Gloria A. Hagopian, RN, EdD 04/20/23 1

Nursing TheoristsNursing Theorists

Week 11 and 12

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DefinitionsDefinitions

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

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DefinitionsDefinitions

Proposition- a statement of relationship between concepts

Conceptual model- made up of concepts and propositions

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Nursing TheoristsNursing 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

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Concepts in the Concepts in the nursing nursing metaparadigmmetaparadigm

Person Recipient of care, including

physical, spiritual, psychological, and sociocultural components

Individual, family, or community

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Concepts in the Concepts in the nursing nursing metaparadigmmetaparadigm

Environment All internal and external

conditions, circumstances, and influences affecting the person

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Concepts in the Concepts in the nursing nursing metaparadigmmetaparadigm

Health Degree of wellness or illness

experienced by the person

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Concepts in the Concepts in the nursing nursing metaparadigmmetaparadigm

Nursing Actions, characteristics and

attributes of person giving care

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Florence Florence NightingaleNightingale

Environmental Environmental TheoryTheory 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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Nightingale’s Nightingale’s ConceptsConcepts Person

Patient who is acted on by nurse Affected by environment Has reparative powers

Environment Foundation of theory. Included

everything, physical, psychological, and social

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Nightingale’s Nightingale’s ConceptsConcepts

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

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Hildegard PeplauHildegard PeplauInterpersonal Interpersonal Relations ModelRelations Model

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Hildegard PeplauHildegard PeplauInterpersonalInterpersonal Relations Model Relations 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

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Peplau’s ConceptsPeplau’s Concepts

Person An individual; a developing

organism who tries to reduce anxiety caused by needs

Lives in instable equilibrium Environment- Not defined

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Peplau’s ConceptsPeplau’s Concepts

Health Implies forward movement of

the personality and human processes toward creative, constructive, productive, personal, and community living

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Peplau’s ConceptsPeplau’s Concepts

Nursing A significant, therapeutic,

interpersonal process that functions cooperatively with others to make health possible

Involves problem-solving

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Virginia HendersonVirginia Henderson

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Virginia Virginia Henderson Henderson

The Nature of The Nature of NursingNursing“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.

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Virginia Virginia HendersonHendersonAnd 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”.

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Virginia HendersonVirginia 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.”

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Fay Abdella- Fay Abdella- Topology of 21 Nursing Topology of 21 Nursing ProblemsProblems

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Fay AbdellaFay AbdellaTopology of 21 Nursing Topology of 21 Nursing ProblemsProblems

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

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Abdella’s ConceptsAbdella’s Concepts Nursing

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

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Abdella’s Abdella’s ConceptsConcepts

Person One who has physical, emotional,

or social needs The recipient of nursing care.

Environment Did not discuss much Includes room, home, and

community

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Ida Jean OrlandoIda Jean OrlandoDeliberative Nursing Deliberative Nursing ProcessProcess

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Ida Jean OrlandoIda Jean OrlandoDeliberative Nursing Deliberative Nursing ProcessProcess

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

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Ida Jean OrlandoIda Jean OrlandoDeliberative NursingDeliberative Nursing Process Process

Nurses’ actions should be deliberative, rather than automatic Deliberative actions explore the

meaning and relevance of an action.

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Dorothy JohnsonDorothy JohnsonBehavioral Systems Behavioral Systems ModelModel

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Dorothy JohnsonDorothy JohnsonBehavioral Systems Behavioral Systems ModelModel

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.

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Dorothy JohnsonDorothy JohnsonBehavioral Systems Behavioral Systems ModelModel

A steady state is maintained through adjusting and adapting to internal and external forces.

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Johnson’s 7 Johnson’s 7 SubsystemsSubsystems

Affiliative subsystem social bonds

Dependency helping or nuturing

Ingestive food intake

Eliminative excretion

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Dorothy JohnsonDorothy JohnsonBehavioral Systems Behavioral Systems Model 7 Sub Model 7 Sub SystemsSystems

Sexual procreation and gratification

Agressive self-protection and preservation

Achievement efforts to gain mastery and

control

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Johnson’s ConceptsJohnson’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

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Dorothy JohnsonDorothy JohnsonBehavioral Systems Behavioral Systems ModelModel

Health Balance and stability.

Nursing External regulatory force that is

indicated only when there is instability.

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Martha RogersMartha RogersUnitary Human Unitary Human

BeingsBeings

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Martha RogersMartha RogersUnitary Human Unitary Human

BeingsBeings 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

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Martha RogersMartha RogersUnitary Human Unitary Human BeingsBeings

Pattern Characteristic of energy field A wave that changes, becomes

complex and diverse Four dimensionality

A nonlinear domain with out time or space

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Roger’s DefinitionsRoger’s Definitions

Integrality Continuous and mutual

interaction between man and environment

Resonancy Continuous change longer to

shorter wave patterns in human and environmental fields

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Martha RogersMartha RogersUnitary Human Unitary Human BeingsBeings

Helicy Continuous, probabilistic,

increasing diversity of the human and envrionmental fields.

