Nursing Theories PDF

Theoretical Foundation of Nursing (1.1) Proposition. statements that describe the relationship between the concepts. - Introduces nursing theory from 3 different perspectives; history, significance, analysi...

Theoretical Foundation of Nursing (1.1) Proposition. statements that describe the relationship between the concepts. - Introduces nursing theory from 3 different perspectives; history, significance, analysis Domain. perspective or territory of a profession or discipline. Theory - a set of statements that tentatively describe. explain, or predict relationships among concepts that Process. organized steps, changes, or functions have been systematically selected and organized as an intended to bring about the desired result. abstract representation of some phenomenon (Power & Paradigm. refers to a pattern of shared understanding Knapp 1995) and assumptions about reality and the world, What are Nursing Theories? worldview, or widely accepted value system. Nursing theories are organized bodies of knowledge Metaparadigm. most general statement of discipline to define what nursing is, what nurses do, and why. and functions as a framework in which the more they do it. restricted structures of conceptual models develop. Theoretical work in nursing focused on articulating Provides a way to define nursing as a unique discipline relationships among four major concepts: person, separate from other disciplines (e.g., medicine). environment, health, and nursing Framework of concepts and purposes intended to Read: (QUICK OVERVIEW OF HISTORY OF NURSING) guide nursing practice at a more concrete and specific level. Components of Nursing Theories DEFINITION OF TERMS Phenomenon - to describe an idea or response about an event, a situation, a process, a group of events, or a Philosophy. beliefs and values that define a way of group of situations. thinking and are generally known and understood by a group or discipline. - May be temporary or permanent. Nursing theories focus on the phenomena of nursing. Theory. A belief, policy, or procedure proposed or followed as the basis of action. It refers to a logical Concepts - Interrelated concepts define a theory. group of general propositions used as principles of - used to help describe or label a phenomenon. explanation. Theories are also used to describe, predict. - words or phrases that identify, define, and or control phenomena establish structure and boundaries for ideas Concept. often called the building blocks of theories. generated about a particular phenomenon. They are primarily the vehicles of thought that involve - May be abstract or concrete. images. Abstract. mentally constructed independently of a Models. representations of the interaction among and specific time or place. between the concepts showing patterns. They present Concrete. directly experienced and related to a an overview of the theory's thinking and may particular time or place. demonstrate how theory can be introduced into practice. Conceptual framework. A group of related ideas, Definition -used to convey the general meaning of the statements, or concepts. It is often used concepts of the concepts of the theory. interchangeably with the conceptual model and with grand theories. Theoretical. particular concept based on the theorist's perspective. Operational. States how concepts are measured. Relational statements - relationships between two or Provide frameworks for nursing interventions and more concepts. suggest outcomes or the effect of nursing practice. Assumptions - accepted as truths and are based on Theories developed at this level have a more direct values and beliefs. Explains the nature of concepts. effect on nursing practice than more abstract theories. definitions, purpose, relationships, and structure of a These theories are interrelated with concepts from theory. range theories or grand theories. (Nursing Metaparadigm) (Why NT important) By Orientation By Abstraction Descriptive Theories Grand Nursing Theories first level of theory development. They describe the Grand theories are abstract, broad in scope, and phenomena and identify its properties and components complex, therefore requiring further research for in which it occurs. clarification. not action-oriented or attempt to produce or change Do not guide specific nursing interventions but rather a situation. provide a general framework and nursing ideas. Two types of descriptive theories: factor-isolating Develop their works based on their own experiences theory, and explanatory theory, and their time, explaining why there is so much 1. Factor-Isolating Theory variation among theories. - Descriptive theories Address the nursing metaparadigm component - a.k.a category-formulating or labeling theory. person, nursing, health, and environment. - Theories under this category describe the properties and dimensions of phenomena. (Example: case studies, literature review, Middle-Range Nursing Theories phenomenology. Ethnography) More limited in scope (compared to grand theories) 2. Explanatory Theory and present concepts and propositions at a lower level - describe and explain the nature of relationships of abstraction. They address a specific phenomenon in of certain phenomena to other phenomena. nursing. Situation-relating Theories Due to the difficulty of testing grand theories, nursing scholars proposed using this level of theory. (Predictive theories, promoting or inhibiting theories) Most middle-range theories are based on a grand Predicts the occurence of a phenomenon when the theorist's works, but they can be conceived from cause is present research, nursing practice, or the theories of other Experimental research is used to generate and test disciplines them in most cases Practice-Level Nursing Theories Situation-relating Theories (Prescriptive Theories) Situation-specific theories that are narrow in scope Address nursing therapeutics and consequences of and focuses on a specific patient population at a specific interventions. time. prevents the occurrence of the phenomenon by controlling or eliminating possible causes. Classification According to Meleis Classification According to Alligood Needs-Based Theories. The needs theorists were the Nursing Philosophy. It is the