GENALYN B. CIRINEO, RN, MSN

Nursing Theories and Frameworks

NURSING THEORIES

1. Florence Nightingale Developed and described the first theory of

nursing. She focused on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.

She believed that in the nurturing environment, the body could repair itself.

Identified 21 nursing problems. She defined nursing as service to individuals and families; therefore to society. Furthermore, she conceptualized nursing as an art and science that molds 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.

2. Faye Abdellah

21 NURSING PROBLEMS 1. To promote good hygiene and physical comfort 2. To promote optimal activity, exercise, rest, and sleep 3. To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection 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 physiologic responses of the body to disease conditions

10. To facilitate the maintenance of regulatory mechanisms and functions

11. To facilitate the maintenance of sensory function

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 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

light of physical and emotional limitations 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 cause of illness

NURSING THEORIES3. Virginia Henderson (1960)

Identified 14 basic needs. She postulated that the unique function of the nurse is to assist clients, sick or well in the performance of those activities contributing to health, its recovery, or peaceful death that clients would perform unaided if they had the necessary strength, will or knowledge.

14 BASIC NEEDS1. breathe normally.2. eat and drink adequately. 3. eliminate body wastes. 4. move and maintain desirable postures. 5. sleep and rest. 6. select suitable clothes--dress and undress. 7. maintain body temperature within normal range by adjusting clothing and modifying the environment.

8. keep the body clean and well groomed and protect the integument. 9. avoid dangers in the environment and avoid injuring others. 10. communicate with others in expressing emotions, needs, fears or opinions. 11. worship according to one's faith. 12. work in such a way that there is a sense of accomplishment. 13. play or participate in various forms of recreation. 14. learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

4. Dorothy E. Johnson Conceptualized the Behavioral System

Model for nursing w/c has 7 subsystems:1. attachment/affiliation2. dependence3. ingestive4. eliminative5. sexual6. aggressive7. achievement

5. Imogene kingPostulated the Goal Attainment Theory.

She descried nursing as a helping profession that assist individual and group in society to attain, maintain, and restore health. If this is not possible, nurse help individual to die with dignity.

In addition, King viewed nursing as an interaction process between client and nurse whereby during perceiving, setting goals, and acting on them, transactions occur and goal are achieved.

6. Madeleine Leininger Developed the Transcultural Nursing

Model. She advocate that nursing is a humanistic and scientific mode of helping a client through specific cultural caring process (cultural values, beliefs and practices) to improve or maintain a health condition.

7. Myra Levinedescribed the Four Conservation Principles. She

advocated that nursing is a human interaction and proposed four conservation principles of nursing which are concerned with unity and integrity of the individual. The four conservation principles are as follows: (1)conservation of energy. The human body functions by using energy. The human body needs energy producing input. (food, oxygen, fluids) to allow energy utilization as an output. (2) conservation of Structural integrity. The human body has physical boundaries (skin and mucous membrane)that must be maintained to facilitate health and prevent harmful agents from entering the body.

(3) conservation of Personal Integrity. The nursing intervention are base on the conservation of an individual clients personality. Every individual has sense of identity, self-worth and self-esteem, which must be preserved and enhanced by nurses. (4) Conservation of Social Integrity. The social integrity of the client reflects the family and the community in which the client functions. Health care institutions may separate individuals from their family. It is important for nurses to consider the individual in the context of the family.

NURSING THEORIES8. Betty Neuman

proposed the Health Care System Model. She asserted that nursing is a unique profession in that ii is concerned with all the variables affecting an individual’s response to stresses, which are intra- (within the individual), inter-(between one or more other people), and extra personal (outside the individual) in nature The concern of nursing is to prevent stress invasion, to protect the client’s basic structure and obtain or maintain a maximum level of wellness. The nurse helps the client through primary, secondary and tertiary prevention modes, to adjust to environmental stressors and maintain client system stability.

NURSING THEORIES9. Dorothea Orem

developed the Self-Care and Self-Care Deficit Theory. She define self-care as “the practice of activities that individual initiate and perform on their own behalf in maintaining life, health and well-being.” she conceptualized three nursing system as follows: (1) wholly Compensatory: when the nurse in expected to accomplish all the patient’s therapeutic self-care or to compensate for the patient’s inability to engage in self-care or when the patient need continuous guidance in self-care;

(2) Partially Compensatory: when both nurse and patient engage in meeting self-care needs; (3)Supportive-Educative: the system that requires assistance in decision making, behavior control and acquisition of knowledge and skills.

