Nursing Theories

FLORENCE NIGHTINGALE FLORENCE NIGHTINGALE (mid-1800)(mid-1800)

Developed and described the Developed and described the first first theory of Nursingtheory of Nursing. Notes on . Notes on Nursing: what it is, What it is not. Nursing: what it is, What it is not. She focused on changing and She focused on changing and manipulating the environment in manipulating the environment in order to put the patient in the best order to put the patient in the best possible conditions for Nature to possible conditions for Nature to act.act.

She believed that in the She believed that in the nurturing nurturing environment, environment, the body could the body could repair itself. client’s environment repair itself. client’s environment is manipulated to include is manipulated to include Pure or fresh air Pure or fresh air Pure water Pure water Sufficient food supplies Sufficient food supplies Efficient drainage Efficient drainage Cleanliness Cleanliness Light (especially direct sunlight)Light (especially direct sunlight)

Florence NightingaleFlorence Nightingale

She is considered as the She is considered as the founder of educated and founder of educated and scientific nursing and scientific nursing and widely known as widely known as "The "The Lady with the Lamp"Lady with the Lamp"

Nursing "is an act of Nursing "is an act of utilizing the environment utilizing the environment of the patient to assist him of the patient to assist him in his recovery"in his recovery"

The Florence Nightingale PledgeThe Florence Nightingale Pledge I solemnly pledge myself before God I solemnly pledge myself before God

and in the presence of this assembly, to and in the presence of this assembly, to pass my life in purity and to practice my pass my life in purity and to practice my profession faithfully. I will abstain from profession faithfully. I will abstain from whatever is deleterious and whatever is deleterious and mischievous, and will not take or mischievous, and will not take or knowingly administer any harmful drug. I knowingly administer any harmful drug. I will do all in my power to maintain and will do all in my power to maintain and elevate the standard of my profession, elevate the standard of my profession, and will hold in confidence all personal and will hold in confidence all personal matters committed to my keeping and all matters committed to my keeping and all family affairs coming to my knowledge in family affairs coming to my knowledge in the practice of my calling. With loyalty the practice of my calling. With loyalty will I endeavor to aid the physician, in will I endeavor to aid the physician, in his work, and devote myself to the his work, and devote myself to the welfare of those committed to my care. welfare of those committed to my care.

VIRGINIA HENDERSON VIRGINIA HENDERSON (1955)(1955)

Introduced the Introduced the nature nature of Nursing Model. of Nursing Model. She She identified fourteen basic identified fourteen basic needs. She postulated needs. She postulated that the unique function that the unique function of the nurse is to assist of the nurse is to assist the clients, sick or well, the clients, sick or well, in the performance of in the performance of those activities those activities contributing to contributing to healthier its recovery. healthier its recovery. The clients would The clients would perform unaided if they perform unaided if they had the necessary had the necessary strength, will or strength, will or knowledge.knowledge.

VIRGINIA HENDERSONVIRGINIA HENDERSON HUMANSHUMANS

PhysiologicalPhysiological 1. Breath normally1. Breath normally 2. Eat and drink adequately2. Eat and drink adequately 3. Eliminate body wastes3. Eliminate body wastes 4. Move and maintain desirable postures4. Move and maintain desirable postures 5. Sleep and rest5. Sleep and rest 6.Select suitable clothes - dress and undress6.Select suitable clothes - dress and undress 7. Maintain body temperature within normal range by adjusting clothing and modifying7. Maintain body temperature within normal range by adjusting clothing and modifying the environment.the environment. 8. Keep the body clean and well groomed and protect the integument.8. Keep the body clean and well groomed and protect the integument. 9.Avoid dangers in the environment and avoid injuring others.9.Avoid dangers in the environment and avoid injuring others. 10.Communicate with others in expressing emotions, needs, fears, or opinions.10.Communicate with others in expressing emotions, needs, fears, or opinions. 14.Learn, discover, or satisfy the curiosity that leads to normal development and health14.Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.and use the available health facilities.

SpiritualSpiritual 11.Worship according to one’s faith.11.Worship according to one’s faith.

SociologicalSociological 12. Work in such a way that there is a sense of accomplishment.12. Work in such a way that there is a sense of accomplishment. 13. Play or participate in various forms of recreation.13. Play or participate in various forms of recreation.

PsychologicalPsychological

FAYE ABDELLAHFAYE ABDELLAH (1960) (1960)

Introduced Introduced patient-centered patient-centered approaches to Nursing approaches to Nursing ModelModel. She identified twenty-. She identified twenty-one nursing problems. She one nursing problems. She define nursing as service to define nursing as service to individuals and families; individuals and families; therefore to society. therefore to society. Furthermore she Furthermore she conceptualized nursing as an conceptualized nursing as an art and a science that molds art and a science that molds the attitudes, intellectual the attitudes, intellectual competencies and technical competencies and technical skills of the individual nurse skills of the individual nurse into the desire and ability to into the desire and ability to help people, sick or well, and help people, sick or well, and cope with their health needs. cope with their health needs.