Characterized by nonrepeating rhymicities

Change

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Dorothea OremDorothea OremSelf-Care ModelSelf-Care Model

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Dorothea OremDorothea OremSelf-Care ModelSelf-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

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Dorothea OremDorothea OremSelf-Care ModelSelf-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

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Dorothea OremDorothea OremSelf-Care ModelSelf-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

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Imogene KingImogene KingGoal Attainment Goal Attainment TheoryTheory

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Imogene KingImogene KingGoal Attainment Goal Attainment TheoryTheory

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

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Imogene KingImogene KingGoal Attainment Goal Attainment TheoryTheory Personal System

Individual; perception, self, growth, development, time space, body image

Interpersonal Socialization; interaction,

communication and transaction Society

Family, religious groups, schools, work, peers

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Imogene KingImogene KingGoal Attainment Goal Attainment TheoryTheory

The nurse and patient mutually communicate, establish goals and take action to attain goals

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Imogene KingImogene KingGoal Attainment Goal Attainment TheoryTheory

Each individual brings a different set of values, ideas, attitudes, perceptions to exchange

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Betty NeumanBetty NeumanSystems ModelSystems Model

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Betty NeumanBetty NeumanHealth CareHealth CareSystems ModelSystems 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

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Betty NeumanBetty NeumanHealth CareHealth CareSystems ModelSystems 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

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Betty NeumanBetty NeumanHealth CareHealth CareSystems ModelSystems Model

Flexible lines of resistance Surround basic core Internal factors that help defend

against stressors

Normal line of resistance Normal adaptation state

Flexible line of defense Protective barrier, changing,

affected by variables

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Betty NeumanBetty NeumanSystems ModelSystems Model

Wellness is equilibrium

Nursing interventions are activites to:

strengthen flexible lines of defense

strengthen resistence to stressors maintain adaptation

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Sister Calista RoySister Calista RoyAdaptation ModelAdaptation Model

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Sister Calista RoySister Calista RoyAdaptation ModelAdaptation 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

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Sister Calista RoySister Calista RoyAdaptation ModelAdaptation 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

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Jean WatsonJean WatsonPhilosophy and Philosophy and Science of CaringScience of Caring

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Jean WatsonJean WatsonPhilosophy and Philosophy and Science of Caring 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

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Jean WatsonJean WatsonPhilosophy and Philosophy and Science of CaringScience of Caring

A caring environment offers development of potential

Caring promotes health better than curing

Caring is central to nursing

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Watson’s 10 Carative Watson’s 10 Carative FactorsFactors

Forming humanistic-altruistic value system

Instilling faith-hope Cultivating sensitivity to

self and others

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Watson’s 10 Carative Watson’s 10 Carative FactorsFactors

Developing helping-trust relationship

Promoting expression of feelings

Using problem-solving for decision making

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Watson’s 10 Carative Watson’s 10 Carative FactorsFactors

Promoting teaching-learning Promoting supportive

environment Assisting with gratification of

human needs Allowing for existential-

phenomenological forces

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Watson’s Watson’s Concepts Concepts

Person Human being to be valued,

cared for, respected, nurtured, understood and assisted

Environment Society

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Jean WatsonJean WatsonPhilosophy and Philosophy and Science of CaringScience of Caring

Health Complete physical, mental and

social well-being and functioning

Nursing Concerned with promoting and

restoring health, preventing illness

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Rosemary ParseRosemary Parse Human Becoming Human Becoming Theory 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

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Parse’s Three Parse’s Three PrinciplesPrinciples

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

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Parse’s Three Parse’s Three PrinciplesPrinciples

Cotranscendence Refers to reaching out and

beyond the limits that a person sets

One constantly transforms

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Rosemary ParseRosemary Parse Human Human BecomingTheory 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

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Rosemary ParseRosemary 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 BecomingTheoryHuman BecomingTheory

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Madeleine LeiningerMadeleine LeiningerCulture Care Culture Care Diversity and Diversity and UniversalityUniversality

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

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Madeleine LeiningerMadeleine LeiningerCulture Care Culture Care DiversityDiversity Modes of nursing action

Cultural care preservation help 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

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Patricia Benner Patricia Benner From Novice to From Novice to ExpertExpert

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Patricia Benner Patricia Benner From Novice toFrom Novice to Expert Expert

Described 5 levels of nursing experience and developed exemplars and paradigm cases to illustrate each level

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Patricia Benner Patricia Benner From Novice toFrom Novice to Expert Expert

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

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Patricia Benner Patricia Benner From Novice toFrom Novice to Expert Expert

Novice Advanced beginner Competent Proficient Expert

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Importance of Importance of Theoretical Theoretical FrameworksFrameworks

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

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Next Steps Next Steps

Responsibility of nurses to know and understand theorists

Critically analyze theoretical frameworks