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Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 1
Nursing Theory, Practice, and Research
Joannes Paulus T. Hernandez, B.S.H.B., B.S.N., R.N.
(Ongoing M.A.N.-A.H.N.)
University of the Philippines Open University-ManilaEmilio Aguinaldo College-ManilaDe La Salle University-Dasmariñas
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 2
Definitions of a Theory
Pinnel and Menesis (1986): Systematic set of
interrelated concepts, definitions and deductions
that describe, explain or predict
interrelationships
Walker and Avant (1983): Internally consistent
group of relational statements (concepts,
definitions and propositions) that presents a
systematic view about a phenomenon and which
is useful for description, explanation, prediction,
and control
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 3
Definitions of a Theory
Chin and Krammer (1991): Creative and
vigorous structuring of ideas that project a
tentative, purposeful and systematic view of a
phenomena
Dickoff and James (1986): Conceptual system of
framework invented for some purpose
Ellis (1986): Coherent set of hypothetical,
conceptual, and pragmatic principles forming a
general frame of reference for a field of inquiry
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 4
Definitions of a Theory
How is theory different from a philosophy?
A theory is a set of concepts, definitions and propositions that
project a systematic view of phenomena by designing specific inter-
relationships among concepts for purposes of describing, explaining
and predicting. (Chinn and Jacobs 1987)
A philosophy is an inquiry into the nature of things based on logical
reasoning rather than empirical methods.
Marriner-Tomey considers the ‘products’ of the following theorists as
philosophies – Nightingale, Widenbach, Henderson, Abdellah, Hall,
Watson and Benner.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 5
Definitions of a Theory
Florence Nightingale never actually formulated a
theory of nursing but was accredited by others
who categorized her personal journaling (“Notes
on Nursing”) and communications into a
theoretical framework.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 6
Definitions of a Theory
What is a model?
A model is an idea that explains by using symbolic and physical visualization
What is a concept?
A mental idea of a phenomenon
What is a construct?
A phenomena that cannot be observed and must be inferred
What is a proposition?
A statement of relationship between concepts
What is a conceptual model?
A conceptual model is made up of abstract and general ideas (concepts) and propositions that specify their relationships
What is a paradigm?
A paradigm is a conceptual diagram
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 2
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 7
Definitions of a Theory
Nursing Models:
Psychiatric Nursing
1. Roy's model of nursing
2. Tidal model
Pediatric Nursing
1. Casey's Nursing Model
Adult Nursing
1. Nightingale's model of nursing
2. Roper, Logan and Tierney
3. Orem's Model of Nursing
Community and Rehabilitation Nursing
1. Orem's Model of Nursing
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 8
Components or Elements of a Theory
1. Purpose: “Why is the theory formulated?” —specifies the context
2. Concepts: building blocks of theory but alone cannot create a theory; varies per experiences and perceptions of the theorist, the nursing metaparadigm—(1) Person, (2) Nursing, (3) Health, and (4) Environment; Key Conceptsgive the theory uniqueness e.g. Orem’s Self Care, Roy’s Adaptation Model, Leininger’sTranscultural Nursing and Levine’s Conservation Principle
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 9
Concepts in the Nursing Metaparadigm
1. Person – Recipient of care, including physical, spiritual,
psychological, and sociocultural components
– Individual, family, or community
2. Nursing– Actions, characteristics and attributes of person giving care
3. Health– Degree of wellness or illness experienced by the person
4. Environment– All internal and external conditions, circumstances, and
influences affecting the person
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 10
Components or Elements of a Theory
3. Definitions: give meaning to concepts—(1)
Descriptive/Conceptual refers to the accepted
meaning of the term already used; (2)
Operational/Stipulative refers to the specific
use or definition of the term within the theory
4. Propositions/Theoretical Assertions:
expressions of relational statements between
and among concepts/links concepts
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 11
Components or Elements of a Theory
5. Assumptions: accepted “truths” that are basic
and fundamental to the theory—(1) Factual
Assumptions are those knowable or potentially
knowable by empirical experience supported
by research; (2) Value Assumptions asserts or
implies what is right, good or ought to be
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N.
12
Components or Elements of a Theory
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 3
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 13
Characteristics of a Theory
1. Systematic, logical and coherent: no
contradictions between and among the
concepts
2. Creative structuring of ideas: concepts
are mental images resulting from one’s
experiences and perceptions
3. Tentative in nature: can change over
time
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N.
14
Theory Development
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 15
Theory Development
1. Theory-Practice-Theory: based on theories developed by other disciplines and used in nursing situations, e.g. Peplau’s Theory of Interpersonal Relations in Nursing based on Sullivan’s Interpersonal theory
2. Practice-Theory: based on clinical practice through actual observations or experiences, e.g. Orlando’s Nursing Process Theory
3. Research-Theory/Inductive Method: based on research findings, e.g. Johnson’s Behavioral Systems Model
4. Theory-Research-Theory: based on other disciplines but given a unique nursing perspective, e.g. conceptual or theoretical frameworks in nursing research studies
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 16
Significant Events in the
Development of Nursing TheoryPrior to 1960
- Nightingale’s works and writings
- Formal education of nurses
- Publication of Nursing Research
60s and 70s
- Scientific era: nurses questioned purpose of nursing
- Publications dealing with philosophy of nursing,
conceptual models and frameworks
- Process of theory development discussed among
professional nurses
- Symposia held on theory development in nursing
- Borrowed theories from other disciplines
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 17
Significant Events in the
Development of Nursing Theory80s
- Acceptance of the significance of theory in nursing
- Revision and further development of theories
- More substantive debate on issues related to theory
development
80s to present
- Publication of books and articles on analysis,
application, evaluation, and further development of
nursing theories
- Courses on theories offered at the graduate school
level
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 18
Uses of Theory
Theory guides and improves nursing practice—helps to identify the focus, the goals, and the means of practice
Theory guides research—research validates and modifies theory; theory forms the basis for hypothesis testing
Theory contributes to the development of the discipline’s body of knowledge—theory in nursing describes, explains, predicts and controls phenomena or events in order to achieve desired outcomes
Theory enhances communication—provides common language for understanding a phenomenon; creates a better link between practitioners, educators, administrators and researchers
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 4
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 19
Types of Theories
1. According to range
a. Grand Theories: broadest in scope, e.g. Henderson’s The Nature of Nursing, Levine’s The Four Conservation Principles of Nursing, Roy’s Adaptation Model, and Orem’s Self Care
b. Middle Range Theories: fill the gap between the grand theory and micro theory; testable, e.g. Peplau’sPsychodynamic Nursing and Orlando’s Nursing Process Theory
c. Micro Theories: narrowest in scope; deal with specific and narrowly defined phenomena, e.g. Synergy Model—pairing the needs of the patient and their family with the strengths of the nurse providing care
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 20
Types of Theories
2. According to orientation or focus of the theory
a. Client-Centered: focuses on the needs and problems of clients which are met, resolved or alleviated by nursing interventions, e.g. Nightingale, Abdellah, Henderson, Orem, Pender, Roy, Levine, and Hall
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 21
Types of Theories
b. Nurse-Client Dynamics: focuses on the interaction between the nurse and client, e.g. Peplau, Watson, King, and Orlando
c. Nurse-Client-Environment Dynamics: focuses on the interaction between the nurse and client in an environment, e.g. Neuman and Leininger
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N.
