Theories of Nursing 1

8/2/2019 Theories of Nursing 1

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NURSING THEORIES

NURSING THEORY

Defines what nursing is, what it does, andthe goals and outcomes of nursing care.


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NURSING THEORIES

Components of Theoretical Foundation

1. Concepts

* the building block of a theory

* a vehicle of thought2. Propositions

* a statement that proposes a relationshipbetween concepts

* represents the theorists view of whichconcepts fit together and in most theories,establish how concepts affect one another


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NURSING THEORIES

THEORY

A set of concepts and propositions thatprovide an orderly way to view

phenomena The purpose of a theory in scientific

disciplines is to guide research enhance

the science by supporting existingknowledge or generating new knowledge(Parse, 1987)


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NURSING THEORIES

Importance of Nursing Theories:

1. Provide a framework for thought in which to examine situations.As new situations are encountered, this framework provides astructure for organization, analysis, and decision making.

2. Provide a structure for communicating with other nurses and withother members of the health care team.3. Assist the discipline of nursing in clarifying beliefs, values and

goals.4. Help define the unique contribution of nursing, proclaim

professional autonomy, and ultimately, control certain aspects of

nursing practice5. For the continued development and evolution of the discipline ofnursing.


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NURSING THEORIES

SCOPE OF THEORIES

Grand Theories

- composed of concepts representingglobal and extreme complex phenomena

- broadest in scope, represents the most

abstract level of development andaddresses the broad phenomena ofconcern within the discipline.


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NURSING THEORIES

SCOPE OF THEORIES

Middle-Range Theories

- addresses more concrete and morenarrowly defined phenomena.

- intended to answer questions about

nursing phenomena, yet they do not coverfull range of phenomena of concern to thediscipline


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Process of KnowledgeDevelopment

Nursing Practice

Nursing Research

Nursing Theory


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Nursing practice, theory, and research areinterdependent

Nursing theory development and nursingresearch activities are directed towarddeveloping nursing practice guidelines.

Nursing practice is the focal point of therelationship between practice, theory andresearch


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Nursing Practice

It provides new material for the ideas that aresystematically developed and organized in the form ofnursing theory

Ideas proposed by nursing theory must be tested andvalidated through nursing research

New knowledge that results from nursing research isused to transform and inform nursing practice

Generates questions that serve as the basis for nursingresearch

Nursing research then influences the development ofnursing theory, which in turn transforms nursing practice


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Knowledge Development inNursing

Metaparadigms of Nursing

Metaparadigm the unifying force in adiscipline that names the phenomena of

concern to that discipline It is broader and focuses on the persons

health, and the environment


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Metaparadigms of Nursing

4 major concepts that provide structure to thedomain of nursing: (PEHN)

1. Person the individual, family, or group whoare in the interest of nursing.

2. Environment the place or community wherecare is provided; it also describes the world aperson lives in and interacts with.

3. Health the continuum of wellness to terminal

illness of individuals.4. Nursing actions and interactions of the nurse

with the person


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Knowledge Development inNursing

Paradigms of Nursing

Paradigm a particular viewpoint or perspective

Paradigm revolution the turmoil and conflictthat occur in a discipline when a competingparadigm gains acceptance over the dominantparadigm

Paradigm shift the acceptance of the

competing paradigm over the prevailingparadigm or a shifting away from one worldviewtoward another worldview.


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Florence Nightingale

The Environmental Theory


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Emerged during the Crimean War, henceshes called the Lady with the Lamp


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Environmental Theory (mid-1800)

Often considered the 1st nurse theorist; definednursing more than 100 years ago, as the act of

utilizing the environment of the patient to assisthim in his recovery

Despite the fact that she did not believe in thegerm theory, her experiences in the Crimean

war magnified her interest in the principles ofsanitation and the relationship betweenenvironment and health.


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She linked healthwith fiveenvironmental

factors1. Pure or fresh air

2. Pure water

3. Efficient drainage

4. Cleanliness

5. Light (especiallydirect sunlight)
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Deficiencies in these five factors producedlack of health or illness.

She believed that in the nurturingenvironment, the body could repair itself.

Clients environment is manipulated to

include appropriate noise, nutrition,hygiene, light, comfort, socialization andhope.


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Virginia Henderson

The Nature of Nursing Model


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Virginia Henderson

Hendersons

definition of theunique function of

nursing was amajor steppingstone in theemergence of

nursing as adiscipline separatefrom medicine.


