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Gloria A. Hagopian, RN, EdD 6/10/2014 1
Nursing Theorists
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Definitions
Theory- a set of related statements thatdescribes or explains phenomena in a
systematic wayConcept-a mental idea of a phenomenon
Construct- a phenomena that cannot be
observed and must be inferred
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Definitions
Proposition- a statement ofrelationship between concepts
Conceptual model- made up ofconcepts and propositions
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Nursing Theorists
Florence Nightingale, HildegardPeplau, Virginia Henderson, Fay
Abdella, Ida Jean Orlando, DorothyJohnson, Martha Rogers, DorotheaOrem, Imogene King, Betty Neuman,
Sister Calista Roy, Jean Watson,Rosemary Rizzo Parse, MadeleineLeininger, Patricia Benner
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Concepts in the
nursing metaparadigm
Person
Recipient of care, including physical,spiritual, psychological, and socioculturalcomponents
Individual, family, or community
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Concepts in the nursing
metaparadigmEnvironment
All internal and external conditions,circumstances, and influences affectingthe person
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Concepts in the nursing
metaparadigmHealth
Degree of wellness or illness experiencedby the person
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Concepts in the nursing
metaparadigmNursing
Actions, characteristics and attributes ofperson giving care
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Florence Nightingale
Environmental 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
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Nightingales Concepts
PersonPatient who is acted on by nurse
Affected by environment
Has reparative powers
Environment
Foundation of theory. Includedeverything, physical, psychological, andsocial
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Nightingales Concepts
Health
Maintaining well-being by using a
persons powersMaintained by control of environment
NursingProvided fresh air, warmth, cleanliness,
good diet, quiet to facilitate personsreparative process
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Hildegard PeplauInterpersonal Relations
Model
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Hildegard PeplauInterpersonal
Relations Model
Based on psychodynamic nursing
using an understanding of ones ownbehavior to help others identify theirdifficulties
Applies principles of human relationsPatient has a felt need
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Peplaus Concepts
Person
An individual; a developingorganism who tries to reduce anxietycaused by needs
Lives in instable equilibrium
Environment- Not defined
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Peplaus Concepts
Health
Implies forward movement of thepersonality and human processestoward creative, constructive,
productive, personal, andcommunity living
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Peplaus Concepts
Nursing
A significant, therapeutic,interpersonal process that functionscooperatively with others to make
health possibleInvolves problem-solving
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Virginia Henderson
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Virginia Henderson
The Nature of Nursing
The unique function of the nurse is to
assist the individual, sick or well, inthe performance of those activitiescontributing to health or its recovery
(or to peaceful death) that he wouldperform unaided if he had thenecessary strength, will, or knowledge.
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Virginia Henderson
And to do this in such a way as to helphim gain independence as rapidly as
possible. She must in a sense, getinside the skin of each of her patientsin order to know what he needs.
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Virginia HendersonShe is temporarily theconsciousness of the unconscious,
the love of life for the suicidal, theleg of the amputee, the eyes of thenewly blind, a means of locomotion
for the infant, knowledge andconfidence for the young mother, themouthpiece for those too weak or
withdrawn to speak, and so on.
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Fay Abdella- Topology of
21 Nursing Problems
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Fay AbdellaTopology of 21 Nursing
Problems
A list of 21 nursing problems
Condition presented or faced by thepatient or family.
Problems are in 3 categories
physical, social and emotional
The nurse must be a good problemsolver
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Abdellas ConceptsNursingA helping profession
A comprehensive service to meet patients
needsIncreases or restores self-help ability
Uses 21 problems to guide nursing care
Health
Excludes illness
No unmet needs and no actual oranticipated impairments
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Abdellas Concepts
Person
One who has physical, emotional, orsocial needs
The recipient of nursing care.
Environment
Did not discuss much
Includes room, home, and community
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Ida Jean Orlando
Deliberative Nursing Process
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Ida Jean Orlando
Deliberative Nursing Process The deliberative nursing process is set in
motion by the patients behavior
All behavior may represent a cry for help.Patients behavior can be verbal or non-verbal.
The nurse reacts to patients behavior and
forms basis for determining nurses acts.
Perception, thought, feeling
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Ida Jean OrlandoDeliberative Nursing
Process
Nurses actions should be deliberative,
rather than automatic Deliberative actions explore the
meaning and relevance of an action.
