Nursing Theories Presented by :- Hariom gangwar Msc Nsg Ist YR Psychiatry nursing

A set of concepts, definitions, relationships, and assumptions that project a systematic view of a phenomena

It may consist of one or more relatively specific and concrete concepts and propositions that purport to account for, or organize some phenomenon (Barnum, 1988)

Concepts – ideas and mental images that help to describe phenomena (Alligood and Marriner-Tomey, 2002)

Definitions – convey the general meaning of the concepts

Assumptions – statements that describe concepts

Phenomenon – aspect of reality that can be consciously sensed or experienced (Meleis, 1997).

A model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline (Alligood and Marriner – Tomey, 2002)

The view or perspective of the discipline

It contains the subject, central concepts, values and beliefs, phenomena of interest, and the central problems of the discipline

Nursing has identified its domain in a paradigm that includes four linkages:

1) person/client 2) health 3) environment 4) nursing

It guides nursing practice and generates knowledge

It helps to describe or explain nursing

Enables nurses to know WHY they are doing WHAT they are doing

Grand theories – broad and complex

Middle-range theories- address specific phenomena and reflect practice

Descriptive theories – first level of theory development

Prescriptive theories – address nursing interventions and predict their consequences

Everyday practice enriches theory

Both practice and theory are guided by values and beliefs

Theory helps to reframe our thinking about nursing

Theory guides use of ideas and techniques

Theory can close the gap between theory and research

To envision potentialities (Gordon, Parker, & Jester, 2001)

Organize patient data Understand patient data Analyze patient data Make decisions about

nursing interventions Plan patient care Predict outcomes of care Evaluate patient

outcomes (Alligood, 2001)

By asking yourself two very important questions…..

What is the nature of knowledge needed for the practice of nursing?

What does it mean to me to practice nursing?

Systems theory Basic Human Needs

theory Health and Wellness

Models Stress and

Adaptation Developmental

Theories Psychosocial

Theories

Essential concepts common among nursing theories:

Man Health Environment Nursing

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

5 Factors for a Healthy Environment:  Pure or fresh air   Pure water   Efficient drainage  Cleanliness  Light, especially directs unlight

Nightingale’s general concepts of Environmental Sanitation includes:

Proper Ventilation Adequate Lighting Cleanliness Adequate Warmth Quiet Diet

Nursing Practice :

The principles of Nursing Practice by FN are continuously 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

Definition:- “Assisting the individual, sick or well, in the

performance of those activities contributing to health or it’s recovery (or to peaceful death) that an individual would perform unaided if he had the necessary strength, will or knowledge”.

Identified 14 basic needs : 1. Breathing normally 2. Eating and drinking adequately 3. Eliminating body wastes 4. Moving and maintaining desirable position 5. Sleeping and resting 6. Selecting suitable clothes

7. Maintaining body temperature within normal range

8. Keeping the body clean and well-groomed

9. Avoiding dangers in the environment

10. Communicating with others

11. Worshipping according to one’s faith

12. Working in such a way that one feels a sense of accomplishment

13. Playing/participating in various forms of recreation

14. Learning, discovering or satisfying the curiosity that leads to normal development and health and using available health facilities.

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

Focus is on PROPER IDENTIFICATION of the problem

Particularly about the proper NURSING DIAGNOSIS

Nurse-centered

Nursing is a comprehensive service that is based on the art and science and aims to help people, sick or well, cope with their health needs.

21 Nursing Problems

To maintain good hygiene. To promote optimal activity; exercise, rest and sleep. To promote safety. To maintain good body mechanics To facilitate the maintenance of a supply of oxygen To facilitate maintenance of nutrition

To facilitate maintenance of elimination

To facilitate the maintenance of fluid and electrolyte balance

To recognize the physiologic response of the body to disease conditions

To facilitate the maintenance of regulatory mechanisms and functions

To facilitate the maintenance of sensory functions

To identify and accept positive and negative expressions, feelings and reactions

To identify and accept the interrelatedness of emotions and illness.

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

To promote the development of productive interpersonal relationship

To facilitate progress toward achievement of personal spiritual goals

To create and maintain a therapeutic environment

To facilitate awareness of self as an individual with varying needs.

To accept the optimum possible goals

To use community resources as an aid in resolving problems arising from illness.

To understand the role of social problems as influencing factors

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

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

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 steppingstone towards a more fulfilling career in nursing

Nursing is an art and science that is humanistic and humanitarian. It is directed toward the unitary human and is concerned with the nature and direction of human development. The goal of nurses is to participate in the process of change..

Nursing interventions seek to promote harmonious interaction between persons and their environment, strengthen the wholeness of the Individual and redirect human and environmental patterns or organization to achieve maximum health.

