Nursing Theories and Application

Jed Ray Montayre, RN, MSN, PhD(c)

METAPARADIGMS  PERSON

HEALTH NURSING ENVIROMENT

NURSING THEORISTS   FLORENCE NIGHTINGALE  HILDEGARD PEPLAU  VIRGINIA HENDERSON  IDA JEAN ORLANDO  DOROTHY JOHNSON  SISTER CALISTA ROY

NURSING THEORISTS   JEAN WATSON  MADELEINE LEININGER  PATRICIA BENNER  ROPER, LOGAN and TIERNEY

FLORENCE NIGHTINGALE   ENVIROMENTAL ADAPTATION THEORY

FLORENCE NIGHTINGALE   Born - 12 May 1820  Founder of modern nursing.  The first nursing theorist.  Also known as "The Lady with the Lamp"  She explained her environmental theory in her famous book Notes on Nursing: What it is, What it is not .

FLORENCE NIGHTINGALE 

 She was the first to propose nursing required specific education and training.  Her contribution during Crimean war is well-known.  She was a statistician, using bar and pie charts, highlighting key points.  International Nurses Day, May 12 is observed in respect to her contribution to Nursing.  Died - 13 August 1910

FLORENCE NIGHTINGALE   Focuses on nursing and the patient environment relationship.  Unsanitary conditions posed health hazard (Notes on Nursing, 1859)

FLORENCE NIGHTINGALE  Person  Patient who is acted on by nurse  Affected by environment  Has reparative powers  People are multidimensional, composed of biological, psychological, social and spiritual components.

FLORENCE NIGHTINGALE  Environment  Foundation of theory. Included everything, physical, psychological, and social  "Poor or difficult environments led to poor health and disease".  "Environment could be altered to improve conditions so that the natural laws would allow healing to occur

FLORENCE NIGHTINGALE  Health  Maintaining well-being by using a person’s powers  Maintained by control of environment  Health is “not only to be well, but to be able to use well every power we have”.  Disease is considered as dys-ease or the absence of comfort.

FLORENCE NIGHTINGALE  Nursing  Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate person’s reparative process  Nursing is different from medicine and the goal of nursing is to place the patient in the best possible condition for nature to act.  Nursing is the "activities that promote health (as outlined in canons) which occur in any caregiving situation.

FLORENCE NIGHTINGALE  Canons of Nursing

•Ventilation and warming •Light, Noise •Cleanliness of rooms/walls •Health of houses •Bed and bedding •Personal cleanliness •Variety •Chattering hopes and advices •Taking food. What food? •Petty management/observation

FLORENCE NIGHTINGALE  NIGHTINGALE PLEDGE

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

FLORENCE NIGHTINGALE  Application of Nightingale's theory in practice: "Patients are to be put in the best condition for nature to act on them, it is the responsibility of nurses to reduce noise, to relieve patients’ anxieties, and to help them sleep." As per most of the nursing theories, environmental adaptation remains the basis of holistic nursing care.

FLORENCE NIGHTINGALE  Nightingale theory and intentional comfort touch in management of tinea pedis in vulnerable populations Incorporating Florence Nightingale's theory of nursing into teaching a group of preadolescent children about negative peer pressure.

“The goal of nursing is “to put the patient in the best condition for nature to act upon him”Nightingale

VIRGINIA HENDERSON  14 NEEDS THEORY

VIRGINIA HENDERSON   The Nightingale of Modern Nursing”  “Modern-Day Mother of Nursing.”  "The 20th century Florence Nightingale."  Born in Kansas City, Missouri, in 1897.  Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital, Washington, D.C. in 1921.

VIRGINIA HENDERSON  INDIVIDUAL/ PERSON  Have basic needs that are component of health.  Requiring assistance to achieve health and independence or a peaceful death.  Mind and body are inseparable and interrelated.  Considers the biological, psychological, sociological, and spiritual components.  The theory presents the patient as a sum of parts with biopsychosocial needs.  2. Environment

VIRGINIA HENDERSON  ENVIRONMENT  Settings in which an individual learns unique pattern for living.  All external conditions and influences that affect life and development.  Individuals in relation to families  Minimally discusses the impact of the community on the individual and family.  Basic nursing care involves providing conditions under which the patient can perform the 14 activities unaided

VIRGINIA HENDERSON  HEALTH  Definition based on individual’s ability to function independently as outlined in the 14 components.  Nurses need to stress promotion of health and prevention and cure of disease.  Good health is a challenge affected by age, cultural background, physical, and intellectual capacities, and emotional balance Is the individual’s ability to meet these needs independently.

