Unit I-N200 NURSING THEORIES

Prepared by: N200 Team

Introduction

Nursing as a unique health care discipline, has 2 essential aspects: a body of knowledge & the application of that knowledge through clinical nursing practice. This body of knowledge called KNOWLEDGE BASE or the science of nursing provide the rationale for nursing interventions. The nurse will also use the knowledge base developed specifically for nursing thru theory development & research.

NURSING KNOWLEDGE
KNOWLEDGE

is an awareness of the reality one acquires through learning or investigation. Every individual collects, organizes, & arranges facts to build a knowledge base relevant to his/her personal reality.

Sources of Knowledge
1.

2.
3.

Traditional knowledge Authoritative knowledge Scientific knowledge

Traditional knowledge
Traditional

knowledge is that part of nursing practice passed down from generation to generation. Weve always done it this way like changing bedclothes of pts. daily & there are no research data to support this why bed linen are changed daily. This is a usual practice that remains a traditional part of patient care

Authoritative Knowledge
Authoritative

knowledge comes from an expert & is accepted as truth based on the persons perceived expertise. Authoritative knowledge generally remains unchallenged as along as the presumed authority maintains his/her perceived expertise.

Scientific Knowledge

Scientific knowledge is that knowledge arrived at through the scientific method (implying thru research). New ideas are tested & measured systematically using objective criteria. Traditional & authoritative knowledge are practical to implement but limiting their usefulness in a wide variety of practice. Nurses often focus on scientific knowledge, commonly called EVIDENCE-BASED practice of RESEARCH-BASED practice.

Types of Knowledge
1.

2.
3.

Science Philosophy Process

Science
Implies

a body of knowledge. Science is observing, identifying, describing, investigating, & explaining events & occurences that are perceived in the world. The science of nursing is the knowledge in & of nursing.

Philosophy

Is the study of wisdom, fundamental knowledge & the processes we use to develop & construct our perceptions in life. It provides a viewpoint & implies a system of values & beliefs. Personal philosophies guide behavior & attitudes. This is developed through : IPR, formal & informal educational experiences, religion & culture & environment. Every nurses philosophy, developed thru education & practice forms the basis for providing nursing care.

Process

Is a series of actions, changes, or functions intended to bring about desired results. During a process, one takes systematic & continuous steps to meet a goal & uses both assessments & feedbacks to direct actions to meet the goal. A particular theory or conceptual framework directs how these actions are carried out

Theory

1. 2. 3.

THEORY is a set of concepts, definitions & assumptions or propositions to explain/ describe a pattern of reality or a phenomenon. COMPONENTS OF THEORY: Concepts Propositions or assumptions Definitions

Concepts
Something

conceived in mind, a thought or a notion (idea) Are mental formulations of a object or event that come from individual perceptual experience They are ideas, mental images They are words that represent reality & enhance our ability to communicate about it.

Conceptual Framework or Model

These

are group of concepts that follows an understandable pattern. Concepts can be thought of as individual bricks and boards used to build a house, with conceptual framework being the BLUEPRINT that specifies where each brick & board should go.

Propositions
They

explain relationships between the concepts Example: Nightingale proposed a beneficial relationship between fresh air & health

Assumptions
These

are statements that describe the concepts or connect two concepts that are factual.

Phenomenon
The

aspect of reality that can be perceived

Nursing Theory
As

defined by Barnum (1998) attempts to describe or explain the phenomenon (process, occurrence, or event) called nursing. Nursing Theory differentiates nursing from other disciplines & activities in that it serves the purposes of describing, explaining, predicting & controlling desired outcomes of nursing care practices.

Nursing Theory
Theories

provide a means of testing knowledge thru research & for nursing, expanding its knowledge base to meet healthcare needs of patients in an everchanging society. Nursing theories focuses on the phenomena of nursing & nursing care.

Four Major Concepts of Nursing

1.

2.
3. 4.

Person (patient/client) Environment Health Nursing

Person
Person

may represent one individual, a family, a community or all of mankind Also referred as the patient (suffer or bear) Also referred to as the client (may not be sick but well)

Environment
May

represent the immediate surroundings, the community or the universe

Health
Represents

a state of well-being

Nursing
Is

the science and the art of the discipline

Theory

generates knowledge for use in the practice.

