Theoretical Foundations of Nursing Midterm Reviewer PDF

THEORETICAL FOUNDATIONS OF NURSING NCM100LC NU LIPA A.Y. 2024-2025 TERM 2 BSN – NUR245 W1: EVOLUTION OF NURSING INTRODUCTION TO NURSING THEORY Nursing Theory an organized framework of concepts and purpos...

THEORETICAL FOUNDATIONS OF NURSING NCM100LC NU LIPA A.Y. 2024-2025 TERM 2 BSN – NUR245 W1: EVOLUTION OF NURSING INTRODUCTION TO NURSING THEORY Nursing Theory an organized framework of concepts and purposes designed to guide the practice of nursing. a conceptualization of some aspect of nursing describes, explains, predicts, and/or prescribes nursing care helps to identify the focus, means, and goals of practice. Nursing theories also enhance communication and accountability for patient care. Theory Came from a greek word "Theoria” which means speculate Theory is the foundation for the art and science of nursing. Theory, research, and practice are bound together in a continuous interactive relationship. Helps explain an event by: Defining ideas or concepts, Explaining relationships among the concepts, and Predicting outcomes Nursing is both a science and an art. The science of nursing is based on data obtained from current research. The art of nursing stems from a nurse’s experience and the unique caring relationship that a nurse develops with a patient. Theory-based nursing practice helps you to design and implement nursing interventions that address individual and family responses to health problems. Theories offer well-grounded rationales for how and why nurses perform specific interventions and for predicting patient behaviors and outcomes. Expertise in nursing is a result of knowledge and clinical experience. Nursing knowledge improves nursing practice by connecting theory and research. Nurses develop theories to explain the relationship among variables by testing the theory through research and applying it in practice. Throughout this process new information often comes to light that indicates the need to revise a theory, and the cycle repeats. Characteristics of a Theory 1. Theories can interrelate concepts in such a way to create a different way of looking at a particular phenomenon. 2. Theories must be logical in nature. 3. Theories should be relatively simple yet generalizable. 4. Theories can be the bases for hypotheses that can be tested. 1 Niña Jane P. Lualhati NUR245 5. Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. 6. Theories can be utilized by the practitioner to guide & improve their practice. 7. Theories must be consistent with other validated theories, laws & principles but will leave open unanswered questions that need to be investigated W2-3: IMPORTANCE OF NURSING THEORY Purpose of Nursing Theory 1. Education 2. Research 3. Clinical practice 4. Conceptual models Components of a Theory For a theory to be a theory, it has to contain concepts, definitions, relational statements, and assumptions that explain a phenomenon. It should also explain how these components relate to each other. 1. Phenomenon - A term given to describe an idea or response about an event, a situation, a process, a group of events, or a group of situations. Phenomena may be temporary or permanent. Nursing theories focus on the phenomena of nursing. 2. Concepts - Interrelated concepts define a theory. Concepts are used to help describe or label a phenomenon. They are words or phrases that identify, define, and establish structure and boundaries for ideas generated about a particular phenomenon. Concepts may be abstract or concrete. a. Abstract Concepts - mentally constructed independently of a specific time or place. b. Concrete Concepts - directly experienced and related to a particular time or place. 3. Definitions - used to convey the general meaning of the concepts of the theory. Definitions can be theoretical or operational. a. Theoretical Definitions - Define a particular concept based on the theorist’s perspective. b. Operational Definitions - States how concepts are measured. 4. Relational statements - define the relationships between two or more concepts. They are the chains that link concepts to one another. 5. Assumptions - accepted as truths and are based on values and beliefs. These statements explain the nature of concepts, definitions, purpose, relationships, and structure of a theory. Assumptions are the “taken-for-granted” statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory 2 Niña Jane P. Lualhati NUR245 Domain of Nursing Domain Perspective of a profession. It provides the subject, central concepts, values and beliefs, phenomena of interest, and central problems of a discipline. The domain of nursing provides both a practical and theoretical aspect of the discipline. It is the knowledge of nursing practice as well as the knowledge of nursing history, nursing theory, education, and research. The domain of nursing gives nurses a comprehensive perspective that allows you to identify and treat patients’ health care needs at all levels and in all health care settings. Metaparadigm of Nursing Four major concepts are frequently interrelated and fundamental to nursing theory: person, environment, health, and nursing. These four are collectively referred to as metaparadigm for nursing. They serve as an umbrella for other concepts that may be present in a nursing theory. 