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Dorothy Johnson
Behavioral Systems Model
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Dorothy Johnson
Behavioral Systems ModelThe person is a behavioral system
comprised of a set of organized,
interactive, interdependent, andintegrated subsystems
Constancy is maintained through
biological, psychological, and sociologicalfactors.
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Dorothy Johnson
Behavioral SystemsModelA steady state is maintained through
adjusting and adapting to internal andexternal forces.
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Johnsons 7 Subsystems
Affiliative subsystem
social bonds
Dependencyhelping or nuturing
Ingestive
food intake
Eliminative
excretion
D h J h
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Dorothy JohnsonBehavioral Systems
Model 7 Sub Systems
Sexual
procreation and gratification
Agressive
self-protection and preservation
Achievement
efforts to gain mastery and control
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Johnsons Concepts
Person
A behavioral system comprised ofsubsystems constantly trying to maintain
a steady state
Environment
Not specifically defined but does say
there is an internal and externalenvironment
D h J h
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Dorothy JohnsonBehavioral Systems
Model
Health
Balance and stability.Nursing
External regulatory force that is indicated
only when there is instability.
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Martha Rogers
Unitary Human Beings
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Martha Rogers
Unitary Human Beings Energy fields
Fundamental unity of things that are
unique, dynamic, open, and infiniteUnitary man and environmental field
Universe of open systems
Energy fields are open, infinite, andinteractive
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Martha Rogers
Unitary Human Beings Pattern
Characteristic of energy field
A wave that changes, becomes complexand diverse
Four dimensionality
A nonlinear domain with out time orspace
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Rogers Definitions
Integrality
Continuous and mutual interaction
between man and environmentResonancy
Continuous change longer to shorter
wave patterns in human andenvironmental fields
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Martha Rogers
Unitary Human BeingsHelicy
Continuous, probabilistic, increasing
diversity of the human andenvrionmental fields.
Characterized by nonrepeatingrhymicities
Change
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Dorothea Orem
Self-Care Model
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Dorothea Orem
Self-Care ModelSelf-care comprises those activities
performed independently by an
individual to promote and maintainperson well-being
Self care agency is the individualsability to perform self care activities
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Dorothea Orem
Self-Care ModelSelf- care deficit occurs when the
person cannot carry out self-care
The nurse then meets the self-careneeds by acting or doing for;guiding,
teaching, supporting or providing theenvironment to promote patientsability
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Dorothea Orem
Self-Care ModelWholly compensatory nursing system
Patient dependent
Partially compensatoryPatient can meet some needs but needs
nursing assistance
Supportive educativePatient can meet self care requisites, but
needs assistance with decision making orknowledge
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Imogene King
Goal Attainment Theory
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Imogene King
Goal Attainment TheoryOpen systems framework
Human beings are open systems in
constant interaction with the environmentPersonal System
individual; perception, self, growth,development, time space, body image
Interpersonal
Society
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Imogene King
Goal Attainment TheoryPersonal SystemIndividual; perception, self, growth,
development, time space, body image
Interpersonal
Socialization; interaction, communicationand transaction
Society
Family, religious groups, schools, work,peers
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Imogene King
Goal Attainment TheoryThe nurse and patient mutually
communicate, establish goals and take
action to attain goals
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Imogene King
Goal Attainment TheoryEach individual brings a different set
of values, ideas, attitudes, perceptions
to exchange
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Betty Neuman
Systems Model
Betty Neuman
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Betty NeumanHealth Care
Systems ModelThe person is a complete system, with
interrelated parts
maintains balance and harmonybetween internal and externalenvironment by adjusting to stress
and defending against tension-producing stimuli
Betty Neuman
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Betty NeumanHealth Care
Systems ModelFocuses on stress and stress reduction
Primarily concerned with effects ofstress on health
Stressors are any forces that alter the
systems stability
Betty Neuman
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Betty NeumanHealth Care
Systems ModelFlexible lines of resistance
Surround basic core
Internal factors that help defend againststressors
Normal line of resistanceNormal adaptation state
Flexible line of defenseProtective barrier, changing, affected by
variables
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Betty Neuman
Systems ModelWellness is equilibrium
Nursing interventions are activites to:strengthen flexible lines of defense
