Nursing Theoriest

8/4/2019 Nursing Theoriest

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Gloria A. Hagopian, RN, EdD 04/13/12

Nursing TheoristsNursing Theorists

Week 11 and 12


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DefinitionsDefinitions

x Theory- a set of relatedstatements that describes or

explains phenomena in asystematic way

x Concept-a mental idea of a

phenomenonx Construct- a phenomena that

cannot be observed and must be

inferred


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DefinitionsDefinitions

x Proposition- a statement ofrelationship between concepts

x Conceptual model- made up ofconcepts and propositions


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Nursing TheoristsNursing Theorists

x Florence Nightingale,Hildegard Peplau, Virginia

Henderson, Fay Abdella, IdaJean Orlando, Dorothy Johnson,Martha Rogers, Dorothea

Orem, Imogene King, BettyNeuman, Sister Calista Roy,

Jean Watson, Rosemary RizzoParse, Madeleine Leininger,Patricia Benner


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Concepts in theConcepts in the

nursingnursing

metaparadigmmetaparadigmxPerson

xRecipient of care, includingphysical, spiritual, psychological,and sociocultural components

x Individual, family, or community


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nursingnursing

metaparadigmmetaparadigmxEnvironment

x

All internal and externalconditions, circumstances, andinfluences affecting the person


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nursingnursing

metaparadigmmetaparadigmxHealth

x

Degree of wellness or illnessexperienced by the person




nursingnursing

metaparadigmmetaparadigmxNursing

x

Actions, characteristics andattributes of person giving care



orenceorenceNightingaleNightingale

EnvironmentalEnvironmentalTheoryTheoryx First nursing theorist

xUnsanitary conditions posed

health hazard (Notes on Nursing,1859)

x 5 components of environment

x ventilation, light, warmth,effluvia, noise

x External influences can

prevent, suppress or



NightingalesNightingales

ConceptsConceptsx

PersonxPatient who is acted on by nurse

xAffected by environment

x

Has reparative powers

x Environment

x

Foundation of theory. Includedeverything, physical,psychological, and social



NightingalesNightingales

ConceptsConceptsx Health

xMaintaining well-being by using a

persons powersxMaintained by control of

environment

x Nursingx Provided fresh air, warmth,

cleanliness, good diet, quiet to

facilitate persons reparative



Hildegard PeplauHildegard Peplau

InterpersonalInterpersonal

Relations ModelRelations Model



Hildegard PeplauHildegard Peplau

InterpersonalInterpersonal

Relations ModelRelations Model

x Based on psychodynamic

nursingxusing an understanding of ones

own behavior to help others

identify their difficultiesx Applies principles of human

relations

x

Patient has a felt need


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Peplaus ConceptsPeplaus Concepts

x Person

xAn individual; a developingorganism who tries to reduceanxiety caused by needs

xLives in instable equilibrium

x Environment- Not defined


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x Health

x Implies forward movement ofthe personality and humanprocesses toward creative,

constructive, productive,personal, and communityliving


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x Nursing

xA significant, therapeutic,interpersonal process thatfunctions cooperatively with

others to make healthpossible

x Involves problem-solving


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Virginia HendersonVirginia Henderson

Vi i iV


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VirginiaV rg n aHendersonHenderson

The Nature ofThe Nature ofNursingNursingThe unique function of the

nurse is to assist theindividual, sick or well, in theperformance of those activities

contributing to health or itsrecovery (or to peaceful death)that he would perform unaided

if he had the necessary


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VirginiaVirginia

HendersonHendersonAnd to do this in such a way as

to help him gain independence

as rapidly as possible. Shemust in a sense, get inside theskin of each of her patients in

order to know what he needs.


