OUTLINE OF TOPICS Definitions of Theory and Nursing Theory Introduction

Historical Perspective and Key concepts Terms used in Theory Development

Types of Nursing Theories Framework of Analysis Significance of Nursing Theories Nursing Theorists and their Works

Florence Nightingale “Environmental Theory” Virginia Henderson “Needs Theory” Faye Abdellah “21 Nursing Problems” Dorothea Orem “Self-care deficit Theory”

Prepared by: Mae Michelle F. Aguilar RN & Kaysie Bustamante RN

NURSING THEORIESNRSG 202-1

By the end of the lecture, nurses will be able to:

Define terms used in Theory Development.

Explain the significance of Nursing Theories (Nightingale, Henderson, Abdellah and Orem) in the Nursing Practice.

Examine the nursing theories and how it applies in the clinical practice setting.

LEARNING OBJECTIVES

ORIGIN: “THOERIA” – speculate

THEORY

GREEK WORD

THEORIES are a set of interrelated concepts that give a systematic view of a phenomenon (an observable fact or event) that is explanatory & predictive in nature.

Theory is “a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena”. (Chinn and Kramer 1999)

Theories are composed of concepts, definitions, models, propositions & are based on assumptions.

They are derived through two principal methods; deductive reasoning and inductive reasoning.

A theory makes it possible to “organize the relationship among the concepts to describe, explain, predict, and control practice” (Torres,1986,p.21).Torres (1990,pp.6–9)

Defined as a belief, policy, or procedure proposed or followed as the basis of action. It is an organized framework of

concepts and purposes designed to guide the practice of nursing.

NURSING THEORY

1. Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon.

2. Theories must be logical in nature.

3. Theories should be relatively simple yet generalizable.

4. Theories can be the bases for hypotheses that can be tested.

CHARACTERISTICS OF THEORIES

5. Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them.

6. Theories can be used by the practitioners to guide and improve their practice.

7. Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated.

Historical Perspectives and Terminology

INTRODUCTION TO NURSING THEORY

Mid 1800’s – Nursing Knowledge is distinct from medical knowledge (Nightingale)

Nursing practices was based on principles and traditions passed on through apprenticeship education and common sense wisdom.

Nursing as a Vocational heritage more than professional vision.

1960’s – debates and discussion regarding the proper direction and appropriate disciple for nursing knowledge development.

MID 1800’S AND 1960’S

CURRICULU

M ERA

•Moving nursing education from hospital-based diploma programs into college and universities

.

RESEARCH ERA

•Research is the path to new knowledge.

•Part of the curricula of developing graduate programs.

HISTORICAL ERAS

GRAD. EDU. ERA

•Masters program in nursing emerged to meet the need for nurses with specialized education in nursing.

•Nursing Theory and Nursing Conceptual models were included as courses in the study of nursing.

THEORY

ERA

•Outgrowth of research era.

•Research without theory produced isolated information; however research and theory produced nursing science.

Evaluation of 25 years of nursing research revealed that nursing lacked conceptual connections and theoretical frameworks.

MILESTONES: 1. Standardization of curricula for nursing master’s education. 2. Doctoral education for nurses should be in nursing.

Transition from vocation to profession.

Nursing practice is based on Nursing Science

MID 1970’S

Preparadigm period to Paradigm period

Introduced an organizational structure for nursing knowledge development to the nursing literature.

Utilization phase of the Theory Era – emphasis shifts from the development to the use and application of what is known.

1980’S

KEY CONCEPTS

Nightingale 1860:

Peplau 1952:

Henderson 1955:

• To facilitate “the body’s reparative processes” by manipulating client’s environment

• Nursing is; therapeutic interpersonal process.

• The needs often called Henderson’s 14 basic needs

Abdellah 1960:

Orlando 1962:

Johnson’s Theory 1968:

• delivering nursing care for the whole person to meet the physical, emotional, intellectual, social, and spiritual needs of the client and family.

• the client is an individual; with a need; that, when met, diminishes distress, increases adequacy, or enhances well-being.

• focuses on how the client adapts to illness and how actual or potential stress can affect the ability to adapt. The goal of nursing to reduce stress so that; the client can move more easily through recovery.

Rogers 1970:

Orem1971:

King 1971:

• maintain and promote health, prevent illness, and care for and rehabilitate ill and disabled client through “humanistic science of nursing”

• self-care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, developmental, or social needs.

• use communication to help client reestablish positive adaptation to environment.

Neuman 1972:

Roy 1979:

Watson’s Theory 1979:

• Stress reduction is goal of system model of nursing practice

• This adaptation model is based on the physiological, psychological, sociological and dependence-independence adaptive modes.

• defines the outcome of nursing activity in regard to the; humanistic aspects of life.

TERMINOLOGY

CONCEPTS

vehicles of thought that involve images. Are words that describe objects, properties, or events & are basic components of theory.

Types: Empirical concepts Inferential concepts Abstract concepts

Specifies the main concepts that encompass the subject matter and the scope of discipline.

