Philosophy of Nursing Theory

8/12/2019 Philosophy of Nursing Theory

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Philosophy of nursing theory


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Learning objectives

Define theory, concept, construct, Metaparadigm , proposition

and model

Discuss the importance of using nursing theories Describe concepts of nursing theories

Explain the types of nursing theories

Describe the application of different nursing theories

Criticize/analyze different nursing theories


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Sub-topics Definitions of theory and related terms Nursing theory

Importance of nursing theories

Development of nursing theories

Major nursing theories

Non-nursing theories used in nursing


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Theory A set of related statements that describes/explains phenomena

in a systematic way.

Theory comes from the Greek word, theoria , which means a

be holding, spectacle or speculation.

Theories are always speculative in nature and are never

considered to be true or proven.

They are always subjected to further development and revisionor may even be discarded if not supported by empirical

evidence


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Concept

Concepts are building blocks of a theory.

A concept is a word picture or mental idea of a phenomenon.

They are words or ideas that symbolize some aspect of reality. A concept may be very concrete such as human heart or very

abstract such as love.

Concrete concepts may be specified and defined more easily

than abstract concepts.


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Construct Construct is highly abstract phenomenon or concept.

It is the term used to indicate a phenomenon that cannot be

directly observed but must be inferred by certain concrete or

less abstract indicators of the phenomenon.

Examples of construct include wellness, mental health, self

esteem and assertiveness.

Each of these concepts can be identified by the presence of

some measurable concepts


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Proposition Proposition is a statement or assertion of the relationship

between concepts.

Propositional statements derived from theories or from

generalizations based on empirical data.

These statements may indicate the relationship between

concepts in several ways and may assert two events tend to

vary together.


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Proposition . . .

Example, there is a relationship between pulse rate and

respiratory rate.

Propositional statements may also assert that one variablecauses on other variable.

Example, bacteria causes disease.


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Model Model is a symbolic representation of some phenomenon or

phenomena.

It represents some aspect of reality, concrete or abstract.

It may be structural, pictorial, diagrammatic, or mathematical.

Difference between theory and model; theory focuses on

statements or explanations of the relationship between

phenomena, a model focuses on the structure or composition

of phenomena.


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Contd Phenomena - It is an idea or fact or event that appears or is

perceived.

Paradigm - the network of science, philosophy and theory

accepted by a discipline or person. The prevailing paradigm directs the activities of a discipline.

Metaparadigm - the most global perspective of a discipline,

singles out the phenomena with a discipline deals in a unique

manner, i.e. person, environment, health, illness, etc.


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Nursing theory

Nursing theory is the term given to the body of knowledge thatis used to support nursing practice.

In their professional education, nurses will study a range ofinterconnected subjects which can be applied to the practicesetting.

This knowledge may be derived from experiential learning,from formal sources such as nursing research or from non-nursing sources.


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Nursing theory

Nursing is many things to many people. Most universally agreed upon is that Nursing is a science

involving people, environment and process fueled by a visionof transcendence in the context of healthcare.

It is interesting to note that 90% of all nursing theories have been generated in the last 25 years.

Many schools encourage students to formulate personal philosophies or mid-range theories of Nursing as part of theircurriculum.

Some might argue that this multiplicity of theory is detrimental(harmful) to the practice and undermines common vision.


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Nursing theory . . .

Others would say that the nature of the young science is

sufficiently far reaching to require such tactics in order to elicit

true consensus.

Nursing theory provides the foundation of nursing knowledge

and gives direction to nursing practice.

Nursing theory should guide the development and futuredirection of nursing research.


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Nursing theory . . . Barnum (1994) offers this vivid analogy to describe nursing

theory: A theory is like a map of a territory as opposed to an aerial

photograph. The map does not display the full terrain(building, roads, moving, vehicles, or grazing livestock):instead it peaks out these parts that are important for its

purpose. If its aim is to guide travelers, the map will highlightthe roads; if its purpose is to describe its terrain, it will showits mountains, plains and rivers. But no map or theory reflects

all that is contained with in a phenomenon. Such a map willdefeat its purpose; giving one a handle on the phenomenon.The handle is created by making the essential parts stand outin relief.


