Unit I-n200 Nursing Theories

Unit I-N200Unit I-N200NURSING THEORIESNURSING THEORIES

Prepared by:Prepared by:

N200 TeamN200 Team

Introduction Introduction Nursing as a unique health care discipline, Nursing as a unique health care discipline,

has 2 essential aspects: a body of knowledge has 2 essential aspects: a body of knowledge & the application of that knowledge through & the application of that knowledge through clinical nursing practice.clinical nursing practice.

This body of knowledge called KNOWLEDGE This body of knowledge called KNOWLEDGE BASE or the science of nursing provide the BASE or the science of nursing provide the rationale for nursing interventions.rationale for nursing interventions.

The nurse will also use the knowledge base The nurse will also use the knowledge base developed specifically for nursing thru’ theory developed specifically for nursing thru’ theory development & research. development & research.

NURSING KNOWLEDGENURSING KNOWLEDGE

KNOWLEDGE is an awareness of the KNOWLEDGE is an awareness of the reality one acquires through learning or reality one acquires through learning or investigation. Every individual collects, investigation. Every individual collects, organizes, & arranges facts to build a organizes, & arranges facts to build a knowledge base relevant to his/her knowledge base relevant to his/her personal reality.personal reality.

Sources of KnowledgeSources of Knowledge

1.1. Traditional knowledgeTraditional knowledge

2.2. Authoritative knowledgeAuthoritative knowledge

3.3. Scientific knowledgeScientific knowledge

Traditional knowledgeTraditional knowledge

Traditional knowledge is that part of Traditional knowledge is that part of nursing practice passed down from nursing practice passed down from generation to generation.generation to generation.

““We’ve always done it this way” like We’ve always done it this way” like changing bedclothes of pts. daily & changing bedclothes of pts. daily & there are no research data to support there are no research data to support this why bed linen are changed daily. this why bed linen are changed daily.

This is a usual practice that remains a This is a usual practice that remains a traditional part of patient caretraditional part of patient care

Authoritative KnowledgeAuthoritative Knowledge

Authoritative knowledge comes from Authoritative knowledge comes from an expert & is accepted as truth based an expert & is accepted as truth based on the person’s perceived expertise. on the person’s perceived expertise.

Authoritative knowledge generally Authoritative knowledge generally remains unchallenged as along as the remains unchallenged as along as the presumed authority maintains his/her presumed authority maintains his/her perceived expertise.perceived expertise.

Scientific KnowledgeScientific Knowledge Scientific knowledge is that knowledge arrived Scientific knowledge is that knowledge arrived

at through the scientific method at through the scientific method (implying thru’ research). New ideas are (implying thru’ research). New ideas are tested & measured systematically using tested & measured systematically using objective criteria.objective criteria.

Traditional & authoritative knowledge are Traditional & authoritative knowledge are practical to implement but limiting their practical to implement but limiting their usefulness in a wide variety of practice. usefulness in a wide variety of practice.

Nurses often focus on scientific knowledge, Nurses often focus on scientific knowledge, commonly called EVIDENCE-BASED practice commonly called EVIDENCE-BASED practice of RESEARCH-BASED practice.of RESEARCH-BASED practice.

Types of KnowledgeTypes of Knowledge

1.1. ScienceScience

2.2. PhilosophyPhilosophy

3.3. ProcessProcess

Science Science

Implies a body of knowledge.Implies a body of knowledge. Science is observing, identifying, Science is observing, identifying,

describing, investigating, & explaining describing, investigating, & explaining events & occurences that are perceived events & occurences that are perceived in the world.in the world.

The science of nursing is the The science of nursing is the knowledge in & of nursing.knowledge in & of nursing.

Philosophy Philosophy Is the study of wisdom, fundamental knowledge Is the study of wisdom, fundamental knowledge

& the processes we use to develop & construct & the processes we use to develop & construct our perceptions in life.our perceptions in life.

It provides a viewpoint & implies a system of It provides a viewpoint & implies a system of values & beliefs. Personal philosophies guide values & beliefs. Personal philosophies guide behavior & attitudes.behavior & attitudes.

This is developed through : IPR, formal & This is developed through : IPR, formal & informal educational experiences, religion & informal educational experiences, religion & culture & environment.culture & environment.

Every nurse’s philosophy, developed thru’ Every nurse’s philosophy, developed thru’ education & practice forms the basis for education & practice forms the basis for providing nursing care.providing nursing care.

Process Process

Is a series of actions, changes, or functions Is a series of actions, changes, or functions intended to bring about desired results.intended to bring about desired results.

During a process, one takes During a process, one takes systematic systematic & & continuous stepscontinuous steps to meet a goal & uses both to meet a goal & uses both assessments & feedbacks to direct actions assessments & feedbacks to direct actions to meet the goal.to meet the goal.

A particular theory or conceptual framework A particular theory or conceptual framework directs how these actions are carried outdirects how these actions are carried out

TheoryTheory

THEORYTHEORY is a set of concepts, is a set of concepts, definitions & assumptions or definitions & assumptions or propositions to explain/ describe a propositions to explain/ describe a pattern of reality or a phenomenon.pattern of reality or a phenomenon.