22
Types of Theories
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 23
Client-Centered Theories
Nightingale
Abdellah
Henderson
Orem
Pender
Roy
Levine
Hall
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 24
Florence Nightingale—
Environmental Theory
First nursing theorist– Unsanitary conditions
posed health hazard (Notes on Nursing, 1859)
5 components of environment– ventilation, light, warmth,
effluvia, noise
External influences can prevent, suppress or contribute to disease or death
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 5
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 25
Environmental Model: Florence Nightingale
Theory Overview
Florence Nightingale is recognized as founder of modern-day nursing.
Her environmental model is based on the idea that the impetus for healing lies within the individual human being and the focus of care is to place the individual in an environment that is supportive to that healing process.
Her 13 canons speak to areas that require the attention of the nurse, such as cleanliness, ventilation, warming, light, noise, variety, nutrition, “chattering hopes and advices,” and observation of the sick.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 26
Nightingale’s Concepts
Theory Overview
Person
– Patient who is acted on by nurse
– Affected by environment
– Has reparative powers
Nursing
– Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate person’s reparative process
– Practice of nursing was based on the belief that germs cause disease
Health
– Maintaining well-being by using a person’s powers
– Maintained by control of environment
Environment
– Foundation of theory. Included everything: physical, psychological, and social
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 27
*****
Religious inspiration
called her to focus on
the health of the
masses
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 28
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 29
Florence Nightingale
Began her nursing training in 1851 in
Germany
Pioneered the concept of formal nursing
education
Her experience in treating sick/injured
soldiers in the Crimean War strongly
influenced her philosophy of nursing
First to use statistics to guide care delivery
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 30
Florence Nightingale
“All sciences of observation depend upon statistical
methods—without these, are blind empiricism. Make
your facts comparable before deducing causes.
Incomplete, pell-mell observations arranged so as to
support theory; insufficient number of observations; this
is what one sees.”
Source: Florence Nightingale: Mystic, Visionary, Healer (B.M. Dossey), p. 230.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 6
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 31
Florence Nightingale
Based her ideas on individual, societal, and professional values
Her strongest influence was education, observation, and hands-on experience
She formulated her values through years of working with charities, hospitals, and the military
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 32
Florence Nightingale
In 1860 Nightingale published Notes on Nursing
Considered the first “nursing theorist”
Information on her theory has been obtained through interpretation of her writings
Her theory significantly influenced 3 other groups of theories - Adaptation Theory, Need Theory, & Stress Theory
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 33
Nightingale’s Notes on Nursing:
Was not written as a nursing text
Was a guide to help organize and manipulate the
environment for persons requiring nursing care
Nightingale originally wanted women to teach
themselves to nurse and viewed Notes on
Nursing as “hints” to enable them to do so
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 34
Nightingale on Notes on Nursing…
“I thank you sincerely & kindly for what you have to say
about my Notes on Nursing—you do not know how, in the
midst of much disappointment, such words cheer &
strengthen us. The only possible merit of my little book is
that there is not a word in it written for the sake of writing,
but only forced out of me by much experience in human
suffering.”
Source: Florence Nightingale: Mystic, Visionary, Healer (B.M. Dossey), p. 231.
Nightingale’s Nursing Theory
The first published nursing theory (1860)
Persons are in relation with the environment
Stresses the healing properties of the physical
environment (fresh air, light, warmth, and
cleanliness)
Nursing puts patients in the “best conditions” for
nature to act upon them
Health is “the positive of which the pathology is the
negative”
“Nature alone cures”
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 36
Nightingale’s Nursing Theory
When aspects of the environment are out of
balance, the client must use energy to counter
these environmental stresses
Stresses drain the client of the energy needed for
healing
Viewed disease as a reparative process
The health of the home/community are critical
components in an individual’s health
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 7
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 37
Nightingale’s Nursing Theory
Theory basis: the inter-relationship of a
healthful environment with nursing
– External influences and conditions can
prevent, suppress, or contribute to disease or
death
Theory goal: Nurses help patients retain their
own vitality by meeting their basic needs
through control of the environment
Nursing’s Focus: control of the environment for
individuals, families and the community
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 38
Three Types of Environments
1. Physical
2. Psychological
3. Social
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 39
Physical Environment
Consists of physical elements where the
patient is being treated
Affects all other aspects of the environment
Cleanliness of environment relates directly
to disease prevention and patient mortality
Aspects of the physical environment
influence the social and psychological
environments of the person
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 40
Psychological Environment
Can be affected by a negative physical
environment which then causes STRESS
Requires various activities to keep the mind
active (i.e, manual work, appealing food, a
pleasing environment)
Involves communication with the person, about
the person, and about other people
– communication should be therapeutic,
soothing, and unhurried
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 41
Social Environment
Involves collecting data about illness and
disease prevention
Includes components of the physical
environment - clean air, clean water, proper
drainage
Consists of a person’s home or hospital room, as
well as the total community that affects the
patient’s specific environment
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 42
5 Major Components of a Healthful Environment
1. Proper ventilation
2. Adequate light
3. Sufficient warmth
4. Control of noise
5. Control of effluvia (noxious odors)
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 8
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 43
Nightingale’s Philosophy in Nursing Practice
13 Canons
Nightingale identified 13 canons to form the boundaries of nursing
practice and expected nurses to be ‘clear thinkers’ and
‘independent’ in their judgments.