Maslows Hierarchy of Needs

Self Actualization Self Esteem Love and Belongingness Needs Safety and Security Needs Physiological Needs

Abraham Maslows Needs Theory

Physiologic needs: air, food, water, shelter, sleep, activity & temperature Safety and Security Needs: Physical & psychologic aspects of safety in environment & relationships Love and Belongingness Needs: giving & receiving affection, attaining a place in the group & maintaining the feeling of belonging Self Esteem: feelings of independence, competence, self-respect & from others recognition, respect, appreciation Self-Actualization: innate need to develop ones maximum potential & realize ones abilities & qualities

Abraham Maslows Needs Theory

Each

individual has a unique characteristic but certain needs are common to all people. A need is something that is desirable, useful or necessary. Human needs are physiologic or psychologic conditions that an individual must need to achieve a state of health or well-being.

Abraham Maslows Needs Theory

1. 2.

3.
4.

5.
6.

CHARACTERISTICS OF BASIC HUMAN NEEDS Needs are universal. Needs may be met in different ways. Needs may be stimulated by external & internal factors. Priorities may be altered. Needs may be deferred. Needs are interrrelated.

Florence Nightingale
Goal of Nursing To facilitate the bodys reparative processes by manipulating the clients environment. Framework Clients environment is manipulated to include appropriate noise, nutrition, hygiene, light, comfort and hope.

Environmental Theory

Florence Nightingale
Environment influences health: 1. Pure air 2. Pure water 3. Efficient drainage 4. Cleanliness 5. Light-direct sunrays > Lack of these environment factors lead to morbidity & mortality

Hildegard Peplau 1952

Goal of Nursing To develop interaction between nurse and client. Interpersonal Relation Model Framework Nursing is a significant, therapeutic, interpersonal process. Nurses participate in structuring health care systems to facilitate natural on-going tendency of humans to develop interpersonal relationship.

Hildegard Peplau
Defined

nursing as interpersonal process of the therapeutic interaction between the individual who is sick or in need of health services & a nurse especially educated to recognize and respond to the need for help.

Cont . Peplau
Person

in terms of man. Man is as organism that lives in an unstable equilibrium

Health-

a word symbol that implies forward movement of personality and other on going processes in the direction of creative productive, personal and comm. Living.

Hildegard Peplau 4 phases of nurse-client interaction

1.

2.
3. 4.

ORIENTATION IDENTIFICATION EXPLOITATION RESOLUTION

Hildegard Peplau

Born in Sept. 1, 1909 Education:diploma prog.in Pottstown, Pennsylvania in 1931, BA in IP psychology in Bennington College, Vermont; continued in Teachers college Columbia University; service as 1Lt. US Army Corps in London Taught the first graduate psychiatric nursing in 1947 (20 years) & her contributions are known worldwide in the Nursing world Died at the age of 89 on March 17, 1999

Cont. Peplau
Nursing

roles - role of a stranger - resource person - teaching - leader - surrogate - counseling

Virginia Henderson 1955

Goal of Nursing To work independently w/ other health care workers, assisting client in gaining independence as quickly as possible, to help client gain lacking strength. 14 Fundamental Needs
Framework Nurses help client to perform Hendersons 14 basic needs.

Virginia Henderson

Definition of Nursing: The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health, or its recovery, or to a peaceful death the he would perform if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. (1966)

Virginia Henderson
Also

defined nursing as temporarily the consciousness of the unconscious, the love of life of 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 voice for those too weak or withdrawn to speak. (1964)

Cont. Henderson
Health

did not give definition of health Environment ( Webster dictionary ) aggregate of all external conditions and influences affecting life. Person as primary importance.

Virginia Henderson 14 FUNDAMENTAL NEEDS

1. 2. 3. 4. 5. 6. 7.

8.

Breathe normally Eating & drinking adequately Eliminating body wastes Moving & maintaining a desirable position Sleeping & resting Selecting suitable clothes Maintaining body temp. w/in normal range by adjusting clothing & modifying environment Keeping the body clean & well groomed to protect integument

9. Avoiding dangers in the environment & avoiding injuring others 10. Communicating w/ others in expressing emotion, needs, fears, or opinions 11. Worshipping according to ones faith 12. Working in such a way that one feels a sense of accomplishment 13. Playing or participating in various forms of recreation 14. Learning, discovering or satisfying the curiosity that leads to normal development & health, & using available health facilities

Cont. Henderson
Roles

of the nurse: - substitutive - supplementary - complementary

Virginia Henderson
Known

around the world for her definition of nursing Her impact on nursing has been so great she has been called the the first lady of nursing, the first truly international nurse, the mother of modern nursing, the American Florence Nightingale Died on March 19, 1996 at the age of 98

Faye Abdellah 1960

Goal of Nursing To provide service to individuals, families and society, to be kind and caring but also intelligent, competent, & technically well prepared to provide this service. 21 Nursing Problems Framework This theory involves Abdellahs 21 nursing problems.