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Importance of nursing theories used to describe, develop, disseminate, and use present

knowledge in nursing. provide a framework for nurses to systematize their nursing

actions: What to ask, what to observe, what to focus on and what to

think about. They provide a framework to develop new and validate

current knowledge. used to define commonalities of the variables in a stated field

of inquiry; guide nursing research and actions predict practice outcomes predict client response.


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Classification of nursing theories

A. Depending On Function Descriptive -to identify the properties and workings of a discipline

Explanatory -to examine how properties relate and thus affect the

discipline

Predictive -to calculate relationships between properties and how

they occur

Prescriptive -to identify under which conditions relationships

occur


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B. Depending on the Generalizability of their principles Grand theory: provides a conceptual framework under which

the key concepts

Leiningers Theory of Culture Care Diversity andUniversality Newmans Theory of Health as Expanding Consciousness Orems Self -Care Deficit Nursing Theory

Parses Theory of Human Becoming


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Middle range theory: is more precise and only analyses a particular situation with a limited number of variables.

Practice /prescriptive/micro theory: explores one particularsituation found in nursing.

It identifies explicit goals and details how these goals will beachieved.


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D. Based on the philosophical underpinnings of the theories Needs theories Interaction theories Outcome theories Humanistic theories


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Contd

1. Needs theories These theories are based around helping individuals to fulfill

their physical and mental needs.

Needs theories have been criticized for relying too much on

the medical model of health and placing the patient in an

overtly dependent position.


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2.Interaction theories As described by Peplau (1988), these theories revolve around

the relationships nurses form with patients.

Such theories have been criticized for largely ignoring the

medical model of health and not attending to basic physical

needs.

3. Outcome theories

Outcome theories portray the nurse as the changing force, who

enables individuals to adapt to or cope with ill health.


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Outcome theories have been criticized as too abstract and

difficult to implement in practice.

4. Humanistic Theories Humanistic theories developed in response to the psycho-

analytic thought that a persons destiny was determined early

in life. Humanistic theories emphasize a persons capacity for self -

actualization.


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Humanists believe that the person contains within himself the

potential for healthy & creative growth.

Carl Rogers developed a person centered model of psychotherapy that emphasizes the uniqueness of the

individual.

The major contribution that Rogers added to nursing practiceis the understandings that each client is a unique individual, so,

person-centered approach now practice in nursing.


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Development of nursing theory The development of nursing theory has provided direction for

the structure of professional nursing practice, education, andresearch

The introduction of nursing theory historically begins withFlorence Nightingale

Conceptual and theoretical nursing models generateknowledge that will:

improve nursing practice guide nursing approach facilitate the organization of curricula for all levels of

nursing education


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Development . . .

From nursing science, conceptual models and nursing theories

evolve.

As the profession continues to expand, its own body of

knowledge, concepts and theories continue to develop to

support nursing practice component .


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Major nursing theories

Nightingale's environmental theory Hendersons Human Needs Theory Orems self care theory Roys Adaptation Model Rogers theory of Science of Unitary Human Beings Roper, Logan and Tierneys activities of daily living theory Faye Abdullah: patient centered approach Newman systems theory Lidya E. Hall: Care, core and cure Kings theory of goal attainment The prescriptive theory of Nursing


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Nightingale's environmental theory

It is one of Nightingale's nursing theories Incorporated the restoration of the usual health status of the

nurse's clients into the delivery of health care

Disease - reparative process

Nurses role - manipulating the environment to facilitate this

process

Her intent was to describe nursing and provide guidelines for

nursing practice and education


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Factors present in the patient's environment

Pure or fresh air

Pure water

Sufficient food supplies Efficient drainage

Cleanliness

Light (especially direct

sunlight)

Ventilation and warming -

Building sickness

Noise Observation of the sick

Social considerations


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Major concepts defined by Nightingale Patient an individual who is responsible, creative, in control

of their lives and health, and desiring good health.

Health a state of wellbeing; using ones power to the fullest.