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Virginia Henderson

She believed that thenurse was concernedwith both healthy and

ill individuals,acknowledged thatnurses interact withclients even when

recovery may not befeasible


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Virginia Henderson

Mentioned the teaching advocacy roles ofthe nurses.

Conceptualized the role of the nurses asassisting sick or healthy individuals to gainindependence in meeting the fourteenfundamental needs

THE FOURTEEN FUNDAMENTAL


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THE FOURTEEN FUNDAMENTAL

NEEDS

NORMAL BREATHING.

Breathing normally

FOOD.

Eating and drinking adequately

EXCRETION.

Eliminating body wastes

MOTION.

Moving and maintaining a desirable position


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NEEDS

REST.

Sleeping and resting

CLOTHING.

Selecting suitable clothes

TEMPERATURE.

Maintaining body temperature within normal rangeby adjusting clothing and modifying the environment

CLEANLINESS.Keeping the body clean and well groomed to protectthe skin


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NEEDS

SAFETY.

Avoiding dangers in the environment and injuringothers

COMMUNICATION.

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

RELIGION.

Worshipping according to ones faith


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Martha RogersTheory of Unitary Human

Beings


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Martha Rogers

According toRogers, everyindividual is a

unitary human being


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Martha Rogers

The UNITARY HUMAN BEING1. is an irreducible, four-dimensional energy field;

the four dimensions being energy fields,openness, pattern and organization and

dimensionality2. interacts continuously and creatively with the

environment3. is more than and different from the sum of its

parts4.behaves as a totality5.participates creatively in change.


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The human being is a four-dimensional energy field


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Martha Rogers

Nurses applying Rogerss theory in practiceshould:

Focus on the persons wholeness

Seek to promote symphonic interaction between thetwo energy fields (human and environment) tostrengthen the coherence and integrity of the person.

Coordinate the human field with the rhythmicities ofthe environmental fields

Direct and redirect patterns of interaction between thetwo energy fields to promote maximum healthpotential


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Sister Callista Roy

The Adaptation Model


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Sr. Callista Roy

The Adaptation Model (1997)


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Sr. Callista Roy

Defines adaptation as the process and

outcome whereby the thinking and feelingperson uses conscious awareness and

choice to create human and environmentalintegration

Viewed each person as a unified

biopsychosocial system in constantinteraction with the environment


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Sr. Callista Roy

The person is an adaptive system, employing afeedback cycle of input (stimuli), throughput(control process) and output (behavior or

adaptive response) All people have certain needs, categorized into

1. Physiological

2. Self-concept

3. Role Function

4. Interdependence


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Sr. Callista Roy

Need for nursing care arises when clientcannot adapt to internal and externalenvironmental demands

The nurse determines what demands arecausing problems for the client; assesseshow well the client is adapting to them

Nursing care, therefore, is directed athelping the client adapt


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Dorothea OremSelf-care and Self-care Deficit Theory


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Dorothea Orem

Defined self-care as the practice ofactivities that individuals initiate andperform on their own behalf in

maintaining life, health and well-being


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Dorothea Orem

Self-care theory is based on fourconcepts:

1. Self-care

2. Self-care Agency

3. Self-care Requisites4. Therapeutic Self-care Demand


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Dorothea Orem

SELF-CARE

Self-care refers to those activities anindividual performs independentlythroughout life to promote and maintain

personal well-being


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Dorothea Orem

SELF-CARE AGENCY

Self-care agency is the individuals ability toperform self care activities.


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Dorothea Orem

It consists of two agents:

1. a self-care agent an individual whoperforms self care independently

2. a dependent care agent a person otherthan the individual who provides the care (e.g.most adults care for themselves, whereasinfants and people weakened by illnessrequire assistance with self-care activities)


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Dorothea Orem

SELF-CARE REQUISITES

Also called self care needs, self-carerequisites are actions taken to provide selfcare.


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Dorothea Orem

THERAPEUTIC SELF-CARE DEMAND

Therapeutic self-care demand refers toall self care activities required to meetexisting self care requisites or actions to

maintain health and well being.


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Imogene KingGoal Attainment Theory


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Imogene King

Described nursing as a helping profession

that assists individuals and groups insociety to attain, maintain, and restore

health If this is not possible, nurses help

individuals die with dignity.


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Imogene King

Viewed nursing as an interaction processbetween client and nurse

During this process of perceiving, settinggoals and acting on them, transitionsoccur and goals are achieved.


