Nursing Theorists 1. Floren Florence ce Nighti Nightingal ngalee - Environm Environment ent theor theory y 2. Hildeg Hildegard ard Pepl Peplau au - Inter Interper person sonal al theor theory y 3. Virgin Virginia ia Hender Henderson son - Need Need Theory Theory 4. Fay Abdel Abdella la - Twent Twenty y One Nurs Nursing ing Prob Problem lemss 5. Ida Jean Jean Orla Orlando ndo - Nursi Nursing ng Proces Processs theory theory 6. Doroth Dorothy y John Johnson son - Syst System em model model 7. Martha Martha Rogers Rogers -Unit -Unitary ary Human Human being beingss 8. Doroth Dorothea ea Orem Orem - Self Self-ca -care re theo theory ry 9. Imogene Imogene King King - Goal Attain Attainment ment theory theory 10. Betty Neuman Neuman - System System model 11. Sister Sister Calista Calista Roy - Adaptation Adaptation theory theory 12. Jean Watson Watson - Philosophy Philosophy and Caring Model 13. Madeleine Leininger -Transcultural nursing 14. Patricia Patricia Benner - From From Novice to Expert 15. Lydia E. Hall Hall - The Core, Care and Cure Cure 16. Joyce Travelbee - Human-To-Human Relationship Model 17. Margaret Newman - Health As Expanding Consciousness 18. Katharine Kolcaba - Comfort Theory 19. Rosemarie Rizzo Parse - Human Becoming Theory 20. Ernestine Wiedenbach - The Helping Art of Clinical Nursing 1. Florence Nightingale- Environmental Theory • • •
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First nursing theorist Unsanitary conditions posed health hazard (Notes on Nursing, 1859) 5 components of environment ventilation, light, warmth, effluvia, noise o External influences can prevent, suppress or contribute to disease or death
Nightingale’s Concepts
1. Person • • •
Patient who is acted on by nurse nu rse Affected by environment Has reparative powers
2. Environment •
Foundation of theory. Included everything, physical, psychological, and social
3. Health •
Maintaining well-being by using a person’s powers
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Maintained by control of environment
4. Nursing •
Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate person’s reparative process
2. Hildegard Peplau -Interpersonal Relations Model • • • •
Based on psychodynamic nursing using an understanding of one’s own behavior to help others identify their difficulties Applies principles of human relations Patient has a felt need
Peplau’s Concepts
1. Person • •
An individual; a developing organism who tries to reduce anxiety caused by needs Lives in instable equilibrium
2. Environment •
Not defined
3. Health •
Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living
4. Nursing •
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A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible Involves problem-solving
3. Virginia Henderson -The Nature of Nursing "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. She must in a sense, get inside the skin of each of her patients in order to know what he needs". 4. Fay Abdella- Topology of 21 Nursing Problems
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A list of 21 nursing problems Condition presented or faced by the patient or family. Problems are in 3 categories physical, social and emotional o The nurse must be a good problem solver
Abdella’s Concepts
1. Nursing • • • •
A helping profession A comprehensive service to meet patient’s needs Increases or restores self-help ability Uses 21 problems to guide nursing care
2. Health • •
Excludes illness No unmet needs and no actual or anticipated impairments
3. Person • •
One who has physical, emotional, or social needs The recipient of nursing care.
4. Environment • •
Did not discuss much Includes room, home, and community
5. Ida Jean Orlando- Deliberative Nursing Process • • • • • •
The deliberative nursing process is set in motion by the patient’s behavior All behavior may represent a cry for help. Patient’s behavior can be verbal or non-verbal. The nurse reacts to patient’s behavior and forms basis for determining nurse’s acts. Perception, thought, feeling Nurses’ actions should be deliberative, rather than automatic Deliberative actions explore the meaning and relevance of an action.
6. Dorothy Johnson-Behavioral Systems Model •
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The person is a behavioral system comprised of a set of organized, interactive, interdependent, and integrated subsystems Constancy is maintained through biological, psychological, and sociological factors. A steady state is maintained through adjusting and adapting to internal and external forces.