COMPONENTS OF THEORY:COMPONENTS OF THEORY:

1.1. ConceptsConcepts

2.2. Propositions or assumptionsPropositions or assumptions

3.3. Definitions Definitions

Concepts Concepts

Something conceived in mind, a Something conceived in mind, a thought or a notion (idea)thought or a notion (idea)

Are mental formulations of a object or Are mental formulations of a object or event that come from individual event that come from individual perceptual experienceperceptual experience

They are ideas, mental imagesThey are ideas, mental images They are words that represent reality & They are words that represent reality &

enhance our ability to communicate enhance our ability to communicate about it.about it.

Conceptual Framework or ModelConceptual Framework or Model

These are group of concepts that These are group of concepts that follows an understandable pattern.follows an understandable pattern.

Concepts can be thought of as Concepts can be thought of as individual bricks and boards used to individual bricks and boards used to build a house, with conceptual build a house, with conceptual framework being the BLUEPRINT that framework being the BLUEPRINT that specifies where each brick & board specifies where each brick & board should go.should go.

Propositions Propositions

They explain relationships between the They explain relationships between the concepts concepts

Example: Nightingale proposed a Example: Nightingale proposed a beneficial relationship between fresh beneficial relationship between fresh air & healthair & health

Assumptions Assumptions

These are statements that describe the These are statements that describe the concepts or connect two concepts that concepts or connect two concepts that are factual.are factual.

Phenomenon Phenomenon

The aspect of reality that can be The aspect of reality that can be perceivedperceived

Nursing TheoryNursing Theory As defined by Barnum (1998) “attempts As defined by Barnum (1998) “attempts

to describe or explain the phenomenon to describe or explain the phenomenon (process, occurrence, or event) called (process, occurrence, or event) called nursing.”nursing.”

Nursing Theory differentiates nursing Nursing Theory differentiates nursing from other disciplines & activities in that from other disciplines & activities in that it serves the purposes of describing, it serves the purposes of describing, explaining, predicting & controlling explaining, predicting & controlling desired outcomes of nursing care desired outcomes of nursing care practices.practices.

Nursing TheoryNursing Theory

Theories provide a means of testing Theories provide a means of testing knowledge thru’ research & for nursing, knowledge thru’ research & for nursing, expanding its knowledge base to meet expanding its knowledge base to meet healthcare needs of patients in an ever-healthcare needs of patients in an ever-changing society.changing society.

Nursing theories focuses on the Nursing theories focuses on the phenomena of nursing & nursing care.phenomena of nursing & nursing care.

Four Major Concepts of NursingFour Major Concepts of Nursing

1.1. Person (patient/client)Person (patient/client)

2.2. EnvironmentEnvironment

3.3. Health Health

4.4. Nursing Nursing

Person Person

Person may represent one individual, a Person may represent one individual, a family, a community or all of mankindfamily, a community or all of mankind

Also referred as the patient (suffer or Also referred as the patient (suffer or bear)bear)

Also referred to as the client (may not Also referred to as the client (may not be sick but well)be sick but well)

Environment Environment

May represent the immediate May represent the immediate surroundings, the community or the surroundings, the community or the universeuniverse

Health Health

Represents a state of well-beingRepresents a state of well-being

Nursing Nursing

Is the science and the art of the Is the science and the art of the disciplinediscipline

Theory generates knowledge for use in Theory generates knowledge for use in the practice.the practice.

Maslow’s Hierarchy of NeedsMaslow’s Hierarchy of Needs

Physiological Needs

Safety and Security Needs

Love and Belongingness Needs

Self Esteem

Self

Actualization

Abraham Maslow’s Needs TheoryAbraham Maslow’s Needs Theory Physiologic needs: air, food, water, shelter, sleep,

activity & temperature Safety and Security Needs: Physical & psychologic

aspects of safety in environment & relationships Love and Belongingness Needs: giving & receiving

affection, attaining a place in the group & maintaining the feeling of belonging

Self Esteem: feelings of independence, competence, self-respect & from others recognition, respect, appreciation

Self-Actualization: innate need to develop one’s maximum potential & realize one’s abilities & qualities

Abraham Maslow’s Needs TheoryAbraham Maslow’s Needs Theory

Each individual has a unique characteristic Each individual has a unique characteristic but certain needs are common to all but certain needs are common to all people.people.

A need is something that is desirable, A need is something that is desirable, useful or necessary.useful or necessary.

Human needs are physiologic or Human needs are physiologic or psychologic conditions that an individual psychologic conditions that an individual must need to achieve a state of health or must need to achieve a state of health or well-being.well-being.

Abraham Maslow’s Needs TheoryAbraham Maslow’s Needs Theory

CHARACTERISTICS OF BASIC HUMAN CHARACTERISTICS OF BASIC HUMAN NEEDSNEEDS

1.1. Needs are universal.Needs are universal.

2.2. Needs may be met in different ways.Needs may be met in different ways.

3.3. Needs may be stimulated by external & Needs may be stimulated by external & internal factors.internal factors.

4.4. Priorities may be altered.Priorities may be altered.

5.5. Needs may be deferred.Needs may be deferred.

6.6. Needs are interrrelated.Needs are interrrelated.

Florence NightingaleFlorence Nightingale

Goal of NursingGoal of Nursing

To facilitate “the body’sTo facilitate “the body’s

reparative processes”reparative processes”

by manipulating theby manipulating the

clients environment.clients environment.

““Environmental Theory”Environmental Theory”

FrameworkFramework

Clients environment is Clients environment is manipulated to include manipulated to include appropriate noise, appropriate noise, nutrition, hygiene, nutrition, hygiene, light, comfort and light, comfort and hope.hope.

