Nursing Theories With Applications

Nursing Theories

1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING

THEORY• Often considered the first nurse

theorist

• Defined nursing as “the act of utilizing the environment of the patient to assist him in his recovery”.

• Nightingale’s theory remains an integral part of nursing and healthcare today.

1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING

THEORY• 5 Factors for a Healtthy

Environment:

– Pure or fresh air

– Pure water

– Efficient drainage

– Cleanliness

– Light, especially direct sunlight

Nightingale’s general concepts of Environmental Sanitation includes:

Proper VentilationAdequate LightingCleanlinessAdequate WarmthQuietDiet

1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING THEORY

Application:A.Nursing Practice

The principles of Nursing Practice by FN arecontinuously used to this very day. With the advent of technology and with it globalization, comes threats from the environment.

> Global Warming> Industrial Noise> Air Pollution> Fad Diets> Vanity

Nurses of today still needs to: Maintain Adequate Ventilation Promote Adequate & Appropriate Nutrition Maintain Normal Homeostatic Body

Temperature Observe Basic Hygiene Comfort Measures including Environmental

Sanitation


B. Nursing Education

St. Thomas & King’s College Hospital in London

- able to provide framework for the establishment of Nursing Training Schools through a Universal template that contains principles of nursing training. It included instruction in Scientific Principles & Practical Experience for the mastery of skills

- FN advocated the separation of nursing training from hospital to more appropriate learning environment in the School or University setting. This was advocated for FN believed the SN’s role is to learn the Art & Science of Nursing before being employed in the Nursing Service.

- FN is also a strong proponent of practice nursing in education. She believed that Good Nursing only come from Good Education


2) VIRGINIA HENDERSON:FOURTEEN FUNDAMENTAL

NEEDS

Assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs

• Patient-centered

• Virginia Henderson’s 14 Fundamental Needs of a Person

1) Breathing normally

2) Eating and drinking adequately

3) Eliminating body waste

4) Moving and maintaining a desirable position

5) Sleeping and resting

6) Selecting suitable clothes

7) Maintaining body temperature within normal range by adjusting clothing and modifying the environment

2) VIRGINIA HENDERSON:FOURTEEN FUNDAMENTAL NEEDS


8) Keeping the body clean and well groomed to protect the integument9) Avoiding dangers in the environment and avoiding injuring others10) Communicating with others in expressing emotions, needs, fears, or opinions11) Worshipping according to one’s faith12) Working in a such way that one feels a sense of accomplishment13) Playing or participating in various forms of recreation14) Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities

Application:

Bedside Nursing

- pt.’s ability to perform the 14 basic needs should be assessed before considering the kind of nursing care function you will administer. Essential to determine if the N will be performing as a HELPER, DOER or a PARTNER

Nsg interventions are implemented according to the 14 basic human needs of the patient. The degree of performance, involvement of the pt. and the level of nursing activity will be dependent on the specific role the nurse will be playing


3) FAYE ABDELLA:PROBLEM SOLVING APPROACH

TO 21 NURSING PROBLEMS

• Focus is on PROPER IDENTIFICATION of the problem

• Particularly about the proper NURSING DIAGNOSIS

• Nurse-centered

21 Nursing Problems

1.To maintain good hygiene.2.To promote optimal activity:

exercise, rest, and sleep.3.To promote safety.4.To maintain good body

mechanics.5.To facilitate the maintenance of

supply of oxygen.6.To facilitate maintenance of

nutrition.7.To facilitate maintenance of

elimination.

3) FAYE ABDELLA:PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS

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

9.To recognize the physiologic response 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 illness

14. To facilitate the maintenance of effective verbal and non-verbal communication.

15. To promote the development of productive interpersonal relationship.

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 needs.19. To accept the optimum possible goals.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.