21 NURSING PROBLEMS21 NURSING PROBLEMS

DOROTHY E. JOHNSON DOROTHY E. JOHNSON (1960-1980)(1960-1980)

Conceptualized Conceptualized the the behavioral behavioral system Model . system Model . According to her According to her each person as a each person as a behavioral system behavioral system is composed of 7 is composed of 7 subsystems .subsystems .

SEVEN SUBSYSTEMSEVEN SUBSYSTEM

1.1. Ingestive Ingestive – taking in nourishment in socially – taking in nourishment in socially and culturally acceptable ways.and culturally acceptable ways.

2. Eliminative 2. Eliminative – riddling the body of waste in – riddling the body of waste in socially culturally acceptable ways.socially culturally acceptable ways.

3. Affiliative 3. Affiliative – security seeking behavior– security seeking behavior4. Aggressive - 4. Aggressive - self-protective behavior.self-protective behavior.5. Dependence – 5. Dependence – Nurturance-seeking behaviorNurturance-seeking behavior6. Achievement – 6. Achievement – Master of oneself and one’s Master of oneself and one’s

environment according to internalized environment according to internalized standard of excellence.standard of excellence.

7. Sexual and role identity behavior7. Sexual and role identity behavior..

IMOGENE KING IMOGENE KING (1971-1981)(1971-1981)

Postulated the Postulated the Goal Goal Attainment TheoryAttainment Theory. She . She described nursing as a helping described nursing as a helping profession that assists profession that assists individuals and groups in individuals and groups in society to attain, maintain, and society to attain, maintain, and restore health. If this is not restore health. If this is not possible, nurses help possible, nurses help individuals die with dignity.individuals die with dignity.

And she viewed nursing as an And she viewed nursing as an interaction process between interaction process between client and nurse whereby client and nurse whereby during perceiving, setting during perceiving, setting goals and acting on them, goals and acting on them, transactions occur and goals transactions occur and goals are achieved.are achieved.

MADELEINE LEININGER (1978-MADELEINE LEININGER (1978-1984)1984)

Developed the Developed the transcultural nursing transcultural nursing model. model. She advocated She advocated that nursing is a that nursing is a humanistic and scientific humanistic and scientific mode of helping a client mode of helping a client through specific cultural through specific cultural caring processes to caring processes to improve or maintain a improve or maintain a health condition.health condition.

MYRA LEVINMYRA LEVIN (1973) (1973)

Described the Described the four four

conservation conservation principles.principles.

1. Conservation of energy. 1. Conservation of energy. The human body functions The human body functions by utilizing energy. The human body needs energy by utilizing energy. The human body needs energy producing input (food, oxygen, fluids) to allow energy producing input (food, oxygen, fluids) to allow energy utilization as output.utilization as output.

2. Conservation of structural integrity. 2. Conservation of structural integrity. The human The human body has physical boundaries (Skin and Mucous body has physical boundaries (Skin and Mucous membrane) that must be maintained to facilitate membrane) that must be maintained to facilitate health and prevent harmful agents from entering the health and prevent harmful agents from entering the body..body..

3. conservation of personal integrity. 3. conservation of personal integrity. The nursing The nursing intervention are based on the conservation of the intervention are based on the conservation of the individual client’s personality. Every individual has a individual client’s personality. Every individual has a sense of identity, self worth and self esteem, which sense of identity, self worth and self esteem, which must be preserved and enhanced by nurses.must be preserved and enhanced by nurses.

4. Conservation of Social Integrity 4. Conservation of Social Integrity – the social – the social integrity of the client reflects the family and the integrity of the client reflects the family and the community in which the client functions. Health Care community in which the client functions. Health Care institutions may separate individuals from their institutions may separate individuals from their family. It is important for nurses to consider the family. It is important for nurses to consider the individual in the context of the family.individual in the context of the family.

BETTY NEUMAN BETTY NEUMAN (1982, 1989, 1992)(1982, 1989, 1992)

Proposed the Proposed the health health care system Model.care system Model. She asserted that She asserted that nursing is a unique nursing is a unique profession in that it is profession in that it is concerned with all the concerned with all the variables affecting an variables affecting an individuals response individuals response to stresses, which an to stresses, which an intra (within the intra (within the individual) inter individual) inter (between one or more (between one or more other people) and other people) and extra personal extra personal (outside the (outside the individual) in Nature.individual) in Nature.

