Nursing Theories

NURSING THEORIES

1. ENVIRONMENTAL THEORY by Florence Nightingale

Getting to Know the THEORIST (FLORENCE NIGHTINGALE) Born in FLORENCE, ITALY On May 12, 1820 (International

Nurses’ Day) 1st Nurse Educator- she entered

FLEIDNER SCHOOL OF NURSING (1st nsg school in Kaiserswerth, Germany)

The Lady with the Lamp (Crimean War)- during the battle of English vs Turkish, she looked for the wounded soldiers healed them w/ her consoling hands

1st Nurse Statistician 1st Nurse Researcher Excellent writer (Notes on Matters

Affecting the Health, Efficiency and Hospital Administration of the British Army, Notes on Hospitals, Report on Measures Adopted for Sanitary Improvements in India, and NOTES ON NURSING)

Died at the age of 90 (August 13, 1910)

“Mother of Modern Nursing”

Theoretical Sources Of Nightingale’s Theory

EDUCATION- her mastery in mathematics and philosophy from her father provided her w/ knowledge and conceptual thought

LITERATURE- her influence with Dickens served as a factor in her definitions of NURSING and Healthcare

INTELLECTUALS- political leaders, intellectuals and social reformers of her time influenced her theoretical and rational thinking; inspired her to change the things she viewed as unacceptable in the society

RELIGIOUS BELIEFS- action for the benefit of others is a primary way of

serving God; is a basis for defining her nursing work as a “RELIGIOUS CALLING”; her faith provided her w/ conviction that education was a significant factor in establishing the profession of nursing.

THE CONCEPTS of NIGHTINGALE’S THEORY (METAPARADIGM in Nursing)

1. PERSON: the one receiving care; a dynamic and complex beingàshe envisioned the person as comprising PHYSICAL, INTELLECTUAL, EMOTIONAL, SOCIAL and SPIRITUAL components.àpatient is passive (nurse should ask the pt for his/ her preference)- nurse is in control of the pt’s environment

2. HEALTH: being well and using every power that the person has to the fullest extentàshe believed in the PREVENTION and HEALTH PROMOTION in addition to nursing pts from illness to health.

3. ENVIRONMENT: anything that can be manipulated to place a pt in the best possible condition for nature to act.àhas physical and psychological componentsàPHYSICAL: ventilation, warmth, light, nutrition, medicine, stimulation, room temperature and activity.àPSYCHOLOGICAL: avoiding chattering hopes and advices and providing variety

4. NURSING: a spiritual calling. Nurses were to assist NATURE to repair the patient.àNURSING PROCESS: assess pt’s situation, identify need, implements a plan of care, re-evaluates the situation, and changes the plan accordingly.àexpected nurses to use their powers of observation in caring for pts

TFN NOTESPrepared by Geraldine Ridad, RN, MAN(CAR)Page 1

àadvocated for nurses to have educational background and knowledge different from those of physiciansànursing education: clinical experience+classroom learning

OVERVIEW of NIGHTINGALE’S THEORY

MANIPULATION OF PHYSICAL ENVIRONMENT is a major component of nursing care

o MAJOR AREAS of Physical,

Social, and Psychological environment:

Health of Houses Ventilation and Warming Light Noise Variety Bed and Bedding Cleanliness of Rooms and

Walls Personal Cleanliness Nutrition and Taking Food Chattering Hopes and Advices Observation of the Sick Petty Management

When one or more aspects of the environment are out of balance, the client must use increased energy to counter the environmental stress (drain the pt of energy needed for healing)

NIGHTINGALE’S 13 CANONS and Nursing Process and Thought.

Is Nightingale’s theory accepted by the Nursing community? PRACTICE

- “Sick Building Syndrome”- nurses need to ask whether buildings and constructions meet Nightingale’s principle of good ventilation and lighting.

EDUCATION - Nightingale’s principles of nursing

training developed a universal pattern for early nurse training schools beginning with St. Thomas Hospital

and King’s College Hospital in London RESEARCH

- Her expertise in scientific inquiry and statistics continues to assist and define Nursing Research

- She also used brief case studies, and possible patterns to demonstrate various concepts she discussed in Notes on Nursing.

Analysis and Evaluation Nightingale’s Theory SIMPLICITY

- 3 major relationships:1. Environment to Patient2. Nurse to Environment3. Nurse to Patient

GENERALITY- Her theory has been used to

provide general guidelines for all nurse practitioners for a number of years

- The concept of the nurse, patient, and environment is still applicable and relevant in all nursing settings today

EMPIRICAL PRECISION - Nurses should base their

practice on observations and experiences rather than systematic, empirical research.