VIRGINIA HENDERSON  NURSING  Temporarily assisting an individual who lacks the necessary strength, will and knowledge to satisfy 1 or more of 14 basic needs.  Assists and supports the individual in life activities and the attainment of independence.  Nurse serves to make patient “complete” “whole", or "independent.”

VIRGINIA HENDERSON  NURSING  The nurse is expected to carry out physician’s therapeutic plan Individualized care is the result of the nurse’s creativity in planning for care.  “Nurse should have knowledge to practice individualized and human care and should be a scientific problem solver.”  In the Nature of Nursing Nurse role is,” to get inside the patient’s skin and supplement his strength will or knowledge according to his needs.”

VIRGINIA HENDERSON The major assumptions of the theory are:

 "Nurses care for patients until patient can care for themselves once again. Patients desire to return to health, but this assumption is not explicitly stated.  Nurses are willing to serve and that “nurses will devote themselves to the patient day and night” A final assumption is that nurses should be educated at the university level in both arts and sciences.

VIRGINIA HENDERSON  The 14 components Breathe normally. Eat and drink adequately. Eliminate body wastes. Move and maintain desirable postures. Sleep and rest. Select suitable clothes-dress and undress. Maintain body temperature within normal range by adjusting clothing and modifying environment • Keep the body clean and well groomed and protect the integument • Avoid dangers in the environment and avoid injuring others. • • • • • •

VIRGINIA HENDERSON  The 14 components

•Communicate with others in expressing emotions, needs, fears, or opinions. •Worship according to one’s faith. •Work in such a way that there is a sense of accomplishment. •Play or participate in various forms of recreation. •Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

VIRGINIA HENDERSON  Application to Nursing Practice  Henderson provides the essence of what she believes is a definition of nursing.  Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the person and how nursing can assist in meeting those needs.  Her definition of nursing and the 14 components of basic nursing care are uncomplicated and selfexplanatory.

VIRGINIA HENDERSON 

 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" (Henderson, 1966)

HILDEGARD PEPLAU THEORY OF INTERPERSONAL RELATIONS

HILDEGARD PEPLAU 

 Born in Reading, Pennsylvania [1909], USA  Diploma program in Pottstown, Pennsylvania in 1931.  BA in interpersonal psychology - Bennington College in 1943.  MA in psychiatric nursing from Colombia University New York in 1947.  EdD in curriculum development in 1953.  Professor emeritus from Rutgers university

HILDEGARD PEPLAU  PERSON  A developing organism that tries to reduce anxiety caused by needs.

HILDEGARD PEPLAU  ENVIRONMENT Existing forces outside the organism and in the context of culture

HILDEGARD PEPLAU  HEALTH  A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, pro ductive, personal andcomm unity living.

HILDEGARD PEPLAU  NURSING  A significant therapeutic interpersonal process. It functions cooperatively with other human process that make health possible for individuals in communities

HILDEGARD PEPLAU  MAJOR ASSUMPTIONS  The theory explains the purpose of nursing is to help others identify their felt difficulties.  Nurses should apply principles of human relations to the problems that arise at all levels of experience.  Peplau's theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process.

HILDEGARD PEPLAU 

 Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care.  Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal.  The attainment of goal is achieved through the use of a series of steps following a series of pattern.  The nurse and patient work together so both become mature and knowledgeable in the process.

HILDEGARD PEPLAU  Roles of nurse

Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust. Teacher: who imparts knowledge in reference to a need or interest Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation

HILDEGARD PEPLAU 

Roles of nurse Counselors : helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate.

Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way

HILDEGARD PEPLAU   Phases of interpersonal relationship  Identified four sequential phases in the interpersonal relationship:  1. Orientation 2. Identification 3. Exploitation 4. Resolution

HILDEGARD PEPLAU  ORIENTATION PHASE

 Problem defining phase  Starts when client meets nurse as stranger  Defining problem and deciding type of service needed  Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past experiences  Nurse responds, explains roles to client, helps to identify problems and to use available resources and services

HILDEGARD PEPLAU  IDENTIFICATION PHASE  Selection of appropriate professional assistance  Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness

HILDEGARD PEPLAU  EXPLOITATION PHASE  Use of professional assistance for problem solving alternatives  Advantages of services are used is based on the needs and interests of the patients  Individual feels as an integral part of the helping environment  They may make minor requests or attention getting techniques

 The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem  Patient may fluctuates on independence  Nurse must be aware about the various phases of communication  Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step

HILDEGARD PEPLAU  RESOLUTION PHASE  Termination of professional relationship  The patients needs have already been met by the collaborative effect of patient and nurse  Now they need to terminate their therapeutic relationship and dissolve the links between them.  Sometimes may be difficult for both as psychological dependence persists  Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals

HILDEGARD PEPLAU  MENTAL HEALTH PROCESS

APPLICATION OF THE THEORY

HILDEGARD PEPLAU 

APPLICATION OF THE THEORY

 Hays .D. (1961). Phases and steps of experimental teaching to patients of a concept of anxiety: Findings revealed that when taught by the experimental method, the patients were able to apply the concept of anxiety after the group was terminated.

 Burd .S.F. Develop and test a nursing intervention framework for working with anxious patients: Students developed competency in beginning interpersonal relationship.

SISTER CALISTA ROY  THE ADAPTATION MODEL

SISTER CALISTA ROY 

 Sr.Callista Roy- nurse theorist, writer, lecturer, researcher and teacher  Professor and Nurse Theorist at the Boston College of Nursing in Chestnut Hill  Born at Los Angeles on October 14, 1939.  Bachelor of Arts with a major in nursing - Mount St. Mary's College, Los Angeles in 1963.  Master's degree program in pediatric nursing - University of California ,Los Angeles in 1966.  Master’s and PhD in Sociology in 1973 and 1977.

SISTER CALISTA ROY  PERSON  Bio-psycho-social being in constant interaction with a changing environment  Uses innate and acquired mechanisms to adapt  An adaptive system described as a whole comprised of parts  Functions as a unity for some purpose  Includes people as individuals or in groups-families, organizations, communities, and society as a whole.

SISTER CALISTA ROY  ENVIRONMENT  Focal - internal or external and immediately confronting the person  Contextual- all stimuli present in the situation that contribute to effect of focal stimulus  Residual-a factor whose effects in the current situation are unclear  All conditions, circumstances, and influences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources, including focal, contextual and residual stimuli

SISTER CALISTA ROY 

SISTER CALISTA ROY  HEALTH  Inevitable dimension of person's life  Represented by a health-illness continuum  A state and a process of being and becoming integrated and whole

SISTER CALISTA ROY  NURSING  To promote adaptation in the four adaptive modes  To promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life, and dying with dignity by assessing behaviors and factors that influence adaptive abilities and by intervening to enhance environmental interactions

SISTER CALISTA ROY  THE CONCEPT OF ADAPTATION  Responding positively to environmental changes.  The process and outcome of individuals and groups who use conscious awareness, self reflection and choice to create human and environmental integration

SISTER CALISTA ROY 

APPLICATION OF THE THEORY

 Scientific knowledge for practice  Clinical assessment and intervention  Research variables  To guide nursing practice  To organize nursing education  Curricular frame work for various nursing colleges

PATRICIA BENNER   Patricia Benner introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences.  She proposed that one could gain knowledge and skills ("knowing how") without ever learning the theory ("knowing that"). AGREE

DISAGREE

MAYBE

PATRICIA BENNER   She conceptualizes in her writing about nursing skills as experience is a prerequisite for becoming an expert

PATRICIA BENNER   Patricia E. Benner, R.N., Ph.D., FAAN is a Professor Emerita at the University of California, San Francisco.  BA in Nursing - Pasadena College/Point Loma College  MS in Med/Surg nursing from UCSF  PhD -1982 from UC Berkeley  1970s - Research at UCSF and UC Berkeley

PATRICIA BENNER   LEVELS OF NURSING EXPERIENCE  She described 5 levels of nursing experience as;  Novice  Advanced beginner  Competent  Proficient  Expert

PATRICIA BENNER  Novice  Beginner with no experience  Taught general rules to help perform tasks  Rules are: context-free, independent of specific cases, and applied universally  Rule-governed behavior is limited and inflexible  Ex. “Tell me what I need to do and I’ll do it.”

