nursing theories

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Overview of philosophical theories, development and nursing theories.


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NURSING THEORIES BY ROSEMARY PALMER RN,RM, BSc Hons (Sport Science & Administration), ADM


THEORY DEVELOPMENT Identify values, beliefs assumptions – PHILOSOPHY Concept analysis (under the 4 headings) –CONCEPT IDENTIFICATION Construct relationships (descriptive theory) –CONCEPTUAL MODEL Test relationships (explanatory theory) – THEORETICAL FRAMEWORK Validate relationships in practice (prescriptive theory)- THEORY


DEFINITIONS CONCEPT –ideas, abstract or not, names, catagories etc. Because everyone has differing interpretations of things concepts must be defined explicitly within a contextual statement. CONCEPTUAL MODEL (descriptive theory): group of related concepts. (some call theoretical framework, theory & conceptual model same thing) not all relationships clear cut. The relationships that do exist can be tested empirically. RELATIONAL STATEMENT (explanatory theory): identifying the theoretical relationship between the concepts. THEORY (predictive & prescriptive theory): all the conceptual relationships in a model must be explicable. Clearly defined, interrelated concepts that can be tested and refined by practice. Until then it is tentative only.


CHARACTERISTICS OF A THEORY Theories can interrelate concepts to give a different perspective on a phenomenon. Must have more than 1 concept and their relationships must be clear. Concepts must be explicitly described. Theories must be logical in nature. Interrelationships must be sequential. No contradictions. Relationships & goals flow from original theoretical assumptions Theories should be relatively simple yet generalisable. Theories can be the basis for hypotheses that can be tested or for theories that can be expanded. Isolated aspects of a theory can be generalisable. Theories contribute to and expand the body of knowledge within a discipline validated by research implementation. Theories can be used by practitioners to guide practice Theories must be consistent with other validated theories, laws & principles but leaves open unanswered question for further investigation.


METAPARADIGM CONCEPTS Human Bio, socio, psycho, cultural, political spiritual being. Set of Open ended systems functioning as a whole with needs. Health A dynamic changing phenomenon requiring a holistic approach to its promotion. A Health- illness continuum. Humans continually adapt, balance to maintain health. Illness occurs when this adaption fails. Environment Both internal & external forces influencing a human continually. Each component vital to living but can be detrimental as well. External environment can also be expectations of health care systems Nursing A set of actions taken on by individuals to promote and maintain health of others, to maintain body etc needs when ill, to rehabilitate, educate and restore to health individuals, families, communities to obtain the best health possible.

Nursing practice : 

Nursing practice Characterised by ; Accountability Acceptance of delegation responsibilities Autonomy in decision making Advocacy To function as a team member and independently To improve practice through research To assist people of all cultural groups to maintain best health and best environments to live in.


NURSING THEORY An organised systematic articulation of a set of statements related to questions within the nursing metaparadigm. USES: To define relationships between ideas/ concepts for further development To guide research, communication and practice To allow prediction of the consequences of care Allow prediction to a range of patient response


LEVELS OF THEORY Metatheory Grand theory Middle Theory Practice Theory: this has 4 steps 1.Factor isolation( identifying and describing a phenomenon) 2.Factor relating (description of possible explanations/ causes of phenomenon) 3.Situation relating (prediction that the phenomenon will occur every time the same situation arises) 4.Situation producing control (stopping the phenomenon occurring by eliminating possible causes)


TYPES OF NURSING THEORY Theories can also be analysed by type: NEEDS: Henderson & Orem INTERACTION: King & Peplau OUTCOME: Levine, Rogers & Roy HUMANISTIC: Watson


OREM NEEDS THEORY: FOCUS:The problems the client presents with and the nurses function to resolve them. ORIENTATION: is disease/ illness PERSON: a set on needs or developing needs NURSE ROLE: to fulfill/ resolve needs. DEPENDENCE: medical orders of care DECISIONS: healthcare professionals