Illness - the reaction of the nature against the conditions inwhich we have placed ourselves.

Environment is external to the person, but affecting the

health of both sick and well persons.


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Environmental.

The environment, one of the chief sources of infection, must

include fresh air, fresh water, efficient drainage, cleanliness,

and light.

Nursing - a service to people intended to relief pain and

suffering.

The goal of nursing is to promote the reparative process by

manipulating the environment.


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Application Applies in all situation that nursing care is provided.

Allows clients to change/ adapt in relation to their diseased

state.

It is used by managers and leaders to influence the positionsabout the nursing care today.


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Application The practice of environment configuration according to

patient's health or disease condition is still applied today

E.g. in cases as patients infected with Clostridium tetani

(suffering from tetanus), who need minimal noise to calm

them and a quiet environment to prevent seizure-causing

stimulus.


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Hendersons Human Needs Theory Virginia Henderson viewed nursing as an art and a discipline

separated from medicine.

She believed that The unique function of the nurse is to assist

the individual, sick or well, in the performance of thoseactivities contributing to health or its recovery (or to a peaceful

death) that he/she would perform unaided if he/she had the

necessary strength, will or knowledge. Identified 14 components of Basic Nursing Care (basic needs

of the patient) :


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14 basic needs . . .

9. Avoid changes in the environment and avoid injuring others.10. Communicate with others expressing emotions, needs, fears,

or opinions.

11. Worship according to ones faith.

12. Work in such a way that there is a sense of accomplishment.

13. Play or participate in various forms of recreation.

14. Learn, discover, or satisfy the curiosity that leads to normal

development and health and use of the available health

facilities.


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Major concepts defined by Henderson

Patient individual; requires assistance to achieve health and

independence or a peaceful death.

Individual will achieve or maintain health if they have the

necessary strength, will or knowledge.Health is a quality of life basic to human functioning.

Health is equated with independence, while illness is

associated with a lack of independence .


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Theory critique

Hendersons theory closely corresponds to Maslows hierarchyof needs

However, she omitted self- actualization from the remit of the

nurse. Henderson viewed the nurses role as that of a substitute for

the patient , helper to the patient, and a partner with the patient.

She listed 14 basic needs that nurses should assist patients with

if the patients are unable to perform them unaided.


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Theory critique These basic needs compose Hendersons component of

nursing care, which mainly focuses on nursing is an art.

Hendersons 14 basic needs are the basis for activities of daily

living theory. Hendersons theory is useful in nursing as the nurse can use

the fourteen basic needs as a basis for their nursing

assessment .


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Orems self care deficit theory

Dorothea Orem first published her concepts of nursing insustaining in 1959, refining them in 1980 and 1985.

Originally, she designed her theory for nursing school

curricula to help students differentiate among nursing actions. She worked on three theories, self care deficits, theory of self

care and theory of nursing systems.

This theory focuses on identifying the patients self-care needs

and nursing actions designed to meet the patients needs.


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Orems General Theory of Nursing

Three Interrelated Theories:

1. Theory of Self-Care = why and how people care for themselves

2. Theory of Self-Care Deficit = why people can be helped

through nursing

3. Theory of Nursing Systems = describes and explains

relationships that must be made and maintained for nursing to be produced


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Self-Care Theory

Based on the concepts of:

Self-care

Self-care agency

Self-care requisites

Therapeutic self-care demand


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Self Care Theory Concepts

Self Care

The performance of

activities that individuals

initiate and perform on

their behalf to maintain

life, health, and well-

being.


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Self Care Theory ConceptsSelf-Care Agency

The individuals ability to perform self -care activities

Consists of TWO agents:

Self-care Agent - person who provides the self-care

Dependent Care Agent - person other than the individual

who provides the care (such as a parent)


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Self -Car e Requi si tes Reasons for which self-care is done; these express the intended or

desired results Consists of THREE categories:

Universal - requisites/needs that are common to all individuals(e.g. air, water, food, elimination, rest, activity, etc.)

