Post on 01-Nov-2014
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Nursing Theories
1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING
THEORY• Often considered the first
nurse theorist
• Defined nursing as “the act of utilizing the environment of the patient to assist him in his recovery”.
• Nightingale’s theory remains
an integral part of nursing and healthcare today.
1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING
THEORY• 5 Factors for a Healtthy
Environment:
– Pure or fresh air– Pure water– Efficient drainage– Cleanliness– Light, especially direct
sunlight
Nightingale’s general concepts of Environmental Sanitation includes:
Proper VentilationAdequate LightingCleanlinessAdequate WarmthQuietDiet
1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING THEORY
Application:A.Nursing Practice
The principles of Nursing Practice by FN arecontinuously used to this very day. With the advent of technology and with it globalization, comes threats from the environment.
> Global Warming> Industrial Noise> Air Pollution> Fad Diets> Vanity
Nurses of today still needs to: Maintain Adequate Ventilation Promote Adequate & Appropriate Nutrition Maintain Normal Homeostatic Body
Temperature Observe Basic Hygiene Comfort Measures including Environmental
Sanitation
1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING THEORY
B. Nursing EducationSt. Thomas & King’s College Hospital in London
- able to provide framework for the establishment of Nursing Training Schools through a Universal template that contains principles of nursing training. It included instruction in Scientific Principles & Practical Experience for the mastery of skills
- FN advocated the separation of nursing training from hospital to more appropriate learning environment in the School or University setting. This was advocated for FN believed the SN’s role is to learn the Art & Science of Nursing before being employed in the Nursing Service.
- FN is also a strong proponent of practice nursing in education. She believed that Good Nursing only come from Good Education
1) FLORENCE NIGHTINGALE: ENVIRONMENTAL NURSING THEORY
2) VIRGINIA HENDERSON:FOURTEEN FUNDAMENTAL
NEEDS
Assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs
• Patient-centered
• Virginia Henderson’s 14 Fundamental Needs of a Person
1) Breathing normally2) Eating and drinking adequately3) Eliminating body waste4) Moving and maintaining a desirable
position5) Sleeping and resting6) Selecting suitable clothes7) Maintaining body temperature within
normal range by adjusting clothing and modifying the environment
2) VIRGINIA HENDERSON:FOURTEEN FUNDAMENTAL NEEDS
2) VIRGINIA HENDERSON:FOURTEEN FUNDAMENTAL NEEDS
8) Keeping the body clean and well groomed to protect the integument9) Avoiding dangers in the environment and avoiding injuring others10) Communicating with others in expressing emotions, needs, fears, or opinions11) Worshipping according to one’s faith12) Working in a such way that one feels a sense of accomplishment13) Playing or participating in various forms of recreation14) Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities
Application:
Bedside Nursing- pt.’s ability to perform the 14 basic
needs should be assessed before considering the kind of nursing care function you will administer. Essential to determine if the N will be performing as a HELPER, DOER or a PARTNER
Nsg interventions are implemented according to the 14 basic human needs of the patient. The degree of performance, involvement of the pt. and the level of nursing activity will be dependent on the specific role the nurse will be playing
2) VIRGINIA HENDERSON:FOURTEEN FUNDAMENTAL NEEDS
3) FAYE ABDELLA:PROBLEM SOLVING APPROACH TO
21 NURSING PROBLEMS• Focus is on PROPER
IDENTIFICATION of the problem
• Particularly about the proper NURSING DIAGNOSIS
• Nurse-centered
21 Nursing Problems
1.To maintain good hygiene.2.To promote optimal activity:
exercise, rest, and sleep.3.To promote safety.4.To maintain good body
mechanics.5.To facilitate the maintenance
of supply of oxygen.6.To facilitate maintenance of
nutrition.7.To facilitate maintenance of
elimination.
3) FAYE ABDELLA:PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS
8.To facilitate the maintenance of fluid and electrolytes balance.