“There is a general agreement that nursing’s metaparadigm consists of the central concepts of person, environment, health and nursing.” (Powers and Knapp)

METAPARADIGM

METAPARADIGM CONCEPTS

THE PERSON

THE ENVIRONMENT

HEALTH

NURSING (GOALS, ROLES & FUNCTIONS)

Specifies the definitions of the metaparadigm concepts in each of the conceptual models of nursing.

There are other theoretical works that may be considered philosophies, works that specify philosophical approaches to nursing.

PHILOSOPHY

representations of the interaction among and between the concepts showing patterns.

In nursing, models are often designed by theory authors to depict the beliefs in their theory (Lancaster and Lancaster 1981).

MODELS

VERBAL MODELS – worded statements, a form of closely related knowledge development.

SCHEMATIC MODELS – diagrams, drawings, graphs and pictures that facilitate understanding.

statements that explain the relationship between the concepts.

PROPOSITION

PROCESS

a series of actions, changes or functions intended to bring about a desired result.

The delivery of nursing care within the nursing process is directed by the way specific conceptual frameworks & theories define the person (patient), the environment, health & nursing.

outlines possible courses of action or to present a preferred approach to an idea or thought.

CONCEPTUAL FRAMEWORK

GENERAL SYSTEMS THEORY

describes how to break whole things into parts & then to learn how the parts work together in “systems”.

These concepts may be applied to different kinds of systems, e.g. Molecules in chemistry, cultures in sociology, and organs in Anatomy & Health in Nursing.

THE DEVELOPMENT OF NURSING THEORIES

ADAPTATION THEORY defines adaptation as the adjustment of living matter to

other living things & to environmental conditions.

Adaptation is a continuously occurring process that effects change & involves interaction & response.

Human adaptation occurs on three levels :1. The internal (self)2. The social (others) &3. the physical (biochemical reactions)

DEVELOPMENTAL THEORY

It outlines the process of growth & development of humans as orderly & predictable, beginning with conception & ending with death.

The progress & behaviors of an individual within each stage are unique.

The growth & development of an individual are influenced by heredity, temperament, emotional, & physical environment, life experiences & health status.

TYPES OF NURSING THEORIESAccording to Scope, Functions and Philosophy

SPECULATIVE – yet to be tested through research and found to be consistently true, valid and reliable in answering questions, solving problems and exploring phenomenon.

ESTABLISHED – Accumulation of facts, principles and laws that have been repeatedly tested through research over time and found to be consistently valid and reliable.

GRAND THEORY - It is the broadest in scope, represents the most abstract level of development, and addresses the broad phenomena of concern within the discipline.

MIDDLE-RANGE THEORY - theory that addresses more concrete and more narrowly defined phenomena. It is intended to answer questions about nursing phenomena, yet they do not cover the full range of phenomena of concern to the discipline

MICRO-RANGE THEORY - concrete and narrow in scope. It explains a specific phenomenon of concern to the discipline

TYPES ACCORDING TO SCOPE

1. NURSING PHILOSOPHY

Meaning of nursing phenomenon through analysis, reasoning and logical argument.

Includes works which predate or introduce the nursing theory era and have contributed to the knowledge development in nursing.

TYPES According to KNOWLEDGE BASE and CHARACTERISTICS

2. NURSING CONCEPTUAL MODELS

Works of grand theorists or pioneers in Nursing.

“Provides a distinct frame of reference for its adherents that tells them how to observe and interpret the phenomena of interest to the discipline.”

3. NURSING THEORIES AND MIDDLE-RANGE THEORIES

Addresses the specifics of nursing situations within the perspective of the model or theory from which they are derived.

PHILOSOPHIES CONCEPTUAL MODELS AND GRAND THEORIES

THEORIES AND MIDDLE-RANGE THEORIES

NIGHTINGALEWIEDENBACHHENDERSONABDELLAH

HALLWATSONBENNER

OREMLEVINEROGERS

JOHNSONROY

NEUMANKING

ROPER, LOGAN, TIERNEY

BARNARDLEININGER

PARSEMISHEL

NEWMANADAM

PENDERPEPLAU

ORLANDOTRAVELBEEKOLCABA

ERICKSON, TOMLIN, SWAINMERCER

Descriptive-to identify the properties and workings of a discipline

Explanatory-to examine how properties relate and thus affect the discipline

Predictive-to calculate relationships between properties and how they occur

Prescriptive -to identify under which conditions relationships occur

TYPES ACCORDING TO FUNCTION (Polit et. al 2001)

1. “Needs” theories Are based around helping individuals to fulfill their physical

and mental needs.

Based on the philosophical underpinnings of the theories:

2.“Interaction” theories As described by Peplau

(1988), these theories revolve around the relationships nurses form with patients.

3. “Outcome” theories" Outcome theories portray the nurse as the

changing force, who enables individuals to adapt to or cope with ill health.

4. “Humanistic” Theories

Humanistic theories developed in response to the psychoanalytic thought that a person’s destiny was determined early in life.

Humanistic theories emphasize a person’s capacity for self-actualization.

Carl Rogers developed a person –centered model of psychotherapy that emphasizes the uniqueness of the individual.