- Her concepts are stated completely and are presented as truths rather than tentative, testable statements.

DERIVABLE CONSEQUENCES - Her writings continue to

motivate creative thinking nurses and her works give food for thought that continues to encourage the profession


2. INTERACTIVE THEORIES

A. THEORY of INTERPERSONAL RELATIONS by HILDEGARD PEPLAU

Getting to Know the Theorist “Psychiatric Nurse of the Century” Born on September 1, 1909 at

Reading, Pennsylvania Graduated from a diploma program in

Pottstown, Pennsylvania in 1931 Then worked as an Operating Room

Supervisor at Pottstown Hospital Later received a Bachelor of Arts in

Internal Psychology from Bennington College in 1943

Finished Master of Arts in Psychiatric Nursing from Columbia University, New York in 1947

Achieved EdD in Curriculum Development in 1953

Had been Professor emeritus from Rutgers University

Published her first book “Interpersonal Relations in Nursing” in 1952

In 1968, introduced interpersonal techniques- “the crux of psychiatric nursing”

Was an Executive Director and President of ANA.

Worked with WHO, NIMH, and nurse corps.

Died peacefully at the age of 89 on March 7, 1999

METAPARADIGM in NURSING

PERSONàa man who is an organism that lives in an unstable balance of a given system.àtries to reduce anxiety caused by needs

HEALTHàa word that symbolizes forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal and community livingàPHYSIOLOGICAL DEMANDS and INTERPERSONAL CONDITIONS must be met for one’s health to be achieved and maintained

ENVIRONMENTàExisting forces outside the organism and in the context of culture.

NURSINGàa significant therapeutic interpersonal process (2 or more persons w/ a common goal). àFunctions cooperatively w/ other human processes that make health possible for individuals in communitiesàtherapeutic because it is a healing art, assisting individual who is sick or in need of health care. OVERVIEW of PEPLAU’S THEORY1. There are 3 sequential phases in the INTERPERSONAL NURSE-PATIENT RELATIONSHIP:

1. ORIENTATION PHASE2. WORKING PHASE

a. IDENTIFICATION PHASEb. EXPLOITATION PHASE

3. RESOLUTION PHASE

ORIENTATION PHASE Nurse and pt come together as

strangers Meeting initiated by patient who

expresses a “FELT NEED”, work together to recognize, clarify, and define facts related to the need (define problem or needs)

Important to explain roles to client and relationship with client

WORKING PHASEa. IDENTIFICATION PHASE

pt participates in GOAL SETTING

has a feeling of BELONGINGNESS and selectively responds to those who can meet his/ her needs

b. EXPLOITATION PHASE pt actively seeks and draws

knowledge and expertise of those who can help

nurse should be prepare the client for termination

RESOLUTION PHASE Occurs after other phases are

completed successfully. Terminates the relationship Pt should not regress and show

independence


2. Peplau advocates that the roles of the nurse in the nurse-patient interpersonal relationship are as follows:

STRANGER (provides acceptance of the pt as a person and due respect over his identity to build TRUST)

RESOURCE PERSON (provides a specific needed information that aids in the understanding of a problem or new situation)

TEACHER (imparts knowledge in reference to a need or interest)

LEADER (helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way)

SURROGATE (temporary care giver)

COUNSELOR (nurse becomes a listening friend and provides guidance and encouragement to make changes)

3. “PSYCHOLOGICAL MOTHERING” includes the ff steps:

The pt is ACCEPTED UNCONDITIONALLY as a participant in a relationship that satisfies his needs

There is recognition of and response to the pt’s readiness for growth, as his initiative; and

Power in the relationship shifts to the patient, as the pt is able to delay gratification and to invest in goal achievement

ACCEPTANCE BY THE NURSING COMMUNITY

PRACTICE- Peplau’s ideas paved way for integrating other scientific disciplines into nursing especially formulating the paradigm of psychiatric nursing in its early days. Her theory is very useful in helping Psychiatric patients.

EDUCATION- her first book is being used as a manual of instruction to help graduate nurses and nursing students in creating a significant nurse-patient relationship.

RESEARCH- lead to newer studies that indicate that broader sets of relationships could also affect a person in many ways; helped nursing experts identify ways to reduce anxiety and stress in patients.