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Virginia HendersonVirginia HendersonShe is temporarily theconsciousness of the

unconscious, the love of lifefor the suicidal, the leg of theamputee, the eyes of the

newly blind, a means oflocomotion for the infant,knowledge and confidence for

the young mother, the


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Fay AbdellaFay AbdellaTopology of 21 NursingTopology of 21 Nursing

ProblemsProblems

x A list of 21 nursing problemsx

Condition presented or faced bythe patient or family.

x Problems are in 3 categoriesx

physical, social and emotionalx The nurse must be a good

problem solver


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Abdellas ConceptsAbdellas Conceptsx Nursing

xA helping profession

xA comprehensive service to meet

patients needsx Increases or restores self-help

ability

xUses 21 problems to guide

nursing care

x Health

x Excludes illness

x No unmet needs and no actual


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AbdellasAbdellas

ConceptsConceptsx PersonxOne who has physical, emotional,

or social needs

x The recipient of nursing care.

x Environment

x Did not discuss much

x Includes room, home, andcommunity


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Ida Jean OrlandoIda Jean OrlandoDeliberative NursingDeliberative Nursing

ProcessProcess


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ProcessProcessx The deliberative nursing process is

set in motion by the patients

behaviorxAll behavior may represent a cry

for help. Patients behavior canbe verbal or non-verbal.

x The nurse reacts to patientsbehavior and forms basis fordetermining nurses acts.

x

Perception, thought, feeling


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ProcessProcess

x Nurses actions should be

deliberative, rather than automaticx Deliberative actions explore the

meaning and relevance of anaction.


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Dorothy JohnsonDorothy Johnson

Behavioral SystemsBehavioral Systems

ModelModel


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ModelModelx The person is a behavioral

system comprised of a set of

organized, interactive,interdependent, andintegrated subsystemsx

Constancy is maintained throughbiological, psychological, andsociological factors.


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Behavioral SystemsBehavioral SystemsModelModel

x A steady state is maintainedthrough adjusting andadapting to internal andexternal forces.


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Johnsons 7Johnsons 7

SubsystemsSubsystemsx Affiliative subsystem

x social bonds

x Dependencyxhelping or nuturing

x Ingestive

x food intake

x Eliminativex excretion

oro y o nsonoro y o nson


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oro y o nsonoro y o nsonBehavioral SystemsBehavioral Systems

Model 7 SubModel 7 SubSystemsSystems

x Sexualx procreation and gratification

x Agressivex self-protection and preservation

x Achievementx efforts to gain mastery and

control


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Johnsons ConceptsJohnsons Conceptsx Person

x A behavioral system comprisedof subsystems constantly trying

to maintain a steady statex Environment

x Not specifically defined but does

say there is an internal andexternal environment

h hD h J h


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ModelModel

x Health

x Balance and stability.x Nursing

x External regulatory force that is

indicated only when there isinstability.


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M th RMartha Rogers


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Martha RogersMartha Rogers

Unitary HumanUnitary Human

BeingsBeingsx Energy fields

x Fundamental unity of things that

are unique, dynamic, open, andinfinite

xUnitary man and environmentalfield

x Universe of open systems

x Energy fields are open, infinite,and interactive


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BeingsBeingsx Pattern

xCharacteristic of energy field

xA wave that changes, becomescomplex and diverse

x Four dimensionality

xA nonlinear domain with out timeor space


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Rogers DefinitionsRogers Definitions

x IntegralityxContinuous and mutual

interaction between man andenvironment

x Resonancyx

Continuous change longer toshorter wave patterns in humanand environmental fields

M th RM th R


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BeingsBeingsx Helicy

xContinuous, probabilistic,

increasing diversity of the humanand envrionmental fields.

xCharacterized by nonrepeatingrhymicities

xChange


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Dorothea OremDorothea Orem

Self-Care ModelSelf-Care Model


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Self-Care ModelSelf-Care Modelx Self-care comprises those

activities performed

independently by an individualto promote and maintainperson well-being

x Self care agency is theindividuals ability to perform

self care activities

HISTORICAL BACKGROUND


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HISTORICAL BACKGROUNDBorn in Baltimore, Maryland on 1914.

Died June 22, 2007

Her father is a construction worker and her mother is a homemaker.