1. Ventilation and warmth: The circulating air should be as pure as the outside air and at an adequate temperature to keep the patient warmed.
2. Light: Direct light contains healing properties for the patient and purifies the air of the room.
3. Cleanliness of rooms and walls: Rooms should be kept clean and free
of dust/debris associated with the ventilation necessary for health.
4. Health of houses: Maintaining a healing environment goes beyond just cleanliness, this also includes the air, water, sanitation and light.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 44
5. Noise: Any loud noise that jars a patient awake and subjects them to a state of excitement is more harmful than continuous noises, however loud.
6. Bed and bedding: The sick should be provided with clean bedding every 12 hours, beds should be narrow and safe in height, positioned in lightest area of the room or near windows, and have adequate pillow support to the head and back to promote breathing.
7. Personal cleanliness: Allowing patients to be soiled and unclean hinders the natural process of health and contributes to the condition in which disease flourishes.
8. Variety: Monotony and redundancy of surroundings are harmful to patients mental state of being, variety in surroundings are mostbeneficial to health.
9. Chattering hopes and advices: Visitors, families and caregivers should not attempt to cheer patients by giving false hopes.
Nightingale’s Philosophy in Nursing Practice
13 Canons
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 45
10. Taking food: The amount of food taken and the amount of food needed should always be considered.
11. What food: Analyze the patient’s tolerance and system reactions to foods not the types of food.
12. Petty Management: Knowing what to do when you are there, and what shall be done when you are not there (providing continuity of care through your documentation).
13. Observation of the sick: Observing the patient for indications of condition change, and to know how to judge the importance of such changes.
While Nightingale’s canons do not specifically address spirituality, she viewed
the patient in a holistic manner having a spiritual dimension as well.
(Alligood, M. R., & Tomey, A. M. (2002). Nursing theory utilization & application (2nd ed.). St. Louis,
Missouri: Mosby. pp. 86-87.)
13 Canons
Nightingale’s Philosophy in Nursing Practice
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 46
Nightingale’s Theory & Nursing’s
Metaparadigm - PERSON
Referred to by Nightingale as “the patient”
A human being acted upon by a nurse, or
affected by the environment
Has reparative powers to deal with disease
Recovery is in the patient’s power as long as a
safe environment exists
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 47
Nightingale’s Theory & Nursing’s
Metaparadigm - NURSING
“I use the word nursing for want of a better word. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient.” Florence Nightingale ("Florence Nightingale", n.d.)
Provides fresh air, light, warmth, cleanliness, quiet, and a proper diet
Facilitates a patient’s reparative process by ensuring the best possible environment
Influences the environment to affect health
Supports the nursing process even before its development
Florence Nightingale. (n.d.). Retrieved February 04, 2006, from
http://en.wikiquote.org/wiki/Florence_Nightingale
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 48
Nightingale’s Theory & Nursing’s
Metaparadigm - NURSINGShe believed that: (1) nursing was a spiritual calling requiring ethics and a societal commitment to help those suffering, and (2) nurses should be formally educated to provide quality care (in contrast to the ‘lay-person nurse’ of that time era).
She also defined three different types of nursing:
1. Nursing proper- nursing the sick
2. General nursing- health promotion
3. Midwifery nursing
Nightingale viewed nursing as the ‘science of environmental management’ (with nurses altering the patient’s environment to promote health and healing). (Alligood, pp. 84-85)
Nursing education belongs in the hands of nurses
Nursing is a discipline distinct from medicine focusing on the patient’s reparative process rather than on their disease
Alligood, M. R., & Tomey, A. M. (2002). Nursing theory utilization & application (2nd ed.). St. Louis, Missouri:
Mosby.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 9
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 49
Nightingale’s Theory & Nursing’s
Metaparadigm - HEALTH
“Health is not only to be well, but to be able to use well every power we
have.” Florence Nightingale ("Florence Nightingale", n.d.)
Maintained by using a person’s healing powers to their fullest extent
Maintained by controlling the environmental factors so as to prevent disease
Disease is viewed as a reparative process instituted by nature
Health & disease are the focus of the nurse
Nurses help patients through their healing process
Florence Nightingale. (n.d.). Retrieved February 04, 2006, from http://en.wikiquote.org/wiki/Florence_Nightingale
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 50
Nightingale’s Theory & Nursing’s
Metaparadigm - ENVIRONMENT
The foundational component of Nightingale’s
theory
The external conditions and forces that affect
one’s life and development
Includes everything from a person’s food to a
nurse’s verbal and non-verbal interactions with
the patient
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 51
Theory Strengths
Although Nightingale developed her theory more than a century ago, her
concept of nursing is still relevant and consistent with our current nursing
process in the 21st century, standing the test of time.
Nightingale’s concept of the physical and psychological environment serves
as the foundation for providing holistic nursing care, while manipulation of
the environment (guided by the canons) works to remove obstacles thereby
creating an opportunity for healing.
Nightingale advocated nursing specialties (public health nursing, and
midwifery), showing consideration for unique patient needs.
Values: ethically based
Vision: personalized and holistic care
Voice: patient advocacy
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 52
Theory Weaknesses
While Nightingale believed in health promotion, patient education
is not specifically addressed.
“Nightingale assumed that the patient would want to be healthy and
therefore would cooperate and assist the nurse to allow nature to help the
patient” (Alligood, p. 85). Yet there is no mention of patient
compliance/care issues. Nor does Nightingale mention enlisting patient
input when planning their care (aside from food preferences). The focus is
on the nurse doing for the patient, rather than fostering patient interaction
and promoting patient responsibility in caring for themselves to their best
ability.
