Nursing Theorists

Week 11 and 12
Definitions
• Theory- a set of related statements that describes or explains phenomena in a
systematic way
• Concept-a mental idea of a phenomenon
• Construct- a phenomena that cannot be observed and must be inferred
Definitions
• Proposition- a statement of relationship between concepts
• Conceptual model- made up of concepts and propositions
Nursing Theorists
• Florence Nightingale, Hildegard Peplau, Virginia Henderson, Fay Abdella, Ida Jean
Orlando, Dorothy Johnson, Martha Rogers, Dorothea Orem, Imogene King, Betty
Neuman, Sister Calista Roy, Jean Watson, Rosemary Rizzo Parse, Madeleine
Leininger, Patricia Benner
Concepts in the nursing metaparadigm
• Person
o Recipient of care, including physical, spiritual, psychological, and sociocultural
components
o Individual, family, or community
Concepts in the nursing metaparadigm
• Environment
o All internal and external conditions, circumstances, and influences affecting
the person
Concepts in the nursing metaparadigm
• Health
o Degree of wellness or illness experienced by the person
Concepts in the nursing metaparadigm
• Nursing
o Actions, characteristics and attributes of person giving care
Florence Nightingale
Environmental Theory
• First nursing theorist
o Unsanitary conditions posed health hazard (Notes on Nursing, 1859)
• 5 components of environment
o ventilation, light, warmth, effluvia, noise
• External influences can prevent, suppress or contribute to disease or death
Nightingale’s Concepts
• Person
o Patient who is acted on by nurse
o Affected by environment
o Has reparative powers
• Environment
o Foundation of theory. Included everything, physical, psychological, and social
Nightingale’s Concepts
• Health
o Maintaining well-being by using a person’s powers
o Maintained by control of environment
• Nursing
 o Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate person’s
reparative process
Hildegard Peplau
Interpersonal Relations Model
Hildegard Peplau
Interpersonal
Relations Model
• Based on psychodynamic nursing
o 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
• Person
o An individual; a developing organism who tries to reduce anxiety caused by
needs
o Lives in instable equilibrium
• Environment- Not defined
Peplau’s Concepts
• Health
o Implies forward movement of the personality and human processes toward
creative, constructive, productive, personal, and community living
Peplau’s Concepts
• Nursing
o A significant, therapeutic, interpersonal process that functions cooperatively
with others to make health possible
o Involves problem-solving
Virginia Henderson
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.
Virginia Henderson
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”.
Virginia Henderson
“She is temporarily the consciousness of the unconscious, the love of life for the suicidal, the
leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant,
knowledge and confidence for the young mother, the mouthpiece for those too weak or
withdrawn to speak, and so on.”
Fay Abdella- Topology of 21 Nursing Problems
Fay Abdella
Topology of 21 Nursing Problems
• A list of 21 nursing problems
o Condition presented or faced by the patient or family.
• Problems are in 3 categories
o physical, social and emotional
• The nurse must be a good problem solver
Abdella’s Concepts
• Nursing
o A helping profession
o A comprehensive service to meet patient’s needs
o Increases or restores self-help ability
o Uses 21 problems to guide nursing care
• Health
o Excludes illness
o No unmet needs and no actual or anticipated impairments
Abdella’s Concepts
• Person
o One who has physical, emotional, or social needs
o The recipient of nursing care.
• Environment
o Did not discuss much
o Includes room, home, and community
Ida Jean Orlando
Deliberative Nursing Process
Ida Jean Orlando
Deliberative Nursing Process
• The deliberative nursing process is set in motion by the patient’s behavior
o 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.
o Perception, thought, feeling
Ida Jean Orlando
Deliberative Nursing
Process
• Nurses’ actions should be deliberative, rather than automatic
o Deliberative actions explore the meaning and relevance of an action.
Dorothy Johnson
Behavioral Systems Model
Dorothy Johnson
Behavioral Systems Model
• The person is a behavioral system comprised of a set of organized, interactive,
interdependent, and integrated subsystems
o Constancy is maintained through biological, psychological, and sociological
factors.
Dorothy Johnson
Behavioral Systems
Model
• A steady state is maintained through adjusting and adapting to internal and external
forces.
Johnson’s 7 Subsystems
• Affiliative subsystem
o social bonds
• Dependency
o helping or nuturing
• Ingestive
o food intake
 • Eliminative
o excretion
Dorothy Johnson
Behavioral Systems
Model 7 Sub Systems
• Sexual
o procreation and gratification
• Agressive
o self-protection and preservation
• Achievement
o efforts to gain mastery and control
Johnson’s Concepts
• Person
o A behavioral system comprised of subsystems constantly trying to maintain a
steady state
• Environment
o Not specifically defined but does say there is an internal and external
environment
Dorothy Johnson
Behavioral Systems
Model
• Health
o Balance and stability.
• Nursing
o External regulatory force that is indicated only when there is instability.