NURSING THEORIES10. Hildegard Peplau

Introduced that Interpersonal Model. She defined nursing as interpersonal process of therapeutic interactions between an individual who is sick or need of health services and a nurse especially educated to recognize and respond to the need for help. She identified four phases of the nurse-client relationship namely:( 1) orientation: the nurse and the client initially do not now each other goals and testing the role each will assume. The client attempts to identify difficulties and the amount of nursing help that is needed;

Identification: the client respond to the professionals or the significant others who can meet the identified needs. Both the client and the nurse plan together an appropriate program to foster health;(3) exploitation the client utilized all available resources to move toward the goal of maximal health or functionality; (4) resolution: refers to the termination phase of the nurse client relationship. It occurs when the clients needs are met and he/she can move toward a new goal. Peplau further assume that nurse client relationship fosters growth in both the client and the nurse.

NURSING THEORIES11. Martha Rogers

conceptualized the Science of Unitary Human Beings. To Rogers unitary man is an energy field constant interaction with the environment. She asserted that human being are more than and different from the sum of their parts. Further more she believed that human being is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion.

12. Sister Callista Roy presented the Adaptation model. She views each person as a unified

biopsychosocial system in constant interaction with a changing environment.

She contended that the person as an adaptive system, functions as a whole through interdependence of its parts. The system consist input control process, output and feedback. In addition, she advocated that all people have certain needs which they endeavor to meet in order to maintain integrity.

These need are divided into four different model, the physiological, self-concept, role function, and interdependence. Accordingly, Roy believed adaptive human behaviors is directed toward an attempt to maintain homeostasis or integrity of individual by conserving energy and promoting survival, growth , reproduction and mastery of the human system.

13. Lydia Hall Introduce the notion that nursing centers

around three components of CARE, CORE, CURE.

Care represents nurturance and is exclusive to nursing.

Core involves the therapeutic use of self and emphasizes the use of reflection.

Cure focuses on nursing related to the physician’s orders.

Core and cure are shared with other health care providers.

14.Ida Jean Orlando Believe that the nurse helps patients meet a perceived

need that the patients cannot meet for themselves. Orlando observed that nurse provide direct assistance

to meet an immediate need for help in order to avoid or to alleviate distress or helplessness.

She emphasized the importance of validating the need and evaluating care based on observable outcomes. She also indicated that nursing actions can be automatic (those chosen for reasons other than the immediate need for help) or deliberative (those resulting from validating the need for help, exploring the meaning of the need, and validating the effectiveness of the actions taken to meet the need.)

Nursing Process Discipline

15. Ernestine Weidenbach The theory of clinical nursing that she is known for has four

elements:

1. A nursing philosophy - a nurse's attitude and belief about life is what motivates a nurse to act in a certain way. Three important components of a nurse's philosophy are reverence for life, respect for the dignity and individuality of each human being, and resolving to act on personal and professional beliefs.

2. A nursing purpose - that which a nurse wants to accomplish through what s/he does.

3. A nursing practice - those (observable) nursing actions that are affected by beliefs and feelings about meeting the patient's needs.

4. The art of nursing - this includes understanding a patient's needs and concerns, developing goals and actions intended to enhance patient's well-being, and directing the activities related to the medical plan to improve the patient's condition.

16. Jean Watson

Conceptualized the Human Caring Model. She emphasized that nursing is the application of

the art and human science through transpersonal caring transactions to help persons achieve mind-body soul harmony, which generates self-knowledge, self-control, self-care, and self-healing.

She included health promotion and treatment of illness in nursing.

17. Rosemarie Rizzo Parse Introduce the theory of Human Becoming. She emphasized free choice of personal

meaning in relating value priorities, co-creating of rhythmical patterns, in exchange with the environment and contranscending in many dimensions as possibilities unfold.

She also believed that each choice opens certain opportunities while closing others. Thus, she referred to revealing-concealing, enabling-limiting, and connecting-separating.

Since each individual makes his or her own personal choices, the role of the nurse is that of guide, not decision maker.

18. Josephine Paterson and Loretta Zderad

Provided a Humanistic Nursing Practice Theory. This is based on their belief that nursing is an

existential experience. Nursing is viewed as a lived dialogue that involves the

coming together of the nurse and the person to be nursed.

The essential characteristics of nursing is nurturance. Humanistic care cannot take place without the

authentic commitment of the nurse being with and doing with the client.

Humanistic nursing also presupposes responsible choices.

19. Helen Erickson, Evelyn Tomlin and Mary Ann Swain

Developed the Modeling and Role - Modeling Theory. The focus of this theory is on the person. The nurse model (assesses), role models (plans), and

intervenes in this interpersonal and interactive theory. They asserted that each individual is unique has some

self-care knowledge, needs simultaneous to be attached to and separate from others, and has adaptive potential, nurses in this theory, facilitate, nurture and accept the person unconditionally.