9.To recognize the physiologic response of the body to disease conditions.
10.To facilitate the maintenance of regulatory mechanisms and functions.
11.To facilitate the maintenance of sensory function.
12.To identify and accept positive and negative expressions, feelings and reactions.
.
3) FAYE ABDELLA:PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS
13.To identify and accept the interrelatedness of emotions and illness
14. To facilitate the maintenance of effective verbal and non-verbal communication.
15. To promote the development of productive interpersonal relationship.
16. To facilitate progress toward achievement of personal spiritual goals.
17. To create and maintain a therapeutic environment.
3) FAYE ABDELLA:PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS
3) FAYE ABDELLA:PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS
18. To facilitate awareness of self as an individual with varying needs.19. To accept the optimum possible goals.20.To use community resources as an aid in resolving problems arising from illness.21.To understand the role of social problems as influencing factors.
Application:• Bedside Nursing
The N’s ability to address & effectively manage the 21 Nursing problems will spell the patient’s state of health – whether he fully recovers well & fast, or deteriorate further with devastating consequences
Ns therefore, have very important role to play. By adhering to these nursing problems, the work of a N becomes More Definite
3) FAYE ABDELLA:PROBLEM SOLVING APPROACH TO 21 NURSING PROBLEMS
4) MADELEINE LEININGER:TRANSCULTURAL NURSING THEORY
• Nursing is a HUMANISTIC and SCIENTIFIC mode of helping through CULTURE-SPECIFIC PROCESS
• Emphasizes human caring varies among cultures
• Culture Care Preservation and Maintenance
• Culture Care Accommodation and Negotiation
• Culture Care Restructuring and Repatterning
4) MADELEINE LEININGER:TRANSCULTURAL NURSING THEORY
Application:Important esp because of the rapid
expansion of knowledge & increasing globalization with the advent of advances in ICT.
Working OverseasImpt to learn the cultures of other
people because each culture has its own sets of patterns, expressions & values of caring.
Getting acquainted with the culture of a country you are seeking employment as a professional nurse will be a good stepping stone towards a more fulfilling career in nursing.
5) MARTHA ROGERSSCIENCE of UNITARY HUMAN BEING
Views the person as a irreducible whole, the whole being greater than the sum of its parts– Man is composed of energy fields,
which are in constant interaction with the environment
– Seek to promote harmonic interactions between the two energy fields (Human and Environmental)
ApplicationHer theory is relevant in
today’s nurses focusing on the Totality of the Person. Nurses should strive to promote symphonic interaction between the 2 energy fields in order to strengthen the coherence & integrity of the person.
5) MARTHA ROGERSSCIENCE of UNITARY HUMAN BEING
Patient has THREE (3) interacting systems
– Individuals / Personal systems How the nurse views and
integrates self based from personal goals and beliefs.
– Group systems / Interpersonal systems
How the N interrelates w/ a co-workers or pt. particularly in N-Pt. relationship
– Social systemshow the N interacts w/ co-workers,
superiors, subordinates & the ct. environment in general
6) IMOGENE KINGGOAL ATTAINMENT THEORY
6) IMOGENE KINGGOAL ATTAINMENT THEORY
Action A means of behavior or activities that are
towards the accomplishment of certain act. It is both PHYSICAL & MENTAL. Mental (POA)
Action (Goal Setting w/ Ct.)
Perform Achieve GoalReaction
A form of reacting or response to a certainStimuli.
InteractionAny situation wherein the N relates & deals
With a ct. or pt.
Transaction
Application:Provides enough direction to
how nurses should be able to behave or act in the presence of pts. Since majority of nursing activities involves direct interaction w/ pts., Ns should understand the basic implications of the Action-Reaction-Interaction-Transaction model of the N-Pt. Relationship.