Florence NightingaleFlorence Nightingale

Environment influences health: Environment influences health: 1.1. Pure airPure air2.2. Pure waterPure water3.3. Efficient drainageEfficient drainage4.4. CleanlinessCleanliness5.5. Light-direct sunraysLight-direct sunrays> Lack of these environment factors lead to > Lack of these environment factors lead to

morbidity & mortalitymorbidity & mortality

Hildegard Peplau 1952Hildegard Peplau 1952


To develop interactionTo develop interaction

between nurse andbetween nurse and

client.client.

““Interpersonal Relation Interpersonal Relation Model”Model”

FrameworkFramework

Nursing is a significant, Nursing is a significant, therapeutic, therapeutic, interpersonal process.interpersonal process.

Nurses participate in Nurses participate in structuring health care structuring health care systems to facilitate systems to facilitate natural on-going natural on-going tendency of humans to tendency of humans to develop interpersonal develop interpersonal relationship.relationship.

Hildegard PeplauHildegard Peplau

Defined nursing as interpersonal process Defined nursing as interpersonal process of the therapeutic interaction between the of the therapeutic interaction between the individual who is sick or in need of health individual who is sick or in need of health services & a nurse especially educated to services & a nurse especially educated to recognize and respond to the need for recognize and respond to the need for help.help.

Cont . Peplau

Person – in terms of man. Man is as organism that lives in an unstable equilibrium

Health- a word symbol that implies forward

movement of personality and other on

going processes in the direction of creative

productive, personal and comm. Living.

Hildegard PeplauHildegard Peplau 4 phases of nurse-client interaction4 phases of nurse-client interaction1.1. ORIENTATIONORIENTATION

2.2. IDENTIFICATIONIDENTIFICATION

3.3. EXPLOITATIONEXPLOITATION

4.4. RESOLUTIONRESOLUTION

Hildegard PeplauHildegard Peplau

Born in Sept. 1, 1909Born in Sept. 1, 1909 Education:diploma prog.in Pottstown, Education:diploma prog.in Pottstown,

Pennsylvania in 1931, BA in IP psychology in Pennsylvania in 1931, BA in IP psychology in Bennington College, Vermont; continued in Bennington College, Vermont; continued in Teacher’s college Columbia University; service Teacher’s college Columbia University; service as 1Lt. US Army Corps in Londonas 1Lt. US Army Corps in London

Taught the first graduate psychiatric nursing in Taught the first graduate psychiatric nursing in 1947 (20 years) & her contributions are known 1947 (20 years) & her contributions are known worldwide in the Nursing worldworldwide in the Nursing world

Died at the age of 89 on March 17, 1999Died at the age of 89 on March 17, 1999

Cont. Peplau

Nursing roles

- role of a stranger

- resource person

- teaching

- leader

- surrogate

- counseling

Virginia Henderson 1955Virginia Henderson 1955


To work independentlyTo work independently

w/ other health carew/ other health care

workers, assisting clientworkers, assisting client

in gaining independencein gaining independence

as quickly as possible, toas quickly as possible, to

help client gain lackinghelp client gain lacking

strength.strength.

““14 Fundamental Needs”14 Fundamental Needs”

FrameworkFramework

Nurses help client to Nurses help client to perform Henderson’s 14 perform Henderson’s 14 basic needs.basic needs.

Virginia HendersonVirginia Henderson

Definition of Nursing:Definition of Nursing:

““The unique function of the nurse is to assist the The unique function of the nurse is to assist the individual, sick or well, in the performance of individual, sick or well, in the performance of those activities contributing to health, or its those activities contributing to health, or its recovery, or to a peaceful death the he would recovery, or to a peaceful death the he would perform if he had the necessary strength, will or perform if he had the necessary strength, will or knowledge. And to do this in such a way as to knowledge. And to do this in such a way as to help him gain independence as rapidly as help him gain independence as rapidly as possible.” (1966)possible.” (1966)


Also defined nursing as…Also defined nursing as…

“…“…temporarily the consciousness of the temporarily the consciousness of the unconscious, the love of life of the suicidal, unconscious, the love of life of the suicidal, the leg of the amputee, the eyes of the the leg of the amputee, the eyes of the newly blind, a means of locomotion for the newly blind, a means of locomotion for the infant, knowledge and confidence for the infant, knowledge and confidence for the young mother, the voice for those too young mother, the voice for those too weak or withdrawn to speak.” (1964)weak or withdrawn to speak.” (1964)

Cont. Henderson

Health did not give definition of health Environment – ( Webster dictionary )

aggregate of all external conditions and

influences affecting life.

Person – as primary importance.

