Nursing
As defined by the INTERNATIONAL COUNCIL OF NURSES as written by Virginia Henderson.
- The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health, it’s recovery, or to a peaceful death the client would perform unaided if he had the necessary strength, will or knowledge.
- Help the client gain independence as rapidly as possible.
Nursing Theory
Over the years, nursing has incorporated theories from non-nursing sources, including theories of systems, human needs, change, problem solving, and decision making. Barnum defines theory as “a construct that accounts for or organizes some phenomenon. A nursing theory, then, describes or explains nursing.”
With the formulation of different theories, concepts, and ideas in nursing it:
- It guides nurses in their practice knowing what is nursing and what is not nursing.
- It helps in the formulations of standards, policies and laws.
- It will help the people to understand the competencies and professional accountability of nurses.
- It will help define the role of the nurse in the multidisciplinary health care team.
Four Major Concepts
Nurses have developed various theories that provide different explanations of the nursing discipline. All theories, however, share four central concepts: Person refers to all human beings. People are the recipients of nursing care; they include individuals, families, communities, and groups. Environment includes factors that affect individuals internally and externally. It means not only in the everyday surroundings but all setting where nursing care is provided. Health generally addresses the person’s state of well-being. The concept of Nursing is central to all nursing theories. Definitions of nursing describe what nursing is, what nurses do, and how nurses interact with clients. Most nursing theories address each of the four central concepts implicitly or explicitly.
Betty Neuman
(1972, 1982, 1989, 1992)
Health Care System Model
The Neuman System Model or Health Care System Model
- Stress reduction is a goal of system model of nursing practice. Nursing actions are in primary, secondary or tertiary level of prevention.
- To address the effects of stress and reactions to it on the development and maintenance of health. The concern of nursing is to prevent stress invasion, to protect the client’s basic structure and to obtain or maintain a maximum level of wellness. The nurse helps the client, through primary, secondary, and tertiary prevention modes, to adjust to environmental stressors and maintain client stability.
Metaparadigm
Person
- A client system that is composed of physiologic, psychological, sociocultural, and environmental variables.
Environment
- Internal and external forces surrounding humans at any time.
Health
- Health or wellness exists if all parts and subparts are in harmony with the whole person.
Nursing
- Nursing is a unique profession in that it is concerned with all the variables affecting an individual’s response to stressors.
Dorothea Orem
(1970, 1985)
Self-Care Deficit Theory
Self-Care Deficit Theory
- Defined Nursing: “The act of assisting others in the provision and management of self-care to maintain/improve human functioning at home level of effectiveness.”
- Focuses on activities that adult individuals perform on their own behalf to maintain life, health and well-being.
- Has a strong health promotion and maintenance focus.
- Identified 3 related concepts:
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- Self-care – activities an Individual performs independently throughout life to promote and maintain personal well-being.
- Health – results when self-care agency (Individual’s ability) is not adequate to meet the known self-care needs.
- Nursing System – nursing interventions needed when Individual is unable to perform the necessary self-care activities:
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- Wholly compensatory – nurse provides entire self-care for the client.
- Example: care of a new born, care of client recovering from surgery in a post-anesthesia care unit
- Partial compensatory – nurse and client perform care; client can perform selected self-care activities, but also accepts care done by the nurse for needs the client cannot meet independently.
- Example: Nurse can assist post operative client to ambulate, Nurse can bring a meal tray for client who can feed himself
- Supportive-educative – nurse’s actions are to help the client develop/learn their own self-care abilities through knowledge, support and encouragement.
- Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies.
- Wholly compensatory – nurse provides entire self-care for the client.
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Dorothy E. Johnson
(1980)
Behavioral System Model
Behavioral System Model
- Focuses on how the client adapts to illness; the goal of nursing is to reduce stress so that the client can move more easily through recovery.
- Viewed the patient’s behavior as a system, which is a whole with interacting parts.
- The nursing process is viewed as a major tool.