Criteria for Evaluating Theoretical WorksFRAMEWORK OF ANALYSIS

Major Concepts and sub-concepts and their definitions are identified.

“The danger of lost meaning when terms are borrowed from other disciplines and used in a different context.” (Ellis)

Diagrams and examples may facilitate clarity and should be consistent.

“HOW CLEAR IS YOUR THEORY?”

CLARITY

Nurse in practice need simple theory, such as middle-range theory to guide practice. (Chinn and Kramer)

“The most useful theory provides the greatest sense of understanding.” (Reynolds)

“Elegant in its simplicity, even though it may be broad in content.” (Walker and Avant)

“How simple is this theory?”

SIMPLICITY

Scopes of concepts and goals within the theory are examined.

The situations the theory applies to should not be limited.

“The broader the scope, the greater the significance of the theory.” (Chinn and Kramer)

“How general is this theory?”

GENERALITY

“ How well the evidence supports the theory is indicative of empirical adequacy.” (Hardy)

Other scientists should be able to evaluate and verify results by themselves.

“How accessible is this theory?”

EMPIRICAL PRECISION

“It is essential for a theory to develop and guide practice...Theories should reveal what knowledge nurses must and should, spend time pursuing.”

“How important is this theory?”DERIVABLE CONSEQUENCE

As a Discipline and Profession

SIGNIFICANCE OF THEORY FOR NURSING

PROFESSION A specialized field of

practice, which is founded upon the theoretical structure of the science or knowledge of the discipline and the accompanying practice abilities.

DISCIPLINE Specific to the academia

and refers to a branch of education, a department of learning or a domain of knowledge.

Theories provided frameworks to structure curriculum content or to guide the teaching of nursing practice in nursing programs.

Discipline is dependent upon theory.

NURSING AS A DISCIPLINE

Focus on knowledge about how nurses function which concentrated on the nursing process to a focus on what nurses know and how they use knowledge to guide their thinking and decision making while concentrating on the patient.

New nursing science is developed through theory based research studies.

Criteria of a profession by Bixler and Bixler published in the American Journal of Nursing 1959

1. Utilizes in its practice a well defined and well- organized body of specialized knowledge that is on the intellectual level of higher learning.

2. Constantly enlarges the body of knowledge it uses and improves its techniques of education and service by the use of the scientific method.

NURSING AS A PROFESSION

3. Entrusts the education of its practioners to institutions of higher education.

4. Applies its body of knowledge in practical services that are vital to human and social welfare.

5. Functions autonomously in the formulation of professional policy and in the control of professional activity thereby.

6. Attracts individuals of intellectual and personal qualities who exalt service above personal gain and who recognize their chosen occupation as a life work.

7. Strives to compensate its practitioners by providing freedom of action, opportunity for continuous professional growth, and economic security.

Presented specific goals and achievements of the profession.

Nurses are recognized for the contribution they make in healthcare and the society.

Nursing theory is a useful tool for reasoning, critical thinking, and decision making in the nursing practice.

NURSING THEORY AND THE PRACTICE OF NURSINGTheory assists the practicing nurse to: •Organize patient data•Understand patient data•Analyze patient data•Make decisions about nursing interventions•Plan patient care•Predict outcomes of care•Evaluate patient outcomes

Professional practice requires a systematic approach that is focused on the patient. Nursing theoretical works provide a perspective of the patient.

aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs1978).

provides the foundations of nursing practice, help to generate further knowledge and indicate in which direction nursing should develop in the future (Brown 1964).

helps us to decide what we know and what we need to know (Parsons1949).

helps to distinguish what should form the basis of practice by explicitly describing nursing.

IMPORTANCE OF NURSING THEORIES

The benefits of having a defined body of theory in nursing include better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education (Nolan 1996).

The main exponent of nursing – caring – cannot be measured, it is vital to have the theory to analyze and explain what nurses do.

NURSING THEORISTS AND THEIR WORKS

MODERN NURSING and ENVIRONMENTAL THEORY

Nursing “is an act of utilizing the environment of the patient to assist

him in his recovery.”

FLORENCE NIGHTINGALE

First Nursing Theorists and the Mother of Modern Nursing.

Born in May 12, 1820 in Italy to a wealthy British family.

In 1853, she accepted the position of superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London.

Biography

•She tended to wounded soldiers during the Crimean War. She became known as the "Lady with the Lamp" because of her night rounds. Immortalized in the poem “Santa Filomena” by Henry Wadsworth Longfellow

•After the Crimean War, she established a nursing school at St. Thomas' Hospital and King’s College in London in 1860.

Nightingale wrote Notes on Nursing (1859), which was the foundation of the curriculum for her nursing school and other nursing schools.

Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army Notes on Hospitals Report on Measures Adopted for Sanitary Improvements in India from June 1869 to June 1870

“She helped to pioneer the revolutionary notion that social phenomena could be objectively measured and subjected to mathematical analysis.” (Cohen)

Nightingale’s research skills: Recording, Communicating, ordering, coding, conceptualizing, inferring, analyzing and synthesizing (Palmer)

Nightingale emphasized the concurrent use of observation and the performance of tasks in the education of nurses.

