Nursing Theorists and Their Work

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NURSING THEORISTS AND THEIR WORK

Transcript of Nursing Theorists and Their Work

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NURSING THEORISTS AND THEIR

WORK

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Self-Care Deficit Theory of Nursing

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• One of America’s foremost nursing theoristso Born in Baltimore, Maryland in 1914o Earned her diploma at Providence Hospital –

Washington, DCo 1939- BSN Ed, Catholic University of Americao 1945- MSN Ed, Catholic University of Americao Involved in nursing practice, nursing service, and

nursing education During her professional career, she worked as a staff

nurse, private duty nurse, nurse educator and administrator and nurse consultant

Received honorary Doctor of Science degree in 1976 Published first formal articulation of her ideas in

Nursing Concepts of Practice in 1971, second in 1980, and in 1995

Orem retired in 1984 and resides in Savannah, Georgia.

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DEVELOPMENT OF THEORYo 1949-1957 Orem worked for the Division

of Hospital and Institutional Services of Indiana State Board of Health

o Her goal was to upgrade the quality of nursing in general hospitals throughout the state. During this time she developed her definition of nursing practice.

o 1959 Orem subsequently served as acting dean of the School of Nursing and as an assistant professor of nursing education

o Orem’s Nursing Concept of Practice was first published in 1971 and subsequently in 1980, 1985, 1991, 1995, and 2001.

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METAPARADIGMPerson o Orem’s theory addresses client’s self-care

needs.o It is defined as goal-oriented activities that

are set towards generating interest in the part of the client to maintain life and health dev’t.

o The theory is aimed towards making the clients perform self-care activities in order to live independently.

o Conceptualized as a total being with universal, developmental needs and capable of contionous self care.

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Nursing o Nursing is helping clients to establish or

identify ways to perform self-care activities.o Nursing actions are geared towards the

independence of the client.o Orem defines nursing as human service.o It is a distinguished human service since its

focus is on persons with inabilities to maintain continuous provision of health care.

o Nursing is based on values.o Goal of nursing – to render the patient or

members of his family capable of meeting the patient’s self care needs.

o To maintain a state of health.

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Health o Orem supports the World Health

Organization’s definition of health as the “ state of physical, mental and social well-being and not merely the absence of disease or infirmity.”

o Orem presents health based on preventive health care.

o The model of health care includes the promotion and maintenance of health, the treatment of disease or injury, and the prevention of complications.

Environment o Orem’s view of health as a phenomenon

affected by inseparable entities shows her view of the surrounding environment as an external source of influence in the internal interaction of a person’s different aspects.

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Self-Care Deficit Theory of Nursing

Self-Care – is an activity that promotes a person’s

well-being. It is performed by persons

who are aware of the time frames on

behalf of maintaining life, continuing

personal dev’t and a healthy functional

living.

Universal Self-care Requisites o Maintenance of a sufficient intake of airso Maintenance of a sufficient intake of foodo Maintenance of a sufficient intake of watero Provisions of care associated with eliminationo Maintenance of balance between activity & resto Maintenance of balance between solitude and social

interactiono Prevention of hazards to human life, human functioning and

human well-beingo Promotion of human functioning and development.

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ASSUMPTIONS People should be self-reliant and responsible for their

own care and others in their family needing care People are distinct individuals Nursing is a form of action – interaction between two or

more persons A person’s knowledge of potential health problem is

necessary for promoting self-care behaviors Self-care and dependent care are behaviors learned

within a socio-cultural context

IMPLICATIONS To Nursing Practice Orem’s Self-care deficit has been used in studies in patients

having heart problems, cancer, and mental illnesses. This theory had been widely used in dealing with geriatric

cases, especially those having chronic-illnesses. Orem’s theory was being used in defining the roles of the

nurse in multiple settings.

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To Nursing Education The use of Orem’s theory in curriculum

development was reported in the late 1970s. This theory is used at all levels of curriculum

and in continuing education. Her theory is used as a strong and effective

framework for curricular design.

To Nursing Research One of the first instruments developed is the

Exercise of Self-Care Agency (ESCA) which was published in 1979

Another instrument developed is the Appraisal of Self-Care Agency (ASA)

Both of these instrument tools are used to assess basic conditioning factors and self-care abilities related to the care of well and the ill.

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CRITICS Strengths Provides a comprehensive base to nursing practice It has utility for professional nursing in the areas of

nursing practice, nursing curricula, nursing education administration and nursing research.

Specifies when nursing is needed. Also includes continuing education as part of the

professional component of nursing education Her self-care approach is contemporary with the

concepts of health promotion and health maintenance.

Limitations In general system theory, a system is viewed as a

single whole thing while Orem defines a system as a single whole thing.

Appears that the theory is illness oriented rather with no indication of its use in wellness settings.