OREM - the person : 

OREM - the person A whole functioning biologically, socially and symbolically Capacity for self knowledge Can engage in deliberate action An open system

OREM – The environment : 

OREM – The environment A set of conditions that motivates a person to establishing goals and adjust behaviour to achieve goals. External= housing etc & Internal=physiological, psychological, social, spiritual

OREM- health : 

OREM- health A state of wholeness or integrity. Healthy is when a person is structurally and functionally sound. Physical, psycho, social, interpersonal aspects and are all inseparable. Self care must be continuous to maintain health

OREM- nursing : 

OREM- nursing A helping service. An art and technology Creative effort for one human to help another Focus’s on an individuals ability for self care, self care deficit and nurses assist with deficit.

OREM –major concepts : 

OREM –major concepts Self care model –derived from functional model of health. Self care deficit Self care requisites –universal, developmental and health deviation self care requisites Self care demands Nursing agency Nursing system- wholly compensatory, partial compensatory and educative-support systems. Basic conditioning factors context, cultural etc Unique and applied knowledge base.


KING INTERACTION THEORY: FOCUS: nurse-patient relationship/ interaction ORIENTATION: illness as an experience PERSON: a set of experiences with meaning NURSE ROLE: external therapeutic agent that interacts with client to bring about end to illness DEPENDENCE: self DECISIONS: professionals but validated by client

KING –the person : 

KING –the person Individuals are thinking, can choose alternatives, set goals and select means towards goals. Have a symbolic way of communication. Are time orientated and reacting Reactions are based on perceptions, expectations and needs An open system

KING – the environment : 

KING – the environment Internal environment transforms energy to enable continuous adjustment to external environment Semi permeable. Exchange of matter, energy and information

KING - health : 

KING - health Dynamic life experiences of a human with continuous adjustments to stressors in external & internal environment Optimal use of ones resources to achieve maximum potential for daily living. The ability to function in social roles Does not include a clinical model Continuous adaption to stress

KING- nursing : 

KING- nursing Helping profession providing a service to fulfill a need. Includes ill, hospitalized, rehabilitation, health education for maintenance of health. Care of dying Interactive process nurse-client each perceives other in situation, set goals and explore means of achieving goals. Actions, reactions & interactions. This theory not possible with non-responding clients e.g. psychotic, comatosed. An observable behaviour In the health care system of a society Goal orientated through interpersonal actions, reactions and interactions

KING- major concepts : 

KING- major concepts Personal system (individual)- perception, self, body image, growth, development, time, space Interpersonal system (group)–goal attainment. Interaction, transaction, communication, role, stress Social system (society)- organisation, authority, power, status, decision making.


LEVINE OUTCOME THEORY: FOCUS: energy, balance & homeostasis ORIENTATION: client has lack of adaption skills or systems deficiency PERSON: an adaptive or developing being NURSES ROLE: an external regulatory mechanism DECISIONS: health professional

LEVINE- the person : 

LEVINE- the person A holistic being who strives to maintain wholeness & intergity A unique individual, feeling, believing, thinking and whole system Humans respond in a predictable way Unique in their responses Humans appraise situations, objects situations conditions. Humans can sense, reflect, reason & understand Human actions are self determined even when emotional Humans are capable of prolonged reflection and raising questions.

LEVINE- the environment : 

LEVINE- the environment Internal: homeostasis, homeorrhesis. A state of energy sparing that also provide the necessary baselines for a multitude of synchronised physiological & psychological functions. A state of conservation. A stabilised flow rather than stasis emphasising the fluid change within space-time continuum. Describes the pattern of adaption which permits the body to sustain its own well being within the vast changes which encroach upon it from the environment. External: pre-conceptual- aspect of the world that individual are able to intercept. Operational- elements that physically affect individual but not perceived by them ( radiation) Conceptual- cultural, spiritual, ideas, beliefs, values, tradition.