Virginia HendersonVirginia Henderson14 FUNDAMENTAL NEEDS14 FUNDAMENTAL NEEDS

1.1. Breathe normallyBreathe normally2.2. Eating & drinking adequatelyEating & drinking adequately3.3. Eliminating body wastesEliminating body wastes4.4. Moving & maintaining a Moving & maintaining a

desirable positiondesirable position5.5. Sleeping & restingSleeping & resting6.6. Selecting suitable clothesSelecting suitable clothes7.7. Maintaining body temp. w/in Maintaining body temp. w/in

normal range by adjusting normal range by adjusting clothing & modifying clothing & modifying environmentenvironment

8.8. Keeping the body clean & well Keeping the body clean & well groomed to protect integumentgroomed to protect integument

9. Avoiding dangers in the 9. Avoiding dangers in the environment & avoiding injuring environment & avoiding injuring othersothers

10. Communicating w/ others in 10. Communicating w/ others in expressing emotion, needs, expressing emotion, needs, fears, or opinionsfears, or opinions

11. Worshipping according to one’s 11. Worshipping according to one’s faithfaith

12. Working in such a way that one 12. Working in such a way that one feels a sense of accomplishmentfeels a sense of accomplishment

13. Playing or participating in 13. Playing or participating in various forms of recreationvarious forms of recreation

14. Learning, discovering or 14. Learning, discovering or satisfying the curiosity that leads satisfying the curiosity that leads to normal development & health, to normal development & health, & using available health facilities& using available health facilities

Cont. Henderson

Roles of the nurse:

- substitutive

- supplementary

- complementary


Known around the world for her definition Known around the world for her definition of nursingof nursing

Her impact on nursing has been so great Her impact on nursing has been so great she has been called the “the first lady of she has been called the “the first lady of nursing,” “the first truly international nursing,” “the first truly international nurse,” “the mother of modern nursing,” nurse,” “the mother of modern nursing,” “the American Florence Nightingale”“the American Florence Nightingale”

Died on March 19, 1996 at the age of 98Died on March 19, 1996 at the age of 98

Faye Abdellah 1960Faye Abdellah 1960Goal of NursingGoal of Nursing

To provide service toTo provide service to

individuals, families andindividuals, families and

society, to be kind andsociety, to be kind and

caring but also intelligent,caring but also intelligent,

competent, & technicallycompetent, & technically

well prepared to providewell prepared to provide

this service.this service.

““21 Nursing Problems”21 Nursing Problems”

FrameworkFramework

This theory involves This theory involves Abdellah’s 21 nursing Abdellah’s 21 nursing problems. problems.

Cont. Abdellah

Nursing Problem – is a condition faced

by the patient or family which the nurse can assist him or them to meet through the performance of her professional functions.

Faye AbdellahFaye Abdellah21 nursing problems21 nursing problems

1.1. To maintain good hygiene & To maintain good hygiene & physical comfortphysical comfort

2.2. To promote optimal activity, To promote optimal activity, exercise, rest & sleepexercise, rest & sleep

3.3. To promote safety thru’ To promote safety thru’ prevention of accident, injury, prevention of accident, injury, trauma & thru’ the prevention trauma & thru’ the prevention of the spread of infectionof the spread of infection

4.4. To maintain good body To maintain good body mechanics & prevent & mechanics & prevent & correct deformitiescorrect deformities

5. To facilitate the maintenance of a 5. To facilitate the maintenance of a supply of oxygen to all body cellssupply of oxygen to all body cells

6. To facilitate the maintenance of 6. To facilitate the maintenance of nutrition of all body cellsnutrition of all body cells

7. To facilitate the maintenance of 7. To facilitate the maintenance of eliminationelimination

8. To facilitate the maintenance of 8. To facilitate the maintenance of fluid & electrolyte balancefluid & electrolyte balance

9. To recognize the physiological 9. To recognize the physiological responses of the body to disease responses of the body to disease conditions-pathological, conditions-pathological, physiological, & compensatroyphysiological, & compensatroy


10. To facilitate the maintenance of 10. To facilitate the maintenance of regulatory mechanisms & regulatory mechanisms & functionsfunctions

11. To facilitate the maintenance of 11. To facilitate the maintenance of sensory functionsensory function

12. To identify & accept positive & 12. To identify & accept positive & negative expressions, feelings & negative expressions, feelings & reactionsreactions

13. To identify & accept the 13. To identify & accept the interrelatedness of emotions & interrelatedness of emotions & organic illnessorganic illness

14. To facilitate the maintenance of 14. To facilitate the maintenance of effective verbal & nonverbal effective verbal & nonverbal communicationcommunication

15. To promote the development 15. To promote the development of productive interpersonal of productive interpersonal relationshipsrelationships

16. To facilitate progress toward 16. To facilitate progress toward achievement of personal achievement of personal spiritual goalsspiritual goals

17. To create &/or maintain a 17. To create &/or maintain a therapeutic environmenttherapeutic environment

18. To facilitate awareness of self 18. To facilitate awareness of self as an individual with varying as an individual with varying physical, emotional & physical, emotional & development needsdevelopment needs

19. To accept the optimum 19. To accept the optimum possible goals in the of possible goals in the of limitations, physical & limitations, physical & emotionalemotional


20. To use community resources as an aid 20. To use community resources as an aid in resolving problems arising from illnessin resolving problems arising from illness

21. To understand the role of social 21. To understand the role of social problems as influencing factors in the problems as influencing factors in the cause of illnesscause of illness

Faye AbdellahFaye Abdellah

These 21 nursing problems became the These 21 nursing problems became the base of Abdellah’s base theory. These base of Abdellah’s base theory. These were her work together w/ Levine in 1954 were her work together w/ Levine in 1954 by using the work of several studies, they by using the work of several studies, they classified medical diagnoses in small classified medical diagnoses in small hospitals into 58 categories. They were hospitals into 58 categories. They were also helped by 40 schools of nursing in the also helped by 40 schools of nursing in the development of the base theory.development of the base theory.

Cont. Abdellah

Person – as physical, emotional, and so

sociological needs.

Health - as a state when the individual has

no unmet needs and no anticipated or

actual impairments.