Johnson’s 7 Subsystems
Affiliative subsystem •
social bonds
Dependency •
helping or nuturing
Ingestive •
food intake
Eliminative •
excretion
Sexual •
procreation and gratification
Aggressive •
self-protection and preservation
Achievement •
efforts to gain mastery and control
Johnson’s Concepts
1. Person •
A behavioral system comprised of subsystems constantly trying to maintain a steady state
2. Environment •
Not specifically defined but does say there is an internal and external environment
3. Health •
Balance and stability.
4. Nursing
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External regulatory force that is indicated only when there is instability.
7. Martha Rogers -Unitary Human Beings • • •
Energy fields Fundamental unity of things that are unique, dynamic, open, and infinite Unitary man and environmental field
Universe of open systems •
Energy fields are open, infinite, and interactive
Pattern • •
Characteristic of energy field A wave that changes, becomes complex and diverse
Pandimensionality •
A nonlinear domain with out time or space
Roger’s Definitions
Integrality •
Continuous and mutual interaction between man and environment
Resonancy •
Continuous change longer to shorter wave patterns in human and environmental fields
Helicy • • •
Continuous, probabilistic, increasing diversity of the human and en vrionmental fields. Characterized by nonrepeating rhymicities Change
8. Dorothea Orem- Self-Care Model •
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Self-care comprises those activities performed independently by an individual to promote and maintain person well-being Self care agency is the individual’s ability to perform self care activities Self- care deficit occurs when the person cannot carry out self-care The nurse then meets the self-care needs by acting or doing for; guiding, teaching, supporting or providing the environment to promote patient’s ability Wholly compensatory nursing system-Patient dependent
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Partially compensatory- Patient can meet some needs but needs n ursing assistance Supportive educative-Patient can meet self care requisites, but need s assistance with decision making or knowledge
9. Imogene King-Goal Attainment Theory • • •
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Open systems framework Human beings are open systems in constant interaction with the environment Personal System individual; perception, self, growth, development, time space, body image o Interpersonal o Society o Personal System Individual; perception, self, growth, development, time space, body image o Interpersonal Socialization; interaction, communication and transaction o Society Family, religious groups, schools, work, peers o The nurse and patient mutually communicate, establish goals and take action to attain goals Each individual brings a different set of values, ideas, attitudes, perceptions to exchange
10. Betty Neuman - Health Care Systems Model • •
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The person is a complete system, with interrelated parts maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli Focuses on stress and stress reduction Primarily concerned with effects of stress on health Stressors are any forces that alter the system’s stability Flexible lines of resistance - Surround basic core Internal factors that help defend against stressors Normal line of resistance - Normal adaptation state Flexible line of defense - Protective barrier, changing, affected by variables Wellness is equilibrium
Nursing interventions are activates to: • • •
strengthen flexible lines of defense strengthen resistance to stressors maintain adaptation
11. Sister Calista Roy - Adaptation Model Five Interrelated Essential Elements
1. 2. 3. 4. 5. •
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Patiency- The person receiving care Goal of nursing- Adapting to change Health-Being and becoming a whole person Environment Direction of nursing activities- Facilitating adaptation The person is an open adaptive system with input (stimuli), who adapts by processes or control mechanisms (throughput) The output can be either adaptive responses or ineffective responses
12. Jean Watson - Philosophy and Science of Caring • • • • • • •
Caring can be demonstrated and practiced Caring consists of carative factors Caring promotes growth A caring environment accepts a person as he is and looks to what the person may become A caring environment offers development of potential Caring promotes health better than curing Caring is central to nursing
Watson’s 10 Carative Factors • • • • • • • • • •
Forming humanistic-altruistic value system Instilling faith-hope Cultivating sensitivity to self and others Developing helping-trust relationship Promoting expression of feelings Using problem-solving for decision making Promoting teaching-learning Promoting supportive environment Assisting with gratification of human needs Allowing for existential-phenomenological forces
Watson’s Concepts •
Person Human being to be valued, cared for, respected, nurtured, understood and assisted Environment Society o Health Complete physical, mental and social well-being and functioning o Nursing Concerned with promoting and restoring health, preventing illness o o
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13. Rosemary Parse - Human Becoming Theory
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Human Becoming Theory includes Totality Paradigm Man is a combination of biological, psychological, sociological and spiritual o factors Simultaneity Paradigm Man is a unitary being in continuous, mutual interaction with environment o Originally Man-Living-Health Theory