DOROTHEA OREMDOROTHEA OREM (1970, 1985) (1970, 1985)

Developed the Developed the self care self care and self care deficit and self care deficit theory. theory. She defined self She defined self care as “the practice of care as “the practice of activities that individuals activities that individuals initiate and perform on initiate and perform on their own behalf in their own behalf in maintaining life, health maintaining life, health and well being.” She and well being.” She conceptualized 3 nursing conceptualized 3 nursing systems as follows:systems as follows:

THREE NURSING SYSTEMSTHREE NURSING SYSTEMS

1. 1. Wholly Compensatory: Wholly Compensatory: when the nurse is when the nurse is expected to accomplish on the patient’s expected to accomplish on the patient’s therapeutic self-care or to compensate for the therapeutic self-care or to compensate for the patient’s inability to engage in self care or patient’s inability to engage in self care or when the patient needs continuous guidance when the patient needs continuous guidance in self care;in self care;

2. 2. Partially Compensatory: Partially Compensatory: When both nurse When both nurse and patient engage in meeting self care needs.and patient engage in meeting self care needs.

3. Supportive-Educative 3. Supportive-Educative – the system that – the system that requires assistance in decision making, requires assistance in decision making, behavior control and acquisition of knowledge behavior control and acquisition of knowledge and skills.and skills.

HILDEGARD PEPLAU HILDEGARD PEPLAU (1952)(1952)

Introduced the Introduced the interpersonal interpersonal modelmodel. She . She identified four identified four phases of the phases of the nurse client nurse client relationship relationship namely:namely:

4 PHASES OF NURSE -4 PHASES OF NURSE -CLIENT RELATIONSHIPCLIENT RELATIONSHIP

1. Orientation – 1. Orientation – the nurse and the client the nurse and the client initially do not know each other’s goals and initially do not know each other’s goals and testing the role each will assume. The clients testing the role each will assume. The clients attempts to identified difficulties and the attempts to identified difficulties and the amount of nursing help that is needed.amount of nursing help that is needed.

2. Identification – 2. Identification – the client responds to the the client responds to the professionals or the significant others who professionals or the significant others who can meet the identified needs.can meet the identified needs.

3. Exploitation – 3. Exploitation – the client utilizes all the client utilizes all available resources to move toward a goal of available resources to move toward a goal of maximum health or functionality;maximum health or functionality;

4. Resolution – 4. Resolution – refers to the termination refers to the termination phase of the nurse-client relationship. phase of the nurse-client relationship.

MARTHA ROGERS MARTHA ROGERS (1970)(1970)

Conceptualized Conceptualized the the Science of Science of Unitary Human Unitary Human BeingsBeings. To . To Rogers, unitary Rogers, unitary man is an energy man is an energy field in constant field in constant interaction with interaction with the environment.the environment.

MARTHA ROGERSMARTHA ROGERS

She asserted that human beings are more She asserted that human beings are more than and different from the sum of their than and different from the sum of their parts; the distinctive properties of the parts; the distinctive properties of the whole are significantly different from those whole are significantly different from those of its parts. of its parts.

Furthermore, she believed that human Furthermore, she believed that human being is characterized by the capacity for being is characterized by the capacity for abstraction and imagery, language and abstraction and imagery, language and thought, sensation and emotion.thought, sensation and emotion.

SISTER CALLISTA ROY SISTER CALLISTA ROY (1979 – 1984)(1979 – 1984)

Presented the Presented the adaptation adaptation modelmodel. She viewed each person as . She viewed each person as a unified biophysical system in a unified biophysical system in constant interaction with a constant interaction with a changing environment. She changing environment. She contended that the person as an contended that the person as an adaptive system, functions as a adaptive system, functions as a whole through interdependence of whole through interdependence of its parts. The system consists of its parts. The system consists of input, control processes, output input, control processes, output and feedback. She advocated that and feedback. She advocated that all people have certain needs all people have certain needs which they endeavor to meet in which they endeavor to meet in order to maintain integrity. These order to maintain integrity. These needs are divided into four needs are divided into four different modes, the physiological, different modes, the physiological, self-concept, role functions and self-concept, role functions and interdependence.interdependence.

LYDIA HALLLYDIA HALL (1962) (1962)

Introduced the Introduced the model in model in nursingnursing: What is it? Focusing on : What is it? Focusing on the notion that centers around the notion that centers around three components of CARE, CORE three components of CARE, CORE and CURE. Care represents and CURE. Care represents nurturance and is exclusive to nurturance and is exclusive to nursing. Core involves the nursing. Core involves the therapeutic use of self and therapeutic use of self and emphasizes the use of reflection. emphasizes the use of reflection. Cure focuses on nursing related to Cure focuses on nursing related to the physician’s orders. Core and the physician’s orders. Core and Cure are shared with the other Cure are shared with the other health care providers.health care providers.