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Born: May 12, 1914, Dallas, Texas Diploma : Knoxville General Hospital School

of Nursing (1936) Graduated in Public Health Nursing, George

Peabody College, TN, 1937 MA : Teacher’s College, Columbia University,

New York, 1945 MPH : John Hopkins University,

Baltimore,1952 Doctorate in nursing: John Hopkins

University, Baltimore, 1954 Position: Professor Emerita, Division of

Nursing, New York University, Consultant, Speaker

Died: March 13, 1994

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ROGER’S NURSING THEORY Nursing is both a science and art, the

uniqueness of nursing, like that of any other science, lies in the phenomenon central to its focus.

Nurses long established concern with the people and the world they live is in a natural forerunner of an organized abstract system encompassing people and the environment

The integralness of people and the environment that coordinate with multidimensional universe of open systems points to a new paradigm.

The purpose of nurses is to promote health and well-being for all persons wherever they are.

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METAPARADIGM Person Defines person as an open system in continuous

process with the open system that is the environment. She defines unitary human being as an “irreucible,

indivisible, pandimensional energy field identified by pattern and manifesting characteristics that are specific to the whole.”

The people has the capacity to participate knowingly and probabilistically in the process of change.

Man is a unified whole possessing his own integrity.

Nursing Nursing is a learned profession, both a science and an

art. An organized body of kowledge which is specific to

nursing is arrived at by scientific research and logical analysis.

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Health Rogers defined health as an expression of the

life process, they are the “characteristics and behavior emerging out of the mutual, simultaneous interaction of the human and environmental fields.”

Health and illness are the part of the sane continuum.

Health and illness are manifestations of pattern and are considered “to denote behaviors that are of high value and low value.

Environment Rogers defines environment as “an irreducible,

pandimensional energy field pattern and manifesting characteristics different from those of the parts.

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IMPLICATIONS To Nursing Practice The Rogerian model is an abstract system of ideas

from which to approach the practice of nursing. Nursing is based on theoretical knowledge that

guides nursing practice. The professional practice of nursing is creative and

imaginative and exists to serve people. It is rooted in intellectual judgment, abstract

knowledge, and human compassion.

To Nursing Education Rogers clearly articulated guidelines for the

education of nurses within the Science of Unitary Human Beings.

Rogers discusses structuring nursing education programs to each nursing as a science and as a learned profession.

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To Nursing Research Rogers’ conceptual model provides a stimulus and

direction for research and theory development in nursing science.

Emerging from Rogers’ model are theories that explain human phenomena and direct nursing practice.

The Rogerian model, with its implicit assumptions, provides broad principles that conceptually direct theory development.

THEORETICAL ASSERTIONS The principles of hemodynamics postulate a way of

perceiving unitary human beings. Rogers identified the principles of change as helicy,

resonancy and integrality. The helicy principle describes spiral dev’t in continuous,

nonrepeating and innovative patterning. Principle of resonancy , patterning changes with dev’t

from lower to higher frequency with varying degrees of intensity.

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Principles of Homeodynamics

Resonancy Helicy Integrality

Midrange

Bultemeier (1993) Barrett (1990a) Floyd (1983)

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Imogene KingGoal Attainment

Theory

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INTRODUCTION Imogene King was born in 1923 Completed her Bachelor in Science of Nursing from St. Louis

University in 1948 Completed her Master of Science in Nursing from St. Louis

University in 1957 Completed her doctorate degree from Teacher’s College,

Columbia university

METAPARADIGMTo Nursing Practice King described a person existing in an open system as a

spiritual being and rational thinker who makes choices. Selects alternative courses of action, and has the ability to

record their history through their own language and symbols, unique, holistic and have different needs, wants and goals.

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METAPARADIGM Person King described a person existing in an open system

as a spiritual being and rational thinker who makes choices.

Selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique, holistic and have different needs, wants and goals.

Nursing Nursing is an act wherein the nurse interacts and

communicates with the client. The nurse helps the client identify the existing

health condition. The goal of the nurse in this theory is to help the

client maintain health through health promotion and maintenance, restoration and caring for the sick and dying.

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Health King viewed health as the ability of a person to

adjust to the stressors that the internal and external environment exposes to the client

Adjusting to the environment bring the client back to their usual roles before the reaction occurred.

EnvironmentEnvironment is the background for human

interactions. It involves: Internal environment – transforms energy to

enable person to adjust to continuous external environmental changes.

External environment – involves formal and informal organizations. Nurse is a part of the patient’s environment.

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Interacting Systems Framework

King proposed that the nurse interacts in the system simultaneously at three different levels, namely Personal, Interpersonal and social Frameworks.Personal – how the nurse views and integrates self based from personal goals and beliefs.Interpersonal - how the nurse interrelates with a co-worker or patient particularly in a nurse-patient relationship.Social - how the nurse interacts with co-workers, superiors, subordinates and the client environment in general.

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ASSUMPTIONS

Basic assumption of goal attainment theory is that nurse and client communicate information, set goal mutually and the act to attain those goals, is also the basic assumption of nursing process.

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IMPLICATION To Nursing Practice Professional have used King’s theory in

different specialized area with the use of dynamic interactive communication between the nurse and the client as a proof.

Professional need communication to successfully and correctly make decisions for their plan of care.