strengthen resistence to stressors
maintain adaptation
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Sister Calista Roy
Adaptation Model
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Sister Calista Roy
Adaptation ModelFive Interrelated Essential Elements
Patiency- The person receiving care
Goal of nursing- Adapting to change
Health-Being and becoming a wholeperson
Environment
Direction of nursing activities-Facilitating adaptation
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Sister Calista Roy
Adaptation ModelThe person is an open adaptive system
with input (stimuli), who adapts by
processes or control mechanisms(throughput)
The output can be either adaptiveresponses or ineffective responses
Jean Watson
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Jean WatsonPhilosophy and Science of
Caring
Jean Watson
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Jean WatsonPhilosophy and
Science of Caring
Caring can be demonstrated and
practicedCaring consists of carative factors
Caring promotes growth
A caring environment accepts a personas he is and looks to what the personmay become
Jean Watson
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Jean WatsonPhilosophy and
Science of Caring
A caring environment offers
development of potential
Caring promotes health better
than curingCaring is central to nursing
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Watsons 10 Carative
Factors
Forming humanistic-altruistic
value systemInstilling faith-hope
Cultivating sensitivity to self andothers
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Watsons 10 Carative
Factors
Developing helping-trust
relationshipPromoting expression of feelings
Using problem-solving fordecision making
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Watsons 10 Carative
Factors
Promoting teaching-learning
Promoting supportive environmentAssisting with gratification of human
needs
Allowing for existential-phenomenological forces
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Watsons Concepts
Person
Human being to be valued, cared
for, respected, nurtured, understoodand assisted
Environment
Society
Jean Watson
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Jean WatsonPhilosophy and
Science of CaringHealth
Complete physical, mental andsocial well-being and functioning
Nursing
Concerned with promoting andrestoring health, preventing illness
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Rosemary Parse
Human Becoming TheoryHuman Becoming Theory includes
Totality Paradigm
Man is a combination of biological,psychological, sociological and spiritualfactors
Simultaneity ParadigmMan is a unitary being in continuous,
mutual interaction with environment
Originally Man-Living-Health Theory
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Parses Three Principles
Meaning
Mans reality is given meaning through
lived experiencesMan and environment cocreate
Rhythmicity
Man and environment cocreate ( imaging,valuing, languaging) in rhythmicalpatterns
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Parses Three Principles
Cotranscendence
Refers to reaching out and beyondthe limits that a person sets
One constantly transforms
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Rosemary Parse
Human BecomingTheoryPerson
Open being who is more than and
different from the sum of the partsEnvironment
Everything in the person and his
experiencesInseparable, complimentary to and
evolving with
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Rosemary Parse
Health
Open process of being and becoming.Involves synthesis of values
Nursing
A human science and art that uses anabstract body of knowledge to servepeople
Human BecomingTheory
Madeleine Leininger
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Madeleine LeiningerCulture Care Diversity and
UniversalityBased on transcultural nursing, whose
goal is to provide care congruent withcultural values, beliefs, and practices
Sunrise model consists of 4 levels thatprovide a base of knowledge fordelivering cultural congruent care
M d l i L i i
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Madeleine Leininger
Culture Care DiversityModes of nursing actionCultural care preservation
help maintain or preserve health, recoverfrom illness, or face death
Cultural care accommodation
help adapt to or negotiate for a beneficial
health status, or face deathCultural care re-patterning
help restructure or change lifestyles that areculturally meaningful
P i i B
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Patricia Benner
From Novice to Expert
Patricia Benner
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Patricia BennerFrom Novice to
Expert
Described 5 levels of nursing
experience and developed exemplarsand paradigm cases to illustrate eachlevel
Patricia Benner
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Patricia BennerFrom Novice to
ExpertLevels reflect:
movement from reliance on past abstractprinciples to the use of past concreteexperience as paradigms
change in perception of situation as a
complete whole in which certain parts arerelevant
Patricia Benner
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Patricia BennerFrom Novice to
Expert
Novice
Advanced beginnerCompetent
Proficient
Expert
I t f Th ti l
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Importance of Theoretical
FrameworksFoundation of any profession is the
development of a specialized body ofknowledge. Theories should bedeveloped in nursing, not borrowtheories form other disciplines
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Next Steps
Responsibility of nurses to know andunderstand theorists
Critically analyze theoreticalframeworks