- To reduce stress so the client can recover as quickly as possible. According to Johnson, each person as a behavioral system is composed of seven subsystems namely:
- Ingestive. Taking in nourishment in socially and culturally acceptable ways.
- Eliminated. Riddling the body of waste in socially and culturally acceptable ways.
- Affiliative. Security seeking behavior.
- Aggressive. Self – protective behavior.
- Dependence. Nurturance – seeking behavior.
- Achievement. Master of oneself and one’s environment according to internalized standards of excellence.
- Sexual role identity behavior
- In addition, she viewed that each person strives to achieve balance and stability both internally and externally and to function effectively by adjusting and adapting to environmental forces through learned pattern of response. Furthermore, She believed that the patient strives to become a person whose behavior is commensurate with social demands; who is able to modify his behavior in ways that support biologic imperatives; who is able to benefit to the fullest extent during illness from the health care professional’s knowledge and skills; and whose behavior does not give evidence of unnecessary trauma as a consequence of illness.
Metaparadigm
Person
- A system of interdependent parts with patterned, repetitive, and purposeful ways of behaving.
Environment
- All forces that affect the person and that influence the behavioral system
Health
- Focus on person, not illness. Health is a dynamic state influenced by biologic, psychological, and social factors
Nursing
- Promotion of behavioral system, balance and stability. An art and a science providing external assistance before and during balance disturbances
Ernestine Wiedenbach
(1964)
The Helping Art of Clinical Nursing
The Helping Art of Clinical Nursing
- Developed the Clinical Nursing – A Helping Art Model.
- She advocated that the nurse’s individual philosophy or central purpose lends credence to nursing care.
- She believed that nurses meet the individual’s need for help through the identification of the needs, administration of help, and validation that actions were helpful. Components of clinical practice: Philosophy, purpose, practice and an art.
Metaparadigm
Person
- Any individual who is receiving help from a member of the health profession or from a worker in the field of health.
Environment
- Not specifically addressed
Health
- Concepts of nursing, client, and need for help and their relationships imply health-related concerns in the nurse—client relationship.
Nursing
- The nurse is a functional human being who acts, thinks, and feels. All actions, thoughts, and feelings underlie what the nurse does.
Faye Glenn Abdellah
(1960)
Twenty One Nursing Problems
Twenty One Nursing Problems
- Nursing is broadly grouped into 21 problem areas to guide care and promote the use of nursing judgement.
- Introduced Patient – Centered Approaches to Nursing Model She defined nursing as service to individual and families; therefore the society. Furthermore, she conceptualized nursing as an art and a science that molds the attitudes, intellectual competencies and technical skills of the individual nurse into the desire and ability to help people, sick or well, and cope with their health needs.
21 Nursing Problems
- To maintain good hygiene.
- To promote optimal activity; exercise, rest and sleep.
- To promote safety.
- To maintain good body mechanics
- To facilitate the maintenance of a supply of oxygen
- To facilitate maintenance of nutrition
- To facilitate maintenance of elimination
- To facilitate the maintenance of fluid and electrolyte balance
- To recognize the physiologic response of the body to disease conditions
- To facilitate the maintenance of regulatory mechanisms and functions
- To facilitate the maintenance of sensory functions
- To identify and accept positive and negative expressions, feelings and reactions
- To identify and accept the interrelatedness of emotions and illness.
- To facilitate the maintenance of effective verbal and non-verbal communication
- To promote the development of productive interpersonal relationship
- To facilitate progress toward achievement of personal spiritual goals
- To create and maintain a therapeutic environment
- To facilitate awareness of self as an individual with varying needs.
- To accept the optimum possible goals
- To use community resources as an aid in resolving problems arising from illness.
- To understand the role of social problems as influencing factors
Metaparadigm
Person
- The recipients of nursing care having physical, emotional, and sociologic needs that may be overt or covert.
Environment
- Not clearly defined. Some discussion indicates that clients interact with their environment, of which nurse is a part.
Health
- A state when the individual has no unmet needs and no anticipated or actual impairment.