Environment - is the home or community from which patients come

Faye AbdellahFaye Abdellah

Born in NY in 1909 & graduated in Fitkin Mem. Born in NY in 1909 & graduated in Fitkin Mem. School of Nursing in 1942; earned 3 degrees at School of Nursing in 1942; earned 3 degrees at Teacher’s college in Columbia U, NYCTeacher’s college in Columbia U, NYC

From position of staff nurse to public health From position of staff nurse to public health nurse in USPHS in ’49nurse in USPHS in ’49

Appointed as chief nurse officer & ’82 was the Appointed as chief nurse officer & ’82 was the first woman to hold position of deputy Surgeon first woman to hold position of deputy Surgeon GeneralGeneral

Retired in 2002 & currently lives in MarylandRetired in 2002 & currently lives in Maryland

Martha Rogers 1970Martha Rogers 1970Goal of NursingGoal of Nursing

To maintain & promoteTo maintain & promote

health, prevent illness &health, prevent illness &

care for & rehabilitate illcare for & rehabilitate ill

& disabled client through& disabled client through

““humanistic science ofhumanistic science of

nursing”nursing”

““Unitary Human Being”Unitary Human Being”

FrameworkFramework

““Unitary man” evolves Unitary man” evolves along life process. along life process. Client continuously Client continuously changes and coexist changes and coexist with environment.with environment.

Martha RogersMartha Rogers

Rogers states that the science of nursing is Rogers states that the science of nursing is “the science of unitary human beings (1983)”“the science of unitary human beings (1983)”

Interrelationships among the concepts of Interrelationships among the concepts of person, environment, health & nursing: these person, environment, health & nursing: these 4 basic concepts are used in nursing models 4 basic concepts are used in nursing models to explain the nursing as profession- “ a to explain the nursing as profession- “ a learned profession w/ full professional learned profession w/ full professional status” meaning not only practice but also status” meaning not only practice but also has a sciencehas a science


The science of unitary man was very abstract & The science of unitary man was very abstract & few would understand the direction of her few would understand the direction of her thinking, energy fields & patterning.thinking, energy fields & patterning.

In 1983, she changed the name theory to the In 1983, she changed the name theory to the science of human beings but did not change the science of human beings but did not change the theory.theory.

She is adamant in saying “nursing exists to She is adamant in saying “nursing exists to serve people”.in their “entirety & wholeness” “for serve people”.in their “entirety & wholeness” “for the realization of maximum health potential the realization of maximum health potential (1970)(1970)

Cont. Rogers

Person – as an open system Health - ( passive health) symbolize

wellness and absence of disease. Environment – an irreducible

‘pandimensional energy field identified by

pattern and manifesting characteristics

different from those of the parts.


Born on may 12, 1914 in Dallas, TexasBorn on may 12, 1914 in Dallas, Texas Enrolled in University of Tennessee Enrolled in University of Tennessee

Knoxville in 1931; entered Knoxville Gen. Knoxville in 1931; entered Knoxville Gen. Hosp. School of Nursing; BSN in Peabody Hosp. School of Nursing; BSN in Peabody college, also took MA in public health in college, also took MA in public health in Johns Hopkins U in 1954Johns Hopkins U in 1954

Lectured around the world, established Lectured around the world, established Society of Rogerian scholarsSociety of Rogerian scholars

Died on March 13, 1994 at age 80Died on March 13, 1994 at age 80

Cont. Rogers

4 building blocks for her model

- energy field

- universe of an open system

- pattern

- pandimensionality

Cont. Rogers

Principles of homeodynamic

- integrality

- helicy

- resonancy

Dorothea Orem 1971Dorothea Orem 1971


To care for and helpTo care for and help

client attain total selfclient attain total self

carecare

““Self-Care Theory”Self-Care Theory”

FrameworkFramework

This is self care deficitThis is self care deficit

theory. Nursing caretheory. Nursing care

becomes necessarybecomes necessary

when client is unable towhen client is unable to

fulfill biological,fulfill biological,

psychological,psychological,

development, or socialdevelopment, or social

needs.needs.

Dorothea OremDorothea Orem

General theory of self-care deficit nursing General theory of self-care deficit nursing delineates when patients are unable to delineates when patients are unable to care for themselves, even w/ assistance of care for themselves, even w/ assistance of family members.family members.

When family members are unable to When family members are unable to provide necessary care there is SELF provide necessary care there is SELF CARE DEMAND that must be met by the CARE DEMAND that must be met by the nursenurse


Composed of 3 interrelated theories:Composed of 3 interrelated theories:

1.1. The theory of self care: explains why & The theory of self care: explains why & how people care for themselves & how people care for themselves & includes self care agency, basic includes self care agency, basic conditioning factors & therapeutic conditioning factors & therapeutic selfcare demandsselfcare demands

2.2. The theory of self care deficitThe theory of self care deficit

3.3. The theory of nursing systemsThe theory of nursing systems


Self care requisites: are ADLSelf care requisites: are ADL

UNIVERSALUNIVERSAL

DEVELOPMENTALDEVELOPMENTAL

HEALTH DEVIATIONHEALTH DEVIATION The self care deficit explains when people The self care deficit explains when people

need nursing careneed nursing care

Dorothea OremDorothea Orem In 1985 presented 3 basic variations in In 1985 presented 3 basic variations in

nursing systems for organizing services:nursing systems for organizing services:1.1. Wholly compensatory system: in which Wholly compensatory system: in which

accomplishing the person’s therapeutic accomplishing the person’s therapeutic self-care is centralself-care is central

