBqThqd4E&ved=0CBQQ9QEwAAhttps://encrypted.google.com/imgres?imgurl=http://richardwiseman.files.wordpress.com/2009/08/light-bulb-glowing-filament-light-blue-uncropped-lores-3-ahd.jpg&imgrefurl=http://richardwiseman.wordpress.com/2009/08/&h=856&w=727&sz=34&tbnid=cc2nXOliH0ghuM:&tbnh=145&tbnw=123&prev=/images%3Fq%3Dlight%2Bbulb%2Bpicture&zoom=1&q=light+bulb+picture&hl=en&usg=__CjMHE_Es3RIrCY7XcVe8ifFq-xY=&sa=X&ei=A3-WTMWCGsPO4AbT6vmOBA&ved=0CCQQ9QEwBghttps://encrypted.google.com/imgres?imgurl=http://richardwiseman.files.wordpress.com/2009/08/light-bulb-glowing-filament-light-blue-uncropped-lores-3-ahd.jpg&imgrefurl=http://richardwiseman.wordpress.com/2009/08/&h=856&w=727&sz=34&tbnid=cc2nXOliH0ghuM:&tbnh=145&tbnw=123&prev=/images%3Fq%3Dlight%2Bbulb%2Bpicture&zoom=1&q=light+bulb+picture&hl=en&usg=__CjMHE_Es3RIrCY7XcVe8ifFq-xY=&sa=X&ei=A3-WTMWCGsPO4AbT6vmOBA&ved=0CCQQ9QEwBghttps://encrypted.google.com/imgres?imgurl=http://richardwiseman.files.wordpress.com/2009/08/light-bulb-glowing-filament-light-blue-uncropped-lores-3-ahd.jpg&imgrefurl=http://richardwiseman.wordpress.com/2009/08/&h=856&w=727&sz=34&tbnid=cc2nXOliH0ghuM:&tbnh=145&tbnw=123&prev=/images%3Fq%3Dlight%2Bbulb%2Bpicture&zoom=1&q=light+bulb+picture&hl=en&usg=__CjMHE_Es3RIrCY7XcVe8ifFq-xY=&sa=X&ei=A3-WTMWCGsPO4AbT6vmOBA&ved=0CCQQ9QEwBghttps://encrypted.google.com/imgres?imgurl=http://www.lightbulbmarket.com/files/1974975/uploaded/Philips%2520Incandescent%2520A-19%2520Light%2520Bulb.gif&imgrefurl=http://www.lightbulbmarket.com/product/050260_60-Watt-A-19-Philips-Light-Bulb&h=600&w=335&sz=43&tbnid=pegb9rybXJ5fGM:&tbnh=301&tbnw=168&prev=/images%3Fq%3Dlight%2Bbulb%2Bpicture&zoom=1&q=light+bulb+picture&hl=en&usg=__4YTIMiLQ2pww-Di4dHQo6CPhtAA=&sa=X&ei=r36WTJcaipbgBqThqd4E&ved=0CBQQ9QEwAAhttps://encrypted.google.com/imgres?imgurl=http://www.lightbulbmarket.com/files/1974975/uploaded/Philips%2520Incandescent%2520A-19%2520Light%2520Bulb.gif&imgrefurl=http://www.lightbulbmarket.com/product/050260_60-Watt-A-19-Philips-Light-Bulb&h=600&w=335&sz=43&tbnid=pegb9rybXJ5fGM:&tbnh=301&tbnw=168&prev=/images%3Fq%3Dlight%2Bbulb%2Bpicture&zoom=1&q=light+bulb+picture&hl=en&usg=__4YTIMiLQ2pww-Di4dHQo6CPhtAA=&sa=X&ei=r36WTJcaipbgBqThqd4E&ved=0CBQQ9QEwAA


24/27

24

Case Study

Mr. Elder works at the zoo. He has a large open wound on his foreheadfrom a tiger attack. Mr. Elder was referred to a home health agencyfor wound management. The wound extends to the skull. Mr. Elderwas out of work as a result of this wound, saw friends infrequently,and was somewhat depressed. His wife spent hours each dayfixing him goodies to help cheer him up because she liked to cook

and found it was a good way to release her own anxiety about herhusbands condition.

After three weeks the wound showed no improvement in healing,although had not become infected. During the agency visit, Mrs.Elder confides in the nurse that her husband was drinking tons of

water and seemed to be urinating frequently. She was worried thathe might hurt himself getting up so often in the middle of the night.She was wondering if there was a pill to help him sleep through thenight. Using theories models, what would the nurse do to help Mr.Elders healing problems?

Case study adapted from Chitty, 2003.


25/27

25

Neumans Nurse: Nancy

IfNancy were the nurse dispatched from the home health agency, shewould use Neumans theory to solve the problem.

Nancy knows that stressors attack the normal and flexible lines ofdefense. There must be an imbalance in Mr. Elders stabilitybecause his wound is not healing. The responses to his stressorare polyuria, polydipsia, both of which are physiological variables.This leads Nancy to believe the stressor is diabetes, and tertiaryinterventions need to be implemented in order to bring aboutreconstitution.


26/27

26

Roys Nurse: Roberta

IfRoberta were the nurse dispatched from the home health agency,she would use Roys theory to solve the problem.

Roberta would assess Mr. Elders physical adaptive modes and identifyhis maladaptive behaviors: Eating too many sweets

Drinking too much water Urinating too frequently Being socially isolated

Roberta would modify the environment (both the internal and external)to create adaptive behaviors and enhance coping: Internal: insulin administration

External: change in diet


27/27

27

Mr. Elders wound started healing almost immediately after

his diabetes was identified and controlled. He was able to

go back to work and to meet with his friends again. Mrs.

Elder learned fun, new diabetic-friendly foods to cook forherself and Mr. Elder.

The advantage of applying both theories to clinical practice

is that it will lead to appropriate client-based nursing care.

2578 Nursing Theories Belal

Documents

Transcript of 2578 Nursing Theories Belal