Nursing
- Broadly grouped in “21 nursing problems,” which center around needs for hygiene, comfort, activity, rest, safety, oxygen, nutrition, elimination, hydration, physical and emotional health promotion, interpersonal relationships, and development of self-awareness. Nursing care is doing something for an individual
Florence Nightingale
(1860)
Environmental Theory
Environmental Theory
- Defined Nursing: “The act of utilizing the environment of the patient to assist him in his recovery.”
- Focuses on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.
- Identified 5 environmental factors: fresh air, pure water, efficient drainage, cleanliness/sanitation and light/direct sunlight.
- Considered a clean, well-ventilated, quiet environment essential for recovery.
- Deficiencies in these 5 factors produce illness or lack of health, but with a nurturing environment, the body could repair itself.
- Developed the described the first theory of nursing. Notes on Nursing: What It Is What It Is Not. She focused on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.
Metaparadigm
Person
- An individual with vital reparative processes to deal with disease.
Environment
- External conditions that affect life and individuals development.
Health
- Focus is on the reparative process of getting well
Nursing
- Goal is to place the individual in the best condition for good healthcare
Evelyn Tomlin, Helen Erickson, and Mary Ann Swain
(1983)
Modeling and Role Modeling Theory
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Modeling and Role Modeling Theory
- Developed Modeling and Role Modeling Theory. The focus of this theory is on the person. The nurse models (assesses), role models (plans), and intervenes in this interpersonal and interactive theory.
- They asserted that each individual unique, has some self-care knowledge, needs simultaneously to be attached to the separate from others, and has adaptive potential. Nurses in this theory, facilitate, nurture and accept the person unconditionally.
Metaparadigm
Person
- A differentiation is made between patients and clients in this theory. A patient is given treatment and instruction; a client participates in his or her own care. “Our goal is for nurses to work with clients.” “A client is one who is considered to be a legitimate member of the decision-making team, who always has some control over the planned regimen, and who is incorporated into the planning and implementation of his or her own care as much as possible.”
Environment
- “Environment is not identified in the theory as an entity of its own. The theorist see environment in the social subsystems as the interaction between self and others both cultural and individual. Biophysical stressors are seen as part of the environment.”
Health
- “Health is a state of physical, mental and social well-being, not merely the absence of disease or infirmity. It connotates a state of dynamic equilibrium among the various subsystems [of a holistic person]”.
Nursing
- “The nurse is a facilitator, not an effector. Our nurse-client relationship is an interactive, interpersonal process that aids the individual to identify, mobilize, and develop his or her own strengths.”
Hildegard Peplau
(1951)
Interpersonal Relations Theory
Interpersonal Relations Theory
- Defined Nursing: “An interpersonal process of therapeutic interactions between an Individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.
- Nursing is a “maturing force and an educative instrument”
- Identified 4 phases of the Nurse – Patient relationship:
- Orientation – individual/family has a “felt need” and seeks professional assistance from a nurse (who is a stranger). This is the problem identification phase.
- Identification – where the patient begins to have feelings of belongingness and a capacity for dealing with the problem, creating an optimistic attitude from which inner strength ensues. Here happens the selection of appropriate professional assistance.
- Exploitation – the nurse uses communication tools to offer services to the patient, who is expected to take advantage of all services.
- Resolution – where patient’s needs have already been met by the collaborative efforts between the patient and the nurse. Therapeutic relationship is terminated and the links are dissolved, as patient drifts away from identifying with the nurse as the helping person.
Metaparadigm
Person
- An organism striving to reduce tension generated by needs
Environment
- The interpersonal process is always included, and psychodynamic milieu receives attention, with emphasis on the client’s culture and mores.
Health
- Ongoing human process that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living.
Nursing
- Interpersonal therapeutic process that “functions cooperatively with others human processes that make health possible for individuals in communities. Nursing is an educative instrument, a maturing force that aims to promote forward movement of personality.
Ida Jean Orlando
(1961)
The Dynamic Nurse-Patient Relationship
The Dynamic Nurse-Patient Relationship
- Conceptualized The Dynamic Nurse – Patient Relationship Model.