1. Person (also referred to as Client or Human Beings) - recipient of nursing care and may include individuals, patients, groups, families, and communities. Person is integrated as “whole.” 2. Environment (or situation) - internal and external surroundings that affect the client. It includes all positive or negative conditions that affect the patient, the physical environment, such as families, friends, and significant others, and the setting for where they go for their healthcare. Environment encompasses the elements external to man. 3. Health - the degree of wellness or well-being that the client experiences. It may have different meanings for each patient, the clinical setting, and the health care provider. Health is the state of wholeness. 4. Nursing - the nurse’s attributes, characteristics, and actions provide care on behalf of or in conjunction with the client. There are numerous definitions of nursing, though nursing scholars may have difficulty agreeing on its exact definition. The ultimate goal of nursing theories is to improve patient care. Nursing is an art, a helping serving and a technology. Evolution of Nursing Theory First nursing theorist: Florence Nightingale Curriculum era: 1900-1940s Research era: 1950-1970s Graduate education era: 1950-1970s Theory era: 1980-1990s Theory utilization era: 2000s-today Theories are dynamic and responsive to the changing environment in which we live. 3 Niña Jane P. Lualhati NUR245 Types of Theory According to Scope Theories have different purposes and are sometimes classified by levels of abstraction (grand versus middle-range versus practice theories). Grand: Broad in scope, complex A grand theory does not provide guidelines for specific nursing interventions but provides the structural framework for broad and abstract ideas related to nursing. Middle-range: Limited in scope and less abstract Middle-range theories address a specific phenomenon and reflect practices of administration, clinical interventions, or teaching. A middle-range theory tends to focus on a concept found in a specific field of nursing, such as uncertainty, incontinence, social support, quality of life, and caring, rather than reflect on a wide variety of nursing care situations, as the grand theories do. Practice: Narrow in scope and focus Practice theories, also known as situation-specific theories, bring theory to the bedside. Narrow in scope and focus, these theories guide the nursing care of a specific patient population at a specific time. Descriptive: Describe phenomena and identify circumstances in which phenomena occur Descriptive theories do not direct specific nursing activities or attempt to produce change but rather help to explain patient assessments. Prescriptive: Address nursing interventions for a phenomenon, guide practice change, and predict the consequences. Nurses use prescriptive theories to anticipate the outcomes of nursing interventions Types of Theory According to Function 1. DESCRIPTIVE - to identify properties and workings of a discipline 2. EXPLANATORY - to examine how properties relate and thus affect the discipline 3. PREDICTIVE - to calculate relationships between properties and how they occur 4. PRESCRIPTIVE - to identify under which conditions relationships occur Types of Theory According to Philosophy 1. "NEEDS" THEORIES - are based on helping individuals to fulfill their physical and mental needs 2. "INTERACTION" THEORIES - As described by Peplau, these theories revolve around the relationships nurses from with patients. 3. "OUTCOME" THEORIES - portray the nurse as the changing force 4. "HUMANISTIC" THEORIES - emphasizes a person's capacity for self-actualization Theory-Based Nursing Practice Theory generates nursing knowledge for use in practice, thus supporting evidence-based practice (EBP). Nursing knowledge - derived from basic and nursing sciences, experience, aesthetics, nurses’ attitudes, and standards of practice 4 Niña Jane P. Lualhati NUR245  Goal of nursing knowledge: To explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines Nursing theories and related concepts continue to evolve. The integration of theory into practice leads to coordinated care delivery and therefore serves as the basis for nursing. Nurses use theory to provide direction in how to use the nursing process. For example, the theory of caring influences what nurses need to assess, how to determine patient needs, how to plan care, how to select individualized nursing interventions, and how to evaluate patient outcomes. Shared Theories Explain a phenomenon specific to the discipline that developed the theory. Also known as a borrowed or interdisciplinary theory. System Theories 1. Input - data or information that comes from a patient’s assessment. 