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NURSING THEORIES
NURSING THEORY
Defines what nursing is, what it does, andthe goals and outcomes of nursing care.
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NURSING THEORIES
Components of Theoretical Foundation
1. Concepts
* the building block of a theory
* a vehicle of thought2. Propositions
* a statement that proposes a relationshipbetween concepts
* represents the theorists view of whichconcepts fit together and in most theories,establish how concepts affect one another
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NURSING THEORIES
THEORY
A set of concepts and propositions thatprovide an orderly way to view
phenomena The purpose of a theory in scientific
disciplines is to guide research enhance
the science by supporting existingknowledge or generating new knowledge(Parse, 1987)
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NURSING THEORIES
Importance of Nursing Theories:
1. Provide a framework for thought in which to examine situations.As new situations are encountered, this framework provides astructure for organization, analysis, and decision making.
2. Provide a structure for communicating with other nurses and withother members of the health care team.3. Assist the discipline of nursing in clarifying beliefs, values and
goals.4. Help define the unique contribution of nursing, proclaim
professional autonomy, and ultimately, control certain aspects of
nursing practice5. For the continued development and evolution of the discipline ofnursing.
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NURSING THEORIES
SCOPE OF THEORIES
Grand Theories
- composed of concepts representingglobal and extreme complex phenomena
- broadest in scope, represents the most
abstract level of development andaddresses the broad phenomena ofconcern within the discipline.
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NURSING THEORIES
SCOPE OF THEORIES
Middle-Range Theories
- addresses more concrete and morenarrowly defined phenomena.
- intended to answer questions about
nursing phenomena, yet they do not coverfull range of phenomena of concern to thediscipline
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Process of KnowledgeDevelopment
Nursing Practice
Nursing Research
Nursing Theory
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Process of KnowledgeDevelopment
Nursing practice, theory, and research areinterdependent
Nursing theory development and nursingresearch activities are directed towarddeveloping nursing practice guidelines.
Nursing practice is the focal point of therelationship between practice, theory andresearch
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Process of KnowledgeDevelopment
Nursing Practice
It provides new material for the ideas that aresystematically developed and organized in the form ofnursing theory
Ideas proposed by nursing theory must be tested andvalidated through nursing research
New knowledge that results from nursing research isused to transform and inform nursing practice
Generates questions that serve as the basis for nursingresearch
Nursing research then influences the development ofnursing theory, which in turn transforms nursing practice
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Knowledge Development inNursing
Metaparadigms of Nursing
Metaparadigm the unifying force in adiscipline that names the phenomena of
concern to that discipline It is broader and focuses on the persons
health, and the environment
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Metaparadigms of Nursing
4 major concepts that provide structure to thedomain of nursing: (PEHN)
1. Person the individual, family, or group whoare in the interest of nursing.
2. Environment the place or community wherecare is provided; it also describes the world aperson lives in and interacts with.
3. Health the continuum of wellness to terminal
illness of individuals.4. Nursing actions and interactions of the nurse
with the person
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Knowledge Development inNursing
Paradigms of Nursing
Paradigm a particular viewpoint or perspective
Paradigm revolution the turmoil and conflictthat occur in a discipline when a competingparadigm gains acceptance over the dominantparadigm
Paradigm shift the acceptance of the
competing paradigm over the prevailingparadigm or a shifting away from one worldviewtoward another worldview.
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Florence Nightingale
The Environmental Theory
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Florence Nightingale
Emerged during the Crimean War, henceshes called the Lady with the Lamp
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Florence Nightingale
Environmental Theory (mid-1800)
Often considered the 1st nurse theorist; definednursing more than 100 years ago, as the act of
utilizing the environment of the patient to assisthim in his recovery
Despite the fact that she did not believe in thegerm theory, her experiences in the Crimean
war magnified her interest in the principles ofsanitation and the relationship betweenenvironment and health.
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Florence Nightingale
She linked healthwith fiveenvironmental
factors1. Pure or fresh air
2. Pure water
3. Efficient drainage
4. Cleanliness
5. Light (especiallydirect sunlight)
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Florence Nightingale
Deficiencies in these five factors producedlack of health or illness.
She believed that in the nurturingenvironment, the body could repair itself.
Clients environment is manipulated to
include appropriate noise, nutrition,hygiene, light, comfort, socialization andhope.
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Virginia Henderson
The Nature of Nursing Model
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Virginia Henderson
Hendersons
definition of theunique function of
nursing was amajor steppingstone in theemergence of
nursing as adiscipline separatefrom medicine.
