Chap10 nrsgfrmk

Using Nursing Theory to Guide Professional Practice

Chapter 10

Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier Inc.

Background Theory-based practice

Provides a systematic, knowledgeable approach to patient care

Contributes to the professional growth of the nurse and the nursing profession as a whole

Nursing theory Provides a systematic, knowledgeable

approach to patient care Serves as a tool for critical thinking and

decision-making in nursing practiceCopyright © 2014, 2009 by Mosby, Inc., an

imprint of Elsevier Inc.

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Background (Cont'd) Philosophies

Express beliefs about nursing and nursing-related values

Provide broad, global explanations of phenomena of interest that contribute to nursing knowledge

Serve as guides for professional practice and influence professional behaviors

Nightingale, Watson, and Benner


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Background (Cont'd) Concepts

Are building blocks of a nursing theory that is initiated based on a personal philosophy or belief about nursing

May be abstract or concrete Describe and classify a phenomenon of

interest Thought of as an idea and must be clearly

defined Constructs

Similar to concepts but more abstractCopyright © 2014, 2009 by Mosby, Inc., an


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Background (Cont'd) Conceptual models or nursing

frameworks Structures that guide the development of

a study Also called paradigm (detailed organizing

framework) Interrelated definitions and concepts

organized for viewing phenomena specific to nursing

Levine, Orem, King, Newman, Roy, and Johnson Copyright © 2014, 2009 by Mosby, Inc., an


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Background (Cont'd) Theories

Integrated set of concepts and statements that can be used to explain, describe, predict, or control a phenomenon

May be developed using inductive or deductive reasoning Deductive reasoning

Proceeds from the general to the specific Inductive reasoning

Proceeds from the specific to the generalCopyright © 2014, 2009 by Mosby, Inc., an


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Background (Cont'd) Middle-range nursing theories

Answer specific nursing practice questions

Describe phenomena, explain relationships, and predict the effects of one phenomenon on another

Should be clear, simple, generalizable, important, and accessible

Orlando, Pender, Leininger, Newman, and Parse


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Theories in Support of Nursing Developmental or physiological theories

Maslow’s Theory of the Hierarchy of Needs

Erikson’s Theory of Psychosocial Development

Systems theory All parts of a system are connected A change in one part will have an effect

on another


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Theories in Support of Nursing (Cont'd)

Role theory Helps nurses function therapeutically in

interactions Helps to understand behaviors

Adaptation theory Helps nurses understand adjusting or

adapting to stimuli


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Nursing Philosophies Florence Nightingale

Philosophy of Nursing Describes the nurse’s function as one that puts

the patient in the best condition for nature (God) to act on him or her

Focuses on the environment and describes in detail the concepts of light, cleanliness, ventilation, warmth, diet, and noise

Three major relationships Environment to patient Nurse to environment Nurse to patient


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Nursing Philosophies (Cont'd) Virginia Henderson

Definition of Nursing Assist the individual, sick or well, in the

performance of those activities contributing to health or its recovery (or to a peaceful death)

Credited with integrating the view of holism into nursing

Identified 14 needs that can be broadly categorized in terms of physical, psychological, emotional, sociological, spiritual, or developmental needs


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Nursing Philosophies (Cont'd) Jean Watson

Philosophy of Science and Caring (originated 1979) Organized around 10 carative factors that

attempted to honor the human dimensions of nursing’s work and the subjective experiences of the people nurses serve

Caring-healing paradigm Commitment to self-care


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Nursing Philosophies (Cont'd) Patricia Benner

From Novice to Expert Focuses on clinical nursing practice and her

belief that nursing knowledge accrues over time

Five levels of skill acquisition1. Novice2. Advanced beginner3. Competent4. Proficient5. Expert


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Nursing Philosophies Question 1

A nurse is using a caring-healing paradigm with 10 carative factors to plan nursing care. Which nurse developed this philosophy?

1. Patricia Benner2. Jean Watson 3. Virginia Henderson4. Nola Pender


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ANSWER Jean Watson. Watson states that her original work was organized around

10 carative factors and believes that if an individual works from a caring-healing paradigm, then it must be lived out in daily life through a commitment to self-care.

1. Patricia Benner's philosophy (from Novice to Expert) focuses on clinical nursing practice and her belief that nursing knowledge accrues over time.

3. Virginia Henderson is well known for the definition of nursing, which states that nursing's primary responsibility is “to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a 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, p. 7).

4. Nola J. Pender developed the Health Promotion Model based on the belief that the patient assumes an active role in managing his or her own health.


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Nursing Theories Hildegard E. Peplau

Known as the mother of psychiatric nursing Theory of Interpersonal Relations (1952)

This is grounded in practice and based on the belief that the goal of nursing should be directed toward reducing dependence and encouraging autonomy.

Nurse, patient, health, and environment are interconnected and should be viewed within the context of the environment.

Interpersonal relationship occurs in interlocking and overlapping phases. Preorientation, orientation, working, and termination


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Nursing Theories (Cont'd) Ida Jean Orlando

Nursing Process Theory The goals of the nurse are to meet the immediate

needs of the patient and relieve distress or discomfort.

Nursing practice should be autonomous. Nurses must explore the patient’s thoughts, feelings,

and perceptions. Assessment includes verbal and nonverbal behaviors. Using the nursing process in the provision of nursing

care provides an overall framework for nursing and is effective in achieving a good outcome.