Cont. Abdellah
Nursing

Problem is a condition faced by the patient or family which the nurse can assist him or them to meet through the performance of her professional functions.

Faye Abdellah 21 nursing problems

1. 2. 3.

4.

To maintain good hygiene & physical comfort To promote optimal activity, exercise, rest & sleep To promote safety thru prevention of accident, injury, trauma & thru the prevention of the spread of infection To maintain good body mechanics & prevent & 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 & electrolyte balance 9. To recognize the physiological responses of the body to disease conditions-pathological, physiological, & compensatroy

Faye Abdellah 21 nursing problems

10. To facilitate the maintenance of regulatory mechanisms & functions 11. To facilitate the maintenance of sensory function 12. To identify & accept positive & negative expressions, feelings & reactions 13. To identify & accept the interrelatedness of emotions & organic illness 14. To facilitate the maintenance of effective verbal & nonverbal communication 15. To promote the development of productive interpersonal relationships 16. To facilitate progress toward achievement of personal spiritual goals 17. To create &/or maintain a therapeutic environment 18. To facilitate awareness of self as an individual with varying physical, emotional & development needs 19. To accept the optimum possible goals in the of limitations, physical & emotional

Faye Abdellah 21 nursing problems

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

Faye Abdellah
These

21 nursing problems became the base of Abdellahs base theory. These were her work together w/ Levine in 1954 by using the work of several studies, they classified medical diagnoses in small hospitals into 58 categories. They were also helped by 40 schools of nursing in the development of the base theory.

Cont. Abdellah
as physical, emotional, and so sociological needs. Health - as a state when the individual has no unmet needs and no anticipated or actual impairments. Environment - is the home or community from which patients come
Person

Faye Abdellah

Born in NY in 1909 & graduated in Fitkin Mem. School of Nursing in 1942; earned 3 degrees at Teachers college in Columbia U, NYC From position of staff nurse to public health nurse in USPHS in 49 Appointed as chief nurse officer & 82 was the first woman to hold position of deputy Surgeon General Retired in 2002 & currently lives in Maryland

Martha Rogers 1970

Goal of Nursing To maintain & promote health, prevent illness & care for & rehabilitate ill & disabled client through humanistic science of nursing Unitary Human Being

Framework Unitary man evolves along life process. Client continuously changes and coexist with environment.

Martha Rogers

Rogers states that the science of nursing is the science of unitary human beings (1983) Interrelationships among the concepts of person, environment, health & nursing: these 4 basic concepts are used in nursing models to explain the nursing as profession- a learned profession w/ full professional status meaning not only practice but also has a science

Martha Rogers

The science of unitary man was very abstract & few would understand the direction of her thinking, energy fields & patterning. In 1983, she changed the name theory to the science of human beings but did not change the theory. She is adamant in saying nursing exists to serve people.in their entirety & wholeness for the realization of maximum health potential (1970)

Cont. Rogers
as an open system Health - ( passive health) symbolize wellness and absence of disease. Environment an irreducible pandimensional energy field identified by pattern and manifesting characteristics different from those of the parts.
Person

Martha Rogers
Born

on may 12, 1914 in Dallas, Texas Enrolled in University of Tennessee Knoxville in 1931; entered Knoxville Gen. Hosp. School of Nursing; BSN in Peabody college, also took MA in public health in Johns Hopkins U in 1954 Lectured around the world, established Society of Rogerian scholars Died on March 13, 1994 at age 80

Cont. Rogers
4

building blocks for her model - energy field - universe of an open system - pattern - pandimensionality

Cont. Rogers
Principles

of homeodynamic - integrality - helicy - resonancy

Dorothea Orem 1971

Goal of Nursing To care for and help client attain total self care Self-Care Theory Framework This is self care deficit theory. Nursing care becomes necessary when client is unable to fulfill biological, psychological, development, or social needs.

Dorothea Orem
General

theory of self-care deficit nursing delineates when patients are unable to care for themselves, even w/ assistance of family members. When family members are unable to provide necessary care there is SELF CARE DEMAND that must be met by the nurse

Dorothea Orem

1.

2. 3.