most abstract type and first group of nurses who thought of giving nursing care sets forth the meaning of nursing phenomena through a conceptual order. Theories under this group are based analysis, reasoning, and logical presentation. Works of on helping individuals to fulfill their physical and mental Nightingale. Watson, Ray, and Benner are categorized needs. Theories of Orem, Henderson, and Abdella are under this group. categorized under this group. Need theories are criticized for relying too much on the medical model of health and placing the patient in an overtly dependent Nursing Conceptual Models. These are comprehensive position. nursing theories that are regarded by some as pioneers in nursing. These theories address the nursing Interaction Theories. These theories emphasized metaparadigm and explain the relationship between nursing en the establishment and maintenance of them. Conceptual models of Levine, Rogers, Roy, King, relationships. They highlighted the impact of nursing on and Orem are under this group. patients and how they interact with the environment, people, and situations. Theories of King. Orlando, and Travelbee are grouped under this category. Grand Nursing Theories. Are works derived from Outcome Theories. These theories describe the nurse nursing philosophies, conceptual models, and other as controlling and directing patient care using their grand theories that are generally not as specific as knowledge of the human physiological and behavioral middle-range theories. Works of Levine, Rogers. Orem, systems. The nursing theories of Johnson, Levine, and King are some of the theories under this category. Rogers, and Roy belong to this group. Middle-Range Theories. Are precise and answer specific nursing practice questions. They address the specifics of nursing situations within the model's perspective or theory from which they are derived. Examples of Middle-Range Theoretical Foundation of Nursing (1.2) Lydia E. Hall Developed the 3c’s theory (Care, Cure, Core) Nursing theorist and their works She defined nursing as “ Participation in care, core, and cure aspects of patient care, where CARE is the sole function of nurses, whereas the CORE and CURE are Florence Nightingale (Lady of the Lamp) shared with other members of the health team” Founder of Modern Nursing and Pioneer of the The major purpose of care is to achieve an Environmental Theory interpersonal relationship with the individual to facilitate the development of the core Defined Nursing “the act of utilizing the environment of the patient to assist to his recovery” - Care – professional nurses’s primary role, such as providing bodily care for the patient Identified 5 environmental factors: fresh air, pure - Core – patient receiving nursing care water, efficient drainage, cleanliness or sanitation, or - Cure – aspect of nursing that involves the direct sunlight administration of medications and treatments Joyce Travelbee Hildegard E. Peplau States in her Human-to-Human Relationship Model Pioneered the Theory of Interpersonal Relations that te purpose of nursing was to help and support an individual, family, or community to prevent or cope Her work influenced by Henry Stack Sullivan, with the struggles of illness and suffering Percival Symonds, Abraham Maslow, and Neal Elgar Miller Nursing was accomplished through human-to- human relationships It helps nurses and healthcare providers develop more therapeutic intervention in the clinical setting Extended the interpersonal rs theories of Peplau and Orlando Virginia Henderson Ida Jean Orlando Developed the Nursing Need Theory Developed the Nursing Process Theory Focuses on the importance of increasing the patient’s independence "Patients have their own meanings and interpretations of situations, and tehrefore nurses must Emphasizes the basic human needs and how nurses validate theur inferences and analyses with patients can assist in meeting those needs before drawing conclusions" Allows nurses to formulate an effective nursing care Faye Glenn Abdellah plan thaf can also be easily adapted when and if any complexity comes up with the patient Developed the 21 Nursing Problems Theory The role of the nurse is to find out and meet the Changed the focus of nursing from disease-centered patient's immediate needs for help to patient-centered and began to include families and the elderly in nursing care Nursing model intended to guide care in hospital institutions but can also be applied to community health nursing Jean Watson Dorothea E. Orem She pioneered the Philosophy and Theory of In her Self-Care Theory, she defined Nursing as "The Transpersonal Caring act of assisting others in the provision and management of self-care to maintain or improve human functioning "Nursing is concerned with promoting health, at the home level of effectiveness." preventing illness, caring for the sick, and restoring health." Focuses on each individual's ability to perform self- care. Mainly concerns with how nurses care for their patients and how that caring progresses into better Composed of three interrelated theories: plans to promote health and wellness, prevent illness (1) the theory of self-care. and restore health. (2) the self-care deficit theory, and Focuses on health promotion, as well as the treatment of diseases. (3) the theory of nursing systems, which is further classified into wholly compensatory, partially Caring is central to nursing practice and promotes compensatory, and supportive educative health better than a simple medical cure. Imogene M. King Myra Estrin Levine Conceptual System and Middle-Range Theory of Goal According to the Conservation Model. "Nursing is Attainment human interaction. "Nursing is a process of action, reaction, and Provides a framework within which to teach beginning interaction by which nurse and client share information nursing students. about their perception in a nursing situation" and "a Logically congruent, externally and internally process of human interactions between nurse and client consistent, has breadth and depth, and is understood, whereby each perceives the other and the situation, with few exceptions, by professionals and consumers of and through communication, they set goals, explore health care. means, and