Developmental - needs resulting from maturation or developdue to a condition or event (e.g. adjustment to new job,

puberty) Health Deviation - needs resulting from illness, injury &

disease or its treatment (e.g. learning to walk with crutchesafter a leg fracture)


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Therapeutic Self-Care Demand The totality of care measures necessary at specific times or

over a duration of time for meeting an individuals self -care

requisites by using appropriate methods and related sets and

actions.

Caremeasures

Caremeasures

Therapeutic

Self Care

Demand


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Self-Care Deficit Nursing Theory

The condition that validates the existence of arequirement for nursing in an adult is the health

associated absence of the ability to maintain

continuously the amount and quality of therapeutic

self-care in sustaining life and health, in recovering

from disease or injury, or in coping with their effects.


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Self-Care Deficit Nursing Theory

Is the central focus of Orems grand theory of nursing

Nursing is required when adults (parent/guardian) are

incapable of or limited in their ability to provide continuous

effective self-care .

Describes and explains how people can be helped through

nursing

Nursing meets these self-care needs through five methods

of help.


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Theory of Nursing Systems


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Theory of Nursing Systems This describes:

How the patients self care needs will be met by the nurse , the

patient, or both

Nursing responsibilities.

Roles of the nurse and patient

Rationales for the nurse-patient relationship

Types of actions needed to meet the patients demands Designed by the nurse

Based on the assessment of patients ability to perform self -care

activities


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Three Classifications of Nursing Systems

1. Wholly Compensatory : a patients self -care agency is solimited that s/he depends on others for well-being.

a. Unable to engage in any form of action (e.g. coma ) b. Aware and who may be able to make observations or

judgments, and decisions about self-care but cannot/shouldnot perform actions requiring ambulation and manipulativemovements (e.g. patients with vertebral fractures )

a. Unable to attend to themselves and make reasonable judgments about self-care but who can be ambulatory andable to perform some self-care with guidance (e.g. severelymentally incompetent )


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Wholly Compensatory Nursing System

Nurse Action

Accomplishespatients therapeutic

self-care

Patient actionlimited

Compensates forpatients inability toengage in self-care

Supports andprotects patient


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2. Partly Compensatory : A patient can meet some self-care

requisites but needs a nurse to help meet others; either the nurse

or the patient have the major role in the performance of self-

care

E.g. a patient with recent abdominal surgery


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Partly Compensatory Nursing System

Nurse action

Performs some self-caremeasures for patient

Compensates for self-carelimitations of patient

Assists patient as required

Regulates self-care agency

Patient ActionPerforms some self-care

agency

Accepts care andassistance from nurse


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3. Supportive-educative : a patient can meet self-care requisites but needs help in decision-making, behavior control, or

knowledge acquisition; the nurses role is to promote the patient

as a self-care agent ( teacher/consultant )


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Supportive-Educative Nursing System

Patient action

Accomplishes self-care

Regulates the exerciseand development of

self-care agency

Nurse action


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Major concepts defined by Orem (general) Patient - is an individual unable to continuously maintain self-

care in sustaining life and health, in recovering from disease or

injury, or in coping with their effects.

Health ability to meet self care demands that contribute tothe maintenance and promotion of structural integrity,

functioning and development.

Illness occurs when an individual is incapable ofmaintaining self-care as a result of health related limitations.


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Concepts .

Environment Any setting in which a patient has un-meetself care needs.

Nursing A service of deliberately selected and performed

actions to assist individuals to maintain self care, including

structural integrity, functioning, and development.


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Theory critique

Orems theory is useful for comprehensive assessment andanalysis of individuals.

The theory is very useful for nurses working with chronically

ill patients in the hospital or other settings.

It is also used in health maintenance and illness prevention.

The term self-care is used by so many premises which may

create confusion.

Individuals emotional needs are neglected.


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Roys Adaptation Model

She focused the individual as a bio-psychosocial adaptivesystem

Described nursing as a humanistic (values others opinions and

viewpoints) discipline that places emphasis on persons coping

abilities.

According to Roy, the individual and environment are sources

of stimuli that require modification for adaptation.


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Major concepts defined by Roy Patient a person or family with unusual stressors or ineffective

coping mechanisms.