Parse’s Three Principles •
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Meaning Man’s reality is given meaning through lived experiences o Man and environment cocreate o Rhythmicity Man and environment cocreate ( imaging, valuing, languaging) in rhythmical o patterns Cotranscendence Refers to reaching out and beyond the limits that a person sets o One constantly transforms o Person Open being who is more than and different from the sum of the parts o Environment Everything in the person and his experiences o Inseparable, complimentary to and evolving with o Health Open process of being and becoming. Involves synthesis of values o Nursing A human science and art that uses an abstract body of knowledge to serve people o
14. Madeleine Leininger - Culture Care Diversity and Universality •
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According to transcultural nursing, the goal of nursing care is to provide care congruent with cultural values, beliefs, and practices Sunrise model consists of 4 levels that provide a base of knowledge for delivering cultural congruent care. Cultural care preservation help maintain or preserve health, recover from illness, or face death o Cultural care accommodation help adapt to or negotiate for a beneficial health status, or face death o Cultural care re-patterning help restructure or change lifestyles that are culturally meaningful o
15. Patricia Benner - From Novice to Expert •
Described 5 levels of nursing experience and developed exemplars and paradigm cases to illustrate each level
1. 2. 3. 4. 5. •
Novice Advanced beginner Competent Proficient Expert Levels reflect: movement from reliance on past abstract principles to the use of past concrete o experience as paradigms change in perception of situation as a complete whole in which certain parts are o relevant
16. Lydia E. Hall - The Core, Care and Cure •
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The theory contains of three independent but interconnected circles: 1. the core, 2. the care and 3. the cure The core is the person or patient to whom nursing care is directed and needed. The core has goals set by himself and not by any other person. The core behaved according to his feelings, and value system. The care circle explains the role of nurse The cure is the attention given to patients by the medical professionals.
Reference
1. Bordage, G. Conceptual frameworks to illuminate and magnify. Medical Education. 2009;43;312-319. 2. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby, Philadelphia, 2002. 3. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002. 4. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange. 5. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williamsand wilkins. 6. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development and Progress 3rd ed. Philadelphia, Lippincott. 7. Taylor Carol,Lillis Carol (2001)The Art and Science Of Nursing Care 4th ed. Philadelphia, Lippincott. 8. Potter A Patricia, Perry G Anne (1992)Fundamentals Of Nursing –Concepts Process and Practice 3rd ed. London Mosby Year Book.
Introduction to Nursing Theories This page was last updated on October 14, 2011 INTRODUCTION •
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Nursing theory is the term given to the body of knowledge that is used to support nursing practice. Nursing theory is a framework designed to organize knowledge and explain phenomena in nursing, at a more concrete and specific level Each discipline has a unique focus for knowledge development that directs its inquiry and distinguishes it from other fields of study.(Smith & Liehr, 2008). Theory-guided, evidence-based practice is the h allmark of any professional discipline. Nursing is a professional discipline (Donaldson & Crowley, 1978). Almost 90% of all Nursing theories are generated in the last 20 years. Nursing models are conceptual models, constructed of theories and concepts A paradigm is a model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline.
METAPARADIGMS IN NURSING Person
Recipient of care, including physical, spiritual, psychological, and sociocultural components. Individual, family, or community
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Environment
All internal and external conditions, circumstances, and influences affecting the person
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Health •
Degree of wellness or illness experienced by the person
Nursing •
Actions, characteristics and attributes of person giving care
COMPONENTS OF A THEORY • •
A theory is a group of related concepts that propose action that guide practice. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing..
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Based on the knowledge structure levels the theoretical works in nursing can be explained as: o o o o
Metaparadigm (Person, Environment, Health & Nursing) – (Most abstract) Nursing philosophies. Conceptual models and Grand theories. Nursing theories and Middle range theories (Least abstract)
DEFINITIONS Theory • •
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a set of related statements that describes or explains phenomena in a systematic way. the doctrine or the principles underlying an art as distinguished from the practice of that particular art. a formulated hypothesis or, loosely speaking, any hypothesis or opinion not based upon actual knowledge. a provisional statement or set of explanatory propositions that purports to accoun t for or characterize some phenomenon.