agree on means to achieve goals. focuses on this process to guide and direct nurses in the nurse-patient relationship going hand-in-hand with Martha E. Rogers their patients to meet good health goals Explains that Theory of Unitary Human Beings the nurse and patient go hand in hand in communicating information set goals together and then In Roger's Theory of Human Beings, she defined take actions to achieve those goals Nursing as "an art and science that is humanistic and humanitarian. The Science of Unitary Human Beings contains two Patricia Benner dimensions, the science of nursing, which is the Patricia Benner developed a concept known as "From knowledge specific to the field of nursing that comes Novice to Expert." from scientific research, and the art of nursing which involves using nursing creatively to help better the lives This concept explains that nurses develop skills and an of the patient understanding of patient care over time from a combination of a strong educational foundation and A patient can't be separated from his or her personal experiences. environment when addressing health and treatment. Dr Beaner proposed that a nurse could gain knowledge and skills without actually learning a theory.  She describes this as a nurse "knowing how without Sister Callista Roy knowing that." She further explains that the In Adaptation Model. Roy defined nursing as a "health development of knowledge in fields such as nursing is care profession that focuses on human life processes made up of the extension of knowledge through and patterns and emphasizes the promotion of health research and understandingg through clinical for individuals, families, groups, and society as a experience whole." Views the individual as a set of interrelated systems Katie Eriksson that strives to maintain a balance between various stimuli The Theory of Caritative Caring was developed by Katie Eriksson Inspired the development of many middle-range nursing theories and adaptation instruments This model of nursing distinguishes between caring ethics, the practical relationship between the patient and the nurse, and Dorothy E. Johnson nursing ethics The Behavioral System Model defined Mursing as an Nursing ethics are the ethical principles that guide a external regulatory force that acts to preserve the nurse's decision-making abilities organization and integrate the patients behaviors at an optimum level under those conditions in which the Caritafive caring consists of love and charity, which is behavior constitutes a threat to the physical or social also known as.caritas. and respect and reverence for health or in which illness is found." human holiness and dignifs Advocates to foster efficient and effective behavioral According to the theory, suffering that occurs as a functioning in the patient to prevent illness and stresses result of a lack of caritative care is a violation of human the importance of research-based knowledge about the dignits effect of nursing care on patients Betty Neuman Madeleine M. Leininger In Neuman's System Model, she defined nursing as a Culture Care Theory of Diversity and Universality unique profession in that is concerned with all of the variables affecting an individual's response to stress." Defined transcultural nursing as a substantive area of study and practice focused on comparative cultural care The focus is on the client as a system (which may be an (caring) values, beliefs, and practices of individuals or individual. family. group, or community) and on the groups of similar or different cultures to provide client's responses to stressors. culture-specific and universal nursing care practices in The client system includes five variables (physiological promoting health or well-being or to help people to face psychological, sociocultural developmental, and unfavorable human conditions, illness, or death in spiritual) It is conceptualized as an inner core (basic culturally meaningful ways energy resources) surrounded by concentric circles that Involves learning and understanding various cultures include lines of resistance, a normal defense line, and a regarding, nursing and health- illness caring practices, flexible line of defense belicis, and values to implement significant and efficient nursing care services to people according to their cultural values and health-llness context Margaret A. Newman competence in the caretakingg Lasks involved in the role, and expresses pleasure and gratification (Mercer, Health as Expanding Consciousness 1986). "Nursing is the process of recognizing the patient in Provides proper health care interventions for relation to the environment, and it is the process cess of nontraditional mothers for them to favorably adopt a the understanding of consciousness." strong maternal identity The theory of health as expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible Local Theories Nursing is regarded as a connection between the nurse and patient, and both grow in the sense of higher Sister Carolina S. Agravante- CASAGRA Transformative levels of consciousness - Leadership Model: Servant-Leader Formula and the Nursing Rosemarie Rizzo Parse - Faculty's Transformative Leadership Behavior Carmelita C. Divinagracia-COMPOSURE Behaviors Model, Human Becoming Theory Sister Letty G. Kuan, Retirement and Role "Nursing is a science, and the performing art of nursing Discontinuity Model is practiced in relationships with persons individuals, groups, and communities) in their processes of Carmencita M. Abaquin- PREPARE ME Holistic Nursing becoming" Interventions Explains that a person is more than the sum of the Cecilia Marcaida Laurente- Theory of Nursing Practice parts, the environment, and the person is inseparable and Career and that nursing is a human science and art that uses an abstract body of knowledge to help people. It centered around three themes: meaning, rhythmicity, and transcendence. Ramona T. Mercer Maternal Role Attainment-Becoming a Mother "Nursing is a dynamic profession with three major foci health promotion and prevention of illness, providing care for those who need professional assistance to achieve their optimal level of health and functioning, and research to enhance the knowledge base for providing excellent