In 1883 - Royal Red Cross by Queen Victoria. In 1907 - the Order of Merit.

In 1908 - Honorary Freedom of the City of London.

She was able to work into her eighties and died in her sleep on August 13, 1910 at age 90

International Nurses Day is celebrated on her birthday.

Education provided by her Father Family’s aristocratic social status. Exposure to political process of the Victorian England The Industrial Age Charles Dickens’ social commentaries and novels Dialogues with many political leaders Unitarian religious affiliation.

INFLUENCES

ENVIRONMENTAL THEORY

1. Person

Patient who is acted on by nurse Emphasized that the Nurse has in

control of the patient’s environment.

Affected by environment Passive yet has reparative powers

Nightingale’s Major Concepts

2. Environment

Foundation of theory.

Included everything, physical, psychological, and social

Nurses are instruments to change the social status of the poor by improving their living conditions

3. Health

“We know nothing of health, the positive of which pathology is the negative, except from the observation and experience.”

Given her definition that of the art of nursing is to “unmake

what God had made disease,” then the goal of all nursing activities should be client health.

Nursing should provide care to the healthy as well as the ill and discussed health promotion as an activity in which nurses should engage.

Envisioned maintenance of health through prevention of disease via environmental control.

4. Nursing

“What nursing has to do… is to put the patient in the best condition for nature to act upon him” (Nightingale, 1859/1992)

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.”

Nursing is having the responsibility for someone else’s health.

She wrote her Notes on Nursing to provide women how to “Think like a Nurse.”

Ventilation and warming Light and noise Health of houses Bed and bedding

Personal cleanliness Variety

Chattering hope and advices Food

•“ Keep the air he breathes as pure as the external air, without

chilling him.”

•Recognized this environmental component as a source of disease and recovery.

VENTILATION AND WARMING

• Provided description for measuring the patient’s body temperature through palpation of extremities.

• Nurses were instructed to manipulate the environment to maintain both ventilation and patient warm by good fire, opening windows and properly positioning the patient in the room.

•“Light has quite as real and tangible effects upon the

human body…who has not observed the purifying

effect of light, and especially of direct sunlight, upon the air of the room?”

LIGHT

•Noises created by physical activities in the environment (room) was to be avoided by the nurse.

NOISE

•Bathing of patients on a frequent, even daily, basis.

•Nurses should wash their hands regularly.

CLEANLINESS

• Noted that a dirty environment (floors, carpets, walls and bed linens) was a source of infection through the organic matter it contained.

•The appropriate handling and disposal of bodily excretions and sewage was required to prevent contamination of the environment.

BED AND BEDDINGS

•“Badly constructed houses do for the healthy what

badly constructed hospitals do for the sick.”

HEALTH OF HOUSES

“To any but an old nurse, or an old patient, the degree

would be quite inconceivable to which the

nerves of the sick suffer from seeing the same walls, the same ceiling, the same surroundings during a long confinement to one or two

rooms”

VARIETY

• Instructed nurses to assess dietary intake , meal schedules and its effect on the patient.

FOOD

•Protects patient from receiving upsetting new, seeing visitors who can affect the patient’s recovery negatively and from suddenly receiving disruptions from sleep.

Chattering of Hope and Advices

Nightingale (1860/1957/1969) believed that five points were essential in achieving a healthful house: “pure air, pure water, efficient drainage, cleanliness and light.”

A healthy environment is essential for healing. She stated that “nature alone cures.”

ASSUMPTIONS

Nurses must make accurate observations of their patients and be able to report the state of the patient to the physician in an orderly manner.

Nursing is an art, whereas medicine is a science. Nurses are to be loyal to the medical plan, but not servile.

Disease is a reparative process. Disease is nature’s effort to remedy a process of poisoning or decay, or a reaction against the conditions in which a person was placed.

Nature is synonymous with God .

Committed to nursing education (training.) Women were to be specifically trained to provide care for the sick and that nurses requiring preventive healthcare requires more training.

Nurses should use common sense, observation, perseverance and ingenuity.

Persons desired good health and that they would cooperate with the nurse.

Did not embrace germ theory but clearly understood the concept of contagion and contamination through organic materials from patients and the environment.

Believed that nurses should be MORAL AGENTS.

Addressed Professional relationship with patients.

Instructed nurses on principle of confidentiality and advocated care for the poor.

Patient decision making – indecision or changing the mind is more harmful to the patient than the patient having to make a decision.

Used Inductive Reasoning to extract laws of health, disease and nursing from her observations and experiences.

LOGICAL FORM

Practice, Education and Research

ACCEPTANCE BY THE NURSING COMMUNITY

Environmental aspects remain integral components of current nursing care.

Multiple authors reviewed her work Petty management concepts and actions , again identifying some of the timelessness and universality of her management style.

PRACTICE

Principles of Nursing Training provided a universal template for early nurse training schools.

Experimental schools established in the USA 1873 : 1. Bellevue Hospital in New York 2. New Haven Hospital 3. Massachusetts Hospital in Boston

EDUCATION

Advocated Nursing school’s independence from a hospital to ensure that students would not be involved in the hospital’s labor pool as part of their training.