Health - a step and process of being and becoming adapted and

whole.

Illness - a lack of integration

Environment all conditions, circumstances, and influences

surrounding and affecting the development and behaviour of persons

or families.

Nursing promotion of patients effective coping and progress

toward adaptation.


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Theory critique Roys theory is useful in guiding the nurse in nursing

observation and interviewing skills to make an individualized

assessment of each person

Serves as a guide in planning and carrying out nursing careaction.

Some concepts remain ambiguous e.g. how does adaptation

takes place. Also the theory only includes assessment and interventions

and not the full nursing process.


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Neumanns health care system model

Developed by Betty Neumann This is a complex system theory, with a focus on stress

reaction and stress reduction.

This comprehensive theory depicts the patient as the core of a

circle (genetics, organ strength or weakness, normal

temperature range) with several protective layers.

N h l h d l


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Neumanns health care system model The patient is continuously exposed to internal and external

stressors:

loss, change, grief, sensory deprivation, and cultural

change

which requires line of defence (nutrition, rest, hydration,

oxygen, financial circumstances, employment, and lifestyle )

and reactions (role expectations, and copping patterns).

Nursing interventions can occur before or after stressors and

at three levels of prevention: primary, secondary, and tertiary.


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Major concepts defined by Neumann Patient- is an open system seeking balance and harmony,

composite of physiological, psychological, socio-cultural, and

developmental variables and viewed as a whole.

It may refer individuals, families, and communities. Health - A dynamic equilibrium of the normal line of defence.


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Neumanns health care system model

Illness - illness is due to reaction to stressors with lines of

resistance (immune and inflammatory response systems).

Environment - comprises internal and external stressors and

resistance factors.

Nursing reduction of stressors through prevention activities

at three levels.

C iti


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Critique

Neumanns theory is applicable to all phases of nursing

process.

It can be applied across all clinical areas and is especially

useful for individuals and families.

It uses a holistic approach because each system or subsystem

cannot be isolated; rather, the influence of each system on the

whole must be considered. The three levels of prevention are useful guides for planning

interventions.


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Theory critique

Particularly useful to nurses working in the community setting ,

but can also be used in the hospital or clinical environment.

It specially shows how to use the nursing process in both

settings.

However, it is wellness oriented, and she uses the terms health

and wellness interchangeably as if they mean the same thing. Also, it is prevention rather than treatment oriented.

R L g d Ti ti iti f d il li i g


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Roper, Logan and Tierneys activities of daily livingtheory

Roper, Logan and Tierney describe nursing s aim as meetingthe needs of society.

They depict 12 basic activities of daily living and describe five

sources of potential or actual problems.

B i ti iti f li i


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Basic activities of living

Maintaining a safeenvironment

Breathing Communication Moving Eating and Drinking Eliminating Personal cleansing and

dressing Maintaining body

temperature Working and playing sleeping Expressing sexuality Dying

h f f bl


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The five sources of problems

1. Disability

2. Pathologic and degenerative tissue change

3. Accident

4. Infection

5. Environmental changes in the physical, psychological and

social sector of the clients life.

Major concepts defined by Roper Logan and Tierney


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Major concepts defined by Roper, Logan and Tierney

Patient - any individual needing help to perform activities of

daily livings.

Health - can only be defined in relation to the individual and

his expectations, and in relation to his optimal level of

functioning in everyday living.

Environment - houses, factories, and offices, sports grounds

and playgrounds and rounds are all environments.

There is also the broader view of environment e.g. climate and

geographical location.


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Concepts . . . Nursing helping patients to prevent, solve, alleviate or cope

with problems (actual or potential) with activities of daily

livings and exists to meet the needs of society.

Theor critiq e


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Theory critique

Concepts, especially metaparadigm concepts, are notwell defined.

The theory follows the biomedical model.

The focus of the theory is on nursing as a helping art.


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G l t th


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General system theory

Provides another approach for studying individuals in their

environment and is used by many disciplines.

General system theory includes content, purpose and process,

breaking down the whole and analyzing the parts.

The relationships between the parts of the whole are examined

to learn how they work together.