2. Output - end product of a system; and in the case of the nursing process it is whether the patient’s health status improves, declines, or remains stable as a result of nursing care. 3. Feedback -serves to inform a system about how it functions. For example, in the nursing process the outcomes reflect the patient’s responses to nursing interventions. The outcomes are part of the feedback system to refine the plan of care. Other forms of feedback in the nursing process include responses from family members and consultation from other health care professionals. 4. Content - product and information obtained from the system. For example, patients with impaired bed mobility have common skin care needs and interventions that are very successful in reducing the risk for pressure ulcers. NURSING a practice-oriented discipline. the word came from a latin word “nutrix” meaning, to nourish. FACT is something that is seen happening or existing. It is an empirical observation. 5 Niña Jane P. Lualhati NUR245  IDEA is a group of interrelated facts. Idea is an image or formulation of something imagined and visualized, of something vaguely assumed, guessed or sensed out of related facts or observations. It is a person’s conception of what is the best example of something. IS NURSING PROFESSION AN ART OR SCIENCE? Nursing profession was both an art and science. The science of nursing is easily noticeable, and it is very critical for each one to know. If you are a nurse, you must know the patient-based nursing care plan (NCP). You must also know the disease mechanisms. Nurses also need to be up to date on new policies, practices, and procedures. Moreover, they need to know how to manipulate new diagnostic equipment and machines. On the other hand, the art of nursing is more than a great deal of science. It is more than just knowing; it is doing. It bridges information from nurses to patients in a skillful way. It is the application of all the science known to nursing to give the utmost care the patient needs. THE PHILIPPINES NURSING ACT OF 2002 R.A. 9173 AN ACT PROVIDING FOR A MORE RESPONSIVE NURSING PROFESSION, REPEALING FOR THE PURPOSE REPUBLIC ACT NO. 7164, OTHERWISE KNOWN AS “THE PHILIPPINE NURSING ACT OF 1991” AND FOR OTHER PURPOSES It is hereby declared the policy of the State to assume responsibility for the protection and improvement of the nursing profession by instituting measures that will result in relevant nursing education, humane working conditions, better career prospects and a dignified existence for our nurses. The State hereby guarantees the delivery of quality basic health services through an adequate nursing personnel system throughout the country. TERMS TO REMEMBER Conceptual Framework set of interrelated concepts that serve as building blocks of theories interrelated concepts or abstractions that are assembled together in some relational scheme by virtue of their relevance to a common theme Hypothesis a statement of predicted relationships between two or more variables, subjected to testing in empirical studies a temporary stand or prediction or guess while the investigation goes on educated guess Assumption basic principles that are accepted as being true on the basis of logic or reason without proof or verification statements that describe concepts definitions, purpose, relationships, and structure of a theory 6 Niña Jane P. Lualhati NUR245 KNOWLEDGE - awareness of reality acquired through insight, learning or investigation information, skills and expertise acquired by a person through various life experiences or through formal or informal learning such as formal education, self-study, vocational. Two Types of Knowledge 1. THEORETICAL KNOWLEDGE - aims to stimulate thinking and broaden understanding of the science and practice of the nursing discipline 2. PRACTICAL KNOWLEDGE - the art of nursing. PHENOMENON is an aspect of reality that can be consciously sensed or experienced. sets of empirical data or experiences that can be physically observed or tangible such as crying or grimacing when in pain. CONCEPTS are ideas and mental images that help to describe phenomena. word or cluster of words describing an object, idea or event. an abstraction based on observation of certain behaviors or characteristics. It describes the essence of a thing. CONCEPTS AND DEFINITIONS Concepts - logistic labels that are assigned to objects or events. Definition - defines the concept in relation to other concepts and permits the description and classification of phenomena. It conveys the general meaning of the concepts. Conceptual definition: meaning of a word based on how a certain theory or relevant literature perceives it to be. (roles or concepts of nurse, patient care, and environment) Operational definition: based on the method of how it was measured or how the person come up with that perception. (Significance of pain perception and practice nursing intervention) NURSING AS A SCIENCE - owes much of its research -orientedness to the systematic works of Florence Nightingale SCHOOL OF THOUGHTS IN NURSING THEORIES (1950-1970) NEED THEORISTS INTERACTION THEORISTS OUTCOME THEORISTS Abdellah King Johnson Orem Wiedenbach Levine Henderson Peplau Roy Travelbee Rogers Orlando Peterson & Zderad 7 Niña Jane P. Lualhati NUR245 REASONS TO STUDY NURSING THEORIES Everyday practice enriches theory Both practice and theory are guided by values and beliefs Theory helps to reframe our thinking about nursing Theory guides use of ideas and techniques Theory can close the gap between theory and research To envision potentialities The overall goal of nursing knowledge is to explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines. Theory generates nursing knowledge for use in practice, thus supporting evidence-based practice. HOW DO NURSES USE THEORY IN EVERYDAY PRACTICE Organize patient data Understand patient data Analyze patient data Make decisions about nursing interventions Plan patient care Predict outcomes of care Evaluate patient outcomes W4: 4 WAYS OF KNOWING 8 Niña Jane P. Lualhati NUR245 1. Empirical Knowing - relating factual and descriptive knowing aimed at the expansion of abstract and theoretical explanations. first primary model of knowing (Kenney, 1996). information source or base of knowing. emphasizes scientific research is important to nursing knowledge. As part of empirics, clinical and conceptual knowledge are the keys to nursing practice (Scultz and Meleis, 1988). The scientific discipline of Nursing. The science of nursing, the knowledge gained through empirical research. EVIDENCE-BASED PRACTICE: accurate and thoughtful decision making about health care delivery for clients; based on the result of the most Relevant and supported evidence derived from research in response to preferences and expectations 2. Ethical Knowing - requires knowledge of different philosophical positions regarding what is good and right in making moral decisions, particularly in the theoretical and clinical components of nursing. The code of moral or code of ethics that leads the conduct of nurses is the main basis for Ethical Knowing. It is deeply rooted in the concepts of human dignity, service and respect for life. Describes, analyzes, and clarifies moral obligation and values in nursing. Lessening suffering, upholding and preserving health is one of the key elements why nursing is a core service in society. EVIDENCE-BASED PRACTICE - moral directions of nursing; requires knowledge of different philosophical positions what is good and right in making moral actions and decisions, particularly in the theoretical and clinical components of nursing it includes all deliberate nursing actions involving and under the jurisdiction of ethics and professionalism 3. Aesthetic Knowing - manifestation of the creative and expressive styles of the nurse. Also known as Esthetics Knowing Deals with the emphatic (primary form) aspect of Nursing The art and act of nursing and is gained through practice and critique Aesthetic knowing focuses on empathy - the ability for sharing or vividly understanding another's feelings. This is the primary form of aesthetic knowing. It also includes the nurse's ability in changing ways and manner of rendering nursing care based on the client's individual needs and perceptions. 4. Personal Knowing - knowledge of the self in relation to other and to self key to comprehending health in terms of personal well-being human beings are not in a fixed state but are constantly engaged in a dynamic state of changes 9 Niña Jane P. Lualhati NUR245  gained through practicing nursing and interacting with patients and through thinking, listening, and reflecting. It involves the entirely of the Nurse-Patient Relationship. It is the most difficult to master and to teach. It involves therapeutic use of self. It takes a lot of time to fully know the nature of oneself in relation to the world around. It is focused on realizing, meeting and defining the real, true self (self- awareness). W5: THEORY DEVELOPMENT Theories are not discovered, instead they are invented Theory development seeks to help the nurse understand the practice in a more complete and insightful way and provides a method of identifying and expressing key ideas about the essence of practice. It is a global term to refer to the process and methods used to create, modify or refine a theory. Theory development is a complex, time-consuming process that covers a number of stages or phases from inception of concepts to testing of theoretical propositions through research. The general purpose of theory development primarily is to ensure adequate and quality nursing delivery and to clarify and improve the status of Nursing as a profession. Florence Nightingale - first modern nursing theorist. Nightingale was the first to delineate what she considered nursing's goal and practice domain, and she postulated that to nurse meant having charge of the personal health of someone. She believes the role of the nurse was seen as placing the client in the best condition for nature to act upon him. Stages of Theory Development STAGE SOURCE OF IMPACT KNOWLEDGE 1. Silent Blind obedience to Little attempt to develop a theory Knowledge medical authority Research was limited to collecting of epidemiologic data (Civil War Trainings of nurses and student nurses were limited to 1868) hospital