mursing care." Nurses are the health professionals having the most sustained and intense interaction with women in the maternity cycle." Maternal role attainment is an interactional and developmental process occurring over Lime. The mother becomes attached to her infant acquires EVOLUTION OF NURSING Medical information in the Edwin Smith Papyrus may date to a time as early as 3000 BC. It details cures A. Intuitive Period (PRIMITIVE ERA – 6TH CENTURY) ailment and anatomical observation Intuition – nursing was ‘untaught’ and instinctive. It Edwin Smith Papyrus is an ancient textbook on surgery was performed of compassion for others almost completely devoid of magical thinking and - Nurse’s role was instinctive and directed describes in exquisite detail the examination, diagnosis, towards comforting, practicing midwifery and treatment, and prognosis of numerous ailments. being wet nurse to a child The KahunGynaecological Papyrus treats women's - Nursing was a function belonged to women complaints, including problems with conception. - Primitive men believed illness was causd by the The earliest known physician is also credited to ancient invasion of evil spirits Egypt ("Chief of Dentists and Physicians" for KingDjoser - Medicine man was called shaman or witch in the 27th century BCE) doctor having the power to heal using magic Peseshet –Earliest known woman physician. - Trephining/ Trephination – oldest surgical procedures known to humanity. Refers to India surgical procedure in which a circular piece of The Atharvaveda –Ancient text dealing with Medicine bone is drilled and excised, most commonly Ayurveda – “Complete knowledge for long life” form human skull Medical system of India with8branchesofmedicine - Music or singing was often used to drive away Charaka and Sushruta– 2 most famous medical spirits textbooks that describe physical examinations, diagnosis, treatment and prognosis and several surgical Prehistoric Medical Practice procedures. Use of mercury Suśrutasamhitā - Describes several surgical Blood Letting with the use of leeches procedures Lobotomies Heroin for headaches Greece and Roman Empire Electroconvulsive Therapy (ECT) Trephining Wound treatment Cannibalistic Medical Practices The Romans attempted to maintain vigorous health, illness was a sign of weakness. RISE OF THE EARLY CIVILIZATION AND ANCIENT Care of the ill was left to the slaves or Greek physicians. CITIES AND THEIR CONTRIBUTION TO MEDICINE Both groups were looked upon as inferior by Roman society Mesopotamia No distinction between rational science and magic THE APPRENTICE PERIOD (6TH CENTURY- 18TH Diagnostic Handbook - introduced the methods of CENTURY) therapy and cause. The text contains a list of medical symptoms and often detailed empirical observations Apprentice – period of ‘on the job’ training along with logical rules used in combining observed From the founding of the Religious orders in the 11th symptoms on the body of a patient with its diagnosis century up to 1836 with the establishment of the and prognosis Kaiserwerth Institute for training of Deaconesses Asipu – Medical Authority/Exorcist-Healer Nursing performed without any formal education and Prophylaxis by people who were directed by more experienced Mental Illness is associated with deities nurses Founding of religious order Egypt Egyptians are considered “The Healthiest of all men” Public Health System Philippines: Philippines Iloilo Mission Hospital School of Nursing The sick needed a spin doctor (“herbolario” or – Established in 1906 it is the first hospital in the “albolario”)to drive the: Philippines which trained Filipino nurse Dwarves, Witches, Omens, Curses, Evil Spirits 19TH CENTURY—THE HUMANISTIC INFLUENCE OF MILITARY RELIGIOUS ORDERS AND THEIR WORK NIGHTINGALE Knights of St. John of Jerusalem (Italian) - Also known In the mid-1800s in England, Pastor Theodore and as “Knight Hospitalers” They founded Hospitals Friderike Fliedner started a hospital in Kaiserworth, Teutonic Knights (German) - Established tent Germany. They created training programs for nurses hospitals for the wounded when they realized there was no workforce in the Knights of St. Lazarus - Founded primarily for nursing hospital. It was with Fliedner’s program that Florence care of lepers in Jerusalem Nightingale“trained” The Alexian Brothers were members of a monastic order founded in 1348. They established the Florence Nightingale Alexian Brothers Hospital School of Nursing the largest Born on May 12, 1820 School of Nursing under religious order. It operated Born to wealthy English parents exclusively for men in United States Known as “The mother of modern nursing” “The Lady with the Lamp” and “Professional Nurse Pioneer IMPORTANT NURSING PERSONAGES Most famous for her work during the Crimean War(1854-1856) St. Clare - founder of the second order of St. Francis Under Florence’s leadership, the nurses brought of Assisi. cleanliness, sanitation, nutritious food and comfort to St. Elizabeth of Hungary – known as the “Patroness of the patients. Nightingale was known for providing the Nurses”, she was the daughter of the Hungarian King. kind of personal care, like writing letters home for She lived her life frugally despite her wealth. soldiers, that comforted them and improved their St. Catherine of Siena – The first lady with the lamp. psychological health. Her group of nurses transformed She was a hospital nurse, prophetess, researcher and a the hospital into a healthy environment within six reformer of society and the church months, and as a result, the death rate of patients fell from 40 to 2 percent. In 1857, Florence returned home RENAISSANCE PERIOD (DARK PERIOD) a heroine. It was the soldiers in Crimea that initially named her the “Lady with the Lamp” because of the Also known as the period of reformation and reassuring sight of her carrying around a lamp to check American civil war on th sick and wounded during the night, and the title Hospitals were closed remained with her. Nursing was the work of least desirable people Published in 1859 Notes on Nursing provides a simple Nurses were educated, filthy and overworked but practical discussion of good patient care, along with Mass exodus of nurses helpful hints. According to Florence