Measurement of the art of nursing could not be accomplished through licensing examinations but she used testing methods, including case studies (notes).

Graphically represented data was first identified in the polar diagrams.

Empirical approach in solving problems of healthcare delivery.

Concepts Nightingale identified have served as basis for current research.

RESEARCH

CRITIQUE

Simple?

Important?

Accessible?

General?

Clear?

Weaknesses There is scant information on the psychosocial

environment when compared to the physical environment.

The application of her concepts in the twentieth century is in question.

Strengths Has broad applicability to the practitioner. Her model can

be applied in most complex hospital intensive care environment, the home, a work site, or the community at large.

Reading her work raises a consciousness in the nurse about how the environment influences client outcomes.

“I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.”

-Florence Nightingale

THE PRINCIPLES AND PRACTICE OF NURSING

“I believe that the function the nurse performs is primarily an independent one – that of

acting for the patient when he lacks knowledge , physical strength, or the will to act for himself as he would ordinarily act in

health, or in carrying out prescribed therapy. This function is seen as complex and creative,

as offering unlimited opportunity for the application of the physical, biological, and

social sciences and the development of skills based on them.” (Henderson, 1960)

VIRGINIA HENDERSON

“The Nightingale of Modern Nursing”. Others named her as the “First Lady of Nursing” and “Modern-Day Mother of Nursing”

Born on November 30, 1897 in Kansas City, Missouri and lived in Virginia.

Biography

In 1918, she entered the Army School of Nursing in Washington, DC.

1921, she was a staff nurse Henry Street Visiting Nurse Service in New York

She began her career as a nurse educator in 1924 at the Norfolk Protestant Hospital in Virginia where she was the first and only teacher in the school of nursing

Five years later she entered Teacher’s College at Columbia University where she earned her B.S. and M.A. degrees in Nursing Education.

1939 – rewrote the 4th edition of Bertha Hammer’s Textbook of the Principles and Practice of Nursing.

Henderson's career in research began when she joined the Yale School of Nursing as Research Associate in 1953 to work on a critical review of nursing research.

In 1955 she published the 5th edition with her own definition of nursing.

1960 – Coauthored Basic of Principles in Nursing care for the International Council of Nurses which was translated into more than 20 languages.

1966-The Nature of Nursing. A definition and its implication for practice, Research and Education

In 1985, Henderson was presented with the first Christianne Reimann Prize from the International Council of Nurses.

She was also an honorary fellow of the United Kingdom's Royal College of Nursing. The same year, she was also honored at the Annual Meeting of the Nursing and Allied Health Section of the Medical Library Association.

Awarded in 1988 by the American Nurses Association for her lifelong contributions to nursing research, education and professionalism.

Henderson died on March of 1996 at the age of 98

ANNIE W. GOODRICH Dean of the Army School of Nursing. Lifted her sights above techniques and routines Nursing is not merely ancillary to medicine.

CAROLINE STACKPOLE Philosophy Professor at Teachers College Importance of physiological balance.

INFLUNCES

JEAN BROADHURST Microbiology Professor at Teachers College Importance of hygiene and asepsis

DR. EDWARD THORNDIKE Illness “is more than a state of disease that most

fundamental needs are not met in hospitals.”

Dr. GEORGE DEAVER Physicist at Bellevue Hospital The Goal of rehabilitative efforts at the institute was

rebuilding the patient’s independence.

BERTHA HARMER Canadian Nurse “Nursing is rooted in the needs of humanity.”

IDA JEAN ORLANDO (PELLETIER) Influence on her Nurse-patient relationship “Ida Orlando made me realize how easily a nurse

can act on misconceptions of the patient’s needs if she does not check her interpretation of them with him.”

NURSING NEED THEORY

1. Person/ Individual

considers the biological, psychological, sociological, and spiritual components.

She defined the patient as someone who needs nursing care, but did not limit nursing to illness care.

Henderson’s Major Concepts

NURSING NEED THEORY

2. Society or Environment

“The aggregate of all external conditions and influences affecting the life and development of an organism.” – Webster’s Dictionary

maintaining a supportive environment is one of the elements of her 14 activities.

She sees individuals in relation to their families but minimally discusses the impact of the community on the individual and family.

She supports the tasks of private and public health agencies keeping people healthy.

She believes that society wants and expects the nurse’s service of acting for individuals who are unable to function independently.

3. Health

Equated health with independence.

“The quality of health rather than life itself, that margin of mental/physical vigor that allows a person to work

most effectively and to reach his highest potential level of satisfaction in life.”

4. Nursing

14 Activities for Client Assistance

Physiological Psychological Aspects of

Communicating and Learning

Spiritual and Moral Sociologically Oriented

to Occupation and Recreation

"nurses care for a patient until a patient can care for him or herself."

nurses are willing to serve and that "nurses will devote themselves to the patient day and night."

nurses should be educated at the college level in both sciences and arts and should be knowledgeable in both biological and social sciences.