settings 2. Received Learning through Theories were borrowed from other disciplines. Knowledge listening to others Nurses rely on the authorities of educators, sociologists, (World War II physiologists, and anthropologists to provide answers to 1940s) nursing problems. Research was primarily educational research or sociologic research 3. Subjective Authority was A negative attitude towards borrowed theories Knowledge internalized and a Nurse scholars focused on defining nursing on developing (1950s) new sense of self theories about and for nursing (Ex.: Hildegard Peplau) emerged Nursing research focused on nurse rather than on clients and clinical situations 10 Niña Jane P. Lualhati NUR245  4. Procedural Separate and Proliferation of approaches to theory development. Knowledge connected Application of theory in practice was frequently (1970s) knowledge underemphasized. Emphasis was placed on the procedures used to acquire knowledge with over attention to the appropriateness of methodology, the criteria for evolution and statistical procedure for data analysis. 5. Constructed Integration of Nursing theory should be based on prior empirical Knowledge different types of studies, theoretical literature, client reports and feelings (1980s) knowledge and the nurse scholar’s intuition or related knowledge about the phenomenon of concerns. Evidence-based practice (EBP) was introduced into nursing to address the widespread recognition to move beyond the attention given to research per se to address the gap in research and practice. Significant Events in Theory Development in Nursing 1859 – Nightingale published Notes on Nursing 1868 – AMA advocated formal training for nurses 1920 – Columbia University Doctorate in Education degree in nursing 1924 – Yale University began the first collegiate school of nursing 1949 – State licensure for registration became standard 1950 – Nursing Research first published 1952 – H. Peplau’s Interpersonal Relations in Nursing 1954 – PhD Program in nursing University of Pittsburg 1956 – Health Amendments Acct passed – funded graduate nursing education 1960 – 1966 – Process of theory development (Abdella, Orlando, Henderson) 1967 – First symposium on theory development 1969 – First nursing theory conference 1972 – NLN adopts requirements for conceptual framework for nursing curricula 1980s – Books written for nurses on how to critique theory, develop theory, and apply nursing theory 1990s – Philosophy and philosophy of science courses offered in doctoral programs 1999 – Philosophy of Nursing first published 2000s – Books published describing, analyzing, and discussing application of middle range theory Categories of Theory Based on Scope 1. Metatheory - Philosophical or methodologic questions related to developing a theoretical base for nursing. 2. Grand Theory – broad perspectives. Composed of relatively abstract concepts that are not operationally defined and attempt to reveal all aspects of human experience and response. Henderson’s The Nature of Nursing Levine’s The Four Conservation 11 Niña Jane P. Lualhati NUR245  Principles of Nursing Orem’s Self Care 3. Middle Range Theory – narrower than grand theory and has less variables. Cover concepts such as pain, symptom management, cultural issues and health promotion. Peplau’s Psychodynamic Nursing Orlando’s Nursing Process Theory 4. Micro Range Theory – least complex Categories of Theory Based on Focus 1. Client Centered Theories - focuses on needs and problems to be prioritized. Nightingale Abdellah Henderson Orem Pender Roy Levine Hall 2. Nurse-Client Dynamics – intrapersonal process. Interaction between nurses and clients. Peplau Watson King Orlando 3. Nurse-Client-Environment Dynamics - transcultural nursing that involves ethical knowing. Leininger Neuman Categories of Theory Based on Purpose 1. Descriptive Theories- first and most important level of theory development. Describe, observe and name concepts, properties and dimensions but they do not explain the interrelationships among the concepts or propositions and they do not indicate how changes in one concept affect other concepts. 2. Explanatory Theories - second level of theory development. Can be viewed in relation to other phenomena. Attempt to tell how or why the concepts are related and may deal with causality, correlations and rules that regulate interactions. 3. Predictive Theories - third level of theory development. Describes precise relationships between concepts. Presuppose prior existence of the more elementary types of theories. Describes future outcomes consistently. 12 Niña Jane P. Lualhati NUR245  4. Prescriptive Theories - highest level of theory development. Prescribe activities necessary to reach definite goal. Components of a Theory 1. Purpose - explains why the theory was formulated and specifies the context and situation in which it should be applied 2. Concepts and Conceptual Definitions - concepts are linguistic labels that are assigned to objects or events and are the building blocks of theories. "Theoretical definition defines the concept in relation to other concepts and permits the description and classification of phenomena.” Operationally defined concepts link the concept to the real world and identify empirical referents of the concept that will permit observation and measurement. 