Concept • •
a mental idea of a phenomenon Concepts are the building blocks—the primary elements—of a theory.
Construct • •
a phenomena that cannot be observed and must be inferred Constructs are concepts developed or adopted for use in a particular theory. The key concepts of a given theory are its constructs.
Proposition •
a statement of relationship between concepts
Conceptual model • •
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made up of concepts and propositions They epresent ways of thinking about a problem or ways of representing how complex things work the way that they do. Different Frameworks will emphasize different variables and outcomes and their interrelatedness.( Bordage, 2009) Models may draw on a number of theories to help understand a particular problem in a certain setting or context. They are not always as specified as theory.
Variables
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Variables are the operational forms of constructs. They define the way a construct is to be measured in a specific situation. Match variables to constructs when identifying what needs to be assessed during evaluation of a theory-driven program.
Middle range theory •
a testable theory that contains a limited number of variables, and is limited in scope as well, yet is of sufficient generality to be useful with a variety of clinical research questions.
NURSING PHILOSOPHIES Theory
Key emphasis
Florence Nightingale’s Legacy of Focuses on nursing and the patient environment relationship. caring Helping process meets needs through the art of individualizing care. Nurses should identify patients ‘need-for –help’ by: Ernestine Wiedenbach: The helping art of clinical nursing
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Observation Understanding client behaviour Identifying cause of discomfort
Determining if clients can resolve problems or have a need for help Virginia Henderson’s Definition Patients require help towards achieving independence. of Nursing Derived a definition of nursing •
Identified 14 basic human needs on which nursing care is based. Faye G.Abedellah’s Typology of Patient’s problems determine nursing care twenty one Nursing problems Lydia E. Hall :Care, Cure, Core Nursing care is person directed towards self love. model Jean Watson’s Philosophy and Caring is moral ideal: mind -body – soul engagemen t with one Science of caring and other.
Patricia Benner’s Primacy of caring
Caring is a universal, social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring. Caring is central to the essence of nursing. It sets up what matters, enabling connection and concern. It creates possibility for mutual helpfulness.
Caring creates - possibilities of coping possibilities for connecting with and concern for others, possibilities for giving and receiving help Described systematically five stages of skill acquisition in nursing practice – novice, advanced beginner, competent, proficient and expert.
CONCEPTUAL MODELS AND GRAND THEORIES Dorothea E. Orem’s Self care deficit theory in nursing
Self–care maintains wholeness. Three Theories: • • •
Theory of Self-Care Theory of Self-Care Deficit Theory of Nursing Systems
Nursing Care: • •
Wholly compensatory (doing for the patient) Partly compensatory (helping the patient do for himself or herself)
Supportive- educative (Helping patient to learn self care and emphasizing on the importance of nurses’ role Holism is maintained by conserving integrity •
Myra Estrin Levine’s: The conservation model
Proposed that the nurses use the principles of conservation of: • • • •
Client Energy Personal integrity Structural integrity Social integrity
A conceptual model with three nursing theories – • •
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Martha E.Roger’s: Science of unitary human beings
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Conservation Redundancy Therapeutic intention Person and environment are energy fields that evolve negentropically
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Nursing is a basic scientific discipline Nursing is using knowledge for human betterment.
The unique focus of nursing is on the unitary or irreducible human being and the environment (both are energy fields) rather than health and illness Dorothy E.Johnson’s Behavioural Individuals maintain stability and balance through adjustments system model and adaptation to the forces that impinges them. •
Individual as a behavioural system is composed of seven subsystems. Attachment, or the affiliative subsystems – is the corner stone of social organisations. Behavioural system also includes the subsystems of dependency, achievement, aggressive, ingestive-eliminative and sexual. Disturbances in these causes nursing problems. Sister Callista: Roy‘s Adaptation Stimuli disrupt an adaptive system model The individual is a biopsychosocial adaptive system within an environment. The individual and the environment provide three classes of stimuli-the focal, residual and contextual.
Betty Neuman’s : Health care systems model
Through two adaptive mechanisms, regulator and cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions Reconstitution is a status of adaptation to stressors A conceptual model with two theories “Optimal patient stability and prevention as intervention” Neuman’s model includes intrapersonal, interpersonal and extrapersonal stressors. Nursing is concerned with the whole person. Nursing actions (Primary, Secondary, and Tertiary levels of prevention) focuses on the variables affecting the client’s response to stressors.