Application:• Bedside Nursing

The N’s ability to address & effectively manage the 21 Nursing problems will spell the patient’s state of health – whether he fully recovers well & fast, or deteriorate further with devastating consequences

Ns therefore, have very important role to play. By adhering to these nursing problems, the work of a N becomes More Definite


4) MADELEINE LEININGER:TRANSCULTURAL NURSING

THEORY• Nursing is a HUMANISTIC and

SCIENTIFIC mode of helping through CULTURE-SPECIFIC PROCESS

• Emphasizes human caring varies among cultures

• Culture Care Preservation and Maintenance

• Culture Care Accommodation and Negotiation

• Culture Care Restructuring and Repatterning

4) MADELEINE LEININGER:TRANSCULTURAL NURSING THEORY

Application:

Important esp because of the rapid expansion of knowledge & increasing globalization with the advent of advances in ICT.

Working Overseas

Impt to learn the cultures of other people because each culture has its own sets of patterns, expressions & values of caring.

Getting acquainted with the culture of a country you are seeking employment as a professional nurse will be a good stepping stone towards a more fulfilling career in nursing.

5) MARTHA ROGERSSCIENCE of UNITARY HUMAN BEING

Views the person as a irreducible whole, the whole being greater than the sum of its parts– Man is composed of energy fields,

which are in constant interaction with the environment

– Seek to promote harmonic interactions between the two energy fields (Human and Environmental)

http://medweb.uwcm.ac.uk/martha/images/portrait.gif

ApplicationHer theory is relevant in

today’s nurses focusing on the Totality of the Person. Nurses should strive to promote symphonic interaction between the 2 energy fields in order to strengthen the coherence & integrity of the person.

5) MARTHA ROGERSSCIENCE of UNITARY HUMAN BEING

http://medweb.uwcm.ac.uk/martha/images/portrait.gif

Patient has THREE (3) interacting systems

– Individuals / Personal systems How the nurse views and integrates self based

from personal goals and beliefs.

– Group systems / Interpersonal systems

How the N interrelates w/ a co-workers or pt. particularly in N-Pt. relationship

– Social systemshow the N interacts w/ co-workers, superiors, subordinates & the ct. environment in general

6) IMOGENE KINGGOAL ATTAINMENT THEORY


Action A means of behavior or activities that are

towards the accomplishment of certain act. It is both PHYSICAL & MENTAL. Mental (POA)

Action (Goal Setting w/ Ct.)

Perform Achieve Goal

ReactionA form of reacting or response to a certain

Stimuli.

InteractionAny situation wherein the N relates & deals

With a ct. or pt.

Transaction

Application:Provides enough direction to how

nurses should be able to behave or act in the presence of pts. Since majority of nursing activities involves direct interaction w/ pts., Ns should understand the basic implications of the Action-Reaction-Interaction-Transaction model of the N-Pt. Relationship.


Peplau is a psychiatric nurse

– Focus: Therapeutic process

– Attained through: Healthy Nurse-Patient Relationship

7) HILDEGARD PEPLAUINTERPERSONAL RELATIONS MODEL

• Four (4) Phases of Nurse-Patient Interaction

1. Orientation• Nurse and patient test the

role each one assumes• Prepares patient for

termination• Patient identifies areas of

difficulty


2. Identification Phase• Patient identifies with

the personnel who can satisfy his needs

3. Exploitation Phase• Nurse maximizes all the

resources to benefit the patient


4. Resolution Phase or Termination Phase• Occurs when patient’s

needs have been met


ApplicationSignificant in terms of the

different phases of the N-Pt. interaction & the different ROLES the N can play in giving nursing care to pts. It thus becomes important for nurses to understand the principles behind each of these concepts so that clinical nsg will be more meaningful for the nurse. Eventually, this will translate to pt. outcomes like:

Improved health

Prevention of Disease pr

Enhancement of care faculties


8) JEAN WATSON: HUMAN CARING MODEL

• Nursing involves the application of ART and HUMAN SCIENCE through TRANSPERSONAL TRANSACTIONS in order to help the person achieve mind, body and soul harmony


7 Assumptions on the Science of Caring

1. Caring can be effectively demonstrated & practiced only interpersonally

2. Effective caring promotes health and individual or family growth

3. Caring responses accept a person not only as he or she is now but as what he or she may become

4. A caring envi. Is one that offers the dev’t of potential while allowing the person to choose the best action for himself at a given point in time.


