Foundations of Nursing Nursing Theories and History Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Faye Abdellah
Patient – Centered Approaches to Nursing Model
FOUNDATIONS OF NURSING Nursing Theories and History
21 Nursing Problems
Lecturer: Mark Fredderick R. Abejo R.N, M.A.N
NURSING THEORIES and CONCEPTUAL FRAMEWORK
Florence Nightingale Developed and described the first theory of nursing Focused on changing and manipulating environment in order to put the patient in the best possible conditions for nature to act. Identified 5 environmental environmental factors: fresh air, pure water, efficient drainage, cleanliness/sanitation and light/direct sunlight. Client’s environment is manipulated manipula ted to include appropriate nose, nutrition, hygiene, light, comfort, socialization and hope.
Virginia Henderson Introduced The Nature of Nursing Model Identified 14 basic needs : o Breathing normally o Eating and drinking adequately o Eliminating body wastes o Moving and maintaining desirable position o Sleeping and resting Selecting suitable clothes o o Maintaining body temperature within normal range Keeping the body clean and well-groomed o Avoiding dangers in the environment o Communicating with others o Worshipping according to one’s faith o Working in such a way that one feels a sense o of accomplishment Playing/participating in various forms of o recreation Learning, discovering or satisfying the o curiosity that leads to normal development and health and using available health facilities. She postulated that the unique function of the nurse is to assists the clients, sick or well in the performance of those activities contributing to health or its recovery, that clients would perform unaided if they had the necessary strength, will or knowledge. Believed that nursing involves in assisting the client in gaining independence as rapidly as possible or assisting him achieved peaceful death if recovery is no longer possible. Foundations of Nursing
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 Defined nursing as service to individuals and families. Conceptualized nursing as an art and a science that molds the attitudes, intellectual competencies and technical skills of the individual nurse into the desire and ability to help people, sick or well and cope with their health needs.
Dorothy Johnson Behavioral System Model According to her, each person as a behavioral system is composed of seven subsystem namely: Ingestive Eliminative Affiliative Aggressive Dependence Achievement Sexual and Role Identity Behavior Imogene King Goal Attainment Theory Described nursing as a helping profession that assists individuals and groups in society to attain, maintain and restore health
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Foundations of Nursing Nursing Theories and History Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
3. Madeleine Leininger Transcultural Nursing Model 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 Myra Levin Four Conservation Principles She advocated that nursing is a human interaction and proposed 4 conservation principles of nursing which are concerned with the unity and integrity of the individual. Conservation of Energy Conservation of Structural Integrity Conservation of Personal Integrity Conservation of Social Integrity Betty Neuman Health care System Model Nursing is a unique profession that is concerned with all the variables affecting an individual’s response to stresses, which are: - intra ( within the individual ) - inter ( between one or more other people ) - extrapersonal ( outside the individual ) The nurse helps the client, through primary, secondary and tertiary prevention to adjust to environment stressors and maintain client stability.
Dorotheo Orem Self-Care and Self-Care Deficit 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: 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. Foundations of Nursing
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
A.
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
B.
Supportive-educative – nurse’s actions are to help the client develop/learn their own self-care abilities through knowledge, support and encouragement. Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies.
C.
Hildegard Paplau Interpersonal Model Defined nursing as 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 and respond to the need for help. 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 Martha Rogers Science of Unitary Human Beings Unitary Man, is an energy field in constant interaction with the environment. Human beings are more than and different from the sum of their parts; the distinctive properties of the whole are significantly different from those of its parts. 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.
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Foundations of Nursing Nursing Theories and History Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
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 spacetime 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
Sister Callista Roy Adaptation Model Viewed each person as a unified biopsychosocial system in constant interaction with a changing environment. Person as an adaptive system consists of input, control, processes, output and feedback. All people have certain needs which is divided into four different modes: physiological, self concept, role function and interdependence.
Lydia Hall Three Components of Nursing : Care, Core and Cure Care: represent nurturance and is exclusive to nursing Core: involves therapeutic use of self and emphasizes the use of reflection Cure: focuses on nursing related to the physician’s orders
Ida Jean Orlando The Dynamic Nurse – Patient Relationship Model Believed that the nurse helps patients meet a perceived need that the patients cannot meet for themselves. Observed that the nurse provides direct assistance to meet an immediate need for help in order to avoid or to alleviate distress or helplessness. She also indicated that nursing actions can be: Automatic Deliberative Advocated the three elements composing nursing situation: Client behavior Nurse reaction Nurse action
Jean Watson Human Caring Model ( Nursing: Human Science and Human Care ) Nursing is the application of the art and human science through transpersonal caring transactions to help persons achieve mind-body-soul harmony, which generates self-knowledge, self-control, self-care and self-healing 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 Foundations of Nursing
Carative Factors: 1. The promotion of a humanistic-altruistic system of values 2. Instillation of faith-hope 3. The cultivation of sensitivity to one’s self and others 4. The development and acceptance of the expression of positive and negative feelings. 5. The systemic use of the scientific problem-solving method for decision making 6. The promotion of interpersonal teaching-learning 7. The provision for supportive, protective and corrective mental, physical, socio-cultural and spiritual environment 8. Assistance with the gratification of human needs 9. The allowance for existential phenomenological forces
Rosemarie Rizzo Parse Theory of Human Becoming Emphasized free choice of personal meaning in relating value priorities, co-creating of rhythmical patterns, in exchange with the environment, and co transcending in many dimensions as possibilities unfold. 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.