2.2. Partially compensatory system: in which Partially compensatory system: in which either the nurse or patient may have the either the nurse or patient may have the major rolemajor role

3.3. Supportive-educative system: wherein the Supportive-educative system: wherein the support, guidance, provision of a support, guidance, provision of a developmental environment, & teaching are developmental environment, & teaching are central componentscentral components


Born in Baltimore, Maryland 1914Born in Baltimore, Maryland 1914 Received a diploma from Providence hospital Received a diploma from Providence hospital

School of Nursing, Washington , DCSchool of Nursing, Washington , DC Held various positions, private & gov’tHeld various positions, private & gov’t Retired in 1984 and continues to work Retired in 1984 and continues to work

individually & w/ collegues to refine the self-care individually & w/ collegues to refine the self-care deficit theorydeficit theory

Received several honorary degrees & Received several honorary degrees & honors/awards & described as one of America’s honors/awards & described as one of America’s foremeost nursing theoristsforemeost nursing theorists

Betty Neuman 1974Betty Neuman 1974


To assist individuals,To assist individuals,families, & groups infamilies, & groups inattaining & maintainingattaining & maintainingmaximal level of totalmaximal level of totalwellness by purposefulwellness by purposefulinterventions.interventions.““Health Care System Health Care System

Model”Model”

FrameworkFramework

Stress reduction is a Stress reduction is a goal of systems goal of systems model of nursing model of nursing practice. Nursing practice. Nursing actions are in actions are in primary, secondary, primary, secondary, or tertiary level of or tertiary level of prevention.prevention.

Betty NewmanBetty Newman

continuation….continuation….


““Total Person Model”Total Person Model”

(Wholistic and an(Wholistic and an

Open-SystemsOpen-Systems

Approach)Approach)

““Systems Model”Systems Model”

Betty NeumanBetty Neuman

Asserted that nursing is a unique Asserted that nursing is a unique profession in that it is concerned w/ all the profession in that it is concerned w/ all the variables affecting an individual’s variables affecting an individual’s response to stresses, which are INTRA- response to stresses, which are INTRA- (within the individual; INTER- ( between (within the individual; INTER- ( between one or more other people); and one or more other people); and EXTRAPERSONAL- (outside the EXTRAPERSONAL- (outside the individual) in nature.individual) in nature.


The concern of nursing is to prevent stress The concern of nursing is to prevent stress invasion, to protect the client’s basic invasion, to protect the client’s basic structure & obtain or maintain a maximum structure & obtain or maintain a maximum level of wellness.level of wellness.

The nurse helps the client through: The nurse helps the client through: PRIMARY, SECONDARY & TERTIARY PRIMARY, SECONDARY & TERTIARY prevention modes, to adjust to prevention modes, to adjust to environmental stressors & maintain client environmental stressors & maintain client system stability.system stability.


She continues to refine, clarify & expand her She continues to refine, clarify & expand her model which focuses on wholistic model which focuses on wholistic approach to nursing care & provides a approach to nursing care & provides a clear direction for nursing interventions. clear direction for nursing interventions. (2002)(2002)

Cont. Newman

based on two major components:

- stress and reaction to stress

Madeleine Leininger 1985Madeleine Leininger 1985


To provide careTo provide careconsistent w/ nursing’sconsistent w/ nursing’semerging science andemerging science andknowledge with caringknowledge with caringAs central focus.As central focus.““Transcultural Nursing”Transcultural Nursing”““Culture care: Diversity Culture care: Diversity

& Universality Theory”& Universality Theory”

FrameworkFramework

With this With this transcultural care transcultural care theory, caring is the theory, caring is the central and unifying central and unifying domain for nursing domain for nursing knowledge and knowledge and practicepractice

Cont. culture care

Culture – are learned and transmitted values, beliefs and practices that provided

a critical means to establish culture care patterns from people.

Culture care- refers to subjectively learned values, beliefs, and patterned lifeways

that assist, support, ,facilitate, or enable

Another person or group to maintain thier

Cont. culture care

Well being and health, , to improve their human conditions and life ways.

Madeleine LeiningerMadeleine Leininger

She advocated that nursing is a humanistic & She advocated that nursing is a humanistic & scientific model of helping a client through specific scientific model of helping a client through specific cultural caring processes ( cultural beliefs & cultural caring processes ( cultural beliefs & practices) to improve or maintain a health condition.practices) to improve or maintain a health condition.

Distintive to her theory: culture care, diversity, Distintive to her theory: culture care, diversity, universality, worldview, & ethnohistoryuniversality, worldview, & ethnohistory

Shared w/ other concepts: care, caring, health, & Shared w/ other concepts: care, caring, health, & nursingnursing

Played a significant role in bringing the caring Played a significant role in bringing the caring concept in the nursing communityconcept in the nursing community

Madeleine LeiningerMadeleine Leininger

Born in Sutton, NebraskaBorn in Sutton, Nebraska Received diploma in 1948 from st. Received diploma in 1948 from st.

anthony’s hosp. School of Nursing in anthony’s hosp. School of Nursing in DenverDenver

First nurse to study anthropology at the First nurse to study anthropology at the doctoral level in from Washington, Seattledoctoral level in from Washington, Seattle

Has several honorary degrees and Has several honorary degrees and currently lives in Omaha, Nebraskacurrently lives in Omaha, Nebraska

Sister Callista RoySister Callista Roy


To identify types ofTo identify types of

demands places ondemands places on

client, assess client, assess

adaptation to demands,adaptation to demands,

and help client to adapt. and help client to adapt.