Nightingale, hygiene, sanitation, fresh air, proper lighting, a good 1ST TRAINING SCHOOL OF NURSING diet, warmth, quietness and attentiveness were necessary conditions for hospitals and were to be United States of America Bellevue Hospital School of ensured by trained nurses. Nightingale implemented Nursing handwashing and other hygiene practices in the war -Founded in 1873 in New York. It was the first school hospital in which she worked. More soldiers die of nursing in the United States to be founded on the because from infection than from bullets she advocated principles of nursing established by Florence sanitary living conditions as of great importance. Nightingale EDUCATION PERIOD (18TH – 20TH CENTURY) 16. Responsibility for probationers’ health and safety, including rules to prevent septicemia and ongoing Florence Nightingale was one of the pioneers in monitoring of probationers’health establishing the idea of nursing schools from her base at 17. Certificates and letters of reference had to be dated St Thomas' Hospital, London in 1860 when she opened and were relevant only for a short time the 'Nightingale Training School for Nurses’, now part of 18. A matron should have a housekeeper under her so King's College London. that she could concentrate on the nursing and the nurse training NIGHTINGALE SCHOOL OF NURSING 19. The superintendent herself must have the highest knowledge of nursing, be herself resident in the hospital, During the war a public subscription fund was set up for make the training in nursing her first object, and be Florence Nightingale to continue her education of herself a trained nurse of the highest order. nurses in England, and the Nightingale Training School at St. Thomas’ Hospital opened in 1860. The education CONTEMPORARY PERIOD (21ST CENTURY) – present of recruits involved a year of practical instruction in the wards, supplemented with courses of lecturing and NURSING AFTER WORLD WAR I followed by two years of work experience in the The silver lining of the great war hospital. After graduation, many of the students staffed Volume of patients drastically change the role of British hospitals, and others spread the Nightingale nurses education system to other countries. The nurses performed triage as patients came in on 1. Government funds should be allotted to nursing ambulance trains,directed corpsmen who had little education First nurse political activist medical training,manage dentire wards of patients and 2. Training schools of Nursing should be in close performed a variety of procedures, including irrigating affiliation wounds and managing infection. 3. Professional nurses should train nurses Dependent to Independent nursing practice 4. Nursing students should be provided with residence Good Infection control and wound care even with the near their training hospitals absence of antibiotics and electricity Written orders of doctors were insisted American nurses worked on base hospitals,hospital Nurses should go with doctors during their rounds trains,hospital ships,field hospitals, camp hospitals and 5. All nurses must be trained, in a regular civil hospital even evacuation hospitals and mobile units. 6. Training was fundamentally on the apprenticeship Mobilizing women and women empowerment model: hands-on, in the wards, under the ward sister Nurses earned the respect of those they served with, 7. Classes, given by medical doctors, augmented and they were decision-makers.That was very different training in the wards for them,not just as nurses but as women 8. The “home sister” or “mistress of probationers” New Opportunities for Women: Wartime and the organized the training American Workforce 9. District nurses had to be hospital-trained (or they Nurses on the Front Lines would not see enough serious cases) 10. Midwifery nurses had to be hospital trained RISE OF THE BSN CURRICULUM 11. Training was required for administrative positions 12. Probationers kept diaries and case notes of their The Degree of Bachelor of Science in work, examined by the matron and home sister, and Nursing: 1941 – 1951 often by Nightingale. A nursing curriculum which was based on the thesis 13. A major component of training was moral: ethical presented by Julita V. Sotejo, graduate of the Philippine standards for patient care General Hospital School of Nursing, tackles on the 14. Technical training had to be updated development of a nursing education within a University- 15. A Probationers’ Home should be provided, with a based College of Nursing. private room for each, comfortable(common) living  When the Japanese occupied the Philippines in Key Principles 1942,training and practice at the hospital schools of 1. Sanitation - Creating a clean and hygienic nursing in Manila was “violently disrupted.” environment to prevent the spread of diseases However,U.S. colonial patterns in Philippine nursing and infections. education soon returned after the U.S. reclaimed the 2. Proper Ventilation - Ensuring sufficient fresh air country in 1945 and even after the Philippines gained to promote respiratory health and reduce the independence from the U.S. July 4, 1946. risk of airborne pathogens. The First Colleges of Nursing in the Philippines 3. Natural Light - Utilizing natural light to positively impact mood, circadian rhythms, and University of Santo Tomas – College of Nursing(1946) overall well-being. – In 1947,the Bureau of Private Schools permitted UST 4. Noise Control - Minimizing noise disturbances to grant the title Graduate Nurse to the 21 students to ensure a peaceful and healing environment who were of advanced standing from 1948 up to the for patients. present Manila Central University – College of Nursing(1947) Major Assumptions The MCU Hospital first offered BSN and Doctor of Medicine degrees in1947 and served as the clinical field 1. Nursing - Nightingale believed that every for practice. woman, at one time in her life, would be a University of the Philippines Manila College of nurse in the sense that nursing is being Nursing (1948) responsible for someone else’s health The idea of opening the college began in a conference 2. Health - Nightingale defined health as being between Miss Julita Sotejo and UP President. In April well and using every power (resource) to the 1948,the University Council approved the curriculum, fullest extent in living life. Additionally, she saw and the Board of Regents recognized the profession as disease and illness as a reparative process that having an equal standing as Medicine, Engineering etc. nature instituted when a person did not attend Miss Julita Sotejo was its first dean. to health concerns. 