5. Caring is more “healthogenic” than is curing. The practice of caring integrates biophysical knowledge w/ knowledge of human behavior to generate or promote hx & to provide care to those who are ill. A science of caring is therefore complementary to the science of curing

6. The practice of caring is central to nursing


10 CARATIVE FACTORS1. Formation of a Humanistic-Altruistic system

of values

2. Instillation of faith-Hope

3. Cultivation of sensitivity to one’s self & to others

4. Development of a helping-trusting, human caring relationship

5. Promotion and acceptance of the expression of positive & negative feelings;

6. Systematic use of a creative problem-solving caring process


10 CARATIVE FACTORS

7. Promotion of transpersonal teaching-learning

8. Provision for a supportive, protective and corrective mental, physical, societal & spiritual environment

9. Assistance with gratification of human needs

10. Allowance for existential-phenomenological-spiritual forces


Application:Her model of nursing reflects & embodies the TRUE ESSENCE or nursing profession to this very day. It viewed the pt. as the Mind-Body-Spirit entity that needs holistic nursing care. It thus becomes a must for all nurses to view each pt. in the light of the caring theory of Watson.

One major implication of the theory is in the realm of Bedside Nursing, where Ns of today have particularly begun to neglect. The essence of nursing is in the caring aspect & caring is taking the wholeness, the totality of the pt. into consideration. It is every Ns duty & obligation to care for his pt. not by merely looking into and caring for his physical dse.but try to care for the pt. for who he is.

9) IDA JEAN ORLANDO: NURSING PROCESS THEORY

The Nursing Process is an interaction of Three Basic Elements:

1. Patient’s Behavior

2. Nurse’s reaction

3. Nursing Actions – designed for the patient’s benefit

The Role of the Nurse is to find out & meet the Pt’s stat need for help. Ns should use his perception, thoughts about the perception or the feeling engendered from their thoughts to explore with patients the meaning of their behavior

9) IDA JEAN ORLANDO: NURSING PROCESS THEORY

The use of the theory keeps the N’s focus on the patient

Application:

The Theory increases the Therapeutic Effectiveness of nurses by the expression of Empathy, Warmth & Genuineness esp in the light of addressing the Stat Need of the Patient for help. This framework will be important for Ns who are assigned in special clinical areas that requires quick decision making & critical thinking skills.

If the patient’s condition improved, then the intervention is effective and the patient moves on to new problems

10) JOYCE TRAVELBEE INTERPERSONAL ASPECTS OF NURSING THEORY

Human to Human Relationship

Greatly emphasized on the Therapeutic Human Relationship between the Nurse & the Patient.

Her model emphasizes:EmpathySympathyRapport & the Emotional aspects of Nursing

4 Interlocking Phases that precedes RAPPORT And the establishment of N-Pt. Relationship:

Original Encounter Emerging Identities Empathy Sympathy

10) JOYCE TRAVELBEE INTERPERSONAL ASPECTS OF NURSING THEORY

Human to Human Relationship

Application:The theory describes the

various stages of interpersonal elations that occur bet a Patient and a N. It thus becomes important for Ns to fully understand the phases and its effects to the patient’s welfare. Due consideration should be given to the pt’s inherent personal characteristics to interact w/ other people, most especially Ns & other members of the healthcare professions.

The key concept of Empthy, Sympathy, Rapport & Emotional Understanding are very important for the Ns of today because it makes the patient feel human.

11) NOLA PENDER: HEALTH PROMOTION MODEL

• Focuses on 10 Categories of determinants of health-Promoting Behaviors.

• Views a person’s health-promoting behavior in the light of his individual characteristics & experiences


• The 10 Determinants are:– Prior related behavior– Perceived benefits of action– Perceived barriers of action– Perceived self-efficacy– Activity related effect– Interpersonal Influences (family, friends,

providers) norms, support & models– Situational Influences ( options, demand

characteristics, aesthetics)– Immediate competing demands (low

control) and preferences (high demand)– Commitment to a plan of action– Personal Factors ( Biological,

Psychological, Sociocultural)


Application:

Health Promotion Activities are themajor Focus of Hx Care Organizations.

In order for Patients to take on theBehaviour we, Hx care professionals,advise them to take, we should carefullylooked into a host of factors that caninfluence his decision to really adopt thebehaviour.