- She believed that the nurse helps patients meet a perceived need that the patient cannot meet for themselves. Orlando observed that the nurse provides direct assistance to meet an immediate need for help in order to avoid or to alleviate distress or helplessness.
- She emphasized the importance of validating the need and evaluating care based on observable outcomes.
- To interact with clients to meet immediate needs by identifying client behaviors, nurse’s reactions, and nursing actions to take
Metaparadigm
Person
- Unique individual behaving verbally nonverbally. Assumption is that individuals are at times able to meet their own needs and at other times unable to do so
Environment
- Not defined
Health
- Not defined. Assumption is that being without emotional or physical discomfort and having a sense of well-being contribute to a healthy state.
Nursing
- Professional nursing is conceptualized as finding out and meeting the client’s immediate need for help.
Imogene King
(1971, 1981)
Goal Attainment Theory
Goal Attainment Theory
- Nursing process is defined as dynamic interpersonal process between nurse, client and health care system.
- Postulated the Goal Attainment Theory. She described nursing as a helping profession that assists individuals and groups in society to attain, maintain, and restore health. If is this not possible, nurses help individuals die with dignity.
- In addition, King viewed nursing as an interaction process between client and nurse whereby during perceiving, setting goals, and acting on them transactions occurred and goals are achieved.
Metaparadigm
Person
- Biopsychosocial being
Environment
- Internal and external environment continually interacts to assist in adjustments to change.
Health
- A dynamic life experience with continued goal attainment and adjustment to stressors.
Nursing
- Perceiving, thinking, relating, judging, and acting with an individual who comes to a nursing situations
Jean Watson
(1979)
The Philosophy and Science of Caring
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The Philosophy and Science of Caring
- Nursing is concerned with promotion health, preventing illness, caring for the sick, and restoring health.
- Nursing is a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human care transactions
- She defined caring as a nurturing way or responding to a valued client towards whom the nurse feels a personal sense of commitment and responsibility. It is only demonstrated interpersonally that results in the satisfaction of certain human needs. Caring accepts the person as what he/she may become in a caring environment
- Carative Factors:
- The formation of a humanistic-altruistic system of values
- Instillation of faith-hope
- The cultivation of sensitivity to one’s self and others
- The development of a helping- trust relationship
- The promotion and acceptance of the expression of positive and negative feelings.
- The systemic use of the scientific problem-solving method for decision making
- The promotion of interpersonal teaching-learning
- The provision for supportive, protective and corrective mental, physical, socio-cultural and spiritual environment
- Assistance with the gratification of human needs
- The allowance for existential phenomenological forces
Metaparadigm
Person
- A valued being to be cared for, respected, nurtured, understood, and assisted, a fully functional, integrated self
Environment
- Social environment, caring and the culture of caring affect health
Health
- Physical, mental, and social wellness
Nursing
- A human science of people and human health; illness experiences that are mediated by professional, personal, scientific, aesthetic, and ethical human care transactions.
Joyce Travelbee
(1966, 1971)
Interpersonal Aspects of Nursing
Interpersonal Aspects of Nursing
- She postulated the Interpersonal Aspects of Nursing Model. She advocated that the goal of nursing individual or family in preventing or coping with illness, regaining health finding meaning in illness, or maintaining maximal degree of health.
- She further viewed that interpersonal process is a human-to-human relationship formed during illness and “experience of suffering”
- She believed that a person is a unique, irreplaceable individual who is in a continuous process of becoming, evolving and changing.
Metaparadigm
Person
- A unique, irreplaceable individual who is in a continuous process of becoming, evolving, and changing.
Environment
- Not defined
Health
- Heath includes the individual’s perceptions of health and the absence of disease.
Nursing
- An interpersonal process whereby the professional nurse practitioner assists an individual, family, or community to prevent or cope with the experience of illness and suffering, and if necessary, to find meaning in these experiences.