Imogene King’s Goal attainment Transactions provide a frame of reference toward goal setting. theory A conceptual model of nursing from which theory of goal attainment is derived. From her major concepts (interaction, perception, communication, transaction, role, stress, growth and development) derived goal attainment theory.
Nancy Roper, WW.Logan and A.J.Tierney A model for nursing based on a model of living
·Perceptions, Judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (Process of nursing). Individuality in living. A conceptual model of nursing from which theory of goal attainment is derived. Living is an amalgam of activities of living (ALs). Most individuals experience significant life events which can affect ALs causing actual and potential problems. This affects dependence – independence continuum which is bidirectional.
Hildegard E. Peplau: Psychodynamic Nursing Theory
Nursing helps to maintain the individuality of person by preventing potential problems, solving actual problems and helping to cope. Interpersonal process is maturing force for personality. Stressed the importance of nurses’ ability to understand own behaviour to help others identify perceived difficulties. The four phases of nurse-patient relationships are: • • • •
1. Orientation 2. Identification 3. Exploitations 4. Resolution
The six nursing roles are: • • • •
1. Stranger 2. Resource person 3. Teacher 4. Leader
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5. Surrogate
6. Counselor Interpersonal process alleviates distress. •
Ida Jean Orlando’s Nursing Process Theory
Nurses must stay connected to patients and assure that patients get what they need, focused on patient’s verbal and non verbal expressions of need and nurse’s reactions to patient’s behaviour to alleviate distress. Elements of nursing situation: 1. Patient 2. Nurse reactions
Joyce Travelbee’s Human To Human Relationship Model
3. Nursing actions Therapeutic human relationships. Nursing is accomplished through human to human relationships that began with: The original encounter and then progressed through stages of Emerging identities
Kathryn E. Barnard’s Parent Child Interaction Model
Ramona T.Mercer’s :Maternal Role Attainment
Katharine Kolcaba’s Theory of comfort
Developing feelings of empathy and sympathy, until the nurse and patient attained rapport in the final stage. Growth and development of children and mother–infant relationships Individual characteristics of each member influence the parent– infant system and adaptive behaviour modifies those characteristics to meet the needs of the system. Parenting and maternal role attainment in diverse populations A complex theory to explain the factors impacting the development of maternal role over time. Comfort is desirable holistic outcome of care. Health care needs are needs for comfort, arising from stressful health care situations that cannot be met by recipients’ traditional support system. These needs include physical, psycho spiritual, social and environmental needs.
Madeleine Leininger’s
Comfort measures include those nursing interventions designed to address the specific comfort needs. Caring is universal and varies transculturally.
Transcultural nursing, culturecare theory
Major concepts include care, caring, culture, cultural values and cultural variations Caring serves to ameliorate or improve human conditions and life base.
Care is the essence and the dominant, distinctive and unifying feature of nursing Rosemarie Rizzo Parse’s :Theory Indivisible beings and environment co-create health. of human becoming A theory of nursing derived from Roger’s conceptual model. Clients are open, mutual and in constant interaction with environment.
Nola J.Pender’s :The Health promotion; model
The nurse assists the client in interaction with the environment and co creating health Promoting optimum health supersedes disease prevention. Identifies cognitive, perceptual factors in clients which are modified by demographical and biological characteristics, interpersonal influences, situational and behavioural factors that help predict in health promoting behaviour
CONCLUSION •
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The conceptual and theoretical nursing models help to provide knowledge to improve practice, guide research and curriculum and identify the goals of nursing practice. Nursing knowledge is the inclusive total of the philosophies, theories, research, and practice wisdom of the discipline.As a professional discipline this knowledge is important for guiding practice.(Smith & Liehr, 2008). It is important the nursing knowledge is learnt, used, and applied in the theory based practice for the profession and the continued development of nursing and academic discipline.
REFERENCES
1. Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26, 113–120.
2. Smith, M. J., & Liehr, P. R. (2008). Middle range theory for nursing. New York: Springer Publishing. 3. George B. Julia , Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange. 4. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. 5. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. 6. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. 7. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book. 8. Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002 9. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby, Philadelphia, 2002.