ASSUMPTIONS

Three Levels of Relationship:

Nurse as a substitute for the patient Nurse as a helper to the patient Nurse as a partner with the patient

“The nurse is a substitute for what the patient lacks to make him ‘complete’, ‘whole’, or ‘independent’, by the lack of physical strength, will or knowledge”

THE NURSE-PATIENT RELATIONSHIP

The nurse “is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of

locomotion for the infant, knowledge and confidence for the young mother, the ‘mouthpiece’ for those too weak

or withdrawn to speak and so on.”

Nurse must able to assess not only the patient’s needs but the condition and pathological states that alters them.

Nurses can alter the environment whenever necessary.

One goal of the nurse is to keep the patient’s days “as normal as possible”

Another goal is promotion of health. “ There is more to be gained by helping every man learn how to be healthy than be preparing the most skilled therapists for service to those in crises.”

Unique distinction from the Physician’s function – the CARE PLAN

Nursing Care Plan – promotes the physician’s therapeutic plan.

NURSE-PHYSICIAN RELATIONSHIP

Works in interdependence with other healthcare professionals.

“No one of the team should make such heavy demands on another members that any one of them is unable to perform

his or her unique functions.”

NURSE AS A MEMBER OF THE HEALTH CARE TEAM

Used the deductive form of logical reasoning.

Deduced her definition of nursing and the 14 needs from physiological and psychological principles.

LOGICAL FORM

Practice, Education and Research

ACCEPTANCE BY THE NURSING COMMUNITY

Nursing Process is the problem solving process and is not peculiar to nursing.

ASSESSMENT PHASE – assess pt. in 14 components of nursing care. Use observation, smell, feeling and hearing. Analyze collected data and differentiate normal from abnormal.

PRACTICE

PLANNING PHASE – Must fit individual’s needs, updating the plan as necessary on the basis of the changes and depending on physician’s prescribed plan.

IMPLEMENTATION PHASE – Individualized interventions depending on factors.

EVALUATION PHASE – evaluate according to the degree in which he or she performs independently.

“ In order for a nurse to practice as an expert in her own right and to use a scientific approach to the improvement of

practice, the nurse needs the kind of education available only in colleges and universities.”

3 Phases of Curriculum Development 1. Fundamental needs of the patient, the planning of

nursing care and the unique function of the nurse to assist in pt.’s activities of daily living.

EDUCATION

2. Helping patients meet their needs during body disturbances or pathological states that demand modifications in the nurse’s plan of care.

3. Patient and family centered. Complete study of patient and patient’s needs

Believed that research was needed to evaluate and improve practice.

Recommended library research.

1964 Survey and Assessment of Nursing Research identified several reasons for the lack of research in clinical nursing.

Major energies of the profession have gone toward improving the preparation for nursing.

RESEARCH

Learning how to recruit and hold sufficient numbers of nurses to meet the growing demand has taken considerable energy.

The need for administrators and educators has almost exhausted the supply of degree of nurses.

A lack of support from the administrators, nursing service administrators and physicians has discouraged researchers.

CRITIQUE

Simple?

Important?

Accessible?

General?

Clear?

Weaknesses Limited in a way that it can generally be applied to fully

functional individuals.

A major shortcoming in her work is the lack of a conceptual linkage between physiological and other human characteristics.

Strengths Her work can be applied to the health of individuals of all

ages. Each of the 14 activities can be the basis for research.

Although the statements are not written in testable terms, they may be reformulated into researchable questions.

The concept of nursing formulated by Henderson in her definition of nursing and the 14 components of basic nursing is uncomplicated and self-explanatory. Therefore, it can be used without difficulty as a guide for nursing practice by most nurses.

“Nursing must not exist in a vacuum. Nursing must grow and learn to meet the new health needs of the

public as we encounter them.” –Virginia Henderson

KEEP CALM

AndMore Slides to GO!!!

PATIENT-CENTERED APPROACHES TO NURSING"Nursing is based on an art and

science that moulds the attitudes, intellectual competencies, and

technical skills of the individual nurse into the desire and ability to help

people, sick or well, cope with their health needs."

FAY ABDELLAH

Born on March 13, 1919 New York City.

the first nurse officer to earn the ranking of a two-star rear admiral. She was the first nurse and the first woman to serve as a Deputy Surgeon General.

Biography

Her work changed the focus of nursing from disease-centered to patient-centered, and began to include the care of families and the elderly in nursing care.

The Patient Assessment of Care Evaluation developed by Abdellah is now the standard used in the United States.

Her publications include Better Nursing Care Through Nursing Research and Patient-Centered Approaches to Nursing.

She was inducted into the National Women's Hall of Fame in 2000.

1. Nursing

A helping profession A comprehensive service to meet patient’s needs Increases or restores self-help ability Uses 21 problems to guide nursing care

Abdellah’s Major Concepts

21 Nursing Problems

Nursing Problems The client’s health needs can be viewed as problems, which

may be overt as an apparent condition, or covert as a hidden or concealed one.