Ernestine Weidenbach Developed the Clinical Nursing – A Helping Art Model She believed that nurses meet the individual’s need for help through the identification of the needs, administration of help and validation that actions were helpful. Components of clinical practice: Philosophy, purpose, practice and an art.
Joyce Travelbee Interpersonal Aspects of Nursing Model The goal of nursing is to assist individual or family in preventing or coping with illness regaining health, finding meaning in illness or maintaining maximal degree of health.
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Foundations of Nursing Nursing Theories and History Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
HISTORY OF NURSING
PERIOD OF INTUITIVE NURSING Beliefs and Practices of Prehistoric Man He was nomad. His philosophy of life was “the best for the most” and he was ruled by the law of selfpreservation. Nursing was a function that belonged to women Believed that illness was caused by invasion of evil spirit Believed that medicine man called “shaman” or witch doctor had the power to heal by using white magic. Practices “trephining” (drilling a hole in the skull with a stone or rock without anesthesia as a last resort to drive evil spirit from the body. Nursing in the Near East Man’s mode of living changed from nomadic style to an agrarian society to an urban community life. Developed a means of communication and the beginnings of a body of scientific knowledge Nursing remained the duty of slaves, wives, sister or mother The care of the sick was still closely related to religion, superstition and magic. Contribution to Medicine and Nursing: Babylonia Code of Hammurabi : Provided laws that covered every facet of Babylonian life including medical practice. Egypt Egyptians introduced the art of embalming which enhance their knowledge of human anatomy. Israel Moses – “Father of Sanitation” He wrote the five book of the Old Testament which: Emphasized the practice of hospitality to strangers and acts of charity. Promulgated laws of control on the spread of communicable disease and the ritual of male circumcision. Nursing in the Far East China Strongly believed in spirits and demons. Prohibition of dissecting the dead human body. Give the world knowledge of material medica which prescribed methods of treating wounds, infection and muscular afflictions. India Men of medicine built hospitals, practiced an intuitive form of asepsis and were proficient in the practice of medicine and surgery. Sushurutu made a list of function and qualifications of nurses. Greece Nursing was the task of untrained slave Introduced the caduceus Hippocrates, Father of Scientific M edicine Rome Attempted to maintain vigorous health, because illness was a sign of weakness. Care of the ill was left to the slaves or Greek physician. Fabiola, made her home the first hospital in the Christian world.
It is called the period of “on the job” training. Nursing care was performed without any formal education and by people who were directed by more experienced nurses. Military Religious Orders: Knights of St. John of Jerusalem Teutonic Knights, tent hospital for wounded Knights of St. Lazarus, nursing care for lepers Rise of Secular Orders, Order of St. Francis of Assisi The Bequines The Oblates Benedictines Ursulines Augustinians Hospitals were poorly ventilated and the beds were filthy. Overcrowding of patients Practice of environmental sanitation and asepsis were non-existent. Older nuns prayed with and took good care of the sick; while the younger nuns washed soiled linens. Important Nursing Personage During The Period of Apprentice St. Claire St. Elizabeth of Hungary “Patroness of Nurses” St. Catherine of Siena “First Lady with a Lamp”
DARK PERIOD OF NURSING The religious upheaval led by Martin Luther destroyed the unity of the Christian faith. The wrath of Protestantism swept away everything connected with Roman Catholicism. Hundreds of hospitals were closed There were no provision for the sick, no one to care for the sick. Nursing become the work of the least desirable women. Several Leaders Sought to Bring Reforms: John Howard Mother Mary Aikenhand Pastor Theodor Fliedner and Frederika Munster Fliedner, established the Institute for Training of Deaconesses at Kaiserwerth, Germany. The first organized training school for nurses. Nursing in America Jeanne Mance, the first laywoman who worked as a nurse in North America. She founded the Hotel Dieu of Montreal, a log cabin hospitals Mrs. Elizabeth Seton, founded the Sister of Charity of Emmitsberg, Maryland American Reforms in Nursing The Nurse’s Society of Philadelphia , organized a school of nursing under the direction of Dr. Joseph Warrington. Nurses were trained on the job and attended some preparatory courses. Women’s Hospital in Philadelphia, established a six month course in nursing. Nursing During the Civil War The American Medical Associa during the Civil War created the Committee on Training of Nurses. Dorothea Dix, established the Nurse Corps of the United States Army. Clara Barton, founded the American Red Cross
PERIOD OF APPRENTICE NURSING
Periods extends from the founding of religious nursing orders in The Crusades and establishment of Kaiserwerth Institute for the Training of Deaconesses.