6) IMOGENE KINGGOAL ATTAINMENT THEORY
Peplau is a psychiatric nurse
– Focus: Therapeutic process
– Attained through: Healthy Nurse-Patient Relationship
7) HILDEGARD PEPLAUINTERPERSONAL RELATIONS MODEL
• Four (4) Phases of Nurse-Patient Interaction
1. Orientation• Nurse and patient test
the role each one assumes
• Prepares patient for termination
• Patient identifies areas of difficulty
7) HILDEGARD PEPLAUINTERPERSONAL RELATIONS MODEL
2. Identification Phase• Patient identifies with
the personnel who can satisfy his needs
3. Exploitation Phase• Nurse maximizes all the
resources to benefit the patient
7) HILDEGARD PEPLAUINTERPERSONAL RELATIONS MODEL
4. Resolution Phase or Termination Phase• Occurs when patient’s
needs have been met
7) HILDEGARD PEPLAUINTERPERSONAL RELATIONS MODEL
ApplicationSignificant in terms of the different phases of the N-Pt. interaction & the different ROLES the N can play in giving nursing care to pts. It thus becomes important for nurses to understand the principles behind each of these concepts so that clinical nsg will be more meaningful for the nurse. Eventually, this will translate to pt. outcomes like:Improved healthPrevention of Disease prEnhancement of care faculties
7) HILDEGARD PEPLAUINTERPERSONAL RELATIONS MODEL
8) JEAN WATSON: HUMAN CARING MODEL
• Nursing involves the application of ART and HUMAN SCIENCE through TRANSPERSONAL TRANSACTIONS in order to help the person achieve mind, body and soul harmony
8) JEAN WATSON: HUMAN CARING MODEL
7 Assumptions on the Science of Caring
1. Caring can be effectively demonstrated & practiced only interpersonally
2. Effective caring promotes health and individual or family growth
3. Caring responses accept a person not only as he or she is now but as what he or she may become
4. A caring envi. Is one that offers the dev’t of potential while allowing the person to choose the best action for himself at a given point in time.
8) JEAN WATSON: HUMAN CARING MODEL
5. Caring is more “healthogenic” than is curing. The practice of caring integrates biophysical knowledge w/ knowledge of human behavior to generate or promote hx & to provide care to those who are ill. A science of caring is therefore complementary to the science of curing
6. The practice of caring is central to nursing
8) JEAN WATSON: HUMAN CARING MODEL
10 CARATIVE FACTORS1. Formation of a Humanistic-Altruistic
system of values2. Instillation of faith-Hope3. Cultivation of sensitivity to one’s self & to
others4. Development of a helping-trusting,
human caring relationship5. Promotion and acceptance of the
expression of positive & negative feelings;
6. Systematic use of a creative problem-solving caring process
8) JEAN WATSON: HUMAN CARING MODEL
10 CARATIVE FACTORS
7. Promotion of transpersonal teaching-learning
8. Provision for a supportive, protective and corrective mental, physical, societal & spiritual environment
9. Assistance with gratification of human needs
10. Allowance for existential-phenomenological-spiritual forces
8) JEAN WATSON: HUMAN CARING MODEL
Application:Her model of nursing reflects & embodies
the TRUE ESSENCE or nursing profession to this very day. It viewed the pt. as the Mind-Body-Spirit entity that needs holistic nursing care. It thus becomes a must for all nurses to view each pt. in the light of the caring theory of Watson.
One major implication of the theory is in the realm of Bedside Nursing, where Ns of today have particularly begun to neglect. The essence of nursing is in the caring aspect & caring is taking the wholeness, the totality of the pt. into consideration. It is every Ns duty & obligation to care for his pt. not by merely looking into and caring for his physical dse.but try to care for the pt. for who he is.