ANALYSIS and EVALUATION SIMPLICITYàher theory is easily understood; basic assumptions and key concepts were clearly given, explained, broken down and outlined.

GENERALITYàher model could be effectively utilized by all nurses in establishing a nurse-pt relationship regardless of their area or clinical setting; but is limited or impossible with senile, comatose or newborn patients. EMPIRICAL PRECISIONàher theory could be tested and observed using pure observation, and with continued research and development, the degree of precision could be increased. DERIVABLE CONSEQUENCESàPeplau is considered as one of the first theorists after Nightingale to present a theory in nursing. Her works have greatly touched the lives of many patients and nurses, from students to practitioners.

B. “THE NATURE OF NURSING MODEL” by Virginia Henderson

Getting to Know the THEORIST “”First Lady of Nursing” First Truly International Nurse” “First Full-Time Instructor” in

nursing in Virginia a renowned teacher, researcher and

scholar The first nursing library was named

after her by Sigma Theta Tau International (Virginia Henderson International Nursing Library)

Died at the age of 98 on March 19, 1996

Concepts of Henderson’s Theory (Metaparadigm in NURSING) PERSON àan individual requiring assistance to achieve health and independence or a peaceful death.àmind and body are inseparableàperson as PATIENTà With 14 fundamental or basic human needsà Patient and family as a single unit


HEALTHàequated with INDEPENDENCE, viewed in terms of the client’s ability to perform 14 components of nursing care UNAIDED.àBasic to human functioningàPromotion of health is more important than care of the sick

ENVIRONMENTàall external conditions and influences that affect life ad developmentàIllness may interfere with the ability to control the environmentàNurse’s function is to alter the environment in such a way as to support the patient (to aid the physician in prescribing protective devices, recommend changes, construction of buildings, etc)

NURSINGàassists and supports the individual in life activities and the attainment of independenceà“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 a peaceful death) that the person would perform unaided given the necessary strength, will or knowledge, and to do this in such a way as to help the individual gain independence as rapidly as possible.”

OVERVIEW of HENDERSON’S THEORY1. Encompasses a definition of

NURSING2. Provides description of the function

of a nurseà Nurse-patient relationship

a. as a SUBSTITUTE for the patient

b. as a HELPER to the patientc. as a PARTNER with the

patientà Nurse-physician relationshipà Nurse as a member of the Healthcare Team

3. Enumerates the 14 components that make up basic nursing care (14 basic needs)

14 BASIC NEEDS

1. Breathe normally 2. Eat and drink adequately3. Eliminate body wastes4. Move and maintain desirable postures5. Sleep and rest6. Select suitable clothes—dress and undress7. Maintain body temperature within normal range by adjusting clothing and modifying 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 in 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 the available health facilities.

Is Henderson’s theory accepted by the Nursing community?

PRACTICEàHenderson’s approach focuses on decision-making and deliberate in such a way that in every step of the NURSING PROCESS, it plays very important roles (ADPIE).

EDUCATION àHenderson developed 3 phases of curriculum development that students should progress in their learningà1st phaseà helping the pt perform activities of the daily living (priority: fundamental needs and planning of care)


à2nd phaseà assisting pts achieve their needs in times of illness (more medical approach and students understands the rationale of physician’s plans/ orders)à3rd phaseà centered on the pt and family together w/ the dynamics affecting the relationship inside the unit.

RESEARCH àvarious research questions commonly arise from Henderson’s 14 components of basic nursing careàUplifted the standards of NURSING through RESEARCHàAdvocated the use of LIBRARY for research purposes

ANALYSIS and EVALUATION SIMPLICITY àher concept of nursing is COMPLEX rather than simplistic.àMany variables and several descriptive interpretations could be derived and other explanatory relationships could be seen.

GENERALITY àthe definitions provided by Henderson are BROAD in scopeàCover ALL AREAS of NURSING PRACTICE and could be APPLIED in EVERY SETTING

DERIVABLE CONSEQUENCES àopened the doors for development by upcoming nursing theoristsàEmphasized importance of NURSING’S INDEPENDENCE AND INTERDEPENDENCE on different healthcare professions. àAdvocated curriculum development and viewed research as an important tool in improving clinical practice of nursing

C. HUMAN-TO-HUMAN RELATIONSHIP BY JOYCE TRAVELBEE

“A nurse does not only seek to alleviate physical pain or render physical care – she ministers to the whole person. The existence of the suffering whether physical, mental or spiritual is the proper concern of the nurse.” - Joyce Travelbee

Getting to Know the Theorist A psychiatric nurse, educator and

writer born in 1926. 1956, she completed her BSN degree

at Louisiana State University 1959, she completed her Master of

Science Degree in Nursing at Yale University

She started Doctoral program in Florida in 1973. Unfortunately, she was not able to finish it because she died later that year. She passed away at the prime age of 47 after a brief sickness.