PATRICIA BENNER  Advanced Beginner  Demonstrates acceptable performance  Has gained prior experience in actual situations to recognize recurring meaningful components  Principles, based on experiences, begin to be formulated to guide actions

PATRICIA BENNER  Competent  Typically a nurse with 2-3 years experience on the job in the same area or in similar day-to-day situations  More aware of long-term goals  Gains perspective from planning own actions based on conscious, abstract, and analytical thinking and helps to achieve greater efficiency and organization

PATRICIA BENNER  Proficient  Perceives and understands situations as whole parts  More holistic understanding improves decision-making  Learns from experiences what to expect in certain situations and how to modify plans

PATRICIA BENNER  Expert  No longer relies on principles, rules, or guidelines to connect situations and determine actions  Much more background of experience  Has intuitive grasp of clinical situations  Performance is now fluid, flexible, and highlyproficient

PATRICIA BENNER   Different levels of skills reflect changes in 3 aspects of skilled performance:  Movement from relying on abstract principles to using past concrete experiences to guide actions  Change in learner’s perception of situations as whole parts rather than in separate pieces  Passage from a detached observer to an involved performer, no longer outside the situation but now actively engaged in participation

Roper–Logan–Tierney Model of Nursing

  Theorists: Nancy Roper, Winifred W. Logan and Alison J. Tierney  One of the widely used nursing model in the United Kingdom.  Also referred as a Human Needs Model  A model of nursing care based on activities of daily living (ADLs).  Theory Sources  Virginia Henderson

Roper–Logan–Tierney Model of Nursing



 Activities of Living (ALs)  There are 12 activities, some of which are essential such as breathing and others that which enhance the quality of life.

Roper–Logan–Tierney Model of Nursing



 Maintaining a safe environment  Communication  Breathing  Eating and drinking  Elimination  Washing and dressing

 Controlling temperature  Mobilisation  Working and playing  Expressing sexuality  Sleeping  Death and dying

Madeleine Leininger   Madeleine Leininger is considered as the founder of the theory of transcultural nursing.  Her theory has now developed as a discipline in nursing.  Transcultural nursing theory is also known as Culture Care theory.

Madeleine Leininger   One of the first nursing theorist and transcultural global nursing consultant.  MSN - Catholic University in Washington DC.  PhD in anthropology University of Washington.

Madeleine Leininger   Transcultural Nursing  Transcultural nursing is a comparative study of cultures to understand similarities (culture universal) and difference (culturespecific) across human groups (Leininger, 1991).

Madeleine Leininger   Culture  Set of values, beliefs and traditions, that are held by a specific group of people and handed down from generation to generation.

Madeleine Leininger   Cultural awareness  It is an in-depth selfexamination of one's own background, recognizing biases and prejudices and assumptions about other people.

Madeleine Leininger   Culturally congruent care  Care that fits the people's valued life patterns and set of meanings -which is generated from the people themselves, rather than based on predetermined criteria.

Madeleine Leininger   Culturally competent care  is the ability of the practitioner to bridge cultural gaps in caring, work with cultural differences and enable clients and families to achieve meaningful and supportive caring.

Madeleine Leininger  Nursing Decisions

Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care. •Cultural preservation or maintenance. •Cultural care accommodation or negotiation. •Cultural care repatterning or restructuring.

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

JEAN WATSON 

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

JEAN WATSON 

Watson’s Concepts Person Human being to be valued, cared for, respected, nurtured, understood and assisted Environment Society Health Complete physical, mental and social well-being and functioning Nursing Concerned with promoting and restoring health, preventing illness

THANK YOU  JED 2013