3. Theoretical Statements - also called propositions. Statement about the relationship between two or more concepts and are used to connect concepts to devise the theory. 2 types: a. Existence Statement- relate to specific concepts and make existence claims about that concept; serve as adjuncts to relational statements and clarify meaning in the theory; termed nonrelational statements and may be right or wrong depending on the circumstance b. Relational Statement - only name and classify objects; may also be classified as associational or causal relationship 4. Structure and Linkages - logical arrangement and specifying linkages of the theoretical concepts and statements. Determination of the order of appearance of relationships, identification of central relationships and delineation of direction, strength and quality of relationships. 5. Assumptions - notations that are taken to be true without proof. Beliefs about a phenomenon that one must accept as true to accept a theory and although they may not be empirically testable, they can be argues philosophically. 6. Models - schematic representations of some aspect of reality. Help illustrate the processes through which outcomes occur by specifying the relationships among the variables in graphic form where they can be examined for inconsistency, or error. WK 6: THEORISTS Nursing Theorists Philosophies 1. Florence Nightingale (1860) Environmental Theory also known as The Lady with the Lamp Born in May 12, 1820 in Florence, Italy Nursing Education: trained in Kaiserwerth, Germany at a Protestant religious community with a hospital and after 3 months she was declared trained as a nurse ( 1851). One day she visited a hospital and that CHANGED HER LIFE. 13 Niña Jane P. Lualhati NUR245  Defined nursing as: "the act of utilizing the environment of the patient to assist him in his recovery", that involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development. Notes on Nursing: “What it is and What it is Not” was a book first published by Florence Nightingale in 1859. “Healthy surroundings were necessary for proper nursing care.” 5 Essential Components of a Healthy Environment: 1. Pure fresh air 2. Pure water 3. Effective drainage 4. Cleanliness 5. Light (sunlight) 5 Major Components of a Healing Environment 1. Ventilation 2. Light 3. Warmth 4. Control noise 5. Control odor 2. Virginia Henderson (1897 – 1996) "The Nightingale of Modern Nursing" "The 20th century Florence Nightingale." The first lady of nursing Popular for her 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." Unlike Nightingale, she was concerned with both healthy and ill individuals "I believe that the FUNCTION the nurse performs is primarily an independent one - that of acting for the patient when he lacks knowledge, physical strength, or the will to act for himself as he would ordinarily act in health, or in carrying out prescribed therapy." She described the nurse's role as: SUBSTITUTIVE (doing for the person) SUPPLEMENTARY (helping the person) COMPLEMENTARY (working with the person) - with the goal of helping the person become as independent as possible 14 BASIC NEEDS OF MAN 1. Eating and drinking 2. Incontinence 14 Niña Jane P. Lualhati NUR245  3. Body posture 4. Mobility 5. Day and night pattern 6. Getting dressed and undressed 7. Body temperature 8. Hygiene 9. Avoidance of danger 10. Communication 11. Contact with others 12. Sense of rule and values 13. Daily activities 14. Recreational activities 15. Learning ability HENDERSON'S 14 COMPONENTS AS APPLIED TO MASLOW'S HEIRARCHY OF NEEDS ESTEEEM 1. Work at something providing a sense of accomplishment 2. Play or participate in various forms of recreation 3. Learn, discover, or satisfy the curiosity. LOVE AND BELONGINGNESS 1. Communicate with others in expressing emotions, needs, fears or opinions. 2. Worship according to one's faith. SAFETY NEEDS 1. Avoid dangers in the environment and avoid injuring others. PHYSIOLOGICAL NEEDS 1. Breathe normally. 2. Eat and drink adequately 3. Eliminate body wastes 4. Move and maintain desirable postures 5. Sleep and rest 6. Select suitable clothes - dress and undress 7. Maintain body temperature within normal range by adjusting clothing and modifying environment 8. Keep the body temperature within normal range by adjusting clothing and modifying environment Henderson's theory revolves around her concept of nursing. She defined nursing in a functional manner. To her, the nurse plans the care appropriate to assisting the individual in activities contributing to his/her health. She further stated that individuals will achieve or maintain health if 15 Niña Jane P. Lualhati NUR245  they have the necessary strength, will or knowledge. She considered the 14 fundamental or basic needs as the basis for the nurses' basic functions. 