3. Person – Nightingale referred to the person as a patient. Nurses performed tasks to and for the Florence Nightingale's Environmental Theory patient and controlled the patient’s environment to enhance recovery. Background and Contributions 4. Environment - Nightingale’s concept of  Early Life – born in Italy in 1820, She defied environment emphasized that nursing was “to societal expectations and pursued her passion assist nature in healing the patient. for nursing Application of the Environmental Theory in Nursing  The Crimean War – She gained recognition for Practice her work in improving sanitary conditions and reducing mortality rates in military hospitals 1. Creating Healing Spaces - Nurses contribute to during the war the healing process by designing patient rooms  Pioneering Reforms – Established the first that promote relaxation and recovery. professional training school for nurses and 2. Incorporating Nature - Nature-based advocated for the better healthcare practices interventions, such as gardens and green spaces, are integrated into healthcare settings to aid in Environmental Theory – emphasizes the impact of the patient healing and well-being. environment on a patient’s healing process. Focuses on 3. Nutrition and Nourishment - Nightgale's theory the essential elements of clear air, pure water, efficient highlights the importance of providing patients drainage, cleanliness, and light with nutritious meals to support their recovery Evidence Supporting the Effectiveness of the 3. Person - Watson uses interchangeably the Environmental Theory terms human being, person, life, personhood, and self. She views the person as “a unity of 1. Reduced Infections - Studies have shown that mind/body/spirit/nature” (1996), and she says implementing Nightingale's principles leads to a that “personhood is tied to notions that one’s significant decrease in hospital-acquired soul possess a body that is not confined by infections. objective time and space 2. Enhanced Patient Outcomes - Patients in 4. Environment - “the caring science is not only environments adhering to the environmental for sustaining humanity, but also for sustaining theory have experienced improved recovery the planet. Belonging is to an infinite universal rates and overall well-being. spirit world of nature and all living things; it is 3. Positive Staff Satisfaction - Nurses working in the primordial link of humanity and life itself, environments aligned with the theory report across time and space, boundaries higher job satisfaction and increased morale. Key Concepts Critique of the Environmental Theory 1. Caring as the Central Focus - emphasizes the 1. Subjectivity - critics argue that the theory lacks importance of engaging in caring relationships scientific objectivity and fails to consider to promote healing and well-being. individual patient preferences. 2. The Ten Carative Factors - factors guide nurses 2. Evolution of Healthcare - As healthcare in providing individualized care that considers practices and technologies evolve, it is the physical, emotional, and spiritual needs of important to adapt the theory to incorporate patients. new advancements and changes. 3. Transpersonal Caring Relationship – built on Conclusion and Relevance of the Environmental Theory trust, empathy, and understanding, creating a Today healing atmosphere for both the patient and the nurse. 1. Jean Watson's Philosophy and Theory of Transpersonal Caring Original 10 Carative Factors 1. Formation of a Humanistic Altruistic System of  Jean Watson - renowned nurse theorist and Values professor who developed the theory of 2. Instillation of Faith-Hope transpersonal caring. She believes that nursing 3. Cultivation of Sensitivity to Self and Others is an art and a science that encompasses 4. Development of a Helping-Trust Relationship compassionate care and holistic healing. 5. Promotion and Acceptance of the Expression Major Assumptions of Positive 6. Systematic Use of the Scientific Problem- 1. Nursing - According to Watson (1988), the word Solving Method for Decision Making nurse is both noun and verb. To her,nursing 7. Promotion of Interpersonal Teaching-Learning consists of “knowledge, thought, values, 8. Provision for a Supportive, Supportive, philosophy, commitment, and action, with Protective, and Corrective Mental, Physical, some degree of passion”. Nurses are interested Sociocultural, and Spiritual Environment in understanding health, illness, and the human Environment experience; promoting and restoring health; 9. Assistance with Gratification of Human Needs and preventing illness. 10. Allowance for Existential-Phenomenological 2. Health - She defined health as “unity and Forces harmony within the mind, body, and soul”; associated with the “degree of congruence between the self as perceived and the self as experienced” Application of Watson's Theory in Nursing 4. Transcendence - Embracing the human experience beyond illness or ailment, valuing Practice the individual's journey. 1. Creating a Healing Environment - Nurses can Major Assumptions create a healing environment by fostering a sense of safety, comfort, and tranquility for patients. 1. Nursing - holistic, relational, spiritual, and 2. Enhancing Nurse-Patient Connections - Nurses ethical caring that seeks the good of self and can establish meaningful connections through others in complex community, organizational, active listening, empathy, and genuine presence. and bureaucratic cultures. 