9) IDA JEAN ORLANDO: NURSING PROCESS THEORY
The Nursing Process is an interaction of Three Basic Elements:1. Patient’s Behavior2. Nurse’s reaction3. Nursing Actions – designed for the patient’s benefit
The Role of the Nurse is to find out & meet the Pt’s stat need for help. Ns should use his perception, thoughts about the perception or the feeling engendered from their thoughts to explore with patients the meaning of their behavior
9) IDA JEAN ORLANDO: NURSING PROCESS THEORY
The use of the theory keeps the N’s focus on the patient
Application:The Theory increases the Therapeutic Effectiveness of nurses by
the expression of Empathy, Warmth & Genuineness esp in the light of addressing the Stat Need of the Patient for help. This framework will be important for Ns who are assigned in special clinical areas that requires quick decision making & critical thinking skills.
If the patient’s condition improved, then the intervention is effective and the patient moves on to new problems
10) JOYCE TRAVELBEE INTERPERSONAL ASPECTS OF NURSING THEORY
Human to Human Relationship Greatly emphasized on the Therapeutic Human Relationship between the Nurse & the Patient.
Her model emphasizes:EmpathySympathyRapport & the Emotional aspects of Nursing
4 Interlocking Phases that precedes RAPPORT And the establishment of N-Pt. Relationship:
Original Encounter Emerging Identities Empathy Sympathy
10) JOYCE TRAVELBEE INTERPERSONAL ASPECTS OF NURSING THEORY
Human to Human Relationship
Application:The theory describes the
various stages of interpersonal elations that occur bet a Patient and a N. It thus becomes important for Ns to fully understand the phases and its effects to the patient’s welfare. Due consideration should be given to the pt’s inherent personal characteristics to interact w/ other people, most especially Ns & other members of the healthcare professions.
The key concept of Empthy, Sympathy, Rapport & Emotional Understanding are very important for the Ns of today because it makes the patient feel human.
11) NOLA PENDER: HEALTH PROMOTION MODEL
• Focuses on 10 Categories of determinants of health-Promoting Behaviors.
• Views a person’s health-promoting behavior in the light of his individual characteristics & experiences
11) NOLA PENDER: HEALTH PROMOTION MODEL
• The 10 Determinants are:– Prior related behavior– Perceived benefits of action– Perceived barriers of action– Perceived self-efficacy– Activity related effect– Interpersonal Influences (family,
friends, providers) norms, support & models
– Situational Influences ( options, demand characteristics, aesthetics)
– Immediate competing demands (low control) and preferences (high demand)
– Commitment to a plan of action– Personal Factors ( Biological,
Psychological, Sociocultural)
11) NOLA PENDER: HEALTH PROMOTION MODEL
Application:
Health Promotion Activities are the
major Focus of Hx Care Organizations.
In order for Patients to take on the
Behaviour we, Hx care professionals,
advise them to take, we should carefully
looked into a host of factors that can
influence his decision to really adopt the
behaviour. It is important for Ns to be ROLE MODELS
for the pts.
12) BETTY NEUMAN: HEALTH CARE SYSTEMS MODEL
• The model is based on the Person’s Relationship to Stress, his Reaction to it and Reconstitution factors that are dynamic in nature
• The concern of nursing is to PREVENT STRESS INVASION
12) BETTY NEUMAN: HEALTH CARE SYSTEMS MODEL
• Person is viewed as an Open System composed of Basic Structure of Energy Resources which includes:
• Physiologic• Psychologic• Sociocultural• Developmental• Spiritual
12) BETTY NEUMAN: HEALTH CARE SYSTEMS MODEL
Basic Structure/Central Core- surrounded by 2 concentric boundaries or Rings called Lines Of Resistance which represents the internal factors that AID the person Defend against a Stressor.
Lines of Resistance – further surrounded by 2 lines of Defense1. Normal Line of Defense2. Flexible Line of Defense
12) BETTY NEUMAN: HEALTH CARE SYSTEMS MODEL
1. Normal Line of Defense- person’s state of equilibrium
or the state of adaptation developed& maintained over time and which isconsidered normal for the person
2. Flexible Line of Defense- dynamic and can be readily and
rapidly changed over a short period of time.