““Adaptation Model”Adaptation Model”

FrameworkFramework

This Adaptation This Adaptation model is based on model is based on the physiological, the physiological, and dependence, and dependence, independence independence adaptive modes.adaptive modes.


Roy believed that adaptive human Roy believed that adaptive human behavior is directed toward an attempt to behavior is directed toward an attempt to maintain HOMEOSTASIS or integrity of maintain HOMEOSTASIS or integrity of the individual by conserving energy & the individual by conserving energy & promoting the survival, growth, promoting the survival, growth, reproduction & mastery of the human reproduction & mastery of the human system.system.


Viewed person as a unified biopsychococial Viewed person as a unified biopsychococial system in constant interaction w/ a changing system in constant interaction w/ a changing environment. She contended that the person environment. She contended that the person as an adaptive system, functions as a as an adaptive system, functions as a WHOLE thru’ interdependence of its parts.WHOLE thru’ interdependence of its parts.

The system consists of input, control The system consists of input, control process, output, & feedback.process, output, & feedback.

In addition advocated that all people have In addition advocated that all people have certain needs which endeavor to meet in certain needs which endeavor to meet in order to maintain integrity.order to maintain integrity.

Cont, Roy

Health – is a state and a process of being

and becoming integrated as a person.

Environment – conditions and circumstances , and influences surrounding and affecting the dev.and

behavior of person and earth resources

That includes focal, contextual, and residual

Cont. Roy

Focal stimuli – external / internal most immediately confronting the system

Contextual- all stimuli present in the situation that contribute to the effect of the

focal

Residual –environmental factors within or without the human system with effects

on the current situation

Cont. Roy

Adaptive modes ( who one is, and how to act in a society

physiological, physical (O2, elimination

nutrition, activity, protection

Self- concept – group identity ( psychological, spiritual

role function

interdependence mode


Born on October 14, 1939 La, californiaBorn on October 14, 1939 La, california BSN from Mount Saint Mary’s college in LA in BSN from Mount Saint Mary’s college in LA in

963 & Ma & PhD in sociology from UCLA in ’73 963 & Ma & PhD in sociology from UCLA in ’73 & ’77 respectively& ’77 respectively

Received numerous awards & is a prolific writer Received numerous awards & is a prolific writer & speaker & her her work has been used in & speaker & her her work has been used in practice, education, administration & researchpractice, education, administration & research

Currently a professor & nurse theorist at Boston Currently a professor & nurse theorist at Boston College of Nursing, MassachusettsCollege of Nursing, Massachusetts

Jean Watson 1979Jean Watson 1979


To promote health,To promote health,restore client to health,restore client to health,and prevent illness.and prevent illness.

““10 Curative Factors”10 Curative Factors”““Theory of Human Theory of Human

Caring”Caring”

FrameworkFramework

This theory involvesThis theory involves

philosophy & sciencephilosophy & science

of caring, caring isof caring, caring is

interpersonal processinterpersonal process

comprising interventionscomprising interventions

that result in meetingthat result in meeting

human needs.human needs.

Jean WatsonJean Watson

She emphasized that nursing is the She emphasized that nursing is the application of the art & human science application of the art & human science thru’ TRANSPERSONAL CARING thru’ TRANSPERSONAL CARING TRANSACTIONS to help persons achieve TRANSACTIONS to help persons achieve mind-body-soul harmony, which generates mind-body-soul harmony, which generates self-knowledge, self-control, self-care, & self-knowledge, self-control, self-care, & self-healing.self-healing.

Jean WatsonJean Watson10 carrative factors10 carrative factors

1.1. Humanistic-altruistic Humanistic-altruistic system of valuessystem of values

2.2. Faith-hopeFaith-hope

3.3. Sensitivity to self & Sensitivity to self & othersothers

4.4. Helping-trusting, human Helping-trusting, human care relationshipcare relationship

5.5. Expression of positive & Expression of positive & negative feelingnegative feeling

6. Creative problem-solving 6. Creative problem-solving caring processcaring process

7. Transpersonal teaching-7. Transpersonal teaching-learninglearning

8. A supportive, protective, 8. A supportive, protective, & corrective mental, & corrective mental, physical, & sociocultural physical, & sociocultural & spiritual environment& spiritual environment

9. Human needs assistive9. Human needs assistive10. Existential-10. Existential-

phenomenological-phenomenological-spiritual forcesspiritual forces

Jean WatsonJean Watson

Born in West Virginia & earned diploma in Born in West Virginia & earned diploma in nursing 1961 from Lewis Gayle School of nursing 1961 from Lewis Gayle School of nursing in Roanoke, Virginia & BS in nursing in Roanoke, Virginia & BS in psychiatric-mental health nursing from psychiatric-mental health nursing from University of Colorado & PhD in University of Colorado & PhD in educational psychologyeducational psychology

Received many awards & currently serves Received many awards & currently serves as distinguished professor of nursingas distinguished professor of nursing

Myra Levine 1973Myra Levine 1973

She advocated & described the 4 She advocated & described the 4 Conservation principles that nursing is a Conservation principles that nursing is a human interaction concerned w/ unity & human interaction concerned w/ unity & integrity of the individualintegrity of the individual

1.1. CONSERVATION OF ENERGY: human CONSERVATION OF ENERGY: human body functions by utilizing energy. The body functions by utilizing energy. The body needs energy producing input (skin, body needs energy producing input (skin, 02, fluids) to allow energy utilization as 02, fluids) to allow energy utilization as output.output.