3. Promoting Holistic Care - By considering all 2. Health - provides a pattern of meaning for aspects of a patient's well-being - physical, individuals, families, and communities. In all emotional, social, and spiritual - nurses can human societies, beliefs and caring practices provide comprehensive care. about illness and health are central features of Criticism and Limitations of Watson's Theory culture. Health is not simply the consequence of a physical state of being. Theory 3. Person - spiritual and cultural being. Persons 1. Ethical Concerns - Some argue that the theory's are created by God, the Mystery of Being, and emphasis on subjective experiences may lead to they engage co-creatively in human biased care and neglect of objective medical organizational and transcultural relationships to evidence. find meaning and value 2. Lack of Empirical Evidence - Critics argue that 4. Environment - complex spiritual, ethical, there is a lack of scientific research supporting ecological, and cultural phenomenon. This the effectiveness of Watson's theory in conceptualization of environment embodies improving patient outcomes. knowledge and conscience about the beauty of life forms and symbolic (representational) systems or patterns of meaning 2. Marilyn Ray's Theory of Bureaucratic Caring Application in Healthcare Settings  Marilyn Anne Ray - renowned nursing scholar and author, best known for her groundbreaking Theory of Bureaucratic Caring. 1. Patient-Centered Care - Ensuring the well-being  Bureaucratic Caring - refers to the integration and satisfaction of patients by recognizing and of attentive and caring practices within addressing their individual needs and bureaucratic systems, transforming them into preferences. compassionate and empathetic environments. 2. Effective Communication - Fostering open and Key Concepts transparent communication among healthcare professionals, patients, and their families. 1. Authentic Presence - Being fully engaged, 3. Collaborative Decision-Making - Involving attentive, and emotionally present in patients as partners in their own care and interactions with patients and colleagues. fostering shared decision-making processes. 2. Enablement - Empowering individuals to make informed decisions and promoting their active participation in their own care. 3. Caring Moment - A unique opportunity for authentic connection and shared understanding that enhances the healing process. Benefits of Implementing the Theory 2. Advanced Beginner Definition: A nurse with some experience who 1. Improved Patient Satisfaction - Enhanced begins to recognize patterns in clinical patient experiences and increased satisfaction situations. rates leading to improved healthcare outcomes. Characteristics: Relies on guidelines but starts 2. Enhanced Employee Engagement - Increased using experiences to handle recurring situations, job satisfaction, motivation, and overall well- though still needs support being of healthcare professionals. 3. Positive Organizational Culture - Promotion of 3. Competent a caring and compassionate work culture that Definition: A nurse with typically 2-3 years of positively impacts the overall organization. experience in the same role. Challenges and Limitations Characteristics: Demonstrates efficiency, organized care, and can make decisions based 1. Time Constraints - Allocating sufficient time for on more comprehensive analysis of a situation. meaningful interactions and incorporating caring practices in busy healthcare settings. 4. Proficient 2. Resistance to Change - Overcoming resistance Definition: A nurse who perceives clinical to adopting new approaches and values within situations in a holistic manner. traditional bureaucratic systems. Characteristics: Uses intuition and experience 3. Evaluation and Measurement - Developing to guide decision-making, anticipates needs, effective methods to evaluate and measure the and focuses on long-term outcomes. implementation and impact of the theory. 5. Expert Definition: A nurse with extensive experience Patricia Benner: Novice to Expert Theory who has an intuitive grasp of clinical situations without needing to rely on rules or guidelines. Patricia Benner's Novice to Expert theory, introduced in Characteristics: Rapid, accurate decision- 1984, is a foundational model that explains how nurses making with a deep understanding of patient develop skills and acquire clinical expertise over time. needs and situations. Drawing from the Dreyfus Model of Skill Acquisition, Benner identified five stages of nursing competence, Nursing Metaparadigm in Benner’s Model focusing on the importance of experiential learning in clinical practice. This model offers a structured 1. Person approach to understanding the progression of nursing  In Benner’s model, the “person” is both skills and is widely used in both nursing education and the patient and the nurse. The model practice. emphasizes the nurse's development as an individual, growing through experiences and interactions with Major Concept and Definition patients. 1. Novice Definition: The beginner with no experience in 2. Health the clinical situations they are expected to  Health is understood not just in terms perform. of the absence of disease but as the Characteristics: Follows strict rules and patient's lived experience. Nurses at guidelines, unable to exercise discretionary different levels of expertise interpret judgment. health differently, with experts focusing on the patient’s holistic health rather than just treating symptoms. 3. Situation Major Concepts and Definitions  Benner and Wrubel (1989) use the term situation rather than environment, 1. Care because situation conveys a social Definition: Care is the foundation of nursing environment with social definition and and a fundamental precondition for life. meaningfulness. They use the Three Dimensions of Care: phenomenological terms being situated Relational: Care is about relationships between and situated meaning, which are individuals. defined by the person’s engaged Practical: Care is rooted in actions and practices. interaction, interpretation,and Moral: Care is a moral imperative directed understanding of the situation. outward, towards the other. 4. Nursing 2. Professional Judgment and Discernment Concept: Judgment is learned through concrete  Nursing in this framework is a practice- clinical experiences and developed through based profession that evolves through professional practice. experience. The ability to provide Sensory and Moral: It involves the ability to effective care grows as nurses gain "see, listen, and touch clinically in a good way.