1952, Psychiatric Nursing Instructor at Depaul Hospital Affilliate School, New Orleans.

Also she taught at Charity Hospital School of Nursing in Louisiana State University, New York University and University of Mississippi.

1970, the Project Director of Graduate Education at Louisiana State University School of Nursing until her death.

Publications:

1963, started to publish articles and journals in nursing.

1966 and 1971, publication of her first book entitled Interpersonal Aspects of Nursing.

1969, when she published her second book Intervention in Psychiatric Nursing: Process in the One-to-One Relationship.

THEORETICAL SOURCES OF TRAVELBEE’S THEORY

Catholic charity institutions Ida Jean Orlando, her instructor—“The

nurse is responsible for helping the patient avoid and alleviate the distress


of unmet needs.” The nurse and patient interrelate with each other.

Viktor Frankl, a survivor of Auschwitz and other Nazi concentration camps—proposed the theory of logotherapy in which a patient is actually confronted with and reoriented toward the meaning of his life.

Concepts of Travelbee’s Theory (Metaparadigm in NURSING) PERSON

à Person is defined as a human being. àBoth the nurse and the patient are human beings. àA human being is a unique, irreplaceable individual who is in continuous process of becoming, evolving and changing.

HEALTHà Health is subjective and objective. àSubjective health—is an individually defined state of well being in accord with self-appraisal of physical-emotional-spiritual status. àObjective health—is an absence of discernible disease, disability of defect as measured by physical examination, laboratory tests and assessment by spiritual director or psychological counselor.

ENVIRONMENTàEnvironment is not clearly defined. àShe defined human conditions and life experiences encountered by all men as sufferings, hope, pain and illness.

NURSINGàNursing is an interpersonal process whereby the professional nurse practitioner assists an individual, family or community to prevent or cope with experience or illness and suffering, and if necessary to find meaning in these experiences.”

Human-to-Human Relationship Model-Humanistic revolution- Interactional Phases of Human-

to-Human Relationship Model:1. Original Encounter àFirst impression by the nurse of the sick person and vice-versa. àStereotyped or traditional roles

2. Emerging Identities àthe time when relationship begins àthe nurse and patient perceives each others uniqueness

3. Empathy àthe ability to share in the person’s experience

4. Sympathy àwhen the nurse wants to lessen the cause of patient’s suffering.àit goes beyond empathy—“When one sympathizes, one is involved but not incapacitated by the involvement.” à therapeutic use of self

5. Rapport à Rapport is described as nursing interventions that lessens the patient’s suffering. à Relation as human being to human being à “A nurse is able to establish rapport because she possesses the necessary knowledge and skills required to assist ill persons and because she is able to perceive, respond to and appreciate the uniqueness of the ill human being.”

àPhases are in consecutive and developmental process.


àLogical Form - An inductive theory that uses specific nursing situations to create general ideas.

Is Travelbee’s Theory Accepted by the Nursing Community? PRACTICE

àHospice – self-actualizing life experience. Assumption of the sick role. Meaning of life and sickness and death.

EDUCATIONàTeaches nurses to understand the meaning of illness and suffering.

RESEARCHàApplied in the theory of caring cancer patients.

ANALYSIS and EVALUATION Clarity

not consistent in clarity and origin.

1. Definition of terms came from dictionaries and books etc.

2. Used different terms for the same definition.

3. Focus more on adult individuals who are sick and the nurse’s role in helping them to find meaning in their sickness and suffering.Deals in families and their needs but not in the community

Simplicity not simple. 1. contains different variables.

GENERALITY Has wide scope of application

but applicable only to those patients in distress and life changing events.

EMPIRICAL PRECISION Low measures of empirical

soundness.

1. Result of lack of simplicity. 2. Defines concepts theoretically but does not define them operationally. 3. The model has not been tested.

DERIVABLE CONSEQUENCES development of quality of

caring. 1. It is useful because of its ability to describe, explain, predict and control a phenomena. 2. Explains the variables that affect the establishment of a therapeutic relationship between nurses and patients. 3. Lack of empirical precision also creates lack of usefulness.



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Nursing Theories