Composed of 3 interrelated theories: The theory of self care: explains why & how people care for themselves & includes self care agency, basic conditioning factors & therapeutic selfcare demands The theory of self care deficit The theory of nursing systems

Dorothea Orem
Self

care requisites: are ADL UNIVERSAL DEVELOPMENTAL HEALTH DEVIATION The self care deficit explains when people need nursing care

Dorothea Orem
1.

2.

3.

In 1985 presented 3 basic variations in nursing systems for organizing services: Wholly compensatory system: in which accomplishing the persons therapeutic self-care is central Partially compensatory system: in which either the nurse or patient may have the major role Supportive-educative system: wherein the support, guidance, provision of a developmental environment, & teaching are central components

Dorothea Orem

Born in Baltimore, Maryland 1914 Received a diploma from Providence hospital School of Nursing, Washington , DC Held various positions, private & govt Retired in 1984 and continues to work individually & w/ collegues to refine the self-care deficit theory Received several honorary degrees & honors/awards & described as one of Americas foremeost nursing theorists

Betty Neuman 1974

Goal of Nursing To assist individuals, families, & groups in attaining & maintaining maximal level of total wellness by purposeful interventions. Health Care System Model Framework Stress reduction is a goal of systems model of nursing practice. Nursing actions are in primary, secondary, or tertiary level of prevention.

Betty Newman
continuation.

Goal of Nursing
Total Person Model (Wholistic and an Open-Systems Approach) Systems Model

Betty Neuman
Asserted

that nursing is a unique profession in that it is concerned w/ all the variables affecting an individuals response to stresses, which are INTRA(within the individual; INTER- ( between one or more other people); and EXTRAPERSONAL- (outside the individual) in nature.

Betty Neuman
The

concern of nursing is to prevent stress invasion, to protect the clients basic structure & obtain or maintain a maximum level of wellness. The nurse helps the client through: PRIMARY, SECONDARY & TERTIARY prevention modes, to adjust to environmental stressors & maintain client system stability.

Betty Neuman
She continues to refine, clarify & expand her model which focuses on wholistic approach to nursing care & provides a clear direction for nursing interventions. (2002)

Cont. Newman

based on two major components: - stress and reaction to stress

Madeleine Leininger 1985

Goal of Nursing To provide care consistent w/ nursings emerging science and knowledge with caring As central focus. Transcultural Nursing Culture care: Diversity & Universality Theory Framework With this transcultural care theory, caring is the central and unifying domain for nursing knowledge and practice

Cont. culture care

are learned and transmitted values, beliefs and practices that provided a critical means to establish culture care patterns from people. Culture care- refers to subjectively learned values, beliefs, and patterned lifeways that assist, support, ,facilitate, or enable Another person or group to maintain thier
Culture

Cont. culture care

Well

being and health, , to improve their human conditions and life ways.

Madeleine Leininger

She advocated that nursing is a humanistic & scientific model of helping a client through specific cultural caring processes ( cultural beliefs & practices) to improve or maintain a health condition. Distintive to her theory: culture care, diversity, universality, worldview, & ethnohistory Shared w/ other concepts: care, caring, health, & nursing Played a significant role in bringing the caring concept in the nursing community

Madeleine Leininger
Born

in Sutton, Nebraska Received diploma in 1948 from st. anthonys hosp. School of Nursing in Denver First nurse to study anthropology at the doctoral level in from Washington, Seattle Has several honorary degrees and currently lives in Omaha, Nebraska

Sister Callista Roy

Goal of Nursing To identify types of demands places on client, assess adaptation to demands, and help client to adapt. Adaptation Model Framework This Adaptation model is based on the physiological, and dependence, independence adaptive modes.

Sister Callista Roy

Roy

believed that adaptive human behavior is directed toward an attempt to maintain HOMEOSTASIS or integrity of the individual by conserving energy & promoting the survival, growth, reproduction & mastery of the human system.

Sister Callista Roy

Viewed person as a unified biopsychococial system in constant interaction w/ a changing environment. She contended that the person as an adaptive system, functions as a WHOLE thru interdependence of its parts. The system consists of input, control process, output, & feedback. In addition advocated that all people have certain needs which endeavor to meet in order to maintain integrity.