Lydia Hall
(1964)
Core, Care and Cure Model
Core, Care and Cure Model
- The client is composed of the ff. overlapping parts: person (core), pathologic state and treatment (cure) and body (care).
- Introduced the model of Nursing: What Is It? Focusing on the notion that centers around three components of Care, Core and Cure.
- Care represents nurturance and is exclusive to nursing. Core involves the therapeutic use of self and emphasizes the use of reflection. Cure focuses on nursing related to the physician’s orders. Core and cure are shared with the other health care providers.
- The major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the core.
Metaparadigm
Person
- Client is composed of body, pathology, and person. People set their own goals and are capable of learning and growing.
Environment
- Should facilitate achievement of the client’s personal goals.
Health
- Development of a mature self-identity that assists in the conscious selection of actions that facilitate growth.
Nursing
- Caring is the nurse’s primary function. Professional nursing is most important during the recuperative period.
Madeleine Leininger
(1978, 1984)
Transcultural Care Theory and Ethnonursing
Transcultural Care Theory and Ethnonursing
- Developed the Transcultural Nursing Model. She advocated that nursing is a humanistic and scientific mode of helping a client through specific cultural caring processes (cultural values, beliefs and practices) to improve or maintain a health condition.
- Nursing is a learned humanistic and scientific profession and discipline which is focused on human care phenomena and activities in order to assist, support, facilitate, or enable individuals or groups to maintain or regain their well being (or health) in culturally meaningful and beneficial ways, or to help people face handicaps or death.
- Transcultural nursing as a learned subfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health-illness caring practices, beliefs and values with the goal to provide meaningful and efficacious nursing care services to people according to their cultural values and health-illness context.
- Focuses on the fact that different cultures have different caring behaviors and different health and illness values, beliefs, and patterns of behaviors.
- Awareness of the differences allows the nurse to design culture-specific nursing interventions.
Martha Rogers
(1970)
Science of Unitary Man
Science of Unitary Man
- Nursing is an art and science that is humanistic and humanitarian. It is directed toward the unitary human and is concerned with the nature and direction of human development. The goal of nurses is to participate in the process of
- Nursing interventions seek to promote harmonious interaction between persons and their environment, strengthen the wholeness of the Individual and redirect human and environmental patterns or organization to achieve maximum health.
- 5 basic assumptions:
- The human being is a unified whole, possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts.
- The individual and the environment are continuously exchanging matter and energy with each other
- The life processes of human beings evolve irreversibly and unidirectionally along a space-time continuum
- Patterns identify human being and reflect their innovative wholeness
- The individual is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion
Metaparadigm
Person
- Unitary man, a four-dimensional energy field.
Environment
- Encompasses all that is outside any given human field. Person exchanging matter and energy.
Health
- Not specifically addressed, but emerges out of interaction between human and environment, moves forward, and maximizes human potential.
Nursing
- A learned profession that is both science and art. The professional practice of nursing is creative and imaginative and exists to serve people.
Myra Estrin Levine
(1973)
Conservation Model
Conservation Model
- Believes nursing intervention is a conservation activity, with conservation of energy as a primary concern, four conservation principles of nursing: conservation of client energy, conservation of structured integrity, conservation of personal integrity, conservation of social integrity.
- Described the Four Conversation Principles. She advocated that nursing is a human interaction and proposed four conservation principles of nursing which are concerned with the unity and integrity of the individual. The four conservation principles are as follows:
- Conservation of energy. The human body functions by utilizing energy. The human body needs energy producing input (food, oxygen, fluids) to allow energy utilization output.
- Conservation of Structural Integrity. The human body has physical boundaries (skin and mucous membrane) that must be maintained to facilitate health and prevent harmful agents from entering the body.
- Conservation of Personal Integrity. The nursing interventions are based on the conservation of the individual client’s personality. Every individual has sense of identity, self worth and self esteem, which must be preserved and enhanced by nurses.
- Conservation of Social integrity. The social integrity of the client reflects the family and the community in which the client functions. Health care institutions may separate individuals from their family. It is important for nurses to consider the individual in the context of the family.
