Gloria A. Hagopian, RN, EdD 4/8/2020 1
Nursing Theorists
Week 11 and 12
Gloria A. Hagopian, RN, EdD 4/8/2020 2
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
Gloria A. Hagopian, RN, EdD 4/8/2020 3
Definitions
Proposition- a statement of relationship between concepts
Conceptual model- made up of concepts and propositions
Gloria A. Hagopian, RN, EdD 4/8/2020 4
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
Gloria A. Hagopian, RN, EdD 4/8/2020 5
Concepts in the nursing metaparadigm
Person Recipient of care, including physical, spiritual, psychological, and sociocultural components
Individual, family, or community
Gloria A. Hagopian, RN, EdD 4/8/2020 6
Concepts in the nursing metaparadigm
EnvironmentAll internal and external conditions, circumstances, and influences affecting the person
Gloria A. Hagopian, RN, EdD 4/8/2020 7
Concepts in the nursing metaparadigm
HealthDegree of wellness or illness experienced by the person
Gloria A. Hagopian, RN, EdD 4/8/2020 8
Concepts in the nursing metaparadigm
NursingActions, characteristics and attributes of person giving care
Gloria A. Hagopian, RN, EdD 4/8/2020 9
Florence NightingaleEnvironmental Theory
First nursing theorist
Unsanitary conditions posed health hazard (Notes on Nursing, 1859)
5 components of environment
ventilation, light, warmth, effluvia, noise
External influences can prevent, suppress or contribute to disease or death
Gloria A. Hagopian, RN, EdD 4/8/2020 10
Nightingale’s ConceptsPerson
Patient who is acted on by nurse
Affected by environment
Has reparative powers
Environment
Foundation of theory. Included everything, physical, psychological, and social
Gloria A. Hagopian, RN, EdD 4/8/2020 11
Nightingale’s Concepts
Health
Maintaining well-being by using a person’s powers
Maintained by control of environment
Nursing
Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate person’s reparative process
Gloria A. Hagopian, RN, EdD 4/8/2020 12
Hildegard PeplauInterpersonal Relations Model
Gloria A. Hagopian, RN, EdD 4/8/2020 13
Hildegard PeplauInterpersonalRelations Model
Based on psychodynamic nursing
using an understanding of one’s own behavior to help others identify their difficulties
Applies principles of human relations
Patient has a felt need
Gloria A. Hagopian, RN, EdD 4/8/2020 14
Peplau’s Concepts
Person
An individual; a developing organism who tries to reduce anxiety caused by needs
Lives in instable equilibrium
Environment- Not defined
Gloria A. Hagopian, RN, EdD 4/8/2020 15
Peplau’s Concepts
Health
Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living
Gloria A. Hagopian, RN, EdD 4/8/2020 16
Peplau’s Concepts
Nursing
A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible
Involves problem-solving
Gloria A. Hagopian, RN, EdD 4/8/2020 17
Virginia Henderson
Gloria A. Hagopian, RN, EdD 4/8/2020 18
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.
Gloria A. Hagopian, RN, EdD 4/8/2020 19
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”.
Gloria A. Hagopian, RN, EdD 4/8/2020 20
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.”
Gloria A. Hagopian, RN, EdD 4/8/2020 21
Fay Abdella- Topology of 21 Nursing Problems
Gloria A. Hagopian, RN, EdD 4/8/2020 22
Fay AbdellaTopology of 21 Nursing Problems
A list of 21 nursing problems
Condition presented or faced by the patient or family.
Problems are in 3 categories
physical, social and emotional
The nurse must be a good problem solver
Gloria A. Hagopian, RN, EdD 4/8/2020 23
Abdella’s ConceptsNursing
A helping profession
A comprehensive service to meet patient’s needs
Increases or restores self-help ability
Uses 21 problems to guide nursing care
Health
Excludes illness
No unmet needs and no actual or anticipated impairments
Gloria A. Hagopian, RN, EdD 4/8/2020 24
Abdella’s Concepts
Person
One who has physical, emotional, or social needs
The recipient of nursing care.
Environment
Did not discuss much
Includes room, home, and community
Gloria A. Hagopian, RN, EdD 4/8/2020 25
Ida Jean OrlandoDeliberative Nursing Process
Gloria A. Hagopian, RN, EdD 4/8/2020 26
Ida Jean OrlandoDeliberative Nursing Process
The deliberative nursing process is set in motion by the patient’s behavior
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.
Perception, thought, feeling
Gloria A. Hagopian, RN, EdD 4/8/2020 27
Ida Jean OrlandoDeliberative NursingProcess
Nurses’ actions should be deliberative, rather than automatic
Deliberative actions explore the meaning and relevance of an action.
Gloria A. Hagopian, RN, EdD 4/8/2020 28
Dorothy JohnsonBehavioral Systems Model
Gloria A. Hagopian, RN, EdD 4/8/2020 29
Dorothy JohnsonBehavioral Systems Model
The person is a behavioral system comprised of a set of organized, interactive, interdependent, and integrated subsystems
Constancy is maintained through biological, psychological, and sociological factors.