3. Faye Glen Abdellah (1960) Patient-Centered Approaches Born -March13.1919 Nursing Diploma from Fitkin Memorial Hospital Columbia University Bachelor's degree in nursing 1945 Master's Degree in Physiology 1947 Doctorate in Education 1955 "I could see people jumping from the zeppelin and I didn't know how to take care of them, so it was then that I vowed that I would learn nursing." Faye was 18 years old where she and her brother witness the explosion of this airship in Lakehurst where her family resided. So together with her brother, they ran to help the injured people. States that nursing is the use of the problem-solving approach with key nursing problems related to the health needs of people. NURSING PROBLEMS: The patient's health needs can be viewed as problems, which may be overt as an apparent condition, or covert as a hidden or concealed one. Accomplishments U.S. Public Health Service (Branch of Military) Chief Nurse Officer First Deputy U.S. Surgeon General Uniformed Services University of Health Sciences Founder and First Dean, Graduate School of Nursing Yale University School of Nursing Nursing Instructor Nursing researcher and theorist "First woman to become a surgeon general as a nurse" Abdellah 's theory, "Nursing is based on an art and science that moulds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs." 11 Nursing Skills Observation of health status Skills of communication Application of knowledge Teaching of patients and families Planning and organization of work Use of resource materials Use of personnel resources 16 Niña Jane P. Lualhati NUR245  Problem-Solving Direction of work of others Therapeutic use of the self Nursing procedure Four categories of patient needs Basic to all patients Substernal care needs Remedial care needs Restorative care needs. 4. Jean Watson Theory of Human Caring Her theories are influenced by the Eastern Philosophy viewpoint, seeing the body as a whole unit, not a sum of parts. This idea links to previous theories to her time, including those of Nightingale, Leininger and Paterson & Zderad. Because of her background in psychology, theorists like Carl Rogers and Richard Lazarus also show some influence. Theory of Human Caring: It is the Blueprint for nurses to restore the art of nursing practice and better care for their patients and themselves. Nursing has changed dramatically as science and medicine have adapted to meet the growing demands of our population. It's increasingly a skilled -based profession with paper works to accomplish. However, it is important to remember the roots of nursing which are based on caring and healing principles. A "good" nurse cannot be defined solely by her ability and skills but also by how well she interacts with the client and family while providing that care. Watson viewed caring as the essence of nursing. Caring connotes responsiveness between the nurse and the person. The nurse co-participates with the person. The purpose of caring is to assist the person in gaining control and becoming knowledgeable, and in the process promote health changes. If we have thought of the concept of empowerment while reading this, yes, we can say that it is similar to that. By allowing the client to be knowledgeable, the nurse provides an environment for better decision-making, better self-control and, better self-respect. The concept is common to Filipino culture: "kakayahan" or "patibayin ang kakayahan," meaning assisting the person in gaining control. "Caring in the nursing profession takes place every time a nurse-to-patient contact is made... That caring makes a difference to the patient's sense of well-being. Caring may occur without curing but curing cannot occur without caring" Nursing Conceptual Models 5. Martha Rogers (1970) The Science of Unitary Human Beings, and Principles of Hemeodynamics "Nursing is an art and science that is humanistic and humanitarian. It is directed toward the unitary human and is concerned with the nature and direction of human development." 17 Niña Jane P. Lualhati NUR245  Rogers postulates that human beings are dynamic energy fields that are integral with environmental fields. Both human and environmental fields are identified by pattern and characterized by a universe of open systems. 6. Dorothea Orem (1971) Self-Care Deficit Theory of Nursing The Historical Evolution of Orem's Model 1949-1957 - Orem worked on developing nursing curriculum and nursing practice 1958-1960 - Worked for the Office of Education, in the U.S. Dept. of Health, Education and Welfare as a curriculum consultant; Guidelines for Developing Curricula for the Education of Practical Nurses was developed (Tomey and Alligood, 2006). 