The significance of King’s theory have been applied to different professional practice setting such as in nursing administration, theory based practice in the emergency department, in tertiary hospitals and in the community.

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To Nursing Education King’s interacting system has been used to

design the nursing curriculum in different schools and universities and framework for nursing education.

It provides a systematic means of viewing the nursing profession, organizing nursing knowledge and clarifying the nursing discipline.

To Nursing Research King’s theory has been one of theoretical

basis of some researchers that helped in formulating a system view of the application of the nursing practice.

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ANALYSIS Simplicity

King’s theory was as a result of careful research study. Her research literature was based on the existing evidences during her study. She maintains the simplicity of her theory even if she presented different complex concepts.

Generality King’s theory has been said to have

limited application for the nursing practice. It was stated that the interaction between the nurse and the client also comprises non-verbal communication that cannot be clearly defined and evaluated.

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HILDEGARD PEPLAUINTERPERSONAL RELATIONS THEORY

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INTRODUCTION Born in Reading, Pennsylvania 1909 Graduated from a diploma program in

Pottstown, Pennsylvania in 1931 Done BA in interpersonal psychology from

Bennington College in 1943 MA in psychiatric nursing from Colombia

University New York in 1947 EdD in curriculum development in 1953 Professor emeritus from Rutgers University Started first post baccalaureate program in

nursing Published Interpersonal Relations in Nursing

in 1952 Became a member of the Army Nurse Corps Died in 1999

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METAPARADIGM Person Peplau defines person as a man who is an

organism that lives in an unstable balance of a given system. A developing organism that tries to reduce anxiety caused by needs.

Health She considers “health” as a word that

symbolizes movement of the personality and other ongoing human processes that directs the person towards creative, constructive, productive and community living.

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Nursing Peplau described Nursing as a significant,

therapeutic interpersonal process. It functions cooperatively with human

processes that present health as a possible goal for individuals

Environment She defines Environment as forces outside

the organism and in the context of the socially-approved way of living, from which vital human social processes are derived such as norms, customs and beliefs.

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Theory of Interpersonal Relations

Peplau described the nurse-patient relationship as a four phase phenomenon.

One can view them as separate entities. Each phase is unique and has

distinguished contributions on the outcome of the nurse-patient intreaction;

Phases of Nurse-Patient Relationship are1. Orientation

2. Identification 3. Exploitation 4. Resolution

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Orientation phase Problem defining phaseStarts when client meets nurse as

strangerDefining problem and deciding type

of service neededClient seeks assistance, conveys

needs, ask questions, shares preconceptions and expectations of past experiences.

Nurse responds, explains roles to client, helps to identify problems and to use available resources and services.

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Factors influencing orientation phase

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Identification Phase Selection of appropriate assistance. Patient begins to have a feeling of belonging and

a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness.

Exploitation Phase Use of professional assistance for problem

solving alternatives Advantages of services are used is based on the

needs and interest of the patients. Individual feels as an integral part of helping

environment. Patient may fluctuates on independence. Nurse must be aware about the various phases of

communication. Nurse aids the patient in exploiting all avenues of

help and progress is made towards the final step.

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Resolution Phase Termination of professional relationship. The patients needs have already been met by the

collaborative effect of patient and nurse Now they need to terminate their therapeutic

relationship and dissolve the links between them Sometimes may be difficult for both a psychological

dependence persists. Patient drifts away and breaks bond with nurse and

healthier emotional balance is demonstrated and both becomes mature individuals.

INTERPERSONAL THEORY AND NURSING PROCESS

Both are sequential and focus on therapeutic ralationships

Both use problem solving techniques for the nurse and patient to collaborate on, with end purpose of meeting the patients needs.

Both use observation communication and recording as basic tools utilized in nursing.

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IMPLICATIONS To Nursing Practice Some of Peplau’s ideas were not widely accepted

at the time they were introduced, such as the concepts of learning through experiences between the patients and the students.

However, as the concepts that form her Interpersonal Relations Model were applied and tested, many nursing experts now recall Peplau as the one who brought a new perspective, a new approach and a theoretical foundation for nursing practice.

To Nursing Education Hildegard Peplau’s book, Interpersonal

Relations in Nursing (1951), is being used as a manual of instruction to help graduate nurses and nursing students alike in creating a significant nurse-patient relationship in any setting they are into.

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To Nursing Research At the arrival of the Interpersonal Model, nursing

researchers follow the major assumption that patient problems were within the person phenomena and were dealt inside the nurse-patient interaction studies.

LIMITATIONS: Intra family dynamics, personal space

considerations and community social service resources are considered less.

Health promotion and maintenance were less emphasized.

Cannot be used in a patient who doesn’t have a felt need eg. With drawn patients, unconscious patients

Some areas are not specific enough to generate hypothesis.

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•Theoretical Foudations of Nursing: The Philippine Perspetive (Eufemia f Octaviano, Carl E. Balita)•Nursing Theorists and Their Works, Sixth Edition (Ann Marriner Tomey, Martha Raile Alligood)•Current [email protected]

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Lani Luz Villasin