Problem-solving process involves identifying the problem, selecting pertinent data, formulating hypotheses, testing hypotheses through the collection of data, and revising hypotheses when necessary on the basis of conclusions obtained from the data. (Abdellah & Levine, 1986)

Problem Solving

2. Health

No unmet needs and no actual or anticipated impairments The purpose of nursing services. she speaks of “total health needs” and “a healthy state of

mind and body.” (Abdellah et al., 1960)

3. Person

One who has physical, emotional, or social needs The recipient of nursing care.

4. Environment

Did not discuss much Includes room, home, and community Society is included in “planning for optimum health on local,

state, and international levels.”

The focus of care pendulum

In her attempt to bring nursing practice to its proper relationship with restorative and preventive measures for meeting total client needs, she seems to swing the pendulum to the opposite pole, from the disease orientation to nursing orientation, while leaving the client somewhere in the middle.

1. Learn to know the patient2. Sort out relevant and significant data3. Make generalizations about available data in relation to

similar nursing problems presented by other patients4. Identify the therapeutic plan5. Test generalizations with the patient and make additional

generalizations

10 Steps to Identify Patient’s Problems

6. Validate the patient's conclusions about his nursing problems

7. Continue to observe and evaluate the patient over a period of time to identify any attitudes and clues affecting his behavior

8. Explore the patient's and family's reaction to the therapeutic plan and involve them in the plan

9. Identify how the nurses feel about the patient's nursing problems

10. Discuss and develop a comprehensive nursing care plan

1. Observation of health status2. Skills of communication3. Application of knowledge4. Teaching of patients and families5. Planning and organization of work6. Use of resource materials7. Use of personnel materials8. problem-solving9. direction of work of others10. therapeutic use of the self11. nursing procedure

11 Nursing Skills

BASIC NEEDS SUSTENAL CARE NEEDS REMEDIAL CARE NEEDS RESTORATIVE CARE NEEDS

4 Categories of Needs

1. To maintain good hygiene and physical comfort.

2. To promote optimal activity: exercise, rest, and sleep.

3. To promote safety through the prevention of accidents, injury, or other trauma and through the prevention of the spread of infection.

21 Nursing Problems

4. To maintain good body mechanics and prevent and correct deformities.

5. To facilitate the maintenance of a supply of oxygen to all body cells.

6. To facilitate the maintenance of nutrition of all body cells.

7. To facilitate the maintenance of elimination.

8. To facilitate the maintenance of fluid and electrolyte balance.

9. To recognize the physiological responses of the body to disease conditions – pathological, physiological, and compensatory.

10. To facilitate the maintenance of regulatory mechanisms and functions.

11. To facilitate the maintenance of sensory functions.

12. To identify and accept positive and negative expressions, feelings, and reactions.

13. To identify and accept the interrelatedness of emotions and organic illness.

14. To facilitate the maintenance of effective verbal and nonverbal communication.

15. To promote the development of productive interpersonal relationships.

16. To facilitate progress toward achievement of personal spiritual goals.

17. To create and/or maintain a therapeutic environment.

18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs.

19. To accept the optimum possible goals in the light of limitations, physical and emotional.

20. To use community resources as an aid in resolving problems arising from illness.

21. To understand the role of social problems as influencing factors in the case of illness.

Weaknesses Little emphasis on what the client is to achieve was given in

terms of client care.

Failure of the framework to provide a perspective on humans and society in general limits the generalizability of the theory.

Abdellah’s framework is inconsistent with the concept of holism.

Strengths As a logical and simple statement, Abdellah’s problem-

solving approach can easily be used by practitioners to guide various activities within their nursing practice.

The theoretical statement places heavy emphasis on problem solving, an activity that is inherently logical in nature.

The problem-solving approach is readily generalizable to client with specific health needs and specific nursing problems.

OREM’S MODEL OF NURSING

DOROTHEA OREM

Born in 1914 in Baltimore, Maryland

In the early 1930s, she earned her nursing diploma from the Providence Hospital School of Nursing in Washington, D.C.

She went on to complete her Bachelor of Science in Nursing in 1939 and her Master's of Science in Nursing in 1945, both from the Catholic University of America in Washington, D.C.

Dorothea Orem had a distinguished career in nursing. She earned several Honorary Doctorate degrees.

the Catholic University of America Alumni Achievement Award for Nursing Theory in 1980, the Linda Richards Award from the National League for Nursing in 1991, and was named an honorary Fellow of the American Academy of Nursing in 1992.

1. Nursing an art through which the practitioner of nursing

gives specialized assistance to persons with disabilities which makes more than ordinary assistance necessary to meet needs for self-care.

The nurse also intelligently participates in the medical care the individual receives from the physician.

Orem’s Major Concepts

Self-Care Deficit Theory

2. Human/Person are defined as “men, women, and children cared for

either singly or as social units,” and are the “material object” of nurses and others who provide direct care.

3. Environment has physical, chemical and biological features. It

includes the family, culture and community.

4. Health “Being structurally and functionally whole or sound.”

Also, health is a state that encompasses both the health of individuals and of groups, and human health is the ability to reflect on one’s self, to symbolize experience, and to communicate with others.

Orem developed the Self-Care Deficit Theory of Nursing, which is composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems.

Self-care is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health and well-being.