Cont, Roy
Health is a state and a process of being and becoming integrated as a person. Environment conditions and circumstances , and influences surrounding and affecting the dev.and behavior of person and earth resources That includes focal, contextual, and residual

Cont. Roy
stimuli external / internal most immediately confronting the system Contextual- all stimuli present in the situation that contribute to the effect of the focal Residual environmental factors within or without the human system with effects on the current situation
Focal

Cont. Roy
Adaptive

modes ( who one is, and how to act in a society physiological, physical (O2, elimination nutrition, activity, protection Self- concept group identity ( psychological, spiritual role function interdependence mode

Sister Callista Roy

Born on October 14, 1939 La, california BSN from Mount Saint Marys college in LA in 963 & Ma & PhD in sociology from UCLA in 73 & 77 respectively Received numerous awards & is a prolific writer & speaker & her her work has been used in practice, education, administration & research Currently a professor & nurse theorist at Boston College of Nursing, Massachusetts

Jean Watson 1979

Goal of Nursing To promote health, restore client to health, and prevent illness. 10 Curative Factors Theory of Human Caring Framework This theory involves philosophy & science of caring, caring is interpersonal process comprising interventions that result in meeting human needs.

Jean Watson
She

emphasized that nursing is the application of the art & human science thru TRANSPERSONAL CARING TRANSACTIONS to help persons achieve mind-body-soul harmony, which generates self-knowledge, self-control, self-care, & self-healing.

Jean Watson 10 carrative factors

1. 2. 3. 4. 5.

Humanistic-altruistic system of values Faith-hope Sensitivity to self & others Helping-trusting, human care relationship Expression of positive & negative feeling

6. Creative problem-solving caring process 7. Transpersonal teachinglearning 8. A supportive, protective, & corrective mental, physical, & sociocultural & spiritual environment 9. Human needs assistive 10. Existentialphenomenologicalspiritual forces

Jean Watson
Born

in West Virginia & earned diploma in nursing 1961 from Lewis Gayle School of nursing in Roanoke, Virginia & BS in psychiatric-mental health nursing from University of Colorado & PhD in educational psychology Received many awards & currently serves as distinguished professor of nursing

Myra Levine 1973

1.

She advocated & described the 4 Conservation principles that nursing is a human interaction concerned w/ unity & integrity of the individual CONSERVATION OF ENERGY: human body functions by utilizing energy. The body needs energy producing input (skin, 02, fluids) to allow energy utilization as output.

Myra Levine 1973

2. CONSERVATION OF STRUCTUTAL INTEGRITY : human body has physical boundaries (skin & mucous membrane) that must be maintained to facilitate health & prevent harmful agents from entering the body.

Myra Levine 1973

3. CONSERVATION OF PERSONAL INTEGRITY: the nursing interventions are based on the conservation of the individual clients personality. >each individual has a sense of identity, self-worth & self-esteem, which must be preserved & enhanced by nurses

Myra Levine 1973

4.CONSERVATION OF SOCIAL INTEGRITY: social integrity of the client reflects the family & community in which the cliwnt 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.

Myra Levine 1973

BSN

degree in 1949 at the University of Chicago, MSN in 1962 at Wayne state University Detroit, Michigan Wrote books in Introduction to Clinical Practice which won the book of the year award

GENERAL THEORIES
1.

2.
3. 4. 5. 6. 7. 8.

Florence Nightingale Virginia Henderson Martha Rogers Sr. Callista Roy Dorothea Orem Betty Neuman Imogene King Dorothy Johnson

SYSTEMS THEORIES
1.

2.
3. 4.

ROYS adaptation theory Nuemans Health Care systems Model Johnsons Behavioral System Model Kings Goal attainment theory

INTERPERSONAL/CARING THEORIES
1.

2.
3.

Peplaus Psychodynamic Nursing Theory Leiningers Transcultural Care Theory Watsons Philosophy & Science of Caring

Profession has the following 8 characteristics

1. The services provided are vital to human

beings and welfare of society. 2. There exists a special body of knowledge that undergoes continual growth thru research. 3. The services provided involve intellectual activities and individual responsibility or accountability.

continuation
4. Practitioners receive education in institutions of higher learning. 5. Practitioners are autonomy and control their own policies and activities. 6. Practitioners are motivated by the service they provide and consider their work important to their lives (altruism).

continuation
7.

8.

Practitioners decisions and conduct are guided by a code of ethics. High standards of practice are encouraged and supported by an organization.

Standards of Practice: are a set of nursing actions that are generally agreed on by nurses as constituting safe and effective client care.
-

They established the foundation of the professional practice of registered nurses. The development of these standards are major functions of nursing professional organizations.

Nursing is a Profession based on the following criteria

1. 2. 3. 4. 5.

Well-defined body of specific and unique knowledge Strong service orientation Recognized authority by a professional group Code of Ethics Professional organization that sets standards

Nursing is a Profession based on the following criteria

continuation

6. Ongoing Research 7. Autonomy