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Betty Neuman

Health Care System Model


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Betty Neuman

Nursing: a unique profession in that it isconcerned with all the variables affectingan individuals response to stresses in

nature Stresses:

1. Intrapersonal (within the individual)

2. Interpersonal (between one or more otherpeople)

3. Extrapersonal (outside the individual)


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Betty Neuman

3 Major Concerns of Nursing1. Prevent stress invasion

2. Protect the clients basic structure

3. Obtain a maximum level of wellness

The nurse helps the client throughprimary, secondary and tertiary

prevention modes, to adjust toenvironmental stressors and maintainclient stability


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Dorothy JohnsonBehavioral System Model


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Dorothy Johnson

Johnson: Each person as a behavioralsystem is composed of sevensubsystems, namely:

1. Ingestive2. Eliminative

3. Affiliative

4. Aggressive5. Dependence

6. Achievement

7. Sexual and role identity behavior


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Dorothy Johnson

Each person tries toachieve balance andstability to function

effectively He does this by

adjusting andadapting to

environmental forcesthrough learnedpatterns of response

Hildegard Peplau


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Hildegard PeplauThe Interpersonal Model


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Hildegard Peplau

Defined nursing as an interpersonalprocess of therapeutic interactionsbetween

1. an individual who is sick or in need ofhealth services; and

2. a nurse especially educated to recognize

and respond to the need for help


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Hildegard Peplau

Identified four phases of nurse-clientrelationship, namely:

1. Orientation.

The nurse and the client initially do not knoweach others goals

Testing the roles each will assume

The client attempts to identify the difficultiesand the amount of nursing help needed


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Hildegard Peplau

2. Identification.

The client responds to the professionals orthe significant others who can meet the

identified needs

Both client and nurse plan together anappropriate program to foster health


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Hildegard Peplau

3. Exploitation.

The client utilizes all available resources tomove toward a goal of maximum health or

functionality


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Hildegard Peplau

4. Resolution.

Refers to the termination phase of thenurse-client relationship

Occurs when the clients needs are met and

he/she can move toward a new goal.

Growth is fostered in both the client and thenurse

The Four Phases of Nurse Client


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The Four Phases of Nurse-ClientRelationship

ORIENTATION



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IDENTIFICATION


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RESOLUTION


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Faye Abdellah

Patient-centered Approaches to Nursing Model


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Faye Abdellah

Her theory emphasizes delivering nursing carefor the whole person to meet the physical,emotional, intellectual, social and spiritual needs

of the client and family.


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Faye Abdellah

The nurse needsknowledge and skills ininterpersonal relations, psychology, growthand development, communication, and

sociology, as well as a knowledge of thebasic sciences and specific nursing skills


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Faye Abdellah

The nurse formulates an individualizedview of the clients needs, which may

occur in the following areas

1.Comfort, hygiene and safety

2.Physiological balance

3.Psychological and social factors

4.Sociological and community factors


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Lydia HallCare, Core and Cure Model


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Lydia Hall

According to her, nursing centersaround three components:

1. CARE

2. CORE

3. CURE


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CARE

Representsnurturance and isexclusive to nursing

Carebears


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CORE

Involves thetherapeuticuse of self andemphasizesthe use ofreflection

Reflection


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CURE

Focuses onnursing-relatedto thephysicians

orders

Summary of Nursing Theories


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Summary of Nursing TheoriesTheorist Goals of Nursing/Key Emphasis

Nightingale To facilitate the bodys reparative processes by manipulating the clients environment

Henderson To work independently with other health care workers, assisting client in gainingindependence as quickly as possible

Nurses help client to perform 14 fundamental needs

Rogers To maintain and promote health, prevent illness, and care for and rehabilitate ill anddisabled client through humanistic science of nursing

Unitary man continuously changes and coexists with environment

Roy To identify types of demands placed on client, assess adaptation to demands, and help

client adaptOrem To care for and help client attain total self-care

Self-care deficit theory: nursing care becomes necessary when client is unable to fulfillbiological, psychological, development or social needs

King Nursing process is defined as dynamic interpersonal process between nurse, client, andhealth care system

Neuman Stress reduction is goal of systems model of nursing practice. Nursing actions are in

primary, secondary or tertiary level of preventionJohnson Subsystems exist in dynamic stability

Peplau To develop interaction between nurse and client

Nursing is a significant therapeutic four-phase interpersonal process

Abdellah To provide service to individuals, families and society; to be kind and caring but alsointelligent, competent and technically well-prepared to provide this service

Theories of Nursing 1

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