Introduction: Over the years, nursing has incorporated theories from non-nursing sources, including theories of systems, human needs, change, problem solving, and decision making. Barnum defines theory as “a construct that accounts for or organizes some phenomenon. A nursing theory, then, describes or explains nursing.” With the formulation of different theories, concepts, and ideas in nursing it: It guides nurses in their practice knowing what is nursing and what is not nursing. It helps in the formulations of standards, policies and laws. It will help the people to understand the competencies and professional accountability of nurses. It will help define the role of the nurse in the multidisciplinary health care team. • • •
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Four Major Concepts Nurses Nurses have have develo developed ped variou various s theori theories es that that provid provide e differ different ent explan explanati ations ons of the nursin nursing g discipline. All theories, however, share four central concepts: Person , refers to all human beings. People are are the the reci recipi pien ents ts of nurs nursin ing g care care;; they they incl includ ude e indi indivi vidu dual als, s, fami familie lies, s, comm commun unit itie ies, s, and and grou groups ps.. Environment includes Environment includes factors that affect individuals internally and externally. It means not only in the everyday surroundings but all setting where nursing care is provided. Health generally addresses the person’s state of well-being. The concept of Nursing is central to all nursing theories. Definitions of nursing describe what nursing is, what nurses do, and how nurses interact with clients. Most nursing theories address each of the four central concepts implicitly or explicitly. Overview of Major Nursing Theorists Theorist Florence Nightingale (1860), Not Notes on Nurs Nursin ing g: What It Is, What It Is Not
Focus / Development Developed and described the first theory of nursin nursing. g. She foc focuse used d the on changi changing ng and manipulating the environment in order to put the patien patientt in best best possib possible le condit condition ions s for nature to act.
Views of Components Person rson:: An indi indivi vid dual ual with with vital ital repa repara rati tive ve proc proces esse ses s to deal deal with with disease. Environment: External conditions that affect life and individuals development. She believed that in the nurturing Heal Health th:: Focu Focus s is on the the repa repara rati tive ve enviro environme nment, nt, the body body could could repair repair itself itself.. process of getting well Clie Client nt’s ’s envi enviro ronm nmen entt is mani manipu pula late ted d to Nursing: Goal is to place the individual include appropriate noise, nutrition, hygiene, in the best condition for good light, comfort, socialization and hope healthcare To assi assist st the the indi indivi vidu dual als s in over overco comi ming ng P: Any individual who is receiving help Ernestine Wiedenbach (1964), obstac obstacles les that that preve prevent nt meeti meeting ng health healthcar care e from a member of the health Clin Clinic ical al Nurs Nursin ing g – A need needs. s. She She advo advoca cate ted d that that the the nurs nurse’ e’s s prof profes essi sion on or from from a work worker er in the the Helping Art individual philosophy or central purpose lends field of health. credence to nursing care. She believed that E: Not specifically addressed nurses nurses meet the indivi individua dual’s l’s need need for help help H: Conce Concepts pts of nursin nursing, g, client client,, and through identification of needs, need need for help help and their their relati relations onship hips s admini administr strati ation on of help, help, and valida validatio tion n that that imply health-related health-related concerns concerns in the actions were helpful. Components of clinical nurse—client relationship.. practice: practice: Philosoph Philosophy, y, Purpose, Purpose, Practice Practice and N: the the nurs nurse e is a func functi tion onal al huma human n an Art. being who acts, thinks, and feels. All actions, thoughts, and feeli elings underlie what the nurse does. She She iden identi tifi fied ed four fourte teen en basi basic c need needs. s. She She Virginia Virginia Henderson Henderson postul postulate ated d that that the unique unique functi function on of the P: Indivi Individua duall requir requiring ing ass assist istanc ance e to (1955) nurse is to assist the clients, sick or well, in achieve health and independence or a The Nature of the performance of those activities peac peacefu efull deat death. h. Mind Mind and and body body are are Nursing contri contribut buting ing to health health or its recove recovery, ry, that that inseparable.
clients would perform unaided if they had the necessary strength, will or knowledge.
Faye Glenn To deliver Abdellah (1960), individual Patient Centered Approaches to Nursing
Jean Watson (1979) Nursing: Human Science and Human Care
nursing
care
for
the
whole
To focus on curative factors derived from a humanistic perspective and from scientific knowledge.