Received her diploma of Nursing in Providence Hospital School of Nursing,

Washington DC, 1930.Finished B.S.N.E and M.S.N.E in Catholic University of America (CUA).

1940 to 1949 Director of School of Nursing and Department of Nursing in

Providence Hospital, Detroit.

1949 to 1957 Work in Division of Hospital and Institutional Services of Indiana

State Board of Health. Her goal is to upgrade the quality of nursing in general

hospitals throughout the state.1957 to 1960 US Department of Health, Education and Welfare, Office of

Education

1959 Published Guidelines for developing Curricula for the Education of

Practical Nurses. She subsequently served as acting dean of the School of

Nursing and as an assistant professor of Nursing Education at CUA. She

continued to develop her concept of Nursing and Self Care during this time.1971 First book of Orem published was Nursing: Concept of Practice.

1976 Degree of Doctor in Science.

Orem retired and resides in Sarannah, Georgia.


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Self-Care ModelSelf-Care Modelx Self- care deficit occurs when

the person cannot carry out

self-care

x The nurse then meets the self-

care needs by acting or doingfor;guiding, teaching,supporting or providing the

environment to promote


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Self-Care ModelSelf-Care Modelx Wholly compensatory nursing

system

xPatient dependentx Partially compensatory

xPatient can meet some needs but

needs nursing assistancex Supportive educative

xPatient can meet self care

requisites, but needs assistance

Metaparadigm


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Metaparadigm:

Nursing - the art of nursing is practiced by doing for thepatient with the disability, by helping him to do for

himself or helping him to learn to do for himself. The goal

of nursing is to move the patient from wholly compensatory

to supportive state if at all possible.Person an individual with physical and emotional

requirements for development and self maintenance of their

well being.

Environment Clients surroundings which may affect their

ability to perform their self care activities.Health Structural and functional soundness and wholeness

of the individual.

I KiImogene King


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Imogene KingImogene King

Goal AttainmentGoal Attainment

TheoryTheory



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TheoryTheoryx Open systems framework

xHuman beings are open systems

in constant interaction with theenvironment

xPersonal Systemx individual; perception, self,

growth, development, time space,body image

x Interpersonal

x

Society



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TheoryTheoryx Personal Systemx Individual; perception, self,

growth, development, timespace, body image

x InterpersonalxSocialization; interaction,

communication and transaction

x SocietyxFamily, religious groups, schools,

work, peers



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TheoryTheoryx The nurse and patient mutually

communicate, establish goals

and take action to attain goals



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TheoryTheoryx Each individual brings a

different set of values, ideas,

attitudes, perceptions toexchange


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Betty NeumanBetty Neuman

Systems ModelSystems Model



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Health CareHealth Care

Systems ModelSystems Modelx The person is a complete

system, with interrelated parts

xmaintains balance andharmony between internaland external environment by

adjusting to stress anddefending against tension-producing stimuli



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Systems ModelSystems Modelx Focuses on stress and stress

reduction

x Primarily concerned witheffects of stress on health

x

Stressors are any forces thatalter the systems stability



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Systems ModelSystems Modelx Flexible lines of resistance

x Surround basic core

x

Internal factors that help defendagainst stressors

x Normal line of resistancex Normal adaptation state

x Flexible line of defensex Protective barrier, changing, affected

by variables


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Systems ModelSystems Modelx Wellness is equilibrium

x Nursing interventions areactivites to:

xstrengthen flexible lines of

defensexstrengthen resistence tostressors

x

maintain adaptation


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Sister Calista RoySister Calista Roy

Adaptation ModelAdaptation Model


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Adaptation ModelAdaptation Modelx Five Interrelated Essential

Elements

xPatiency- The person receivingcare

xGoal of nursing- Adapting to

changexHealth-Being and becoming a

whole person

x

Environment


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Adaptation ModelAdaptation Modelx The person is an open adaptive

system with input (stimuli),

who adapts by processes orcontrol mechanisms(throughput)

x The output can be eitheradaptive responses or

ineffective responses

Jean WatsonJean Watson


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Philosophy andPhilosophy and