Metaparadigm
Person
- A holistic being
Environment
- Broadly, includes all the individual’s experiences
Health
- The maintenance of the client’s unity and integrity
Nursing
- A discipline rooted in the organic dependency of the individual human being on his or her relationship with others
Rosemarie Rizzo Parse
(1981)
Theory of Human Becoming
Theory of Human Becoming
- Nursing is a scientific discipline, the practice of which is a performing art
- Three assumption about Human Becoming
- Human becoming is freely choosing personal meaning in situation in the intersubjective process of relating value priorities
- Human becoming is co-creating rhythmic patterns or relating in mutual process in the universe
- Human becoming is co-transcending multidimensionality with emerging possibilities.
Metaparadigm
Person
- A major reason for nursing existence
Environment
- Man and environment interchange energy to create what is in the world, and man chooses the meaning given to the situations he creates
Health
- A lived experience that is a process of being and becoming
Nursing
- Nursing Practice is directed toward illuminating and mobilizing family interrelationships in light of the meaning assigned to health and its possibilities as language in the co created patterns of relating.
Sister Callista Roy
(1979)
Adaptation Model
Adaptation Model
- Viewed humans as Biopsychosocial beings constantly interacting with a changing environment and who cope with their environment through Biopsychosocial adaptation mechanisms.
- Presented the Adaptation Model. She viewed each person as a unified biopsychosocial system in constant interaction with a changing environment. She contented that the person as an adaptive system, functions as a whole through interdependence of its part. The system consists of input, control processes, output feedback.
- Focuses on the ability of Individuals, families, groups, communities, or societies to adapt to change.
- The degree of internal or external environmental change and the person’s ability to cope with that change is likely to determine the person’s health status.
- Nursing interventions are aimed at promoting physiologic, psychologic, and social functioning or adaptation.
- To identify the types and demands placed on a client and client’s adaptation to the demands.
Metaparadigm
Person
- Biopsychological being and the recipient of nursing care.
Environment
- All conditions, circumstances, and influences surrounding and affecting the development of an organism or groups of organisms
Health
- The person encounters adaptation problems in changing the environment.
Nursing
- A theoretical system of knowledge that prescribes a process of analysis and action related to the care of the ill or potentially ill persons
Virginia Henderson
(1955)
The Nature of Nursing Model
The Nature of Nursing Model
- Introduced The Nature of Nursing Model. She identified fourteen basic needs.
- She postulated that the unique function of the nurse is to assist the clients, sick or well, in the performance of those activities contributing to health or its recovery, the clients would perform unaided if they had the necessary strength, will or knowledge.
- She further believed that nursing involves assisting the client in gaining independence as rapidly as possible, or assisting him achieves peaceful death if recovery is no longer possible.
- Defined Nursing: “Assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that an individual would perform unaided if he had the necessary strength, will or knowledge”.
- Identified 14 basic needs :
- Breathing normally
- Eating and drinking adequately
- Eliminating body wastes
- Moving and maintaining desirable position
- Sleeping and resting
- Selecting suitable clothes
- Maintaining body temperature within normal range
- Keeping the body clean and well-groomed
- Avoiding dangers in the environment
- Communicating with others
- Worshipping according to one’s faith
- Working in such a way that one feels a sense of accomplishment
- Playing/participating in various forms of recreation
- Learning, discovering or satisfying the curiosity that leads to normal development and health and using available health facilities.
Metaparadigm
Person
- Individual requiring assistance to achieve health and independence or a peaceful death. Mind and body are inseparable.
Environment
- All external conditions and influences that affect life and development
Health
- Equated with independence, viewed in terms of the client’s ability to perform 14 components of nursing care unaided: breathing, eating, drinking, maintaining comfort, sleeping, resting clothing, maintaining body temperature, ensuring safety, communicating, worshiping, working, recreation, and continuing development.
Nursing
- Assists and supports the individual in life activities and the attainment of independence.