Gloria A. Hagopian, RN, EdD 4/8/2020 30
Dorothy JohnsonBehavioral Systems Model
A steady state is maintained through adjusting and adapting to internal and external forces.
Gloria A. Hagopian, RN, EdD 4/8/2020 31
Johnson’s 7 Subsystems
Affiliative subsystem
social bonds
Dependency
helping or nuturing
Ingestive
food intake
Eliminative
excretion
Gloria A. Hagopian, RN, EdD 4/8/2020 32
Dorothy JohnsonBehavioral Systems Model 7 Sub Systems
Sexual
procreation and gratification
Agressive
self-protection and preservation
Achievement
efforts to gain mastery and control
Gloria A. Hagopian, RN, EdD 4/8/2020 33
Johnson’s Concepts
Person
A behavioral system comprised of subsystems constantly trying to maintain a steady state
Environment
Not specifically defined but does say there is an internal and external environment
Gloria A. Hagopian, RN, EdD 4/8/2020 34
Dorothy JohnsonBehavioral Systems Model
Health
Balance and stability.
Nursing
External regulatory force that is indicated only when there is instability.
Gloria A. Hagopian, RN, EdD 4/8/2020 35
Martha RogersUnitary Human Beings
Gloria A. Hagopian, RN, EdD 4/8/2020 36
Martha RogersUnitary Human Beings
Energy fields
Fundamental unity of things that are unique, dynamic, open, and infinite
Unitary man and environmental field
Universe of open systems
Energy fields are open, infinite, and interactive
Gloria A. Hagopian, RN, EdD 4/8/2020 37
Martha RogersUnitary Human Beings
Pattern
Characteristic of energy field
A wave that changes, becomes complex and diverse
Four dimensionality
A nonlinear domain with out time or space
Gloria A. Hagopian, RN, EdD 4/8/2020 38
Roger’s Definitions
Integrality
Continuous and mutual interaction between man and environment
Resonancy
Continuous change longer to shorter wave patterns in human and environmental fields
Gloria A. Hagopian, RN, EdD 4/8/2020 39
Martha RogersUnitary Human Beings
Helicy
Continuous, probabilistic, increasing diversity of the human and envrionmental fields.
Characterized by nonrepeating rhymicities
Change
Gloria A. Hagopian, RN, EdD 4/8/2020 40
Dorothea OremSelf-Care Model
Gloria A. Hagopian, RN, EdD 4/8/2020 41
Dorothea OremSelf-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
Gloria A. Hagopian, RN, EdD 4/8/2020 42
Dorothea OremSelf-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
Gloria A. Hagopian, RN, EdD 4/8/2020 43
Dorothea OremSelf-Care Model
Wholly compensatory nursing system
Patient dependent
Partially compensatory
Patient can meet some needs but needs nursing assistance
Supportive educative
Patient can meet self care requisites, but needs assistance with decision making or knowledge
Gloria A. Hagopian, RN, EdD 4/8/2020 44
Imogene KingGoal Attainment Theory
Gloria A. Hagopian, RN, EdD 4/8/2020 45
Imogene KingGoal Attainment Theory
Open systems framework
Human beings are open systems in constant interaction with the environment
Personal System
individual; perception, self, growth, development, time space, body image
Interpersonal
Society
Gloria A. Hagopian, RN, EdD 4/8/2020 46
Imogene KingGoal Attainment Theory
Personal System
Individual; perception, self, growth, development, time space, body image
Interpersonal
Socialization; interaction, communication and transaction
Society
Family, religious groups, schools, work, peers
Gloria A. Hagopian, RN, EdD 4/8/2020 47
Imogene KingGoal Attainment Theory
The nurse and patient mutually communicate, establish goals and take action to attain goals
Gloria A. Hagopian, RN, EdD 4/8/2020 48
Imogene KingGoal Attainment Theory
Each individual brings a different set of values, ideas, attitudes, perceptions to exchange
Gloria A. Hagopian, RN, EdD 4/8/2020 49
Betty NeumanSystems Model
Gloria A. Hagopian, RN, EdD 4/8/2020 50
Betty NeumanHealth CareSystems Model
The person is a complete system, with interrelated parts
maintains balance and harmony between internal and external environment by adjusting to stress and defending against tension-producing stimuli
Gloria A. Hagopian, RN, EdD 4/8/2020 51
Betty NeumanHealth CareSystems 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
Gloria A. Hagopian, RN, EdD 4/8/2020 52
Betty NeumanHealth CareSystems Model
Flexible lines of resistanceSurround basic core
Internal factors that help defend against stressors
Normal line of resistanceNormal adaptation state
Flexible line of defenseProtective barrier, changing, affected by variables
Gloria A. Hagopian, RN, EdD 4/8/2020 53
Betty NeumanSystems Model
Wellness is equilibrium
Nursing interventions are activites to:
strengthen flexible lines of defense
strengthen resistence to stressors