Alligood, M. R., & Tomey, A. M. (2002). Nursing theory utilization & application (2nd ed.). St. Louis, Missouri:
Mosby.
Although Nightingale considered nursing a spiritual calling, and
envisioned the patient as having a spiritual component, she did not
address this dimension specifically.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 53
“…it does no good to pray to God to save us from disease as we
continue to drain our sewage into the lakes from which one drinks.”
"Diseases are not individuals arranged in classes like cats and dogs,
but conditions growing out of one another. The specific disease is the
grand refuge of the weak, uncultured, unstable minds, such as now rule
in the medical profession. There are no specific diseases; there are
specific disease conditions.” Florence Nightingale ("Florence
Nightingale", n.d.)
Florence Nightingale. (n.d.). Retrieved February 04, 2006, from http://en.wikiquote.org/wiki/Florence_Nightingale
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 54
Faye Abdellah—Typology of 21 Nursing
Problems
A list of 21 nursing problems
– Condition presented or
faced by the patient or
family.
Problems are in 3 categories
– physical, social and
emotional
The nurse must be a good
problem solver
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 10
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 55
Abdellah’s Typology of 21 Nursing Problems
Abdellah’s typology was divided into three areas: (1) the physical, sociological, and emotional needs of the patient; (2) the types of interpersonal relationships between the nurse and the patient; and (3) the common elements of patient care. The typology would provide a method to evaluate a student’s experiences and nurse’s competency based on outcome measures. (Tomey & Alligood, Nursing theorists and their work 4th ed., p. 115).
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 56
Abdellah’s Typology of 21 Nursing Problems:
1. To promote good hygiene and physical comfort
2. To promote optimal activity, exercise, rest, and sleep
3. To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection
4. To maintain good body mechanics and prevent and correct deformities
5. To facilitate the maintenance of a supply of oxygen to all body cells
6. To facilitate the maintenance of nutrition of all body cells
7. To facilitate the maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic responses of the body to disease conditions
10. To facilitate the maintenance of regulatory mechanisms and functions
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 57
Abdellah’s Typology of 21 Nursing Problems:
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings, and reactions
13. To identify and accept the interrelatedness of emotions and organic illness
14. To facilitate the maintenance of effective verbal and nonverbal communication
15. To promote the development of productive interpersonal relationships
16. To facilitate progress toward achievement of personal spiritual goals
17. To create and maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs
19. To accept the optimum possible goals in light of physical and emotional limitations
20. To use community resources as an aid in resolving problems arising from illness
21. To understand the role of social problems as influencing factors in the cause of illness
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 58
Patient-Centered Approaches: Faye Glenn Abdellah
Theory Overview
Faye Glenn Abdellah conducted research to identify ways to promote patient-centered comprehensive nursing care.
Nursing focused rather than patient focused.
21 basic nursing problems evolved through research focused on aneffort to move the focus of care from the disease to the patient.
The problems may be overt or covert, and problem solving is to used by the nurse.
The nursing process as a problem-solving process is compatible
with this approach.
Solving covert problems may resolve overt problems.
PLANNING is done primarily by the NURSE.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 59
Abdellah’s Concepts
Theory Overview
Person
– One who has physical, emotional, or social needs
– The recipient of nursing care.
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
Environment
– Did not discuss much
– Includes room, home, and community
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 60
Henderson’s Theory—Definition of Nursing
“The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. She must in a sense, get inside the skin of each of her patients in order to know what he needs.”
“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.”
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 11
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 61
Definition and Components of Nursing: Virginia Henderson
Theory Overview
Virginia Henderson presented her definition of nursing as part of her effort to regulate nursing practice through licensure to protect nursing practice and the public.
14 components of basic nursing care augment the definition to provide an overall guide to the practice of nursing.
The source of difficulty resides with the client and not with the nurse.
Consequences of nursing actions include increased independence in the satisfaction of the client’s 14 fundamental or basic needs or peaceful death.
First nurse to speak to the importance of a peaceful death.
In NURSING DIAGNOSIS the focus will be on what the patient lacks the strength, will, or knowledge to accomplish.
The use of critical thinking in nursing practice is supported by the quote:“The nurse who operates under a definition that specifies an area of independent practice…must assume responsibility for identifying problems…”
No nursing model was developed.
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B.S.H.B., B.S.N., R.N. 62
Henderson’s Concepts
Theory OverviewPerson
– An individual person or client is a whole, complete and independent being with biological, sociological, and spiritual components which are operationalized in the 14 fundamental or basic human needs
– The person must maintain physiological and emotional balance: the mind and body are inseparable
– The patient is an individual who requires assistance to achieve health and independence or peaceful death
– The patient and his family are viewed as a unit
Nursing
– Nursing is assisting the individual
– Nurses’ function is to alter the environment in such a way as to support the patient
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B.S.H.B., B.S.N., R.N. 63
Henderson’s Concepts
Theory Overview
Health
– Health is equated with independence
– Individuals will achieve or maintain health if they have the necessary strength, will or knowledge.
– Health is viewed in terms of the patient’s ability to independently perform the 14 basic needs
Environment
– “The aggregate of all external conditions and influences affecting the life and development of an organism…”
– Can act either positively or negatively upon the patient
– Required of 7 essentials
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B.S.H.B., B.S.N., R.N. 64
7 Essentials in the Environment
1. Light
2. Temperature
3. Air movement
4. Atmospheric pressure
5. Appropriate disposal of waste
6. Minimal quantities of injurious chemicals
7. Cleanliness of surfaces and furnishings coming in contact with the individual
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B.S.H.B., B.S.N., R.N. 65
14 Basic Human Needs
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable position
5. Sleep and rest
6. Select suitable clothes—dress and undress
7. Maintain body temperature within normal range by adjusting clothing and modifying the environment
8. Keep the body clean and well-groomed and protect the integument
9. Avoid dangers in the environment and avoid injuring others;
10. Communicate with others expressing emotions, needs, fears, or opinions
11. Worship according to one’s faith
12. Work in such a way that there is a sense of accomplishment
13. Play or participate in various forms of recreation
14. Learn, discover, or satisfy the curiosity that leads to normal development and health, and use available health facilities
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B.S.H.B., B.S.N., R.N. 66
Dorothea Orem—
Self-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
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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B.S.H.B., B.S.N., R.N. 68
Self Care Deficit Nursing Theory: Dorothea E. Orem
Theory Overview
Dorothea E. Orem’s general theory of nursing is made up of the three interrelated theories of self-care, self-care deficit, and nursing systems.