It is important for Ns to be ROLE MODELS

for the pts.

12) BETTY NEUMAN: HEALTH CARE SYSTEMS

MODEL• The model is based on

the Person’s Relationship to Stress, his Reaction to it and Reconstitution factors that are dynamic in nature

• The concern of nursing is to PREVENT STRESS INVASION


MODEL• Person is viewed as an Open

System composed of Basic Structure of Energy Resources which includes:

• Physiologic• Psychologic• Sociocultural

• Developmental

• Spiritual


MODELBasic Structure/Central Core

- surrounded by 2 concentric boundaries or Rings called Lines Of Resistance which represents the internal factors that AID the person Defend against a Stressor.

Lines of Resistance – further surrounded by 2 lines of Defense

1. Normal Line of Defense

2. Flexible Line of Defense


MODEL1. Normal Line of Defense

- person’s state of equilibrium

or the state of adaptation developed

& maintained over time and which is

considered normal for the person

2. Flexible Line of Defense

- dynamic and can be readily and

rapidly changed over a short period

of time.

- adjusts to situations that threatens the imbalance w/in the client’s stability

Stressors:

Intrapersonal

Interpersonal

Extrapersonal


MODELFOCUS of Nursing Interventions :

- keeping or maintaining the stability of the open system which can be carried out on three levels of prevention

APPLICATION

Very comprehensive model of nsg that outlines the

way how Ns provide HOLISTIC NURSING CARE to

pts. Emphasis is on the management of Stress thru

adequate understanding of the complex client system.

Strong Advocate of Prevention Interventions which is

congruent to the aims of modern-day nsg & Hxcare

services. It is a MUST that Ns perform thorough &

comprehensive assessment that includes ALL

aspects of the Ct.

13) SISTER CALISTA ROY: ADAPTATION MODEL

• Man is a BIOPSYCHOSOCIAL BEING

• Four (4) modes of Adaptation– Physiologic Mode– Self Concept– Role Function

– Interdependence


Her Model is best exemplified in the Nursing Process which includes the following steps:

1. Assessment of Behavior

2. Assessment of Stimuli

3. Nursing Diagnosis

4. Goal Setting

5. Intervention

6. Evaluation


APPLICATIONBest applied in the performance of the Nursing

Process which is cyclical in nature.

The Assessment component is the Stimuli or Input

The Planning & Implementation are the Throughput

process.

The Evaluation which provides necessary feedback to the

Goal of care is the Output.

The N decides what necessary actions should be

taken next in the light of the patient’s response to the Nursing

Interventions. This action by the N is Adaptation in its simplest

terms

Patients adopt too. The Nursing interventions we perform

ultimately elicits a response from them. Depending on the

nature & extent of the nursing interventions, pts may or may

not actually adopt according to our expectations

14) DOROTHEA OREM: SELF CARE AND

SELF CARE DEFICIT THEORYThree (3) Nursing Systems based on

Art of Care of Patient Needs

• 1. Wholly Compensatory or Total Compensatory

– For paralyzed patients, for ICU patients

• 2. Partial Compensatory– Patient performs some of

nursing care needs

• 3. Supportive-Educative– For up and about patient

14) DOROTHEA OREM: SELF CARE AND

SELF CARE DEFICIT THEORYAPPLICATION

The elements of the theory clearly emphasizethe need to understand the importance of self- care in the Promotion and maintenance ofHealth & Wellbeing.

Focus on the pt’s capacity/ability to perform self-care activities in order to determine which self-care activities to perform for the client.

The model emphasizes on Education & Supportive Measures

Health Education – very important aspect of clinical nursing today

15) PATRICIA BENNER NURSING EXPERTISE MODEL

Her concern is:“How do Nurses learn to

do Nursing”

Experience-based skill acquisition – is safer & quicker when it is founded on a sound educational base

Skill – refers to Nursing interventions and Clinical judgment skills in actual clinical situations.As the N gains experience, Clinical knowledge becomes a GOOD MIX of PRACTICAL & THEORETICAL KNOWLEDGE


LEVELS OF SKILL ACQUISITION:

1. Novice

2. Advanced Beginner

3. Competent

4. Proficient

5. Expert


APPLICATION

Instrumental in differentiating knowledge development & career progression in Nursing.