“ more experience, moving from rule- Link to Perception: Perception in nursing is based care to intuitive, expert-level analog and subjective, involving the integration care. of professional knowledge and previous Application to nursing theory experience. Patricia Benner’s Novice to Expert model provides a 3. Moral Practice Is Founded on Care comprehensive understanding of how nurses develop Concept: Empathy and reflection must work expertise over time. By emphasizing experiential together in moral practice. learning and mentorship, the model outlines a clear Empathy and Reflection: Empathy is the path for the development of nursing competence. This foundation of moral action, and it involves framework is essential for clinical practice, education, recognizing what the patient needs most. and leadership, helping to ensure that nurses provide high-quality care as they progress in their careers. 4. Person-Oriented Professionalism Focus: Person-oriented professionalism demands that nurses see the patient as a Kari Martinsen: Philosophy of Caring suffering person, protecting their integrity. Engagement: Nurses must invest themselves in Overview: Kari Martinsen is a Norwegian nurse and caring encounters, obligating themselves to do philosopher whose work focuses on the philosophy of their best for the patient. care, emphasizing the moral, practical, and relational aspects of care. 5. Sovereign Life Utterances Key Point: Her philosophy revolves around the idea that Concept: These are pre-cultural phenomena care is fundamental not only to nursing but to life itself. fundamental to all societies, including openness, She critiques modern healthcare's focus on efficiency mercy, trust, hope, and love. and objectivity, advocating for a return to the moral Relation to Care: Without these qualities, life foundation of care. disintegrates. Care helps to realize these utterances in both personal and professional interactions. Caring Actions: Through caring actions, nurses can help patients experience love, trust, hope, and mercy.  Application to Nursing Theory 6. The Untouchable Zone Definition: A protective boundary that nurses 1. Practical Implications: Martinsen’s must not cross in caring encounters, ensuring philosophy emphasizes that nursing is not just a professionalism and impartiality. set of tasks, but a moral and relational practice. Duality: While respecting this zone, care must 2. Education: Nurses must be trained not only also involve openness and vulnerability in in technical skills but also appropriate ways. in moral discernment and empathetic care. 3. Clinical Practice: The philosophy of caring 7. Vocation demands that nurses treat Concept: Vocation is a call to care for others, patients as whole persons, recognizing their grounded in the law of neighborly love. dignity and suffering. Professional and Personal Refinement: Nursing requires personal growth alongside professional knowledge. 3. Katie Eriksson: Theory of Caritative Caring 8. The Eye of the Heart Overview: Katie Eriksson is a Finnish-Swedish Concept: Stemming from the parable of the nurse and theorist whose Theory of Caritative Good Samaritan, the "eye of the heart" refers to Caring is rooted in the idea of caring as a human the ability to be moved by the suffering of science with a deep ethical and spiritual others. foundation. Holistic Understanding: Seeing the patient with the "eye of the heart" combines perception and understanding. Major Concepts & Definitions 9. The Registering Eye Caritas: Love and charity; the foundation of caring. Definition: The registering eye is concerned Caring Communion: Deep, intimate connection that with objectifying the patient and classifying defines the caring reality. clinical situations. Critique: Martinsen warns that a one-sided The Act of Caring: Involves faith, hope, love, and focus on this perspective can remove creative actions. compassion from nursing, reducing the patient's Caritative Caring Ethics: Distinction between caring will to live. ethics (moral relation with the patient) and nursing ethics (rules guiding nursing decisions). 10. Nursing Metaparadigm Nursing: Caring goes beyond nursing, but is Dignity: Absolute and relative human dignity; respect fundamental to it. True care involves relational, for the patient’s uniqueness. practical, and moral elements. Person: Individuals are shaped by their social Invitation: Welcoming the patient to the caring and communal environments. A person cannot communion. be separated from these contexts. Suffering: The ontological concept involving human Health: Health is understood in both classical struggle; three types: illness, care, and life. and modern terms, involving both the body’s condition and medical competence. Reconciliation: Achieving peace and new wholeness Environment: Space and situation are after suffering. important in nursing. Time, architecture, and Caring Culture: The caring environment shaped by interactions create the ambiance of care. values, traditions, and rituals Human Being: Entity of body, soul, and spirit, fundamentally religious and striving for communion. Health: Movement towards wholeness and holiness, involving balance between suffering and health. Nursing: Love and charity, or caritas, as the basic motive ofcaring has been found in Eriksson (1987b, 1990,2001) as a principal idea even in her early works Environment: Caring culture as a context of love, charity, and ethical Interaction Application to Nursing Theory Clinical Practice: Nurses are called to offer caritative care, focusing on alleviating suffering, preserving dignity, and supporting the patient’s overall well-being. The nurse-patient relationship is sacred and central to the healing process. Nursing Education: Nursing education should focus on developing nurses who embody caritas—compassion, love, and mercy in their care. Emphasizes the importance of ethical discernment, spiritual care, and the moral responsibility of caring. Application to Nursing Theory Caring Ethics: Eriksson's theory provides a moral and ethical framework for nursing practice, where the nurse’s role is to alleviate suffering through compassionate, dignified care. Holistic Care: Caritative caring integrates physical, mental, and spiritual care, ensuring that nursing addresses the whole person, not just their illness.