Human Caring Model
Ida Jean Orlando (1961) The Dynamic NursePatient Relationship
She believed that the nurse helps patients meet a perceived needs that the patient cannot meet for themselves. To interact with clients to meet immediate needs by identifying client behaviors, nurse’s reactions, and nursing actions to take
E: All external conditions and influences that affect life and development. H: Equated with independence, viewed in terms of the client’s ability to perform 14 components of nursing care unaided: breathing, eating, drinking, maintaining comfort, sleeping, resting clothing, maintaining body temperature, ensuring safety, communicating, worshiping, working, recreation, and continuing development. N: Assists and supports the individual in life activities and the attainment of independence. P: The recipients of nursing care having physical, emotional, and sociologic needs that may be overt or covert. E: Not clearly defined. Some discussion indicates that clients interact with their environment, of which nurse is a part. H: a state when the individual has no unmet needs and no anticipated or actual impairment. N: Broadly grouped in “21 nursing problems,” which center around needs for hygiene, comfort, activity, rest, safety, oxygen, nutrition, elimination, hydration, physical and emotional health promotion, interpersonal relationships, and development of selfawareness. Nursing care is doing something for an individual P: A valued being to be cared for, respected, nurtured, understood, and assisted, a fully functional, integrated self E: Social environment, caring and the culture of caring affect health H: Physical, mental, and social wellness N: A human science of people and human health; illness experiences that are mediated by professional, personal, scientific, aesthetic, and ethical human care transactions. P: Unique individual behaving verbally nonverbally. Assumption is that individuals are at times able to meet their own needs and at other times unable to do so E: Not defined H: Not defined. Assumption is that being without emotional or physical discomfort and having a sense of well-
Lydia Hall (1964), Nursing: What Is It?
To provide professional nursing care to people past the acute stage of illness. She conceptualized three components of Nursing: CARE, CORE, and CURE. Care represents nurturance and is exclusive to nursing. Core involves the therapeutic use of self and emphasizes the use of reflection. Cure focuses on nursing related to the physician’s order
Hildegard Peplau (1952), Interpersonal Relations in Nursing
She identifies four phases of the nurse-client relationship namely: ORIENTATION, IDENTIFICATION, EXPLOITATION, RESOLUTION
Joyce Travelbee (1966, 1971), Interpersonal Aspects of Nursing
To assist individuals, families, communities, and groups to prevent or cope with illness, regain health, finding meaning in illness, or maintaining, maximal degree of health. She further viewed that interpersonal process is a human-to-human relationship formed during illness and “experience of suffering”.
Martha Rogers (1970), The Science of Unitary Man
To assist the client in achieving a maximum level of wellness. To Rogers, unitary man is an energy field in constant interaction with the environment. She asserted that human beings are more than and different from the sum if their parts; the distinctive properties
being contribute to a healthy state. N: Professional nursing is conceptualized as finding out and meeting the client’s immediate need for help. P: Client is composed of body, pathology, and person. People set their own goals and are capable of learning and growing. E: Should facilitate achievement of the client’s personal goals. H: Development of a mature selfidentity that assists in the conscious selection of actions that facilitate growth. N: Caring is the nurse’s primary function. Professional nursing is most important during the recuperative period. P: An organism striving to reduce tension generated by needs E: The interpersonal process is always included, and psychodynamic milieu receives attention, with emphasis on the client’s culture and mores. H: Ongoing human process that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living. N: Interpersonal therapeutic process that “functions cooperatively with others human processes that make health possible for individuals in communities. Nursing is an educative instrument, a maturing force that aims to promote forward movement of personality. P: A unique, irreplaceable individual who is in a continuous process of becoming, evolving, and changing. E: Not defined H: Heath includes the individual’s perceptions of health and the absence of disease. N: An interpersonal process whereby the professional nurse practitioner assists an individual, family, or community to prevent or cope with the experience of illness and suffering, and if necessary, to find meaning in these experiences. P: Unitary man, a four-dimensional energy field. E: Encompasses all that is outside any given human field. Person exchanging matter and energy. H: Not specifically addressed, but
of the whole are significantly different from its parts. Furthermore, she believed that human being is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion.
Imogene M. King (1971, 1981), Open Systems Model, Goal Attainment Theory
Betty Neuman (1972, 1982, 1989, 1992) The Neuman System Model or Health Care System Model.
