Summary of Theoretical Foundations of Nursing

Theorist ENVIRONMENTAL 1. Florence Nightingale Environmental Theory

INTERACTIVE 2. Hildegard Peplau Interpersonal Relations Theory

3. Virginia Henderson 14 Basic Human Needs

4. Joyce Travelbee Human-toHuman Relationship Model

-------------------------------------Metaparadigms-----------------------------------------------Person Health Environment Nursing Passive patient. Being well and Those elements Provided fresh air, using every power external to and warmth, cleanliness, that a person has to which affect the good diet, quiet to the fullest extent health of the sick facilitate person’s and healthy person; reparative process; includes everything nurse who is in from the pt’s food control of the and flowers to the patient’s patient’s verbal environment and non-verbal interactions with the pt Man who is an Symbolizes Forces outside the Significant, organism that lives movement of the organism and in therapeutic in an unstable personality and the context of the interpersonal balance of a given other ongoing socially-approved process; functions system human processes way of living, from cooperatively with that directs the which vital human human processes person towards social processes that present health creative, are derived such as as a possible goal constructive, norms, customs, for individuals productive and and beliefs community living Pt; an individual Quality of life and Settings in which I say that the nurse who requires is very basic for a an individual does for others what assistance to person to function learns unique they would do for achieve health and fully; requires pattern for living; themselves if they independence or in independence and all external had the strength, the some cases, a interdependence conditions and will, and the peaceful death influences that knowledge. But I go affect life and on to say that the development nurse makes the patient independent of him or her as soon as possible

Human being; a unique, irreplaceable individual who is in the process of becoming, evolving and changing

Subjective: an individually defined state of well being in accord with selfappraisal of physicalemotional-spiritual status Objective: an absence of discernible disease,

Associated with environment: Human conditions and life experiences encountered by all mean as sufferings, hope, pain and illness

An interpersonal process whereby the professional nurse practitioner assist an individual, family or community to prevent or cope with the experience of illness and suffering and if necessary, to find meaning in these experiences

Theory Components 12 Canons: Ventilation and warmth; Light; Cleanliness; Health of Houses; Noise; Bed and Bedding; Personal Cleanliness; Variety; Chattering Hopes and Advices; Taking food; Petty Management; Observation of the sick

4 phases of Nurse-Pt Relationship: Orientation; Identification; Exploitation; Resolution Nursing Roles: Stranger; Resource Person; Teacher; Leader; Surrogate; Counselor

14 Basic Needs Breathing normally; Eating and drinking adequately; Eliminating body wastes; Moving and maintaining a desirable position; Sleeping and resting; Selecting suitable clothes; Maintaining a normal body temperature by adjusting clothing and modifying the environment; Keeping the body clean and well groomed to promote integument; Avoiding dangers in the environment and avoiding injuring others; Communicating with others in expressing emotions, needs, fears or opinions; Worshipping according to one’s faith; Working in such a way that one feels a sense of accomplishment; Playing or participating in various forms of recreation; Learning, discovering or satisfying the curiosity that leads to normal development and health, and using available health facilities Human-to-human relationship model Original encounter; Emerging identities; Empathy; Sympathy; Rapport

----------------------------Application to:----------------------------Practice Education Research Environmental Development of Invented the aspects as integral excellent training “polar diagrams” part of nursing system in St. to analyze and care: good Thomas Hospital gather data ventilation; proper and King’s College disposal; control of Hospital in London; noise; sanitation; Scientific principles water treatments and practical experience in mastery of skills Provides clear design for the practice of psychiatric nursing; Emphasized the devt of interpersonal relationship between the pt and nurse Nurses as direct caregiver help pts to become independent

Author of “Interpersonal Relations in Nursing” which aids nurses; Formulated effective psychotherapeutic methods

Hospice is one of her essential contributions; Asserted that finding meaning in illness and suffering enables the patient not only to accept illness but it will also serve as a selfactualizing