A peripheral concept, basic conditioning factors, applies to all of the theories.
The major concepts of self-care are self-care, self-care agency, self-care requisites (universal, developmental, and health deviation), and therapeutic self-care demand. The basic premise of the model is that individuals can take responsibility for their health and the health of others. In a general sense, individuals have the capacity to care for themselves or their dependents.
A self-care deficit exists when the therapeutic self-care demand exceeds self-care agency.
Nursing systems involve nursing agency and the design of nursing systems for care (wholly compensatory, partly compensatory, and supportive-educative).
Orem’s nursing process is a three-step process (diagnosis and prescription, nursing system design, production and management of nursing systems).
Desired outcomes, using Orem’s theory, would reflect adequate self-care agency.
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B.S.H.B., B.S.N., R.N. 69
Orem’s Basic Conditioning Factors
1. Familial
2. Personal
3. Social
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B.S.H.B., B.S.N., R.N. 70
Orem’s Concepts
Theory OverviewPerson
– Man as an integrated whole—a unity functioning biologically, symbolically and socially, logical and reflective of his or her experiences, self-reliant, responsible for self-care and well-being of his or her dependents
– Patient as an individual who is in need of assistance in meeting specific health-care demands because of lack of knowledge, skills, motivation, or orientation
Nursing
– As a (1) Community service—as an interpersonal process since it requires the social interaction of a nurse with a patient and involves transaction between them, an (2) Art—as the ability to assist others in the design, provision, and management of systems of self-care to improve or maintain human functioning at some level of effectiveness, and a (3) Technology—techniques of nursing must be learned, and skill and expertness in their use must be developed by person who pursue nursing as a career
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 71
Orem’s Concepts
Theory Overview
Health
– As a state of wholeness or integrity of the individual human being, his parts, and his modes of functioning
– A healthy person is likely to have sufficient self-care abilities to meet his/her universal self-care needs
Environment
– Elements external to man
– Man and environment as an integrated system related to self-care
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B.S.H.B., B.S.N., R.N. 72
Assumptions involving the concept of self-care:
1. Self-care is a requirement of every person.
2. Universal self-care involves meeting basic human needs.
3. Health-deviation self-care is related to disease or injury.
4. Each adult has both the right and the responsibility to care forhim/herself in order to maintain rational life and health; he/she may also have responsibilities for dependents.
5. Self-care is learned behavior processed by the ego and influenced by both self-concept and level of maturity.
6. Self-care is deliberative action.
7. Awareness of relevant factors and their meaning is a prerequisite condition for self-care action.
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B.S.H.B., B.S.N., R.N. 13
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 73
Assumptions underlying the general
theory of nursing:
1. Human beings require continuous deliberate inputs to themselves and their environment to remain alive and function in accordancewith natural human endowments.
2. Human agency, the power to act deliberately, is exercised in theform of care of self and others—identifying needs and making needed inputs.
3. Mature human beings experience privations in the form of limitations for action in care of self and others involving the making of life-sustaining and function-regulating inputs.
4. Human agency is exercised in discovering, developing, and transmitting to others, the ability to identify needs and make inputs to self and others.
5. Groups of human beings with structured relationships tend to cluster tasks and allocate responsibilities for providing care to group members who experience privation. The group can require deliberate input to self and others.
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B.S.H.B., B.S.N., R.N. 74
Key Concepts
Agent: person taking action
Self-care agent: provider of self-care
Dependent self-care agent: provider of infant care or dependent adult care
Self-Care: the practice of activities that individuals personally initiate and perform on their own behalf in maintaining life, health, and well-being divided into three categories: (1) Demands; (2) Capabilities; and (3) Deficits.
Self-Care Requisites: expressions of purposes to be attained, and results desired from deliberate engagement in self-care divided into three categories: (1) Universal self-care requisites; (2) Developmental self-care requisites; and (3) Health-deviation self-care requisites.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 75
Key Concepts
Universal self-care requisites:
1. Sufficient intake of air.
2. Sufficient intake of water.
3. Sufficient intake of food.
4. Provision of care associated with elimination
processes.
5. Balance between activity & rest.
6. Balance between solitude & social interaction.
7. Prevention of hazards.
8. Promotion of human functioning & development within
social groups in accord with human potential,
limitations, and human desire to be normal.
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B.S.H.B., B.S.N., R.N. 76
Key Concepts
Developmental self-care requisites ─ either specialized expressions of universal self-care requisites that have been particularized for developmental processes, or they are new requisites derived from:
1. conditions that support life processes and promote
specific developmental stages.
2. conditions affecting human development either
concerns the provision of care to prevent occurrence
of adverse conditions or concerns the provision of
care to prevent occurrence of or to overcome effects
of losses.
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B.S.H.B., B.S.N., R.N. 77
Key Concepts
Health deviation self-care requisites ─ an individual with an illness, disease or injury is likely to have additional demands for self-care divided into six categories:
1. Seeking and securing appropriate medical assistance when
exposed to specific physical, biological agents, or environmental
conditions associated with human pathological states or when
there is evidence of genetic, physiological or psychological
conditions known to produce human pathology.
2. Being aware and attending to the effects and results of
pathological conditions and states including effects on
development.
3. Effectively carrying out medically prescribed diagnostic, therapeutic and
rehabilitative measures directed towards preventing specific types of
pathology, regulation of human integrated functioning, correction of
deformities, or compensating for disabilities.