2. CONSERVATION OF STRUCTUTAL 2. CONSERVATION OF STRUCTUTAL INTEGRITY : human body has physical INTEGRITY : human body has physical boundaries (skin & mucous membrane) boundaries (skin & mucous membrane) that must be maintained to facilitate health that must be maintained to facilitate health & prevent harmful agents from entering & prevent harmful agents from entering the body.the body.


3. CONSERVATION OF PERSONAL 3. CONSERVATION OF PERSONAL INTEGRITY: the nursing interventions are INTEGRITY: the nursing interventions are based on the conservation of the individual based on the conservation of the individual client’s personality.client’s personality.

>each individual has a sense of identity, >each individual has a sense of identity, self-worth & self-esteem, which must be self-worth & self-esteem, which must be preserved & enhanced by nursespreserved & enhanced by nurses


4.CONSERVATION OF SOCIAL 4.CONSERVATION OF SOCIAL INTEGRITY: social integrity of the client INTEGRITY: social integrity of the client reflects the family & community in which reflects the family & community in which the cliwnt functions.’the cliwnt functions.’

> Health care institutions may separate > Health care institutions may separate individuals from their family. It is important individuals from their family. It is important for nurses to consider the individual in the for nurses to consider the individual in the context of the family.context of the family.


BSN degree in 1949 at the University of BSN degree in 1949 at the University of Chicago, MSN in 1962 at Wayne state Chicago, MSN in 1962 at Wayne state University Detroit, MichiganUniversity Detroit, Michigan

Wrote books in “ Introduction to Clinical Wrote books in “ Introduction to Clinical Practice” which won the book of the year Practice” which won the book of the year awardaward

GENERAL THEORIESGENERAL THEORIES

1.1. Florence NightingaleFlorence Nightingale2.2. Virginia HendersonVirginia Henderson3.3. Martha RogersMartha Rogers4.4. Sr. Callista RoySr. Callista Roy5.5. Dorothea OremDorothea Orem6.6. Betty NeumanBetty Neuman7.7. Imogene KingImogene King8.8. Dorothy JohnsonDorothy Johnson

SYSTEMS THEORIESSYSTEMS THEORIES

1.1. ROY’S adaptation theoryROY’S adaptation theory

2.2. Nueman’s Health Care systems ModelNueman’s Health Care systems Model

3.3. Johnson’s Behavioral System ModelJohnson’s Behavioral System Model

4.4. King’s Goal attainment theoryKing’s Goal attainment theory

INTERPERSONAL/CARING INTERPERSONAL/CARING THEORIESTHEORIES

1.1. Peplau’s Psychodynamic Nursing TheoryPeplau’s Psychodynamic Nursing Theory

2.2. Leininger’s Transcultural Care TheoryLeininger’s Transcultural Care Theory

3.3. Watson’s Philosophy & Science of Watson’s Philosophy & Science of CaringCaring

Profession has the following 8 Profession has the following 8 characteristicscharacteristics

1.1. TheThe services provided are vital to human services provided are vital to human beings and welfare of society.beings and welfare of society.

2.2. There exists a special body of knowledge There exists a special body of knowledge that undergoes continual growth thru that undergoes continual growth thru research.research.

3.3. The services provided involve intellectual The services provided involve intellectual activities and individual responsibility or activities and individual responsibility or accountability.accountability.

continuation…continuation…

4.4. Practitioners receive education inPractitioners receive education in

institutions of higher learning.institutions of higher learning.

5.5. Practitioners are autonomy and controlPractitioners are autonomy and control

their own policies and activities.their own policies and activities.

6.6. Practitioners are motivated by the servicePractitioners are motivated by the service

they provide and consider their work they provide and consider their work important to their lives (altruism).important to their lives (altruism).


7.7. Practitioners decisions and conduct are Practitioners decisions and conduct are

guided by a code of ethics.guided by a code of ethics.

8.8. High standards of practice are encouragedHigh standards of practice are encouraged

and supported by an organization. and supported by an organization.

Standards of Practice: are a set of nursingStandards of Practice: are a set of nursing

actions that are generally agreed on by nursesactions that are generally agreed on by nurses

as constituting safe and effective client care.as constituting safe and effective client care.

- They established the foundation of the They established the foundation of the professional practice of registered nurses.professional practice of registered nurses.

- The development of these standards are The development of these standards are major functions of nursing professional major functions of nursing professional organizations.organizations.

Nursing is a Profession based on Nursing is a Profession based on the following criteriathe following criteria

1.1. Well-defined body of specific and unique Well-defined body of specific and unique knowledgeknowledge

2.2. Strong service orientationStrong service orientation3.3. Recognized authority by a professional Recognized authority by a professional

groupgroup4.4. Code of EthicsCode of Ethics5.5. Professional organization that sets Professional organization that sets

standardsstandards

Nursing is a Profession based on Nursing is a Profession based on the following criteriathe following criteria


6.6. Ongoing Research Ongoing Research

7. Autonomy7. Autonomy

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Unit I-n200 Nursing Theories

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