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Virginia Henderson
She believed that thenurse was concernedwith both healthy and
ill individuals,acknowledged thatnurses interact withclients even when
recovery may not befeasible
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Virginia Henderson
Mentioned the teaching advocacy roles ofthe nurses.
Conceptualized the role of the nurses asassisting sick or healthy individuals to gainindependence in meeting the fourteenfundamental needs
THE FOURTEEN FUNDAMENTAL
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THE FOURTEEN FUNDAMENTAL
NEEDS
NORMAL BREATHING.
Breathing normally
FOOD.
Eating and drinking adequately
EXCRETION.
Eliminating body wastes
MOTION.
Moving and maintaining a desirable position
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NEEDS
REST.
Sleeping and resting
CLOTHING.
Selecting suitable clothes
TEMPERATURE.
Maintaining body temperature within normal rangeby adjusting clothing and modifying the environment
CLEANLINESS.Keeping the body clean and well groomed to protectthe skin
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NEEDS
SAFETY.
Avoiding dangers in the environment and injuringothers
COMMUNICATION.
Communicating with others in expressing emotions,needs, fears or opinions
RELIGION.
Worshipping according to ones faith
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Martha RogersTheory of Unitary Human
Beings
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Martha Rogers
According toRogers, everyindividual is a
unitary human being
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Martha Rogers
The UNITARY HUMAN BEING1. is an irreducible, four-dimensional energy field;
the four dimensions being energy fields,openness, pattern and organization and
dimensionality2. interacts continuously and creatively with the
environment3. is more than and different from the sum of its
parts4.behaves as a totality5.participates creatively in change.
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The human being is a four-dimensional energy field
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Martha Rogers
Nurses applying Rogerss theory in practiceshould:
Focus on the persons wholeness
Seek to promote symphonic interaction between thetwo energy fields (human and environment) tostrengthen the coherence and integrity of the person.
Coordinate the human field with the rhythmicities ofthe environmental fields
Direct and redirect patterns of interaction between thetwo energy fields to promote maximum healthpotential
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Sister Callista Roy
The Adaptation Model
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Sr. Callista Roy
The Adaptation Model (1997)
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Sr. Callista Roy
Defines adaptation as the process and
outcome whereby the thinking and feelingperson uses conscious awareness and
choice to create human and environmentalintegration
Viewed each person as a unified
biopsychosocial system in constantinteraction with the environment
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Sr. Callista Roy
The person is an adaptive system, employing afeedback cycle of input (stimuli), throughput(control process) and output (behavior or
adaptive response) All people have certain needs, categorized into
1. Physiological
2. Self-concept
3. Role Function
4. Interdependence
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Sr. Callista Roy
Need for nursing care arises when clientcannot adapt to internal and externalenvironmental demands
The nurse determines what demands arecausing problems for the client; assesseshow well the client is adapting to them
Nursing care, therefore, is directed athelping the client adapt
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Dorothea OremSelf-care and Self-care Deficit Theory
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Dorothea Orem
Defined self-care as the practice ofactivities that individuals initiate andperform on their own behalf in
maintaining life, health and well-being
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Dorothea Orem
Self-care theory is based on fourconcepts:
1. Self-care
2. Self-care Agency
3. Self-care Requisites4. Therapeutic Self-care Demand
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Dorothea Orem
SELF-CARE
Self-care refers to those activities anindividual performs independentlythroughout life to promote and maintain
personal well-being
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Dorothea Orem
SELF-CARE AGENCY
Self-care agency is the individuals ability toperform self care activities.
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Dorothea Orem
It consists of two agents:
1. a self-care agent an individual whoperforms self care independently
2. a dependent care agent a person otherthan the individual who provides the care (e.g.most adults care for themselves, whereasinfants and people weakened by illnessrequire assistance with self-care activities)
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Dorothea Orem
SELF-CARE REQUISITES
Also called self care needs, self-carerequisites are actions taken to provide selfcare.
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Dorothea Orem
THERAPEUTIC SELF-CARE DEMAND
Therapeutic self-care demand refers toall self care activities required to meetexisting self care requisites or actions to
maintain health and well being.
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Imogene KingGoal Attainment Theory
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Imogene King
Described nursing as a helping profession
that assists individuals and groups insociety to attain, maintain, and restore
health If this is not possible, nurses help
individuals die with dignity.
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Imogene King
Viewed nursing as an interaction processbetween client and nurse
During this process of perceiving, settinggoals and acting on them, transitionsoccur and goals are achieved.
