Nursing Theory and Theorists
4 Essential concepts common among nursing theories:
Florence Nightingales’s Environmental Theory
- Defined Nursing: “The act of utilizing the environment of the patient to assist him in his recovery.”
- Focuses on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.
- Identified 5 environmental factors: fresh air, pure water, efficient drainage, cleanliness/sanitation and light/direct sunlight.
- Considered a clean, well-ventilated, quiet environment essential for recovery.
- Deficiencies in these 5 factors produce illness or lack of health, but with a nurturing environment, the body could repair itself.
Dorothea Orem’s Self-Care Theory
- 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:
- Self-care – activities an Individual performs independently throughout life to promote and maintain personal well-being.
- Self-care deficit – results when self-care agency (Individual’s ability) is not adequate to meet the known self-care needs.
- 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.
- Wholly compensatory – nurse provides entire self-care for the client.
- Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies.
Virginia Henderson’s Definition of the Unique Function of Nursing
- Defined Nursing: “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 :
- Breathing normally
- Eating and drinking adequately
- Eliminating body wastes
- Moving and maintaining desirable position
- Sleeping and resting
- Selecting suitable clothes
- Maintaining body temperature within normal range
- Keeping the body clean and well-groomed
- Avoiding dangers in the environment
- Communicating with others
- Worshipping according to one’s faith
- Working in such a way that one feels a sense of accomplishment
- Playing/participating in various forms of recreation
- Learning, discovering or satisfying the curiosity that leads to normal development and health and using available health facilities.
Madeleine Leininger’s Transcultural Care Theory and Ethnonursing
- Nursing is a learned humanistic and scientific profession and discipline which is focused on human care phenomena and activities in order to assist, support, facilitate, or enable individuals or groups to maintain or regain their well being (or health) in culturally meaningful and beneficial ways, or to help people face handicaps or death.
- Transcultural nursing as a learned subfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health-illness caring practices, beliefs and values with the goal to provide meaningful and efficacious nursing care services to people according to their cultural values and health-illness context.
- Focuses on the fact that different cultures have different caring behaviors and different health and illness values, beliefs, and patterns of behaviors.
- Awareness of the differences allows the nurse to design culture-specific nursing interventions.
Callista Roy’s Adaptation Theory
- Viewed humans as Biopsychosocial beings constantly interacting with a changing environment and who cope with their environment through Biopsychosocial adaptation mechanisms.
- Focuses on the ability of Individuals., families, groups, communities, or societies to adapt to change.
- The degree of internal or external environmental change and the person’s ability to cope with that change is likely to determine the person’s health status.
- Nursing interventions are aimed at promoting physiologic, psychologic, and social functioning or adaptation.
Martha Roger’s Concept of Science of Unitary Human Beings, and Principles of Homeodynamics
- 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
Hildegard Peplau’s Interpersonal Relations Theory
- Defined Nursing: “An interpersonal process of therapeutic interactions between an Individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.
- Nursing is a “maturing force and an educative instrument”
- Identified 4 phases of the Nurse – Patient relationship:
- Orientation – individual/family has a “felt need” and seeks professional assistance from a nurse (who is a stranger). This is the problem identification phase.
- Identification – where the patient begins to have feelings of belongingness and a capacity for dealing with the problem, creating an optimistic attitude from which inner strength ensues. Here happens the selection of appropriate professional assistance.
- Exploitation – the nurse uses communication tools to offer services to the patient, who is expected to take advantage of all services.
- Resolution – where patient’s needs have already been met by the collaborative efforts between the patient and the nurse. Therapeutic relationship is terminated and the links are dissolved, as patient drifts away from identifying with the nurse as the helping person.
Lydia Hall’s Key Concepts of Three Interlocking Circles Theory
- Nursing is participation in care, core and cure aspects of patient care, where CARE is the sole function of nurses, whereas the CORE and CURE are shared with other members of the health team.
- The major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the core.
Dorothy Johnson’s Key Concepts of Behavioral System
- Each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual.
Faye Glenn Abdellah’s Concept of Twenty One Nursing Problems
- Nursing is broadly grouped into 21 problem areas to guide care and promote the use of nursing judgement.
- 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.
- 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
Imogene King’s Goal Attainment Theory
- Nursing is a process of action, reaction, and interaction whereby nurse and client share information about their perception in the nursing situation
Jean Watson’s The Philosophy and Science of Caring
- 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
Rosemarie Rizzo Parse’s Theory of Human Becoming
- Nursing is a scientific discipline, the practice of which is a performing art
- Three assumption about Human Becoming
- Human becoming is freely choosing personal meaning in situation in the intersubjective process of relating value priorities
- Human becoming is co-creating rhythmic patterns or relating in mutual process in the universe
- Human becoming is co-transcending multidimensionally with emerging possibilities.