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B.S.H.B., B.S.N., R.N. 78
Key Concepts
4. Being aware of, attending to, or regulating the discomforts or deleterious effects of medical care measures performed or prescribed by physicians, including their effects on development.
5. Modifying self-concept to be able to accept one’s state of health or the need for specific forms of health care.
6. Learning to live with the effects of pathological conditions and states and the effects of medical diagnosis and treatment measures, in a lifestyle that promotes continued personal development.
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Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 79
Key Concepts
Therapeutic self-care demand ─ the sum
total of actions needed to perform in order
to meet known self-care requisites
Self-care agency ─ the ability of a person
to initiate and perform activities of self-
care
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Nursing Systems 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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B.S.H.B., B.S.N., R.N. 86
Sister Calista Roy—Adaptation Model
Five Interrelated Essential Elements
1. Patient: The person receiving care
2. Goal of nursing: Adapting to
change
3. Health-Being and becoming a
whole person
4. Environment
5. Direction of nursing activities-
Facilitating adaptation
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
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 87
Nola J. Pender—Health Promotion Model
Influenced by: (1) Bandura’s Social Learning
Theory, which emphasized the importance of
cognitive processes in behavior change and (2)
Fishbein’s Theory of Reasoned Action, which is
focused on behavior as a function of personal
attitudes and social norms.
Two main domains: (1) Cognitive-perceptual factors;
and (2) Modifying factors
Health Promotion is directed towards increasing the
(1) level of well-being and (2) self-actualization of a
given individual or group.
Health-promoting behaviors increase self-awareness,
self-satisfaction, enjoyment and pleasure.
Health-promoting behaviors are continuing self-care
activities that must be an integral part of an
individual’s lifestyle, e.g. physical exercise, proper
nutrition, and stress management.
Disease Prevention or Health Protection refers to
activities directed towards decreasing the probability
of experiencing illness by active protection of the
body against pathological stressors, e.g. detection of
illness in the asymptomatic stage.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 88
Assumptions
1. Persons seek to create conditions of living through which they can express their unique human health potential.
2. Persons have the capacity for reflective self-awareness, including assessment of their own competencies.
3. Persons value growth in directions viewed as positive and attempt to achieve a personally acceptable balance between change and stability.
4. Individuals seek to actively regulate their own behavior.
5. Individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time.
6. Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their lifespan.
7. Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 89
Propositions
1. Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health-promoting behavior.
2. Persons commit to engaging in behaviors from which they anticipate deriving personally valued benefits.
3. Perceived barriers can constrain commitment to action, a mediator of behavior as well as actual behavior.
4. Perceived competence or self-efficacy to execute a given behavior increases the likelihood of commitment to action and actual performance of the behavior.
5. Greater perceived self-efficacy results in fewer perceived barriers to a specific health behavior.
6. Positive affect toward a behavior results in greater perceived self-efficacy, which can in turn, result in increased positive affect.
7. When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 90
Propositions
8. Persons are more likely to commit to and engage in health-promoting behaviors when significant others model the behavior, expect the behavior to occur, and provide assistance and support to enable the behavior.
9. Families, peers, and health care providers are important sources of interpersonal influence that can increase or decrease commitment to and engagement in health-promoting behavior.
10. Situational influences in the external environment can increase or decrease commitment to or participation in health-promoting behavior.
11. The greater the commitment to a specific plan of action, the more likely health-promoting behaviors are to be maintained over time.
12. Commitment to a plan of action is less likely to result in the desired behavior when competing demands over which persons have little control require immediate attention.
13. Commitment to a plan of action is less likely to result in the desired behavior when other actions are more attractive and thus preferred over the target behavior.
14. Persons can modify cognitions, affect, and the interpersonal and physical environment to create incentives for health actions.
Source: Pender, N.J., Murdaugh, C. L., & Parsons, M.A. (2002).
Health Promotion in Nursing Practice (4th Edition). Upper Saddle River, NJ: PrenticeHall.
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•Provide training, guidance, and positive reinforcement.Confidence in one's ability to take action6. Self-Efficacy
•Provide how-to information.•Promote awareness.•Provide reminders.
Strategies to activate "readiness"5. Cues to Action
•Identify and reduce barriers through reassurance, incentives, and assistance.
One's belief in the tangible and psychological costs of the advised behavior
4. Perceived Barriers
•Define action to take — how, where, and when.•Clarify the positive effects to expected.•Describe evidence of effectiveness.
One's belief in the efficacy of the advised action to reduce risk or seriousness of impact
3. Perceived Benefits
•Specify and describe consequences of the risk and the condition.One's belief of how serious a condition and its consequences are
2. Perceived Severity
•Define population(s) at risk and their risk levels.•Personalize risk based on a person's traits or behaviors.•Heighten perceived susceptibility if too low.
One's belief of the chances of getting a condition
1. Perceived Susceptibility
ApplicationDefinitionConcept
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Nurse-Client Dynamics
Peplau
Watson
King
Orlando
Parse
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Hildegard Peplau—Interpersonal 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
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 99
Peplau’s Concepts
Person
– An individual; a developing organism who tries to reduce anxiety caused by needs
– Lives in unstable equilibrium
Nursing
– A significant, therapeutic, interpersonal process that functions cooperatively with others to make health possible
– Involves problem-solving
Health
– Implies forward movement of the personality and human processes toward creative, constructive, productive, personal, and community living
Environment - Not defined
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B.S.H.B., B.S.N., R.N. 100
Jean Watson—
Philosophy and Science of Caring
Caring can be demonstrated and
practiced
Caring consists of 10 Carative
Factors
Caring promotes growth
A caring environment accepts a
person as he is and looks to what
the person may become
A caring environment offers
development of potential
Caring promotes health better than
curing
Caring is central to nursing
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 101
Watson’s 10 Carative Factors
1. Forming humanistic-altruistic value system
2. Instilling faith-hope
3. Cultivating sensitivity to self and others
4. Developing helping-trust relationship
5. Promoting expression of feelings
6. Using problem-solving for decision making
7. Promoting teaching-learning
8. Promoting supportive environment
9. Assisting with gratification of human needs
10. Allowing for existential-phenomenological forces
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 102
Watson’s Concepts
Person– Human being to be valued, cared for, respected, nurtured, understood and assisted
Environment– Society
Health– Complete physical, mental and social well-being and functioning
Nursing– Concerned with promoting and restoring health, preventing illness
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Imogene King—
Goal Attainment Theory
The nurse and patient mutually communicate,
establish goals and take action to attain goals
Each individual brings a different set of
values, ideas, attitudes, perceptions to
exchange
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 King—
Goal Attainment Theory
Personal System
– Individual; perception, self, growth, development,
time space, body image
Interpersonal
– Socialization; interaction, communication and
transaction
Society
– Family, religious groups, schools, work, peers
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Ida Jean Orlando—
Deliberative Nursing Process
The deliberative nursing process is set
in motion by the patient’s behavior
– All behavior may represent a cry for
help. Patient’s behavior can be
verbal or non-verbal.