LEVINE- health : 

LEVINE- health Person interacts with environment: Adaption – historicity, specificity, redundancy Organismic response ( a change in behaviour during an attempt to adapt) –fight or flight, inflammatory, stress, preceptual ( there are 9 models to guide assessment) Conservation –conservation of energy, conservation of structural integrity, conservation of personal integrity, conservation of social integrity.

LEVINE - health : 

LEVINE - health Every individual has a unique range of adaptive responses Responses vary with heredity, age, gender or challenges of illness An ongoing process of change in which the patient maintains integrity within the realities of the environment. Achieved by the frugal, economic contained and controlled use of environmental resources in his/her best interest. Health promoted by use of conservation principle. Health is wholeness and successful adaption Not just the healing of an affected part, it is return to daily activities Disease is an unregulated, undisciplined change that must be stopped or death will ensue.

LEVINE- nursing : 

LEVINE- nursing The nurse creates the environment where healing can occur. Uses illness adaption model using interventions and evaluating nursing interventions. Total patient care (but assessment models are physical medical models) A profession as well as an academic discipline always practiced and studied in concert with other healthcare disciplines. Nursing involves engaging in human interactions Nursing promotes wholeness recognising uniqueness of individuals and activities needed Nurses must defend client integrity Humans make decisions by prioritising Individual must be able to contemplate situation, condition Individual will act deliberately to attain goal Nursing must recognise detailed care individually with an empiric framework for that client. Nursing needs existing and emerging demands of self care Uses nursing process


WATSON HUMANISTIC THEORY: FOCUS: evolutionary idealism ORIENTATION: on the process of self fulfillment, spiritual evolution and self-trancendence. PERSON: the centre of conscious energy with human self awareness NURSES ROLE: one who recognises patterns in client needs and works to achieve satisfactory evolution of self DECISIONS: client

WATSON – the person : 

WATSON – the person A human being is a valued person to be cared for, respected, nurtured, understood and assisted. A fully functional integrated self. Whole greater than parts Their unique and subjective experiences, their own emotions, memories & desires creates their own perception of their life in the world.(phenomenonology) Clients have soul & spirit –transcendental.

WATSON- the environment : 

WATSON- the environment Internal – biophysical, spiritual and mental factors External- stress change, comfort, cleanliness. People are part of nature and should espect the ecosystem A caring attitude is transmitted by the culture of a profession as a unique way of coping with the environment

WATSON- health : 

WATSON- health Harmony between the spheres of human –mind, body, spirit, world. A subjective WHO ‘health’ must be added to – a high level of physical, mental & social functioning A general adaptive- maintenance level of daily functioning The absence of illness

WATSON -nursing : 

WATSON -nursing Concerned with promoting health preventing illness, caring for the sick and restoring health. Focuses on health promotion and treatment of disease. Holistic A human science of persons and health-illness experiences that are mediated by professional, personal, scientific, aesthetic and ethical human transactions. Uses nursing process. A science and an art

WATSON –major concepts : 

WATSON –major concepts Human caring & loss. The science of caring Has 10 carative factors Threatened by tasks and technology. Assumptions for caring: 1. Caring can only be practiced interpersonally 2.Caring consists of carative factors that result in the satisfaction of certain health needs 3.Effective caring promotes health 4.Caring accepts person as is now and in future 5.Caring environment is one that offers development of potential and allowing choice of best action 6.Caring is complementary to curing 7.Caring is central to nursing


Carative 1.HUMANISTIC –ALTRUISTIC VALUE SYSTEM Begins with the sharing with parents Mediated through ones own life experiences Necessary for nurse maturation which then promotes altruistic behaviour toward others.

Carative2. FAITH-HOPE : 

Carative2. FAITH-HOPE Essential to carative & curative.