Science of CaringScience of Caring



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Science of CaringScience of Caring

x Caring can be demonstrated

and practicedx Caring consists of carative

factors

x Caring promotes growthx A caring environment accepts

a person as he is and looks to

what the person may become


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Watsons 10 CarativeWatsons 10 Carative

FactorsFactorsxForming humanistic-

altruistic value systemx Instilling faith-hope

xCultivating sensitivity toself and others


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FactorsFactors

xDeveloping helping-trust

relationshipxPromoting expression of

feelings

xUsing problem-solving fordecision making


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FactorsFactorsx Promoting teaching-learning

x Promoting supportiveenvironment

x Assisting with gratification of

human needsx Allowing for existential-

phenomenological forces


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WatsonsWatsons

ConceptsConceptsxPersonxHuman being to be valued,

cared for, respected,nurtured, understood andassisted

xEnvironmentxSociety



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Science of CaringScience of CaringxHealthx

Complete physical, mentaland social well-being andfunctioning

xNursingxConcerned with promoting

and restoring health,

preventing illness

Rosemary ParseRosemary Parse


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Human BecomingHuman Becoming

TheoryTheoryx Human Becoming Theory

includes Totality Paradigm

x Man is a combination ofbiological, psychological,sociological and spiritual factors

Simultaneity Paradigmx Man is a unitary being incontinuous, mutual interactionwith environment

x Ori inall Man-Livin -Health


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Parses ThreeParses Three

PrinciplesPrinciplesx Meaning

xMans reality is given meaning

through lived experiencesxMan and environment cocreate

x Rhythmicity

xMan and environment cocreate( imaging, valuing, languaging) inrhythmical patterns


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Parses ThreeParses Three

PrinciplesPrinciplesxCotranscendencex

Refers to reaching out andbeyond the limits that aperson sets

x

One constantly transforms



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HumanHuman

BecomingTheoryBecomingTheoryx Person

xOpen being who is more than and

different from the sum of theparts

x Environmentx

Everything in the person and hisexperiences

x Inseparable, complimentary toand evolving with


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x Health

xOpen process of being andbecoming. Involves synthesis ofvalues

x NursingxA human science and art that

uses an abstract body ofknowledge to serve people

Human BecomingTheoryHuman BecomingTheory

a e e ne e n ngera e e ne e n ngerC l C


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ggCulture CareCulture Care

Diversity andDiversity andUniversalityUniversalityx Based on transcultural

nursing, whose goal is toprovide care congruent withcultural values, beliefs, andpractices

x Sunrise model consists of 4levels that provide a base ofknowledge for delivering

cultural con ruent care

Madeleine LeiningerMadeleine Leininger


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Madeleine LeiningerMadeleine Leininger

Culture CareCulture Care

DiversityDiversityx Modes of nursing actionxCultural care preservation

x

help maintain or preserve health,recover from illness, or face death

xCultural care accommodationx help adapt to or negotiate for a

beneficial health status, or face deathxCultural care re-patterning

x help restructure or change lifestylesthat are culturally meaningful

Patricia BennerPatricia Benner


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From Novice toFrom Novice to

ExpertExpert



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ExpertExpert

x Described 5 levels of nursing

experience and developedexemplars and paradigm casesto illustrate each level



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ExpertExpertx Levels reflect:

x

movement from reliance on pastabstract principles to the use ofpast concrete experience asparadigms

x change in perception of situationas a complete whole in whichcertain parts are relevant



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ExpertExpertx Novice

x Advanced beginnerx Competent

x Proficient

x Expert

Importance ofImportance of


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Importance ofImportance of

TheoreticalTheoretical

FrameworksFrameworksx Foundation of any profession

is the development of aspecialized body of knowledge.Theories should be developed

in nursing, not borrow theories

form other disciplines


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Next StepsNext Steps

x Responsibility of nurses toknow and understand theorists

x Critically analyze theoreticalframeworks

Documents

Nursing Theoriest