The nurse reacts to patient’s behavior
and forms basis for determining nurse’s
acts.
– Perception, thought, feeling
Nurses’ actions should be deliberative,
rather than automatic
– Deliberative actions explore the
meaning and relevance of an
action.
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Rosemary Parse—
Human Becoming Theory
Human Becoming Theory
includes Totality Paradigm
– Man is a combination of
biological, psychological,
sociological and spiritual
factors
Simultaneity Paradigm
– Man is a unitary being in
continuous, mutual
interaction with environment
Originally Man-Living-Health
Theory
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Parse’s Three Principles
1. Meaning
– Man’s reality is given meaning through lived experiences
– Man and environment co-create
2. Rhythmicity
– Man and environment co-create ( imaging, valuing, languaging) in rhythmical patterns
3. Co-transcendence
– Refers to reaching out and beyond the limits that a person sets
– One constantly transforms
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B.S.H.B., B.S.N., R.N. 111
Rosemary Parse—
Human Becoming Theory
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
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
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Nurse-Client-Environment
Dynamics
Neuman
Leininger
Johnson
Roger
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Betty Neuman—Systems 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
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 Neuman—Systems Model
Flexible lines of resistanceSurround basic core
Internal factors that help defend against stressors
Normal line of resistanceNormal adaptation state
Flexible line of defenseProtective barrier, changing, affected by variables
Wellness is equilibrium
Nursing interventions are activites to: strengthen flexible lines of defense
strengthen resistence to stressors
maintain adaptation
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Madeleine Leininger—
Culture Care Diversity and Universality
Based on transculturalnursing, 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 Leininger—
Culture Care Diversity and Universality
Modes of nursing action
– Cultural care preservationhelp maintain or preserve health, recover from illness, or
face death
– Cultural care accommodation
help adapt to or negotiate for a beneficial health status,
or face death
– Cultural care re-patterning
help restructure or change lifestyles that are culturally
meaningful
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Dorothy Johnson—
Behavioral Systems Model
The person is a behavioral system
comprised of a set of organized,
interactive, interdependent, and
integrated subsystems
– Constancy is maintained
through biological,
psychological, and sociological
factors.
A steady state is maintained
through adjusting and adapting to
internal and external forces.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 124
Johnson’s 7 Subsystems
1. Affiliative subsystem: social bonds
2. Dependency: helping or nurturing
3. Ingestive: food intake
4. Eliminative: excretion
5. Sexual: procreation and gratification
6. Aggressive: self-protection and preservation
7. Achievement: efforts to gain mastery and
control
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 125
Johnson’s Concepts
Person– A behavioral system comprised of subsystems constantly trying to maintain a steady state
Nursing– External regulatory force that is indicated only when there is instability
Health– Balance and stability
Environment– Not specifically defined but does say there is an internal and external environment
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 126
Martha Rogers—
Science of Unitary Human Beings
Energy fields
– Fundamental unity of things
that are unique, dynamic,
open, and infinite
– Unitary man and
environmental field
Universe of open systems
– Energy fields are open, infinite,
and interactive
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 22
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 127
Roger’s Definitions
Pattern
– Characteristic of energy field
– A wave that changes, becomes complex and diverse
Four dimensionality
– A non-linear domain with out time or space
Integrality
– Continuous and mutual interaction between man and environment
Resonancy
– Continuous change longer to shorter wave patterns in human and environmental fields
Helicy
– Continuous, probabilistic, increasing diversity of the human andenvironmental fields.
– Characterized by non-repeating rhythmicities
– Change
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 128
Patricia Benner –
From Novice to Expert
Described 5 levels of nursing
experience and developed
exemplars and paradigm cases to
illustrate each level
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
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 129
Patricia Benner –
From Novice to Expert
Novice
Advanced beginner
Competent
Proficient
Expert
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 130
Nursing Research
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 131
Nursing research
Includes study of:
1. Aspects
2. Components
3. Activities
4. Phenomena relating to health and of interest to nurses
To:
1. Describe
2. Explain
3. Predict
4. Control
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 132
Purposes of Research to Nursing
Nursing is a profession
Major means to generate knowledge
To evaluate and document nurses
contributions to client’s health, well-being,
and health care delivery system
Duties of a nurse: RA 9173 Section 28e
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 23
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 133
ICN Definition (Position Statement on
Nursing Research, 1999)
“Nursing research is needed to generate new knowledge, evaluateexisting practice and services, and provide evidence that will inform nursing education, practice, research and management.”
“Research is directed toward understanding the fundamental mechanisms that affect the ability of individuals, families and communities to maintain or enhance optimum function and minimize the negative effects of illness. Nursing research should also be directed toward the outcomes of nursing interventions, so as to assure the quality and cost-effectiveness of nursing care.”
“Nursing research also encourages knowledge of policies and systems that effectively and efficiently deliver nursing care; awareness of the profession and its historical development; understanding of ethical guidelines for the delivery of the nursing services; and knowledge of systems that effectively prepare nurses to fulfill the profession’s current and future social mandate.”