To communication to help the client reestablish a positive adaptation to his or her environment. She described nursing as a helping profession that assists individuals and groups in society to attain, maintain, and restore health. If this is not possible, nurses help individuals die with dignity. In addition, King viewed nursing as an interaction process between client and nurse whereby during perceiving, setting goals, and acting on them, transactions occur and goals are achieved To address the effects of stress and reactions to it on the development and maintenance of health. The concern of nursing is to prevent stress invasion, to protect the client’s basic structure and to obtain or maintain a maximum level of wellness. The nurse helps the client, through primary, secondary, and tertiary prevention modes, to adjust to environmental stressors and maintain client stability.
To use conservation activities aimed at optimal use of client’s resources. 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. FOUR CONSERVATION PRINCIPLES: 1. Conservation of energy 2. Conservation of structural integrity 3. Conservation of personal integrity 4. Conservation of social integrity. Sister Callista Roy To identify the types and demands placed on (1979) a client and client’s adaptation to the Adaptation Model demands. Myra Estrin Levine (1973), Conservation Model
emerges out of interaction between human and environment, moves forward, and maximizes human potential. N: A learned profession that is both science and art. The professional practice of nursing is creative and imaginative and exists to serve people. P: Biopsychosocial being E: Internal and external environment continually interacts to assist in adjustments to change. H: A dynamic life experience with continued goal attainment and adjustment to stressors. N: Perceiving, thinking, relating, judging, and acting with an individual who comes to a nursing situations
P: A client system that is composed of physiologic, psychological, sociocultural, and environmental variables. E: Internal and external forces surrounding humans at any time. H: Health or wellness exists if all parts and subparts are in harmony with the whole person. N: Nursing is a unique profession in that it is concerned with all the variables affecting an individual’s response to stressors. P: a holistic being E: Broadly, includes all the individual’s experiences H: The maintenance of the client’s unity and integrity N: A discipline rooted in the organic dependency of the individual human being on his or her relationship with others
P: Biopsychological beign and the recipient of nursing care. E: All conditions, circumstances, and influences surrounding and affecting the development of an organism or groups of organisms H: The person encounters adaptation problems in changing the environment. N: A theoretical system of knowledge that prescribes a process of analysis and action related to the care of the ill or potentially ill persons
Dorothy E. Johnson (1980), The Behavioral System Model for Nursing
Rosemarie Rizzo Parse (1981), Man-Living-Health: Theory of Nursing
Human Theory
Becoming
To reduce stress so the client can recover as quickly as possible. According to Johnson, each person as a behavioral system is composed of seven subsystems namely: INGESTIVE, ELIMINATIVE, AFFILIATIVE, AGGRESSIVE, DEPENDENCE, ACHIEVEMENT, and SEXUAL AND ROLE IDENTITY. In addition, she viewed that each person strives to achieve balance and stability both internally and externally and to function effectively by adjusting and adapting to environmental forces through learned pattern of response. Furthermore, She believed that the patient strives to become a person whose behavior is commensurate with social demands; who is able to modify his behavior in ways that support biologic imperatives; who is able to benefit to the fullest extent during illness from the health care professional’s knowledge and skills; and whose behavior does not give evidence of unnecessary trauma as a consequence of illness. To focus on human as living unity and human’s qualitative participation with health experience. She emphasized free choice of personal meaning in relating value priorities, co-creating of rhythmical patterns, in exchange with the environment and contranscending in many dimensions as possibilities unfold. She also believed that each choice opens certain opportunities while closing others. Thus, referred to revealingconcealing, enabling-limiting, and connecting-separating. Since each individual makes his or her own personal choices, the role of the nurse is that of guide, not decision maker.
P: A system of interdependent parts with patterned, repetitive, and purposeful ways of behaving. E: All forces that affect the person and that influence the behavioral system H: Focus on person, not ill ness. Health is a dynamic state influenced by biologic, psychological, and social factors N: Promotion of behavioral system, balance and stability. An art and a science providing external assistance before and during balance disturbances
P: A major reason for nursing existence E: Man and environment interchange energy to create what is in the world, and man chooses the meaning given to the situations he creates H: A lived experience that is a process of being and becoming N: Nursing Practice is directed toward illuminating and mobilizing family interrelationships in light of the meaning assigned to health and its possibilities as language in the cocreated patterns of relating.