Self-care agency is the human’s ability or power to engage in self-care and is affected by basic conditioning factors.

THEORY OF SELF-CARE

Basic conditioning factors:

age Gender Developmental state Health state, Socio-cultural orientation Health care system factors Family system factors Patterns of living Environmental factors Resource adequacy and availability.

Therapeutic Self-care Demand is the totality of “self-care actions to be performed for some duration in order to meet known self-care requisites by using valid methods and related sets of actions and operations.”

Self-care Deficit delineates when nursing is needed. Nursing is required when an adult (or in the case of a dependent, the parent or guardian) is incapable of or limited in the provision of continuous effective self-care.

Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, to know, and to help others meet their therapeutic self-care demands by exercising or developing their own self-care agency.

Nursing System is the product of a series of relations between the persons: legitimate nurse and legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds available self-care agency, leading to the need for nursing.

SELF-CARE REQUISITES or requirements can be defined as actions directed toward the provision of self-care.

Universal self-care requisites Developmental self-care requisites Health deviation self-care requisites

Universal self-care requisites are associated with life processes and the maintenance of the integrity of human structure and functioning.

1. The maintenance of a sufficient intake of air

2. The maintenance of a sufficient intake of water

3. The maintenance of a sufficient intake of food

4. The provision of care associated with elimination process and excrements

5. The maintenance of a balance between activity and rest

6. The maintenance of a balance between solitude and social interaction

7. The prevention of hazards to human life, human functioning, and human well-being

8. The promotion of human functioning and development within social groups in accord with human potential, known human limitations, and the human desire to be normal

Developmental self-care requisites are “either specialized expressions of universal self-care requisites that have been particularized for developmental processes or they are new requisites derived from a condition or associated with an event.”

Health deviation self-care requisites are required in conditions of illness, injury, or disease or may result from medical measures required to diagnose and correct the condition.

1. Seeking and securing appropriate medical assistance

2. Being aware of and attending to the effects and results of pathologic conditions and states

3. Effectively carrying out medically prescribed diagnostic, therapeutic, and rehabilitative measures

4. Being aware of and attending to or regulating the discomforting or deleterious effects of prescribed medical measures

5. Modifying the self-concept (and self-image) in accepting oneself as being in a particular state of health and in need of specific forms of health care

6. Learning to live with the effects of pathologic conditions and states and the effects of medical diagnostic and treatment measures in a life-style that promotes continued personal development

According to Orem, nursing is required when an adult is incapable or limited in the provision of continuous, effective self-care.

5 METHODS OF HELPING: Acting for and doing for others Guiding others Supporting another Providing an environment promoting personal development in

relation to meet future demands Teaching another.

THEORY OF SELF-CARE DEFICIT

Describes how the patient's self-care needs will be met by the nurse, the patient, or by both.

Orem identifies three classifications of nursing system to meet the self-care requisites of the patient:

wholly compensatory system partly compensatory system supportive-educative system.

THEORY OF NURSING SYSTEMS

Wholly compensatory nursing system

represented by a situation in which the individual is unable “to engage in those self-care actions requiring self-directed and controlled ambulation and manipulative movement or the medical prescription to refrain from such activity… Persons with these limitations are socially dependent on others for their continued existence and well-being.”

Partly compensatory nursing system represented by a situation in which “both nurse and

patient perform care measures or other actions involving manipulative tasks or ambulation… [Either] the patient or the nurse may have the major role in the performance of care measures.”

Supportive-educative system also known as supportive-developmental system, the

person “is able to perform or can and should learn to perform required measures of externally or internally oriented therapeutic self-care but cannot do so without assistance.”

People should be self-reliant, and responsible for their care, as well as others in their family who need care.

People are distinct individuals. Nursing is a form of action. It is an interaction between two

or more people.

ASSUMPTIONS

Successfully meeting universal and development self-care requisites is an important component of primary care prevention and ill health.

A person's knowledge of potential health problems is needed for promoting self-care behaviors.

Self-care and dependent care are behaviors learned within a socio-cultural context.

Weaknesses Simple yet complex. The use of self-care in multitude of

terms.

Orem’s definition of health was confined in three static conditions which she refers to a “concrete nursing system,” which connotes rigidity.

Throughout her work, there is limited acknowledgement of the individual’s emotional needs.

Strengths applicable for nursing by the beginning practitioner as

well as the advanced clinicians.

specifically defines when nursing is needed: Nursing is needed when the individual cannot maintain continuously that amount and quality of self-care necessary to sustain life and health, recover from disease or injury, or cope with their effects.

Three identifiable nursing systems were clearly delineated and are easily understood.

George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.

Betty M. Johnson and Pamela B. Webber, Theory and Reasoning in Nursing., 2nd ed. New York, Williams & Wilkins

Mariner 5th edition http://nursingtheories.weebly.com/index.html http://nursing-theory.org/articles/nursing-theory-definition.php http://currentnursing.com/nursing_theory/

development_of_nursing_theories.html

REFERENCES

KEEP CALM

AndThank You For

Listening!

KEEP CALM

AndThank You For

Listening!