The focus of Nursing education has shifted from a disease-oriented approach to holistic care approach; Stated that nursing programs need to offer a much broader background in communication techniques, values

Nurse’s education demands universal understanding of diverse human being; Designed three phases of curriculum development

Formulated concepts of anxiety as a means to constructively resolve angry feelings through experiential learning within the nurse-pt relationship Recommended library research; Advocated research as a way to improve practice

Utilized by various authors in their study of recently diagnosed cancer patients and their personal search for meaning

Theorist

Person

SYSTEMS 5. Betty Neuman Systems Model

Sees person (IFC/S) as an open system that works together with other parts of its body as it interact with the environment

6. Dorothy Johnson Behavioral Systems Model

Medicine focuses on biological system, nursing focuses on behavioural system

7. Imogene King Goal Attainment Theory

Exists in an open system as a spiritual and rational thinker who makes choices, selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique and holistic and have different needs, wants and goals An individual with physical and emotional requirements for development of self and

8. Dorothea Orem Self Care Deficit Theory in Nursing

Health disability, or defect as measured by physical examination, laboratory tests, assessment by a spiritual director, or psychological counsellor. Dynamic; depends upon which state of the health continuum they are in line with, the person maybe in line with the state of wellness or illness

Environment

Nursing

Theory Components

Can be internal, external and created forces that interact with a person’s state of health. Can be: intrapersonal or interpersonal

Requires a holistic approach, an approach that considers all factors affecting a client’s health

An elusive state that is affected by social, psychological, biological, and physiological factors

Not specifically defined but does say there is an internal and external environment

External regulatory force that is indicated only when there is instability

Ability of a person to adjust to the stressors that the internal and external environment exposes to the client

The process of balance involving internal and external interactions inside the social system

An act wherein the nurse interacts and communicates with the client

“Structural and functional soundness and wholeness of the individual” (Orem 1991).

Client’s surroundings which may affect their ability to perform their selfcare activities.

The acts of a specially trained and able individual to help a person or multiple people deal with their actual or

Practice experience

Education clarifications, and care of the dying

Research

Client Variables; Lines of Resistance, Normal Line of Defense, Flexible Line of Resistance, Stressors, Reaction, Prevention and Reconstitution; Prevention: Primary, Secondary, Tertiary

Goal-directed, integrated and holistic approach to client care; Formulated Neuman Nursing Process format: Nsg Dx, Nsg Goals, Nsg Outcomes

Additional clarification and generation of testable nursing theories; Guide model to enhance the nursing care of clients with specific physiological stressors

7 Behavioral Subsystems: Attachment or Affiliative; Dependency; Ingestive; Eliminative; Sexual; Aggressive; Achievement

Used assessment, disorders, tx and evaluation instead of nsg process; The behavioral system is said to determine and limit the interaction between the pt and his environment

Holistic curriculum; Provides an effective framework in conceptual evolution among levels of nursing students from diploma to associate to baccalaureate programs Focuses on the patient as a behavioral system and its dysfunction

Note: Nurse interacts simultaneously on 3 levels: Personal, Interpersonal & Social Self Care; Self Care Requisites: Universal , Developmental, Health Deviation; Therapeutic self-care demand; Self-care agency; Agent; Dependent care agent; Nursing Agency; Nursing Design

Utilized by professionals in most specialty areas; Developed the Goal Oriented Nursing Record (GONR) which is used to record goals and outcomes in patient settings

Nursing curriculum development and practice application in Ohio state and other universities

Described nursing mgt of Pertussis; Teaching self-care to Diabetic pts and ESRF; Pain assessment

Came up with the idea of a need for nsg-specific knowledge structure; Author of “Guides

Stated that nursing research would identify and explain the behavioral system disorders which arise in connection with illness and develop the rationale for the means of mgt Her work served as a theoretical bases for various studies

Developed a number of instruments for research; The 1st instrument

Theorist

Person maintenance of their well-being.

Health

Environment

Nursing potential self-care deficits.