Martha Rogers
Unitary Human Beings
Martha Rogers
Unitary Human Beings
• Energy fields
o Fundamental unity of things that are unique, dynamic, open, and infinite
o Unitary man and environmental field
• Universe of open systems
o Energy fields are open, infinite, and interactive
Martha Rogers
Unitary Human Beings
• Pattern
o Characteristic of energy field
o A wave that changes, becomes complex and diverse
• Four dimensionality
o A nonlinear domain with out time or space
Roger’s Definitions
• Integrality
o Continuous and mutual interaction between man and environment
• Resonancy
o Continuous change longer to shorter wave patterns in human and
environmental fields
Martha Rogers
Unitary Human Beings
• Helicy
 o Continuous, probabilistic, increasing diversity of the human and
envrionmental fields.
o Characterized by nonrepeating rhymicities
o Change
Dorothea Orem
Self-Care Model
Dorothea Orem
Self-Care Model
• 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
Dorothea Orem
Self-Care Model
• 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
Dorothea Orem
Self-Care Model
• Wholly compensatory nursing system
o Patient dependent
• Partially compensatory
o Patient can meet some needs but needs nursing assistance
• Supportive educative
o Patient can meet self care requisites, but needs assistance with decision
making or knowledge
Imogene King
Goal Attainment Theory
Imogene King
Goal Attainment Theory
• Open systems framework
o Human beings are open systems in constant interaction with the environment
 Personal System
 individual; perception, self, growth, development, time space,
body image
 Interpersonal
 Society
Imogene King
Goal Attainment Theory
• Personal System
o Individual; perception, self, growth, development, time space, body image
• Interpersonal
o Socialization; interaction, communication and transaction
• Society
o Family, religious groups, schools, work, peers
Imogene King
Goal Attainment Theory
• The nurse and patient mutually communicate, establish goals and take action to
attain goals
Imogene King
Goal Attainment Theory
• Each individual brings a different set of values, ideas, attitudes, perceptions to
exchange
Betty Neuman
Systems Model
Betty Neuman
Health Care
Systems Model
• The person is a complete system, with interrelated parts
o maintains balance and harmony between internal and external environment
by adjusting to stress and defending against tension-producing stimuli
Betty Neuman
Health Care
Systems Model
• Focuses on stress and stress reduction
• Primarily concerned with effects of stress on health
• Stressors are any forces that alter the system’s stability
Betty Neuman
Health Care
Systems Model
• 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
Betty Neuman
Systems Model
• Wellness is equilibrium
• Nursing interventions are activites to:
 strengthen flexible lines of defense
 strengthen resistence to stressors
 maintain adaptation
Sister Calista Roy
Adaptation Model
Sister Calista Roy
Adaptation Model
• Five Interrelated Essential Elements
o Patiency- The person receiving care
o Goal of nursing- Adapting to change
o Health-Being and becoming a whole person
o Environment
o Direction of nursing activities- Facilitating adaptation
Sister Calista Roy
Adaptation Model
• 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
Jean Watson
Philosophy and Science of Caring
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
Jean Watson
Philosophy and
Science of Caring
• 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
Watson’s 10 Carative Factors
• Developing helping-trust relationship
• Promoting expression of feelings
• Using problem-solving for decision making
Watson’s 10 Carative Factors
• Promoting teaching-learning
• Promoting supportive environment
• Assisting with gratification of human needs
• Allowing for existential-phenomenological forces
Watson’s Concepts
• Person
o Human being to be valued, cared for, respected, nurtured, understood and
assisted
• Environment
o Society
Jean Watson
Philosophy and
Science of Caring
• Health
o Complete physical, mental and social well-being and functioning
• Nursing
o Concerned with promoting and restoring health, preventing illness
Rosemary Parse
Human Becoming Theory
• Human Becoming Theory includes Totality Paradigm
o Man is a combination of biological, psychological, sociological and spiritual
factors
Simultaneity Paradigm
o Man is a unitary being in continuous, mutual interaction with environment
 • Originally Man-Living-Health Theory
Parse’s Three Principles
• Meaning
o Man’s reality is given meaning through lived experiences
o Man and environment cocreate
• Rhythmicity
o Man and environment cocreate ( imaging, valuing, languaging) in rhythmical
patterns
Parse’s Three Principles
• Cotranscendence
o Refers to reaching out and beyond the limits that a person sets
o One constantly transforms
Rosemary Parse
Human BecomingTheory
• Person
o Open being who is more than and different from the sum of the parts
• Environment
o Everything in the person and his experiences
o Inseparable, complimentary to and evolving with
Rosemary Parse
• Health
o Open process of being and becoming. Involves synthesis of values
• Nursing
o A human science and art that uses an abstract body of knowledge to serve
people
Human BecomingTheory
Madeleine Leininger
Culture Care Diversity and Universality
• Based on transcultural nursing, whose goal 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
Madeleine Leininger
Culture Care Diversity
• Modes of nursing action
o 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
Patricia Benner
From Novice to Expert
Patricia Benner
From Novice to
Expert
• Described 5 levels of nursing experience and developed exemplars and paradigm
cases to illustrate each level
Patricia Benner
From Novice to
Expert
• Levels reflect:
o movement from reliance on past abstract principles to the use of past
concrete experience as paradigms
o change in perception of situation as a complete whole in which certain parts
are relevant
Patricia Benner
From Novice to
Expert
• Novice
• Advanced beginner
• Competent
• Proficient
• Expert
Importance of Theoretical Frameworks
• Foundation of any profession is the development of a specialized body of knowledge.
Theories should be developed in nursing, not borrow theories form other
disciplines
Next Steps
• Responsibility of nurses to know and understand theorists
• Critically analyze theoretical frameworks