Foundations of Nursing
PERIOD OF EDUCATED NURSING This period began on June 15, 1860 when the Florence Nightingale School of Nursing opened at St. Thomas Hospital in London (St.Thomas Hospital School of Nursing) Abejo
Foundations of Nursing Nursing Theories and History Prepared by: Mark Fredderick R. Abejo R.N, M.A.N
Facts About Florence Nightingale Recognized as the “Mother of Modern Nursing” Also known as the “ Lady with a Lamp” Born on May 12, 1820 in Florence Italy Not contented with the social custom imposed upon her as a Victorian Lady, she developed her self-appointed goal: “To change the profile of nursing” Compiled notes of her visits to hospitals, her observation of the sanitary facilities and social problems of the places she visited. Advocated for care of those afflicted with disease caused by lack of hygienic practices. At the age of 31, she overcome her family’s resistance to her ambitions. She entered the Deaconess School at Kaiserworth. Worked as a superintendent for Gentlewomen during illness. Upgraded the practice of nursing and made nursing an honorable profession for gentlewomen. Led the nurses that took care of the wounded during the Crimean War.
Important Person/Groups/Events During Period of Educated Nursing Linda Richards, First graduate nurse in the US Dr. William Halstead, Designed the first rubber gloves Caroline Hampton Robb, The first to nurse to wear gloves while working as an operating room nurse. Clara Louise Maas, Engaged in medical research on yellow fever, She died of yellow fever Establishment of nursing organization; the American Nurses Association and the National League for Nursing Education. Development of private duty nursing, settlement house nursing, school nursing, government service of nurses and maternal and prenatal health nursing.
Prominent Person Involved in Nursing Works (Philippine Revolution)
Hospitals and School of Nursing
PERION OF CONTEMPORAY NURSING Period after World War II Establishment of the World Health Organization by the UN Use of atomic / nuclear energy for medical diagnosis and treatment Utilization of computers and use of sophisticated equipment for diagnosis and therapy Health is perceived as a fundamental human right.
HISTORY OF NURSING IN THE PHILIPPINES
Earliest Hospitals Hospital Real de Manila ( 1577) San Lazaro Hospital ( 1578 ) Hospital de Indio ( 1586 ) Hospital de Aguas Santas ( 1590 ) San Juan de Dios Hospital ( 1596 ) Foundations of Nursing
Iloilo Mission Hospital School of Nursing ( Iloilo City, 1906 ) - In April 1944, 22 nurses graduated took the first Nurses Board Examination at the Iloilo Mission Hospital. St. Paul’s Hospital School of Nursing (Manila, 1907) Philippine General Hospital School of Nursing ( 1907 ) - Anastacia Giron-Tupas, the first Filipino nurse to occupy the position of chief nurse and superintendent in the Philippines. St. Luke’s Hospital School of Nursing ( Quezon City, 1907 ) Requirements for Admission: At least completion of seventh grade Sound physical and mental health Good moral character Good family and social standing Recommendations from three different persons well known in the community Mary Johnston Hospital and School of Nursing ( Manila, 1907 ) Philippine Christian Mission Institute School of Nursing San Juan de Dios Hospital School of Nursing (1946) Emmanuel Hospital School of Nursing ( Capiz, 1913 ) Southern Islands Hospital School of Nursing ( Cebu, 1918 )
First Colleges of Nursing in the Philippines
EARLY BELIEFS AND PRACTICES Beliefs about causation of disease: Enemy or a witch and evil spirit People believed that evil spirits could be driven away by persons with power to expel demons. People believed I special gods of healing, with the priest- physician (called “word doctors”). If they used leaves or roots, they were called herb doctors (“Herbolarios”) Herbicheros one who practiced witchcraft. Persons suffering from disease without any identified cause were believed to be bewitched by the “mangkukulam or mangagaway. Difficult childbirth were attributed to “nono”
Josephine Bracken, installed a field hospital in Tejeros for wounded. Rosa Sevilla de Alvero Dona Hilaria de Aguinaldo, organized Filipino Red Cross. Dona Maria Agoncillo de Aguinaldo, 2nd wife of Emilio Aguinaldo, Pres. Of Filipino Red Cross in Batangas Melchora Aquino ( Tandang Sora ) Capital Salome Agueda Kahabagan Trinidad Tecson, “ Ina ng Biac na Bato “
University of Sto.Tomas College of Nursing (1946) Manila Central University College of Nursing (1947) University of the Philippines College of Nursing (1948)
Nursing Leaders in the Philippines
Anastacia Giron – Tupas, First Filipino nurse to hold the position of Chief Nurse Superintendent; founder of the Philippine Nurses Association. Cesaria Tan, First Filipino to receive a Masters degree in Nursing abroad. Socorro Sirilan, Pioneered in Hospital Social Service in San Lazaro Hospital where she was the chief nurse Rosa Militar, pioneer in school health education Sor Ricarda Mendoza, pioneer in nursing education. Socorro Diaz, first editor of the PNA magazine called “ The Message “ Conchita Ruiz, First full time editor of the newly named PNA magazine “The Filipino Nurse”
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