They view nursing as a self-care model based on the client's perception of the world and adaptations to stressors.

20. Margaret Newman Focused on health as expanding consciousness. She believed that human are unitary beings in

whom disease is a manifestation of the pattern of health.

She defined consciousness as the information capability of the system which is influenced by time, space, and movement and is ever-expanding.

Change occurs through transformation. Nursing is involved with human beings who have

reached choice points and found that their old ways are no longer effective.

Caring is a moral imperative for nursing. The nurse is a partner with the client rather than

the goal setter and outcome predictor.

21. Anne Boykin and Savina Schoenhofer

Presented the grand theory of Nursing as Caring. They believed that all persons are caring, and

nursing is a response to a unique social call. The focus of nursing is on nurturing persons living

and growing in caring in a manner that is specific to each nurse-nursed relationship or nursing situation.

Each nursing situation is original. They support that caring is a moral imperative.

Nursing as Caring is or based on need or deficit but is an egalitarian model of helping.

MORAL THEORIES1. Freud

Believed that the mechanism for right and wrong within the individual is the superego, or conscience. He hypothesized that a child internalizes and adopts the moral standards and character or character trait of the model parent through the process on identification. The strength of the superego depends on the intensity of the child’s feelings of aggression or attachment toward the model parent rather than on the actual standards of the parent.

2. Erickson

Erickson’s theory on the development of virtues or unifying strengths of the “good man” suggests that moral development continues throughout life. He believed that if the conflicts of each psychosocial developmental stage are favorably resolved then an “ego- strength” or virtue emerges.

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3. Kohlberg Suggested 3 levels of moral development that encompasses 6 stages. He focused on the reasons for the making of a decision, not on the morality of the decision itself. At first level called the pre-moral or pre-conventional level, children are responsive to cultural rules and labels of good and bad, right and wrong. However, children interpret these in terms of the physical consequences of their actions, e.i. punishment or reward. At the second level, the conventional level, the individual is concerned about maintaining the expectation of the family, groups, or nation and sees this as right. Level three is called the post conventional, autonomous, or principled level. At this level, people make an effort to define valid values and principles without regard to outside authority or to the expectations of others. This involves respect for other humans and belief that relationships are based on mutual trust.

4. Peters Proposed a concept of rational morality based on principles. Moral development is usually considered to involve three separate components: moral emotion (what one feels), moral judgment (how one reasons), and moral behavior (how one acts). In addition, Peters believed that the development of character traits or virtues is an essential aspect of moral development. And that virtues or character traits can be learned from others and encourage by the example of others. Also Peters believed that some virtues can be described as habits because they are in some sense automatic and therefore are performed habitually, such as politeness, chastity, tidiness, thrift, and honestly.

5. Schulman and MeklerBelieved that morality is measure of how

people treat fellow humans and that a moral child is one who strives to be kind and just. They believed that morality has two components, namely:1. The intention of the person acting must be good

in the sense that the goal of the act is the well being of one or more people.

2. The person acting must be fair or just in the sense that the person considers the rights of others without prejudice or favoritism. Furthermore, the aforementioned authors asserted that the theory of moral development is based on three foundations, which they believed can be taught, as follows:

a. Internalizing parental standards of right and wrong.b. developing emphatic reactionsc. acquiring personal standards

6. GilliganInclude the concepts of caring and

responsibility. She described three stages in the process of developing an “ethic of care” which are as follows:1. Caring for oneself2. Caring for others3. Caring for self and othersShe believed that women see morality in the integrity of relationships and caring. Fro women, what is right is taking responsibility for others as a self-chosen decision. On the other hand, men consider what is right to be what is just.

C. Spiritual Theories1. FOWLER

Described the development of faith. He believed that faith, or the spiritual dimensions is a force that gives meaning to a person’s life. He used the term “faith” as form of knowing, a way of being in relation to “an ultimate environment”. To Fowler, faith is a relational phenomenon: it is “an active made of being in relation to another or others in which we invest commitment, belief, love, risk and hope.”

2. WesterhoffProposed that faith is a way of behaving. He

developed a four stage theory of faith development based largely on his life experiences and the interpretation of those experiences. These stages are as follows:a) Experience faith (infancy/early adolescence):

experiences faith through interaction with others who are living a particular faith.

b) Affiliative faith (late adolescence) actively participates in activities that characterize a particular faith tradition.

c) Searching faith (young adulthood) through a process of questioning and doubting own faith, acquires a cognitive as well as affective faith.

d) Owned faith (middle adulthood/ old age) puts faith into personal and social action and is willing to stand up for what the individual believes even against the nurturing community.