G l t th


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General system theory . . . .

Von Bertalanffy (1969 - 1976) developed general system theorywhich assumes the following:

All systems must be goal directed.

A system is more than the sum of its parts .

A system is ever-changing, and any change in one parts affects

the whole.

Bounders are implicit, and human systems are open and

dynamic.

General


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General ..

Examples of nursing theories that have used the systems

approach to client care:

Roy's adaptation model (1980)

Halls philosophy of nursing (1964)

Newmans health care system model (1972)

Johnson's behavioural model (1968) Parses theory for Nursing (1981)

Human needs theory


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Human needs theory

Maslows hierarchy of humans needs is any physiological or

psychological factors necessary for a healthy existence.

The most prominent theorist to focus on human needs has been

Abram Maslow (1970).

Human needs theory


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Human needs theory

It states that all humans are born with instinctive needs.

These needs grouped into 5 categories; are arranged in the

order of importance from those essential for physical survival

to those necessary to develop a persons fullest potential. provides a framework for recognizing and prioritizing basic

human needs.

This hierarchy is constructed as a pyramid.

Human needs theory


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Human needs theory

It is often depicted as a pyramid consisting of five levels:

the four lower levels are grouped together as being

associated with Physiological needs/deficiency needs

while the top level is termed growth needs/Being needs

associated with psychological needs.

Human needs theory


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Human needs theory Deficiency needs must be met first.

Once these are met, seeking to satisfy growth needs drives

personal growth.

The higher needs in this hierarchy only come into focus when

the lower needs in the pyramid are satisfied.

Once an individual has moved upwards to the next level, needs

in the lower level will no longer be prioritized.

Deficiency and being needs


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Deficiency and being needs The deficiency needs are: physiologic, safety and security,

love and belonging, and esteem needs.

B-needs = self actualization and transcendence ( be greater,

better) needs

1 Physiological needs


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1. Physiological needs

These are the basic human needs for such things as air, food,

warmth, water, excretion, sexual and other bodily needs.

If some needs are not fulfilled, a person's physiological needs

take the highest priority. Physiological needs can control thoughts and behaviors.

can cause people to feel sickness, pain, and discomfort.

2 Safety needs


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2. Safety needs

With their physical needs relatively satisfied, the individual's

safety needs take over and dominate their behavior.

manifest themselves in such things as a preference for job

security, grievance procedures for protecting the individual

from unilateral authority, savings accounts . . . .

Safety and Security needs


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Safety and Security needs

Personal security from crime

Financial security

Health and well-being

Safety net against accidents/illness and the adverse impacts

3 Social needs/belongingness
http://en.wikipedia.org/wiki/Crimehttp://en.wikipedia.org/wiki/Crime


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3. Social needs/belongingness

After physiological and safety needs are fulfilled, the third

layer of human needs is social.

This psychological aspect of Maslow's hierarchy involves

emotionally-based relationships in general, such as:

friendship

intimacy having a supportive and communicative family


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4. Esteem needs


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4. Esteem needs All humans have a need to be respected , to have self-esteem,

self-respect, and to respect others. People need to engage themselves to gain recognition and have

an activity that give the person a sense of contribution, to feel

accepted and self-valued.

Imbalances at this level can result in low self-esteem or

inferiority complexes.

5 Self-actualization


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5. Self-actualization

Self-actualization and transcendence are "being" or "growth"

needs (also termed "B-needs")

they are enduring motivations or drivers of behavior.

Change theory


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g y People grow and change throughout their lives.

Change happens daily. This changes and growth affects human kinds.

Change is continuous.

Reactions to changes are grounded in the basic human needs

for self-esteem, safety, and security.

Change may be planned or unplanned.

Kurt Lewin (1962) developed the theory of change.

Change theory


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Change theory . . .

Lewin identified three states of change: unfreezing,

movement, and refreezing.

Unfreezing is the recognition of the need for change and the

dissolution of previously held patterns of behaviour. Movement is the shift of behaviour towards a new and more

healthful pattern.

Refreezing is the long term solidification of the new pattern

of behaviour.

Philosophy of Nursing Theory

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