- adjusts to situations that threatens the imbalance w/in the client’s stability
Stressors:Intrapersonal InterpersonalExtrapersonal
12) BETTY NEUMAN: HEALTH CARE SYSTEMS MODEL
FOCUS of Nursing Interventions :- keeping or maintaining the stability of the open system which can be carried out on three levels of prevention
APPLICATIONVery comprehensive model of nsg that outlines the
way how Ns provide HOLISTIC NURSING CARE topts. Emphasis is on the management of Stress thru adequate understanding of the complex client
system.Strong Advocate of Prevention Interventions which iscongruent to the aims of modern-day nsg & Hxcare services. It is a MUST that Ns perform thorough & comprehensive assessment that includes ALL aspects of the Ct.
13) SISTER CALISTA ROY: ADAPTATION MODEL
• Man is a BIOPSYCHOSOCIAL BEING
• Four (4) modes of Adaptation– Physiologic Mode– Self Concept– Role Function– Interdependence
13) SISTER CALISTA ROY: ADAPTATION MODEL
Her Model is best exemplified in the Nursing Process which includes the following steps:1. Assessment of Behavior2. Assessment of Stimuli3. Nursing Diagnosis4. Goal Setting5. Intervention6. Evaluation
13) SISTER CALISTA ROY: ADAPTATION MODEL
APPLICATIONBest applied in the performance of the Nursing
Process which is cyclical in nature. The Assessment component is the Stimuli or InputThe Planning & Implementation are the Throughput
process.The Evaluation which provides necessary feedback to the
Goal of care is the Output.The N decides what necessary actions should be
taken next in the light of the patient’s response to the NursingInterventions. This action by the N is Adaptation in its simplest terms
Patients adopt too. The Nursing interventions we performultimately elicits a response from them. Depending on the nature & extent of the nursing interventions, pts may or may not actually adopt according to our expectations
14) DOROTHEA OREM: SELF CARE AND
SELF CARE DEFICIT THEORYThree (3) Nursing Systems based
on Art of Care of Patient Needs
• 1. Wholly Compensatory or Total Compensatory
– For paralyzed patients, for ICU patients
• 2. Partial Compensatory– Patient performs some of
nursing care needs
• 3. Supportive-Educative– For up and about patient
14) DOROTHEA OREM: SELF CARE AND
SELF CARE DEFICIT THEORYAPPLICATION
The elements of the theory clearly emphasizethe need to understand the importance of self- care in the Promotion and maintenance ofHealth & Wellbeing.
Focus on the pt’s capacity/ability to perform self-care activities in order to determine which self-care activities to perform for the client.
The model emphasizes on Education & Supportive Measures
Health Education – very important
aspect of clinical nursing today
15) PATRICIA BENNER NURSING EXPERTISE MODEL
Her concern is:“How do Nurses learn to
do Nursing”Experience-based skill acquisition – is safer & quicker when it is founded on a sound educational base
Skill – refers to Nursing interventions and Clinical judgment skills in actual clinical situations.As the N gains experience, Clinical knowledge becomes a GOOD MIX of PRACTICAL & THEORETICAL KNOWLEDGE
15) PATRICIA BENNER NURSING EXPERTISE MODEL
LEVELS OF SKILL ACQUISITION:
1. Novice2. Advanced Beginner3. Competent4. Proficient5. Expert
15) PATRICIA BENNER NURSING EXPERTISE MODEL
APPLICATION
Instrumental in differentiating knowledge development & career progression in Nursing.
It is important for Nursing students and professional nurses alike to learn through Experience or by Experiential Learning. Learning by experience will allow you to gain Mastery of a given skill.
16) LYDIA HALLCORE, CARE, CURE MODEL
Individuals could be conceptualized in
3 Separate Domains:
1. CARE – hands on bodily care
2. CORE – using the self in relationship to the client
3. CURE – applying medical knowledge
Nurses function in all 3 Domains but in
different Degrees.