Theory Components

Practice and control

Education for Developing Curriculum for the Education of Prac. Nurses” and “Foundations of Nsg and Its Practice”

Research developed named Exercise SelfCare Agency (ESCA)

Typology provided scientific body of knowledge and filled-in the gaps of weaknesses in nursing education

Believed that evidenced-based practice on scientific data has a great impact in nursing research

Nurse action 9. Faye Abdellah Typology of Nursing Problems

Individual having physical, emotional and sociological needs

“Total health needs”; “health state of mind and body”

Included in “planning for optimum health on local, state, national, and international levels”

comprehensive service that is based on an art and science and aims to help people, sick or well, cope with their health needs.

21 Nursing problems: Overt or Covert *see below Identify overt and covert nursing problems + solve overt and covert nursing problems = quality professional nursing care

Organized and systematic basis of nsg practice; Typology helps in efficient ADPIE; Uses scientific basis in PS

Basic to all pts: To promote good hygiene and physical comfort ;To promote optimal activity, exercise, rest, and sleep ;To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection; To maintain good body mechanics and prevent and correct deformities Sustenal Care Need To facilitate the maintenance of a supply of oxygen to all body cells; To facilitate the maintenance of nutrition of all body cells; To facilitate the maintenance of elimination; To facilitate the maintenance of fluid and electrolyte balance; To recognize the physiologic responses of the body to disease conditions; To facilitate the maintenance of regulatory mechanisms and functions; To facilitate the maintenance of sensory function Remedial Care To identify and accept positive and negative expressions, feelings, and reactions; To identify and accept the interrelatedness of emotions and organic illness; To facilitate the maintenance of effective verbal and nonverbal communication; To promote the development of productive interpersonal relationships; To facilitate progress toward achievement of personal spiritual goals; To create and maintain a therapeutic environment; To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs Restorative Care To accept the optimum possible goals in light of physical and emotional limitations; To use community resources as an aid in resolving problems arising from illness; To understand the role of social problems as influencing factors in the cause of illness.

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9. Faye Abdellah Typology of Nursing Problems

Individual having physical, emotional and sociological needs

“Total health needs”; “health state of mind and body”

Theorist DEVELOPMENTAL 10. Sr. Callista Roy Adaptation Model

Person Humans are holistic, adaptive systems; A whole with the parts that function in unity for some purpose; Not limited to just the individual can include; groups, families, organizations, communities, and society as a whole

Health A state and a process of being and becoming integrated as a whole person; Reflection of adaptation that is the interaction of the person and the environment

11. Madeleine Leininger Transcultural Nursing

Humans are believed to be caring and capable and to be able to be concerned about the needs, well being, and survival to others

Is a state of well being that is culturally defined, valued and practiced and which reflects the ability of individuals or groups to perform their culturally expressed, beneficially and patterned lifeways.

Included in “planning for optimum health on local, state, national, and international levels” Environment Includes all the conditions, circumstances, and influences surrounding and affecting the development and behaviours of the person; Stimuli include can be categorized as focal, contextual and residual; Internal and External

comprehensive service that is based on an art and science and aims to help people, sick or well, cope with their health needs. Nursing Acts to enhance the interaction of the person with the environment to promote adaptation; A science and practice that expands adaptive abilities and enhances person and environmental transformation.

21 Nursing problems: Overt or Covert *see below Identify overt and covert nursing problems + solve overt and covert nursing problems = quality professional nursing care

It is about the worldview, social structure and environmental context.