maintain adaptation
Gloria A. Hagopian, RN, EdD 4/8/2020 54
Sister Calista RoyAdaptation Model
Gloria A. Hagopian, RN, EdD 4/8/2020 55
Sister Calista RoyAdaptation Model
Five Interrelated Essential Elements
Patiency- The person receiving care
Goal of nursing- Adapting to change
Health-Being and becoming a whole
person
Environment
Direction of nursing activities-
Facilitating adaptation
Gloria A. Hagopian, RN, EdD 4/8/2020 56
Sister Calista RoyAdaptation 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
Gloria A. Hagopian, RN, EdD 4/8/2020 57
Jean WatsonPhilosophy and Science of Caring
Gloria A. Hagopian, RN, EdD 4/8/2020 58
Jean WatsonPhilosophy 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
Gloria A. Hagopian, RN, EdD 4/8/2020 59
Jean WatsonPhilosophy and Science of Caring
A caring environment offers development of potential
Caring promotes health better than curing
Caring is central to nursing
Gloria A. Hagopian, RN, EdD 4/8/2020 60
Watson’s 10 Carative Factors
Forming humanistic-altruistic value system
Instilling faith-hope
Cultivating sensitivity to self and others
Gloria A. Hagopian, RN, EdD 4/8/2020 61
Watson’s 10 Carative Factors
Developing helping-trust relationship
Promoting expression of feelings
Using problem-solving for decision making
Gloria A. Hagopian, RN, EdD 4/8/2020 62
Watson’s 10 Carative Factors
Promoting teaching-learning
Promoting supportive environment
Assisting with gratification of human needs
Allowing for existential-phenomenological forces
Gloria A. Hagopian, RN, EdD 4/8/2020 63
Watson’s Concepts
Person
Human being to be valued, cared for, respected, nurtured, understood and assisted
Environment
Society
Gloria A. Hagopian, RN, EdD 4/8/2020 64
Jean WatsonPhilosophy and Science of Caring
Health
Complete physical, mental and social well-being and functioning
Nursing
Concerned with promoting and restoring health, preventing illness
Gloria A. Hagopian, RN, EdD 4/8/2020 65
Rosemary ParseHuman Becoming Theory
Human Becoming Theory includes Totality Paradigm
Man is a combination of biological, psychological, sociological and spiritual factors
Simultaneity Paradigm
Man is a unitary being in continuous, mutual interaction with environment
Originally Man-Living-Health Theory
Gloria A. Hagopian, RN, EdD 4/8/2020 66
Parse’s Three Principles
Meaning
Man’s reality is given meaning through lived experiences
Man and environment cocreate
Rhythmicity
Man and environment cocreate ( imaging, valuing, languaging) in rhythmical patterns
Gloria A. Hagopian, RN, EdD 4/8/2020 67
Parse’s Three Principles
Cotranscendence
Refers to reaching out and beyond the limits that a person sets
One constantly transforms
Gloria A. Hagopian, RN, EdD 4/8/2020 68
Rosemary ParseHuman BecomingTheory
Person
Open being who is more than and different from the sum of the parts
Environment
Everything in the person and his experiences
Inseparable, complimentary to and evolving with
Gloria A. Hagopian, RN, EdD 4/8/2020 69
Rosemary Parse
Health
Open process of being and becoming. Involves synthesis of values
Nursing
A human science and art that uses an abstract body of knowledge to serve people
Human BecomingTheory
Gloria A. Hagopian, RN, EdD 4/8/2020 70
Madeleine LeiningerCulture 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
Gloria A. Hagopian, RN, EdD 4/8/2020 71
Madeleine LeiningerCulture Care Diversity
Modes of nursing action
Cultural care preservationhelp maintain or preserve health, recover from illness, or face death
Cultural care accommodation
help adapt to or negotiate for a beneficial health status, or face death
Cultural care re-patterning
help restructure or change lifestyles that are culturally meaningful
Gloria A. Hagopian, RN, EdD 4/8/2020 72
Patricia Benner From Novice to Expert
Gloria A. Hagopian, RN, EdD 4/8/2020 73
Patricia Benner From Novice toExpert
Described 5 levels of nursing experience and developed exemplars and paradigm cases to illustrate each level
Gloria A. Hagopian, RN, EdD 4/8/2020 74
Patricia Benner From Novice toExpert
Levels reflect:
movement from reliance on past abstract principles to the use of past concrete experience as paradigms
change in perception of situation as a complete whole in which certain parts are relevant
Gloria A. Hagopian, RN, EdD 4/8/2020 75
Patricia Benner From Novice toExpert
Novice
Advanced beginner
Competent
Proficient
Expert
Gloria A. Hagopian, RN, EdD 4/8/2020 76
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
Gloria A. Hagopian, RN, EdD 4/8/2020 77
Next Steps
Responsibility of nurses to know and understand theorists
Critically analyze theoretical frameworks