1. CURE – limited to helping patients/families deals w/ the measures instituted by the physician
2. CARE – exclusive for nursing
3. CORE – shared w/ Social workers, Psychologists, Clergy & other Professionals
16) LYDIA HALLCORE, CARE, CURE MODEL
APPLICATION
Foundation for classifying the Professional N’s functions today. Ns are able to carry out Nursing Interventions INDEPENDENTLY
DEPENDENTLY INTERDEPENDENTLY
CORE – maintains that it is the N responsibility to make sure that the client receives the highest level of care possible from all concerned Hx Professionals. Ns ROLES: COLLABORATOR, COORDINATOR and in COOPERATION with other members of the HX team that pertains to PATIENT’S WELFARE.
16) LYDIA HALLCORE, CARE, CURE MODEL
CURE – clearly delineates nursing functions that are DEPENDENT on the members of the Medical Profession. Interventions carried out needs a written order from the doctor/s
CARE – refers to the independent roles & functions of the Nurse insofar as her knowledge & skills about the patient’s condition will allow her to carry on with her Nursing Responsibilities
17) MYRA LEVINE:FOUR CONSERVATION
PRINCIPLES OF NURSING• 1. Conservation of
Energy– Example: complete
bed rest without bathroom privileges
• 2. Conservation of Structural Integrity– Example: turn patient
from side to side every two hours to avoid bed sores
17) MYRA LEVINE:FOUR CONSERVATION
PRINCIPLES OF NURSING• 3. Conservation of
Personal Integrity– Example: maintain
patient’s privacy
• 4. Conservation of Social Integrity– Example: maintenance
of patient’s relationships
17) MYRA LEVINE:FOUR CONSERVATION
PRINCIPLES OF NURSINGAPPLICATION
Ns should be able to identify themany Nurse-Patient activities whichare implied in the 4 Conservation Models. It can be applied to geriatric nursing where majority of the elderly pts will have some problems in at least 2 of the conservation models.
Structural integrity focuses on the body’s ability to ward of infections & other bodily harm. It means that it is important to keep these barriers – skin & mucous membranes - intact
18) MARJORIE GORDON:HUMAN FUNCTIONAL HEALTH PATTERNS
– Focus is on Eleven (11) Health Patterns
– Advantage to the nurse:
• It enables the nurse to determine the client’s response as functional or dysfunctional
18) MARJORIE GORDON:HUMAN FUNCTIONAL HEALTH PATTERNS
• Eleven Functional Health Patterns
– Health perception– Nutritional / Metabolic– Elimination– Activity and Exercise
Pattern– Cognitive Perceptual
Pattern
18) MARJORIE GORDON:HUMAN FUNCTIONAL HEALTH PATTERNS
• Eleven Functional Health Patterns– Sleep and Rest– Self perception / Self
concept– Role Relationship
Pattern– Sexuality /
Reproductive– Coping-Stress-
Tolerance– Value Belief Patterns
18) MARJORIE GORDON:HUMAN FUNCTIONAL HEALTH PATTERNS
SISTER LETTY G. KUANDissertation: “Retirement & Role Discontinuities”
“I have grown and sown and now I can reap the reward & blessing of a life lived in joy & love, for I too have made
others grow”
RetirementRole Discontinuities
(Aging Process)Change of Life
OutcomeFruitful Retirement
And Aging
Determinants of Fruitful Aging Prepared retirement Health Status Income Family Constellation Self-preparation
CONCEPTUAL MODEL
CARMENCITA ABAQUINDissertation: “PREPARE ME” Interventions & the Quality of Life of Advance Progressive Cancer
Patients“To Nursing… may be able to
provide the care that our clients need in maintaining their quality of life and being instrumental in “Birthing” them to External life”CONCEPTUAL FRAMEWORK
Holistic Nursing Intervention“PREPARE ME” PresenceReminisce TherapyPrayerRelaxation ActivitiesMeditationValue Clarification
Terminally ILL Patients(CANCER)
PhysicalPsychological
SocialReligious
Level of IndependenceEnvironment
Spiritual
QUALITYOF LIFE