Learned humanistic and scientific profession and discipline which is focused on human care phenomena and activities in order to assist, support, facilitate individual to maintain their well being in culturally, meaningful and beneficial ways

Three models of Actions and Decisions: Culture Care Preservation or Maintenance; Culture Care Accomodation; Culture Care Restructuring or Repatterning

Theory Components

Organized and systematic basis of nsg practice; Typology helps in efficient ADPIE; Uses scientific basis in PS Practice Manipulating the stimuli and not the patient; Nurses enhance the interaction of person and their environment thus improving health

Prepares nurses to prevent culture shock and conflicts as they practice with different cultures; Provides human care and health behaviours as background knowledge to understand nursing phenomena

Typology provided scientific body of knowledge and filled-in the gaps of weaknesses in nursing education Education Development of curriculum devt in various institutions; Three vertical strands in the curriculum: The adapting person, Health-illness; Nursing Management; Two horizontal strands in the curriculum: Nursing process, Student adaptation and leadership Helps produce a well-qualified faculty prepared in Transcultural Nursing to teach and guide students; Education in Transcultural Nursing leads to culturally competent nursing care

Believed that evidenced-based practice on scientific data has a great impact in nursing research Research Development and testing of theories; Practice-based research; Development of programs of research; Development of adaptation research instruments

Focused on culture care; With research method of (ethnonursing) to examine theories

Theorist 12. Jean Watson Philosophy and Science of Caring

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Person A human being has needs (biophysical, psychophysical, psychosocial and intrapersonal) that are to be valued, respected, supported and cared for.

Health Health is viewed in a holistic approach; it is being able to function mentally, physically, spiritually, and socially to your full capacity.

Environment The environment should be conducive to holistic healing (mentally, physically, socially, spiritually) as it is critical to the patients well being.

Nursing The contact and the bond between two individuals is the foundation of nursing. Providing professional, caring, and thoughtful interactions in order to promote holistic health and prevent illness.

Theory Components The original theory developed in 1979, was organized around 10 carative factors: Formation of a Humanistic-altruistic system of values; Instillation of faith-hope; Cultivation of sensitivity to one's self and to others; Development of a helping-trusting, human caring relationship; Promotion and acceptance of the expression of positive and negative feelings; Systematic use of a creative problem-solving caring process; Promotion of transpersonal teaching-learning; Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment; Assistance with gratification of human needs; Allowance for existential-phenomenological-spiritual forces.

Practice Caring as an essential field in nursing; Example in clinical setting (ICUs, NICUs, Pedia and Gerentological Units)

Education Author of “Nursing: Human Science and Human Care- a Theory of Nursing”; Described the Core Nursing as aspects of the nurse-patient relationship resulting in a therapeutic result

Research Research Must focus on both subjective and objective patient outcomes in knowing that caring is important in nursing

As Jean developed her theory over time, she became to change these carative factors into clinical caritas processes. These included: • Formation of humanistic-altruistic system of values, becomes: "Practice of loving-kindness and equanimity within context of caring consciousness • Instillation of faith-hope, becomes: "Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and one-being-cared- for"; • Cultivation of sensitivity to one's self and to others, becomes: "Cultivation of one's own spiritual practices and transpersonal self, going beyond ego self"; • Development of a helping-trusting, human caring relationship, becomes: "Developing and sustaining a helping-trusting, authentic caring relationship"; • Promotion and acceptance of the expression of positive and negative feelings, becomes: "Being present to, and supportive of the expression of positive and negative feelings as a connection with deeper spirit of self and the one-being-cared-for"; • Systematic use of a creative problem-solving caring process, becomes: "creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices"; • Promotion of transpersonal teaching-learning, becomes: "Engaging in genuine teaching-learning experience that attends to unity of being and meaning attempting to stay within other's frame of reference"; • Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment, becomes: "Creating healing environment at all levels, (physical as well as non-physical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated"; • Assistance with gratification of human needs, becomes: "assisting with basic needs, with an intentional caring consciousness, administering ‘human care essentials', which potentiate alignment of mindbody-spirit, wholeness, and unity of being in all aspects of care"; tending to both embodied spirit and evolving spiritual emergence;

Theorist •

Person Health Environment Nursing Theory Components Practice Education Research Allowance for existential-phenomenological-spiritual forces, becomes: "opening and attending to spiritual-mysterious, and existential dimensions of one's own life-death; soul care for self and the onebeing-care-for.