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Betty Neuman
Health Care System Model
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Betty Neuman
Nursing: a unique profession in that it isconcerned with all the variables affectingan individuals response to stresses in
nature Stresses:
1. Intrapersonal (within the individual)
2. Interpersonal (between one or more otherpeople)
3. Extrapersonal (outside the individual)
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Betty Neuman
3 Major Concerns of Nursing1. Prevent stress invasion
2. Protect the clients basic structure
3. Obtain a maximum level of wellness
The nurse helps the client throughprimary, secondary and tertiary
prevention modes, to adjust toenvironmental stressors and maintainclient stability
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Dorothy JohnsonBehavioral System Model
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Dorothy Johnson
Johnson: Each person as a behavioralsystem is composed of sevensubsystems, namely:
1. Ingestive2. Eliminative
3. Affiliative
4. Aggressive5. Dependence
6. Achievement
7. Sexual and role identity behavior
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Dorothy Johnson
Each person tries toachieve balance andstability to function
effectively He does this by
adjusting andadapting to
environmental forcesthrough learnedpatterns of response
Hildegard Peplau
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Hildegard PeplauThe Interpersonal Model
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Hildegard Peplau
Defined nursing as an interpersonalprocess of therapeutic interactionsbetween
1. an individual who is sick or in need ofhealth services; and
2. a nurse especially educated to recognize
and respond to the need for help
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Hildegard Peplau
Identified four phases of nurse-clientrelationship, namely:
1. Orientation.
The nurse and the client initially do not knoweach others goals
Testing the roles each will assume
The client attempts to identify the difficultiesand the amount of nursing help needed
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Hildegard Peplau
2. Identification.
The client responds to the professionals orthe significant others who can meet the
identified needs
Both client and nurse plan together anappropriate program to foster health
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Hildegard Peplau
3. Exploitation.
The client utilizes all available resources tomove toward a goal of maximum health or
functionality
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Hildegard Peplau
4. Resolution.
Refers to the termination phase of thenurse-client relationship
Occurs when the clients needs are met and
he/she can move toward a new goal.
Growth is fostered in both the client and thenurse
The Four Phases of Nurse Client
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The Four Phases of Nurse-ClientRelationship
ORIENTATION
The Four Phases of Nurse Client
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The Four Phases of Nurse-ClientRelationship
IDENTIFICATION
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The Four Phases of Nurse Client
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The Four Phases of Nurse-ClientRelationship
RESOLUTION
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Faye Abdellah
Patient-centered Approaches to Nursing Model
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Faye Abdellah
Her theory emphasizes delivering nursing carefor the whole person to meet the physical,emotional, intellectual, social and spiritual needs
of the client and family.
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Faye Abdellah
The nurse needsknowledge and skills ininterpersonal relations, psychology, growthand development, communication, and
sociology, as well as a knowledge of thebasic sciences and specific nursing skills
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Faye Abdellah
The nurse formulates an individualizedview of the clients needs, which may
occur in the following areas
1.Comfort, hygiene and safety
2.Physiological balance
3.Psychological and social factors
4.Sociological and community factors
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Lydia HallCare, Core and Cure Model
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Lydia Hall
According to her, nursing centersaround three components:
1. CARE
2. CORE
3. CURE
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CARE
Representsnurturance and isexclusive to nursing
Carebears
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CORE
Involves thetherapeuticuse of self andemphasizesthe use ofreflection
Reflection
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CURE
Focuses onnursing-relatedto thephysicians
orders
Summary of Nursing Theories
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Summary of Nursing TheoriesTheorist Goals of Nursing/Key Emphasis
Nightingale To facilitate the bodys reparative processes by manipulating the clients environment
Henderson To work independently with other health care workers, assisting client in gainingindependence as quickly as possible
Nurses help client to perform 14 fundamental needs
Rogers To maintain and promote health, prevent illness, and care for and rehabilitate ill anddisabled client through humanistic science of nursing
Unitary man continuously changes and coexists with environment
Roy To identify types of demands placed on client, assess adaptation to demands, and help
client adaptOrem To care for and help client attain total self-care
Self-care deficit theory: nursing care becomes necessary when client is unable to fulfillbiological, psychological, development or social needs
King Nursing process is defined as dynamic interpersonal process between nurse, client, andhealth care system
Neuman Stress reduction is goal of systems model of nursing practice. Nursing actions are in
primary, secondary or tertiary level of preventionJohnson Subsystems exist in dynamic stability
Peplau To develop interaction between nurse and client
Nursing is a significant therapeutic four-phase interpersonal process
Abdellah To provide service to individuals, families and society; to be kind and caring but alsointelligent, competent and technically well-prepared to provide this service