Carative 3. CULTIVATION OF SENSITIVITY TO ONESELF AND OTHERS Nurses should feel emotion when it presents itself. Development of ones own feelings are needed before one can interact and be geniely sensitive to others Sensitivity promotes self growth, self actualisation Nurses promote health only with interpersonla relationships.


carative 4. HELPING TRUSTING RELATIONSHIP Must have congruency empathy and warmth to establish rapport and caring Communication is verbal and non verbal. Listening important.


Carative 5. THE EXPRESSION OF FEELING BOTH NEGATIVE & POSITIVE Feelings alter thoughts & behaviour so need to be taken into account. Awareness of the feelings helps to understand the behaviour.


Carative 6. USE OF SCIENTIFIC PROBLEM SOLVING MTHODS Allows prediction, control and self correction Sciene of caring is not neutral and objective always.


Carative 7. PROMOTION OF INTERPERSONAL TEACHING-LEARNING Nurse must focus on learning procees as well as teaching procvess Understand the persons perception of the situation


Carative 8. PROVIION OF SUPPORTIVE ENVIRONMENT Psychological, mental, physical, sociocultural and spiritual environment. Each have internal and external variables which the nurse manipulates to support & protect client Comfort, security, privacy also important.


Carative 9. ASSIST WITH GRATIFICATION OF HUMAN NEEDS Maslows hierarchy of needs Lower order needs Higher order needs (achievement, affiliation, intrapersonal self actualisation)


Carative 10- THE ALLOWANCE OF EXISTENTIAL- PHENOMENOLOGICAL FORCES Understanding people from the way they view a situation Confront death or life from their perspective.

HENDERSON –the person : 

HENDERSON –the person NEEDS THEORY (see OREM) Has basic needs that are component of health Requires assistance to achieve health and independence or a peaceful death Mind & body inseparable & interrelated Biological, social, spiritual, psychological components Patient is neither client nor consumer

HENDERSON- the environment : 

HENDERSON- the environment Setting in which individuals learn a unique pattern of living All external conditions that affect life & development Individuals in relation to family Community impact Nurses should act for individuals tht cant function independently. Society should contribute to nursing education

HENDERSON- health : 

HENDERSON- health Individuals ability to function independently as outlined in 14 components assessment Promotion of health & prevention |& cure for disease Good health is a challenge affected by age, cultural background, physical and intellectual capacity, emotional balance and individuals ability to meet needs.

HENDERSON -nursing : 

HENDERSON -nursing Temporarily assisting an individual who cannot through lack of strength, will or knowledge satisfy 1 or more of 14 components. Assists & supports individuals in life activities and the attainment of independence Makes patient independent asap. Carry our physicians orders plus own care plan Uses nursing research Should be a legal & independent practitioner as long as not doing physician functions. Should have knowledge to carry out individualised care and be a problem solver “get inside the patients skin” Must assess needs and help individual meet health need plus provide environment in which individual can be independent Nursing is not just following physician orders. Be available 24/7

ROY –the person : 

ROY –the person An adaptive system with coping processes A whole comprised of parts Functions as a unity with some purpose An adaptive system with cognator and regulator subsystems to maintain adaption in 4 modes- psycho-physical, self concept group identity, role function and interdependence

ROY- nursing : 

ROY- nursing OUTCOME THEORY. Adaption model Nursing is a science and practice that expands abilites, enhances person & environment transformation Goals are to promote adaption in individuals contributing to health, quality of life and dying with dignity Assess behaviour and factors that influence adaption then intervene to expand these adaptions and the environment to do it.

ROY –the environment : 

ROY –the environment All conditions, circumstances and influences surrounding and affecting development and behavioor with consideration to mutuality of person & earth resources 3 kinds of stimuli- focal, contextual, residual Significant stimuli in all human development includes stage of development, family and culture

ROY- health : 

ROY- health A state and process of being and becoming integrated and whole that reflects person and environment mutually. Integrated Compensatory Compromised adaption.

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