It is important for Nursing students and professional nurses alike to learn through Experience or by Experiential Learning. Learning by experience will allow you to gain Mastery of a given skill.

16) LYDIA HALLCORE, CARE, CURE MODEL

Individuals could be conceptualized in

3 Separate Domains:

1. CARE – hands on bodily care

2. CORE – using the self in relationship to the client

3. CURE – applying medical knowledge

Nurses function in all 3 Domains but in

different Degrees.

1. CURE – limited to helping patients/families deals w/ the measures instituted by the physician

2. CARE – exclusive for nursing

3. CORE – shared w/ Social workers, Psychologists, Clergy & other Professionals


APPLICATION

Foundation for classifying the Professional N’s functions today. Ns are able to carry out Nursing Interventions INDEPENDENTLY

DEPENDENTLY INTERDEPENDENTLY

CORE – maintains that it is the N responsibility to make sure that the client receives the highest level of care possible from all concerned Hx Professionals. Ns ROLES: COLLABORATOR, COORDINATOR and in COOPERATION with other members of the HX team that pertains to PATIENT’S WELFARE.


CURE – clearly delineates nursing functions that are DEPENDENT on the members of the Medical Profession. Interventions carried out needs a written order from the doctor/s

CARE – refers to the independent roles & functions of the Nurse insofar as her knowledge & skills about the patient’s condition will allow her to carry on with her Nursing Responsibilities

17) MYRA LEVINE:FOUR CONSERVATION

PRINCIPLES OF NURSING• 1. Conservation of Energy

– Example: complete bed rest without bathroom privileges

• 2. Conservation of Structural Integrity– Example: turn patient

from side to side every two hours to avoid bed sores


PRINCIPLES OF NURSING• 3. Conservation of

Personal Integrity– Example: maintain

patient’s privacy

• 4. Conservation of Social Integrity– Example: maintenance

of patient’s relationships


PRINCIPLES OF NURSINGAPPLICATION

Ns should be able to identify themany Nurse-Patient activities whichare implied in the 4 Conservation Models. It can be applied to geriatric nursing where majority of the elderly pts will have some problems in at least 2 of the conservation models.

Structural integrity focuses on the body’s ability to ward of infections & other bodily harm. It means that it is important to keep these barriers – skin & mucous membranes - intact

18) MARJORIE GORDON:HUMAN FUNCTIONAL HEALTH

PATTERNS– Focus is on Eleven

(11) Health Patterns

– Advantage to the nurse:

• It enables the nurse to determine the client’s response as functional or dysfunctional


PATTERNS• Eleven Functional Health

Patterns

– Health perception– Nutritional / Metabolic– Elimination– Activity and Exercise

Pattern– Cognitive Perceptual

Pattern


PATTERNS• Eleven Functional Health

Patterns– Sleep and Rest– Self perception / Self

concept– Role Relationship

Pattern– Sexuality /

Reproductive– Coping-Stress-

Tolerance– Value Belief Patterns


PATTERNS

SISTER LETTY G. KUANDissertation: “Retirement & Role Discontinuities”

“I have grown and sown and now I can reap the reward & blessing of a life lived in joy & love, for I too have made

others grow”

RetirementRole Discontinuities

(Aging Process)Change of Life

OutcomeFruitful Retirement

And Aging

Determinants of Fruitful Aging Prepared retirement Health Status Income Family Constellation Self-preparation

CONCEPTUAL MODEL

CARMENCITA ABAQUINDissertation: “PREPARE ME” Interventions & the

Quality of Life of Advance Progressive Cancer Patients

“To Nursing… may be able to provide the care that our clients need in maintaining their quality of life and being instrumental in “Birthing” them to External life”CONCEPTUAL FRAMEWORK

Holistic Nursing Intervention“PREPARE ME” PresenceReminisce TherapyPrayerRelaxation ActivitiesMeditationValue Clarification

Terminally ILL Patients(CANCER)

PhysicalPsychological

SocialReligious

Level of IndependenceEnvironment

Spiritual

QUALITYOF LIFE

Nursing Theories With Applications

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