1960-1970 - Eventually served as the acting dean of the School of Nursing at the Catholic University of America 1971 - Published Nursing: Concepts of Practice Self-care agency - Human's ability or power to engage in self-care and is affected by basic conditioning factors. Basic conditioning factors - Age, gender, developmental state, health state, sociocultural orientation, health care system factors. Family system factors, patterns of living, environmental factors, and resource adequacy and availability. Nursing Agency - Complex property or attribute of people educated and trained as nurses that enables them to act, to know, and to help others meet their therapeutic self­ care demands. SELF-CARE DEFICIT THEORY OF NURSING: Dorothea Orem's theory is based on the belief that the individual has a need for self-care actions and that nursing can assist the person in meeting that need to maintain life, health, and well-being. This is a general theory composed of 3 related theories: (1) THE THEORY OF SELF-CARE - "Self-care comprises the practice of activities that maturing and mature persons initiate and perform, within time frames, on their own behalf in the interest of maintaining life, healthful functioning, continuing personal development and well-being through meeting known requisites for functional and developmental regulations" Self-care - consists of activities that individuals carry out on their own behalf. These actions are deliberate, have pattern and sequence, and are developed from day-to-day living. Self-care agency - The human's acquired ability or power to engage in self-care. This ability to engage in self-care is affected by basic conditioning factors (age, gender, developmental state, health state, socio- cultural, health care system, family system, patterns of living, environmental and resource adequacy and availability). For instance, infants and children, as well as aged, ill, and disabled people, require help with self-care activities. Self-care requisites - defined as "the reasons for which self-care is undertaken; they express the intended or desired results". (2) THE THEORY OF SELF-CARE DEFICIT- (3) THE THEORY OF NURSING SYSTEMS 18 Niña Jane P. Lualhati NUR245  7. Imogene King (1971) Goal Attainment Theory King has interrelated the concepts of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and space into a theory of goal attainment. KINGS GOAL ATTAINMENT THEORY Her theory deals with a nurse-client dyad, a relationship to which each person brings personal perceptions of self, role, and personal levels of growth and development. The nurse and client communicate, first in interaction and then in transaction, to attain mutually set goals. The relationship takes place in space identified by their behaviors and occurs in forward­ moving time. KING'S INTERACTING AND OPEN SYSTEMS MODEL Focus is on the person and the three interacting systems: i. Personal - perception, self-growth and development, body image, space, and time. ii. Interpersonal - interaction, communication, transaction, role, and stress. iii. Social - organization, authority, power, status, and decision making. 8. Sister Callista Roy (1979) Adaptation Model Roy's theory is grounded on humanism with the belief that a person has his own creative power and has coping abilities to enhance wellness. "The model provides a way of thinking about people and their environment that is useful in any setting. It helps one prioritize care and challenges the nurse to move the patient from survival to transformation." She viewed humans as biopsychosocial beings constantly interacting with a changing environment and who cope with their environment through Biopsychosocial adaptation mechanisms. There are two categories of coping mechanisms according to Roy namely the regulator and the cognator subsystems: Regulator Subsystem - transpires through neutral, chemical and endocrine processes like the increase in vital signs-sympathetic response to stress. Cognator Subsystem - occurs through cognitive-emotive processes. The Roy adaptation model views the patient as an adaptive system. According to Roy's model, the goal of nursing is to help the person adapt to changes in physiological needs, self-concept, role function, and interdependent relations during health and illness. The need for nursing care occurs when the patient cannot adapt to internal and external environmental demands. All individuals must adapt to the following demands: meeting basic physiological needs, developing a positive self-concept, performing social roles, and achieving a balance between dependence and independence. 19 Niña Jane P. Lualhati NUR245  The nurse determines which demands are causing problems for a patient and assesses how well the patient is adapting to them. Nurses direct care at helping the patient adapt to the changes. Adaptation: the process and outcome whereby thinking and feeling persons, as individuals and in groups, use conscious awareness and choice to create human and environmental integration Adaptive Responses: responses that promotes integrity of the human system, that is, survival, growth, reproduction, mastery, and personal and environmental transformation. The level of adaptation of a person is determined by the combined effect of stimuli, which could either be focal, contextual or residual. Roy's model revolves around the concept of man as an adaptive system. The person scans the environment for stimuli and ultimately adapts. The nurse, as part of his environment, assists the person in his effort to adapt by appropriately managing his environment. 20 Niña Jane P. Lualhati NUR245