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Nursing Theories (Cont'd) Nola J. Pender

Health Promotion Model Based on the belief that the patient assumes an

active role in managing his or her own health Focuses on wellness and clarifies the nurse’s role

in health promotion Focuses on 10 determinants of health promoting

behavior: (1) prior related behavior, (2) personal factors, (3) perceived benefits to an action, (4) perceived barriers to an action, (5) perceived self-efficacy, (6) activity-related affect, (7) interpersonal influences, (8) situational influences, (9) commitment to a plan of action, and (10) intermediate competing demands and preferences


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Nursing Theories (Cont'd) Madeline Leininger

Culture Care Theory of Diversity and Universality The purpose is “to provide culturally congruent

nursing care in order to improve or offer a different kind of nursing care service to people of diverse or similar cultures” (Leininger, 1996, p. 72).

Distinguished the term transcultural nursing Leininger (1996, p. 75) stated that: “Nurses need to

realize that humans are complex beings who want their holistic views of life, care, culture, and health to remain together and do not want to be viewed as fragmented organs or body parts.”


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Nursing Theories (Cont'd) Margaret A. Newman

Theory of Health as Expanding Consciousness This focuses on patterns, life processes, and wholeness. Life process is a progression toward higher levels of

consciousness and health, and Newman believed that health and the evolving pattern of consciousness are the same.

Interactions that occur between the environment and the person are key processes.

Both health and illness can be seen as the manifestation of the pattern of the person-environment.

Nurses need to listen to the rhythm of another person's interactive pattern (irregular, difficult to sense, or chaotic); nurses need to “hang in there” with clients (patients) until a new rhythm emerges.


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Nursing Models Dorothy E. Johnson

Behavioral Systems Model This focuses on human behavior. The goals of nursing are to assess the internal

and external environments and help the patient select mutual goals and develop interventions.

Persons are composed of seven interrelated behavioral components (subsystems) that function together to form a whole. Attachment, dependency, ingestive, eliminative,

sexual, aggressive, achievement, restorative behavior


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Nursing Models (Cont'd) Imogene M. King

Theory of Goal Attainment Humans are composed of three interacting

systems (personal, interpersonal, and social). Human beings are the focus of nursing care. “Provides a process for human interactions that

lead to transactions and to goal attainment for individuals, families and communities .The structure is human beings transacting with their environment” (p. 62).

The goal is health for individuals, groups, society, and the world.


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Nursing Models (Cont'd) Myra E. Levine

Conservation Model It is based on three concepts: wholeness,

adaptation, and conservation. Conservation occurs in four areas: energy,

structural integrity, personal integrity, and social integrity.

Health or well-being of the patient (wholeness) is sustained through adaptation, a process of change in which conservation is the outcome.


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Nursing Models (Cont'd) Betty Neuman

Healthcare Systems Model A person is a complex system who responds to

stressors originating in both the internal and external environments.

It guides nursing practice at three levels of prevention: primary, secondary, and tertiary.

Nursing should treat the whole person, whereas systems (individuals, group, family, or community) are seen as being in constant change or motion, and interventions are aimed at maintaining stability.


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Nursing Models (Cont'd) Dorothea E. Orem

Theory of Self-Care Deficit Composed of three theories: nursing systems, self-care

deficit, and self-care Outcome of all nursing actions: promote self-care in all

individuals Defines activities of self-care as purposeful, ordered, and

learned Self-care agency: the degree to which a person is able to

participate in this Self-care deficit: the degree to which the patient is

unable to perform self-care Appropriate care developed through three operations:

diagnostic, prescriptive, and regulatoryCopyright © 2014, 2009 by Mosby, Inc., an


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Nursing Models (Cont'd) Sister Callista Roy

Roy Adaptation Model Based on adaptation and adaptive behaviors that

are produced by altering the environment Goal: promote adaptive responses through a six-

step nursing process Assessing behaviors, assessing stimuli, formulating a

nursing diagnosis, setting goals to promote adaptation, implementing interventions, and evaluating whether the goals have been met

Person: biopsychosocial adaptive system with physiologic, self-concept, role function, and interdependent modes


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Nursing Models Question 2A nurse wants to use Imogene King’s model to plan nursing care. Which principle should the nurse remember?

1. “The interpersonal relationship occurs in phases known as preorientation, orientation, working, and termination.”2. “Nursing practice will be guided towards three levels of prevention: primary, secondary, and tertiary.” 3. “Human beings are the focus of nursing care, and the goal is health for individuals, families, communities, and the world.”4. “Conservation is guided in four areas: energy, structural integrity, personal integrity, and social integrity.”


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answer. “Human beings are the focus of nursing care,

and the goal is health for individuals, families, communities, and the world.” According to Imogene King (1996), human beings are the focus of nursing care, and the goal of the framework is health for individuals, families, communities, and the world.

1. Peplau believed that the interpersonal relationship occurs in interlocking and overlapping phases known as preorientation, orientation, working, and termination.

2. The Healthcare Systems Model by Betty Neuman guides nursing practice at three levels of prevention: primary, secondary, and tertiary.

4. Conservation is guided by four principles: conservation of energy, conservation of structural integrity, conservation of personal integrity, and conservation of social integrity according to Myra Levine.


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Your Nursing Theory/Philosophy Personal nursing theory/philosophy

It will be up to you to choose the nursing theory most in line with your beliefs and appropriate to your practice.

This provides the rationales for why you do what you do and serves to guide nursing practice.

Developing a personal philosophy of nursing will require examination of your personal beliefs and professional practice and will reveal your growth as a nurse.


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