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 134
Quantitative vs. Qualitative
Objective
One reality
Reduction, control, prediction
Mechanistic
Parts equal the whole
Report statistical analysis
Researcher separate
Subjects
Context free
Subjective
Multiple realities
Discovery, description, understanding
Imperative
Organismic
Whole is greater than the parts
Report is rich in narrative
Researcher part of the research process
Participants
Context dependent
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 135
Steps in the Research Process
1. Identify the problem
2. Conduct literature review
3. Identify theoretical/conceptual framework
4. Formulate hypothesis
5. Operationalize variables
6. Select research design
7. Ascertain and select sample
8. Conduct a pilot study
9. Collect data
10. Analyze data
11. Interpret results
12. Disseminate information
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 136
Research Problem
A situation in need of a description or quantification, solution, improvement or alteration
Criteria: (1) Significance of the problem; (2) Researchability of the problem; (3) Feasibility; (4) Interest to the researcher
The focus of nursing research during the 1980s is clinical problems
→→→→ Both quantitative and qualitative research involve identifying a research problem/ question, collecting and analyzing data. Quantitative studies are reported using descriptive and analytic statistics while qualitative studies are reported in narrative format.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 137
Contents of a Research Proposal
1. The problem (background of the study, objectives of the study, statement of the problem, significance of the study, scope and limitation of the study, and definition of terms)
2. Theoretical background (review of literature, conceptual framework, and hypotheses)
3. Methodology (research design, research setting, sampling design, sample size, statistical analysis, data gathering process, research tools, and ethical considerations)
4. Plan for data analysis and interpretation
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 138
Purposes of Literature Review
To search for research ideas/topics
To be oriented to what is known
To establish the conceptual context of our
study
To assess the feasibility of the study
To be informed on research purposes
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 24
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 139
Framework
An abstract logical structure of meaning that guides the development of the study and enables the researcher to link the findings to nursing body of knowledge
1. A conceptual framework deals with
abstractions that are put together because of
their relevance to a common theme
2. A theoretical framework does not have a
deductive system or propositions that asserts
a relationship between concepts
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 140
Hypothesis
A statement of the anticipated or expected
relationship between variables (research
concepts): the independent and the dependent
An independent variable is the presumed
“cause”
A dependent variable is the presumed “effect”
The variability in the dependent variable is
presumed to be due to the variability in the
independent variable
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 141
Operational Definition
A specification of the operations that a researcher must perform to collect the required information
Operational reasoning is the process of identification and discrimination between alternatives and viewpoints
Inductive reasoning is the process of forming general conclusions from articular instances
Statements that are taken for granted or are considered true, even though they have not been scientifically tested are called assumptions
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 142
Data Collection Methods
Physiological/biophysical measures
Observational methods—use of checklists and rating scales
Interviews
Use of questionnaires
Psychological measures
Content analysis
Delphi technique
Projective techniques
Diaries
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 143
Validity vs. Reliability
Validity of a research tool is the extent to which the instrument actually reflects the construct or variable being examined
1. Internal validity is the extent to which the results of the
study can actually be attributed to the action of the
independent variable and not something else
2. External validity is the degree to which the findings of
the study can be generalized to the target population
Reliability is concerned with how consistently the measurement technique measures the concept of interest
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 144
Research Designs
A non-experimental design does no manipulation of the independent variable.
─ A descriptive design describes a situation as it naturally happens.
─ A correlational design examines the relationships between or
among two or more variables.
An experimental design manipulates the independent (experimental) variable using both experimental and control groups to establishes a cause and effect relationship.
─ A true experiment has three features: (1) subjects are randomly
assigned; (2) experimental variable is manipulated; and (3) with at
least 2 groups—experimental and control
─ A quasi-experimental design is one where the investigator
manipulates the independent variable but does not include
randomization or controls.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 25
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 145
Probability vs. Non-probability Sampling
In probability sampling every member of the
population has a probability of being included in
the sample, e.g. simple random sampling,
stratified random sampling, cluster sampling,
and systematic sampling
In non-probability sampling not every element of
the population has an opportunity to be included,
e.g. accidental/convenience, quota, purposive,
network/snowballing
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 146
Levels of Measurement in Research
1. Nominal is used when data can be organized into categories of a defined property but the categories cannot be compared.
2. Ordinal is used when data can be assigned to categories of an attribute that can be ranked.
3. Interval is used when data have equal distances between intervals in the scale but there is no absolute zero point.
4. Ratio is used when data has an absolute zero point (as opposed to interval) and is the highest form of measure.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 147
Data Analysis
Frequency tabulations
Measures of central tendency (mean,
median, mode)
Correlations (scatterplot, chi-square,
Spearman rank-order correlation, and
Pearson r)
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 148
Elements of an Ethical Research
Protecting subjects’ rights
Balancing the benefits and risks in a study
Obtaining informed consent
Obtaining institutional approval for
research
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 149
Ethical Issues and Considerations in Research
Autonomy: The researcher should get the research participants/respondents’ informed consent. Informed consent implies that: (1) the participant received adequate information about the research project; (2) the participant understood what he/she is expected to do and the implications of his/her participation; and (3) he/she participated voluntarily.
Right to privacy: The researcher should ensure the anonymity of the research participants and the confidentiality of the data/information collected from them.
Anonymity: Refers to the protection of participants in a study that even the researcher cannot link them the information they provided.
Confidentiality: Refers to the protection of the participants that their identities will not be linked to the information they provided and will never publicly divulged.
Joannes Paulus T. Hernandez,
B.S.H.B., B.S.N., R.N. 150
Ethical Issues and Considerations in Research
Beneficence: This implies the benefits of the research to the research subjects/participants. This should be adequately explained to the participants.
Nonmaleficence: Refers to the avoidance of harm or reduction of risks to the research subject. The researcher should weigh the risks and the benefits of the study. The benefits should be far greater than the risks.
Social justice: This includes three issues: (1) right to be represented in the sample; (2) right of equal access to knowledge; and (3) right not to be discriminated against. This ethical value is prominent in experimental studies particularly those studies that have great promise to do good (e.g. drug that may cure a disease) to the participants.
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