5 basic assumptions: The human being is a unified whole, possessing individual

integrity and manifesting characteristics that are more than and different from the sum of parts.

The individual and the environment are continuously exchanging matter and energy with each other

The life processes of human beings evolve irreversibly and unidirectionally along a space-time continuum

Patterns identify human being and reflect their innovative wholeness

The individual is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion

 

Patient has THREE 3 interacting systems –

1. Individuals /Personalsystems  :

How the nurse views and integrates self basedfrom personal goals and beliefs.

2. Groupsystems / Interpersonalsystems :

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

3. Socialsystems :

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

Action : A means of behaviour 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

Reaction A form of reacting or response to a certain Stimuli. Interaction Any 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

Four (4) Phases of Nurse-Patient Interaction

1. Orientation

Nurse and patient test therole 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 there sources to

benefit the patient

4. Resolution Phase or Termination Phase :

• Occurs when patient’s needs have been met

Application :

Significant 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

Nursing is concerned with promotion health, preventing illness, caring for the sick, and restoring health.

Nursing is a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human care transactions

She defined caring as a nurturant way or responding to a valued client towards whom the nurse feels a personal sense of commitment and responsibility. It is only demonstrated interpersonally that results in the satisfaction of certain human needs. Caring accepts the person as what he/she may become in a caring environment

Carative Factors:  

The promotion of a humanistic-altruistic system of values Instillation of faith-hope The cultivation of sensitivity to one’s self and others The development and acceptance of the expression of positive

and negative feelings. The systemic use of the scientific problem-solving method for

decision making The promotion of interpersonal teaching-learning The provision for supportive, protective and corrective mental,

physical, socio-cultural and spiritual environment Assistance with the gratification of human needs The allowance for existential phenomenological forces

The Nursing Process is an interaction of Three Basic Elements:

1. Patient’s Behaviour 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 behaviour

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

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

Patient.

Her model emphasizes: Empathy Sympathy Rapport &  the Emotional aspects of Nursing 

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

Original Encounter Emerging Identities Empathy Sympathy

Application:

 The theory describes the various stages of interpersonal relations 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 

Focuses on 10 Categories of determinants of health-Promoting Behaviours.

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

The10 Determinants are :

Prior related behaviour

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 the major Focus of  Hx  Care Organizations . In order for Patients to take on the Behaviour we, Hx care professionals , advise them to take, we should carefully looked into a host of factors that can influence his decision to really adopt the behaviour.

It is important for Ns to be ROLE MODELS for the pts.

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 Person is viewed as an Open System composed of Basic

Structure of Energy Resources which includes: • Physiologic • Psychologic • Sociocultural • Developmental • Spiritual

Basic 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

1.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

FOCUS 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 & Hx care services. It is a MUST that Ns perform thorough &comprehensive assessment that includes ALL aspects of the Ct.

Man is a BIO PSYCHOSOCIAL 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 Behaviour  2. Assessment of Stimuli 3. Nursing Diagnosis 4. Goal Setting 5. Intervention 6. Evaluation

APPLICATION :

Best 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 Through put process .

The Evaluation which provides necessary feedback to the Goal of care is the Output

The N decides what necessary actions should betaken 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

Defined Nursing: “The act of assisting others in the provision and management of self-care to maintain/improve human functioning at home level of effectiveness.”

Focuses on activities that adult individuals perform on their own behalf to maintain life, health and well-being.

Has a strong health promotion and maintenance focus.

Identified 3 related concepts: 1. Self-care - activities an Individual performs independently

throughout life to promote and maintain personal well-being. 2.Self-care deficit - results when self-care agency

(Individual’s ability) is not adequate to meet the known self-care needs.

3.Nursing System - nursing interventions needed when Individual is unable to perform the necessary self-care activities: Wholly compensatory - nurse provides entire self-care for

the client. Example: care of a new born, care of client recovering from

surgery in a post-anesthesia care unit Partial compensatory - nurse and client perform care, client

can perform selected self-care activities, but also accepts care done by the nurse for needs the client cannot meet independently. Example: Nurse can assist post operative client to ambulate,

Nurse can bring a meal tray for client who can feed himself Supportive-educative - nurse’s actions are to help the client

develop/learn their own self-care abilities through knowledge, support and encouragement.

Theory provides direction for nursing research

Relationships of components in a theory help to drive the research questions for understanding nursing

Chinn and Kramer (2004), indicate a spiral relationship between the two

Medical science Nursing education Professional nursing

organizations Evolving research

approaches Global concerns Consumer demands Technologies

Leah Curtin, RN, MS, FAAN (1989)Former Editor, Nursing Management