IDA JEAN ORLANDOIDA JEAN ORLANDO

(1961) (1961) Conceptualized the Conceptualized the dynamic dynamic

nurse-patient relationship nurse-patient relationship model. model. She believed that the She believed that the nurse helps patients meet a nurse helps patients meet a perceived need that the patients perceived need that the patients cannot meet for themselves. She cannot meet for themselves. She indicated that nursing actions indicated that nursing actions can be automatic (those chosen can be automatic (those chosen for reasons other than the for reasons other than the immediate need for help) or immediate need for help) or deliberative (those resulting from deliberative (those resulting from validating the need for help, validating the need for help, exploring the meaning of the exploring the meaning of the need, and validating effectiveness need, and validating effectiveness of the actions taken to meet the of the actions taken to meet the need). She also advocated that need). She also advocated that the three elements composing the three elements composing nursing situation are client-nursing situation are client-behavior, nurse reaction and behavior, nurse reaction and nurse action.nurse action.

ERNESTINE WEIDENBACH ERNESTINE WEIDENBACH (1964) (1964)

Developed the clinical Developed the clinical nursing a helping art model. nursing a helping art model. She advocated that the She advocated that the nurse’s individual philosophy nurse’s individual philosophy or central purpose lends or central purpose lends credence to nursing care. credence to nursing care. She believed that nurses She believed that nurses meet the individual’s need for meet the individual’s need for help through the help through the identification of the needs, identification of the needs, administration of help, and administration of help, and validation that actions were validation that actions were helpful. Components of helpful. Components of clinical practice: Philosophy, clinical practice: Philosophy, purpose, practice and an art.purpose, practice and an art.

JEAN WATSON JEAN WATSON (1979-1985) (1979-1985)

Conceptualized the Conceptualized the human caring human caring model model (Nursing: Human science and (Nursing: Human science and Human Care). She emphasized that Human Care). She emphasized that nursing is the application of the art nursing is the application of the art and human science through and human science through transpersonal caring transactions to transpersonal caring transactions to help persons achieve mind-body-soul help persons achieve mind-body-soul harmony, which generates self-harmony, which generates self-knowledge, self control, self-care and knowledge, self control, self-care and self healing.self healing.

ROSEMARIE RIZZO PARSEROSEMARIE RIZZO PARSE(1981, 1987, 1992 )(1981, 1987, 1992 )

introduced the theory introduced the theory of human becoming. of human becoming. She emphasized free She emphasized free choice of personal choice of personal meaning in relating meaning in relating value priorities, co-value priorities, co-creating of rhythmical creating of rhythmical patterns, in exchange patterns, in exchange with the environment, with the environment, and contras ending in and contras ending in many dimensions as many dimensions as possibilities unfold. possibilities unfold.

JOYCE TRAVEL BEE (1966-JOYCE TRAVEL BEE (1966-1971)1971)

she postulated the interpersonal she postulated the interpersonal aspects of nursing model. She aspects of nursing model. She advocated that the goal of nursing is advocated that the goal of nursing is to assist individual or family in to assist individual or family in preventing or coping with illness, preventing or coping with illness, regaining health, finding meaning in regaining health, finding meaning in illness, or maintaining maximal illness, or maintaining maximal degree of health.degree of health.

JOSEPHINE PETERSON JOSEPHINE PETERSON and and

LORETTA ZDERAD LORETTA ZDERAD

(1976)(1976) provided the humanistic nursing practice provided the humanistic nursing practice

theory. This is based on their belief that theory. This is based on their belief that nursing is an existential experience. nursing is an existential experience. Nursing is viewed as a lived dialogue Nursing is viewed as a lived dialogue that involves the coming together of the that involves the coming together of the nurse and the person to be nursed. The nurse and the person to be nursed. The essential characteristic of nursing is essential characteristic of nursing is nurturance. Humanistic care cannot take nurturance. Humanistic care cannot take place without the authentic commitment place without the authentic commitment of the nurse to being with and the doing of the nurse to being with and the doing with the client. Humanistic nursing also with the client. Humanistic nursing also presupposes responsible choices.presupposes responsible choices.

HELEN ERICKSON, EVELYN TOMLIN HELEN ERICKSON, EVELYN TOMLIN and MARY ANN SWAIN and MARY ANN SWAIN

(1983)(1983) developed modeling and role developed modeling and role

modeling theory. The focus of this modeling theory. The focus of this theory is on the person. The nurse theory is on the person. The nurse models (assesses), role models models (assesses), role models (plans), and intervenes in this (plans), and intervenes in this interpersonal and interactive theory.interpersonal and interactive theory.

MARGARET NEWMAN MARGARET NEWMAN

focused on health as focused on health as expanding expanding consciousness. She consciousness. She defined defined consciousness as the consciousness as the info. Capability of info. Capability of the system which is the system which is influenced by time, influenced by time, space and movement space and movement and is ever-and is ever-expanding.expanding.